Psychological aspects in anonymous and non-anonymous oocyte donation

Critical Analysis of The Changes in CFM Resolution 2294/21 And Its Impacts on Assisted Human Reproduction

The Brazilian Federal Board of Medicine (CFM) issued resolution number 2294/21, which regulates human reproduction procedures in Brazil, bringing significant changes to clinical practice in assisted human reproduction, and it raised ethical, bioethical, and legal discussions between professionals and patients. This study aims to analyze these changes in different aspects, especially because some of them are controversial. Evidence-based knowledge resources were used to support the analyses of crucial points that were impacted by this change. A literature review was carried out to obtain information about guidelines and laws, as well as articles that contemplate ethical discussions on assisted reproduction. The search sites used were BVS, Pub Med, LILACS and Google Scholar. The keywords used were law, legislation, bioethics, reference guide and assisted human reproduction. Relevant official documents from the Brazilian State were also found and included in the survey. The new resolution regarding the use of assisted reproduction techniques brought important changes, with clinical implications for couples who wish to become pregnant, and there is a need for a broad discussion concerning these repercussions from clinical, ethical, bioethical, and legal points of view.

Altruism or obligation? The motivations and experience of women who donate oocytes to known recipients in assisted conception treatment: an interpretative phenomenological analysis study

INTRODUCTION

This qualitative study was conducted to explore the motivations and experience of oocyte donors donating to women known to them.

METHODS

Three women who donated oocytes to a close relative were interviewed and data were analysed using an Interpretative Phenomenological Analysis approach.

RESULTS

The two key elements noted were "motivations for donation" and "coping with the consequences of oocyte donation". The motivation for donation was influenced by the familial bond that was strengthened by the donation process in some cases. The concept of altruistic oocyte donation stemmed from the narratives of giving the gift of motherhood and gaining a positive self-image and respect from others. Coping with the consequences of oocyte donation tests the donor identity, their wishes for a positive outcome, concerns regarding disclosure of biological motherhood and detachment from the egg and potential child.

DISCUSSION

Motivation is influenced by a combination of factors including the rewards of altruistic behaviour, the existence and potential strengthening of the relationship between donor and recipient, but possibly also, a sense of obligation and societal expectations. Oocyte donation can be variously viewed by donors as a unique way of reproductive empowerment or an example of acceding to subtle coercion and thus disempowerment. The study also highlights the clinical as well as ethical importance of providing support services for oocyte donors and recipients.

[Information, transmission, secrecy: What kind of discourse for children born by gamete donation?]

The number of children born through gamete donation grows by the conceptions made abroad. All the couples engaging in this process do not benefit from of the same support around the issues raised by the information to the child and its terms. Through a literature review, the authors explore the data on information intentions from parents to child and to entourage, the influence of the issue of anonymity, the effective rate information, the influences of the age of the child, the terms information and links with family dynamics. The quantitative findings underscore the complexity of this task, since 10-90 % of couples report an intention to inform their child from conception through donation, while 5-30 % actually inform them after birth. Fifty-nine to 93 % of the relatives are nevertheless informed. The authors will highlight the psychopathological tracks that support the possibility of narration for parents: the internalization of their infertility, the representation of the gift, the development of rivalry towards donors, the secrecy and privacy. The objective of this article is to enable carers to accompany this reflection among future parents, a better listening of the issues raise by the couples allowing shoring their process.

[Psychosocial factors in reproductive medicine]

INTRODUCTION

Since the development of assisted reproduction technology in the 1970s, assisted reproduction has become increasingly used by couples for various reasons. Concurrently, the diagnostic possibilities regarding the health of the unborn child have been elaborated.

METHODS/RESULTS

The present literature review describes and discusses the possibilities of assisted reproduction (in-vitro fertilization (IVF), intracytoplasmic sperm injection ICSI, cryopreservation, conception of children with the help of a third person) with respect to their psychosocial meaning for those affected and for the children conceived in this manner. The psychological strain pairs experience in the context of prenatal diagnostics and the resulting decisions are illustrated by a case study.

CONCLUSIONS

The continued progression in the possibilities and resulting conflicts and decision- making processes in reproductive medicine confronts clinicians and psychosomatic/psychotherapeutic practitioners with many new challenges. In conclusion clinical recommendations for the psychosocial counseling of couples are given.

A longitudinal study of recipients' views and experiences of intra-family egg donation

BACKGROUND

For the past 10 years, we have been carrying out a longitudinal investigation of egg donation families in the UK; a subsample of recipients in these families had a child by egg donation from a sister or sister-in-law. In response to the current debate over the practice of intra-family donation, together with the general lack of available data on the consequences of donation between family members, we examined recipients' experiences of donation between sisters and sisters-in-law.

METHODS

We analysed data from a subsample of recipient mothers who were taking part in a larger investigation of gamete donation families. Mothers were visited at home and interviewed when their child was aged 1, 3, 7 and 10 years. Data from nine recipient mothers whose egg donor was either their sister or sister-in-law were examined to assess the nature of mothers', fathers' and the child's relationship with the donor, and whether mothers had disclosed the nature of their child's conception to others, including the child.

RESULTS

The majority of recipient mothers reported positive relationships between the donor and members of their family (themselves, their partner and their children). Most mothers were happy with the donor's level of involvement with the child and reported that they and the donor maintained their social roles within the family, i.e. as mother and aunt, respectively. By age 10, two children had been told that they had been conceived using egg donation, both of whom had been told the identity of the donor.

CONCLUSIONS

Although the sample was small, this study provides the first longitudinal data on the experiences of families created using donated gametes from a family member. Intra-family donation between sisters or sisters-in-law can be a positive experience for recipients during the first 10 years following the child's birth. Studies that are specifically designed to look at donation between family members are needed to better evaluate the practice.

'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.

[Current practices of oocyte donation in France and Europe]

This review aims to evaluate, in France, oocyte donation, an assisted reproductive technique (ART), for which 25 years of experience have shown its efficacy for the palliative treatment of infertility caused by ovarian exocrine failure. Its indications have since been expanded to cover certain genetic diseases and document failures of other ART attempts. Oocyte donation is performed within the framework of French legislation - bioethics laws 94-653 and 94-654 of 29 July 1994, and the revised bioethics law 2004-800 of 6 August 2004. Its main fundamental principles are: voluntary, free, anonymous donation, for which regulated confidentiality is assured and now - judicial decree 2004-606 of 24 June 2004 - and the synchronization of donor-recipient cycles with fresh embryo transfer in accordance with established safety procedures. According to the 2004 results of the French Group for the Study of Oocyte Donation (GEDO) for French centers actively involved in ART, the chance of pregnancy was increased to 43.4% for synchronized cycles with fresh embryo transfers versus 18.7% for deferred cycles with frozen-thawed embryos (P<0.01). In addition, follow-up studies reported the excellent family relationships and physical and psychological development of these children. The major difficulties encountered in the daily practice of oocyte donation concern the recruitment and management of donors, but also, and above all, the lack of optimal means to exercise this medical specialty, due to the lack of recognition of the organizational duties incurred, which are the cornerstone of the character-specific functioning of this type of ART. In comparison, we foresee that the discrepancies of this ART practice in Europe, with it differential facets, will lead to medical nomadism for those couples financially able to do so, when national conditions of access fail because of prohibitions but also as a consequence of insufficient means to perform the inherent tasks. Today, it seems essential to provide information on the particularity and practice of oocyte donation required for the comprehension of its obligations for the different players with the aim of obtaining the means necessary for the perpetuation of its practice.

Disclosure decisions among pregnant women who received donor oocytes: a phenomenological study

OBJECTIVE

To investigate the controversy surrounding disclosure among donor oocyte recipients. This controversy is escalating worldwide, yet little research has sought to understand the disclosure experience of pregnant, donor oocyte recipient women. This study aims to provide an in-depth description of the disclosure experience, and identify factors that were significant to recipient women which influenced their reasoning as they formulated disclosure decisions.

DESIGN

Qualitative, naturalistic design, using a phenomenological approach.

SETTING

The home or private office of the recipient woman.

PATIENT(S)

Donor oocyte recipient women between 9-23 weeks of gestation.

RESULT(S)

Disclosure decisions were influenced by multiple factors emerging from the women's values and beliefs and their social and cultural environment. Values and beliefs consisted of the right to know and the duty to protect. Social and cultural factors included social support, culture of the family, evolution of the social process, and personal testimonials. Women's age and selection of donor type were interrelated with disclosure decisions.

CONCLUSION(S)

Disclosing women voiced the right of the child to know, and perceived social and cultural factors as conducive to disclosure. Nondisclosing and undecided women emphasized protecting normative relationships, perceived a social stigma, and were unable to identify a benefit to disclosing. Women's age and choice of oocyte donor should be considered when counseling recipient women.

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).

Recipients of Oocyte Donation: An Integrative Review

OBJECTIVE

To conduct a systematic review of published research to provide a synthesis of the psychosocial characteristics of donor oocyte recipient women.

DATA SOURCES

The sample of published studies was selected from 1983 to September 2002. Retrieval of the studies used online computer searches from CINAHL, MEDLINE, PsycINFO, and Wilson's Social Science Abstracts using the terms reproduction techniques, in vitro fertilization, oocyte donation, oocyte recipients, and egg donation; citations from references and bibliographies of previously located articles; and two 60-minute retrieval sessions with a librarian specializing in health science literature.

STUDY SELECTION

The majority of studies retrieved were completed in the natural sciences. The final sample resulted in 16 studies.

DATA EXTRACTION

Each study was read and the data were extracted using a survey instrument developed by the investigator.

DATA SYNTHESIS

Multiple methodologies were used in the sample; most were exploratory, retrospective, and descriptive studies. Thus, the data were analyzed using a qualitative discursive approach. A total of 827 donor oocyte recipient women participated in the studies.

CONCLUSIONS

Published research investigating the psychosocial characteristics of donor recipient women was categorized into six focused areas: motivation; desired donor characteristics; selection of a known versus an anonymous donor; demographic, educational, and psychosocial profiles; disclosure of the method of conception to family members, friends, and the resulting child; and the relationship between the oocyte recipient and her resulting offspring. Research involving the psychosocial aspects of donor oocyte recipient women is in the infancy stage.

Don d’ovocytes en France et bilan national (GEDO). Dispositions différentielles européennes

Oocyte donation (OD), a technique successfully used in Assisted reproductive techniques (ART), has been effective for 20 years as the palliative treatment of certain exocrine ovarian failures. Its indications have also been extended to cover some genetic diseases and documented occult ovarian insufficiency. In France, after an extensive judicial and ethical deliberation, OD was deemed legal and its practice was proscribed in the Bioethics Laws 94-653 and 94-654 of 29 July 1994. Its essential underlying principles are: voluntary, free, anonymous and confidential OD; according to a French decree to meet safety concerns, OD-derived embryos must be quarantined for six months. In vitro fertilization (IVF) programs using donated oocytes are conducted in authorized centers under the responsibility of physicians authorized to retrieve and manipulate donated oocytes. The managers of these programs are the system's keystone, as their role includes, among other, the verification of indications, legal documents, public health safety, anonymous pairing of donor and recipient, and the collection of outcome data. At present, depending of the year, French programs have achieved 17-22% clinical pregnancy rates from transferred OD-derived frozen-thawed embryos, and follow-up studies reported excellent results concerning family relationships, and the physical and psychological development of the children. However, difficulties encountered in the daily practice of OD have led concerned physicians to form the Study group for OD (GEDO) to explore different topics with the aim of improving the overall management of this form of ART. We discussed these points herein, in comparison with the approaches of other European countries.

Exploring the beliefs and experiences of potential egg share donors

BACKGROUND

To date there are few attitudinal studies of women's experiences of egg donation, motivation to donate or their thoughts about eggs donated. Studies are predominantly discussed in terms of a specific treatment option and the ethical implications of different treatments. These studies are mainly designed by professionals working in assisted reproductive technology in line with a clinical agenda.

AIM

This study aimed to explore the beliefs and experiences of potential egg share donors using an interpretative phenomenological methodology to equip health care practitioners to deal better with patients' needs and desires.

METHOD

Open-ended interviews were conducted immediately following introductory consultations with 11 potential egg share donors from one fertility centre in the United Kingdom (UK). The sample was opportunistic. Data collection took 8 months and van Manen's interpretative phenomenological method was used.

FINDINGS

Analysis revealed six themes of egg sharing: motherhood (the predominant theme within which all other themes could be subsumed), context, doubt, coping, exchange and empathy. Themes illustrated women's continuation with the scheme despite fears about giving away eggs, the parenting skills of recipient couples and future repercussions of positive outcomes for donor and recipient.

CONCLUSIONS

Egg sharing could be seen as a marker of hope. Buoyed up by the possibility of a successful outcome, women are prepared to undertake repetitive treatment attempts despite continued failure to conceive and knowledge of a slim chance of a positive outcome. Implications for practice, policy and ethics result in recommendations for more in-depth interview work by independent researchers to gain a clearer picture of women's responses to reproductive technologies and the development of services in line with patient need and individual expectation.

To tell or not to tell: the decision-making process of egg-donation parents

Little research has examined the views of parents of children conceived as a result of the use of donated eggs (egg-donation parents) on whether, what and how to tell their children about the way in which they were conceived. Thus, the aim of the present study was to assess the pattern of disclosure in egg-donation families. A representative sample of 17 egg-donation families with a 3-8-year-old child was recruited through UK fertility clinics. All mothers were administered a standardized interview assessing the extent of their disclosure and the main reasons for their decision. Content analysis was carried out on the transcripts from the interviews with the mothers. Not one set of parents had told their child at this stage, and 47% had no intention of telling their child about the way in which they were conceived. Twenty-nine per cent intended to tell their child in the future. Nearly two-thirds had told a friend or family member. Non-disclosure largely stemmed from a desire to protect the child, a belief that there was no need to tell, and a desire to protect the mother. Reasons for intending to disclose to the child included the belief that he or she had a right to know, and to avoid disclosure from someone else. Egg-donation parents with a 3-8-year-old child appear to resemble donor insemination parents in that they tend to favour a position of non-disclosure. The findings demonstrate the importance of understanding the views of egg-donation parents themselves, if openness is to be encouraged in these families.

Motivation, attitudes and experience of donation: a follow-up of women donating eggs in assisted conception treatment

This paper reports a follow-up of 39 women who had donated eggs to an assisted conception unit. Their experience of donation and their motivation and attitudes were assessed. Comparisons were made with a group of semen donors who were attending a second unit. Female and male donors donated for altruistic reasons and neither group wished to have contact with recipients or donor offspring or have their identity revealed. Female donors were more involved in the donation process and more interested in the outcome of donation. They also appeared to be more motivated by 'helping' than male donors. The sample of female donors contained a small group of women who were donating to sisters and friends. In comparison with anonymous donors, these women reported more effects upon the family and issues of secrecy and openness were more apparent. The results are discussed in the light of previous studies and the legal framework for donation in the UK. Attention is drawn to the lack of social psychological analyses in this controversial medical area.