Cost-benefit Analysis of IUI and IVF based on willingness to pay approach; case study: Iran

Assisted reproductive technologies (ARTs) are often considered luxury services by policy-makers and the general population, which are always susceptible of removal from public funding of health care. The analysis of the economic aspects of this scope seems essential due to the high prevalence of infertility in Iran and the high costs of infertility treatments. This study aimed to investigate the value put on IUI and IVF treatments by communities in Iran and the affordability of services based on community preferences. A cost-benefit analysis (CBA) was performed based on the WTP approach, and the contingent valuation method (CVM) was used to estimate WTP for IUI and IVF using a researcher-made survey in two cities of Kerman and Isfahan, Iran, in 2016–17. The sample size was 604, and the study sample frame to estimate WTP included two groups of couples who were/were not aware of their fertility statuses. The costs of one cycle of IUI and IVF were calculated according to the treatment protocols, tariffs of 2016–17, and medical information records of patients. The mean direct and indirect medical costs of one cycle of IUI and IVF were equivalent to 19561140 and 60897610 IRR, respectively. Also, the mean WTP for IUI and IVF treatments were obtained of 15941061 and 28870833 IRR, respectively. The demand for IUI and IVF treatments was elastic and the community was sensitive to price changes of these treatment methods. IUI and IVF treatments brought no positive net benefits, and economic variables had the highest impact on the WTP and community preferences, indicating the significant role of financial constraints in the community's valuation for advanced infertility treatments in Iran.

That Which Was "Not": Some Thoughts Regarding Oedipus's Modern Conflicts

Historically, psychoanalysis has positioned the Oedipus complex as its focal point, based on a parental configuration of two-parent families consisting of a (male) father and a (female) mother. The modern era allows, albeit highly ambivalently, for the diversity of marital and parental configurations, reflecting cultural change as well as advances in the medical-technology of in vitro fertilization and of sperm and egg donations. The author discusses the analyses of two lesbian women who have chosen to mother a baby via an anonymous sperm donation. The author then takes up the question of whether unconscious oedipal conflicts influenced the decisions these patients made. She also questions whether the father in contemporary analytic thinking needs be a (male) "father" who is the "third," the "other." The work of Freud, Loewald, Searles, Poland, Ogden, and others will be brought to bear on these questions.

[Surrogacy in Maternity. A Depersonalising Human Relationship Phenomenology]

Ethical and bioethical problems, which are typical of the practice of surrogate motherhood, refer to its protagonists: the couple that orders it, due to its demand to satisfy the desire of paternity and maternity and the promptness of having a female body to fulfill its aspirations; the expectant mother, and the physical and psychic repercussions coming from the role performed in the surrogacy contract, as well as the risks of manipulation and exploitation, related to her position; the baby and his right to grow counting on the certainty of his parental relationships and on the preservation of his emotional balance. The human and anthropological importance of these issues, along with the growing development of this practice in the world, has questioned our moral conscience. In this context, the expectant mother, the weakest and the most affected part among the parts involved in the surrogacy contract, demands a particular attention. In this sense, the aim of this work is to lead a phenomenological analysis of the different steps of the practice of surrogacy, from the first stage of collection and classification of the information referring to the candidates, to the stage of the insemination and of its consequences about to the private life of the expectant. On the other hand, this work tries to justify the existence of a parallelism, as for the exploitation of the female body, between the practice of surrogate motherhood and prostitution. Finally, the issue relating to the effective social emancipation of the surrogate women in poor countries, the real autonomy and the freedom of their decision, as well as the typical features of the desire of paternity of the ordering couple are dealt with. The carried out study has allowed to conclude that this practice always implies a degree of physical, psychic and moral exploitation of the expectant mother, which suggests its prohibition at global level.

Effect of lifestyle on quality of life of couples receiving infertility treatment

This study investigated the effect of lifestyle on the quality of life among couples undergoing infertility treatment. The research universe consisted of 200 couples undergoing infertility treatment in Akdeniz University's Center of Reproductive Endocrinology and Assisted Reproductive Techniques. The data collection tools the authors used were a personal information form requesting sociodemographic characteristics and history of infertility, the SF-36 Quality of Life Scale, and the Healthy Lifestyle Behaviors Scale. This study revealed that the quality of life of the women in the study was lower than that of the men. The authors also found that the couples' quality of life was reduced by variables such as advanced age, low education level, unemployment status, lower income, long duration of infertility, high body mass index, history of andrological surgery, and previous experience of assisted reproduction techniques three or more times. Last, it was determined that the couples' quality of life improved as their healthy lifestyle behaviors increased. Demonstrating positive health behavior is likely to improve the quality of life of couples undergoing infertility treatment.

Psychological trait and state characteristics, social support and attitudes to the surrogate pregnancy and baby

BACKGROUND

Personality differences between surrogate mothers (SMs) who gestate and relinquish and intended mothers (IMs) who commission a genetically related or unrelated baby have been unexplored in the UK. Furthermore, the psychological effects of the arrangement have not been determined in a prospective longitudinal study, making this the first quantitative report of psychological functioning in SMs and IMs.

METHODS

SMs and IMs (n = 81: 61 surrogate, 20 intended) undergoing genetic or gestational surrogacy (4 groups) were assessed by postal questionnaire during the first, second and third trimesters of pregnancy. Those with a positive outcome were assessed again in the first week, at 6 weeks and 6 months post-delivery of the surrogate baby.

RESULTS

There were no significant differences between or within SM and IM groups on personality characteristics. Social support, marital harmony and state anxiety differed significantly (to P < 0.01) between SMs and IMs at different stages of the arrangement. Differences in attitudes towards the pregnancy and the baby were also observed between groups during pregnancy (to P < 0.001), but there was no evidence of post-natal depression amongst the groups studied.

CONCLUSIONS

These results are important because they demonstrate psychological effects of the surrogate arrangement are notable and occur over an extended period of time. It also shows that psychological screening and support prior to, during and following surrogacy is indicated.

Parental coping with sudden infant death after donor insemination: case report

We report the case of an artificial donor insemination couple experiencing sudden infant death of their 8-month-old child. Six months after the incident, the couple were investigated by means of an extensive interview, a repertory grid investigation and the Family Assessment Measure, as well as at 6 years after the incident by an extensive interview. The results show the importance of the diagnosis of male infertility and the preceding fertility treatment for coping with the death of their child. Six months after the incident, acute feelings associated with bereavement are mixed with feelings of anger and shame, apparently due to the experience of infertility. However, secrecy and shame associated with male infertility and donor insemination make it impossible for the couple to communicate their feelings to each other or to friends and relatives; furthermore, they decline psychological counselling. Repertory grid investigation and the Family Assessment Measure point to significant problems within the partnership. Six years after the incident, the couple's relationship is destabilized and both partners plan to divorce. We suggest a possible link between donor insemination secrecy and difficulties with coping. We discuss implications for couple counselling and emphasize the necessity for an improved legal framework for donor insemination in Germany.

Why do children want to know more about the donor? The experience of youngsters raised in lesbian families

In this study, we focus on the donor origin of youngster who are raised in lesbian donor insemination (DI) families. The aim was to explore why some of these DI children like to know more about the donor while others do not, these data were gathered by means of a semi-structured interview. Secondly, we investigated, by means of several questionnaires, whether psychological variables such as global self-esteem, emotional and behavioral adjustment and children's perception of the quality of the parent-child relationship were in some way linked to whether or not they wanted to know more about the donor. In our study the majority of the children who preferred to have no information about the donor expressed their loyalty towards the social mother. For the majority of the children who opted for donor information, curiosity was the most salient motive. No differences were found with regard to the psychological variables between the two groups considered. In conclusion, the wish to know more about the donor or the absence of such a need is not reflected in the child's well-being and is not linked to the quality of the parent-child interaction.

Family functioning in lesbian families created by donor insemination

The quantitative and qualitative data of this study on family functioning in lesbian donor insemination families reveal that according to both parents and children, the quality of children's relationship with the social mother is comparable to that with the biological mother. Unlike fathers in heterosexual families, the lesbian social mother is as much involved in child activities as is the biological mother. Furthermore, the lesbian social mother has as much authority as does the father in heterosexual families.

[The emotional burden of artificial insemination: increased anxiety and depression following an unsuccessful treatment]

OBJECTIVE

Determination of the emotional burden of the first IVF or ICSI treatment cycle, the effect of the treatment on the marital relationship, and the course of the treatment following a failed and a successful first attempt.

DESIGN

Descriptive longitudinal study with repeated measures before and after the first treatment cycle.

METHOD

240 women and 219 men filled in questionnaires both before and after the first treatment cycle in the area of anxiety, depression, and the marital relationship (as measured with the 'Spielberger state trait anxiety inventory' (STAI), the 'Beck depression inventory for primary care' (BDI-PC) and the 'Maudsley marital questionnaire' (MMQ), respectively), as well as their plans for further treatment.

RESULTS

After a first failed treatment cycle, both women and men showed an increase in depression, while women also showed increased anxiety. No differences were found between pre- and post-treatment levels of anxiety and depression after a successful treatment. After the first failed cycle, almost 13% of the women showed clinically relevant forms of depression. There was an increase in dissatisfaction with the sexual relationship in both men and women regardless of the success of the treatment. Before the start of the first treatment cycle, 2% of the couples had no intention to undergo further treatment if the first cycle failed; none of these couples started a new cycle. Ultimately, 18% of the couples refrained from further treatment following a failed first treatment cycle.

CONCLUSION

After a failed first treatment cycle the couples showed an increase in depression and one in eight women had a clinically relevant form of depression. More than one out of every 6 couples decided to refrain from further treatment after a failed first cycle.

Evaluations of emotional reactions and coping behaviors as well as correlated factors for infertile couples receiving assisted reproductive technologies

The purpose of this research was to explore the following objectives for infertile couples receiving infertility treatment: Differences between wives and husbands in their emotional reactions and coping behaviors. This research, using structured questionnaires, was based on 120 infertile couples attending the Intrauterine Insemination (IUI) or the In Vitro Fertilization-Embryo Transfer (IVF-ET) program. The research instruments consisted of Demographic Data Form, Profile of Mood States (POMS), and Ways of Coping Questionnaire. The research results showed that infertile wives experienced more emotional disturbance than husbands did, as shown in the four subscales of Tension-Anxiety, Depression-Dejection, Anger-Hostility, and Fatigue-Inertia, as well as the total scale of POMS. It was also shown that wives adopted more coping behaviors to deal with infertility and treatment than husbands did, as revealed in the subscales of Self-Controlling, Seeking Social Support and Escape-Avoidance and the total scale of the Ways of Coping Questionnaire. All of the above reached significant statistical differences. The emotional reactions of infertile couples varied with the differences in education levels, duration of treatment, number of treatments received, and numbers of existing children. The emotional reactions of infertile husbands had a significantly positive correlation with the factors Confronting, Accepting Responsibility, and Escape-Avoidance. The emotional reactions of wives had a significantly negative correlation with Positive Reappraisal. The research results can provide clinical staff with a correct understanding of the differences between husbands and wives in emotional reactions and coping behavior, as well as related factors, to help them to provide better medical treatment.

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'.

Lessons from a recent adoption study to identify some of the service needs of, and issues for, donor offspring wanting to know about their donors

This paper draws on some of the major findings of a recent large-scale study of over 400 adult adopted people, who either searched for origins information or were sought out by birth relatives, to identify the potential profile of donor offspring seeking origins information. It is predicted that more women than men will search, that people who search will be in their twenties or older, and that the age at which searching begins may be delayed by the effects of the social stigma attached to gamete donation and by the greater likelihood of accidental disclosure in adulthood resulting from the higher incidence of secrecy about donor assisted conception. Two of the single triggers for adopted people to begin searching (as opposed to multiple triggers) - becoming a parent and the death of adoptive parents - may also be among the triggers for donor offspring to begin searching. The search may be complicated further when undertaken after accidental disclosure. Finally, it is argued that some donor offspring will experience a normative urge for identity completion and seeking relationships similar to that experienced by adopted people. This urge may stem from the fact that some donor offspring attach an identity to their donor that extends beyond needing factual details about their physical characteristics (though not necessarily a desire to establish a relationship). Some donor offspring are likely to encounter a desire for face-to-face contact, regardless of whether a face-to-face meeting was the original intention. The need for services to help donor offspring, donors, family members and others affected by the situation is identified.

To tell or not to tell--what parents think about telling their children that they were born following donor insemination

Pioneering legislation regarding donor insemination was introduced in Sweden in 1985. The law gives the child, upon reaching sufficient maturity, the right to obtain information about the donor and his identity. One hundred and forty-eight Swedish couples with children conceived through donor insemination after the law was introduced have answered questions about disclosure and donation in a questionnaire. This article addresses the reasoning employed by individual couples in their decision whether or not to inform the children about their origin. Parental reflections on their decision and the children's reactions to receiving this information are also presented. Five categories of parental arguments are reported. These included 'reasons to tell', 'reasons not to tell', 'reasons why the question about telling or not would not be answered at all', 'inconclusive types of reasoning, that can still influence the fundamental decision' and 'context-dependent reasons associated with actual circumstances'. Through this meta-classification of arguments it was possible to identify clues to how professionals could facilitate parental decision-making and promote disclosure. Parents who had informed their children did not regret their decision. All of the parents who responded to the question of whether it had been beneficial to the child to tell answered 'yes'.

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.

Social versus biological parenting: family functioning and the socioemotional development of children conceived by egg or sperm donation

By investigating egg donation families, donor insemination families, adoptive families, and families created by in vitro fertilization, the aim of the present study was to examine parents' emotional well-being, the quality of parenting, and childrens' socioemotional development in families with a child who is genetically unrelated to the mother or the father. The differences that were found to exist between families according to the presence or absence of genetic ties between parents and their children reflected greater psychological well-being among mothers and fathers in families where there was no genetic link between the mother and the child. The families did not differ with respect to the quality of parenting or the psychological adjustment of the child.

Effects of adoptive status on evaluations of children

The authors examined whether being adopted or semi-adopted (born of artificial insemination with donor sperm and genetically linked to the mother but not to the social father) is a stigmatizing attribute affecting evaluations made of a child, and whether the gender of the rater moderates the effects of adoptive status on evaluations of children. Participants included 129 undergraduate students from the United States who were presented with written scenarios describing a child's adoptive status. They were asked to evaluate the child on a number of attributes. Results showed that adoptive status did not affect evaluations of children, although rater gender moderated the effects of adoptive status.

Secrecy, anonymity, and deception in donor insemination: a genetic, psycho-social and ethical critique

The number of medically assisted conceptions involving donors is increasing. At the same time, due to advances in medicine, greater emphasis has been placed on an individual's genetic origins. This trend places individuals who have no access to information on their genetic origins in a vulnerable position. Because of the secrecy and anonymity that has surrounded donor inseminations, many individuals who were so conceived are irreversibly cut off from any possible contact with or even knowledge about their genetic fathers, who will also never have the opportunity to meet their offspring. In view of the accumulated evidence concerning the detrimental effect of secrecy, anonymity and deception in donor insemination, this paper argues that these practices are not only psychologically and socially harmful but also ethically unacceptable.

Disclosure issues and decisions of couples who conceived via donor insemination

Disclosing the use of donor insemination (DI) to family, friends, and offspring poses a quandary for many DI patients. A cross-sectional survey was conducted to determine whether couples opted to share information about conception via donor sperm with their children, as well as the issues and concerns that arose for parents once infertility treatment was completed. Twenty-seven married heterosexual infertile husbands and wives who had used DI to conceive completed a follow-up questionnaire asking them about disclosure decisions as well as thoughts about DI as a reproductive option. Results revealed that nearly three-quarters of the sample had not disclosed to their child and did not plan to, although 85% had told at least one other person about conception via DI. With few exceptions, husbands and wives agreed about how to handle disclosure. Notably, 32% of the mothers reported not knowing when or how to disclose. However, the majority of couples were not offered psychological counseling prior or subsequent to DI. It is suggested that mental health professionals should be aware of the divergence of opinion between what they believe about the benefits of disclosure/counseling, the beliefs of infertile couples about disclosure and what is actually known about the benefits of full disclosure among all involved parties.

Identity, genealogy, and the social family: the case of donor insemination

In this paper I discuss whether or not biographical information concerning the sperm donor should be disclosed to children conceived through donor insemination. Policies of disclosure for example in the context of adoption, have been justified on the basis of a notion of identity which emphasizes genetic ties. This notion of identity and the policies of disclosure of information concerning biological parents based on it, have been criticized by many writers, including feminists, as reinforcing explanations of human organization and development based on biological determinism rather than on ideas such as social construction. Further, this notion of identity is seen to emphasize the importance of genetic parenthood over the commitment involved in bringing up a child as a social parent. While agreeing with these criticisms of that particular notion of identity, I argue that the notion of identity as a whole should not be summarily rejected. Rather, it should be re-interpreted using a sociological approach incorporating the notion of narrative. This second narrative notion of identity is developed with reference to the situation of some groups of children, who like those born from donor insemination, generally do not have any knowledge of their biological parent[s], for example adoptees, the children of the disappeared in Argentina and child migrants. In this paper, policies of disclosure which allow these children to gain some knowledge of their biological parents are discussed in light of the two notions of identity. It is argued that disclosure may be justified on the basis of a narrative notion of identity. This allows for the rigid dichotomy created between biological determinism and social construction: the importance of social parents to the child is emphasized, however the desire a child may have to know something about her or his biological parent is not denied or dismissed.

Telling donor insemination offspring about their conception: the nature of couples' decision-making

The issue of openness and secrecy in the use of donor gametes is the subject of considerable disagreement and debate, not only for social scientists and health professionals, but also for the recipients of donor gametes. This paper has its origins in a study of 58 couples who had a child/children as a result of donor insemination (DI) at the Dunedin Infertility Clinic. Respondents completed questionnaires and took part in an interview during which they were asked whether they intended to tell their offspring about their DI conception. The nature of agreement/disagreement between partners on this issue, the dynamics operating between couples that may affect decision-making, and the views of couples in a time-frame perspective are the focus of this paper. Transcripts from some of the interviews are presented to illustrate the points made and commentary and discussion is provided.

Information sharing in donor insemination: a conflict of rights and needs

It is now 110 years since the first reported medical use of donor insemination (DI). Despite its somewhat doubtful beginnings and its chequered history, especially up until the 1970s, DI has become a well accepted and utilised part of most infertility treatment services. An American survey in 1988 reported that approximately 80,000 women a year undergo the procedure, and that over 30,000 children are born each year. The only figures from the United Kingdom cover a 5-month period between August 1 and December 31, 1991, and show that 4,260 patients were treated with DI during this period. The treatment was carried out in 85 different centres.

[Maternity, sterility and reproduction technology]

The idea of maternity--and paternity as well--reaches far beyond the field of biological reproduction inasmuch as it implies a subject's desire, besides being regulated by the symbolic order: Language, myths, patterns and values of a given culture. From this point of view, infertility cannot be considered as a mere somatic illness, but as a human problem implying psychological and social aspects that require a search for solutions unlikely to be reduced to a sole medical operation. The development of the new reproductive technology is in keeping with the increasing medicalization of human lives, human sexuality, and human bodies.

The relationship between sex role and emotional functioning in patients undergoing assisted conception

It is suggested that infertility may be distressing because it results in an inability to fulfil traditional roles and thus those individuals who adhere to traditional sex roles may be more distressed by the experience of infertility. In order to examine the relationship between sex role and emotional well-being in infertility patients, 58 women attending a clinic for assisted conception procedures and 31 of their male partners completed questionnaires assessing sex-role type (i.e. masculine, feminine, androgynous or undifferentiated) and emotional, marital and sexual functioning. Women with a traditional feminine sex-role type were more anxious than those with a masculine sex-role type but there were no differences in depression or marital or sexual functioning. Men with an undifferentiated sex-role type were more anxious and depressed than those with other sex-role types. The findings are discussed in terms of the relationship between sex role and infertility, previous research into sex differences in distress amongst infertility patients, and the problems associated with measuring distress.

Artificial insemination: can appropriate stimulation improve success rates?

Studies of other animal species suggest that stimulation during copulation has important effects on the probability of conception. Thus appropriate stimulation during artificial insemination may improve rates of conception.

Attitudes of donors and recipients to gamete donation

An anonymous questionnaire was circulated at two gamete donation clinics to survey the attitudes of donor insemination patients (n = 71; 89% response rate), sperm donors (n = 52; 85% response rate) and ovum donors (n = 5; 63% response rate) to the release of medical records with non-identifying information, or with identifying information of the donor involved. The majority of established sperm donors agreed to the release of medical records with or without identifying information. In the subset of potential sperm donors 85% would not enter a sperm donation programme unless anonymity was maintained, but 60% would agree to the release of non-identifying medical records. Sixty per cent of recipients of donated spermatozoa would agree to the release of medical records with identifying information of the donor, but 85% stated that they would not tell their children of their genetic origin. There is a significant difference between the attitudes of potential sperm donor recruits to these questions and those of established donors and recipients of donated spermatozoa. In conclusion, the results of this survey show that although established sperm donors would continue to donate spermatozoa if their status of anonymity was withdrawn, recruitment of new donors would be significantly reduced. This would be to the detriment of gamete donation programmes and to the subfertile couples who request this form of treatment.

Pregnancy outcome, health of children, and family adjustment after donor insemination

We evaluated the pregnancies of 427 women who conceived through artificial insemination by donor (AID) at our clinic over a 12-year period. Initial phone contact was followed by a questionnaire. Outcome was known for 594 of the 606 pregnancies, with a total of 502 live-born children including 15 sets of twins. The spontaneous abortion rate was 16.5%, with no difference between fresh- and frozen-semen pregnancies. Significant correlations were found between spontaneous abortion rate and maternal age (P less than .001) and spontaneous abortion rate and cycle of conception (P less than .025). Follow-up was completed on 481 children, among whom the following were found: one chromosomal anomaly, 22 major congenital anomalies, four children with possibly syndromic conditions, and 38 with minor congenital anomalies. Of the school-aged children, 5.8% had recognized learning disabilities and 10.5% were considered gifted by their schools. We also investigated the psychological impact of AID on each family. The majority of couples (71.7%) informed their obstetricians of the AID. Half of the couples did not tell any family or friends. Many couples did not (47%) or probably did not (14%) plan to tell their children of their origins. The divorce rate among those with AID children was 7.2%, which was significantly less (P less than .01) than that in a matched population. Psychological counseling specifically related to AID was sought by 2.8% of the couples. We conclude that AID children are at similar risk for congenital anomalies as normally conceived children, but they experience lower rates of family dissolution.

Gynecological and childbearing needs of lesbians

This descriptive study explored how self-identification as lesbian ("coming out") affected gynecological and childbearing needs and experiences. Twenty interviews were conducted using a researcher-designed interview schedule. The majority of lesbians disclosed their sexual/affectional identity to providers ostensibly to negate heterosexual assumptions. Fear and the unpleasantness of coming out influenced the majority to postpone gynecological care or to seek lesbian-sensitive providers. Half of the participants had gone to ob/gyn appointments accompanied by the partner. Traditional health history questions about marital status, sexual activity, and birth control elicited inaccurate information from participants. Participants believed important qualities in providers to be: sensitivity, knowledge about lesbian sexuality, and female gender. Providers need to learn clues of lesbian identification or coming out; they should also strive to use inclusive gender words and remove heterosexual assumptions. Seventy percent of participants desired children; alternative insemination was an accepted method of conception to most. Midwives can play a special role with lesbians desiring pregnancy and children.

[Value hierarchy in semen donors with respect to motivating factors in their personality]

The author uses the assumption that the hierarchy of values provides the picture of the cognitive and emotional maturity of the subject, that it informs on his personality traits and forms his moral background and lifestyle. The majority of his decisions is shaped by motivating factors where vital needs and values are decisive. The submitted paper contributes to the recognition of the motivation of the decision to become a donor of semen and to the recognition of personality traits of the donors. A group of eighty donors is compared with a matched-pair group of men refusing to become donors. From spontaneously reported vital needs and values the author elaborated a hierarchical system used for comparison of the two groups as well as social sub-groups of these groups classified according to the education of the subjects (primary education, secondary education, university graduates and students). No substantial difference was found between donors and men in the control group. In donors there is a more pronounced trend towards altruistic forms of behaviour, a more responsible attitude to health whereby they conceive children as a predicate of a healthy family. Personality traits of donors are from this aspect very positive. This is most marked in the group of university students.

Attitudinal survey of sperm donors to an artificial insemination clinic

Donors (n = 42) to an artificial-insemination-by-donor sperm clinic were surveyed to ascertain individual motivations and attitudes regarding participation. Responses were compared to those of a matched control group (n = 50) of nondonors. Donors were motivated by money, with the majority (69%) unwilling to participate if financial incentives were withdrawn. Anonymity was desired, and donors did not favor disclosure of information to a national registry tracking insemination outcomes. However, donors and controls did endorse providing sperm for an infertile brother. Donors and controls differed significantly in response to 2 of 15 questions asked, with differences due to perceptions of donor motivation. Although perceived as altruistic by peers, donors did not envision themselves as such, and most considered donating semen similar to donating blood or organs.

The health experience of single women who have children through artificial donor insemination

Little is known about the health care needs of single women who decide to have children through artificial insemination. An exploratory qualitative research study was conducted to investigate this health experience. A case study design was used, consisting of two single women who had children through artificial donor insemination. Results suggested that the decision to have donor insemination was made after a lengthy process of considering multiple factors. The subjects' relationships and roles were affected, as were future goals and aspirations. Personal perspectives of self-enhancement were evident and feelings of aloneness and vulnerability. Health care needs that can be met by the clinical specialist were identified with emphasis on the decision counseling, direct care, educative, and leadership aspects of this nursing role. Directions for future research were proposed.

Survey of attitudes regarding the use of siblings for gamete donation

We conclude that the acceptability of using a sister for gamete donation is high among couples desiring ovum donation. On the contrary, couples undergoing AID generally rejected the concept of using the husband's brother as a known donor. Thus, although similar in concept, disparity exists regarding the use of siblings for gamete donation. Though the use of sibling gamete donation may provide a short-term solution to the dwindling supply of acceptable gamete donors, the long-term acceptability of such practice remains unknown.

Effect of artificial insemination with donor semen on the psyche of the husband

It has been argued that artificial insemination with donor semen (AID) can be detrimental to the psyche of the sterile husband. This issue has been scrutinized on a larger scale empirical basis using four groups of husbands whose wives were either pregnant due to AID or were under AID without being pregnant yet or were pregnant without AID or were assumedly fertile without being pregnant. Psychometric data was obtained of the corresponding husbands. The results indicate that AID is no threat to the husbands of all groups. Infertile men do not seem to be a psychological risk group. Fertile men tend to reject AID.

Artificial insemination using donor semen and the issue of secrecy: the views of donors and recipient couples

The issue of secrecy and artificial insemination using donor semen has psychosocial, moral and legal implications. These implications are explored within the context of New Zealand AID practice, and particularly, recent legislation aimed at clarifying the status of the child. The results of two studies, one covering 37 donors involved in six AID programmes and the other covering 55 couples who had been accepted into one of the same six programmes, insomuch as they relate to issues of secrecy, are reported. Recipient couples and donors, while thinking that secrecy is important, have told other people-a not dissimilar situation to what occurred in the adoption field 25 years ago. Forty-one per cent of recipient couples and donors do not believe children should be told of their origins. A high 46% of couples had not yet decided if they would tell their child. Donors are almost equally divided over the child's right to non-identifying information about them. Donors are more likely than recipient couples to believe that the child who knows s/he has been conceived via AID will want information about them. Only 11% of donors and 5% of couples believe a child would want to know the identity of the donor, although for three quarters of both groups the issue is far from clear. Donors were not as opposed to the possibility of tracing occurring as some doctors suggest. Response to questions concerning the legal position suggests there is considerable confusion amongst both groups. The overwhelming majority of couples were intending to place the husband's name on the birth certificate, regarding him as the father.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitudes towards donor insemination--a post-Warnock survey

In a multi-centred study, a total of 799 patients, donors and health-care professionals concerned with artificial insemination with donor semen (AID) responded to a questionnaire regarding their attitudes towards current provision of AID services and proposed legislation. There was little support for any fundamental change in the way in which AID is practised, at least in those centres. The anonymous status of the donor met with universal agreement. Although there was some support for the communication of non-identifying details to the recipient couple, where they wanted them, there was no support for any legislation which might give the AID child a right of access to details of the donor. The greatest divergence of opinion was over the question of who should have access to AID treatment and whether or not screening procedures should be applied to prospective parents. Most respondents felt that the closed and confidential relationship between the clinic and the other parties involved should not automatically be extended to general practitioners or any national bodies. In respect of specific recommendations of the Warnock Committee, there was support for changes which might legitimize or assist the present system, but not for any which might be restrictive.

The prospect of surrogate mothering: clinical concerns

There have been, in the last decade, approximately 500 surrogate births in the United States and the demand is increasing. The average cost is $25,000 and as there is no regulatory legislation in place, each arrangement is covered by a private legal contract. There is little reliable data regarding any member of the "incubating family", or on the adopting couple. This paper is an attempt to point out the potential hazards, based on a theoretical and clinical appreciation of child and adult biopsychosocial processes. The authors advocate careful longitudinal study of all children and adults involved in this complex reproductive alternative.

[Catamnestic study of 96 couples with heterologous insemination]

96 couples who had made an artificial insemination with donor sperm within 1968 and were interviewed in 1984, regardless whether the treatment was successful or not. The aim of the inquiry was to see how the partnership and the children developed as well as the actual feeling of the decision made. Three groups resulted which can be compared with each other: a) couples with successful treatment and children conceived by artificial insemination, b) couples with unsuccessful treatment by artificial insemination and consequent adoption of a child, c) couples with unsuccessful treatment by artificial insemination and without adoption of a child. 63 (65.6%) had at least one conception. 68 children were born to 55 couples. In the case of 9 men a normal conception took place after completion of the treatment. About 10% became divorced in the groups a and b and about 35% in group c. No couple regretted the treatment. The fathers of the divorced couples experienced themselves as fathers. The development of the children conceived in artificial insemination with donor sperm has not been showing any signs of unusual disturbances.

Semen donors in New Zealand: their characteristics and attitudes

The characteristics and attitudes of 37 semen donors in six New Zealand AID programmes are reported. Donors were found to be highly educated and, as a result, in predominantly professional and technical fields. The major reason for being a donor was altruism--a desire to help infertile couples, although financial considerations were a factor for almost one-quarter of the respondents. The attitude of donors towards payment differs markedly from the attitudes of specialists providing AID services. Personal knowledge of infertile couples was found to be a factor leading one-quarter of the donors to offer their services. There is a wide variation in the number of times that some donors are asked to donate, with some specialists operating outside the guidelines produced by the Royal New Zealand College of Obstetricians and Gynaecologists. Donors are almost equally divided on the issue of the child's right to know of the nature of her/his conception. Almost one-quarter of donors would still donate if there was a possibility that they could be traced in the future and a further 30% were unsure. These findings challenge some of the traditionally accepted views about the need for donor anonymity. It was found that 39% of donors expressed an interest in knowing the outcome of their donations. The results of the study have implications for policy and practice issues associated with the psychosocial aspects of AID. One implication is that it seems important that the psychosocial needs of donors be considered and that programmes should be flexible in responding to the differing attitudes, expectations, and needs of donors.

Complexity of motivation for artificial insemination by donor

A thorough evaluation of underlying motives for a decision by patients to make use of artificial insemination by a donor as a possible solution for the problem of involuntary childlessness as result of the male factor, should be a necessary prerequisite for the use of this procedure. In such a situation, an external factor (semen of an anonymous donor) is introduced to a complex dyadic system which is particularly susceptible to emotional stress. The implications of various less conspicuous but extremely important motives in the behaviour of such patients are stressed.