Anonymous or identity-registered sperm donors? A study of Dutch recipients' choices

BACKGROUND: The aim of the present study was to gain insight into parents' own donor preferences within a system offering the choice between an anonymous and identity-registered donor. A comparison was made between recipients choosing for an anonymous donor (AD choosers) and those choosing for an identifiable donor (ID choosers) with regard to their sexual orientation, demographic characteristics, disclosure issues and infertility distress. METHODS: Data from 105 couples (61% heterosexual, 39% lesbian) were registered on a standardized form during implication counselling sessions previous to treatment. RESULTS: Sixty-three per cent of the heterosexual couples and 98% of the lesbian couples had chosen an ID donor. Major differences between ID and AD choosers were identified. Among the ID choosers secrecy towards the child was no option, whereas 83% of the AD choosers did not intend to inform their child. Compared with heterosexual ID choosers, AD choosers were more distressed about their infertility and had a lower educational level. CONCLUSION: Legislation imposing ID donors appears to be acceptable for the majority of this study population. For a vulnerable group of heterosexual couples, who remained secretive about the use of a donor, adaptation to the new system is not self-evident.     

Reproductive decisions of men with microdeletions of the Y chromosome: the role of genetic counselling.

Couples dealing with microdeletions of the Y chromosome have to make decisions about their reproductive future. Do they opt for intracytoplasmic sperm injection (ICSI), artificial insemination with donor insemination (AID) or no treatment? We analysed this decision in 28 couples and investigated the role of the counsellor and the counselling process on the final decision of the couple. Ten counsellors from six fertility clinics in The Netherlands and Belgium were interviewed about their genetic counselling of couples dealing with microdeletions. The answers to the questionnaire were converted to 11 dichotomous variables. Of the 1627 tested men in the six centres, 37 (2.3%) had a microdeletion in the AZFc region, a subregion of the AZF region on the Y chromosome important for normal spermatogenesis. The decisions of 28 of them could be analysed. Most couples chose ICSI (79%). The remaining couples chose donor insemination (7%) or refrained from treatment (14%). Several variables, including the counselling procedure, the counsellor and the available treatments in the fertility centre, influenced the decision of the couple. In conclusion, most couples dealing with microdeletions in the AZF region choose ICSI. Several aspects of the process of genetic counselling appear to be related to the final decision.     

Topic avoidance and family functioning in families conceived with donor insemination

BACKGROUND: While a move away from non-disclosure and secrecy toward more openness is demonstrated in the changing practices of donor insemination worldwide, scholars and practitioners continue to debate the effects of disclosure versus secrecy. This study examines if an association exists between adult donor offspring's perceptions of their parents' use of topic avoidance to maintain secrecy, and their perceptions of their family's functioning. METHODS: Using a cross-sectional design, a convenience sample of 69 young adult donor offspring completed a demographic questionnaire, a topic avoidance scale relative to each of their rearing parents, and the Beavers Self Report Family Instrument. RESULTS: There was a moderate significant inverse correlation between family functioning and topic avoidance in general, as well as for donor insemination-related topics, for both mothers (r = -0.55, r = -0.40, respectively, P 相似文献   

Birth after treatment of a male with seminoma and azoospermia with cryopreserved-thawed testicular tissue

The case of an infertile couple in which a testicular seminoma and azoospermia were discovered in the husband during infertility treatment is described. A small piece of testicular tissue, obtained by biopsy from the healthy testis [testicular sperm extraction (TESE)], was deep-frozen before oncology therapy was initiated. The patient's lymphocyte karyotype was normal and no Y microdeletions were found. After conclusion of oncology treatment, the tissue was thawed and successfully used in the intracytoplasmic sperm injection (ICSI) procedure. A healthy girl was born. Testicular tumours are known to impair fertility in the majority of patients, and fertility deteriorates further after cytotoxic and surgical oncology treatment. Until recently in Slovenia, for young oncology patients cryopreservation was applied only to high quality ejaculate fulfilling the criteria for intrauterine insemination or in-vitro fertilization after thawing. Failing that, the only remaining options were fertilization by donor spermatozoa or child adoption. New assisted reproductive technologies, of which the ICSI procedure is the most successful, are suitable for the treatment of only the most severe cases of male infertility. It is reasonable to cryopreserve even poor quality ejaculate prior to the oncology therapy, as well as testicular tissue in cases of azoospermia.     

Achievement of second parenthood in an ART programme using frozen donor semen: cohort follow-up

BACKGROUND: This study was designed to determine the efficacy of a programme using frozen donor semen in a cohort of patients returning for treatment after previously conceiving through donor insemination (DI). METHODS: The cohort included 222 couples with secondary infertility (previous live birth) in one University Hospital Centre. The treatment sequence involved DI cycles until completion. Live births, drop-out for personal or medical reasons and recourse to IVF with donor semen (IVF-D) were recorded for all patients. Live births were expressed as both rate per cycle and crude cumulative rate. RESULTS: At the end of the DI cycles, 65% of couples in the cohort achieved second parenthood. Most of them (77%) succeeded after only four DI cycles. The majority of couples who stopped treatment did so for personal reasons. CONCLUSIONS: Patients involved in a second parenthood project belong to a 'selected' population. Management and counselling of such patients need to reconcile the early efficacy of DI cycles, the invasiveness of the IVF-D procedure and the availability of donor semen.     

Family environment and shame: Is there a relationship?

This study was designed to examine the relationship between dysfunctional families in childhood and shame experienced by adults and compare feelings of guilt and shame. The results indicated that the shame young adults feel is correlated with their perceived family environment as a child. Greater feelings of shame on the Test of Self-Conscious Affect (TOSCA) were correlated with lower Family Environment Scale scores on Cohesion, Expressiveness, Intellectual-Cultural Orientation, Moral-Religious Emphasis and Organization and higher Conflict scores. Other variables were also examined. The results support the hypothesis that people coming from dysfunctional families experience more shame as adults and that guilt and shame are differentially related to dysfunctional families. © 1996 John Wiley & Sons, Inc.     

Families created by gamete donation: follow-up at age 2

BACKGROUND: Findings are presented of the second phase of a longitudinal study of families created through gamete donation. METHODS: At the time of the child's second birthday, 46 donor insemination families and 48 egg donation families were compared with 68 natural conception families on standardized interview and questionnaire measures of the psychological well being of the parents, parent-child relationships and the psychological development of the child. RESULTS: The gamete donation mothers showed a trend towards greater pleasure in their child accompanied by a perception of their child as more vulnerable, with egg donation mothers tending towards greater pleasure and donor insemination mothers tending towards greater concern. The fathers did not differ on any of the variables under study. CONCLUSIONS: The findings from this recent cohort add further weight to the growing body of research showing that the absence of a genetic link between a parent and a child does not necessarily jeopardize the development of a positive relationship between them.     

Psychological screening and the success of donor insemination

In a previous case series, a psychologist‘s rating ofcouples’ emotional adjustment and readiness for donorinsemination was predictive of pregnancy rates. We attemptedto replicate this finding with an extended series of 120 consecutivecouples in which each spouse filled out questionnaires whenevaluated for donor insemination. The Stress and InfertilityQuestionnaire measured specific attitudes and anxieties aboutdonor insemination. The Brief Symptom Inventory assessed psychologicaldistress. The Dyadic Adjustment Scale measured marital happiness.A psychologist used these questionnaires to rate the couple‘soverall adjustment in regard to donor insemination. Those couplesrated as distressed had a session of psychological counselling.Outcome was reviewed at a mean of 20 months after evaluation,with categories of pregnancy, continuing donor insemination,failure to begin the programme, or dropped out. For the 120couples overall, psychological factors did not predict pregnancyoutcome. Younger age of the wife did predict higher pregnancyrates     

Pregnancy after direct intraperitoneal insemination of spermatozoa from a man with severe infertility, after unsuccessful application of other methods of assisted fertilization

Direct intraperitoneal insemination (DIPI) is one of the least invasive strategies of assisted reproduction. Unexplained infertility and male sub-fertility are the major indications for DIPI. It is otherwise well known that assisted procreation gives poor results in severe male infertility. This is a report of a pregnancy that occurred as a result of a direct intraperitoneal insemination of prepared spermatozoa characterized by a particularly severe astheno-teratozoospermia in a couple unsuccessfully treated with other, more invasive methods of assisted fertilization.     

Psychological considerations of anonymous oocyte donation

This study involved 50 patients interviewed in conversationswith a psychologist. It was found that it was possible to characterizethe kind of couples using assisted reproductive techniques interms of diagnostic and psychological profile. Other observationsincluded the repercussions of this action on the couples' stabilityin case of failure or success, the desire for children and theplans concerning them, the secrecy theme and questions arisingfrom the practice of anonymous or non-anonymous oocyte donation.The relationship between recipients and donors, as well as thespecific relationship between couples and their consultants,were also examined. It is concluded that the problems encountereddiffer according to the infertility diagnosis. Donor anonymityallows oocyte recipients to impose their own identity patternsonto the future child and to introduce him/her in an unbiasedway to their own lives. Artificial techniques to assist in theconception of a child do not appear to interfere with the couple'srelationship and their desire for a child, which remains constantfor each member of the couple.     

Male infertility and donor insemination: couples' decisions, reactions and counselling needs

This paper reports findings of a postal survey of 205 couplesbelonging to the National Association for the Childless, whoseinfertility had been attributed to the male partner. Spontaneousresolution was seldom reported, but 36 couples had become parentsby donor insemination (DI) and 28 through adoption. Almost athird of respondents had managed to resolve their childlessness.Although reasons for rejecting DI or preferring other optionswere offered by 60 couples, 125 had taken active steps towardsit. Most of the 80 couples who had been counselled had foundthis helpful. Regardless of counselling, of the 76 couples whohad considered whether or not to tell their children of theirmode of conception, 56 (74%) stated that they had no intentionof doing so. Quantitative indices from two self-report scalesconfirm that male infertility is commonly a source of distress,especially for the female partner. However, the data also suggestthat this is not necessarily associated with chronic maritaldiscord. Couples who had already decided for or against DI reportedless distress than others. The need for mutual support may wellbe enhanced until the couple's quest for a child has been eitherachieved or abandoned.     

Termination of pregnancy after conception with donor oocytes and donor spermatozoa: case report

Two couples, each suffering from longstanding primary subfertility due to severe oligoasthenoteratozoospermia in the male partner and perimenopause in the female, were referred to Bourn Hall Clinic for assisted conception treatment. Both couples received independent counselling prior to being accepted onto our programme. Both women conceived following embryo transfer. The embryos were created from (separate) donor oocytes and donor spermatozoa, and three and two embryos were transferred respectively. The first recipient conceived a triplet pregnancy, while the second conceived a twin pregnancy. Both felt unable to cope with their multiple pregnancies and declined further counselling. Both were offered elective fetal reduction; however, both declined and both decided to terminate their pregnancies. Both patients underwent termination of pregnancy, despite being advised against it. The reasons couples may opt for termination of their much-wanted pregnancies, after a protracted period of infertility, intensive and expensive infertility treatment and despite the counselling they receive before, during and after their treatment, are discussed.     

Embryo donation families: mothers' decisions regarding disclosure of donor conception

BACKGROUND: Previous data suggest that parents who adopt a child tend to support full disclosure while donor conception families prefer to keep the method of conception relatively private. It is not known whether parents in embryo donation families will tend towards the adoption model, therefore, we studied families with a child conceived using donated embryos. METHODS: A total of 21 embryo donation families with a child aged 2-5 years were recruited through UK fertility clinics. Mothers were administered a standardized semi-structured interview, obtaining data on the extent of their disclosure to children and other family members and their reasons for this decision. RESULTS: At the time of interview, 9% of mothers had told their child how they had conceived; 24% of mothers reported that they were planning to tell the child in future; 43% had decided that they would never tell the child, and the remaining 24% were undecided. However, nearly three-quarter of mothers (72%) had disclosed to other family members. Maternal grandparents were more likely to have been told than paternal grandparents (P < 0.025). Reasons cited for non-disclosure to the child included the desire to protect the child, the belief that disclosure is unnecessary, and the concern that family relationships would be damaged. Reasons in favour of disclosure included the desire to avoid accidental disclosure and the belief that the child has the right to know. CONCLUSIONS: Embryo donation mothers were similar to parents of donor insemination and oocyte donation children in their attitudes towards disclosure of donor conception.     

Non-genetic and non-gestational parenthood: consequences for parent-child relationships and the psychological well-being of mothers, fathers and children at age 3

BACKGROUND: Findings are presented of the third phase of a longitudinal study of children conceived by assisted reproduction procedures involving surrogacy and/or donor conception. METHODS: At the time of the child's third birthday, 34 surrogacy families, 41 donor insemination families and 41 oocyte donation families were compared with 67 natural conception families on standardized interview and questionnaire measures of the psychological well-being of the parents, mother-child relationships and the psychological well-being of the child. RESULTS: The differences found between family types reflected higher levels of warmth and interaction between mothers and their 3-year-old children in assisted reproduction families than in families with a naturally conceived child. A higher proportion of surrogacy parents than donor conception parents had told their children about the nature of their birth. CONCLUSIONS: It appears that the absence of a genetic and/or gestational link between parents and their child does not have a negative impact on parent-child relationships or the psychological well-being of mothers, fathers or children at age 3.     

Surrogacy: the experience of commissioning couples

BACKGROUND: Findings are presented of a study of families with a child created through a surrogacy arrangement. This paper focuses on the commissioning couples' reports of their experiences. METHODS: A total of 42 couples with a 1-year-old child born through surrogacy were assessed using a standardized semi-structured interview. Data were obtained on motivations for surrogacy, details about the surrogate mother, experience of surrogacy during pregnancy and after birth and disclosure of the surrogacy to friends and family. RESULTS: Couples had considered surrogacy only after a long period of infertility or when it was the only option available. Couples retrospectively recalled their levels of anxiety throughout the pregnancy as low, and relationships between the couple and the surrogate mother were found to be generally good. This was the case regardless of whether or not the couple had known the surrogate mother prior to the arrangement. After the birth of the child, positive relations continued with the large majority of couples maintaining some level of contact with the surrogate mother. All couples had told family and friends about the surrogacy and were planning to tell the child. CONCLUSIONS: Commissioning couples generally perceived the surrogacy arrangement as a positive experience.     

Adjusting to life when assisted conception fails

According to our basic (psychosomatic) tenet, every somatic problem has its emotional side; therefore, medical treatment and counselling are not separate but are interlinked and equally important. First interviews and interviews after failed assisted reproductive technology (ART) are held together in four person settings; the couple with two counsellors. The sessions last for approximately 1 h. The aim is to help patients escape the agonizing and distressing state in which they are kept by their foci (psychogenic aspects causing distress). Stress and iatrogenic factors are discussed and when patients are able to re- experience their suffering, many possible psychological effects on infertility and/or treatment failure are explored. If the patients consciously perceive these mechanisms of action, they will turn to their basic emotional needs and perspectives; approximately 30% of them will conceive later while approximately 20% opt for adoption. However, half of the patients take no positive action, neither giving up nor continuing with activities for a child. Nor do they seek counselling. The analysis of many of their reports argues in favour of an adaptive model for coping with reproductive failure.      

Psychosocial characteristics of infertile couples: a study by the 'Heidelberg Fertility Consultation Service'

BACKGROUND: The aim of the study was to identify differences in psychological characteristics between couples with fertility disorders, especially idiopathic infertility, and a representative sample. MATERIAL AND METHODS: A total of 564 couples was examined using psychological questionnaires pertaining to sociodemographic factors, motives for wanting a child, dimensions of life satisfaction and couple relationships, physical and psychic complaints, and a personality inventory. RESULTS: Specific to our sample was the high educational level of the couples, and the large number with idiopathic infertility (27% of all diagnoses). There were no remarkable differences in psychological variables between the infertile couples and a representative sample, except that the infertile women showed higher scores on the depression and anxiety scales. Couples with idiopathic infertility showed no remarkable differences in the questionnaire variables compared with couples with other medical diagnoses of infertility. CONCLUSIONS: A typical psychological profile for infertile couples could not be identified using standardized psychometric rating methods. This may be an effect of the specific characteristics of our sample. For some couples, the infertility crisis can be seen as a cumulative trauma, which indicates that these couples have a marked need for infertility counselling.     

Seeking conception: experiences of urban Indian women with in vitro fertilisation

OBJECTIVES: This paper reports on a study of involuntarily childless Indian women/couples seeking in vitro fertilisation (IVF). The focus is on the social context of infertility and on women's perceptions of and experiences with IVF. METHODS: Twenty-two childless women/couples who sought IVF. The sample was drawn from consenting clients of clinics in two major Indian cities, viz. New Delhi and Mumbai. RESULT: In-depth interviews revealed that infertility is deeply feared, women's status and security are affected, and they experience stigmatisation and isolation. IVF was pursued after less intrusive avenues had been exhausted. Inadequate information/counselling is provided, success rates are low, IVF is commercialised and the process is physiologically, emotionally and financially stressful. CONCLUSION: In Indian society fertility defines womanhood and motherhood, and infertility is stigmatised. Women faced a lot of pressures to produce a biological child, and go through all kinds of treatments, including the expensive ARTs, to have a child. PRACTICE IMPLICATIONS: Integration of infertility services into the state's reproductive health programme and disseminate information on infertility and to offer other appropriate choices, such as adoption. Effective counselling on coping with psychosocial/sexual problems. Monitoring of the prevalence of sex preselection.     

School-aged children of donor insemination: a study of parents' disclosure patterns

BACKGROUND: A major concern in relation to donor insemination (DI) is whether children should be told about their genetic origins. This study compared the thoughts, feelings and experiences of DI parents who were inclined towards openness with those who were inclined towards non-disclosure. METHODS: Forty-six families with a 4- to 8-year-old DI-conceived child were interviewed about their decision, their reasons and subsequent concerns regarding disclosure. RESULTS: Thirty-nine percent of parents were inclined towards disclosure whilst the remaining 61% were not. The two main reasons for favouring disclosure were to avoid accidental discovery and a desire for openness. Non-disclosing parents felt that there was no reason to tell and wished to protect family members. The children who had been told reacted with either curiosity or disinterest. CONCLUSIONS: In spite of donor anonymity, parents who were intending to tell their child in the future had optimistic expectations of their child's reaction. Parents who had already told their child generally described the telling experience as a positive one.     

Perinatal and obstetric outcomes of donor insemination using cryopreserved semen in Victoria, Australia.

This study compared the perinatal and obstetric outcomes of 1552 donor insemination pregnancies in Victoria, Australia, with a control group of 7717 normally conceived pregnancies from the general population. Data on the outcomes of pregnancies of at least 20 weeks gestation, for both groups, were obtained from the same population-based birth registry. The study showed that there were no significant differences between the donor insemination and control groups in the incidence of preterm birth, low birthweight, multiple birth, perinatal death and birth defects, or in the sex ratio. Pregnancies conceived by donor insemination were significantly more likely than controls to have an induced labour (OR = 1.6, 95% CI 1. 4-1.8), a forceps delivery (OR = 1.5, 95% CI 1.3-1.8) and/or a Caesarean section (OR = 1.6, 95% CI 1.4-1.9) and to develop pre-eclampsia (OR = 1.4, 95% CI 1.2-1.8) after adjusting for maternal age, multiple birth, parity and presentation. Reasons for the higher rate of induced and operative deliveries are not clear. Overall, the study's findings are reassuring for couples considering infertility treatment with donor insemination. The study illustrates the importance of complete follow-up in studies of pregnancy outcomes after assisted conception and the use of appropriate population-based control groups with comparable ascertainment of outcomes.