See what you missed at ASRM 2024 with the ASRM 2024 Recorded Bundle 

Menu
Close Close Icon
Ethics Committee teaser

Disclosure of medical errors involving gametes and embryos: an Ethics Committee opinion

Download a PDF of this document
Medical providers have an ethical duty to disclose clinically significant errors involving gametes and embryos as soon as they are discovered. Clinics also should have written policies in place for reducing and disclosing errors. This document was reviewed and affirmed in 2015 and replaces the earlier document of the same name (Fertil Steril 2011;96:1312–4). (Fertil Steril® 2016;106:59–63. ©2016 by American Society for Reproductive Medicine.)

KEY POINTS

  • The practice of reproductive medicine can involve medical errors in which gametes and embryos are lost, degraded, or misdirected, as well as near misses in which errors are averted before producing any clinical impact.
  • Fertility programs should have in place rigorous procedures to prevent the loss, degradation, or misdirection of gametes and embryos and to ensure proper identification of all gametes, embryos, and patients.
  • Clinics should address medical errors and near misses by conducting a root-cause analysis aimed at revealing any systems failures.
  • Clinics have an ethical obligation to disclose errors out of respect for patient autonomy and in fairness to patients.
  • Clinics must disclose errors in which the wrong sperm are used for insemination, or gametes or embryos are mistakenly switched resulting in fertilization, embryo transfer, implantation, or the birth of a child with a different genetic parentage than intended, as soon as they are discovered.
  • Clinics should promote a culture of truth telling and should establish written policies and procedures regarding disclosure of errors to patients.

The practice of reproductive medicine involves the retrieval, processing, transfer, and storage of human gametes and embryos. Manipulation of the elements of conception outside the body creates opportunities for the loss, degradation, or misdirection of gametes and embryos in the course of fertility care. Any instance in which gametes or embryos are lost, degraded, or misdirected constitutes an adverse event and will likely be considered a medical error. ‘‘Near misses,’’ that is, possible errors averted before producing any clinical impact that reaches the patient, also occur. This document reviews the conditions under which it is ethically obligatory to disclose to patients such medical errors or near misses involving gametes and embryos. It also considers how and when disclosure might be done.

Medical errors are mistakes that have potentially negative consequences for patients (1–3). Harm can occur from something done to the patient (errors of commission) or from something not done (errors of omission). Some medical errors may be judged clinically inconsequential. Where harm is believed minimal, practitioners may be uncertain whether to inform the patient and whether disclosure is always practical or serves the interests of the patient. In these cases, the Ethics Committee of the American Society for Reproductive Medicine (ASRM) believes that there should be a strong presumption in favor of disclosure. Physicians and patients may differ in judgments about whether harm is minimal. Moreover, the many factors discouraging physicians from error disclosure counsel in favor of a presumption favoring disclosure in these cases.

In the provision of fertility care, other errors involving gametes and embryos harm the patients who supply these reproductive materials. When errors are clinically relevant, fairness to patients, protection from harm, and respect for patient autonomy require open and honest disclosure of errors immediately upon recognition, even though disclosure may be difficult for clinicians. The scope of disclosure also includes other health-care providers who are involved in a fertility patient's care, including treating physicians within the clinic's practice or those independent of the clinic who provide necessary ancillary services such as surgical sperm extraction. Shared knowledge of errors by all members of a patient's health-care team allows for any adjustments in the treatment plan to proceed in a coordinated and consistent manner.

With near misses, the possibility of harm is averted before it reaches the patient. Reasons for disclosure of near misses may include patient autonomy and the importance of assessing clinic procedures for reducing systemic possibilities for error. The ASRM Ethics Committee believes that disclosure should be considered in these cases but is not obligatory. In addition, clinics should have policies in place to conduct a root-cause analysis when medical errors and near misses occur to guard against system error. Clinics should periodically review these policies for adequacy and for compliance with them.

While medical error can occur at any point in the delivery of assisted reproductive care, this document focuses on two specific types of errors: [l] errors that lead to gametes or embryos being lost or degraded, with the diminished reproductive opportunity that such errors can bring; and [2] situations in which the gametes or embryos employed in fertility care are not those originally intended for use in the patient undergoing treatment, potentially leading to the birth of a child with an unplanned genetic parentage. We believe that physicians in the first instance are obligated to disclose errors that affect the number or quality of gametes or embryos, except in those instances in which the error's impact is so clearly minimal that it could not possibly affect the patient's interests, as discussed below. In the second instance in which gametes or embryos are misdirected, the obligation to disclose errors is without exception. Here the patient's right to know is compelling; physicians are obligated to disclose to patients any error as soon as discovered that could lead to a child being born with an unintended paternity or maternity.


MEDICAL ERRORS LEADING TO GAMETES OR EMBRYOS BEING LOST OR DEGRADED

Medical errors in fertility practice involving gametes or embryos can be devastating to patients and clinic personnel, often raising legal, ethical, and practical concerns in their wake (4). This section discusses circumstances in which the mistake leads to the loss or degradation of sperm, eggs, or embryos intended to be used for reproduction.

Some errors leading to the loss or degradation of gametes or embryos clearly have no adverse clinical consequences for patients. Such would be the case, for example, if a small portion of a semen sample were accidentally spilled in the laboratory but enough remained to provide a suitable specimen for insemination, or if atretic oocytes or noncleaving embryos were lost. Because the patient has not been harmed and disclosure may cause needless worry or mistrust, it may be argued that disclosure is not required in these cases. This argument defers to a clinician's individual judgment about the minimal nature of the harm and the value of disclosure in these situations.

Arguments in favor of disclosure, even of errors with minimal clinical impact, raise concerns about deferring to physicians' judgments about whether errors are of clinical consequence. Disclosing errors is difficult and many physicians are reluctant to engage in disclosure discussions (5). Physicians thus may be overly likely to justify nondisclosure on the basis that the error was of little clinical importance. Critics also question whether physicians are the best judges of the meaning of ‘‘harm’’ in such cases and argue that respect for patient autonomy means that patients should be informed about events that they might judge to be harmful to them. These concerns weigh in favor of disclosure in cases in which the error reached the patient but is judged to have been inconsequential by the physician.

This second approach thus advises, ‘‘even trivial medical errors should be disclosed to patients, and decisions to withhold information need ethical justification’’ (6). The ASRM Ethics Committee believes that the presumption should be to disclose, rather than not to disclose, mistakes that have potentially adverse effects for patients, even if the mistakes are seemingly minor. If, on the other hand, there is clearly no adverse effect, and if disclosure may unnecessarily compound the stress of patients, disclosure may be considered to not be obligatory.

There are also near misses surrounding loss or degradation of gametes or embryos. Examples are errors in the identification of gametes or embryos for disposal, or errors in the management of preservation techniques. Backup checking or other system methods may catch these errors before they are implemented. With near misses, the errors are caught before they actually occur, so that there is by definition no effect on the patient. However, near misses may indicate systemic difficulties clinics need to address so that errors do not occur in the future. They also illustrate the importance of having effective system methods to catch errors. Advocates of disclosure contend that disclosure may encourage practitioners to recognize systemic errors and take remedial steps that may reduce risks of harmful errors to subsequent patients (7). In these cases, the ASRM Ethics Committee believes that disclosure is not required but that clinics should have policies to identify near misses and to take steps to guard against them.

Other errors may, or do, have an adverse effect on patients by affecting their ability to have a biologically related child. For example, some errors may require the couple to undergo another treatment cycle, with its corresponding costs and burdens. Such would be the case if an error resulted in an insufficient number or inadequate quality of gametes or embryos available for fertilization or transfer or prevented the couple from having a genetically related child. In such circumstances, we believe that the best ethical practice is to disclose errors that affect the number or quality of gametes or embryos. If the error is something that would or should be entered in the medical record, it should be disclosed.

ERRORS INVOLVING MISDIRECTION OF GAMETES OR EMBRYOS

A second type of error, considerably less common, occurs when the gametes or embryos used in infertility treatment are not those originally intended for a particular patient. This might occur when the gametes or embryos of one person or couple are mistakenly used with the gametes or embryos of another person or mistakenly transferred to the uterus. This would include inseminating a patient with the wrong sperm, combining the wrong sperm with the wrong eggs in the laboratory, or transferring the wrong embryos to a patient. When gametes or embryos are banked, it might involve the use of different materials than those originally intended for the patient.

In cases in which gametes or embryos of one person or couple are misdirected to another, patients face not only the loss of gametes or embryos that would have enabled them to reproduce but also the possibility that the gametes or embryos will result in a child intended for another couple. If the latter case, couples face potential legal disputes to determine the child's parentage and custody arrangements (8). Discovery of the error may occur shortly after the gametes are used or the embryos are transferred, or discovery may occur later. A particularly unfortunate scenario involves discovery of the error after the child is born and has been raised for some time by the couple who is not the child's intended parents (9).

Gamete or embryo banking also creates the possibility of use of materials different from those originally selected for a patient. In cases of donor gametes, the result might be the conception or birth of a child with different genetic characteristics than those originally intended.

Disclosure of any identified misdirection should take place immediately after discovery. Respect for patient autonomy requires disclosure even if the embryo has not implanted or a child has not been born. Some might argue that the ethical duty to minimize harm justifies not telling the patients of the error because disclosure may be harmful, such as leading to a pregnancy termination or creating stress. We believe this view is misguided. Disclosure of the error will enable the persons most directly affected to decide on a course of action. If a pregnancy has been established, this course of action may involve continuing the pregnancy, making advance arrangements about parentage, and securing legal counsel to take steps to develop a workable solution for this unforeseen outcome. An alternative course of action may be a decision to terminate the pregnancy. The duty to disclose also holds if the child has been born and some time elapses before the error is discovered. Realizing the complexity of disclosure in such a case, careful assessment and planning should be undertaken but disclosure should still take place as soon as possible.


REASONS FOR DISCLOSING ERRORS

A fundamental principle of medical ethics is to respect patients by treating them as autonomous individuals. This means dealing with patients honestly and openly, and it includes the duty to provide patients with information necessary to understand their diagnosis, course of treatment, and risks and benefits so they can make knowing and informed decisions. The ethical dictum of ‘‘first do no harm’’ includes harm to the patient's status as an autonomous individual.

Respect for patients means providing them with information necessary to understand their situations and to make choices about future courses of treatment. Such information includes telling patients when physicians or other members of the medical team have made an error or mistake that affects the well-being or goals of the patient. In such cases there is an ethical duty to disclose the mistake and enable steps to prevent harmful effects, if possible. Disclosure also guards against an erosion of trust because failure to disclose ‘‘potentially involves deception and suggests preservation of narrow professional interests over the wellbeing of patients’’ (2).

The principle of informed consent and the need for disclosure of mistakes is recognized directly or indirectly in ethical statements of the American Medical Association, the American College of Physicians, the American Congress of Obstetricians and Gynecologists, the Joint Commission, and many other professional associations. In addition to a duty to disclose relevant information to patients, there is also a moral duty not to lie, falsify records, or ask or require team or staff members to engage in deception or actions that prevent patients from being properly informed about their situation.

Principles of open and honest communication with patients have special significance in reproductive medicine. Fertility treatments are often stressful, and patients may be particularly sensitive to the statements of their health-care providers. In addition, errors in reproductive medicine may affect the couple's ability to have a child. In situations in which errors are particularly serious—where embryos are mistakenly transferred to the wrong patient—the error may lead to the birth of a different child than was intended. Such births can lead to significant emotional turmoil and the burdens of parentage or custody lawsuits, which can adversely affect all involved parties, including the children.


THE PROCESS OF DISCLOSING ERRORS

Clinic personnel may be reluctant to disclose errors for various reasons. They may be concerned about negative consequences to them or their practice, including concerns about losing patients, facing compensation demands, implicating other members of the medical team, being sued, harming the clinic's reputation, and having complaints filed to medical licensing boards. Practitioners may also feel discomfort about admitting mistakes (3, 7). Encouraging a climate of transparency and nonretribution is important to counteract this reluctance.

Although admitting a medical error might be difficult, disclosing, rather than hiding, the error is ethically and legally appropriate, both to avoid further harm to the patient and to avoid the additional wrongs that an attempt at secrecy might entail. Practitioners who hide their error may gamble that the error will not be discovered. For example, a practitioner may try to keep secret the error of inseminating a patient with the wrong sperm, hoping that a pregnancy is not established. Yet such an act may further injure patients by depriving them of the opportunity to take corrective or other remedial action. It is recognized that ‘‘errors do not necessarily constitute improper, negligent, or unethical behavior, but failure to disclose them may’’ (10). Covering up an error may also lead to penalties for practitioners, including the loss of a physician's medical license (11). Moreover, with contemporary forms of genetic testing, errors of misdirection are unlikely to remain undiscovered.

Some studies suggest that patients are less likely to take legal action if they are informed honestly about mistakes (2). If one does not tell and the patient later learns of the error, then the patient ‘‘is likely to be more hostile and suit-prone’’ because of the perceived violation of the practitioner's obligations to the patient (3). Disclosure is also important if the clinic uses it as an opportunity to prevent future similar mistakes or to improve the quality of care (12). Clinicians should, however, be prepared for negative consequences from disclosure, such as loss of patients to other clinics, expectations of compensation, or initiation of a legal suit.

Health-care workers may not know how or when to inform patients (13). As such, clinics should have a basic policy of disclosing all important clinical events to patients. In addition, guidelines and written clinic policies may be helpful (5, 14). Such policies should include the definitions of key events and terms, statements about who should be informed, how further investigation will be conducted, and when and how information will be discussed with patients. Clinic policies should also reflect a culture of encouraging disclosure of and discussion about errors in the clinic itself. A culture of openness includes conveying to the medical team awareness of the harm that can come from hiding errors, of the consequences of secrecy to staff members, and of policies in place to minimize errors.

It is also important for written policies to include rigorous procedures to prevent the loss or degradation of gametes and embryos and to ensure proper identification of all gametes, embryos, and patients. This should include written labeling as well as verbal identification at the initiation of embryo transfer. Clinics may also choose to distinguish between individual errors and system errors. Recognizing system errors can help lessen the odds of a similar systemic mistake in the future (7). This can be part of the culture of encouraging disclosure of and discussion about errors in the clinic itself.

Clinic policy should include suggestions for facilitating the process of disclosure. For example, it is advisable for practitioners to: a) initiate the disclosure rather than waiting for the patient to ask and, b) regard disclosure as a process involving more than one discussion (2). Clinic personnel should also let the patient know what steps are being taken to prevent recurrences. Those who have studied disclosure of errors recommend that an apology and empathy can help; to express condolences is not necessarily to admit fault (12). Conversely, the lack of an apology may be distressing to the patients (11). Personnel should disclose what is known and what is uncertain and then provide updates if more is learned about the error (15).

We conclude that the best ethical practice is for programs to have in place rigorous procedures to prevent errors. To prepare for the possibility that errors may occur despite these procedures, programs should foster an environment of truth telling that will allow prompt identification and disclosure of errors to patients. It is recommended that clinics have written policies and procedures that outline how to reduce and disclose medical errors.


Acknowledgments:

This report was developed by the Ethics Committee of the American Society for Reproductive Medicine as a service to its members and other practicing clinicians. While this document reflects the views of members of that Committee, it is not intended to be the only approved standard of practice or to dictate an exclusive course of treatment in all cases. This report was approved by the Ethics Committee of the ASRM and the Board of Directors of the ASRM.

This document was reviewed by ASRM members and their input was considered in the preparation of the final document. The following members of the ASRM Ethics Committee participated in the development of this document. All Committee members disclosed commercial and financial relationships with manufacturers or distributors of goods or services used to treat patients. Members of the Committee who were found to have conflicts of interest based on the relationships disclosed did not participate in the discussion or development of this document.

Judith Daar, J.D.; Paula Amato, M.D.; Jean Benward, L.C.S.W.; Lee Rubin Collins, J.D.; Joseph B. Davis, D.O.; Leslie Francis, J.D., Ph.D.; Elena Gates, M.D.; Sigal Klipstein, M.D.; Barbara Koenig, Ph.D.; Laurence McCullough, Ph.D.; Richard Reindollar, M.D.; Mark Sauer, M.D.; Rebecca Sokol, M.D., M.P.H.; Andrea Stein, M.D.; Sean Tipton, M.A.

REFERENCES


  1. Institute of Medicine. To Err is Human: Building a Safer Health System. Washington, DC: National Academies Press. Available at: http://iom.nationalacademies.org/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx; 1999. Last accessed March 1, 2016.
  2. Hebert PC, Levin AV, Robertson G. Bioethics for clinicians: 23. Disclosure of medical error. CMAJ 2001;164:509–13.
  3. Thurman AE. Institutional responses to medical mistakes: ethical and legal perspectives. Kenn Inst Ethics J 2001;11:147–56.
  4. Vaughn M, Hossain A, Phelps JY. Liability for mismanagement of sperm specimens in fertility practices. Fertil Steril 2015;103:29–32.
  5. Vincent C. Understanding and responding to adverse events. New Engl J Med 2003;348:1051–6.
  6. University of Washington School of Medicine. Ethics in medicine: mistakes. Available at: http://depts.washington.edu/bioethx/topics/mistks.html. Last accessed March 1, 2016.
  7. Chamberlain CJ, Koniaris LG, Wu AW, Pawlik TM. Disclosure of ‘‘nonharmful’’ medical errors and other events. Arch Surg 2012;147:282–6.
  8. Perry-Rogers v. Fasano, 715 N.Y.S.2d 19 (2000).
  9. Robert B. v. Susan B., 109 Cal. App. 4th 1109 (2003).
  10. Snyder L, Leffler C, Ethics and Human Rights Committee, American College of Physicians. Ethics manual (fifth edition). Ann Int Med 2005;142:560–82.
  11. In the matter of accusation against Steven L. Katz. Case no. 03-2001- 122617. OAH no. N2004080093. Sacramento, CA: Medical Board of California Department of Consumer Affairs; 2005.
  12. University of Toronto Joint Centre for Bioethics. Sunnybrook and Women’s College Health Sciences Centre Administrative Manual. Available at: http://www.jointcentreforbioethics.ca/research/documents/sunnybrook_policy.pdf. Last accessed July 16, 2015.
  13. DeVita MA. Honestly, do we need a policy on truth? Kenn Inst Ethics J 2001;11:157–64.
  14. University of Pittsburgh Medical Center–Presbyterian Hospital. Policy and procedural manual. Guidelines for discussion and disclosure of conditions and events with patients, families, and guardians. Kenn Inst Ethics J 2001;11:165–8.
  15. American Medical Association Council on Ethical and Judicial Affairs. Code of medical ethics. Available at: http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics.page? Last accessed March 1, 2016.

Topic Resources

View more on the topic of embryo
Coding Icon

How to bill for an FET

Is there a new update to the 89272 code that allows its use without View the Answer
Coding Icon

Codes for Embryo Biopsy

When doing a preimplantation genetic test (PGT) biopsy, can you bill for each day a biopsy is performed or can you only bill once for the cycle? View the Answer
Coding Icon

Billing for assisted hatching at biopsy and transfer

We would also like to know if you can bill assisted hatching with biopsy and then assisted hatching again during the transfer cycle. View the Answer
Coding Icon

Shipping of frozen embryos

I have some infertility coverage, under which my insurance said they will cover frozen embryo shipping/transport from one facility to another.  View the Answer
Document Icon

Clinical management of mosaic results from preimplantation genetic testing for aneuploidy of blastocysts: a committee opinion (2023)

This document incorporates studies about mosaic embryo transfer and provides evidence-based considerations for embryos with mosaic results on PGT-A. View the Committee Opinion
Videos Icon

How to EDGE

Explore the ASRM EDGE tool for embryo grading. Learn grading steps, view dashboards, and assign blastocyst grades using the SART and Gardner scales in ASRM Academy. View the ASRMed Talk Video
Legal Icon

Frozen Embryo Destruction and Potential Travel Restrictions for Surrogacy Arrangements

Legally Speaking™ focuses on the impact and the potential implications of legal developments on the assisted reproductive technologies. View the Column
Videos Icon

Journal Club Global: Transferencia de embriones frescos versus congelados: ¿Cuál es la mejor opción

Los resultados de nuevas técnicas de investigación clínica que utilizan información de bancos nacionales de vigilancia médica.   View the Video
Document Icon

Defining embryo donation: an Ethics Committee opinion (2023)

The ethical appropriateness of patients donating embryos to other patients for  family building, or for research, is well established.
View the Committee Opinion
Coding Icon

Does the number of eggs being frozen matter?

There is currently only one CPT code for the cryopreservation of mature oocytes and embryos.  View the Answer
Coding Icon

Reproductive Tissue Storage

What are the CPT codes for the Storage of Reproductive Cells/Tissues? View the Answer
Coding Icon

Lab RVUs

Is there a list of RVUs for embryology and andrology laboratory procedures, and if so, where can it be found? View the Answer
Coding Icon

ICSI and Embryo Biopsy

How to bill for ICSI or embryo biopsies that occur in different days?  View the Answer
Coding Icon

Embryo Biopsy

Have any new codes been introduced for the lab portion of PGT? View the Answer
Coding Icon

Embryo Biopsy Embryologist Travel Costs

Can we bill insurance for the biopsy procedure? Can we bill for travel expenses? View the Answer
Coding Icon

Embryo Biopsy PGS Testing

What codes are appropriate for PGS testing? View the Answer
Coding Icon

Embryo Co-culture

Can codes 89250 and 89251 be billed on different days of the same cycle?  View the Answer
Coding Icon

Embryo Culture Denied As Experimental

We have received denials from insurance payers when billing CPT code 89251.  View the Answer
Coding Icon

Embryo Culture Less Than And More Than Four Days

When coding 89250 culture of oocytes/embryo <4 days, should that code be submitted to the insurance company for each of the days? View the Answer
Coding Icon

Embryo Freezing/Thawing

Our question refers to the CPT code 89258 “Cryopreservation; Embryo(s)” and 89352 “Thawing of Cryopreserved; Embryo”.  View the Answer
Coding Icon

Embryo Storage Fees For Multiple Cycles

We bill embryo storage 89342 for a year's storage.  View the Answer
Coding Icon

Embryo Thawing/Warming

Is it allowable to bill 89250 for the culture of embryos after thaw for a frozen embryo transfer (FET) cycle? View the Answer
Coding Icon

Gamete Thawing/Warming

Can patients be charged for each vial/straw of reproductive gametes or tissues thawed? View the Answer
Coding Icon

D&C Under Ultrasound Guidance

What are the CPT codes and ICD-10 codes for coding a surgical case for a patient with history of Stage B adenocarcinoma of the cervix ... View the Answer
Coding Icon

Assisted Hatching Billed With Embryo Biopsy

Do you know if both assisted hatching (89253) and embryo biopsy for PGS/PGD/CCS (89290/89291) can be billed during the same cycle?  View the Answer
Coding Icon

Assisted Zona Hatching

Can assisted hatching and embryo biopsy for PGT-A; PGT-M or PGT-SR be billed during the same cycle? View the Answer
Coding Icon

Billing For Cryopreservation Of Embryos Under The Male Partner

Can 89258 be billed under the male partner of a female patient? View the Answer
Coding Icon

Embryo Transfer

A summary of Embryo Transfer codes collected by the ASRM Coding Committee View the Coding Summary
Legal Icon

Colorado court balances religious and secular beliefs in frozen embryo divorce dispute

The day before the Dobbs decision, the Colorado Court of Appeals ruled on a divorcing couple’s disputed control over their frozen embryos. View the Legally Speaking
Videos Icon

Journal Club Global: Is PGT-P cutting edge or should we cut it out?

PGT for polygenic risk scoring (PGT-P) is a novel screening strategy of embryos for polygenic conditions and traits. View the Video
Document Icon

Disposition of unclaimed embryos: an Ethics Committee opinion

Programs should create and enforce written policies addressing the designation, retention, and disposal of unclaimed embryos. View the Committee Opinion
Document Icon

A review of best practices of rapid-cooling vitrification for oocytes and embryos: a committee opinion (2021)

The focus of this paper is to review best practices for rapid-cooling cryopreservation of oocytes and embryos. View the Committee Opinion
Document Icon

Ethics in embryo research: a position statement by the ASRM Ethics in Embryo Research Task Force and the ASRM Ethics Committee (2020)

Scientific research using human embryos advances human health and offspring well-being and provides vital insights into the mechanisms for reproduction. View the Committee Opinion
Document Icon

Guidance for Providers Caring for Women and Men Of Reproductive Age with Possible Zika Virus Exposure (Updated 2019)

This ASRM guidance specifically addresses Zika virus infection issues and concerns of individuals undergoing assisted reproductive technologies (ART). View the Guideline
Document Icon

Blastocyst culture and transfer in clinically assisted reproduction: a committee opinion (2018)

The purposes of this document is to review the literature regarding the clinical application of blastocyst transfer. View the Committee Opinion
Document Icon

Posthumous retrieval and use of gametes or embryos: an Ethics Committee opinion (2018)

Posthumous gamete retrieval or use is ethically justifiable if written documentation from the deceased authorizing the procedure is available. View the Committee Opinion
Document Icon

Disclosure of medical errors involving gametes and embryos: an Ethics Committee opinion (2016)

Medical providers have an ethical duty to disclose clinically significant errors involving gametes and embryos as soon as they are discovered.  View the Committee Document
Document Icon

Recommended practices for the management of embryology, andrology, and endocrinology laboratories: a committee opinion (2014)

A general overview for good management practices within the endocrinology, andrology, and embryology laboratories in the United States. View the Recommendation
Document Icon

Informed consent and the use of gametes and embryos for research: a committee opinion (2014)

The ethical conduct of human gamete and embryo research depends upon conscientious application of principles of informed consent. View the Committee Opinion
Tool Icon

ASRM EDGE Tool

Get the EDGE on your fellow Embryologists! As the grading of embryos varies within IVF laboratories and between laboratories, EDGE allows you to compare yourself against embryologists in the US and around the world. Learn more about the EDGE Tool

Topic Resources

View more on legal/ethical issues
PR Bulletin Icon

ASRM announces support for HOPE with Fertility Services Act

The American Society for Reproductive Medicine is proud to endorse the HOPE with Fertility Services Act (HR 8821).

View the Press Release
Document Icon

Family members as gamete donors or gestational carriers: an Ethics Committee opinion (2024)

The use of adult intrafamilial gamete donors and gestational surrogates is ethically acceptable when all participants are fully informed and counseled. View the Committee Document
Document Icon

Financial ‘‘risk-sharing’’ or refund programs in assisted reproduction: an Ethics Committee opinion (2023)

Financial ‘‘risk-sharing’’ fee structures in programs charge patients a higher initial fee but provide reduced fees for subsequent cycles. View the Committee Document
Document Icon

Planned oocyte cryopreservation to preserve future reproductive potential: an Ethics Committee opinion (2023)

Planned oocyte cryopreservation is an ethically permissible procedure that may help individuals avoid future infertility. View the Committee Opinion
Document Icon

Ethical considerations for telemedical delivery of fertility care: an Ethics Committee opinion (2024)

Telemedicine has the potential to increase access to and decrease the cost of care. View the Committee Opinion
Document Icon

Interests, obligations, and rights in gamete and embryo donation: an Ethics Committee opinion (2019)

This Ethics Committee report outlines the interests, obligations, and rights of all parties involved in gamete and embryo donation. View the Committee Opinion
Legal Icon

The Supreme Court Overturns Right to Abortion, Raising Questions and Uncertainties for ART Patients and Providers

A summary of the U.S. Supreme Court’s ruling and various opinions in Dobbs v. Jackson Mississippi Women’s Health. View the Column
Document Icon

Provision of fertility services for women at increased risk of complications during fertility treatment or pregnancy: an Ethics Committee opinion (2022)

Providers may conclude that the medical risks of fertility treatment for a given patient are too high, in which case it is ethical to decline to provide treatment. View the Committee Opinion
Document Icon

Access to fertility services by transgender and nonbinary persons: an Ethics Committee opinion (2021)

The provision of fertility services to transgender individuals and the denial of access to fertility services is not justified. View the Committee Opinion
Document Icon

Interpretation of clinical trial results: a committee opinion (2020)

Evidence from clinical trials is fundamental to ethical medical practice. View the Committee Opinion
Document Icon

Ethics in embryo research: a position statement by the ASRM Ethics in Embryo Research Task Force and the ASRM Ethics Committee (2020)

Scientific research using human embryos advances human health and offspring well-being and provides vital insights into the mechanisms for reproduction. View the Committee Opinion
Document Icon

Compassionate transfer: patient requests for embryo transfer for nonreproductive purposes (2020)

A patient request to transfer embryos into her body in a location or at a time when pregnancy is highly unlikely ... View the Committee Opinion
Document Icon

Child-rearing ability and the provision of fertility services: an Ethics Committee opinion (2017)

Fertility programs may withhold services on the basis that patients will be unable to provide minimally adequate or safe care for offspring. View the Committee Opinion
Document Icon

Informed consent and the use of gametes and embryos for research: a committee opinion (2014)

The ethical conduct of human gamete and embryo research depends upon conscientious application of principles of informed consent. View the Committee Opinion

Ethics Opinions

Ethics Committee Reports are drafted by the members of the ASRM Ethics Committee on the tough ethical dilemmas of reproductive medicine.
Ethics Committee teaser

Use of preimplantation genetic testing for monogenic adult-onset conditions: an Ethics Committee opinion (2024)

Preimplantation genetic testing for adult-onset monogenic diseases is ethically allowed when fully penetrant or conferring disease predisposition.
Ethics Committee teaser

Family members as gamete donors or gestational carriers: an Ethics Committee opinion (2024)

The use of adult intrafamilial gamete donors and gestational surrogates is ethically acceptable when all participants are fully informed and counseled.
Ethics Committee teaser

Financial ‘‘risk-sharing’’ or refund programs in assisted reproduction: an Ethics Committee opinion (2023)

Financial ‘‘risk-sharing’’ fee structures in programs charge patients a higher initial fee but provide reduced fees for subsequent cycles.
Ethics Committee teaser

Planned oocyte cryopreservation to preserve future reproductive potential: an Ethics Committee opinion (2023)

Planned oocyte cryopreservation is an ethically permissible procedure that may help individuals avoid future infertility.

More Resources

MAC 2021 teaser
ASRM Academy on the Go

ASRM MAC Tool 2021

The ASRM Müllerian Anomaly Classification 2021 (MAC2021) includes cervical and vaginal anomalies and standardize terminology within an interactive tool format.

View the MAC Tool
EMR Phrases teaser
Practice Guidance

EMR Shared Phrases/Template Library

This resource includes phrases shared by ASRM physician members to provide a template for individuals to create their own EMR phrases.

View the library
Practice Committee Documents teaser

ASRM Practice Documents

These guidelines have been developed by the ASRM Practice Committee to assist physicians with clinical decisions regarding the care of their patients.

View ASRM Practice Documents
Ethics Committee teaser

ASRM Ethics Opinions

Ethics Committee Reports are drafted by the members of the ASRM Ethics Committee on the tough ethical dilemmas of reproductive medicine.

View ASRM Ethics Opinions
Coding Corner general teaser
Practice Guidance

Coding Corner Q & A

The Coding Corner Q & A is a list of previously submitted and answered questions from ASRM members about coding. Answers are available to ASRM Members only.

View the Q & A
Covid-19 teaser
Practice Guidance

COVID-19 Resources

A compendium of ASRM resources concerning the Novel Corona virus (SARS-COV-2) and COVID-19.

View the resources
Couple looking at laptop for online patient education materials

Patient Resources

ReproductiveFacts.org provides a wide range of information related to reproductive health and infertility through patient education fact sheets, infographics, videos, and other resources.

View Website