Donor insemination: attitudes of parents towards disclosure

OBJECTIVE

To determine attitudes of parents of children conceived by donor insemination to telling the children of their origin.

DESIGN

Questionnaire survey, in 1992-1993, of parents who had had a child by donor insemination at four New South Wales clinics from 1979 to 1990.

SETTING

Three hospital-based clinics (two public, one private) and a private clinic service.

PARTICIPANTS

276 families who altogether had had 420 children by donor insemination.

MAIN OUTCOME MEASURES

Number of children told that they had been conceived by donor insemination; parents' intentions, before conceiving and after the birth, of informing the child; and whether other people were informed of the child's origin.

RESULTS

Of 393 families who could be contacted, 353 agreed to participate and 276 (70%) replied to the questionnaire. Only 22 of the 420 children (5.2%) had been informed of their origin. Before conceiving, 18% of parents (49/273) planned to tell the child. Seventy-one per cent of families (182/257) had told others of the origin of the child, but 94% (241/257) had not told the child. Of the 29% of families (75/257) who had not told others of the child's origins, none had told the child. As the children grow older, more parents decide not to tell them of their origin.

CONCLUSIONS

Most parents of children conceived by donor insemination do not plan to tell their child, but most of these parents have told others, creating the potential for accidental disclosure. Because of the small number of children who are told of their origin, there may not be a need for government-regulated donor registers, provided donor insemination units maintain a high standard of record-keeping.

Stigma, disclosure, and family functioning among parents of children conceived through donor insemination

OBJECTIVE

To examine the influence of gender, male infertility factor, and other demographic variables on stigma and whether parents tell their children that they were conceived by donor insemination (DI) and to ascertain if stigma and the disclosure decision affect parental bonding with the child or the quality of the interparental relationship.

DESIGN

One hundred eighty-four San Francisco Bay Area couples who had become parents by DI were asked to complete a self-administered questionnaire.

SETTING

A private infertility practice.

PATIENT(S)

Eighty-two men and 94 women who completed the questionnaire.

MAIN OUTCOME MEASURE

A questionnaire assessing disclosure, stigma, parental bonding, and the quality of the interparental relationship.

RESULT(S)

Factors that increased the couple's likelihood of disclosure included younger age, azoospermia, lower stigma scores, and having more than one DI child. Fathers who scored higher on stigma reported less parental warmth and parental fostering of independence.

CONCLUSION(S)

Because the decision regarding disclosure of DI treatment was not linked to parental bonding with the child or to the quality of the interparental relationship, we cannot conclude that nondisclosure is harmful to family relationships or is a symptom of family problems. The husband's perceptions of stigma however, may affect the father--child relationship adversely.

Donor insemination: Dutch parents' opinions about confidentiality and donor anonymity and the emotional adjustment of their children

Results from a comparative study investigating 38 donor insemination (DI) Dutch families with 4-8 year old children are presented. The aims of this study were to investigate parents' opinions on the issues of confidentiality and donor anonymity, to assess the emotional development of the children, and to examine in DI families the association between secrecy with regard to the use of a donor and the emotional adjustment of the children. The DI families were compared to families with a child conceived by in-vitro fertilization (IVF) and to families with a naturally conceived child. Secrecy appeared to be associated with DI and not with IVF: 74% of the DI parents intended not to inform the child about the way in which she/he was conceived, whereas none of the IVF parents intended to keep the secret. Only one set of DI parents and two sets of IVF parents had actually told the child. As to donor anonymity, a spread of opinions appeared among DI parents; 57% preferred an anonymous donor, 31% would have liked non-identifying information about the donor, 9% preferred the donor's identity to be registered and 3% remained unsure. Parents' major concern was to know more about the medical/genetic background of the donor. Mothers and fathers in the DI families differed in their opinions concerning the issues of confidentiality and donor anonymity: fathers, more often than mothers, were secretive with regard to the use of a donor and husbands, more often than their wives, were in favour of donor anonymity. With regard to the emotional development of the children, more emotional/behavioural problems were revealed among DI children than among children who were naturally conceived. No association was found between secrecy and the emotional/behavioural adjustment of the children.

Preferences for intracytoplasmic sperm injection versus donor insemination in severe male factor infertility: a preliminary report

With the advent of intracytoplasmic sperm injection (ICSI), our programme noted a drop in the number of couples using donor insemination (DI) for severe male factor infertility. Over the first 8 months in which our infertility programme offered both treatments, 27 consecutive couples scheduled for ICSI and 15 consecutive couples scheduled for DI were evaluated Since all patients in our infertility programme beginning in-vitro fertilization (IVF) with planned ICSI or starting DI undergo a semi-structured psychological interview, the psychologist's clinical notes as well as the medical chart were reviewed and coded retrospectively to determine factors related to a couple's treatment choice. Couples who chose IVF-ICSI over DI had a higher occupational status and included husbands with higher educational levels. Their most common motivation was to have the husband's biological child (93% of couples in the ICSI group). The most common motivation for choosing DI (60% of DI couples) was that IVF was not financially affordable. Choice of treatment was not related to psychological adjustment, the husband having prior biological children, or his risk of passing on a genetic defect to offspring. These preliminary data raise the concern that, with the success of ICSI, DI may change in the USA from being an option dictated by semen quality to a second choice treatment utilized for economic reasons.

A comparison of single and married recipients of donor insemination

There has been some controversy surrounding the use of donor insemination (DI) for single women. The purpose of the present study was to compare psychological characteristics of married versus single women who were DI recipients. A total of 17 single women and 17 married women completed psychological questionnaires regarding psychiatric symptomatology, self-esteem, and their attitudes towards DI prior to treatment. There were no significant differences between the groups in psychiatric symptomatology or level of self-esteem. A significant difference was found in the amount of time taken to decide to use DI with single women waiting longer. There were no significant differences between groups in reported concerns about the child. There were significant differences in attitudes towards disclosure with more single than married women reporting that they would tell the child about using DI to conceive.

Donor insemination programmes with personal donors: issues of secrecy

This study involved 46 recipients and donors in personal donor programmes interviewed anonymously by postal questionnaire and interview: 38% (30/80) of possible recipients responded. The total number of people told about the donor involvement ranged between two and 78, with no significant gender difference. Relationships had changed for half of the participants in the programmes with 75% reporting that they had developed a closer relationship and 25% reporting a deterioration. Contact between couples and donors was seen as being in the original role of family friend or relative rather than as donor. An equal proportion of recipients (63%) and donors (78%) agreed to the donor being identified to any offspring although this was qualified with regard to the age of the child. Reasons for identification were given as avoidance of family secrets and the rights of the child to have information concerning their conception. Those who did not agree said that the child was better off not knowing, or who wished to preserve donor anonymity. The donor group was more likely than the recipients to say that identification to the child was in the best interests of the social parents because it allowed all those involved to feel part of a single family group. It was found that for both recipients and donors, the advantages given for having a personal donor was openness within the relationship. For the recipients, this focused on knowledge of the donor background and, for related couples, having a common genetic relationship. For donors, the advantages given were: knowing the child's environment, having access to a child and the ability to choose recipients. A disadvantage for donors and recipients was the possibility of a change in the relationship and for donors an added disadvantage was having to share in the emotional stress of the treatment and negative outcomes. More men than women placed importance on having a donor with a similar genetic background.

Feelings of couples who have had a child by donor insemination: the degree of congruence

The study aimed to assess the congruence of feelings about donor insemination (DI) in couples who have had a child by this means. Male and female partners of 50 couples (in continuing relationships) who had had a child by DI individually completed a questionnaire. A Likert scale (0, very unhappy to 7, very happy) was used to assess feelings before, during and after treatment, and the perception of their partner's feelings. Individual partner's responses were also compared for views about the donor and assessment of their relationship. For both males and females, their feelings about DI before, during and after treatment did not correlate with their perceived view of their partner's feelings. This difference was much more striking before treatment started with male feelings (mean +/- SD) being 4.1 +/- 1.8 compared to the females' perception of the males' feelings of 3.5 +/- 1.9 (t test, p = 0.004) and females' feelings of 3.7 +/- 2.0 compared to the males' perception of female feelings of 4.3 +/- 2.0 (p = 0.05). In comparing attitudes about the donor, individual couples' views did not correlate well, the exceptions being their views on whether or not to have another child and whether they wanted the same donor. All but one couple agreed that the DI child had brought them closer together as well as agreeing that they confided in each other. The marital interaction assessment showed close compatibility in most issues. The impact of DI on couples affected by male factor infertility raises many issues, the views of which may not be shared between partners. This is especially the case of attitudes about the donor and is of some concern when viewed in the wider context of marital and parent-child relationships. It is not known whether these opposing views have an impact on the later development of these relationships but they should be considered as part of the preparation for beginning treatment.

Successful donor insemination and its impact on recipients

Male and female partners of couples who conceived a child by donor insemination (DI) independently completed a questionnaire. Fifty-seven women and 53 men representing 58 couples taking part. Fifty-one were in a continuing relationship and seven were separated. A likert scale (0-7) of "happiness' before, during and after treatment and their perception of their partner's feelings were used as measures. These feelings were evaluated in relation to demographic and clinical factors. Fifty-one women and 49 men who were in a continuing relationship answered questions about their feelings about DI, compared to six and three, respectively, who had separated. Feelings about DI were consistently low before treatment began. For both continuing and separated couples there was an improvement of their feelings about having DI during treatment, and then again after treatment was complete. For the male partner, factors that were associated with greater unhappiness included difficulties with the relationship prior to treatment, waiting time for treatment and subsequent separation. The women, however, had more positive experiences with no measured factors adversely affecting their feelings about DI. The arrival of the DI child had a significant effect in improving the relation-ship. Our findings suggest that for many couples acceptance of the DI program was less than ideal and only improved with having the treatment and then conceiving. The data highlight the need for psychosocial assistance to be made available to couples prior to the commencement of treatment.

Donor insemination: the gifting and selling of semen

The authors examine the implications for individuals and society of how semen is provided for use in donor insemination treatment. In particular, they focus on whether 'donors' make a gift of their semen or are paid. The role of health professionals in shaping the nature and meaning of semen provision is also explored. The currently predominant practice of buying semen is compared with other reproductive and biomedical exchanges: oocyte and embryo donation, surrogacy, and blood, organ and fetal tissue donation. The authors suggest that the commercialisation of semen determines and reflects the type of men frequently recruited to provide semen. This in turn influences the meaning that donors themselves, recipients, offspring, health professionals and society at large attribute to the provision of semen.

Donor insemination: a comparison of lesbian couples, heterosexual couples and single women

OBJECTIVE

To compare single women, lesbian couples, and heterosexual couples receiving therapeutic donor insemination (TDI).

DESIGN

Chart review followed by anonymous mail questionnaires to donor insemination recipients and their partners.

SETTING

Infertility clinic in a university hospital.

PATIENTS

One hundred fifteen women receiving donor insemination were identified by chart review.

RESULTS

Too few single women responded for reliable comparison. Lesbian women were similar to married women in age, education, duration, and outcome of donor insemination. When considering alternatives to TDI, married women were more likely to consider adoption and lesbians were most likely to consider using a known semen donor or having intercourse with a man aware of their desire to have a child. Married couples were less likely to tell others, including the child, about conception by donor insemination. They were also less likely to support disclosing identifying data about the donor to the child. Lesbians were more likely to report stress in their relationships as a result of TDI. Married men were most likely to support mandatory counseling before TDI initiation.

Donor insemination, the impact on family and child development

The practice of donor insemination (DI) has undergone major changes in the past 20 years. Attention was paid to the long-term psychological effects, the pleas for openness became stronger over the years and the use of anonymous donors became subject to public debate in several countries. The present article reviews what empirical research there is into DI families and their children. Over the years follow up studies have appeared sporadically and in spite of the varying quality of the research methods, preliminary findings have emerged. Research into the confidentiality issue in DI couples revealed that 47-92% of the DI parents intended to keep the donor origin secret from their children. DI couples just starting treatment more often intended to tell their children the DI origin than those who already had children. It is, however, too early to tell whether the public pleas for more openness did affect attitudes of the DI patients themselves. Research into the psychological well-being of DI parents and children failed to reveal major psychological problems. DI parents appeared to be well adjusted and to have stable marital relationships. DI children did not show significantly more emotional disturbances than controls. The quality of the parent-child relationship was better in the DI group than in the controls of naturally conceived parents.

Disclosure of donor insemination: parental attitudes

Disclosures by parents with a child conceived by donor insemination were compared to those of parents with adopted children and parents with children conceived by in vitro fertilization. None of the donor-insemination parents had told their child. The factors found to create the greatest difficulties for disclosure were the father's infertility, the timing and method of telling, and the lack of genetic information for the child.

Donor insemination: effects on parents

OBJECTIVE

To examine the psychosocial effects of donor insemination on couples.

DESIGN

Questionnaire survey of couples who had a child by donor insemination at four NSW clinics over a 15-year period.

RESULTS

Forty-seven per cent of couples thought their marriage had improved, while 3% thought their marriage had deteriorated as a result of having a child by donor insemination. Seventy-six per cent felt it had a positive personal effect and almost all couples had no regrets about having a child this way. Over 90% of respondents felt very close to these children. In those who also had children not conceived by donor insemination (60 couples), men were significantly closer to their children by donor insemination than to their "other" children (P < 0.001). There was a significant sex difference in perceptions of the child's resemblance (P < 0.0001): 61% of women thought their child conceived by donor insemination resembled their partner, while 89% of men thought the child resembled their partner. Twenty-one per cent of couples were concerned about having to tell the child about donor insemination.

CONCLUSION

Donor insemination can have positive psychosocial effects on couples and close relationships exist between the parents and their children conceived by donor insemination. The concern about the physical appearance of children conceived by donor insemination can be allayed by our finding that the majority of couples see a resemblance between the child and their partner.

Unconventional conceptions and HIV

The condom is widely recommended as the principal method for preventing HIV transmission, but such advice obviously does not apply to women who are seeking to become pregnant. In this sense, 'safer sex' is incompatible with reproduction. Existing research into HIV transmission has examined the choices made by those wishing to conceive within a sexual relationship; such research shows that HIV is not a highly significant factor in their decision-making processes. This study aims to extend the debate by exploring the decision-making processes of women seeking to become pregnant with donated sperm. In particular, we focus on women outside the fertility clinic system who do not have access to sperm screened for HIV to see whether HIV is a significant factor in these women's decisions. The study involved in-depth interviews with 20 women (14 lesbians, one bisexual and five heterosexuals) recruited through informal networking and snowball sampling. HIV was a salient concern for our sample, largely because of their contacts with gay men, but nonetheless most of these women took some risks. On the one hand, the conscious deliberations necessary to conceive through self-insemination facilitated risk reduction, as did factors such as 'stranger-danger'. On the other hand, factors such as the scarcity of suitable sperm donors and the women's own feelings of gratitude and loyalty to their donors mitigated against their requesting that their donor take an HIV test. This study highlights the need to provide information for women seeking self-insemination, and to remove restrictions on access to fertility clinics, in order to reduce their risk of HIV infection and subsequent vertical transmission.

Marketed sperm: use and regulation in the United States

OBJECTIVE

To collate information relating to the current use of marketed semen for therapeutic donor insemination (DI) in the United States.

DATA IDENTIFICATION

Literature was identified by Medline search and government document review.

LITERATURE SELECTION

Materials selected for review included empirical studies, policy reviews, legal documents, and government surveys relating to use of donor sperm.

RESULTS

Use of marketed (donor) sperm is associated with significant medical, genetic, and psychological risk. These risks directly affect the individuals involved in therapeutic DI. Also, the public's health is involved because these risks include transmission of infectious disease and genetic anomalies. Legal and social concerns associated with therapeutic DI include offspring's knowledge of genetic endowment, parental responsibility, and donor confidentiality. This analysis shows that policies currently in place regarding the use of marketed semen in therapeutic DI do not ensure consumer safety and do not protect society's interest.

CONCLUSIONS

Current policies need to be improved to protect those directly involved in the therapeutic DI process and to address public health and societal concerns. Recommendations include: [1] programs to assure quality and safety of marketed sperm, [2] implementation of a central registry to collect information about the use and outcomes of therapeutic DI, and [3H] expansion of available therapeutic DI guidelines to address psychological and social support for persons involved in therapeutic DI.

Families created by the new reproductive technologies: quality of parenting and social and emotional development of the children

The creation of families by means of the new reproductive technologies has raised important questions about the psychological consequences for children, particularly where gamete donation has been used in the child's conception. Findings are presented of a study of family relationships and the social and emotional development of children in families created as a result of the 2 most widely used reproductive technologies, in vitro fertilization (IVF) and donor insemination (DI), in comparison with control groups of families with a naturally conceived child and adoptive families. The quality of parenting was assessed using a standardized interview with the mother, and mothers and fathers completed questionnaire measures of stress associated with parenting, marital satisfaction, and emotional state. Data on children's psychiatric state were also obtained by standardized interview with the mother, and by questionnaires completed by the mothers and the children's teachers. The children were administered the Separation Anxiety Test, the Family Relations Test, and the Pictorial Scale of Perceived Competence and Social Acceptance. The results showed that the quality of parenting in families with a child conceived by assisted conception is superior to that shown by families with a naturally conceived child. No group differences were found for any of the measures of children's emotions, behavior, or relationships with parents. The findings are discussed in terms of their implications for understanding the role of genetic ties in family functioning and child development.

Non-traditional mothers: single heterosexual/lesbian women and lesbian couples electing motherhood via donor insemination

The purpose of the project was to explore the motivation, reproductive and postdelivery experiences, and future concerns of single heterosexual and lesbian women and lesbian couples who attempted conception via donor insemination (DI). All women who had completed at least one cycle of DI between 1987 and 1992 at a large medical school infertility program were mailed a comprehensive 'Motherhood' questionnaire. Forty-five women completed the survey (response rate = 88%) of whom 14 were lesbians, 28 were heterosexuals, two were bisexual and one was celibate. The only major differences between the heterosexual women and the lesbian women were that the heterosexual women were older and had started DI attempts at an older age than the lesbian women. The majority of women reported that four major considerations prompted their decision to initiate DI when they did: feeling secure in their employment, the sense that time was running out, feeling that they had 'worked through' concerns about parenting, and that they had sufficient social support. Three characteristics were deemed moderately or very important in their selection of sperm donors: ethnicity, education and height. After achieving a pregnancy, most women wished to know more detailed information about their donor. Unlike heterosexual couples, all single and lesbian women planned to disclose the fact of DI to their offspring but were uncertain of when or how to accomplish this. The greatest worry reported by respondents was how their child would deal with the absence of a known designated father. Overall, the women were gratified with their experience of DI, and the majority would 'absolutely' recommend it to a friend.

A survey of semen donor attitudes

Semen donors have been required to register with the Human Fertilization and Embryology Authority since its formation in 1990. Since then many clinics have reported a shortage of donor semen for donor insemination treatment. Is this because potential donors are worried about the protection of their anonymity? No published studies are available concerning the attitudes to semen donation in the UK. It was against this background that an investigation of the attitudes of potential semen donors was carried out. Four dimensions were investigated: (i) motives, (ii) personal detachment and involvement, (iii) detachment and involvement with respect to recipients, and (iv) detachment and involvement with respect to offspring. A total of 55 potential semen donors completed the attitude questionnaire from semen donation programmes in three in-vitro fertilization units. The questionnaire format was found to be an effective method of data collection for this sensitive area of research, and the major findings were (i) 89% of potential donors required confidentiality and guaranteed anonymity; (ii) 82% did not mind providing non-identifying information to the recipients and offspring; (iii) 69% of potential donors expected financial reward; and (iv) 69% did not welcome counselling.

A study of parenting of IVF and DI children

This article describes a study which provides data about the long-term issues experienced by parents rearing children from in vitro fertilization and donor insemination programmes. Fifty-four families bringing up a total of 101 children, 74 of whom were the result of assisted conception interventions, were interviewed. The methodology was such as to secure a representative cross-section of participants. The findings presented in this article relevant to medicine and law relate to: (1) The consequences where 50% of the genetic history of a child created by the use of donated gametes is unknown to the parents and the child. (2) The impact of male infertility, as a largely taboo subject, on family relationships, and the consequent deception of the child. (3) The dilemmas of maintaining a secret for a lifetime from much loved children, all relatives and friends.

Psychosocial aspects of donor insemination. Attitudes and opinions of Danish and Swedish donor insemination patients to psychosocial information being supplied to offspring and relatives

BACKGROUND

The purpose of this study was to evaluate the attitudes and opinions among donor insemination recipient couples with respect to the informing of offspring and relatives, the effects of donor insemination on sexual life and marital status, and their concerns about the risk of getting a sexually transmitted disease.

METHODS

A questionnaire study design. Three hundred and sixteen (194 Danish and 122 Swedish) couples were included.

RESULTS

Answering rate among the Danish couples was 89% and among the Swedes 75%, (p < 0.01). Fifty percent of the Danish couples and 66% of the Swedes were of the opinion that the treatments should be kept secret from good friends, (p < 0.05). Sixty-seven percent of the Danes and 87% of the Swedes found it important that knowledge about the inseminations was not made common knowledge to all interested parties, (p < 0.005). Parameters in which there were no differences between Danes and Swedes: Fifty-one percent of the couples would withhold information about the insemination from the child even when it was old enough to understand this information. Seventy percent of the couples would prefer not to know themselves, whether they had been conceived by donor insemination. Nineteen percent of the Danish couples would not have accepted donor insemination if the legislation guaranteeing donor anonymity had not been in existence. Eighty percent thought that their sexual life was unaffected during the course of the treatment. When asked, 95% were still married to the same partner with whom they began the treatment. Eighty-five percent of the couples were worried about getting a sexually transmitted disease through the treatment.

CONCLUSION

The results suggest that secrecy about the treatment and donor anonymity have a high priority among Danish and Swedish recipient couples, irrespective of the different legislation in the two countries.

[Family secrets exemplified by heterologous insemination]

Potential consequences of intrafamilial concealment are discussed in the context of coping with the stigmatizing diagnosis of male infertility and its treatment by artificial insemination by donor. First results of a longitudinal study are presented. A 5-year follow-up was obtained from 40 out of 57 couples initially interviewed. 34 of the couples had kept donor insemination secret even towards their families. 10 of them considered themselves oppressed by the secrecy, especially at the time of insemination. Only two out of 26 successful couples intended to reveal details of conception to the child. These findings suggest that information of the children can follow different strategies. Children should be acquainted with details of their conception if friends or relatives of the parents are informed, in order to reduce the risk of the traumatic event of information by others. In all other cases the decision to inform children or not is to be left in the hands of the parents. Even though maximum candidness is considered desirable today, the "cathartic" revelation of family secrets can be as destructive as their conservation.