Strategies for disclosure: how parents approach telling their children that they were conceived with donor gametes

OBJECTIVE

To describe how parents envision, plan, and enact disclosing to their children that they were conceived with donor gametes.

DESIGN

In-depth ethnographic interviews.

SETTING

Participants were recruited from 11 medical infertility practices and 1 sperm bank in Northern California.

PATIENT(S)

A total of 141 married couples who had conceived a child using donor gametes (62 with donor sperm and 79 with donor oocytes).

INTERVENTION(S)

Husbands and wives were interviewed together and separately.

MAIN OUTCOME MEASURE(S)

Thematic analysis of interview transcripts.

RESULT(S)

Disclosing parents predominantly subscribed to one of two disclosure strategies: the conviction that early disclosure is of paramount importance so that the child "always knows," or the belief that later disclosure is preferable after family routines have been established and the child has the maturity to understand biologic concepts and has developed a sense of discretion. No parent regretted disclosing, and many expressed relief.

CONCLUSION(S)

Parents choosing early disclosure were more at ease with the disclosure process, whereas parents choosing later disclosure reported greater uncertainty about how and when to disclose. Parents wished for more peer and/or professional support and guidance to assist them with disclosure, not only initially but continuing long after their children were born.

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.