Physician views on ethically challenging clinical scenarios: a society for reproductive endocrinology and infertility member survey.

PURPOSE: The goal of this study was to examine Reproductive Endocrinology and Infertility (REI) physicians' views regarding ethically challenging clinical scenarios. METHODS: This national, cross-sectional survey study was administered to members of the Society for Reproductive Endocrinology and Infertility (SREI). The survey consisted of nine scenarios and six demographic questions. Topics included: using a gestational carrier without a medical indication, transferring multiple embryos into a gestational carrier, selecting embryo sex, using preimplantation genetic testing for polygenic conditions (PGT-P), and offering futile care. RESULTS: 154 REI physicians completed the survey (response rate ~ 20%). A large majority of respondents (88.3%) reported discomfort with transferring more than one embryo into a gestational carrier, and 59.7% reported discomfort with using a gestational carrier without a medical indication. About half of participants (52.6%) reported comfort with performing in vitro fertilization (IVF) solely for sex selection. Most respondents reported discomfort with the use of PGT-P for medical conditions (74.0%) and non-medical traits (89.6%). In contrast, 57.8% of participants reported comfort with performing IVF perceived to be futile, most commonly citing that it could provide psychological benefit and facilitate the transition to an alternative family building option, such as oocyte donation or adoption. Higher mean comfort scores across all scenarios were associated with working at a private practice (p = 0.003) and male gender (p = 0.004). CONCLUSION: Results from this survey provide insight into clinicians' views on ethically challenging scenarios and can inform the development of policies at the clinic and professional society levels that promote respectful and responsible patient care.