Developments in the storage of embryos in France and the limitations of the laws of bioethics. Analysis of procedures in 17 storage centres and the destiny of stored embryos.

摘要

BACKGROUND TO THE STUDY: 1985 witnessed the first transfers of frozen embryos resulting in live births in France. Since this time the number of embryos obtained by in vitro fertilisation (IVF) has increased each year. In 1999 each IVF attempt obtains, on average, 4.5 embryos that can be successfully implanted. In this paper we consider only those couples who have successfully obtained embryos (either by ICSI or traditional IVF techniques). The aims of the study are: To show how developments in embryo production and conservation have influenced the number of embryos stored. To address the socio-medical and ethical issues raised and to provide practitioners with some thoughts for reflection when consulting with couples based on the study findings To discuss the results of our findings in the light of those ethical questions raised by the imminent revision of the Laws of Bioethics. METHOD: In the first instance we did a retrospective analysis of quantitative data that 17 storage centres had collected overa period of 5 years. This period was marked by the implementation in 1994 of Laws described as Bioethics' Laws in France. During a second period we conducted a qualitative study regarding the fate of stored embryos. In order to do this, we began an analysis of the "status" of embryos and the decisions of those couples whose embryos were still in storage. For this a questionnaire was used. FINDINGS: The number of embryos that remain in storage in the 17 storage centres has increased reaching a total of 17,592 embryos involving 3,888 couples. The results show a consistent and persistent increase in the number of embryos stored before and after 1994. The qualitative study shows that: 51% of couples with embryos in storage can no longer be found, 23.6% request a continuance of storage, 12% would accept donating their embryos to medical research, 9.1% would wish for other couples to take eventual ownership of the embryo in 7.2% of cases the storage centre has can provide no information concerning the continuing ofstorage of such embryos. INTERPRETATION: The Bioethics Laws have therefore not succeeded in limiting the inflation in the number of embryos stored despite that the fact that this was one of the major concerns of those involved in formulating the laws and the medical professionals involved. Our study shows that the guidelines provided by these Laws remain ambiguous and that the objectives defined therein are thus difficult to achieve. Our study highlights the impact of such developments on the possible eventual "destiny" of such embryos, the behaviour of and the advice provided to couples, and the management practice of the storage centres involved. We present these results in the light of the laws established in 1994 in order to define not only the benefits but also the potential limitations of such legislation. No guidelines were laid down regarding the future of embryos belonging to a couple that no longer wishes to embark upon a "parental project". As a result it is not possible to terminate the conservation of such embryos which therefore remain in storage awaiting the revision of the current laws. The major objectives of our study assess the impact of the Laws and their impact on practice and to contribute to the debate which has yet to take place in the social and political arena.