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

A Systematic Review of Qualitative Studies Investigating Motives and Experiences of Recipients of Anonymous Gamete Donation

The decision to use an anonymous gamete donation in fertility treatment could have significant long-term psychological and social effects for all stakeholders involved. In light of the growing recognition of donor-conceived children's right to know their genetic parentage, this entails profound ethical implications. This review aims to carve out the full spectrum of recipients' motives and experiences related to donor anonymity which could serve as an analytical framework for future ethical and sociological research on issues of donor anonymity. This review was conducted following a seven-step approach for systematic reviews of empirical bioethics literature. The characteristics and quality of the studies included in this review were reported. Data analysis was conducted using qualitative content analysis and was informed by sociological functionalist theorizations of ignorance. The 53 studies selected showed a diverse spectrum of characteristics concerning date and country of study, methodology, family type of participants, sample size, and the timing of data collection in relation to the stage of treatment. A total of 22 categories of motives and experiences of recipients concerning donor anonymity were identified inductively and grouped into five main categories. Donor anonymity was identified as a eufunctional form of ignorance, by which the recipients experienced or intended to control, regulate, or protect inter-stakeholder relations. Interpreting recipients' motives and experiences concerning donor anonymity as a form of ignorance directed toward particular stakeholders helps reframe the discourse on donor anonymity. It is a fruitful approach that can be refined further and applied in future research. This review identified possible directions for future investigations on motives for donor anonymity: the need for more thorough inquiries into the change in recipients' preferences over time, such as in the form of longitudinal studies and research on the perspective of non-biological parents.

Longitudinal associations between prenatal testosterone and postpartum outcomes in a sample of first-time expectant lesbian couples

Although increasing numbers of gay and lesbian individuals ultimately become parents, the vast majority of research on the transition to parenthood focuses exclusively on heterosexual samples. Even less is known about the physiological implications of this major life transition among those who identify as sexual minorities. The present study begins to redress these gaps in the literature by assessing prospective links between prenatal testosterone, a steroid hormone that is negatively associated with nurturance and caregiving, and postpartum outcomes in a sample of 25 first-time expectant lesbian couples (N = 50 individuals). Consistent with prior work in heterosexual samples, which suggests that lower testosterone promotes both partnering and parenting, we found that, in both partners, lower testosterone during the prenatal period predicted better romantic relationship and parenting outcomes at three-months postpartum (e.g., higher relationship quality, more time spent doing baby care). There was also evidence for dyadic associations; for instance, birth mothers reported more overprotective behavior, and non-birth mothers reported greater commitment, when their female partners had lower testosterone. Together, our findings contribute important new knowledge about the functionality of testosterone in close relationships contexts, including some of the first evidence among sexual minorities.

Establishment of Legal Paternity for Children of Unmarried American Women : Trade-Offs in Male Commitment to Paternal Investment

The establishment of a legal father for children of unmarried parents reflects both high paternity confidence and male willingness to commit to paternal investment. Whether an unmarried man voluntarily acknowledges paternity after a child is born has important consequences for both the mother and child. This paper brings to bear a life history perspective on paternity establishment, noting that men face trade-offs between mating and parental effort and that women will adjust their investment in children based on expected male investment. I predict that paternity establishment will be more likely when the mother has high socioeconomic status, when maternal health is good, and when the child is male, low parity, or a singleton (versus multiple) birth. I further predict that establishment of paternity will be associated with increased maternal investment in offspring, resulting in healthier babies with higher birthweights who are more likely to be breastfed. These predictions are tested using data on 5.4 million births in the United States from 2009 through 2013. Overall the results are consistent with the hypothesis that the trade-offs men face between reproductive and parental investment influence whether men voluntarily acknowledge paternity when a child is born.

Comparison of multiple psychological distress measures between men and women preparing for in vitro fertilization

OBJECTIVE

To compare multiple measures of psychological distress between men and women preparing for IVF.

DESIGN

Retrospective cohort study.

SETTING

Outpatient, academic infertility clinic.

PATIENT(S)

One hundred sixty-two consecutive couples presenting for infertility treatment with IVF.

INTERVENTION(S)

Measures were completed as part of a routine, infertility-focused psychological evaluation, including the Beck Depression Inventory, State-Trait Anxiety Inventory, State-Trait Anger Inventory, and Impact of Events Scale.

MAIN OUTCOME MEASURE(S)

Scores of above psychological questionnaires.

RESULT(S)

Psychological distress scores were statistically significantly higher among women than men for symptoms of depression, state anxiety, infertility specific distress, and general perceived stress. However, aside from infertility-specific distress (d = .43), effect sizes for the paired differences between females and males ranged from d = .18 to .23.

CONCLUSION(S)

Women consistently scored higher on multiple measures of psychological distress than their male partners in the context of preparing for IVF. Comparison of infertility-specific distress scores yielded the largest statistically and clinically significant difference compared with traditional measures of general depression and anxiety symptoms.

Experience of parenthood, couple relationship, social support, and child-rearing goals in planned lesbian mother families

BACKGROUND

The phenomenon of planned lesbian families (i.e., two-mother families in which the child was born to the lesbian relationship) is relatively new and very little research has been conducted among those families. The overall aim of this research was to examine whether planned lesbian mother families differ from heterosexual families on factors that are assumed to influence the parent-child relationship, such as experience of parenthood, child-rearing goals, couple relationship, and social support.

METHOD

A hundred lesbian two-mother families were compared with 100 heterosexual families having naturally conceived children. A variety of measures were used to collect the data, including questionnaires and a diary of activities kept by the parents.

RESULTS

Lesbian parents are no less competent or more burdened than heterosexual parents. Both lesbian and heterosexual parents consider it important to develop qualities of independence in their child. However, 'conformity' as a child-rearing goal is less important to lesbian mothers. Furthermore, lesbian social mothers feel more often than fathers in heterosexual families that they must justify the quality of their parenthood.

CONCLUSION

There are few differences between lesbian couples and heterosexual couples, except that lesbian mothers appear less attuned to traditional child-rearing goals and lesbian social mothers appear more to defend their position as mother.

Access to donor insemination: Canadian ideals--UK law and practice

Reproductive technology has made a huge impact on society, exposing many long-standing, unresolved anomalies in our values and traditions. Access to medically assisted reproduction is particularly controversial, raising medical, legal and ethical issues. The 1980s saw increasing demands across several jurisdictions for clear legal rules, the hope being expressed in Canada that "the law may reflect the community's level of tolerance; but...also stretch or fashion it in the interests of a worthy goal." The Canadian Law Reform Commission recommended that, with regard to donor insemination, "protection for the traditional family should not be incorporated in legislation" and that "access should be limited only in terms of the cost and scarcity of resources", selection not being based on "family status, sexual orientation and so on". This paper attempts a comparative examination of UK legislation on reproductive technology in this light, with particular focus on the rationing of access to donor insemination.

Counselling lesbian couples: requests for donor insemination on social grounds

Fertility centres are increasingly involved in dealing with requests from lesbian couples for donor insemination (DI). Data were collected on 95 Belgian lesbian couples who applied for DI. The majority of couples were well integrated in a social environment (family, friends and work) that consisted mainly of heterosexuals. They tended to be open about their homosexuality and most couples considered the social environment to be tolerant towards their homosexual orientation. Couples who considered alternatives to DI would have liked to have had more information on the donor and were more inclined to introduce a 'godfather' who would take special interest in the child. Couples who considered DI to be the best solution considered the absence of a father to be less of a problem for the child and wished to have no information at all as regards the donor. Approximately half the couples considered their family a two-mother unit. For the other couples, the family unit consisted of a mother and her partner who shared parental responsibility for the child equally. The issues that are considered important to cope with and on which lesbian couples should be counselled are presented in the discussion.

Psychosocial aspects of selected issues in women's reproductive health: current status and future directions

Emphasizing research published in the past decade, this article presents a summary and evaluation of psychosocial investigations of women's reproductive health, with a focus on selected aspects of menstruation, pregnancy and birth, infertility, and menopause. In some areas, studies have focused on negative physical and psychological concomitants of these health issues. However, research reveals substantial individual variability, with most women adapting well to reproductive health changes. Although methodological and conceptual shortcomings have limited firm conclusions, research has advanced our understanding of the multivariate biological, psychological, and social influences on women's reproductive health and associated outcomes. Understanding and promoting women's reproductive health across the lifespan requires biopsychosocial approaches to research.

Gamete and embryo donation: ethical implications for families

This paper considers the ethical implications of gamete and embryo donation for both donating and receiving families. It suggests that the key ethical issue for receiving families is whether to tell the child about the means of conception. The ethical debate on this topic gains much from reviewing the research evidence of what parents actually do and the reasons they give for their actions. The research indicates that very few parents intend to tell the child; however, it is noted that this decision needs to be interpreted in the light of the legislation in many countries that ensures donor anonymity. It is suggested that the debate needs to be extended to include the views of the members of the families of the donors (for example, what they consider to be their rights, interests and responsibilities in relation to the donor, the donation, the child and the receiving families) to achieve an adequate consideration of the ethical implications for those families.

Donor insemination: eugenic and feminist implications

One concern regarding developments in genetics is that, when techniques such as genetic engineering become safe and affordable, people will use them for positive eugenics: to "improve" their offspring by enpowering them with exceptional qualities. Another is whether new reproductive technologies are being used to improve the condition of women or as the tools of a patriarchal system that appropriates female functions to itself and exploits women to further its own ends. Donor insemination is relevant to both of these issues. The degree to which people have used donor insemination in the past for positive eugenic purposes may give some insight into the likelihood of developing technologies being so used in the future. Donor insemination provides women with the opportunity to reproduce with only the most remote involvement of a man. To what degree do women take advantage of this to liberate themselves from male dominance? Through questionnaires and interviews, women who have used donor insemination disclosed their criteria for selecting sperm donors. The results are analyzed for the prevalence of positive eugenic criteria in the selection process and women's attitudes toward minimizing the male role in reproduction.

Lesbian couples as therapeutic donor insemination recipients: do they differ from other patients?

Reports were based on 23 lesbian couples seeking therapeutic donor insemination (TDI). Seventeen single women and 14 heterosexual couples with known infertility, due to vasectomy, were recipient controls. No group differences were found on self-esteem, psychiatric symptomatology or dyadic adjustment, except that lesbians reported greater dyadic cohesion than heterosexuals. Lesbians and single women were likely to disclose their use of TDI to others and had planned to disclose this to any child conceived; married couples were divided on this issue. Groups were alike in what they wanted to know about the donor (principally health variables and medical history), and in their concerns about the use of TDI (genetic and medical history). Groups differed in the reasons they elected to use TDI, with lesbian couples and single women choosing TDI affirmatively, and married couples accepting it as a last resort.