Egg donation, surrogate mothering, and cloning: attitudes of men and women in Germany based on a representative survey

Attitudes of Different Religions Toward Surrogacy: Analysis of 11 Countries' Situation Using Machine Learning Approach and Artificial Neural Networks

Individuals may develop different attitudes on bioethics in general and reproductive ethics in particular, due to the effects of different sociocultural environments. Individuals' attitudes toward surrogacy are affected positively or negatively depending on religious and cultural environments. This study was conducted to determine and compare the attitudes of different religions toward surrogacy. This study is cross-sectional and collected from individuals living in Turkey, India, Iran, the Turkish Republic of Northern Cyprus, Madagascar, Nepal, Nigeria, Pakistan, Mexico, England, and Japan between May 2022 and December 2022. The study was conducted with individuals belonging to Islam, Christianity, Hinduism, Buddhism, and Atheism. The study was conducted with 1177 individuals from different religions who agreed to participate in the study by snowball sampling method. The introductory Information Form and "Attitude Questionnaire Toward Surrogacy" were used as data collection tools. R programming language 4.1.3 was used for regression analysis with machine learning approach and artificial neural networks, and SPSS-25 was used for other statistical analyses. There was a significant difference between the total mean score of the individuals' Attitudes toward Surrogacy Questionnaire and their religious beliefs (p < 0.05). When the results of the analysis of the regression model with the dummy variable, which was carried out with the aim of revealing the effects of religious belief on the attitude toward surrogacy, are examined, statistical estimates of the regression model show that the model is significant and usable F(4,1172) = 5.005, p = 0.001). It explains 1.7% of the total variance of the level of religious belief's attitude toward surrogacy. In the regression model, when the t-test results regarding the significance of the regression coefficient are examined, among the participants, it was determined that the mean score of those who believed in Islam (t =  - 3.827, p < 0.001) and those who believed in Christianity (t =  - 2.548, p < 0.001) was lower than the mean score of those who believed in Hinduism (Constant) (p < 0.05). Individuals' attitudes toward surrogacy differ according to their religion. The best performing algorithm for the prediction model was random forest (RF) regression. The contributions of the variables to the model were calculated with Shapley values (Shapley Additive Explanations (SHAP)). The SHAP values of the variables in the best performing model were examined to avoid bias in terms of comparison in the performance criterion. SHAP values (Shapley Additive Explanations) show the contribution or importance of each variable in the estimation of the model. It is determined that the most important variable that should be in the model to predict the Attitude Toward Surrogacy Survey variable is the Nationality variable. It is recommended that studies on attitudes toward surrogacy should be conducted by taking religious and cultural values into consideration.

At risk of reproductive disadvantage? Exploring fertility awareness among migrant women in Germany

This study examined awareness about fertility among immigrant women and non-migrants in Germany. The social relevance of infertility and fertility treatment is increasing in Western countries due to continually low overall birth rates, a high rate of childlessness, and a gap between the desired and actual numbers of children. While there is growing interest in infertility and reproductive medicine in general, previous studies have rarely included immigrant or ethnic minorities in Europe. This study investigated whether knowledge on the age-related fertility decline (ARFD) varies between migrant groups and the majority group, and the role of education. Working hypotheses were drawn from theoretical considerations on frameworks of migrant assimilation. The analysis was based on data collected in a social science pilot study on reproductive medicine, representative of the general population ('NeWiRe' 2014-2015). The sample included 962 women aged 18-50 years living in Germany. Approximately 81% of the sample were immigrants who originated from Turkey, Poland, the Balkan countries or countries of the (post-Soviet) Commonwealth of Independent States. While rather poor overall, knowledge on ARFD was found to be significantly lower in the migrant groups compared with the majority group. This minority-group disadvantage cannot be explained by sociodemographic or cultural variables. Future research should include minority groups in empirical studies on awareness about fertility in order to better understand the causes of this disadvantage, and the potential reproductive needs of migrants.

Perspectives and attitudes of Jordanian medical and paramedical students toward surrogate pregnancy

PURPOSE

This study aims at investigating the perspectives of Jordanian medical and paramedical students on surrogate pregnancy.

METHODS

A questionnaire-based cross-sectional study design was used. The sample consisted of n=328 students of both genders. The questionnaire responses were numerically coded and analyzed across gender and the level of education.

RESULTS

Approximately, 18% of the students reported good awareness about the ethical dilemmas of surrogacy. The results showed a general reluctance to accept surrogate pregnancy as the majority (80.5% of male students and 97.6% of female students) had a negative attitude toward surrogacy. In addition, undergraduate students were less supportive to surrogate pregnancy than graduate students. Religious considerations were the main reason (accounts for about 70%) for driving negative attitude toward surrogacy.

CONCLUSION

The findings of the study indicate a general reluctance toward accepting the concept of surrogate pregnancy, which is mainly due to religious reasons.

A survey of public attitudes towards third-party reproduction in Japan in 2014

Objective

The objective of this study was to examine public attitudes towards third-party reproduction and the disclosure of conception through third-party reproduction.

Methods

We conducted the web-based survey for the public attitude towards third-party reproduction in February 2014. Twenty-five hundred people were recruited with equal segregation of age (20s, 30s, 40s, and 50s) and gender. We analyzed the association between gender, age, infertility, and ethical view using a questionnaire regarding donor sperm, donor oocyte, donor embryo, gestational surrogacy, and disclosure to offspring.

Results

Of the respondents, 36.2% approved and 26.6% disapproved of gamete or embryo donation. The frequency of those who approved was lowest in females in the 50–59 year age group, and was significantly higher in males or females with infertility. Secondly, 40.9% approved and 21.8% disapproved of gestational surrogacy. The frequency of those who approved gestational surrogacy was higher in males or females with infertility. Thirdly, 46.3% of respondents agreed and 20.4% disagreed with “offspring have the right to know their origin”. Those who disagreed were primarily in the 50–59 year age group of both genders, and disagreement was significantly higher in the infertility group compared with non-infertility group.

Conclusion

In this study, public attitudes were affected by gender, age, and experience of infertility. These study findings are important in understanding the attitude towards third-party reproduction and disclosure to the offspring. Respondents having indecisive attitudes were >30%, which might indicate an increased requirement for information and education to enhance the discussion on the ethical consensus on third-party reproduction in Japan.

The relationship of sociocultural beliefs and infertile couples' attitude toward reproductive donation: A descriptive-correlational study

Background

There are controversial views on accepting a reproductive donation in the world.

Objective

This study aimed to determine the relationship between the sociocultural beliefs and infertile couples' attitude toward reproductive donation in Mashhad, Iran.

Materials and Methods

This descriptive correlational study was conducted out on 115 infertile couples visiting Milad Infertility Center in Mashhad, Iran with using convenience sampling. The research instruments were valid and reliable sociocultural beliefs and attitude questionnaires, which were completed by the respondents on a self-report basis.

Results

The mean score of attitude toward reproductive donation in infertile women and men was 58.3 ± 12.6 and 57.8 ± 12.0, and the mean score of sociocultural beliefs in infertile women and men was 67.7 ± 11.5 and 67.6 ± 12.4, respectively. There was a direct correlation between sociocultural beliefs and attitude toward reproductive donation in infertile women (p < 0.001) and men (p < 0.001), that is, women and men with a higher score of sociocultural beliefs had a higher score of attitude as well. A direct correlation was also seen between sociocultural beliefs and infertile women and men's public attitude, their attitude towards genetic bound between parents and children, their attitude regarding the issue of confidentiality of the donation process, as well as attitude in relation to oocyte donation, embryo donation, and surrogacy (p < 0.001).

Conclusion

The findings suggest that sociocultural beliefs that surround reproductive donation could influence infertile couple's attitude toward accepting these therapeutic alternatives in infertile couples. It is therefore recommended to take steps to incorporate sociocultural beliefs into the routine care of infertile couples with the help of social media to give them ability for making more pragmatic decision in relation to their chosen options.

Assisted reproductive technologies and the Iranian community attitude towards infertility

Since the late 1990s, assisted reproductive technologies (ARTs) have been legitimized in Iran through an official religious endorsement. Iran, under the dominant authority of the Shia sect, is now the most enthusiastic adopter of ARTs in the Muslim world, permitting all forms of treatments, including third party donation. This study examined the public perception of assisted conception and its influence on the adoption of these methods in Iran. The study was questionnaire-based and conducted in 2012 in Shiraz, the most populated city in the south of Iran. It included 405 Iranian residents selected through the cluster sampling method. The results indicated that respondents did not support all types of assisted reproduction. Amongst modern infertility treatment methods, IVF (using husband's sperm and wife's egg) was the most widely accepted. Gestational surrogacy and the use of donated gametes were less accepted. Demographic variables including gender, marital status, age, education and employment status were linked to significant differences in public opinion. It was concluded that members of the public require better information about gamete donation and surrogacy, as this could shape infertile couples' decision-making.

Exploring Motivations, Awareness of Side Effects, and Attitudes among Potential Egg Donors

This research study surveyed prospective egg donors at orientation to (a) understand women's motivations to donate eggs, (b) assess awareness and knowledge of egg donation prior to entry into the egg donation program, and (c) explore attitudes toward egg donation. Ninety-two women completed the questionnaire at one fertility clinic located in the Midwest between August 2011 and August 2012. Descriptive and inferential statistics as well as textual analysis were used to analyze the data. Three themes emerged regarding participant motivations: (1) altruistic, (2) financial, and (3) desire to pass on genetic material. The majority of participants were unconcerned with potential physical and psychological side effects; however, differences emerged based on motherhood status and educational level. Although potential donors felt recipients should receive some information about the donor, they tended to value privacy regarding information giving to resultant offspring. This research study has implications for social work practice, policy, and future research. It is crucial that women receive adequate procedural and side effect information prior to engaging in egg donation.

What do you know about reproductive medicine?--results of a German representative survey

OBJECTIVE

The use of reproductive medical treatments has become increasingly routine in recent years. This paper reports on a study of how different aspects of modern reproductive medicine are perceived by the German population.

DESIGN

Findings from a nationally representative sample of 2110 men and women aged 18 to 50 are presented. Participants responded to a questionnaire seeking self-report information about attitudes and knowledge regarding different aspects of reproductive medicine.

RESULTS

The majority of respondents had already heard or read something about reproductive medicine; knowledge gaps were prevalent in men and individuals with lower levels of education. The decrease in female fertility usually was underestimated, whereas both the number of involuntarily childless couples and the success rate of reproductive medical treatment were overestimated. One-third of participants would make use of reproductive medicine to have their own child.

CONCLUSION

This study revealed inadequacies in the knowledge of the German general population regarding reproductive medicine. Despite the low interest and poor knowledge of the topic, a broad acceptance of reproductive medical methods was reported. The results illustrate the need for adequate information transfer regarding female fertility as well as success rate and risks of reproductive medical interventions.

Childless Canadian men's and women's childbearing intentions, attitudes towards and willingness to use assisted human reproduction

STUDY QUESTION

What are the childbearing intentions of currently childless men and women? What is their attitude towards, and willingness to use, assisted human reproduction (AHR) treatments and family-building options should they be faced with fertility challenges in the future?

SUMMARY ANSWER

Men and women expect to become parents significantly later in life than they believe is ideal. If faced with future fertility challenges, respondents were open to using IVF, but were not positively predisposed to third-party family-building options.

WHAT IS KNOWN ALREADY

Delayed childbearing is an increasing worldwide phenomenon that has considerable health and fertility-related implications. Research to date has focused primarily on women, and indicates a lack of knowledge about the fertility life span and the limitations of AHR in fully compensating for age-related fertility declines.

STUDY DESIGN, SIZE, DURATION

Cross-sectional study of 2000 childless women and 599 childless men, conducted between April 2010 and May 2011.

PARTICIPANTS/MATERIALS, SETTING, METHODS

A total of 2599 childless, presumed fertile individuals between the ages of 20 and 50 years. An online questionnaire assessed fertility beliefs and intentions and willingness to use AHR.

MAIN RESULTS AND THE ROLE OF CHANCE

The findings indicate that men and women expect to become parents significantly later in life than they believe is ideal. If faced with fertility challenges in the future, both men and women were open to using IVF. Men were significantly more willing to consider using donated eggs and embryos, gestational surrogacy and fertility preservation. Women were significantly more willing to consider using home fertility testing, IVF, ICSI and donor sperm. Overall, the childless respondents were not positively predisposed to third party-family-building options.

LIMITATIONS

The geographic specificity of the sample, the online format and recruitment methods may limit the generalizability of these findings.

WIDER IMPLICATIONS OF THE FINDINGS

Given the worldwide trend towards delayed childbearing, and the widespread availability of AHR, it is likely that these findings could extend to the wider North American, European and Australasia populations of English- and French-speaking childless men and women. However, it should be noted that international differences exist, especially concerning regulations governing the funding of AHR and payment for gametes and surrogacy. It is significant that women and men in this study indicated a lack of willingness to consider the use of third third-party treatments--the very options they may need to use in building their families, if the increasing trend towards delayed childbearing continues.

STUDY FUNDING/COMPETING INTERESTS

This research was funded by a grant from the Canadian Institutes of Health Research and Assisted Human Reproduction Canada #PAH-103594, 2009/10. No competing interests.

Gestational surrogacy: Viewpoint of Iranian infertile women

BACKGROUND

Surrogacy is a popular form of assisted reproductive technology of which only gestational form is approved by most of the religious scholars in Iran. Little evidence exists about the Iranian infertile women's viewpoint regarding gestational surrogacy.

AIM

To assess the viewpoint of Iranian infertile women toward gestational surrogacy.

SETTING AND DESIGN

This descriptive study was conducted at the infertility clinic of Tabriz University of Medical Sciences, Iran.

MATERIALS AND METHODS

The study sample consisted of 238 infertile women who were selected using the eligible sampling method. Data were collected by using a researcher developed questionnaire that included 25 items based on a five-point Likert scale.

STATISTICAL ANALYSIS

Data analysis was conducted by SPSS statistical software using descriptive statistics.

RESULTS

Viewpoint of 214 women (89.9%) was positive. 36 (15.1%) women considered gestational surrogacy against their religious beliefs; 170 women (71.4%) did not assume the commissioning couple as owners of the baby; 160 women (67.2%) said that children who were born through surrogacy would better not know about it; and 174 women (73.1%) believed that children born through surrogacy will face mental problems.

CONCLUSION

Iranian infertile women have positive viewpoint regarding the surrogacy. However, to increase the acceptability of surrogacy among infertile women, further efforts are needed.

Oocyte donation: a risk factor for pregnancy-induced hypertension: a meta-analysis and case series

BACKGROUND

In 2008 and 2009, the authors saw in their institution three women who had undergone oocyte donation and went on to develop severe de novo hypertension before the 26(th) week of gestation, with values above 180/110 mm Hg. Pregnancy was prematurely terminated in these cases because of the acute threat to the mother's life, and none of the three neonates survived. Five further cases with better outcomes were found to have occurred from 2006 to 2010. On the basis of this experience, the authors performed a meta-analysis to determine whether oocyte donation elevates the risk of pregnancy-induced hypertension (PIH). The cases are discussed in detail.

METHODS

Systematic review of the literature on PIH after oocyte donation, with meta-analysis and calculation of an odds ratio. We also provide a retrospective chart review of our own case series.

RESULTS

28 publications were evaluated. The overall rate of PIH in a total of 2308 deliveries after oocyte donation was 22.6%. With the aid of data from 11 studies, the course of pregnancy in a total of 644 oocyte recipients was compared to that in a control group of 2320 women who were not oocyte recipients. The calculated odds ratio for PIH after oocyte donation, compared to conventional reproductive therapy, was 2.57 (95% CI, 1.91-3.47), while the calculated odds ratio for PIH after oocyte donation, compared to other women in the control group, was 6.60 (95% CI, 4.55-9.57).

CONCLUSION

The data reveal that oocyte donation confers a considerable risk that the recipient will develop PIH. The very early and severe cases of preeclampsia that we report here are rather atypical; similar cases may have occurred elsewhere without finding their way into the relevant literature. The authors recommend close surveillance of pregnancies following allogenic oocyte transplantation by physicians with special expertise in prenatal medicine.