Ethics Committee of the American Society for Reproductive Medicine (2021). Disposition of unclaimed embryos: an Ethics Committee opinion. Fertility and sterility. https://doi.org/10.1016/j.fertnstert.2021.02.020
Ethics Committee of the American Society for Reproductive Medicine. Disposition of unclaimed embryos: an Ethics Committee opinion. Fertility and sterility. 2021. doi:10.1016/j.fertnstert.2021.02.020
Ethics Committee of the American Society for Reproductive Medicine. "Disposition of unclaimed embryos: an Ethics Committee opinion." Fertility and sterility, 2021.
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The 2021 ASRM Ethics Committee opinion holds that clinics may ethically thaw and discard unclaimed embryos after reasonable efforts to reach the patients. The committee also holds that unclaimed embryos may not go to other couples or to research without written instructions. The opinion covers frozen embryos when patients cannot be reached and reports no new data.
Key Findings
Once a program reasonably deems embryos unclaimed, the committee holds it may remove them from storage and thaw them without transfer.
Absent program policy, embryos may be considered unclaimed once "a reasonable period of time" passes with "reasonable efforts" to make contact. Programs should define both in writing.
For unclaimed embryos with a do-not-discard directive, discarding is "ethically permissible" if the policy was acknowledged before freezing, or consent predates the policy and contact attempts failed.
Unclaimed embryos go to research or reproductive use only with documented consent, the committee holds. A cited study found only 20% of patients would be very likely to give embryos to research.
The opinion replaces the committee's 2013 document "Disposition of Abandoned Embryos."
The ASRM Ethics Committee's Position
“programs or facilities may dispose of unclaimed embryos by removing them from storage and thawing without transfer.”
Quoted verbatim from this paper.
Interpretation
The document is an expert committee opinion reviewed by ASRM members. The document presents no new data on patients or outcomes. Its conclusions are ethical judgments for programs and facilities that store embryos made through IVF. The committee says United States law gives no clear guidance on when disposal is lawful, and it gives no legal advice. The committee calls the opinion one appropriate way to manage the problem and says other plans may be appropriate.
RRM Context
Unclaimed embryos exist because IVF creates embryos beyond those transferred. The opinion describes patients with mixed feelings about embryos, some keeping them as insurance against misfortune. Restorative reproductive medicine (RRM) treats the cause of infertility. Cause-based care leaves no surplus embryos to store or dispose of.
Our editorial summary of this paper, not the article's abstract.
Abstract
Programs should create and enforce written policies addressing the designation, retention, and disposal of unclaimed embryos. In the absence of program-specific policies, it is ethically permissible for a program or facility to consider embryos to have been unclaimed if a reasonable period of time has passed since contact with an individual or couple; efforts as outlined in the consent form have been made to contact the individual or couple; and no written instructions from the individual or couple with dispositional control exist concerning disposition. In such cases, programs or facilities may dispose of unclaimed embryos by removing them from storage and thawing without transfer. In the absence of specific written instructions, unclaimed embryos may not be donated to others for reproductive use or be used in research. This statement replaces the American Society for Reproductive Medicine Ethics Committee document "Disposition of Abandoned Embryos" published in 2013.
Ethics Committee of the American Society for Reproductive Medicine, 2016
Ethics and Policy › Reproductive Ethics › Embryo Disposition · Clinical Guidelines and Standards › Guidelines by Issuing Body › United States Professional Societies
Sigal Klipstein, Ricardo Azziz, Katherine Cameron, Lee Collins, Christos Coutifaris, Susan Crockin, Judith Daar, Joseph Davis, Ruth Farrell, Catherine Hammack-Aviran, Elizabeth Ginsburg, Mandy Katz-Jaffe, Jennifer Kawwass, Catherine Racowsky, Robert Rebar, Richard Reindollar, Ginny Ryan, Mary Samplaski, Peter Schlegel, David Shalowitz, Chevis Shannon, Sean Tipton, Lynn Westphal, Julianne Zweifel, 0000-0003-0284-2845
S Klipstein, R Azziz, Kathy Cameron, Kate Cameron, Katie Cameron, K Cameron, L Collins, C Coutifaris, Sue Crockin, S Crockin, J Daar, Joe Davis, Joey Davis, J Davis, R Farrell, Cathy Hammack-Aviran, Kate Hammack-Aviran, C Hammack-Aviran, Liz Ginsburg, Beth Ginsburg, Betsy Ginsburg, E Ginsburg, M Katz-Jaffe, Jen Kawwass, Jenny Kawwass, J Kawwass, Cathy Racowsky, Kate Racowsky, C Racowsky, Bob Rebar, Rob Rebar, Bobby Rebar, R Rebar, Rick Reindollar, Dick Reindollar, Rich Reindollar, R Reindollar, G Ryan, M Samplaski, Pete Schlegel, P Schlegel, Dave Shalowitz, D Shalowitz, C Shannon, S Tipton, L Westphal, J Zweifel
PMID 34148589 34148589 DOI 10.1016/j.fertnstert.2021.02.020 10.1016/j.fertnstert.2021.02.020 Ethics Committee of the American Society for Reproductive Medicine et al. 2021, Ethics Committee of the American Society for Reproductive Medicine 2021