title: The decision-making process for the fate of frozen embryos by Japanese infertile women: a qualitative study.
abstract: BACKGROUND
  Previous 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.
  
  
  METHODS
  Ten 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.
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  Patients' 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.
authors.affiliation: The Department of Obstetrics and Gynecology, The University of Tokyo School of Medicine, Tokyo, Japan. shizukoimai@hotmail.com
authors.forename: Shizuko
authors.initials: S
authors.lastname: Takahashi
authors.forename: Misao
authors.initials: M
authors.lastname: Fujita
authors.forename: Akihisa
authors.initials: A
authors.lastname: Fujimoto
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Fujiwara
authors.forename: Tetsu
authors.initials: T
authors.lastname: Yano
authors.forename: Osamu
authors.initials: O
authors.lastname: Tsutsumi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Taketani
authors.forename: Akira
authors.initials: A
authors.lastname: Akabayashi
mesh_terms: D000328:Adult; D044466:Asian People / Q000523:psychology / Q000706:statistics & numerical data; D003220:Conflict, Psychological; D015925:Cryopreservation / Q000191:economics; D003466:Cultural Characteristics; D003657:Decision Making / Q000941:ethics; D019924:Embryo Disposition; D033041:Embryo Research; D004644:Emotions; D005260:Female; D006801:Humans; D007246:Infertility / Q000523:psychology; D007564:Japan; D008297:Male; D028681:Moral Obligations; D036301:Qualitative Research; D012747:Sexual Partners; D011795:Surveys and Questionnaires