A follow-up study of the long-term satisfaction,reproductive experiences,and self-reported health status of oocyte donors in Spain

Purpose: The aim of this study is to evaluate the health of oocyte donors and explain how they regard their experience in the long-term.

Materials and methods: This is a cross-sectional study in a single fertility centre that consists of a telephone interview guided by a semi-structured questionnaire covering several aspects of reproductive health and personal experience.

Results: At the time of interview, 84 out of 121 women (69%) had children while 64 (53%) were already mothers at the time of their donation. Of the 38 women achieving a pregnancy after donation, five reported six pregnancy complications. Two out of 121 (2%) women reported being in menopause (aged 41 and 45). Twenty-three women (19%) reported gynaecological issues and eight (7%) reported fertility problems, although only four consulted a specialist. Most of women highlighted positive feelings about their donation (113, 93%) and 155 (97%) would recommend donating. Less than half (53, 44%) mentioned some negative aspects, mainly related to physical discomfort: injections (20,17%), pain (17, 14%), and side effects of ovarian stimulation (10, 8%).

Conclusion: The impact of donation on women’s life was mostly favourable, with the majority of participants reporting positive aspects and recommending donation, although some negative feelings as physical discomfort also arose. Therefore, more comfortable stimulation protocols could be developed.     

Clinical factors associated with the outcome of oocyte donation

This article aims at reviewing the literature in order to provide a summary of the actual knowledge about the clinical factors of the oocyte recipient (other than those affecting the morphology of the uterine cavity) influencing the outcome of oocyte donation cycles. Recipient age, from 45 years onwards, is clearly associated with a poorer outcome in oocyte donation cycles as well as the presence of a hydrosalpinx. The negative impact of smoking has recently been confirmed. The exact influence of a high body mass index is under examination but it is likely that it is associated with a lower ongoing pregnancy rate. Endometriosis does not have a negative impact when standard endometrial priming protocols are used in oocyte donation. During endometrial priming, serum estradiol levels and endometrial thickness, if >5 mm, does not influence negatively the outcome; however duration of estrogen treatment of more than 7 weeks is associated with a diminished pregnancy and implantation rate.     

A protocol for satisfying the ethical issues raised by oocyte donation: the free, anonymous, and fertile donors

A new protocol was developed to provide participants of our oocyte donation program with oocytes donated by donors who were not financially rewarded, were anonymous, and fertile. Each participant provided an oocyte donor selected among fertile friends or family members. The retrieved oocytes were anonymously exchanged between phenotypically matched donor-recipient pairs. In the first 30 months of activity, we obtained 111 embryos suitable for transfer or cryopreservation from 52 retrievals, and 40 embryo transfers (ETs) were performed. Recipients received oral Estradiol-valerate and vaginal micronized progesterone. Fifteen embryos were transferred in 8 ETs conducted after donor-recipient synchronization. This resulted in four pregnancies, all ongoing (ongoing pregnancy rate 50% per transfer). Of the 96 cryopreserved embryos, 82 were thawed for ET, and 45 surviving embryos were transferred in 32 ETs. This resulted in eight pregnancies, with six ongoing or delivered (ongoing pregnancy rate 19% per transfer). The overall ongoing pregnancy rate of 25% per transfer indicates that our approach is a viable method for obtaining donated oocytes while respecting the ethical guidelines that recommended that donation of human gametes should be free, and from anonymous and fertile donors. Furthermore, guaranteeing anonymous oocyte donation had practical importance because, for many volunteer donors, it played a crucial role in their decision to donate.     

Do attitudes toward disclosure in donor oocyte recipients predict the use of anonymous versus directed donation?

Objective: To compare the demographic and psychological characteristics of oocyte recipients and to determine whether the issue of disclosure about the use of a donor is a correlate of the decision to use an anonymous or directed donor.

Design: Cross-sectional study.

Setting: University teaching hospital.

Patient(s): Ninety consecutive recipients of donated oocytes (64 of whom used anonymous donors and 26 of whom used directed donors).

Intervention(s): Pretreatment psychosocial evaluation.

Main Outcome Measure(s): Recipient opinions and attitudes regarding the choice of donor type and disclosure to others as determined through a semistructured interview.

Result(s): There were no statistically significant differences with regard to demographic characteristics between recipients who used anonymous and directed donors. There were statistically significant differences between the groups with regard to the issue of disclosure. Recipients who used directed donors were more likely to have told others about using an oocyte donor and were more likely to indicate that they intended to inform the child about the nature of his or her conception.

Conclusion(s): Oocyte recipients who use known donors differ significantly from those who use anonymous donors with regard to the issue of disclosure to others. Further studies are needed to determine the causal direction of this relation.     

A study exploring UK midwives' knowledge and attitudes towards caring for women who have been sexually abused

Objective

to investigate midwives’ knowledge and attitudes in relation to caring for women who have been sexually abused.

Design

survey using a postal questionnaire. The questionnaire looked at midwives’ knowledge and attitudes towards a range of aspects of sexuality and childbirth. The area of caring for women who have been sexually abused was one aspect of this study. The questionnaire included fixed response and open-ended questions. Quantitative data were analysed using χ²-test, logistic regression, Mann–Whitney U-test, Kruskal Wallis test and Mantel–Haenszel test. Qualitative data were analysed using a modified constant comparative approach as described by Morse and Field [1995. Qualitative research methods for health professionals, second edn. Sage Publications, London].

Setting

four National Health Service trusts within the East and West Midlands.

Participants

489 community and hospital-based midwives.

Findings

372 midwives returned their questionnaire giving a 76% response rate. The majority of midwives in the sample group did not feel adequately prepared to deal with a disclosure of sexual abuse (n=207, 56%), with a further 109 (29%) midwives being ‘unsure’ if they could deal with such a disclosure. Community midwives rated themselves as more able to deal with disclosures of sexual abuse compared with hospital-based midwives (χ²=4.044, df=1, p=0.044). The analysis of the in-depth responses to the open-ended questions showed that a small number of midwives were very knowledgeable about the topic of sexual abuse and had experience in dealing with these situations. In contrast, it emerged that the majority of midwives had little if any education in this area and felt unable to deal effectively with disclosures of sexual abuse.

Key conclusions and implications for practice

the finding that the majority of midwives did not feel adequately prepared to deal with disclosures of sexual abuse may have implications for the quality of care received by survivors of sexual abuse. It is possible that midwives who have been inadequately prepared for dealing with such disclosures may give inappropriate advice, and may inadvertently compound the feelings of powerlessness that women have experienced. Aspects of sexuality and, in particular, caring for women who have been sexually abused should be included in all pre-registration curricula, and post-registration education should include this topic to either update midwives or introduce these topics to qualified midwives. As the incidence of sexual abuse is high and may potentially affect a significant number of childbearing women, it is recommended that further good-quality research should be conducted in this area.     

A follow-up survey on the reproductive intentions and experiences of women undergoing planned oocyte cryopreservation

Research questionWhat are the current reproductive attitudes and experiences of women who have previously undergone planned oocyte cryopreservation (OoC)?DesignRetrospective questionnaire-based cohort study involving women who had previously undergone planned OoC between January 2009 and September 2016 at a single centre. Eligible women were contacted via e-mail and invited to complete an anonymous standardized questionnaire that had been developed to evaluate their current relationship status and reproductive situation, their attitudes towards planned OoC and their future reproductive intentions.ResultsOf 460 women who had completed at least one OoC cycle, questionnaires were obtained from 138 women. After a mean (± SD) follow-up of 4.5 ± 2.4 years, two-thirds of respondents (65%) anticipated using their oocytes at some point in the future. The respondents reported an overwhelmingly positive attitude towards planned OoC, with 98% indicating they would recommend this intervention to others. Overall, 83% of respondents were single at the time they requested OoC but only 44% were single at the time they completed the survey. While 43/62 (69%) of women became pregnant after undergoing OoC, the majority 30/43 (70%) of these pregnancies were achieved without using their vitrified oocytes. Finally, 13/28 (46%) who used their cryopreserved oocytes stated that they had achieved a live birth.ConclusionsThe majority of women who undergo OoC do not regret their experience and many have found a partner in subsequent years. Twenty-one per cent of respondents who attempted to conceive after OoC had a live birth using their cryopreserved oocytes.     

Being an identity-release donor: a qualitative study exploring the motivations,experiences and future expectations of current UK egg donors

The objective of this study was to examine the motivations, experiences and future expectations of identity-release egg donors in the UK following the removal of donor anonymity and the increase in financial compensation for egg donation. This exploratory, in-depth qualitative study comprised semi-structured interviews with 11 women who had attended an egg donation screening appointment at a UK clinic during a four-month period in 2014. Interviews were conducted two to six weeks after the woman had donated or had withdrawn/been rejected from the donation process. Participants’ primary motivation for donating was to help infertile women have their ‘own child’, and the recent increase in financial compensation did not seem to play a significant role in their decision. All were happy to be identifiable and contacted by children born as a result of their donation. However, some were hesitant about providing non-identifying information about themselves for these offspring and wished for further information about the recipient(s) of their eggs and the outcome of their donation. Whilst this study was limited due to the small sample size, it is the first study of UK egg donors following the rise in donor compensation and suggests that other strategies may be more effective in increasing donor numbers.     

The experiences of patients and the maternal representations throughout the different steps of an oocyte donation

This research aims to study the experiences and the maternal representations of infertile women throughout the different steps of a medically assisted procreation (MAP) with oocyte donation. The analysis of collected data (interviews and questionnaires) shows that the resort of egg donation creates psychic adjustment (particularly in terms of maternal representations) that appear specific to this type of procreation.     

Complementary medicine: knowledge, use and attitudes of doctors

The recent growth in interest in the use of complementary medicine by the general public has been well reported. Health professionals, particularly nurses and midwives, are incorporating the use of complementary therapies into their practice. The medical profession is involved in the political processes affecting legislation governing complementary medicine and it is therefore important to determine the views of doctors when considering the use of complementary therapies by nurses within the health-care system. A critical review of published research studies which consider the knowledge, use and attitudes of doctors to complementary medicine is presented. These studies suggest doctors' interest in complementary medicine but they also raise a number of concerns including lack of evidence to demonstrate effectiveness, possible harmful effects, inadequate knowledge of doctors and lack of statutory regulation for most therapies. Recommendations of recent reports are outlined which attempt to address these and other issues.     

A qualitative study exploring women's personal experiences of their perineum after childbirth: Expectations, reality and returning to normality

Objective

to explore the feelings, perceptions and experiences of women in relation to their perineum following childbirth in the early postnatal period.

Design

a qualitative study using grounded theory. Data were collected using diaries and interviews and analysed using constant comparative method.

Setting

hospital and community setting in the South of England.

Participants

women (n=11) aged 20–42 years who had a vaginal birth.

Findings

one core category, ‘Striving for normality’ and five major categories emerged: (1) ‘preparing for the unknown’, (2) ‘experiencing the unexpected’, (3) ‘adjusting to reality’, (4) ‘getting back to normal’ and (5) ‘recovery of self’. ‘Striving for normality’ was where women wanted to be able to do normal things and feel like their normal selves soon after the birth of their baby. Much of what the women described doing during the early postnatal period was related to achieving this goal.

Key conclusions

the initial impact of childbirth on the perineum and surrounding area meant that in the first few postnatal days women largely concentrated on managing the effects of this. The impact however, went beyond the immediacy of coping with bodily functions extending into other daily activities in terms of managing and completing them. Examples of daily living activities in this context include bathing, eating, walking as well as completing household chores. Returning to normal following childbirth is significant for women and successfully achieving daily living activities is part of this process. However, women in this study seemed unprepared for the reality of this experience.

Implications for practice

women may be poorly prepared for the impact that perineal pain and discomfort can have on their lives especially related to successfully completing daily living activities in the early postnatal period. Consideration should be given to finding different ways of communicating the impact to women such as in the early postnatal period, rather than during pregnancy. The underpinning philosophy of care for the postnatal period should encapsulate a holistic approach, where physical symptoms of perineal pain and discomfort experienced by women are not tackled in isolation from any psychosocial impact this may also have.     

Midwives' knowledge of,attitudes towards and experiences of caring for women with intellectual disability during pregnancy and childbirth: A cross-sectional study in Sweden

Objective

to investigate midwives' knowledge of, attitudes towards and experiences of caring for women with intellectual disability (ID) during pregnancy and childbirth.

Design/setting

a cross-sectional study among six hundred midwives working at antenatal care and labour wards in Sweden.

Results

more than four out of five (81.5%) midwives had experience of caring for women with ID. Almost all midwives (97.1%) reported that caring for women with ID is different from caring for women without ID. Almost one-half (47.3%) had not received any education about pregnancy and delivery of women with ID, and a majority of the midwives (95.4%) requested evidence-based knowledge of women with ID in relation to childbirth. High proportion (69.7%) of the midwives were of the opinion that women with ID cannot satisfactorily manage the mother role, and more than one-third (35.7%) of the midwives considered that women with ID should not be pregnant and give birth at all. Most midwives partly/totally agreed that children of women with ID should grow up with their parents supported by the social authorities, but nearly one-fifth (19.1%) partly/totally agreed that the children should grow up in foster care.

Conclusions

even if the majority of midwives had experience of caring for women with ID, they were uncertain about how to adapt and give advice and they needed more knowledge about these women. Some midwives had negative attitudes towards childbearing among women with ID. Health Service providers should encourage midwives to update their knowledge and provide supportive supervision in midwifery care for women with ID.     

Absence of laws regarding sperm and oocyte donation in Japan and the impacts on donors,parents, and the people born as a result

An absence of any statutory law in Japan regarding donor conception creates uncertainty about the status of donors in relation to the child(ren) born as a result. Laws that provide for certainty regarding the status of the donor are called for, as are laws that address donor anonymity. It would be pragmatic to introduce a prospective system that requires open donation, allowing information to be recorded and released to donor‐conceived people upon request. For past donations, a voluntary register should be established, which would allow those people who are seeking information to register this.     

A qualitative study exploring student midwives' experiences of carrying a caseload as part of their midwifery education in England

Objective

to explore student midwives' experiences of caseloading to develop an understanding of how they perceive this educational strategy has impacted on their learning journey to becoming a midwife.

Design

a qualitative approach drawing upon the principles of grounded theory. Data were collected by in-depth semi-structured interviews.

Setting

a university in the South of England providing undergraduate pre-registration midwifery education across Advanced Diploma and BSc (Hons) programmes.

Participants

eight Caucasian female final-year student midwives aged 23–50 years who had completed their caseloading experience.

Findings

one core category (‘making it good’) and four major categories emerged: (1) ‘developing and managing caseload’, (2) ‘learning partnerships’, (3) ‘feeling like a midwife’ and (4) ‘afterwards’. The core category was reflected in all the other categories and was dependent upon them.

Key conclusions and implications for practice

students identified caseloading as a highly beneficial learning approach, facilitating application of theory to practice and acquisition of new skills promoting confidence and competence in practice. Students articulated an overwhelming desire and concern to meet and facilitate women’s expectations. Perceptions of letting the woman down evoked feelings of inadequacy and failure. Flexible working practices, on-call commitment and carrying a caseload alongside academic and home commitments was, for many, emotionally stressful. Effective preparation of students for the realities of caseloading, the development of realistic caseloads that take account of the student’s individual situation, and the provision of supportive frameworks are essential.     

Helping parents to tell their children about the use of donor insemination (DI) and determining their opinions about open-identity sperm donors

OBJECTIVE: To look at the level of compliance with Swedish law whether or not parents intend to tell their child about donor insemination. We also wanted to look at the parents' attitudes towards open-identity sperm donors and at relationships within the family. METHOD: All parents who were treated and gave birth to a child through donor insemination from 1997 to 2003 were included in the study. Sixteen of 20 couples (80%) were willing to take part in an interview, where the men and women were interviewed separately. The children of these couples had an average age of 2.9 years. RESULTS: Three of the 16 couples had told their child about donor insemination and 9 couples intended to tell the child when he/she was older. Thus 12 couples (75%) had disclosed or planned to inform their child in the future. Fourteen of 16 couples had told others about the donor insemination. The majority (21 of 31 individuals) had a positive attitude towards open-identity for sperm donors and 16 of 31 would have chosen an open-identity sperm donor if they had had the choice between that and an anonymous donor. All the parents felt they had an equal relationship with their child. CONCLUSION: Couples who conceived a child through donor insemination are open about the donor insemination, both to other people in their surroundings and in their intention to tell the child. These families seem to be functioning well with relaxed attitudes towards the donor insemination process.     

A qualitative study exploring junior paediatricians', midwives', GPs' and mothers' experiences and views of the examination of the newborn baby

OBJECTIVE: to explore the experiences and attitudes of midwives, junior paediatricians (SHOs), GPs, and mothers to the examination of the newborn baby. To provide an appreciation of their views on several issues, in particular the purpose and value of the examination, who is thought to be appropriate to carry it out and when and where it should take place. DESIGN: qualitative using semi-structured interviews, which were exploratory and interactive, in order to examine the range and diversity of experiences and attitudes to the neonatal examination. SETTING: South-east England. PARTICIPANTS: four samples were purposefully selected to include ten each of midwives, SHOs, GPs and recently delivered mothers. SHOs were currently working in paediatric departments of a district general hospital or teaching hospital and their experience of conducting examinations of the newborn baby ranged from several months to several years. Midwives included both those trained in the examination and currently conducting examinations, and those not so trained and not carrying out the examination. Most of the midwives had been qualified for over ten years and had a wide range of clinical experience in hospital and community settings. The GPs were from ten practices in two Health Authorities and all had some experience of conducting neonatal examinations. Of the mothers, a few had had their babies examined at home by midwives, others in hospital by an SHO. Mothers included those with a family history of problems relevant to the examination, those with previous pregnancy complications and others with no problems or complications. Some were first-time mothers. FINDINGS: all groups perceived the examination to be a useful screening tool providing reassurance to parents. They considered both midwives and SHOs to be appropriate professionals to carry out the examination, if adequately trained. Most thought that midwives have a better rapport with mothers, are able to provide continuity of care and more often discuss health-care issues than do SHOs. Few SHOs reported receiving any formal training in the examination of the newborn baby. IMPLICATIONS FOR PRACTICE: the extension of the practice of midwives examining the newborn baby following relevant training would be acceptable to all stakeholders. The implications of increased demands on the midwives' workload may need to be considered.