Consent in fertility care is version control wearing a lab coat

In most areas of medicine consent is a document signed before a procedure. In fertility care it is a long-running, multi-party agreement that changes shape over months and can be withdrawn by one party without the other. Clinics that store it as a scanned signature eventually discover the gap at the worst possible moment.

Four properties that make fertility consent different

It is multi-party

A cycle can involve an intended mother, a partner, an egg donor, a sperm donor and a surrogate. Each has consented to a different thing, at a different time, under a different document. “The couple consented” is not a statement the record can safely make.

It is time-bound

Storage consent expires. Gamete storage periods run for years and require renewal, often by someone who has since moved house twice. A consent that lapsed eight months ago looks identical, in a folder of PDFs, to one that is current.

It is revocable, asymmetrically

A gamete provider may generally withdraw consent up to the point of use. That withdrawal has to propagate immediately to the lab, to storage and to any scheduled procedure — not at the next audit.

It is conditional

Consent to treatment is not consent to embryo research, to training use, to genetic testing, or to posthumous use. These are separate decisions that people answer differently, and they need to be stored as separate, queryable facts rather than as prose inside a form.

What storing it properly looks like

The useful mental model is version control. Each consent is an object with a subject, a scope, a validity window, a version and a status. Signing creates a version; amending creates another; withdrawal is an event, not a deletion.

• Every consent attaches to a person, not to a couple or a cycle, because people participate in more than one.
• Scope is structured — treatment, storage, research, training, disclosure — so the lab can ask a precise question and get a precise answer.
• Validity has an explicit end date, and the system raises the renewal before it lapses rather than reporting it afterwards.
• Superseded versions are retained and readable. What someone agreed to in March is a fact about March.
• Withdrawal writes a new state and triggers downstream holds. It never edits the original.

The question the system must answer in seconds

Before any use of gametes or embryos, one question has to be answerable with certainty: is there, right now, valid and unwithdrawn consent from every party whose consent this specific act requires?

If answering that involves opening a folder, reading a form and making a judgement, then the answer is being recomputed by a human under time pressure at the exact moment when being wrong is most costly. That is a design problem, not a training problem.

Where paper actually fails

It is rarely a missing signature. It is a renewal nobody tracked, a withdrawal that reached the counsellor but not the lab, a donor consent that covered treatment but not the genetic testing that was later ordered, or a second version signed at a different branch that nobody reconciled with the first.

Each of those is a synchronisation failure between people who were all acting reasonably. Structured, versioned consent on a shared record does not make the conversations easier — but it does make sure everyone is looking at the same answer.