British women's attitudes towards oocyte donation: ethnic differences and altruism

OBJECTIVE

This study assessed the importance of altruism and willingness to donate oocytes in British Asian and Caucasian samples. The Theory of Planned Behaviour (TPB) was used to test the importance of attitudes towards oocyte donation, normative and control beliefs to attitudes to donate oocytes.

METHOD

One hundred and one participants (55% Asian, 45% Caucasian) completed questionnaires measuring altruism and attitudes to Oocyte donation. There were no socio-demographic differences between ethnic groups.

RESULTS

Few women were willing to donate oocytes, Asian women were least likely to donate oocytes, and altruism was not related to willingness to donate. Forty-one participants considered themselves 'possible' oocyte donors and 54 as definite 'non' donors. Possible donors reported significantly more positive attitudes towards egg donation; asking women to donate under various circumstances; to the consequences of donating their eggs; positively experiencing egg donation and to factors that would induce women to donate. Subjective norms and behavioural control also influenced intention to donate.

CONCLUSION

A number of components of the TPB were able to predict possible oocyte donation, and non-oocyte donation.

PRACTICE IMPLICATIONS

This study provides some empirical support for specific factors influencing cultural differences in gamete donation in the UK. A future culturally appropriate targeted approach to donation education could redress the present imbalance in supply and demand of gametes in infertility treatment.

Disclosure decisions among pregnant women who received donor oocytes: a phenomenological study

OBJECTIVE

To investigate the controversy surrounding disclosure among donor oocyte recipients. This controversy is escalating worldwide, yet little research has sought to understand the disclosure experience of pregnant, donor oocyte recipient women. This study aims to provide an in-depth description of the disclosure experience, and identify factors that were significant to recipient women which influenced their reasoning as they formulated disclosure decisions.

DESIGN

Qualitative, naturalistic design, using a phenomenological approach.

SETTING

The home or private office of the recipient woman.

PATIENT(S)

Donor oocyte recipient women between 9-23 weeks of gestation.

RESULT(S)

Disclosure decisions were influenced by multiple factors emerging from the women's values and beliefs and their social and cultural environment. Values and beliefs consisted of the right to know and the duty to protect. Social and cultural factors included social support, culture of the family, evolution of the social process, and personal testimonials. Women's age and selection of donor type were interrelated with disclosure decisions.

CONCLUSION(S)

Disclosing women voiced the right of the child to know, and perceived social and cultural factors as conducive to disclosure. Nondisclosing and undecided women emphasized protecting normative relationships, perceived a social stigma, and were unable to identify a benefit to disclosing. Women's age and choice of oocyte donor should be considered when counseling recipient women.

2006 Guidelines for gamete and embryo donation

The 2006 Guidelines for Gamete and Embryo Donation provide the latest recommendations for evaluation of potential sperm, oocyte, and embryo donors, incorporating recent information about optimal screening and testing for sexually transmitted infections, genetic diseases, and psychological assessments. This revised American Society for Reproductive Medicine Practice Committee document incorporates recent information from the US Centers for Disease Control and Prevention, the US Food and Drug Administration, and the American Association of Tissue Banks, with which all programs offering gamete and embryo donation services must be thoroughly familiar.

Using therapeutic cloning to fight human disease: a conundrum or reality?

The development and transplantation of autologous cells derived from nuclear transfer embryonic stem cell (NT-ESC) lines to treat patients suffering from disease has been termed therapeutic cloning. Human NT is still a developing field, with further research required to improve somatic cell NT and human embryonic stem cell differentiation to deliver safe and effective cell replacement therapies. Furthermore, the implications of transferring mitochondrial heteroplasmic cells, which may harbor aberrant epigenetic gene expression profiles, are of concern. The production of human NT-ESC lines also remains plagued by ethical dilemmas, societal concerns, and controversies. Recently, a number of alternate therapeutic strategies have been proposed to circumvent the moral implications surrounding human nuclear transfer. It will be critical to overcome these biological, legislative, and moral restraints to maximize the potential of this therapeutic strategy and to alleviate human disease.

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.

Kinderwunsch und Wunschkinder

Definition of problem:

BACKGROUND

Reproductive Biomedicine and new reproductive technologies (ART) belong to the fields of medicine that initiated most of the discussion on enhancement and desire fulfilling medicine in bioethics during the last years. One of the crucial questions to be answered is the definition of the right to procreate/right for a genetically related child. Closely connected are controversial opinions in regard to the definition of sterility as a disease/illness, or a mere fate, or malfunction, which does not have to be medically cured. Arguments: After a cursory description of the national and international debate, we introduce some results of our 'bioethical field studies', exploring and comparing the views of experts (human geneticists, ethicists, pediatricians, obstetricians and midwifes) and couples/patients (IVF couples, high genetic risk couples and couples with no known risk for an inherited disease or infertility problem) on sterility, the right to procreate, possibilities and appropriate limits of IVF in Germany.

CONCLUSION

According to the WHO, sterility has to be defined as an illness, if the respective couples have a desire for a child. IVF can be a means for a cure. Since 2004, Germany does no longer supply a thoroughly insurer financed IVF treatment. Our surveys indicate that this change, though supported by many experts, is hard to accept for couples concerned. Only obstetricians share the WHO's view that sterility should count as an illness. Many ethicists see a proclaimed human right to procreate as merely negative right, although many support free IVF treatment for poor couples. We challenge the expert majority view on the basis of the capability approach (Amartya Sen) and functional liberalism (Herlinde Pauer Studer) and with a view to the international state of the art in IVF. The desire to have children cannot be reduced to a non-authoritative preference whose fulfillment is optional, but has to be conceptualized as a normative need that ought to be met.

Surrogacy families: parental functioning, parent-child relationships and children's psychological development at age 2

BACKGROUND

Findings are presented of the second phase of a longitudinal study of families created through surrogacy.

METHODS

At the time of the child's 2nd birthday, 37 surrogacy families were compared with 48 egg donation families and 68 natural conception families on standardised interview and questionnaire measures of the psychological well-being of the parents, parent-child relationships and the psychological functioning of the child.

RESULTS

The surrogacy mothers showed more positive parent-child relationships, and the surrogacy fathers reported lower levels of parenting stress, than their natural conception counterparts. The surrogacy children did not differ from the natural conception children with respect to socio-emotional or cognitive development.

CONCLUSIONS

Surrogacy does not appear to impact negatively on parenting or child development in families with 2-year-old children.

Comparison of conscious sedation for oocyte retrieval between low-anxiety and high-anxiety patients

STUDY OBJECTIVE

To investigate the correlation among the level of anxiety, the intravenous propofol requirement for conscious sedation, and recovery profile in in vitro fertilization patients.

DESIGN

Prospective, randomized, double-blinded study.

SETTING

Operating room of tertiary-care university hospital.

PATIENTS

One hundred fifty consecutive women scheduled for oocyte retrieval under conscious sedation.

INTERVENTIONS

Anxiety scores were separately measured by an anesthesiologist who was not involved in sedation. The patients were divided into 2 groups, high-anxiety and low-anxiety, as determined by using the median of anxiety VAS scoring for assessment of preoperative anxiety (4.0 cm). The subjects were collected, 76 in high-anxiety group and 74 in low-anxiety group.

MEASUREMENTS

An infusion of propofol with a preset target concentration of 2.5 microg/mL(-1) was started until the patient had reached and maintained a sedation level of 3 on a 5-point sedation scale. Hemodynamic variables were recorded by using standard monitors. The scorings of sedation, operability, and satisfaction were assessed by one of the investigator-anesthesiologists. Data of induction quality and concentration of propofol were obtained from Target-Controlled Infusion system that runs on a microcomputer connected to an infusion pump (Becton-Dickinson infusion system, Le Grande chemin, France). Recovery data were measured in the recovery room.

MAIN RESULTS

The high-anxiety group required more for the induction of sedation and a larger amount of total dosage of propofol for sedation, as compared with the low-anxiety group. The concentrations of propofol on the Target-Controlled Infusion at sedation level 3 of the high-anxiety group were significantly higher than those of the low-anxiety group. Context-sensitive half time of high-anxiety group was also longer than that of the low-anxiety group. The postoperative pain score of the high-anxiety group was higher than that of the low-anxiety group. Increased preoperative anxiety was significantly correlated with postoperative wound pain (r = 0.240, P = 0.009) and previously experienced pain on same procedure (r = 0.252, P = 0.031), but not with pain on propofol injection (r = -0.05, P = 0.58).

CONCLUSIONS

The high-anxiety group needs more sedative requirement of propofol for conscious sedation than the low-anxiety group. Thus, we suggest that propofol dose for such sedation must take into account the individual patient's anxiety level when propofol is administered by an anesthesiologist for oocyte retrieval.

Comparative assessment of pre- and post-donation attitudes towards potential oocyte and embryo disposition and management among ovum donors in an oocyte donation programme

BACKGROUND

In anonymous oocyte donation programmes, the disposition of retrieved oocytes and subsequent embryo management are at the discretion of the IVF programme and the oocyte recipients, as donors waive all rights following their donation. Nonetheless, donors are routinely made aware of ways in which oocytes and resulting embryos may be used and elect to proceed with the process even in the presence of reservations to some clinical scenarios before their donation. The aim of our study was to examine oocyte donors' attitudes to oocyte and embryo disposition and management and how initial reservations change over the course of the donation process.

METHODS

Oocyte donors in a university-based IVF programme were asked about their willingness to donate in relation to various clinical scenarios during the initial screening interview and at the post-donation exit interview. Results were tabulated as 'yes' or 'no'.

RESULTS

At the pre-donation interview, 72% of donor candidates expressed reservations to one or more clinical scenarios. More reservations were expressed at the post-donation interview compared with the pre-donation interview. The greatest reservations were donating to recipients >50 years of age (P < 0.05). Despite this, 97% of donors were willing to donate again.

CONCLUSION

Oocyte donors' attitudes towards various clinical scenarios changed following their donation, reflecting overall greater reservations following the donation process. Although speculative, donors may be more willing to assert their opinions or donor attitudes become more restrictive.

Subsidized in-vitro fertilization treatment and the effect on the number of egg sharers

Egg sharing remains a controversial practice, mainly because of the presumed element of payment. In order to find out to what extent financial considerations motivated the women to share their oocytes, the data on egg sharing in Belgium are analysed. Belgium began providing full reimbursement for six in-vitro fertilization (IVF) cycles on 1 July 2003. Since this date, the numbers of egg sharers dropped approximately 70%. Although these data show that a large number of the donors were mainly motivated by the reduced cost of IVF, it cannot be concluded that money was the only motive to share. Nevertheless, to increase voluntary consent by egg sharers, public funding for infertility treatment should be provided.

Donor anonymity: rights and meanings

Any debate over the removal of donor anonymity needs to recognize that the discourse of donating will differ from the discourse of any resultant child. Donor discourse will not contain concepts of father/mother/parent/family whereas the child discourse will. This has implications for any contact with the donor and for counselling practice.

The acceptability of posthumous human ovarian tissue donation in Utah

BACKGROUND

Infertility due to accelerated loss of ovarian follicles/oocytes may occur through numerous mechanisms. As a result, posthumous human oocyte donation, banking and maturation protocols for research and fertility restoration are current interests in reproductive medicine.

METHODS

A computer-generated sample of Utah residents (n = 704) were surveyed regarding demographics, willingness to donate organs, IVF acceptability and posthumous follicle/oocyte donation for: research, fertilization with monitoring to the preembryo stage (eight cells), and fertilization and subsequent transfer of embryos derived from themselves, their partner or non-spousal relative for whom they act as guardian.

RESULTS

Ovarian tissue donation for follicle/oocyte retrieval, maturation and scientific investigation without fertilization was acceptable (>or=70%) to a majority of the Utah population. However, fertilization of oocytes or fertilization and transfer of resulting preembyos derived from such donations to cause a pregnancy was less acceptable (58.3% and 57.4%, respectively) in the population responding for their own or partner's oocytes, and more so when the donation was guardian-directed (54.8% and 52.1%, respectively). Similar declines in the level of acceptance were noted when those who had an express interest in such donations (ovarian failure or surgical castration) were surveyed (n = 50).

CONCLUSIONS

This study substantiates the ethical recommendation that explicit prior written consent of the donor be obtained when ovarian tissue donations are procured for fertilization, or transfer of a preembryo to cause a pregnancy. In light of the rapid technological advancements in ovarian follicle/oocyte cryopreservation and maturation, the time may have come to provide potential organ donors the opportunity to specify their desires regarding ovarian tissues when registering for organ donation.

Will removal of anonymity influence the recruitment of egg donors? A survey of past donors and recipients

The UK Government has determined that children born from egg donation have the same right to know their biological parent as adopted children on reaching the age of 18. There is concern as to the effect of loss of anonymity on egg donor recruitment, since a wait of 1 or 2 years is not unusual for couples awaiting treatment. Some fertility programmes have introduced egg-sharing to circumvent these delays. However, egg-sharing may involve a sub-fertile donor and thus is likely to be less successful overall than egg donation. Recently, the Human Fertilisation and Embryology Authority announced a consultation exercise to consider whether egg donors should receive increased payment or benefits in kind for their donation. To investigate whether or not removal of anonymity would have influenced or would influence their future participation, past egg donors and recipients have been surveyed. Questionnaires were sent to 867 former egg donors (n=504) and recipients (n=363), who were anonymous to each other. Response rates were similar between donors (32.7%) and recipients (39.1%). Of donors, 36.4% would not have participated had donor anonymity been waived, but 69.1% would donate anonymously again. Of recipients, 53.5% would not have proceeded had donor anonymity been waived, whereas 96.5% would receive anonymously donated eggs again. The results indicate that removal of anonymity for egg donors is likely to lead to a further restriction of an already unsatisfactory service to patients requiring donated eggs unless fundamental new initiatives are implemented.

Depression in primary versus secondary infertility egg recipients

Women with primary infertility and their husbands were significantly more depressed than women with secondary infertility and their husbands, and the difference in levels of depression of women compared with their husbands was significantly greater for primary than for secondary infertility. Depressive symptomology for childless individuals is greater for wives than for their husbands.

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.

How would revealing the identity of gamete donors affect current practice?

The possibility of revealing the identity of gamete donors may change the decision of a donor to collaborate with infertility clinics and patients. Previous experiences with patients and donors, as well as different cultural viewpoints in northern and southern Europe, are presented.

The Personal, Interpersonal, and Political Issues of Egg Donation

This article considers the implications of Canada's new legislation, Bill C-6: An act respecting assisted human reproduction and related research, for future oocyte donors and recipients. Specifically, this article explores the prohibition of payment to donors for oocyte donation, from the perspective of a paid oocyte donor.

Recipients of Oocyte Donation: An Integrative Review

OBJECTIVE

To conduct a systematic review of published research to provide a synthesis of the psychosocial characteristics of donor oocyte recipient women.

DATA SOURCES

The sample of published studies was selected from 1983 to September 2002. Retrieval of the studies used online computer searches from CINAHL, MEDLINE, PsycINFO, and Wilson's Social Science Abstracts using the terms reproduction techniques, in vitro fertilization, oocyte donation, oocyte recipients, and egg donation; citations from references and bibliographies of previously located articles; and two 60-minute retrieval sessions with a librarian specializing in health science literature.

STUDY SELECTION

The majority of studies retrieved were completed in the natural sciences. The final sample resulted in 16 studies.

DATA EXTRACTION

Each study was read and the data were extracted using a survey instrument developed by the investigator.

DATA SYNTHESIS

Multiple methodologies were used in the sample; most were exploratory, retrospective, and descriptive studies. Thus, the data were analyzed using a qualitative discursive approach. A total of 827 donor oocyte recipient women participated in the studies.

CONCLUSIONS

Published research investigating the psychosocial characteristics of donor recipient women was categorized into six focused areas: motivation; desired donor characteristics; selection of a known versus an anonymous donor; demographic, educational, and psychosocial profiles; disclosure of the method of conception to family members, friends, and the resulting child; and the relationship between the oocyte recipient and her resulting offspring. Research involving the psychosocial aspects of donor oocyte recipient women is in the infancy stage.

Parenting infants conceived by gamete donation

In recent years, concerns have been raised regarding the potentially negative consequences of gamete donation for parent-child relationships. Findings are presented of a study of families with an infant conceived by gamete donation. Fifty donor insemination families and 51 egg donation families were compared with 80 natural conception families on standardized interview and questionnaire measures of the psychological well-being of the parents, the quality of parent-child relationships, and infant temperament. The differences that were identified indicated more positive parent-child relationships among the gamete donation than the natural conception parents, accompanied by greater emotional involvement with the child. Comparisons were also carried out between the donor insemination and the egg donation parents on their experiences of gamete donation. In contrast to the findings of earlier investigations, the donor insemination and egg donation parents appeared to be more open toward disclosing the donor conception to the child. It was concluded that infants conceived by egg or sperm donation did not appear to be at risk for parenting difficulties.

Characterization of potential oocyte donors in Sweden

BACKGROUND

Oocyte donation has been permitted by Swedish legislation since January 2003. While donors are anonymous to the receiving couple, offspring have the legal right to receive identifying information about the donor when they reach adult age. Our aim was to investigate factors of potential importance for women's willingness to donate oocytes.

METHOD

A questionnaire regarding attitudes towards oocyte donation was sent to a randomized sample of 1000 women aged 25-35 years (73% response).

RESULTS

Seventeen percent would consider donating oocytes, whereas 39% opposed this, and 44% were doubtful. Potential donors were less likely to have children of their own and thought the genetic link was of less importance. Potential donors would feel happy about helping a childless couple, and 38% would be glad to be contacted by the offspring. Factors that would increase women's willingness to donate were being able to talk to experienced donors, proximity to the clinic and availability of counselling.

CONCLUSION

The results indicate considerable interest in donating oocytes among a subset of women in Sweden. Potential donors associated donation with altruistic motives. The issue of offspring's right to know about their origin appears to be complicated. This suggests that information about the consequences of donation is of great importance.

Anonymous oocyte donation: a follow-up analysis of donors' experiences

BACKGROUND

this study was conducted to assess oocyte donors' satisfaction after the procedure and to obtain information on base rates of various experiences associated with oocyte donation.

METHODS

volunteer anonymous oocyte donors seen at a university-based IVF programs were identified (N = 54). The follow-up questionnaire asked donors to rate aspects of clinic interactions, medical procedures and experiences during and after the process, as well as expectations and level of fulfillment.

RESULTS

ten individuals were lost to follow-up and 20 donors did not respond. The typical oocyte donor respondent (N = 24) was 26.5 years old, Caucasian, single with no children and had experienced some college education. Mean follow-up time was 21 months. Overall, 79% were satisfied or extremely satisfied with their experience, 42 % would be an oocyte donor again and 50% would recommend that a friend consider being an oocyte donor. Donors tolerated procedures well, but most did experience cramping and injection site pain. A significant proportion experienced anxiety and negative emotional experiences during the process. Expectations were fulfilled regarding helping another woman and sense of satisfaction, but most (87.5%) expressed the desire to know the outcome for the recipient.

CONCLUSIONS

the data demonstrate that oocyte donation was a positive experience for the majority of women in the program, although emotional symptoms are normative.

[Attitudes toward oocyte donation and surrogate motherhood are strongly influenced by own experiences]

The aim of the study was to find out the attitudes of different groups towards technologies which are prohibited by the German Embryo Protection Law. We evaluated by using a questionnaire, in how far oocyte donation and surrogate motherhood were accepted in Germany in different groups of the population. 34 infertile patients, 74 patients who asked for preimplantation genetic diagnosis (PID), 29 women, who had finished family planning, and 59 medical students were asked for their opinion in a standardized and closed questionnaire. Overall the different groups, especially medical students, were very critical towards oocyte donation and surrogate motherhood. However, to help another couple to conceive a child 68.6 % of PID patients, 62.1 % of infertile patients, 43.2 % of women with finished family planning, and 47.6 % of students were prepared to donate oocytes. On the other hand, only 40.9 %, 40.0 %, 25.9 %, and 13.2 % of PID patients, infertile patients, women with finished family planning and medical students, respectively, would accept oocyte donation for themselves. Regarding surrogate motherhood, the PID group and students were strictly against the idea to be a surrogate mother by themselves. Members of the infertile group as well as those women with finished family planning were more indifferent regarding this question. Students and women with finished family planning, however, would prefer adoption, whilst PID- and infertility groups are more indifferent. Men are more positive towards both techniques as compared to women. As compared to known data from other countries, the acceptance of oocyte donation in all groups and surrogate motherhood is comparable to other European countries, when only PID patients and infertile patients are respected. The other two groups are more critical against surrogate motherhood. To conclude, it becomes apparent how opinions regarding these techniques are influenced by the own situation and experiences.

Exploring the beliefs and experiences of potential egg share donors

BACKGROUND

To date there are few attitudinal studies of women's experiences of egg donation, motivation to donate or their thoughts about eggs donated. Studies are predominantly discussed in terms of a specific treatment option and the ethical implications of different treatments. These studies are mainly designed by professionals working in assisted reproductive technology in line with a clinical agenda.

AIM

This study aimed to explore the beliefs and experiences of potential egg share donors using an interpretative phenomenological methodology to equip health care practitioners to deal better with patients' needs and desires.

METHOD

Open-ended interviews were conducted immediately following introductory consultations with 11 potential egg share donors from one fertility centre in the United Kingdom (UK). The sample was opportunistic. Data collection took 8 months and van Manen's interpretative phenomenological method was used.

FINDINGS

Analysis revealed six themes of egg sharing: motherhood (the predominant theme within which all other themes could be subsumed), context, doubt, coping, exchange and empathy. Themes illustrated women's continuation with the scheme despite fears about giving away eggs, the parenting skills of recipient couples and future repercussions of positive outcomes for donor and recipient.

CONCLUSIONS

Egg sharing could be seen as a marker of hope. Buoyed up by the possibility of a successful outcome, women are prepared to undertake repetitive treatment attempts despite continued failure to conceive and knowledge of a slim chance of a positive outcome. Implications for practice, policy and ethics result in recommendations for more in-depth interview work by independent researchers to gain a clearer picture of women's responses to reproductive technologies and the development of services in line with patient need and individual expectation.

Psychological characteristics and factors related to willingness to donate again among anonymous oocyte donors

OBJECTIVE

To assess post-donation psychological status of a large sample of professionally recruited, paid anonymous donors and to determine whether there were any differences between those who were willing to donate again and those who were not.

DESIGN

Cross-sectional survey.

SETTING

Healthy donors who were recruited by two private groups.

SUBJECT(S)

One hundred fifteen donors who had completed at least one donation cycle at one of six IVF programs in a large Midwestern city.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURES

Self-report questionnaire assessing psychological symptoms, self-esteem, expectations, satisfaction, and attitudes toward donation.

RESULT(S)

Psychological symptomatology and self-esteem were in the normal range. Altruism and compensation were the two most frequently cited motivators for donation. Of the donors, 82% were moderately to very satisfied with the donation experience. First-time donors were significantly younger, reported more post-donation psychiatric symptoms, and had slightly lower self-esteem. Of the donors, 35% stated they would donate again; 37% would not, and 28% were undecided. Donors who were willing to donate again reported significantly less ambivalence about donation and significantly greater satisfaction with the medical aspects of donation.

CONCLUSION(S)

Approximately one third of donors are willing to donate more than once. These women report less ambivalence and greater satisfaction with the donation experience.

To tell or not to tell: the decision-making process of egg-donation parents

Little research has examined the views of parents of children conceived as a result of the use of donated eggs (egg-donation parents) on whether, what and how to tell their children about the way in which they were conceived. Thus, the aim of the present study was to assess the pattern of disclosure in egg-donation families. A representative sample of 17 egg-donation families with a 3-8-year-old child was recruited through UK fertility clinics. All mothers were administered a standardized interview assessing the extent of their disclosure and the main reasons for their decision. Content analysis was carried out on the transcripts from the interviews with the mothers. Not one set of parents had told their child at this stage, and 47% had no intention of telling their child about the way in which they were conceived. Twenty-nine per cent intended to tell their child in the future. Nearly two-thirds had told a friend or family member. Non-disclosure largely stemmed from a desire to protect the child, a belief that there was no need to tell, and a desire to protect the mother. Reasons for intending to disclose to the child included the belief that he or she had a right to know, and to avoid disclosure from someone else. Egg-donation parents with a 3-8-year-old child appear to resemble donor insemination parents in that they tend to favour a position of non-disclosure. The findings demonstrate the importance of understanding the views of egg-donation parents themselves, if openness is to be encouraged in these families.

Egg and Embryo Donation and the Meaning of Motherhood

As part of a larger study on donor-assisted conception, this paper reports research which explored the ways in which women who have donated or received eggs or embryos interpret such donations in the context of motherhood. Narrative analysis of women's accounts revealed that egg and embryo donations are not interpreted as incompatible with motherhood; that they may be explained as contributing to the significance of motherhood through the desire to assist some women to whom motherhood has been denied; and that the welfare of offspring of donated eggs and embryos is considered by donors. Differences were found between the meanings of egg donation and embryo donation, including likening eggs to cells and embryos to children, and in donors the expression of stronger maternal connection to the offspring of donated embryos. These accounts reveal individual variation, complexity, and change, reflecting (among other things) the dynamic process of narrative revision.

Embryo donation at an Australian university in-vitro fertilisation clinic: issues and outcomes

OBJECTIVES

To review the choices of couples relinquishing frozen embryos and the outcomes of embryo donation at a major in-vitro fertilisation (IVF) clinic.

DESIGN AND SETTING

Retrospective audit of 11.5 years of data (1991-2002) from the Monash University IVF clinic, Melbourne.

PARTICIPANTS

Couples who make decisions regarding the fate of their frozen embryos, and recipient couples taking part in embryo adoption.

MAIN OUTCOME MEASURES

Couples' choices with regard to the fate of their frozen embryos, and the outcome of donated embryo treatment cycles.

RESULTS

Of 1246 couples relinquishing frozen embryos, 1116 (89.5%) opted to discard rather than donate their embryos. Sixty-six per cent of donated embryos survived thawing. From donated-embryo transfer to 50 women in 92 cycles, a 17.4% pregnancy rate per transfer cycle was achieved, and 10 women delivered 11 healthy babies at term. At the time of our audit there were 98 couples on the waiting list to adopt embryos.

CONCLUSIONS

It is worth considering how couples can be encouraged to donate rather than discard their surplus frozen embryos. An educational program on relevant legal, social and clinical issues may facilitate this.

Changing attitudes towards third-party reproductive techniques

A growing number of children around the world are conceived through third-party reproductive techniques. The increased demand for these programs has resulted in an ongoing trend towards greater openness and less anonymity in gamete donation. This has led to changes in public policy regarding the identity of donors, to a greater concern for the well-being of donors, and to calls for disclosure to offspring about their donor gamete conception.

Assessing the influence of payment on motivations of women participating as oocyte donors

We report on the motivations of potential ovum donors entering an assisted reproduction program and discuss the potential ramifications of escalating payments to donors. From July 1995 to July 1998, recruitment of ovum donors was directed at healthy women between 21 and 34 years of age. Financial remuneration for services rendered was USD 2,500 from July 1995 through March 1998 and increased to USD 5,000 after that. Donors were screened and consented according to established SART guidelines. The demographic background of the women was similar for women paid USD 2,500 to those receiving USD 5,000. The financial motivation was greater in those receiving USD 5,000 (68%) than USD 2,500 (39%). Some form of expressed altruism was similarly present in both groups (USD 5,000 90%, and USD 2,500 91%). However, altruism expressed as the sole motivation occurred more in those receiving USD 2,500 (61%) compared to USD 5,000 (32%). Financial reimbursement has escalated for the services of ovum donors in order to maintain the increasing demand. While money has become a dominant factor motivating ovum donors, its seductive nature requires even greater attention to adequate informed consent. Young donors may be unable to adequately weigh the risks of ovarian hyperstimulation and oocyte retrieval against the monetary reward.

Oocyte donor screening: the selection process and cost analysis

OBJECTIVE

To evaluate the selection process and cost of screening oocyte donors.

DESIGN

Retrospective analysis.

SETTING

University-based IVF program.

PATIENT(S)

Potential oocyte donors.

INTERVENTION(S)

Outcomes of all inquiries by individuals responding to recruitment advertisements for oocyte donors over a 10-month period were assessed. Recruitment and screening costs to bring a single donor into the program were calculated.

MAIN OUTCOME MEASURE(S)

The attrition rate for each step of the oocyte donor screening process was determined. The costs assessed over the study period included the following: advertisement, administrative, professional, ultrasound, and blood screening. The total cost to bring a single donor into the program was calculated.

RESULT(S)

Advertisements led to 315 phone inquiries from potential oocyte donors. Of these, a total of 223 (71%) voluntarily withdrew from the screening process, 54 (17%) were screened out for medical or psychological reasons, and 38 (12%) entered the active donor pool. The total cost to bring a single donor into the program was approximately 1,869 dollars.

CONCLUSION(S)

There was significant attrition in the screening process for oocyte donation that needs to be taken into account in determining the costs of managing the program.

Pregnancy and child outcome after oocyte donation

During the last decade oocyte donation has been highly successful for treating women previously thought to be hopelessly infertile. The pregnancy rate after oocyte donation is among the highest reported for any fertility-enhancing procedure. Most investigators have noted an increased rate of obstetric complications in these pregnancies. In particular, pregnancy-induced hypertension appears to occur more often than expected, and the Caesarean section rate is high. However, the majority of oocyte recipients experience a favourable pregnancy and perinatal outcome. When perinatal complications occur they are usually related to multiple gestation. The high frequency of multiple pregnancy after oocyte donation, as well as in all other fields of assisted reproduction, deserves attention, and efforts to avoid multi-fetal gestation must be made. There are only a few studies on post-natal growth and development of young children born after oocyte donation. The health of these children appears to be within normal ranges. The psychological consequences of the treatment on the child require further investigation. Thus far, studies have shown normal socio-emotional development in the child and a warm relationship between the parents and the child in oocyte donation families.

A follow-up study with oocyte donors exploring their experiences, knowledge, and attitudes about the use of their oocytes and the outcome of the donation

OBJECTIVE To learn what information oocyte donors were given and wanted to have about the use of their oocytes and the outcome of the donation.

DESIGN

In-depth interviews.

SETTING

Participants recruited through IVF clinics, matching agency, the Internet, word of mouth, and newspaper ads.

PARTICIPANT(S)

Thirty-three former oocyte donors and six women preparing to donate.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

None.

RESULT(S)

Thirty-three former donors completed 66 donation cycles; 48 donation cycles were anonymous. Only 41% (16 of 39) of all participants were comfortable giving the recipient couple complete dispositional authority over the resulting embryos; the remainder wanted some control. One quarter did not want embryos used for research. Fifty-four percent (21 of 39) thought donation of excess embryos to another couple was acceptable, but one third wanted to be informed. Of the 25 anonymous donors, 6 learned the outcome of the donation; 14 others wanted to know. All hoped the donation was successful.

CONCLUSION(S)

Because oocyte donors' need for information varies, clinics should consider being more flexible in their disclosure policies. Disclosure about the possible uses of donor oocytes or embryos should be mandatory. Findings have implications for the informed consent and counseling processes.

A qualitative follow-up study of women's experiences with oocyte donation

Oocyte donation is growing at an exponential rate. Currently, thousands of women donate each year. The health services that donors receive deserve evaluation. Thirty-three former donors were recruited from IVF clinics, a matching agency, the Internet, advertisements, and word of mouth. In-depth interviews were conducted to learn what motivated the donation, to determine how satisfied donors were with the experience and what issues played a role in donor satisfaction, and to identify recommendations to improve the process. None of the participants regretted their decision to donate, but they were not always completely satisfied with the donation experience. The physical process, compensation, quality of medical care, and level of involvement in the process were the primary factors that affected satisfaction. Matching agencies and IVF clinics may improve donor satisfaction by: minimizing trips to the clinic; using protocols that limit the number of intramuscular injections; reducing the risk of hyperstimulation syndrome; providing follow-up care; reimbursing for expenses such as lost work, travel, and child care; separating direct reimbursements from 'income' to decrease the amount of taxes donors must pay on compensation; treating donors with respect and appreciation; and informing them about the outcome. Improved donor satisfaction is likely to improve donor recruitment and retention.

Embryo donation programs and policies in North America: survey results and implications for health and mental health professionals

OBJECTIVE

To use survey results from Society of Assisted Reproductive Technology to describe program policies regarding embryo donation, report protocols used for the disposition of cryopreserved embryos, and discuss clarification of guidelines governing ethical and psychosocially informed embryo donation.

METHOD(S)

A 66-item questionnaire was sent to the 312 Society of Assisted Reproductive Technology programs, generating 108 responses.

RESULT(S)

Seventy-eight (72%) of 108 programs offer embryo donation. Forty (37%) have actually performed donation, with 246 cycles completed and 53 "take-home babies." Disposition agreements for donors address divorce (92%) and death (90%). Only 28% require that potential donors undergo psychologic evaluation. Ninety-five percent of programs do not compensate donors. Seventy-one percent require a complete medical and psychologic history and 10% require genetic karyotyping. Three percent limit the number of donations. Eligible recipients include married couples (100%), unmarried couples (61%), lesbian couples (55%), and single women (59%). Sixty-four percent of programs require psychologic screening. Storage limits range from 2-10 years. Forty-nine percent of programs have unclaimed embryos in storage.

CONCLUSION(S)

Embryo donation is more often contemplated than performed. Variability in program procedures and policies suggests that guidelines need to be clarified. The complexity of the psychosocial and ethical issues underscores the importance of a routine, comprehensive psychologic assessment.

Counselling couples and donors for oocyte donation: the decision to use either known or anonymous oocytes

In order to avoid a long waiting period, the Centre for Reproductive Medicine of the Free University of Brussels suggests that couples in need of donor oocytes search for a donor among family and friends. Recipient couples can choose between two types of donation: known donation, i.e. treatment with the oocytes of the donor recruited by the couple, or anonymous donation, i.e. an exchange of the donor recruited by the couple with a donor recruited by another couple in order to ensure anonymity between donor and recipients. In total, 144 couples were counselled by a psychologist in the decision-making process with regard to the kind of donation to be used. Some 68.8% of the recipient couples preferred known donation. This choice was mainly motivated by reasons related to fears associated with anonymity, such as fear of the unknown origin of genetic material and the trust that couples had in 'their' donor. Almost one-third of the couples opted to use anonymous oocytes. The desire to establish explicit boundaries between the two families involved was the major motivation for this choice. Approximately 44% of the couples were willing to tell the child about the oocyte donation.

A survey of anonymous oocyte donors: demographics

This is a questionnaire based study of 501 women enquiring about anonymous oocyte donation at a private in-vitro fertilization (IVF) unit, investigating the demographic characteristics and logistic issues involved in ovum donation. The 501 women were made up of 356 women who did not donate ('non-donors') and 145 women who eventually donated their oocytes ('donors'). Although there was a majority of housewives among the enquirers, women in full-time employment were the majority of actual donors. Logistic factors such as the travel and time commitment involved were major reasons for non-donation as well as concerns about complications. There was a paucity of ethnic donors. Recruitment strategies must focus on retaining potential donors and ensuring a higher proportion become actual donors. These strategies must address the logistic difficulties associated with non-donation including transport problems and social commitments by assisting with childcare provision and travel. Improving donor education and the access to more personal and non-threatening information were other areas that needed attention which were highlighted in the survey.