Screening in or out of the new reproductive options: who decides and why

A lively controversy exists among infertility specialists about the value and necessity of screening candidates for inclusion into infertility programs. Advocates of screening argue that there is both a child advocacy and community welfare responsibility to evaluate prospective candidates (and donors) for the new assisted reproductive techniques. Opponents of screening argue that screening is costly and superfluous, since the majority of applicants are highly motivated and well-adjusted individuals who have the 'right' to pursue parenthood, if they choose. A pilot survey was undertaken to determine whether infertility programs currently have explicit policies regarding suspension or refusal of treatment on psychological grounds and to determine what would (or should) constitute grounds for denial of infertility treatment. A Treatment Refusal Questionnaire was mailed to all members of the Psychological Special Interest Group of the American Fertility Society. Forty-two responded (response rate of 47%). Results revealed that the majority of respondents did not have a formal policy regarding suspension or refusal of treatment, although they did have informal criteria. Four criteria were significantly endorsed as constituting 'red flags' for treatment rejection: substance abuse, physical abuse, severe marital strife, and coercion of one spouse by another. Furthermore, treatment decisions were modified by the type of intervention sought, so that for example, more stringent criteria were operative if clients sought ovum donation than if they sought ovulation induction. These and other findings are presented and discussed.