“Something of the two of us”. The emotionally loaded embryo disposition decision making of patients who view their embryo as a symbol of their relationship

Abstract

Objectives: This paper describes a recently identified conception of the cryopreserved embryo as a symbol of one’s relationship (SOR). Methods: A questionnaire was sent together with the embryo disposition decision (EDD) form to patients for whom embryos were cryopreserved at the department in Ghent, Belgium. We collected data on patient characteristics, their EDD attitudes and the reasons for their willingness or unwillingness to consider each of the disposition options (donation to others for reproduction, donation for science and discarding). Results: The SOR view was found more often in patients who were less educated and whose last treatment was less than 3 years ago. Viewing the embryo as a SOR was not linked to more difficult decision making, but to more emotionally loaded decision making. In particular, patients with this view more often reported feelings of grief. This view was also linked to the outcome of the decision making process. Conclusion: The conception of the embryo as a SOR is part of an affective attitude towards embryos that has an impact on patients’ disposition decisions. Alongside patients’ values and principles, it is important that counselors acknowledge and clarify patients’ affective conceptualizations.

Keywords:

• Coping with the aftermath of infertility
• counselling psychology
• decision making
• embryo disposition
• reproductive medicine

Acknowledgement

VP and PDS are holders of a Postdoctoral Fellowship (VP) and a Fundamental Clinical Research Mandate (PDS) by the Flemish Foundation for Scientific Research (FWO-Vlaanderen).

Declaration of Interest: The authors report no conflicts of interest.

Current knowledge on the subject

• A significant number of patients find it difficult to choose an embryo disposition for unused embryos after IVF/ICSI treatment.

• Qualitative research shows that patients have a variety of concepts and that their understanding of embryos has implications for their views about the disposition options.

• In our previous qualitative study, we observed a way of conceptualizing the embryo that had not been portrayed before: the embryo as a symbol of the relationship between the partners.

What this study adds

• This survey showed that the view of the embryo as a symbol of the partner relationship was held by two thirds of the women and was associated with the time since the last treatment cycle and the women’s education level.

• Although patients with this view did not find the decision more difficult to make, the view was linked to the way they dealt with the decision. Patients with this view were more likely to view the embryo as something too private to give away and more often feared that they would think too much about the possible child. Furthermore, the patients who shared this view perceived the decision as more emotionally loaded (specifically with feelings of grief).

• The view of the embryo as a symbol of the relationship between the partners is a concept with an affective load, embedded in the patients’ social reality. Giving its established link with patients’ embryo disposition decisions, it is a concept worthy of being included in future research, counseling and informing patients about embryo disposition decision making.