Exploring the beliefs and experiences of potential egg share donors

Appraising risk in active surveillance of localized prostate cancer

Objectives

Men diagnosed with low‐risk prostate cancer are typically eligible for active surveillance of their cancer, involving monitoring for cancer progression and making judgements about the risks of prostate cancer against those of active intervention. Our study examined how risk for prostate cancer is perceived and experienced by patients undergoing active surveillance with their clinicians, how risk is communicated in clinical consultations, and the implications for treatment and care.

Method

Participants were nine patients and three clinicians from a university hospital urology clinic. A staged, qualitative, multi‐method data collection approach was undertaken, comprising: observations of consultations; patient and clinician interviews; and patient surveys. The three data sets were analysed separately using thematic analysis and then integrated to give a comprehensive view of patient and clinician views.

Results

Thirty data points (eight patient surveys; 10 observations of consultations between patients and clinicians; 10 patient interviews; and two clinician interviews) combined to create a detailed picture of how patients perceived and appraised risk, in three themes of “Making sense of risk”, “Talking about risk” and “Responding to risk”.

Conclusion

Effective risk communication needs to be finely tuned and timed to individual patient's priorities and information requirements. A structured information exchange process that identifies patients' priorities, and details key moments in risk assessment, so that complexities of risk are discussed in ways that are meaningful to patients, may benefit patient care. These findings could inform the development of patient‐centric risk assessment procedures and service delivery models in prostate cancer care more broadly.

Rethinking gamete donor care: A satisfaction survey of egg and sperm donors in the UK

OBJECTIVE

Despite poor clinic communication and staff treatment being reported by donors, high rates of overall satisfaction are still reported in surveys. This study will evaluate the importance of communication and interaction between donors and fertility clinic staff in gamete donor care.

METHODS

We report on 120 egg and sperm donors' responses to a UK-wide online satisfaction survey. The survey focused on donors' interactions with fertility clinic staff pre-, during, and post- donation. Basic cross-tabulation was performed on the data using online survey software. Textual data was read and extracts identified, which illustrated and expanded on the findings from the numerical data. Diagrammatic modeling was also utilised to analyse the textual data, with particular focus to relationships between the donors and clinic staff, the main activities within the gamete donation process, and how these activities may affect donor satisfaction with the gamete donation process.

RESULTS

Donors expressed concern for the infertile couple and the resulting child; conveyed frustration at not receiving information on the expenses they could claim; felt lost in the system regarding the ease of making clinic appointments, and once made they were routinely not seen on time for these appointments. Donors also negatively commented on aftercare, the location and condition of the donation room, and information on contraception. In addition, Ovarian Hyperstimulation Syndrome was frequently reported, with these egg donors believing that clinic staff were not concerned with their physical or emotional well-being, but were instead disproportionately focused on extracting the eggs.

CONCLUSIONS

The multifaceted notion of donors highlights the complexity inherent to the gamete donation process, which comprises various aspects of uncertainty in the donation system, and ambiguity in the donation process. Categorising donors as Altruist, Customer, and Patient, conveys the particular importance of staff communication and treatment in donor care. These categories are not mutually exclusive however, in that an individual donor may experience more than one of these perspectives during the course of their gamete donation journey. Finally, there were a number of exemplar cases, where donors reported high satisfaction throughout, and these correlated with them being given a single point of contact at the clinic. Subject to resource constraints, we suggest that this practice should be implemented throughout clinics in the UK, so that donors have access to dedicated clinic staff who not only support them emotionally and physically throughout the gamete donation process, but also ensure that communication is open, clear, timely, and consistent.

A systematic review investigating psychosocial aspects of egg sharing in the United Kingdom and their potential effects on egg donation numbers

This review aims to provide an up-to-date knowledge of the psychosocial aspects of egg donation from the perspectives of the egg share donor and their recipient. It explores the motives, experiences and attitudes of egg sharers and their views towards donor anonymity and disclosure. Conclusions are made on how these findings can guide clinical practice and improve egg sharing numbers. A systematic search of peer-reviewed journals of four computerized databases was undertaken. Eleven studies were included in the review. Psychosocial aspects towards donation were positive from the egg share donor and recipient. Concerns raised were whether participating in the egg sharing scheme would impact on their success rates, as well as frustration expressed by a minority regarding the lack of knowledge of egg sharing outside of fertility clinics. The 2005 legislative changes in the UK have not caused the anticipated dramatic decrease in egg donation; however, oocyte donation still falls short of demand. Egg sharing provides a practical option for more patients to access IVF, whilst also providing more donor oocytes. Improved information provision will result in greater awareness of egg sharing, with the potential to recruit more donors and meet the needs of recipients currently on long waiting lists.

"I'd Know That My Child Was Out There": Egg Donation, the Institutionalized "Ideal" Family, and Health Care Decision Making

This study investigates how young women of egg-donating age perceive egg donation. Using institutional theory, this study demonstrates how participants frame a health care decision, such as egg donation, utilizing familial ideals. Results revealed that women expressed the importance of ownership over their genetic material and that familial ideals encourage an ideal way to create a family, which egg donation only fits as a last resort. Results show that familial ideals reach past the institution of family into broader decision making, such as that of health care. Further, results show that as more families are constructed through assisted reproductive technologies, attempts should be made to gradually alter the familial ideal to encompass novel medical technologies such as egg donation.

Egg-share donors’ and recipients’ knowledge, motivations and concerns: clinical and policy implications

This paper reports the results of a survey study examining the knowledge, motivations and concerns of egg-share donors and recipients, and assesses the clinical and policy implications of these findings. The survey, combining quantitative and qualitative items, was completed by 48 donors and 38 recipients who took part in an egg-sharing scheme at the London Women's Clinic between 2007 and 2009. Although the most important motivation for all egg-sharers was to have a baby, both donors and recipients displayed multiple motivations, including elements of self-interest and altruism. Many viewed egg-sharing as a reciprocal process in which two women with different needs help one another. The results are reassuring from an ethical and policy perspective: they suggest that if information about egg-sharing was more widely available (especially through general practitioners), more women may consider becoming egg-share donors, gaining swift access to their own treatment and reducing the UK's egg donor shortage.

'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.

British South Asian communities and infertility services

This paper presents key findings from the first major study of the provision of infertility services to South Asian communities in the UK. The research aimed to explore the social meanings of infertility and to examine the experiences of couples receiving fertility treatment. Focus groups with people from Pakistani, Bangladeshi and Indian communities (n = 93) revealed a strongly pro-natalist ideology and a relatively limited knowledge of infertility and treatments. Interviews with 50 participants from the same communities revealed a general satisfaction with secondary level infertility services. However, a minority felt inadequately informed about their condition, tests undertaken and treatment options; only one-third were given any written information about treatment; many were concerned about delays and waiting times; a minority felt that staff could be more sympathetic in their response to 'failed' treatment and several couples suggested that additional emotional support would be helpful. No information or resources were available in any South Asian language and the arrangements for communication support for non-English speakers were generally less than adequate. There was little evidence of the use of data on ethnic or religious background in infertility clinics. Recommendations for policy and practice are proposed.

Patient experiences of an "egg sharing" programme

INTRODUCTION

This paper reports on a qualitative empirical study of the experiences of women (and their partners) attending one UK assisted conception unit, who have considered egg sharing.

AIMS

In the absence of any published research of the experiences of people contemplating egg sharing and the considerable concerns that egg sharing had generated (for an overview see Blyth, 2002), the major purpose of the study was to examine the experiences not only of those who had considered and proceeded with egg sharing but also those who had considered, but had then decided against, egg sharing. In addition, since the views of male partners are frequently overlooked in studies of assisted conception treatment (cf. Ahuja, Mostyn, & Simons, 1997) the project actively sought the involvement of the women's partners. The study was designed to explore couples' motivation for egg sharing, their experiences of treatment, attitudes regarding information about egg sharing treatment and outcomes, and attitudes towards egg sharing.

METHODS

The centre sent a written invitation to participate in the study to all women who had indicated an interest in egg sharing and who had received both information and counselling in advance of proceeding (n = 60). Of these, 43 had decided to proceed after the counselling session and 17 had decided not to do so. Expressions of interest in participating in the study were received from 20 women: (a) five women had proceeded with egg sharing but had not been successful with their own treatment at the time of interview--all husbands/partners also participated (n = 10); (b) seven women had proceeded with egg sharing and had conceived (one of whom had conceived unexpectedly without assisted conception services)--5 couples and 2 women participated (n = 12); (c) six women decided to proceed with egg sharing, however an insufficient number of eggs were available following egg retrieval to enable egg sharing to take place--all husbands/partners also participated (n = 12); (d) two women decided not to proceed--and both husbands/partners participated (n = 4). The study data were derived from retrospective semi-structured interviews conducted by the author with these 20 women and 18 husbands/partners. Respondents also completed a paper exercise following the interview indicating their level of agreement or disagreement with a number of statements relating to egg sharing that were derived from responses to the HFEA's consultation on the withdrawal of payment to donors (HFEA 1998a.). While there was an overall 33% response rate, the response rate for those who had decided to proceed with egg sharing (41.9%) was greater than for those who had decided not to proceed (11.8%). Consequently, this study under-represents the views of women and their partners who had considered, but then rejected, egg sharing. Couples agreeing to participate in the research were given a choice of being interviewed together or separately and in their own home or at an alternative venue. This choice of separate or joint interviews was offered as part of the explicit effort to involve men in the study and to maximize participant choice. Twelve couples agreed to be interviewed separately; six couples were interviewed together and two women whose partners did not take part in the study were interviewed alone. There was no evidence of any significant differences in interview data between joint and separate interviews. Indeed, there was little disagreement between partners at all; this is probably not surprising, given that they will have discussed their decision about egg sharing together and will be aware of each other's views about at least some of the issues discussed during interview. All except four interviews took place in respondents' own homes. Two interviews took place in the centre at the respondents' requests and two interviews were conducted by telephone because of geographical considerations. All interviews were audio-recorded with respondents' permission and subsequently transcribed verbatim. The research was conducted in accordance with the British Psychological Society Statement of Ethical Principles for Conducting Research with Human Subjects (British Psychological Society, 2002). Ethical approval was given by the University of Huddersfield Ethics Committee.

Mirror gametes donation

Candidate recipients of donor gametes have a moral obligation to make a contribution to the system from which they benefit by reciprocating. They can do this as a couple when the partner of the person who has no usable gametes donates and receives the mirror gametes in return. In an indirect exchange system, the couple receives bonus points for their donation so that their waiting time for the gametes is reduced or even fully canceled. A system of strict reciprocity is rejected as unfair because it excludes categories of people from access to donor gametes. Also candidate recipients who for medical or psychological reasons do not qualify as donors should have access to donor gametes on the basis of points collected on other criteria. Not only contribution but also need (the wish to have a child) should be taken into account when allocating donor gametes. The mirror exchange system can alleviate the shortage of both sperm and egg donation in an ethically acceptable way.

"It just alienated us": a case study to explore the impact of assisted reproductive technology on family relationships

New reproductive technologies have the capacity to impact on both personal and healthcare relationships. This article utilizes a case study approach to unpack experiences of one couple who encountered immense and unforeseen difficulties as a result of treatment with assisted reproductive technology. Findings of this case reveal both difficulties and breaches in obtaining informed consent and the consequences these breaches have on relationships. Comprehensive information contributes to positive relationships between patients and healthcare providers. Maintaining supportive relationships between all parties concerned with assisted reproductive technology services is essential, as rifts in these relationships can be devastating and long-lasting.

What about the women? Ethical and policy aspects of egg supply for cloning research

As more and more countries open their doors to human cloning and embryonic stem cell research, scientists will be confronted with one fundamental problem: where will all the eggs come from? The mass harvesting of eggs raises serious issues about women's health, status and well-being. This paper critically examines proposals for ova supply such as altruistic donation, surplus IVF eggs and commercial sale. It questions the meaningfulness of informed consent and the risk-benefit ratio in a climate where powerful economic and social forces increasingly view the risks to women as the necessary trade-off for scientific advance.

Semen donor recruitment in an oocyte donation programme

The article presents a new system for the recruitment of gamete donors. The system is a partial application of the mirror exchange system: the male partner of a couple donates sperm, and in return, he receives the guarantee that his partner benefits from a greatly reduced waiting time for donor oocytes. More specifically, the woman will obtain donor oocytes within a period of 8 months. The procedure was very successful in recruiting sperm donors while avoiding the ethical objections raised against other incentives to attract donors. The data indicate that the system would also work to encourage IVF patients to share their oocytes.

Subsidized in-vitro fertilization treatment and the effect on the number of egg sharers

Egg sharing remains a controversial practice, mainly because of the presumed element of payment. In order to find out to what extent financial considerations motivated the women to share their oocytes, the data on egg sharing in Belgium are analysed. Belgium began providing full reimbursement for six in-vitro fertilization (IVF) cycles on 1 July 2003. Since this date, the numbers of egg sharers dropped approximately 70%. Although these data show that a large number of the donors were mainly motivated by the reduced cost of IVF, it cannot be concluded that money was the only motive to share. Nevertheless, to increase voluntary consent by egg sharers, public funding for infertility treatment should be provided.

Policy formation in gamete donation and egg sharing in the UK—a critical appraisal

This article considers two key policy documents concerning donor-assisted conception in the UK, The British Fertility Society's Recommendations for Good Practice on the Screening of Egg and Embryo Donors and the Human Fertilisation and Embryology Authority's Guidance for Egg Sharing Arrangements. It discusses both the process and the evidence used in formulating those sections of the documents which relate to donor anonymity. The paper concludes that psycho-social policy developments in assisted conception, such as those relating to donor anonymity, should be subjected to comparable levels of rigour and scrutiny to those that are applied in the formulation of medical and scientific policies.