COMPARISON OF DISPOSITION DECISIONS OF ELECTIVE FERTILITY PRESERVATION VERSUS FERTILITY TREATMENT PATIENT POPULATIONS UTILIZING ASSISTED REPRODUCTIVE TECHNOLOGIES

Abstract

The objective of this study is to compare surplus oocyte or embryo disposition decisions in the elective fertility preservation (FP) and fertility treatment (FT) populations. Retrospective cohort study conducted at a single academic medical center. Patients who underwent ART cycles between January and December 2019 were included. Demographic, occupational and insurance data were collected from medical records and disposition decisions at age 50 and at death were gathered from consent forms completed prior to cycle initiation. Disposition options include disposal, donation to research, transfer to a storage facility, or reassignment of ownership. Descriptive statistics were reported as mean ± (SEM) for continuous variables and percentages for categorical variables. All continuous variables were compared using Mann-Whitney test, and categorical variables were compared using Fisher’s exact test or Chi-square test. A p-value<0.05 was considered statistically significant. All statistical analyses were done using GraphPad Prism software. When investigating disposition decisions at age 50, the elective FP population predominantly elected to donate oocytes to research while the FT population elected to discard supernumerary embryos (OR 0.5667 [0.3905-0.8315], p=0.0032). As such, the elective FP population predominantly chose non-disposal disposition decisions compared to the FT population (OR 0.2914 [0.2060-0.4131], p<0.0001). An analysis of disposition decisions at death showed that there was no difference in the proportion of each population that discarded versus donated to research. When comparing disposal to any other decision, FT patients were more likely to discard while elective FP patients elected non-disposal decisions (OR 0.3540 [0.2520-0.4996], p<0.0001). Both populations had a majority that elected other options than donation to research, however a significantly higher proportion did so within the elective FP population (OR 0.6721 [0.4879-0.9416], p=0.0236). The FT population represents a group of infertility patients, in contrast to the elective FP population who are mostly unaware of their fertility status at the time of cycle start. The odds that elective FP patients donate to research compared to FT patients reflects a differential value placed on oocytes compared to embryos in these two populations. This phenomenon touches on the perceived “moral status” held by an embryo that oocytes do not, that in turn influences patients’ desire for these to be a substrate for research. Furthermore, the increased odds of the FT population to dispose embryos than the elective FP population to dispose oocytes implies that in the case of oocytes, FP patients are more comfortable with gamete use in research or reassignment of ownership while FT patients want to retain full control of embryo fate.