P–351 Ethical challenges posed by an increase of surplus frozen embryos in Argentinean fertility centers
Authors: Lima N S , Martínez A G 
Published: August 2021

Abstract

Study question
Can an increase in the quantity of frozen embryos lead to more difficulties in embryo disposition decisions (EDD)?

Summary answer
EDD posed clinical and ethical challenges and might be influenced by having more available embryos, due to changes in the laboratory procedures.

What is known already
Previous research suggests that many people find EDD difficult and emotionally distressing. Patients face ambivalence during the decision-making process which could lead to embryo abandonment. Regulation of embryo dispositions varies among countries, but in the Latin American context, the regulatory gap generates insecurities in healthcare professionals. Cultural values towards the embryo can be associated with discomfort, guilt, or psychological burden. Studies suggest that patients often feel that they are unable to make a satisfactory decision when presented with the current embryo disposition options. Thus, other ‘solutions’, such as the request for nonreproductive transfer, appear and raises ethical questions and concerns.

Study design, size, duration
This is an observational study which follows a thematic literature review, that identifies the main reasons for difficulties with embryo disposition decisions, in different countries. It focuses on the regulatory background of the principal ART providers worldwide to discuss the best course of action for Argentina, that faces the problem of EDD at a regulatory level. To inform the discussion, a comparative survey from an Argentinean context, was carried out.

Participants/materials, setting, methods
Most fertility clinics in Argentina are private entities, as there are very few public providers. Access to ART treatments has been regulated since 2013, but the law fails to define a number of important issues, including EDD and national registries. An online survey was sent to all reproductive facilities to collect data on storage content and the results were complemented with data from the Latin American Register (RedLara) and the Argentine Registry of Assisted Fertilization.

Main results and the role of chance
The survey results showed that in 2017, there were approximately 54.432 frozen embryos stored in 46 Argentinean fertility centers and the total amount in 2020 reached 91.724 stored in 54 centers. Despite the number of treatment cycles (IVF + OD) being constant between 2017 and 2020 (with a slight increase of 8%), the number of frozen embryos has increased exponentially (by 68.5%). This is a consequence of the improvements in cryopreservation techniques (vitrification) and the development of more efficient ovarian stimulation protocols, that have facilitated a rise in elective single embryo transfer. These advances, coupled with an inefficient regulatory framework, generate uncertainties in physicians who might already be conflicted and therefore provide little or inadequate guidance for patients facing EDD. Three strategies could be implemented to facilitate EDD under this particular setting. First, counseling sessions at different treatment stages should be encouraged and are conducted by trained mental health professionals, who are aware of their patient’s changing attitudes towards surplus embryos. Second, both aneuploid embryos and embryos which were cryopreserved more than 10 years ago could form part of a national bank for research purposes, using classified storage content. Third, promote effective regulation that includes EDD and explicit storage limits.

Limitations, reasons for caution
The influence of the Catholic Church on policy makers regarding embryo dispositions is the main drawback. There is a need to foster a regulatory framework that considers the changes in IVF procedures and practices. On a practical level, psychosocial care is missing as part of healthcare teams’ practices.
Wider implications of the findings: The survey results revealed that IVF centers in Argentina will face an increase in euploid, aneuploid and untested frozen embryos, due to the changes registered in laboratory procedures. This tendency shows the need to discuss EDD with patients from the beginning of fertility treatment, through to its conclusion.

Trial registration number
Not applicable