Psychological issues of infertility and assisted reproductive technology

This article presents a model for conceptualizing the emotional consequences of infertility experienced by most couples with this problem. The article also discusses the need for patient preparation for alternative reproductive techniques with donor gametes and examines the main issues that need to be explored. Recommendations are made for physicians and couples challenged by infertility's intense and surprising emotional consequences.

Attitudes of parents of young children to sperm donation--implications for donor recruitment

An anonymous questionnaire was circulated to parents of young children to survey exposure to publicity about and attitudes to sperm donation (n = 192 couples; 50% response rate). Of those surveyed, 55% of men and women had seen or heard of the need for sperm donors; for 26% of couples, one or both partners had considered donation, and among half of those (13% of total) no objections to donating were raised. However, only two men had approached the clinic as donors. Objections to donation centred mainly on discomfort at having children outside their family, worry about future contact with donor insemination children, and worry about incest. Women were three times as likely to raise these objections as men. Of all respondents, 20% thought a donor should be used for only one recipient couple, while 50% suggested three or fewer families. Overall, 41% rated having non-identifying information about the recipient couple(s) as an important aspect of sperm donation, although only 9% of men and 17% of women considered personal contact important. While many people are aware of and receptive to the idea of being donors, very few act. Many would prefer that their spermatozoa were used for only one or a few couples about whom they had some information.

Personality characteristics analysis in couples undergoing artificial insemination

The personality characteristics of 40 couples admitted into an artificial insemination scheme have been analysed. The personality study was carried out using Cattell's questionnaire 16 PF (form C) and EPI questionnaire (Eysenck Personality Inventory). The results show significant statistical differences between males and females with a greater conformity with the group, in women; women are also bolder and more disciplined from an emotional point of view, whereas men are more radical.

Adoption and donor insemination: factors influencing couples' choices

The increasing availability of donor insemination (DI) gives couples faced with male infertility a choice between DI and adoption, and for many, DI is now the preferred option. The results of a study of 54 couples who gave birth to a child or children by means of DI are presented both quantitatively and qualitatively, and show that most couples who have children by DI have considered adoption. Their reasons for choosing DI range from the practical to the emotional, from perceived negative aspects of adoption to perceived advantages of DI. This article discusses these perceptions and their implications.

Psychological screening and the success of donor insemination

In a previous case series, a psychologist's rating of couples' emotional adjustment and readiness for donor insemination was predictive of pregnancy rates. We attempted to replicate this finding with an extended series of 120 consecutive couples in which each spouse filled out questionnaires when evaluated for donor insemination. The Stress and Infertility Questionnaire measured specific attitudes and anxieties about donor insemination. The Brief Symptom Inventory assessed psychological distress. The Dyadic Adjustment Scale measured marital happiness. A psychologist used these questionnaires to rate the couple's overall adjustment in regard to donor insemination. Those couples rated as distressed had a session of psychological counselling. Outcome was reviewed at a mean of 20 months after evaluation, with categories of pregnancy, continuing donor insemination, failure to begin the programme, or dropped out. For the 120 couples overall, psychological factors did not predict pregnancy outcome. Younger age of the wife did predict higher pregnancy rates.

Appraisal, coping, and emotional health of infertile couples undergoing donor artificial insemination

OBJECTIVES

To describe differences between wives and husbands undergoing donor artificial insemination (AID), in terms of stress level, factors contributing to the stress of AID, cognitive appraisal of AID, ways of coping, and emotional health.

DESIGN

Descriptive correlational.

SETTING

A gynecology-endocrinology clinic at a university hospital and a private infertility practice in the midwestern United States.

PARTICIPANTS

Forty wives and thirty-five husbands participating in AID.

MAIN OUTCOME MEASURES

Perceived level of stress, factors contributing to the stress of AID, appraisal of AID, revised ways of coping, and profile of mood states.

RESULTS

Wives had greater stress levels, used more ways of coping, and more often appraised AID as a harm-loss, threat, or challenge. Husbands more often appraised AID as a beneficial experience. Individuals who appraised AID differently differed in emotional health and levels of stress.

CONCLUSIONS

Investigations into the relationships among stress levels, stressors, appraisal, coping, situational factors, and emotional health will help nurses understand how these factors affect the health of couples undergoing AID.

[Familial relations in connection with donor insemination. Psychological effects of secretiveness]

In Norway approximately 150 children are born every year as a result of artificial insemination. In 1987 an Act was passed regulating this practice. Hospital gynaecologists are given the authority to implement this Act, and the responsibility for doing so. With the current practice of artificial insemination, two types of secrets evolve: The anonymity of the donor, as required by law, will prevent the child from ever identifying its biological father. The secrecy of conception, as recommended by experienced gynaecologists as the best method of protecting the child and the parents, will continuously present the family with unresolved questions that may create problems within the family. It is assumed that it would present an undue burden on the child not to be able to identify its biological father. As a family psychiatrist the author has discussed the secrecy issue with nine couples with children conceived by artificial insemination using donor semen, and another eight couples that were offered this treatment. A common denominator for these couples turned out to be the problem of living their entire life not knowing the origin of their child. Most of the couples are afraid that the secret could be divulged during a family quarrel. Invisible alliances could develop between members of the family. In the long run, honesty about the conception reduces the mental strain on the family. Family therapists will generally advise against secrecy in these matters and will help parents choosing alternative ways of coping with the problems.

Vasectomy as a reason for donor insemination

Among 200 couples referred for counselling with a view to donor insemination (DI) were 21 whose request arose from an earlier vasectomy. This had been judged irreversible, apart from one case where the man had been sterilised for genetic reasons and therefore had not sought reversal. An overall incidence of 10.5% indicates that vasectomy may lead to fertility problems in the event of remarriage, which has become more common with an increasing divorce rate. All 21 husbands but only 3 wives had been previously married; 3 former wives had died, otherwise all previous marriages had ended in divorce. Most husbands were considerably older than their second wives, especially as compared with the majority of men in the larger series who were still in a first marriage. Their relative maturity may have helped them to respond more sensitively to their wives' maternal needs when they already had children of their own. During a follow-up interval of up to 8 years, 2 couples had separated after a brief relationship but 9 of the other 12 contacted had become parents by DI. The 3 remaining couples included a wife who at the latest report was 5 months pregnant, and 2 who were still pursuing treatment. Despite the low failure rate in this small series we should bear in mind that DI is not an ideal solution to the problem of male infertility, nor always even acceptable.(ABSTRACT TRUNCATED AT 250 WORDS)

A controlled study of the psycho-social development of children conceived following insemination with donor semen

Although donor insemination has been used to produce pregnancies for many years, there has been little information on how children conceived in this unusual manner develop psycho-socially. We have therefore carried out a controlled quantitative assessment comparing children who were conceived by donor insemination to adoptees and naturally conceived children who were matched for age and sex. We conclude that the psycho-social development of donor insemination children was no different from the two control groups.

[1992 results of sperm donor procreation. French Federation of CECOS and private cooperative centers]

In 1992, the results record the referred activity of French Federation of CECOS and IFREARES-Toulouse. 6,714 patients underwent donor inseminations for one or more cycles, 20,525 cycles were undertaken resulting in 2,234 pregnancies using AID or IVF. 606 volunteers men come forwards as donors. The analysis of 1,777 deliveries resulting of recoveries realised in 1991, showed with IVF a high rate for twins and multiple births. The activity of semen preservation and embryo's storage is always increasing. The wishes about the parentless outcome embryos is performed.

Confidentiality and American semen donors

Most American donor insemination programs include a policy of complete confidentiality concerning the donor of the semen. This is the result of a long legal tradition of American constitutional law. However, some slight abridgement of this body of legal decisions might be very much in the best interests of children arising from donor insemination, and even--in most cases, in fact--the donors themselves. With regard to the children, the factors involved are both those of genetic counseling, should the need arise, and psychological development. Of course, as at present, the donor must be relieved of all responsibility, both legal and financial.

Male infertility: artificial insemination by donor

It is now known that in about 40 per cent of couples attending infertility clinics, it is the man who has the underlying problem. Jacquie Cox looks at artificial insemination by donor as an alternative to treatment for infertility.

Quality of parenting in families created by the new reproductive technologies: a brief report of preliminary findings

The creation of families by means of the new reproductive technologies has raised important questions about the consequences for parent-child relationships, particularly where gamete donation has been used to conceive the child. Preliminary findings are presented of a study of the quality of parenting in families created as a result of the two most widely used reproductive technologies, in vitro fertilization and donor insemination, in comparison with a control group of families with a naturally conceived child and a control group of 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. 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. The findings are discussed in terms of their implications for understanding the role of genetic ties in parent-child relationships.

Children from anonymous donors: an inquiry into homosexual and heterosexual parents' attitudes

This study compared two groups of homosexual and heterosexual parents with respect to their attitudes towards the donor-origin of their children. All couples had applied at the Fertility Clinic for artificial insemination with anonymous donor sperm (AID). Both groups had used anonymous donors in order to conceive. However, the sexual orientation of the parents and the presence or absence of a social father was different in the two groups. By comparing such different families it was hoped to obtain insight into those factors which influence parents' attitudes concerning donor insemination. Twenty-five lesbian and 25 heterosexual parents were interviewed. The open-ended questionnaires solicited information on the following issues: attitudes towards secrecy/disclosure of the use of a donor, views on anonymity/identity registration of the donor, parents' cognitive and emotional representation of the donor. Response rates differed between the groups: all homosexual parents consented to the interview and 44% of the heterosexual parents did so. Parents' attitudes depended on several variables. The different family structures were related to different motivations for AID treatment. For heterosexual couples, the use of a donor offered them the opportunity to become a 'normal family'. For homosexual couples, creating a two-mother family unit meant going one step further in 'being different'. Attitudes towards the use of a donor were consequently different: heterosexual couples chose secrecy and donor anonymity. Homosexual parents intended to inform their children. Of these homosexual parents, 40% would prefer the identity of the donor to be registered. This evolution towards removal of the anonymity seemed to be encouraged by the openness surrounding the use of a donor itself. In both groups it remained difficult to reduce the donor to an anonymous sperm cell, fantasies and questions about the donor continued to exist over the years.

Psychological aspects of donor insemination: evaluation and follow-up of recipient couples

OBJECTIVE

To evaluate the utility of psychological screening for couples entering a donor insemination program.

DESIGN

Each spouse completed questionnaires. A psychologist reviewed them and rated the psychological fitness of the couple for participation in the program. Follow-up questionnaires were sent to each couple at a mean of 11 months after entry into the program.

SETTING

Applicants for donor insemination were studied in an infertility program in a large, tertiary referral center.

PATIENTS, PARTICIPANTS

Consecutive applicants to enter the donor insemination program were required to participate in the initial evaluation.

INTERVENTIONS

Couples judged by the psychologist to be at risk for a poor psychological outcome had an assessment and counseling interview with the psychologist before proceeding with insemination.

MAIN OUTCOME MEASURES

Initially, the Stress and Infertility Questionnaire measured specific anxieties related to donor insemination, marital and sexual impact, and attitudes about confidentiality; the Brief Symptom Inventory measured psychological distress; and the Dyadic Adjustment Inventory assessed marital satisfaction. At follow-up, 48% of couples returned a modified version of the Stress and Infertility Questionnaire and the other two questionnaires.

RESULTS

The psychologist's rating was predictive of pregnancy rates (59% for excellent candidates, 41% for acceptable couples, and 14% for couples psychologically at risk). At-risk couples were more likely to drop out of the program (50% versus only 20% of other couples). Sexual problems were reported by 59% of women and 53% of men. Couples believed that a child should not be told of the donor insemination (74% of wives and 80% of husbands). Initially, 64% of wives and 70% of husbands chose total secrecy with families or friends, and these attitudes shifted little over time.

CONCLUSION

This screening procedure is cost-effective and suggests that psychological intervention should be attempted with at-risk couples.

Identifiable semen donors--attitudes of donors and recipient couples

Fifty-three couples embarking on donor insemination (DI) replied to an anonymous questionnaire asking what they wanted to know about the donor should they become pregnant. Fifty-one percent were definitely and 32% probably going to tell a child of its donor origins. Items most frequently listed for themselves and on behalf of a child were--interests/sports (57%), physical attributes (41%), occupation (37%) and family background (26%). Forty-two percent of the women and 28% of the men thought the child should have access to the identity of the donor eventually. Thirty-eight donors were surveyed by a questionnaire; 68% were agreeable to their identity being available to a donor insemination child when the child reached maturity. When the category of identifiable donor was created, 20 of 36 (56%) new donors and donors still donating chose this option.

Sperm donors: their attitudes toward providing medical and psychosocial information for recipient couples and donor offspring

OBJECTIVES

To determine the willingness of sperm donors to provide in-depth medical and psychosocial information on their application forms and to share this information with recipient couples and their offspring.

DESIGN

Sperm donors in two donor programs were asked to complete 12-page application forms. In addition to frequency tabulations of responses, chi 2 analyses were performed to compare responses from two programs.

SETTING

The two donor programs were Baylor College of Medicine Sperm Bank Program, Scott Department of Urology, Houston, Texas, and Reproductive Resources, Metairie, Louisiana.

MAIN OUTCOME MEASURES

Attitude toward providing in-depth medical and psychosocial information to recipient couples.

RESULTS

Ninety percent of these donors are willing to complete lengthy application forms providing medical and psychosocial information. Ninety-six percent are willing to share this information in a nonidentifying manner with recipient families. Thirty-six percent say that they will be donors if anonymity cannot be guaranteed, and 60% indicate that they will meet or provide identifying information to the child at age 18. Seventy-two percent left personal messages to their potential offspring.

CONCLUSIONS

Sperm donors are willing to provide in-depth nonidentifying information for recipient families. Permanent files with medical and psychosocial information on all donors should be developed, maintained, and made available to all recipients, whether they request donor information at the time or conception or not.

Attitudes towards gamete donation among couples undergoing in vitro fertilization

The attitudes of 234 anonymous couples undergoing in vitro fertilization toward sperm and oocyte donation were explored by questionnaire. All the questionnaires were returned of which 222 (95%) were complete and analysed. A high proportion of couples found the use of donor sperm acceptable for therapeutic, diagnostic and treatment purposes (77%, 90% and 97% respectively) and 72%, 84% and 90% respectively were willing to donate oocytes for these purposes. Of potential oocyte donors 41% would agree to nonanonymous donation, 12% would wish to meet the recipient couple and although only 4% wanted to choose the recipient, a quarter of the couples would prefer a relative or friend as the recipient. Provision of nonidentifying information about the donor to the recipient couple was acceptable to almost 70% whereas 40% found giving the same information to the child acceptable.

[Dimensions of the personality of semen donors and their social behavior]

The authors examined using three generally accepted methods, the personality structure of 80 semen donors (Cattell's 16-factor questionnaire, 16PF, Eysenck's personality questionnaire EOD and Leary's method of interpersonal diagnosis of personality). The donors were selected by means of the Questionnaire of semen donors. The group is subdivided into four subgroups by the grade of education, i.e. university graduates, men with secondary and elementary education and university students. All are 20-40 years old. The authors describe the assembled results in different sub-groups and in the group as a whole and compare them mutually and with the standardized norm. With regard to the specificity of individual methods and their application the findings are summarized. The donors are balanced personalities, slightly extrovert, emotionally well developed with a realistic outlook. They have positive, sensitive relations with their environment an behaviour towards other people, they are considerate, careful and disciplined. They respect social norms as regards preservation of originality of personality. They have a slight tendency of sheltering behaviour, they wish to be somewhat more aggressive. No pathological phenomena were observed in the donors. Their intelligence is above average. They make a favourable impression with regard to the demand of mental health and transmission of genetic information. The authors evaluate favourably the Questionnaire for semen donors as the method for selection of donors.

[The problem of marital infertility caused by the male partner pathology in view of potential semen donors]

An inquiry was carried out in 91 students of the V year of Medical Academy, potential semen donors for artificial insemination, for gaining an insight into the degree of acceptance of this problem in their present situation and in assumed possible infertility of them or their partners, and the foreseen results of sociocultural consequences of the infertility of one of the partners in a married couple, as regarded by the responders. The highest grade of acceptance of semen donation for heterologous insemination was shown by students living in cities and coming from the families of the intelligentsia. Among the factors determining this attitude the most frequent were: altruistic attitude, followed by economic gains. Religion had only a slight influence on this attitude. In the studied group a higher acceptance was gained in case of female infertility by resolving the problem by use of the so called proxy-mother, than by artificial insemination in case of male infertility. Nearly half the responders supported adoption of a child in preference to artificial insemination, while heterologous insemination was preferred mainly by responders coming from small towns and villages.

The study of psychological factors in couples receiving artificial insemination by donor: a discussion of methodological difficulties

Artificial insemination by donor (AID) may be the only means by which many infertile couples are able to have a child. However, the treatment is not invariably successful and it is postulated in the literature that psychological factors may be implicated when conception does not occur. Further investigation is required to establish the nature of any relationship between psychological stress and conception after AID but designing an adequate study is confounded by many methodological difficulties. These include issues relating to ethics, recruitment, measurement and logistics. In this paper, such aspects are examined and the importance of research in this field for nursing is highlighted.