Guidelines for infertility counselling in different countries: is there an emerging trend?

BACKGROUND

It is widely accepted that infertility and involuntary childlessness, and the decision to engage with assisted reproduction technology (ART) services as a patient, donor or surrogate can entail wide-ranging psychosocial issues. Psychosocial counselling has, therefore, become valued as an integral element of ART services. The objective of this study was to begin to map out what exists globally by the way of guidelines for infertility counselling.

METHODS

Data were analysed from formal guidelines produced by seven national infertility counselling bodies, onetransnational infertility counselling organization, reports of the American Society for Reproductive Medicine Ethics Committee and Practice Committee and the ESHRE Task Force on Ethics and Law. Additional sources of data were the International Infertility Counseling Organization and counselling colleagues internationally.

RESULTS

Four broad areas concerning contemporary practice in infertility counselling are identified: (i) the legal mandate for counselling; (ii) eligibility credentials for individuals carrying out professional counselling activities; (iii) different forms of counselling and (iv) counselling practice in relation to specific elements of assisted reproduction treatment.

CONCLUSIONS

Internationally, the development of infertility guidelines is best described as a 'work in progress', although key trends are evident.

Cross-border reproductive services--suggestions for ethically based minimum standards of care in Europe

Cross-border reproductive services (CBRS) is a phenomenon discussed worldwide. The major challenges associated with CBRS are the lack of data on the number of patients travelling for treatment and lack of transparency regarding the quality and safety of treatment procedures, especially in countries that have not yet introduced legislation or binding professional guidelines. This has given rise to practices that range from dubious to irresponsible treatment. Given that pan-European (let alone globally encompassing) legislation or guidelines are unlikely to appear quickly if at all, the authors suggest the implementation of ethically based minimum standards of care to which clinics and service providers can adhere on a voluntary basis. Such minimum standards of care can result in providing infertility treatment that is transparent, accountable and carried out responsibly for all parties involved.

Genes r us? Making sense of genetic and non-genetic relationships following anonymous donor insemination

This exploratory qualitative study investigates the experiences of eight adults conceived following anonymous sperm donation who had discovered the identity both of their donor and of donor half-siblings and had established contact with each other. It focuses primarily on participants' reflections on genetic and social kinship relationships. Data were collected from this group as well as from the son of the donor and the donor-conceived half-sister of one participant by means of semistructured interviews utilizing asynchronous email and digitalized voice recording. Participants discussed their experience of genetic disconnection resulting from learning of their donor-conceived status and of revising their personal biographies and developing new kinship networks as a result of discovering the identity of their donor and the existence of donor half-siblings. The study highlights participants' agency expressed through their ability to draw on both genetic and non-genetic elements of their inheritance to redefine their self-identity and extend their familial/kinship networks in meaningful ways.

CBRC and psychosocial counselling: assessing needs and developing an ethical framework for practice

Encountering infertility and involuntary childlessness and undergoing infertility treatment are acknowledged as stressful experiences that impact on individuals' psychological and emotional health – and for which access to psychosocial counselling by a skilled mental health professional may be beneficial. Evidence of patients', gamete donors' and surrogates' experiences indicates that utilization of infertility treatment in another country may not only exacerbate these psychosocial adversities, but may also pose additional risks to the psychological or physical health of participants, thus further emphasizing the need for competent psychosocial counselling services in cross-border reproductive care. However, this is a largely neglected topic in recent discussions of both CBRC itself and of infertility counselling practice. This paper extends the previous work undertaken by two of the authors to begin to map out practice issues within an ethical framework for counsellors when working with clients, donors, surrogates, individuals conceived following infertility treatment and existing children in clients', donor's and surrogates' families where cross-border reproductive treatment is considered or undertaken.

Relinquishing frozen embryos for conception by infertile couples

This qualitative study sought to provide an in-depth understanding of the experiences of couples who have relinquished their stored frozen embryos to one or more infertile couples. All couples were recruited through a U.S. based not-for-profit, prolife, Christian "embryo adoption" agency. In-depth semistructured interviews were undertaken via e-mail. Implications for practice strategies, including effective ways for educating couples with surplus frozen embryos are offered.

Patient experiences of an "egg sharing" programme

INTRODUCTION

This paper reports on a qualitative empirical study of the experiences of women (and their partners) attending one UK assisted conception unit, who have considered egg sharing.

AIMS

In the absence of any published research of the experiences of people contemplating egg sharing and the considerable concerns that egg sharing had generated (for an overview see Blyth, 2002), the major purpose of the study was to examine the experiences not only of those who had considered and proceeded with egg sharing but also those who had considered, but had then decided against, egg sharing. In addition, since the views of male partners are frequently overlooked in studies of assisted conception treatment (cf. Ahuja, Mostyn, & Simons, 1997) the project actively sought the involvement of the women's partners. The study was designed to explore couples' motivation for egg sharing, their experiences of treatment, attitudes regarding information about egg sharing treatment and outcomes, and attitudes towards egg sharing.

METHODS

The centre sent a written invitation to participate in the study to all women who had indicated an interest in egg sharing and who had received both information and counselling in advance of proceeding (n = 60). Of these, 43 had decided to proceed after the counselling session and 17 had decided not to do so. Expressions of interest in participating in the study were received from 20 women: (a) five women had proceeded with egg sharing but had not been successful with their own treatment at the time of interview--all husbands/partners also participated (n = 10); (b) seven women had proceeded with egg sharing and had conceived (one of whom had conceived unexpectedly without assisted conception services)--5 couples and 2 women participated (n = 12); (c) six women decided to proceed with egg sharing, however an insufficient number of eggs were available following egg retrieval to enable egg sharing to take place--all husbands/partners also participated (n = 12); (d) two women decided not to proceed--and both husbands/partners participated (n = 4). The study data were derived from retrospective semi-structured interviews conducted by the author with these 20 women and 18 husbands/partners. Respondents also completed a paper exercise following the interview indicating their level of agreement or disagreement with a number of statements relating to egg sharing that were derived from responses to the HFEA's consultation on the withdrawal of payment to donors (HFEA 1998a.). While there was an overall 33% response rate, the response rate for those who had decided to proceed with egg sharing (41.9%) was greater than for those who had decided not to proceed (11.8%). Consequently, this study under-represents the views of women and their partners who had considered, but then rejected, egg sharing. Couples agreeing to participate in the research were given a choice of being interviewed together or separately and in their own home or at an alternative venue. This choice of separate or joint interviews was offered as part of the explicit effort to involve men in the study and to maximize participant choice. Twelve couples agreed to be interviewed separately; six couples were interviewed together and two women whose partners did not take part in the study were interviewed alone. There was no evidence of any significant differences in interview data between joint and separate interviews. Indeed, there was little disagreement between partners at all; this is probably not surprising, given that they will have discussed their decision about egg sharing together and will be aware of each other's views about at least some of the issues discussed during interview. All except four interviews took place in respondents' own homes. Two interviews took place in the centre at the respondents' requests and two interviews were conducted by telephone because of geographical considerations. All interviews were audio-recorded with respondents' permission and subsequently transcribed verbatim. The research was conducted in accordance with the British Psychological Society Statement of Ethical Principles for Conducting Research with Human Subjects (British Psychological Society, 2002). Ethical approval was given by the University of Huddersfield Ethics Committee.

Ethical objections to sex selection for non-medical reasons

This paper examines the main ethical argument used to support the use of sex selection for non-medical reasons, namely that sex selection for non-medical reasons should be allowed on the grounds of reproductive autonomy. A critique of this argument is offered, concluding that sex selection for non-medical reasons should not be permitted.