Patient motivations and barriers in the donation of surplus embryos: a systematic review

Cryopreservation of surplus embryos in assisted reproductive technology has led to their substantial accumulation in fertility clinics worldwide, raising ethical, legal and logistical challenges. This systematic review examines the factors influencing patients' decisions regarding surplus embryo disposition, including donation, continued storage or disposal. Following PRISMA guidelines, 24 studies from 15 countries were analysed, incorporating qualitative, quantitative and mixed-methods research. Findings reveal that patients' choices are shaped by the moral status attributed to embryos (e.g. 'cell cluster' versus 'potential child'), religious beliefs, educational level, gamete origin and storage duration. While many patients prefer donating embryos to research or other couples, emotional attachment and ethical concerns often lead to indecision or prolonged storage. Additionally, inadequate counselling and legal restrictions further complicate decision making, with many patients reporting insufficient information and support. The review highlights the need for improved patient-centred counselling, culturally sensitive policies and standardized ethical guidelines to address embryo accumulation while respecting patient autonomy. Future research should explore cross-cultural perspectives and develop interventions to facilitate informed, ethically sound decisions.