Unmet communication needs and moral work in the disposition decision concerning surplus frozen embryos: The perspectives of IVF users.

The disposition decision is a frequently unresolved issue for many IVF users with surplus frozen embryos (SFEs), and this study draws attention to their experiences and moral work, locating it in the Jewish-Israeli context that legally enables the donation of SFEs to research but prohibits donation to other infertile people. To explore the (mis)understandings and (mis)communication underlying IVF users' decisions concerning the fate of their SFEs, the records of 674 IVF users with SFEs stored for more than 5 years during 1996-2011 were analyzed, and 89 IVF users with different disposition decisions were recruited for semi-structured interviews. With an average of 5.1 SFEs, after an average of 8 years of storage, no response to a written request for a disposition decision came from 60% (n = 404) of IVF users with SFEs. Payment for storage and defrosting were the two most frequent choices (13%, n = 89 and 89, respectively) followed by donation to research and transfer (7%, n = 47 and 45, respectively). Three themes emerged from the interviews: misunderstanding the consequences of not returning the disposition form, communication gaps regarding donation to research, and the unmet wish to donate embryos to infertile people. We conclude by discussing the experiences and views of IVF users as reflecting the implications of the liminality and boundary-work surrounding the frozen embryo as a moral work object, and their consequences for policy recommendations.

Embryo quality in controlled ovarian stimulation for in vitro fertilization in young poor responders.

This retrospective matched case control study was conducted to evaluate the effects of poor ovarian response in a group of young women (20-30 years) on embryos quality in controlled ovarian hyperstimulation (COH) for in vitro fertilization. Thirty-nine young patients with poor ovarian response (≤5 oocytes on retrieval) were enrolled and compared to age- and date-matched controls. Maximal Estradiol levels, number of oocytes aspirated, number of M2 oocytes and number of fertilized oocytes were significantly lower in the study group compared to controls. Implantation rate and rate of good quality embryos transferred of the study group and control were comparable (15.3 versus 16.3% and 62 versus 67.2%, respectively). Additionally, clinical pregnancy rate per transfer and delivery rate per transfer were also comparable (26.6 versus 35.8% and 23.3 versus 30.7%, respectively). The rate of cycles with no transfer, however, was 23.07% in the study group compared to zero cycles with no transfer in the control group. We conclude that young poor responders may still have reasonable proportion of good quality embryos when compared to controls. This results in comparable implantation rate and clinical pregnancy rate. Cycle transfer cancelation, however, represents a true barrier for achieving pregnancy.

Effects of cancer on ovarian response in controlled ovarian stimulation for fertility preservation.

OBJECTIVE: To evaluate the effects of cancer on ovarian response in controlled ovarian hyperstimulation (COH). DESIGN: Retrospective analysis study. SETTING: University-based tertiary medical center. PATIENT(S): 81 cancer patients undergoing controlled ovarian stimulation cycles for fertility preservation, and age- and date-matched controls undergoing COH for in vitro fertilization (IVF) for male factor infertility. INTERVENTION(S): Controlled ovarian hyperstimulation and oocytes retrieval. MAIN OUTCOME MEASURE(S): Maximal estradiol levels at day of human chorionic gonadotropin administration, duration of stimulation, total amount of gonadotropins administered, number of dominant follicles, number of oocytes retrieved, and rate of metaphase 2 oocytes. RESULT(S): The overall number of dominant follicles and the number of oocytes aspirated of the study group and control were comparable (8.8 ± 5.3 vs. 9.7 ± 4.9, and 11.93 ± 8.3 vs. 12.3 ± 7.9, respectively). The total dose of gonadotropins used and number of stimulation days of the study group (2,250 IU [1,800-3,000 IU] and 9.5 [8-11]) were also similar to the controls (2,100 IU [1,700-2,900] and 10 [9-13]). Comparison between four subgroups of cancer-breast cancer, soft tissue sarcoma, hematologic malignancies, and gastrointestinal tract cancers-showed no difference in their ovarian response indexes. Regression analysis to assess the effect of cancer on ovarian response showed no effect on the main outcome measured. CONCLUSION(S): Cancer does not influence ovarian response in COH for fertility preservation.

Effects of salpingectomy on ovarian response in controlled ovarian hyperstimulation for in vitro fertilization: a reappraisal.

To evaluate the effects of salpingectomy on ovarian response in controlled ovarian hyperstimulation (COH), 36 women who underwent controlled ovarian stimulation cycles for IVF before and after salpingectomy were studied. The overall number of dominant follicles and the number of oocytes aspirated before and after salpingectomy were comparable (7.2 ± 3.8 vs. 7.3 ± 3.7 and 10.2 ± 6.6 vs. 10.3 ± 7.4, respectively) as well as maximal E(2) levels, daily doses of gonadotropins, and the number of dominant follicles before and after surgery on the operated side, demonstrating that salpingectomy does not influence ovarian response in COH.