Katsuzaki Shizuka, Takimoto Yoshiyuki, Morioka Chikako, Nakayama Masahiro, Harada Tatsuya, Urata Yoko, Ishikawa Tomonori, Takagi Masatoshi
Patient Relations and Clinical Ethics Center, The University of Tokyo Hospital, Tokyo, Japan.
Department of Pediatrics and Developmental Biology, Institute of Science Tokyo, Tokyo, Japan.
Front Reprod Health. 2025 Sep 4;7:1646340. doi: 10.3389/frph.2025.1646340. eCollection 2025.
The growing use of fertilization (IVF) in Japan has led to an increase in surplus frozen embryos and the associated ethical dilemmas. Cultural values, institutional practices, and limited legal guidance contribute to patient distress and uncertainty. However, little is known about how Japanese patients perceive surplus embryos, and how these views relate to their emotional experiences and support preferences.
This qualitative study included semi-structured interviews with 46 female patients who had undergone IVF recruited from three Japanese fertility clinics with varying policies for embryo disposition. The interviews were conducted online between May 2024 and March 2025. Data were analyzed using thematic analysis guided by Boyatzis's inductive coding method.
Participants conceptualized embryos in three main ways: as "life," as genetically connected "blood ties," or as "cells or eggs." These perceptions-now more diverse than in earlier reports-influence emotional responses and dispositional decisions. Viewing embryos as life forms is often associated with guilt and sorrow, particularly in the absence of clear information or acceptable options, and could be understood as a form of moral distress from the patient's perspective. Practical considerations, such as storage fees and future family planning, also shaped both perceptions and emotional burden. Gendered responses were observed: women with female-factor infertility tended to internalize blame, while male-factor diagnoses allowed for emotional distancing. Institutional factors, including storage fees, a lack of legal frameworks, and stigma, shape moral distress and decision-making. While embryo donation for research is often preferred, donation to other patients is strongly opposed, reflecting cultural concerns about kinship and genetic identity. Support preferences range from symbolic closures to informal peer dialogues.
Patient perceptions of surplus embryos are shaped by cultural values, gendered expectations, and institutional factors, and practical constraints. These findings highlight the need for culturally responsive, ethically grounded, and flexible care models that acknowledge moral distress as experienced by patients and the growing diversity in how embryos are conceptualized.
体外受精（IVF）在日本的使用日益增加，导致剩余冷冻胚胎数量增多以及相关的伦理困境。文化价值观、机构做法和有限的法律指导加剧了患者的困扰和不确定性。然而，对于日本患者如何看待剩余胚胎，以及这些观点如何与他们的情感体验和支持偏好相关联，我们知之甚少。
这项定性研究包括对46名接受过体外受精的女性患者进行半结构化访谈，这些患者来自三家对胚胎处置政策不同的日本生育诊所。访谈于2024年5月至2025年3月在线进行。数据采用博亚齐斯归纳编码法指导的主题分析进行分析。
参与者对胚胎的概念化主要有三种方式：视为“生命”、视为有基因联系的“血缘关系”或视为“细胞或卵子”。这些认知——现在比早期报告中的更加多样——影响情感反应和处置决定。将胚胎视为生命形式通常与内疚和悲伤相关，特别是在缺乏明确信息或可接受选择的情况下，从患者角度看，这可被理解为一种道德困扰形式。实际考虑因素，如储存费用和未来计划生育，也塑造了认知和情感负担。观察到了性别差异反应：患有女性因素不孕症的女性倾向于自责，而男性因素诊断则允许情感上的疏离。机构因素，包括储存费用、缺乏法律框架和污名，塑造了道德困扰和决策。虽然通常更倾向于将胚胎捐赠用于研究，但强烈反对捐赠给其他患者，这反映了对亲属关系和基因身份的文化担忧。支持偏好范围从象征性结束到非正式的同伴对话。
患者对剩余胚胎的认知受到文化价值观、性别期望、机构因素和实际限制的影响。这些发现凸显了需要建立具有文化响应性、基于伦理且灵活的护理模式，承认患者所经历的道德困扰以及胚胎概念化方式日益增加的多样性。
