Anonymous oocyte donation: a follow-up questionnaire

Exploring the knowledge and attitudes of women of reproductive age from the general public towards egg donation and egg sharing: a UK-based study

STUDY QUESTION

What are the knowledge and views of UK-based women towards egg donation (ED) and egg sharing (ES)?

SUMMARY ANSWER

Lacking knowledge of the practices of ED and ES could be an influential factor in donor egg shortages, rather than negative perceptions or lack of donor anonymity and financial incentives.

WHAT IS KNOWN ALREADY

The increasing age of women trying to conceive has led to donor egg shortages, with ED and ES failing to meet demand. Indeed, in recent years in the UK, ES numbers have fallen. This results in long waiting lists, forcing patients abroad for fertility treatment to take up cross border reproductive care. Previous research suggests a lack of knowledge of ED among members of the general public; however, no study has yet assessed knowledge or views of ES in the general public.

STUDY DESIGN, SIZE, DURATION

Six hundred and thirty-five UK-based women over 18 years were voluntarily recruited from social media community groups by convenience sampling. The recruitment period was from February to April 2020.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Participants completed a previously validated questionnaire regarding female fertility, ED and ES, including knowledge, perceptions and approval of the practices and relevant legislation. This included ranking key benefits and issues regarding egg sharing. The questionnaire was completed using the online Qualtrics survey software. Statistical analysis was conducted using SPSS.

MAIN RESULTS AND THE ROLE OF CHANCE

Regarding knowledge of ED and ES, 56.3% and 79.8%, respectively had little or no prior knowledge. Upon explanation, most approved of ED (85.8%) and ES (70.4%). A greater proportion of respondents would donate to a family member/friend (49.75%) than to an anonymous recipient (35.80%). Overall, ES was viewed less favourably than ED, with ethical and practical concerns highlighted. Women aged 18-30 years were significantly more likely to approve of egg donation practice compared to those aged >30 years (P < 0.0001). Those against ES found fears of financial coercion or negative psychological wellbeing the most concerning. About 35.8% and 49.7% would personally consider anonymous and known ED, respectively, whilst 56.7% would consider ES. Those answering in favour of egg sharing were significantly more likely to give higher benefit ratings compared to those against the practice (P < 0.001). Most agreed (55.8%) with and were not deterred to donate (60.1%) by the 'Disclosure of Donor Identity' legislation. Only 31.6% agreed with the compensatory cap; however, 52.7% would not be more motivated to donate by an increased cap.

LIMITATIONS, REASONS FOR CAUTION

There were several limitations of the study, including the use of convenience sampling and the voluntary nature of participation opening the study up to sampling and participation bias. Finally, closed questions were predominantly used to allow the generation of quantitative data and statistical analysis. However, this approach prevented opinion justification and qualitative analysis, limiting the depth of conclusions drawn.

WIDER IMPLICATIONS OF THE FINDINGS

To our knowledge, this is the first study to survey the general public's knowledge and views of ED/ES using a previously validated questionnaire. The conclusion that lack of knowledge could be contributing to the current donor shortfall in the UK demonstrates that campaigns to inform women of the practices are necessary to alleviate donor oocyte shortages.

STUDY FUNDING/COMPETING INTEREST(S)

No external funds were used for this study. The authors have no conflicts of interest.

TRIAL REGISTRATION NUMBER

NA.

A mental health intervention program for the oocyte donors: protocol for a mixed methods study

BACKGROUND

Oocyte donation is one of the assisted reproductive techniques that can undermine the mental health of the women donor. As such, the aim of this study is to design a mental health promotion program for oocyte donors.

METHODS

This is an exploratory mixed methods study (qualitative-quantitative) that consists of three phases. In the first phase, a qualitative study will be conducted to identify the needs and strategies of the mental health promotion program for the women donors. In this phase, the participants will be selected using purposeful sampling method and the data will be collected through semi-structured interviews. In the second phase, the initial draft of the program is designed and validated in the panel of experts and using the classic Delphi technique and, then, the program is finalized. In the third phase, the designed program will be implemented as a quasi-experimental study in two groups of program recipients (intervention) and control, and the effectiveness of the intervention program will be evaluated.

DISCUSSION

In order to design a documentation-based mental health promotion program for the oocyte donors, their experience during the process of oocyte donation should be evaluated. Doing so, the program will be developed based on the specific circumstances of the target population and their social and cultural context and, hence, will have the highest impact.

Egg donors' motivations, experiences, and opinions: A survey of egg donors in South Africa

The objective of this study was to gain information from egg donors in South Africa (SA) which could be pertinent to policy development on egg donation. The study was conducted on egg donors in the database of a Cape Town-based egg donation agency who donated within a year preceding the study. 150 egg donors from the population of 226 participated in an online survey. The main results are: 95% of respondents experienced egg donation as being positive. However, 7% of respondents report not giving proper informed consent, and a similar percentage of respondents also report not knowing whether any medical risks actually materialised as sequelae to their donations. This is a cause for concern and should be investigated further. Regarding donor anonymity, which is currently the legal position in SA, 79% of respondents indicated that they would still have donated had they been legally required to release their identities. Accordingly, possible legal reform away from the current system of donor anonymity seems unlikely to significantly impact the supply of donated eggs. Regarding motivation, respondents report being primarily motivated by wanting to help infertile women. However, respondents believe that a fair and realistic amount of compensation would be about 60% higher than what is currently paid as the national standard fixed amount. This fixed-amount compensation system should be further investigated in terms of its legality, impact on donor profile, and its current amount.

Being an identity-release donor: a qualitative study exploring the motivations, experiences and future expectations of current UK egg donors

The objective of this study was to examine the motivations, experiences and future expectations of identity-release egg donors in the UK following the removal of donor anonymity and the increase in financial compensation for egg donation. This exploratory, in-depth qualitative study comprised semi-structured interviews with 11 women who had attended an egg donation screening appointment at a UK clinic during a four-month period in 2014. Interviews were conducted two to six weeks after the woman had donated or had withdrawn/been rejected from the donation process. Participants' primary motivation for donating was to help infertile women have their 'own child', and the recent increase in financial compensation did not seem to play a significant role in their decision. All were happy to be identifiable and contacted by children born as a result of their donation. However, some were hesitant about providing non-identifying information about themselves for these offspring and wished for further information about the recipient(s) of their eggs and the outcome of their donation. Whilst this study was limited due to the small sample size, it is the first study of UK egg donors following the rise in donor compensation and suggests that other strategies may be more effective in increasing donor numbers.

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.

[Are patients in the postpartum period potential egg donors?]

OBJECTIVES

In France, oocyte donation program is still underdeveloped because of lack of donors and this situation entails an important wave of cross border medical tourism to different European countries mainly Spain and Greece. In 2011, the General inspection of social affairs report recommended to the biomedicine agency to promote spontaneous oocyte donation via different channels of information to develop this national program. The main objective of this study is to assess the knowledge of women after baby delivery about oocyte donation. The second objective is the identification of ways to assure better information and to promote oocyte donation.

PATIENTS AND METHODS

We conducted a prospective study with anonymous questionnaire distribution to women after delivery at obstetrics/gynecology department of the Regional University Hospital and Maternity-Children Unit "Victor-Pauchet" of Amiens, from December 2012 to January 2013.

RESULTS

Two hundred and fifty-five questionnaires were distributed and 242 of them were analyzed (94.9%). About oocyte donation knowledge: 28% did not know it was possible, 45% did not know it was legal in France, 54% did not know who was concerned and 36% know that a treatment is necessary, 9% think that oocyte donation is paid and 10% it is non-anonymous. If 67% seems to be favorable to this initiative, only 35% could accept to realize it. About information efficiency, 88% think not to receive enough information, 64% would like to have more information. The health care professional wanted to give this information is an obstetrician (51%), a midwife (37%) and a nurse (12%).

DISCUSSION AND CONCLUSION

Oocyte donation program is misoriented due to a lack of information. Obstetricians and midwives have an important educational and informative role to support oocyte donation. Specific strategy of communication and valuable targeted information are needed to motivate potential donor and achieve the objectives of the program.

Gamete donors' satisfaction; gender differences and similarities among oocyte and sperm donors in a national sample

OBJECTIVE

To explore oocyte and sperm donors' emotional stress, experiences of care and satisfaction after donation.

DESIGN

Prospective multicenter study.

SETTINGS

All fertility clinics performing gamete donation in Sweden during the period 2005 to 2008.

POPULATION

Of 220 eligible oocyte donors who were approached, 181 agreed to complete the first questionnaire and 165 completed the second questionnaire 2 months after oocyte donation. Of 156 eligible sperm donors 119 accepted to complete the first questionnaire before donation. Eighty-nine participants completed the second questionnaire 2 months after sperm donation.

METHODS

Standardized and study-specific questionnaires.

MAIN OUTCOME MEASURES

Satisfaction with the donation, respondents' mental health and overall care.

RESULTS

A larger percentage of sperm donors (97.8%) were satisfied with their overall experience of being a donor than oocyte donors (85.9%, p = 0.003). Some oocyte and sperm donors did not receive sufficient information about practical issues (9.1% and 13.5%, respectively) and future consequences (12.8% and 3.4%, respectively, p = 0.014). The donors' symptoms of anxiety and depression did not show any differences in relation to negative or positive perceptions of satisfaction. The donors who did not indicate ambivalence before treatment were on average almost five times more satisfied compared with those who did indicate ambivalence (odds ratio 4.71; 95% CI 1.34-16.51).

CONCLUSIONS

Most donors were satisfied with their contribution after the donation. Oocyte and sperm donors who expressed ambivalence before donation were less satisfied after donation. In vitro fertilization staff fulfilled most of the donors' needs for information and care.

Survey report of gamete donors' and recipients' preferences regarding disclosure of third party reproduction outcomes and genetic risk information

AIM

Issues surrounding egg donation informed consent have recently been spotlighted due to advances in medical genetics. We sought information on attitudes and desires of donors and recipients to craft a program policy on counseling, disclosures, and re-contacting participants.

METHODS

Between April 2003 and September 2006 we conducted a questionnaire-based evaluation in our oocyte donor program. Donors pre-donation (n=265) and those undergoing the process (n=60), and recipients either ante- or postpartum (n=57), were asked about their desire to know/disclose obstetric outcomes (Question 1); willingness for contact in the event of a medical emergency (Question 2); and wish to know/disclose a liveborn's medical condition (Question 3).

RESULTS

Pre-donation questioning among all donors generally revealed reticence to Question 1 (31% [n=83]), but were overall amenable with Questions 2 and 3 (83% [n=220] and 83% [n=219]). Following the donation process, no differences in Questions 1 and 2 were noted, but fewer donors were amenable with Question 3 (pre-donation 93% [n=56] versus post-donation 38% [n=23]; P<0.01). Overall, recipients were amenable to all three questions (88% [n=50], 74% [n=42] and 88% [n=50]), with similar responses both ante- and postpartum.

CONCLUSION

All programs participating in gamete donation should establish a comprehensive disclosure policy, including consents that are built upon effective lines of communication between clinical staff and legal counsel assuring that parentage, relinquishment, and re-contact information in donor-recipient agreements are consistent with clinic consent documents and desires of both parties; All decisions must be adequately documented and honored and long-term counseling needs should be addressed.

'I feel like they were mine and I should be looking after them': an exploration of non-patient women's attitudes towards oocyte donation

The aims of this study were to qualitatively assess the meaning of oocytes and oocyte donation for treatment and research among non-patient women in the UK using Interpretative Phenomenological Analysis. This study also assessed the application of components of the Theory of Planned Behaviour (TPB) in intentions and attitudes towards oocyte donation. Eight parous and nulliparous women from White and South Asian backgrounds, who reported no fertility problems, were interviewed. Four interrelated super-ordinate themes were identified: (1) oocytes as 'Just a cell' and 'Potential life'; (2) oocyte donation as 'Altruism' and 'Not normal behaviour'; (3) 'Importance of motherhood' and the 'Importance of a genetic link'. Ethnic differences were observed in the final theme (4) which identified the importance of 'Social Support' and 'Reproductive Control' in women's discourses of oocyte donation. Analysis revealed participant's beliefs and thoughts about oocyte donation were complex, interwoven and paradoxical. Previous quantitative studies that have assessed components of the TPB in relation to oocyte donation have failed to identity important alternative explanations of oocyte donation and subtle complexities in attitudes.

Gamete donors' and recipients' evaluation of donor counselling: a prospective longitudinal cohort study

BACKGROUND

Those considering donating or receiving gametes are required to undergo counselling to ensure that they are aware of and consider the psychosocial, emotional and ethical complexities of donor conception before proceeding.

AIMS

The aim of this study was to evaluate gamete donors' and recipients' views about donor counselling and beliefs about disclosure of the use of donor gametes to conceive, before and after attending counselling.

METHOD

All donors and recipients and their partners who attended donor counselling at Monash IVF, Melbourne, Australia, for the first time between February 2003 and March 2004 were asked to complete self-report questionnaires. Using seven-point Likert scales where higher scores indicated more positive views, participants rated the importance of discussing a range of topics before, and the usefulness of discussing these after attending counselling.

RESULTS

Pre-counselling questionnaires were completed by 152 of 184 (83%) individuals and 72 (47%) of those also completed the post-counselling questionnaire. Donors' post-counselling ratings were significantly higher than their pre-counselling ratings. For recipients the pre- to post-counselling changes were less pronounced. Both donors and recipients rated matters relating to disclosure and the possible future interaction between donor and child the most useful to discuss. More participants favoured disclosure after than before counselling (84% vs 66%, P = 0.01).

CONCLUSIONS

This study suggests that counselling is beneficial for those contemplating donor procedures, particularly donors, and that most have a positive attitude towards disclosure after counselling.

Attitudes towards gamete donation among Swedish gynaecologists and obstetricians

BACKGROUND

Assisted reproductive technology (ART) legislation in Sweden has undergone a gradual transformation from being fairly restrictive when first introduced to becoming more permissive in recent years. Regarding gamete donation, Sweden became the first country to pass legislation about disclosure by establishing a child's right to find out the identity of the gamete donor once the child has reached maturity. Our aim was to investigate attitudes towards gamete donation among Swedish gynaecologists and obstetricians.

METHODS

A questionnaire was mailed to all gynaecologists and obstetricians listed from a commercial register of all working in Sweden. Among 1230 eligible gynaecologists/obstetricians, 854 (69%) answered the questionnaire.

RESULTS

In general, the majority of Swedish gynaecologists/obstetricians had positive attitudes towards gamete donation. Although a majority advocated openness regarding informing the child that he or she was conceived by making use of gamete donation, approximately 40% opposed allowing the child to receive any information about the donor when the child has reached maturity. Even though Swedish legislation has allowed sperm donation to lesbian couples since July 2005, one-third of the gynaecologists/obstetricians opposed donation to lesbians.

CONCLUSIONS

The results indicate that the gynaecologists'/obstetricians' negative attitudes towards disclosure may influence patients' ability to discuss their thoughts and feelings about donation. This may also have a negative impact on donor recruitment as well as on the extent of methods made accessible within ART.

A retrospective comparison of clinical outcomes and satisfaction using reconstituted recombinant gonadotropins (rFSH) or cartridge rFSH with a pen device in donor oocyte cycles

BACKGROUND

Use of recombinant follicle stimulating hormone (rFSH) in a cartridge pen device offers obvious benefits for donor oocyte cycles including the administration of fewer and more patient-friendly injectable medications.

METHODS

In a University-based IVF program, a total of 98 oocyte donor cycles using rFSH either reconstituted or as a pen device given to 118 recipients (eight split cycles) were retrospectively reviewed. Following discontinuation of oral contraceptive, controlled ovarian hyperstimulation was begun using either reconstituted rFSH (n = 19) or rFSH with a cartridge pen device (n = 79) (150-300 IU qd). GnRH-antagonists (Ganirelix, Organon) and an additional 75 IU of rFSH/day were begun when lead follicles were 13-14 mm in greatest diameter. The primary endpoints analyzed included cycle stimulation characteristics for each donor group and donor medication tolerance assessment with respect to each rFSH formulation, while secondary outcome measures included clinical pregnancy and implantation rates.

RESULTS

Oocyte donors using the pen required significantly less rFSH (2734 IU vs. 3276 IU, p < 0.05) and scored significantly higher medication tolerance scores (3.9 +/- 0.4 vs. 3.1 +/- 0.6, p < 0.05). No other differences in cycle stimulation for oocyte donors and clinical outcomes for recipients were seen including pregnancy rates (pen, 77% vs. reconstituted, 55%, p - NS) and clinical pregnancy rates (61% vs. 45%, p - NS). However, significantly greater implantation rates (57% vs. 31%, p < 0.01) occurred in the pen group.

CONCLUSION

Compared to reconstituted formulations, the pen device results in lower gonadotropin requirements and provides a simplified dosing method with better tolerance.

A review of family donor constructs: current research and future directions

This review addresses research on gamete donors, recipients, and offspring and demonstrates that the foci on all three within the triad are largely directed at disclosure or anonymity; and each in turn centers on the perceived importance of the genetic link. The importance attached to genetics has led some countries to review the ethics of anonymous gamete donation (e.g. New Zealand's 'open system' of information sharing) and has led other countries (Sweden, Austria, Victoria, Australia; the Netherlands, the UK) to change their laws allowing donor gamete offspring the right to obtain identifying information about their genetic parent. This review demonstrates that genealogical inconsistencies between and within members of the triad are common regardless of legislation. A discussion of future trends and concerns, relating to the use of gamete donation and the effects legislation is likely to have on the donor triads in the UK following 2005, is provided. The review also addresses the importance of testing theoretical models within future research, and argues this would lead to a better understanding of the underlying problems encountered at a psychosocial level, such as continued preference for anonymity in donors and denial in large numbers of users of the involvement of a donor in conception. Lack of disclosure effectively prevents true implementation of legislation; if a child is not informed, it is the result of donated gametes, it cannot take up the legally available option of finding out identifiable information about their genetic parent(s).

Anonymous oocyte donation: a follow-up analysis of donors' experiences

BACKGROUND

this study was conducted to assess oocyte donors' satisfaction after the procedure and to obtain information on base rates of various experiences associated with oocyte donation.

METHODS

volunteer anonymous oocyte donors seen at a university-based IVF programs were identified (N = 54). The follow-up questionnaire asked donors to rate aspects of clinic interactions, medical procedures and experiences during and after the process, as well as expectations and level of fulfillment.

RESULTS

ten individuals were lost to follow-up and 20 donors did not respond. The typical oocyte donor respondent (N = 24) was 26.5 years old, Caucasian, single with no children and had experienced some college education. Mean follow-up time was 21 months. Overall, 79% were satisfied or extremely satisfied with their experience, 42 % would be an oocyte donor again and 50% would recommend that a friend consider being an oocyte donor. Donors tolerated procedures well, but most did experience cramping and injection site pain. A significant proportion experienced anxiety and negative emotional experiences during the process. Expectations were fulfilled regarding helping another woman and sense of satisfaction, but most (87.5%) expressed the desire to know the outcome for the recipient.

CONCLUSIONS

the data demonstrate that oocyte donation was a positive experience for the majority of women in the program, although emotional symptoms are normative.

Psychological characteristics and factors related to willingness to donate again among anonymous oocyte donors

OBJECTIVE

To assess post-donation psychological status of a large sample of professionally recruited, paid anonymous donors and to determine whether there were any differences between those who were willing to donate again and those who were not.

DESIGN

Cross-sectional survey.

SETTING

Healthy donors who were recruited by two private groups.

SUBJECT(S)

One hundred fifteen donors who had completed at least one donation cycle at one of six IVF programs in a large Midwestern city.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURES

Self-report questionnaire assessing psychological symptoms, self-esteem, expectations, satisfaction, and attitudes toward donation.

RESULT(S)

Psychological symptomatology and self-esteem were in the normal range. Altruism and compensation were the two most frequently cited motivators for donation. Of the donors, 82% were moderately to very satisfied with the donation experience. First-time donors were significantly younger, reported more post-donation psychiatric symptoms, and had slightly lower self-esteem. Of the donors, 35% stated they would donate again; 37% would not, and 28% were undecided. Donors who were willing to donate again reported significantly less ambivalence about donation and significantly greater satisfaction with the medical aspects of donation.

CONCLUSION(S)

Approximately one third of donors are willing to donate more than once. These women report less ambivalence and greater satisfaction with the donation experience.

Egg and Embryo Donation and the Meaning of Motherhood

As part of a larger study on donor-assisted conception, this paper reports research which explored the ways in which women who have donated or received eggs or embryos interpret such donations in the context of motherhood. Narrative analysis of women's accounts revealed that egg and embryo donations are not interpreted as incompatible with motherhood; that they may be explained as contributing to the significance of motherhood through the desire to assist some women to whom motherhood has been denied; and that the welfare of offspring of donated eggs and embryos is considered by donors. Differences were found between the meanings of egg donation and embryo donation, including likening eggs to cells and embryos to children, and in donors the expression of stronger maternal connection to the offspring of donated embryos. These accounts reveal individual variation, complexity, and change, reflecting (among other things) the dynamic process of narrative revision.

A comparison of oocyte donors' and gestational carriers/surrogates' attitudes towards third party reproduction

PURPOSE

This study was designed to compare levels of satisfaction for ovum donors and gestational carriers/surrogates (GCS), investigate attitudes, and explore beliefs about the role genetics, gestation, and environment play in various characteristics.

DESIGN

An east coast IVF center and two California-based agencies recruited donor and GCS candidates.

METHODS

Participants received mailed questionnaires that included sections on demographics, attitudes, and beliefs.

RESULTS

Both groups were highly satisfied with their participation. Donors were not willing to be GCS, and GCS were not willing to be donors. GCS thought about and disclosed their participation, felt children should be told about GCS, and desired future contact with the child(ren) more than did donors (p < 0.002). Donors did not indicate a preference about disclosure. Contact with recipients did not correlate with satisfaction.

CONCLUSION

Women who chose to donate eggs or to be GCS hold distinct and different beliefs about the role of gestation and genetics.