Decisional and psycho-social aspects of the embryo disposition context

• Main Author: Stiel, Mareike
• Published: Cardiff University 2010
• Subjects: 612.6
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.584910

Embryos in cryo-storage accumulate worldwide with conservative estimates suggesting that over 180,000 embryos are currently in storage in the United Kingdom. Couples keep their embryos in storage despite having satisfied their family building needs and evidence suggests that a proportion of couples will need decisional support in resolving the embryo disposition decision. The aim of the studies presented in this thesis was to better understand the embryo disposition decision context, establish factors associated with the decision (facilitators and impediments) and identify targets for decision support to improve patient experiences. The work presented in this thesis demonstrates that the embryo disposition decision is embedded in a complex and distressing decision context that makes it difficult for couples to choose a disposition option. The complexity and difficulty of the decision context emerges from couples' affective forecasting, their representation of embryos, their treatment experience, reproductive life stage and personality characteristics. An affective and cognitive embryo representation measure was developed allowing a multifaceted assessment of how couples feel and think about their embryos. It was suggested that the difficulty and complexity of the decision context emerges because in order to make a disposition decision couples need to achieve integration of their embryo representations with their disposition intentions. Embryo representations as well as embryo disposition preferences may change as a function of treatment experience, especially treatment success which makes the integration process even more difficult. The new measures offer the opportunity to integrate findings from cross-cultural settings, and are hoped to be used to support patients during treatment.