Observed Discrepancies in Donors’ Information Sharing and Oocyte-Embryo Management and Disposition Reported to Reproductive Health Professionals: A Call for Programmatic Improvement

Abstract

Background: Information-sharing practices, disposition of oocytes, and embryo management are at the discretion of the individual assisted reproductive technology (ART) program, donors, and recipients. Ideally, these practices and policies should reflect the information and decision-making needs of the people involved. The ART program that was the focus of this study has incorporated pre- and postdonation discussion of oocyte and embryo disposition into the screening and follow-up processes to improve overall satisfaction. To improve programmatic policy, we assessed how these discussions and the informed consent process were reflected in oocyte donors’ legal contracts. Methods: This retrospective chart review (n = 55) was designed to identify and assess discrepancies between donors’ consented preferences and their executed legal agreements with oocyte recipients. Results: Sixty-three percent of donors had legal contracts that were inconsistent with their medical informed consent. Of this group, 58% agreed with the intended parents’ desires for contact and disposition, resulting in a shift to a position that was more amenable than their signed consent. In contrast, 42% refused to change their desire as expressed in the signed consent, rejecting the intended parents’ request. Most of the differences were around embryo donation, disposition, or donation for research. Seventeen percent of donors were unwilling to allow disclosure of a medical–genetic issue if identified in an offspring. Conclusions: It is imperative for donor coordinators, agency managers, physicians, psychologists, and attorneys to recognize that such discrepancies may occur. These discrepancies may be a sign of duress, manipulation, or anxiety in donors. Alternatively, donors may become clear about their desires and advocate for them as they learn more about the personal implications of their donation through discussions with mental health and legal professionals. Effective communication for all parties is fundamental to create a circle of communication that connects physicians, attorneys, and psychologists and supports donor and recipient decision making.

Keywords:

• assisted reproductive technology
• embryo disposition
• IVF
• legal agreement
• oocyte donor
• screening

Notes

In this case, the recipient was not told that donor sperm was used. The physician lied to the recipient and her husband and used the semen from a medical student, although he later disclosed the origin of the sperm (Henig 2004).

Author SL was the Scientific Director for the ART program where the study was conducted. Author AJ was not connected to the clinic outside of this study, nor did she provide any legal services or consultation to the clinic, the donors, or the recipients.

Clinics are asked to comply with ASRM recommendations to limit donor compensation to not more than $10,000 per retrieval cycle (ASRM 2002).