ART programs and embryo storage: Reasons for public health concern

Infertility is a growing public health problem in the United States. Assisted reproductive technologies (ART) — in vitro fertilization (IVF) and related procedures — resulted in 38,910 live-birth deliveries and 52,041 infants in 2005. Approximately one percent of the U.S. infants born in 2005 were conceived through ART. Embryo freezing and storage is an integral component of ART treatment as not all embryos are transferred in each IVF cycle. Couples undergoing IVF who decide to cryopreserve embryos usually state in writing their wishes regarding the future disposition of cryopreserved embryos. If couples have not detailed their wishes and cannot be reached, ART programs face enormous ethical, legal, and practical issues regarding abandoned embryos.

A multidisciplinary team, comprised of faculty in law, medicine, and public health conducted a national study of ART programs to examine embryo storage policies and practices, including the education and counseling of families, informed consent procedures, and cryopreservation agreements. With >100 participating programs, our study identified that clear, concise guidelines for cryopreservation agreements do not exist. Many agreements fail to provide couples reassurance that their wishes for the disposition of their embryos would be fulfilled if a dispute occurred between the parents, if death were to occur to one or both parents, or if they were unable to be contacted. This paper addresses the creation of Model Embryo Cryopreservation Agreement Guidelines, designed to provide ART programs the necessary elements to produce a cryopreservation agreement that is unambiguous and to inform public health policy.