Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-14T23:22:50.321Z Has data issue: false hasContentIssue false
  • English
  • Français

An Examination into the Embryo Disposal Practices of Human Fertilization and Embryology Authority Licenced Fertility Centers in the United Kingdom

Published online by Cambridge University Press:  29 December 2020

ABIGAIL MAGUIRE
Get access Rights & Permissions [Opens in a new window]

Abstract

When fertility centers dispose of embryos, how should this be done? Current regulatory guidelines by the Human Fertilisation and Embryology Authority state that, when terminating the development of human embryos, a clinic should act with sensitivity, taking account of the embryo’s “special status” and respecting the interests of the gamete providers and recipients. As yet, it is unclear as to how and to what extent this achieved within fertility clinics in the UK. Resultantly, this paper examines the largely undocumented domain of embryo disposal practice. By undertaking an empirical study into policy and procedure and noting divergence in clinic practice, it then comments on the ethical implications of these protocols for patients and practitioners. Specifically, this paper argues for a more holistic approach to embryo disposal. An approach that effectively meets the requirements of the lab, is respectful of the “special status” of the human embryo, and, perhaps most importantly, reflects the multifaceted needs of the patient.

Keywords

embryo disposalHuman Fertilisation and Embryology Authorityfertility clinicshuman embryo
Type
Bioethics Beyond Borders
Information
Cambridge Quarterly of Healthcare Ethics , Volume 30 , Issue 1 , January 2021 , pp. 161 - 174
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Notes

1. Human Fertilisation and Embryology Authority. I have remaining embryos: What are my options? 2017, at 2; available at https://www.hfea.gov.uk/media/2514/i-have-remaining-embryos-what-are-my-options.pdf (last accessed 1 Dec 2018).

2. Prior, Lord. Embryos, Parliament: Written Questions and Answers, 22 Nov, HL 3074; available at https://www.parliament.uk/business/publications/written-questions-answers-statements/written-question/Lords/2016-11-08/HL3075 (last accessed 30 Nov 2018).

3. Human Fertilisation and Embryology Authority. Code of Practice. 9th ed, 2019, at 151 (15.13); available at https://portal.hfea.gov.uk/media/1376/code-of-practice-9th-edition.pdf (last accessed 14 Jan 2019).

4. A similar study detailing embryo disposal practices in the USA was conducted in 2004. See Gurmankin, A, Sisti, D, Caplan, A. Embryo disposal practices in IVF clinics in the United States. Politics and the Life Sciences 2004;22(2):4–8 CrossRefGoogle Scholar.

5. Human Fertilisation and Embryology Authority. F-2014-00288: Embryos currently in storage. Information received on Oct 28 2014 in response to the Freedom of Information Act 2000, 2014; available at https://www.hfea.gov.uk/about-us/freedom-of-information/previous-responses-to-foi-requests/ (last accessed 19 Nov 2018).

6. Human Fertilisation and Embryology Authority. F-2016-00015: Use, storage and disposal of embryos in 2014 and 2015. Information received on Feb 9 2016 in response to the Freedom of Information Act 2000, 2016; available at https://www.hfea.gov.uk/about-us/freedom-of-information/previous-responses-to-foi-requests/ (last accessed 19 Nov 2018).

7. Human Fertilisation and Embryology Authority. Multiple births: What you need to know, 2016; available at https://ifqlive.blob.core.windows.net/umbraco-website/1315/2017-02-24-multiple-births-leaflet-final.pdf (last accessed 2 Aug 2018).

8. Human Fertilisation and Embryology Authority. Register forms—embryo and gamete movement—out: Guidelines for completion. Version 2, 2009; available at https://web.archive.org/web/20151005101232/http://www.hfea.gov.uk/docs/HFEA_Register_Form_Completion_Manual_-_Embryo_and_Gamete_Movement__-_out_Form_v2009.pdf (last accessed 22 Aug 2018).

9. Human Fertilisation and Embryology Authority [Internet]. Embryo freezing, c2017; available at https://www.hfea.gov.uk/treatments/fertility-preservation/embryo-freezing/ (last accessed 2 Dec 2018).

10. See note 1, Human Fertilisation and Embryology Authority 2017, at 2.

11. See note 3, Human Fertilisation and Embryology Authority 2019, at 147.

12. See note 5, Human Fertilisation and Embryology Authority 2014, at line 20.

13. See note 7, Human Fertilisation and Embryology Authority 2009, at 6.

14. Human Fertilisation and Embryology Authority. Withdrawing your consent (WC) form. Version 7, 2017 Apr, at 3; available at https://ifqlive.blob.core.windows.net/umbraco-website/1421/wc-form.pdf (last accessed 23 Nov 2018).

15. See note 3, Human Fertilisation and Embryology Authority 2019, at 51.

16. See note 3, Human Fertilisation and Embryology Authority 2019, at 151.

17. Human Fertilisation and Embryology Act 1990, at s.17(1)(c); available at https://www.legislation.gov.uk/ukpga/2008/22 (last accessed 21 Nov 2018).

18. See note 8, Human Fertilisation and Embryology Authority c2017, at section 11.

19. Human Fertilisation and Embryology Authority [Internet]. All clinics, c2018; available at https://www.hfea.gov.uk/choose-a-clinic/clinic-search/all-clinics/a (last Accessed 3 August 2018).

20. WC (Withdrawal of Consent form)/WT (Women’s consent to storage and treatment form)/MT (Men’s consent to storage and treatment form).

21. See note 3, Human Fertilisation and Embryology Authority 2019, at 181. See also: Association of Clinical Embryologists. Guidelines on good practice in clinical embryology laboratories. Human Fertility 2012;15(4):174–89Google Scholar.

22. Human Fertilisation and Embryology Authority. State of the Fertility Sector 2016–2017, 2017, at 16; available at https://www.hfea.gov.uk/media/2437/hfea_state_of_the_sector_report_tagged.pdf (last accessed 11 Aug 2018).

23. See note 3, Human Fertilisation and Embryology Authority 2019, at 181.

24. See note 8, Human Fertilisation and Embryology Authority c2017, at section 11.

25. Williams, C, Wainwright, SP, Ehrich, K, Michael, M. Human embryos as boundary objects? Some reflections on the biomedical worlds of embryonic stem cells and pre-implantation genetic diagnosis. New Genetics and Society: Critical Studies of Contemporary Biosciences 2008;27(1):7–18 CrossRefGoogle Scholar.

26. Parry, S. The politics of cloning: Mapping the rhetorical convergence of embryos and stem cells in parliamentary debates. New Genetics and Society 2003;22(2):145–68CrossRefGoogle ScholarPubMed.

27. Brazier, M. Regulating the reproduction business? Medical Law Review 1999;7(2):166–93CrossRefGoogle ScholarPubMed, at 188.

28. Zucca, L. Evans v United Kingdom: Frozen embryos and conflicting rights. Edinburgh Law Review 2008;11(3):446–9CrossRefGoogle Scholar, at 446.

29. Montgomery, H. An Introduction to Childhood: Anthropological Perspectives on Children’s Lives. Oxford: Wiley Blackwell; 2009: 80 Google Scholar.

30. Elves, C, McGuinness, S. The statutory time limit for maintaining human embryos in culture: Background paper. In: Nuffield Council on Bioethics. Human Embryo Culture: Discussion concerning the statutory time limit for maintaining human embryos in culture in the light of some recent scientific developments; 2017:13–36 Google Scholar, at 13.

31. See note 3, Human Fertilisation and Embryology Authority 2019, at 13.

32. Officially, the Report of the Committee of Inquiry into Human Fertilisation and Embryology chaired by Dame (now Baroness) Warnock.

33. Department for Health and Social Security. Report of the Committee of Inquiry into Human Fertilisation and Embryology (Cmnd.9314). London: Her Majesty’s Stationery Office; 1984 Google Scholar, at 11.9.

34. Warnock, M. Anne McLaren as Teacher. The International Journal of Developmental Biology 2001;45:487–90Google Scholar, at 489.

35. See note 33, Department for Health and Social Security 1984, at 11.15.

36. See note 33, Department for Health and Social Security 1984, at 11.17.

37. Jones, DA. The “special status” of the human embryo in the United Kingdom: An exploration of the use of language in public policy. Human Reproduction and Genetic Ethics 2011;17(1):68–83 CrossRefGoogle ScholarPubMed, at 72.

38. MacKellar C. The 14-day rule for human embryonic research in the UK. Bionews. 2016 May 23; available at https://www.bionews.org.uk/page_95530 (last accessed 5 Sept 2018).

39. Human Tissue Authority. Code of Practice A: Guiding principles and the fundamental principle of consent. 2017, at 6; available at https://www.hta.gov.uk/hta-codes-practice-and-standards-0 (last accessed 12 Sept 2018).

40. See note 39, Human Tissue Authority 2017, at 15.

41. Human Tissue Act 2004, at s.44.1; available at Human Fertilisation and Embryology Act 1990, at s.17(1)(c); available at https://www.legislation.gov.uk/ukpga/2004/30/contents (last accessed 30 July 2018).

42. Human Tissue Authority. Code of Practice E: Research. 2017, at 30; available at https://www.hta.gov.uk/hta-codes-practice-and-standards-0 (last accessed 2 Nov 2018).

43. It is worth noting here that pregnancy remains (fetal tissue or products of conception resulting from pregnancy loss or termination of pregnancy before 24 weeks) are subject to the same conditions as all other tissue from the living under the Human Tissue Act 2004. However, the HTA provides separate guidance on the disposal of pregnancy remains; reflecting its very sensitive nature.

44. See note 42, Human Tissue Authority 2017, at 30–31.

45. See note 3, Human Fertilisation and Embryology Authority 2019, at 13.

46. See note 8, Human Fertilisation and Embryology Authority 2017, at section 11.

47. Nachtigall, RD, MacDougall, K, Lee, M, Harrington, J, Becker, G. What do patients want? Expectations and perceptions of IVF clinic information and support with respect to frozen embryo disposition. Fertility and Sterility 2010;94(6):2069–72CrossRefGoogle Scholar, at 2072.

48. See note 3, Human Fertilisation and Embryology Authority 2019, at 46.

49. de Lacey, S. Death in the clinic: Women’s perceptions and experiences of discarding supernumerary IVF embryos. Sociology of Health and Illness 2017;39(3):397–411 CrossRefGoogle ScholarPubMed. See also note 47, Nachtigall et al. 2010.

50. See note 3, Human Fertilisation and Embryology Authority 2019, at 151.

51. Fuscaldo, G, Russel, D, Gillam, L. How to facilitate decisions about surplus embryos: Patients’ views. Human Reproduction 2007;22(12):3129–38CrossRefGoogle ScholarPubMed.

52. Laruelle, C, Englert, Y. Psychological study of in vitro fertilitzation-embryo transfer participants’ attitudes toward the destiny of their supernumerary embryos. Fertility and Sterility 1995;63(5):1047–50CrossRefGoogle ScholarPubMed.

53. McMahon, C, Gibson, F, Leslie, G, Saunders, D, Porter, K, Tennant, C. Embryo donations for medical research: Attitudes and concerns of potential donors. Human Reproduction 2003;18(4):871–7CrossRefGoogle Scholar.

54. Blyth E, Frith, L, Paul, M, Berger, R. Embryo relinquishment for family building: How should it be conceptualised ? International Journal of Law, Policy and the Family 2011;25:260–85CrossRefGoogle Scholar.

55. de Lacey, S. Parent identity and ‘virtual’ children: Why patients discard rather than donate unused embryos, Human Reproduction 2005;20(6):1661–9CrossRefGoogle ScholarPubMed.

56. Melamed, RM, Bonetti, T, Braga, D, Madaschi, C, Iaconelli, A, Borges, E. Deciding the fate of supernumerary frozen embryos: Parents’ choices. Human Reproduction 2009;12(4):185–90Google ScholarPubMed.

57. Lyerly, A, Steinhauser, K, Namey, E, Tulsky, J, Cook-Deegan, R, Sugarman, J et al. Factors that affect infertility patients’ decisions about disposition of frozen embryos, Fertility and Sterility 2006;85(6):1623–30CrossRefGoogle ScholarPubMed.

58. Lyerly, A, Steinhauser, K, Voils, C, Namey, E, Alexander, C, Bankowski, B et al. Fertility patient’s views about frozen embryo disposition: Results of a multi-institutional U.S. survey. Fertility and Sterility 2010;93(2):499–509CrossRefGoogle Scholar.

59. Frith, L, Bryth, E, Paul, M, Berger, R. Conditional embryo relinquishment: Choosing to relinquish embryos for family-building through a Christian embryo “adoption” programme. Human Reproduction 2011;26(12):3327–38CrossRefGoogle ScholarPubMed.

60. Goedeke, S, Daniels, K, Thorpe, M, du Prees, E. The fate of unused embryos: Discourses, action possibilities and subject positions. Qualitative Health Research 2017;27(10):1529–40CrossRefGoogle ScholarPubMed.

61. Provoost V, Pennings G, De Sutter P, Gerris J, Van de Velde A, Dhont M. To continue or discontinue storage of cryopreserved embryos? Patients’ decisions in view of their child wish. Human Reproduction 2011;26(4):861–72.

62. Nachtigall, R, Becker, G, Friese, C, Butler, A, MacDougall, K. Parents’ conceptualization of their frozen embryos complicated the disposition decision. Fertility and Sterility 2005;84(2):431–4CrossRefGoogle Scholar.

63. See note 60, Goedeke et al. 2017, at 1532.

64. See note 55, de Lacey 2005.

65. See note 56, Melamed et al. 2009.

66. Millbank, J, Stuhmcke, A, Karpin. Embryo donation and understanding of kinship: The impact of law and policy. Human Reproduction 2017;32(1):133–8Google ScholarPubMed.

67. Stiel, M, McMahon, C, Elwyn, G, Boivin, J. Pre-birth characteristics and 5-year follow-up of women with cryopreserved embryos after successful in vitro fertilisation treatment. Journal of Psychosomatic Obstetrics and Gynecology 2010;31(1): 32–9CrossRefGoogle ScholarPubMed.

68. Ellison, D, Karpin, I. Embryos disposition and the new death scene. Cultural Studies Review 2011;17(1):81–100 Google Scholar, at 88.

69. See note 68, Ellison, Karplin 2011, at 90.

70. Dickens, B. The use and disposal of stored embryos. International Journal of Gynecology and Obstetrics 2016;134(1):114–7CrossRefGoogle ScholarPubMed.

71. For example, Clinic 2 responded that “no patients have requested… the method of disposal”

72. See note 49, de Lacey 2017, at 407.

73. de Lacey S. Decisions for the fate of frozen embryos: Fresh insights into patient’s thinking and their rationales for donating or discarding embryos. Human Reproduction, 2007;22(6):1751–8, at 1756. Also see note 60, Goedeke et al. 2017, at 1532.

74. See note 68, Ellison, Karplin 2011, at 89.

75. Provoost, V, Pennigs, G, De Sutter, P, Dhont, M. 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. Journal of Psychosomatic Obstetrics and Gynecology 2012;33(2):45–52 CrossRefGoogle ScholarPubMed.

76. See note 49, de Lacey 2017, at 405–6.

77. For example, one study records an increased intensity and duration of grief with increased gestation. See Greenfeld, D, Diamond, M, Decherney, A. Grief reactions following IVF treatment. Journal of Psychosomatic Obstetrics and Gynecology 1988;8(3):169–74CrossRefGoogle Scholar. Likewise, de Lacey considers the experiences of those who have chosen to discarded their embryos to be ‘sequestered losses with disenfranchised grief’. See note 48, de Lacey 2017, at 406.

78. See note 49, de Lacey 2017, at 405. See also note 58, Lyerly et al. 2010, at 507.

79. See note 3, Human Fertilisation and Embryology Authority 2019, at 151.