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

Decisional conflict among couples seeking specialty treatment for infertility in the USA: a longitudinal exploratory study

STUDY QUESTION

What are couples' decisional conflicts around family-building approaches before and after seeking a specialty consultation for infertility?

SUMMARY ANSWER

Decisional conflict is high among couples before an initial specialty consultation for infertility; on average, women resolved decisional conflict more quickly than men.

WHAT IS KNOWN ALREADY

Couples have multiple options for addressing infertility, and decisional conflict may arise due to lack of information, uncertainty about options and potential risks or challenges to personal values.

STUDY DESIGN, SIZE, DURATION

We conducted a total of 385 interviews and 405 surveys for this longitudinal, mixed-methods cohort study of 34 opposite-sex couples who sought a new reproductive specialty consultation (n = 68), who enrolled before the initial consultation and were followed over 12 months.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The in-depth, semi-structured interviews included questions about information gathering, deliberation and decision-making, and self-administered surveys included the Decisional Conflict Scale (DCS), at six time points over 12 months. A DCS total score of 25 is associated with implementing a decision, and higher scores indicate more decisional conflict. A systematic content analysis of interview transcripts identified major themes. Paired t tests identified differences in DCS between women and men within couples. Linear mixed models predicted changes in DCS over time, adjusting for sociodemographic and fertility-related factors.

MAIN RESULTS AND THE ROLE OF CHANCE

The major qualitative themes were communication with partners, feeling supported and/or pressured in decision (s), changing decisions over time and ability to execute a desired decision. Average DCS scores were highest before the initial consultation. Within couples, men had significantly higher decisional conflict than women pre-consultation (48.9 versus 40.2, P = 0.037) and at 2 months (28.9 versus 22.1, P = 0.015), but differences at other time points were not significant. In adjusted models, predicted DCS scores declined over time, with women, on average, reaching the DCS threshold for implementing a decision at 2 months while for men it was not until 4 months.

LIMITATIONS, REASONS FOR CAUTION

This is a convenience sample from a single center, and generalizability may be limited.

WIDER IMPLICATIONS OF THE FINDINGS

Understanding how couples discuss and make decisions regarding family-building could improve the delivery of patient-centered infertility care. Our findings are the first to prospectively explore decisional conflict at multiple time points in both men and women; the observed gender differences underlie the importance of supporting both partners in clinical decision-making for infertility.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by the National Institute of Child Health and Human Development under Grant [R21HD071332], the Research and Education Program Fund, of the Advancing a Healthier Wisconsin endowment at Medical College of Wisconsin, the National Research Service Award under Grant [T32 HP10030] and the use of REDCap for data collection from the National Center for Advancing Translational Sciences, National Institutes of Health under Grant through [8UL1TR000055]. The authors have no competing interests.

Secrecy, disclosure and everything in-between: decisions of parents of children conceived by donor insemination, egg donation and surrogacy

This study examined families where children lack a genetic and/or gestational link with their parents. A total of 101 families (36 donor insemination families, 32 egg donation families and 33 surrogacy families) were interviewed when the child was aged 7 years. Despite a shift in professional attitudes towards openness, about half of the children conceived by egg donation and nearly three-quarters of those conceived by donor insemination remained unaware that the person they know as their mother or father is not, in fact, their genetic parent. By contrast, almost all the surrogacy parents had told their child how they were born. A majority of parents who planned never to tell their child about their conception had told at least one other person. However, qualitative data indicated that to categorize families as 'secret' or 'open' is inadequate. In fact many parents engage in 'layers' of disclosure about their child's conception, both with their child and with family and friends.

Agreement on perceptions of quality of life in couples dealing with infertility

OBJECTIVE

To examine the extent to which men and women seeking treatment for infertility were able to accurately perceive their partners' ratings of their quality of life (QOL).

DESIGN

Cross-sectional prospective study. Quality of life was measured as a multidimensional construct.

SETTING

Assisted reproduction clinic of a university hospital.

PARTICIPANTS

One hundred and sixty-two couples participated. The men's and women's mean ages were 36.1 and 32.1 years, respectively. Most participants had no children, and no previous assisted reproduction attempts.

METHODS

Men and women completed the World Health Organization-Quality of Life-Brief (WHOQOL-Brief) and the Beck Depression Inventory independently. Paired t tests were used to explore men's perceptions of their wives' QOL ratings and wives' perceptions of their husbands' ratings. Multiple regression and repeated-measures ANCOVA were used to examine the role of depression.

RESULTS

Proxy assessments were consistently lower than self-reports on the domains of QOL. The influence of depression on agreement was minimal, and no gender effect was observed.

CONCLUSION

Findings indicated little agreement in perceptions of the partner's QOL, with each partner tending to underrate the other's view. Practitioners need to consider the differences between partners to enable partners to better understand and support each other.

Parental information sharing with donor insemination conceived offspring: a follow-up study

BACKGROUND

Studies of parental decision making regarding information sharing with offspring conceived as a result of donor insemination are almost all based on a 'one point in time' design. This study reports on parental decision making at two points in time, Time 1 and Time 2, 14 years apart.

METHODS

Forty-four of 57 families (77%) who had agreed to take part in a follow-up study were interviewed. An in-depth semi-structured interview format was used. In addition, two questionnaires seeking mainly quantitative data were administered.

RESULTS

Fifteen families (35%) had told their offspring of the donor insemination conception at Time 2 (2004). An additional seven families said they had always wanted or intended to tell the children and asked for assistance on how to do this. Where partners were in agreement on information sharing at Time 1 (1990)-either to tell or not to tell-this position was maintained. Where there was disagreement, or uncertainty, two-thirds had not told and one-third had.

CONCLUSIONS

Despite the professional and socio-political culture at the time of treatment, almost half of the families in this study ended up sharing the donor insemination conception with their offspring. The results support the need for appropriate preparation for donor insemination family building.

The psychopathogenic power of secrecy: child development and family dynamics after heterologous insemination

This study presents the outcome of a 7-year psychotherapy of a girl who was born after donor insemination (DI) and who became ill with a compulsive disorder at the age of 8 years. Our demonstration supplements the present existing statistical data about families into which children have been born with the aid of DI. Aspects of child development, communication within the family, and family dynamics related to this specific constellation will be pointed out. This case study shows important aspects of the individual and the development of the family with regard to DI-constellations. Our paper emphasizes, in contrast to constellations of foster care or adoption, the impact on the parents' conscious knowledge and the child's unconscious knowledge of an absent--as well as less-known--family member (here: the invisible father) on the child's emotional development, health and competence of tying bonds. We also examine the relationship between the parents and their relationship with their DI child. Implications for individual therapy and therapeutic management of the family will be discussed, covering development of bonding and identity of the DI child, the father's role, dynamics of the couple, and the incognito of the 'invisible father'.

Disclosure of donor insemination to the child: the impact of Swedish legislation on couples' attitudes

The question whether or not parents of children conceived after donor insemination (DI) tell their offspring about its biological background was addressed. Swedish legislation from 1985 gives the child born after DI the right, when grown up, to receive identifying information about the sperm donor. Until now no information about compliance with the law has been available. All parents who gave birth to a child by DI after the new legislation in two major Swedish fertility centres (Stockholm and Umeâ) received a questionnaire containing questions about the issue of informing the child. The response rate was 80%. The majority of parents (89%) had not informed their children, whereas 59% had told someone else. As a response to an open question, 105/132 parents chose to comment on their answer about not having informed their child. Of these families, 61 intended to tell their child later, 16 were not sure and 28 were not going to inform the child. Compliance with the law must be regarded as low since only 52% of the parents had told or intended to tell their child. In addition, concern is raised about the children who run the risk of being informed by someone other than their parents.