Osamu Tsutsumi

The decision-making process for the fate of frozen embryos by Japanese infertile women: a qualitative study

BackgroundPrevious studies have found that the decision-making process for stored unused frozen embryos involves much emotional burden influenced by socio-cultural factors. This study aims to ascertain how Japanese patients make a decision on the fate of their frozen embryos: whether to continue storage discard or donate to research.MethodsTen Japanese women who continued storage, 5 who discarded and 16 who donated to research were recruited from our infertility clinic. Tape-recorded interviews were transcribed and analyzed for emergent themes.ResultsA model of patients’ decision-making processes for the fate of frozen embryos was developed, with a common emergent theme, “coming to terms with infertility” resulting in either acceptance or postponing acceptance of their infertility. The model consisted of 5 steps: 1) the embryo-transfer moratorium was sustained, 2) the “Mottainai”- embryo and having another child were considered; 3) cost reasonability was taken into account; 4) partner’s opinion was confirmed to finally decide whether to continue or discontinue storage. Those discontinuing, then contemplated 5): the effect of donation. Great emotional conflict was expressed in the theme, steps 2, 4, and 5.ConclusionsPatients’ 5 step decision-making process for the fate of frozen embryos was profoundly affected by various Japanese cultural values and moral standards. At the end of their decision, patients used culturally inherent values and standards to come to terms with their infertility. While there is much philosophical discussion on the moral status of the embryo worldwide, this study, with actual views of patients who own them, will make a significant contribution to empirical ethics from the practical viewpoint.

Delayed implantation may be a cause of recurrent implantation failure

We report a rare case of delayed implantation of frozen-thawed embryo transfer in a hormone-controlled cycle due to delayed window of implantation (WOI). Synchronizing embryo growth with the endometrial hormonal environment is important for successful implantation. Initially, our patient underwent multiple unsuccessful endometrium-matched blastocyst transfers after five days of progesterone treatment. We found that day 3 embryo and two-day delayed blastocyst transfers were more successful than the normal blastocyst transfer. Finally she underwent two successful single embryo implants that resulted in pregnancies. We suggest that a delay in the WOI may have been the cause for the recurrent implantation failure.