Changes in patient preferences in the disposal of cryopreserved embryos.

BACKGROUND The disposal of unused cryopreserved embryos can be a difficult decision for patients and the existence of unclaimed embryos raises ethical concerns for clinics. This study examined changes in patients' preferences for disposition of unused embryos and the relevance of a two-stage process for obtaining consent. METHODS Patients who had not returned for cryopreserved embryos for over 5 years were contacted and asked to specify their current preferences for embryo disposition. These preferences were compared with dispositional choices made at the time of embryo freezing. RESULTS Over one-third of patients had not returned for cryopreserved embryos within 5 years, and 31% of these declined to provide an updated directive. Those with a live birth through treatment were more likely to provide a new directive and more likely to choose to discard rather than donate embryos for research. Prior to IVF, the majority of non-returnees had elected to donate unused embryos for research, but 59% of all couples changed their minds after treatment. CONCLUSIONS Changes in preferences for embryo disposition was linked to treatment outcome and highlighted the need for a two-stage process to obtain fully informed consent. In this Canadian sample, patients' affinity for research declined after treatment.