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Petra T, Wischmann T, Mayer-Lewis B. Evaluation of infertility counselling in Germany. Arch Gynecol Obstet 2024; 309:1065-1073. [PMID: 38172455 DOI: 10.1007/s00404-023-07316-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/21/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE This paper reports on the first evaluation of infertility counselling in Germany. METHODS Sixty-nine infertility counsellors provided feedback via 524 survey sheets and 182 questionnaires were filled in by clients. RESULTS The results show a high level of satisfaction on behalf of the clients. They valued the emotional support, information, and exploration of family-building options with and without medical assistance and the counsellors' expertise. During counselling, coping with the emotional burden of infertility was an important issue, but in more than half of all counselling sessions, future parental issues were addressed. The group of clients seeking support can be described to be very heterogeneous, and counselling issues comprise a wide range of aspects. CONCLUSIONS This piece of research suggests that the following issues need to be considered to improve infertility counselling. Better integration of counselling in infertility clinics, more awareness for infertility counselling for other medical and non-medical professions Better funding for counselling so that its uptake is not dependent upon the financial resources of clients Awareness for new groups of clients and counselling issues such as single and transgender individuals, co-parenting families There is a need for more research and the development of counselling concepts.
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Affiliation(s)
- Thorn Petra
- Praxis für Paar- und Familientherapie, Langener Strasse 37, 64546, Moerfelden, Germany.
| | - Tewes Wischmann
- Institute of Medical Psychology, University Hospital Heidelberg, Bergheimer Str. 20, 69115, Heidelberg, Germany
| | - Birgit Mayer-Lewis
- Lutheran University of Applied Sciences-Evangelische Hochschule Nürnberg, Bärenschanzstraße 4, 90429, Nuremberg, Germany
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Lindheim SR, Madeira JL, Ludwin A, Kemner E, Parry JP, Sylvestre G, Pennings G. Societal pressures and procreative preferences for gay fathers successfully pursuing parenthood through IVF and gestational carriers. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2019; 9:1-10. [PMID: 31934649 PMCID: PMC6951275 DOI: 10.1016/j.rbms.2019.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 08/11/2019] [Accepted: 09/16/2019] [Indexed: 06/10/2023]
Abstract
This retrospective study surveyed decision-making and challenges among 78 gay cisgender male couples utilizing in-vitro fertilization (IVF) and a gestational carrier. While most couples (67.1%) found the decision to actively pursue fertility treatment 'not difficult', 32.9% felt that it was 'somewhat difficult' or 'very or extremely difficult'. Almost 30% of couples had not undertaken financial planning for treatment, which introduced delays of > 2 years for 25.3% of participants. Conceiving twins was 'important to very important' in 52.3% of couples, and 84.2% of couples chose to transfer two embryos to 'increase the odds' or reach an ideal family size in a single attempt despite increased complications with multiple pregnancies. Paternal leave was granted for one partner in 47.3% of couples, and for both partners in 43.2% of couples. One-third of couples reported experiencing discrimination, prompting a partner to seek employment, and 38% changed jobs or careers. For 80.3% of couples, the estimated cost exceeded US$100,000. Couples where one partner was aged > 50 years were significantly more likely to find the decision to actively pursue fertility treatment 'very or extremely difficult' (28.6%), and less likely to agree on becoming parents (64.3%). Gay male couples undergoing assisted reproduction face challenges regarding decision-making, lack of infertility benefits and discrimination, which appear to be influenced by age and country of residence. Policy and educational changes are needed, including broader fertility benefits, more egalitarian parental leave, and greater awareness of risks inherent to multiple gestation.
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Affiliation(s)
- Steven R. Lindheim
- Department of Obstetrics and Gynecology, Wright State University, Boonshoft School of Medicine, Dayton, OH, USA
| | | | - Artur Ludwin
- Department of Gynaecology and Oncology, Jagiellonian University, Krakow, Poland
- Ludwin & Ludwin Gynaecology, Private Medical Center, Krakow, Poland
| | - Emily Kemner
- Department of Obstetrics and Gynecology, Wright State University, Boonshoft School of Medicine, Dayton, OH, USA
- Wright-Patterson Medical Center, Department of Obstetrics and Gynecology, Wright-Patterson Air Force Base, Dayton, OH, USA
| | | | - Georges Sylvestre
- Department of Obstetrics and Gynecology, Flushing Medical Center, Flushing, NY, USA
| | - Guido Pennings
- Bioethics Institute Ghent, Ghent University, Department of Philosophy and Moral Science, Gent, Belgium
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Italian gay fathers' experiences of transnational surrogacy and their relationship with the surrogate pre- and post-birth. Reprod Biomed Online 2017; 34:181-190. [DOI: 10.1016/j.rbmo.2016.10.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 10/18/2016] [Accepted: 10/19/2016] [Indexed: 11/20/2022]
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Wilson TL. Unravelling orders in a borderless Europe? Cross-border reproductive care and the paradoxes of assisted reproductive technology policy in Germany and Poland. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2016; 3:48-59. [PMID: 29774250 PMCID: PMC5952659 DOI: 10.1016/j.rbms.2017.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 11/21/2016] [Accepted: 02/27/2017] [Indexed: 06/08/2023]
Abstract
This article examines assisted reproduction policy and practices in Germany and Poland. Germany is among the most restrictive countries in the European Union (EU) with respect to assisted reproductive technologies. In contrast, Poland only recently passed legislation regulating assisted reproductive technologies. Before this, most practices were unregulated, despite vocal opposition to all forms of IVF from conservative Roman Catholic activists. Germany and Poland differ significantly regarding the cultural narratives and historical experience that impact attitudes toward reproduction. In Germany, discussions on assisted reproduction often invoke concerns about medical intervention in ethically complex matters, due - in part - to the country's National Socialist past. My objectives in this article centre on examining assisted reproduction contexts in each of these two countries, with attention to the framing of debates on reproduction, the anxieties that inform them, and the resulting paradoxes. I consider the unintended consequences of domestic policy and their importance regarding cross-border reproductive care (CBRC). Within the borderless EU, the widespread practice of CBRC demonstrates the ineffectiveness of national policies. Moreover, this shift in location can impact practices and trends found in other accessible, but less restrictive countries. Of particular concern are the relocation of risk to 'bioavailable' populations in less affluent countries and the reification of cultural and socio-economic hierarchies.
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Messinis IE, Messini CI, Daponte A, Garas A, Mahmood T. The current situation of infertility services provision in Europe. Eur J Obstet Gynecol Reprod Biol 2016; 207:S0301-2115(16)30952-6. [PMID: 28029395 DOI: 10.1016/j.ejogrb.2016.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 10/14/2016] [Indexed: 11/23/2022]
Abstract
Infertility is a global medical problem of the reproductive system which may affect the quality of a woman's life. Whether infertility provision varies between different European countries has not been investigated in the context of a comparative study. There are, however, differences in legislation between different countries, which encourage "infertility tourism". Women cross borders in order to get access to those treatment modalities that are not provided in their own country. Oocyte donation for example and the high cost of the services locally are common reasons for this mobility. Although treatment of infertility is still aetiology based, unexplained cause is most often the underlying reason. The invention of in vitro fertilisation (IVF) has changed the management of infertility globally. In most European countries, treatment is mainly provided by well-organised private IVF centres using highly effective methodologies. Different European scientific organisations, together with European Board and College of Obstetrics and Gynaecology (EBCOG), should provide recommendations to the European Union on the development of common legislation to streamline quality assured clinical care for infertile couples. This will hopefully help to eliminate possible inequalities, providing evidence based services according to patients' needs and also reduce the cross border healthcare demand in European countries.
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Affiliation(s)
- Ioannis E Messinis
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; European Board and College of Obstetrics & Gynaecology (EBCOG), Belgium.
| | - Christina I Messini
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Alexandros Daponte
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Antonios Garas
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Tahir Mahmood
- Department of Obstetrics & Gynaecology, Victoria Hospital, Kirkcaldy, Scotland, UK; European Board and College of Obstetrics & Gynaecology (EBCOG), Belgium
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Millbank J. Rethinking "Commercial" Surrogacy in Australia. JOURNAL OF BIOETHICAL INQUIRY 2015; 12:477-490. [PMID: 25015592 DOI: 10.1007/s11673-014-9557-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 12/05/2013] [Indexed: 06/03/2023]
Abstract
This article proposes reconsideration of laws prohibiting paid surrogacy in Australia in light of increasing transnational commercial surrogacy. The social science evidence base concerning domestic surrogacy in developed economies demonstrates that payment alone cannot be used to differentiate "good" surrogacy arrangements from "bad" ones. Compensated domestic surrogacy and the introduction of professional intermediaries and mechanisms such as advertising are proposed as a feasible harm-minimisation approach. I contend that Australia can learn from commercial surrogacy practices elsewhere, without replicating them.
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Hammarberg K, Stafford-Bell M, Everingham S. Intended parents' motivations and information and support needs when seeking extraterritorial compensated surrogacy. Reprod Biomed Online 2015; 31:689-96. [PMID: 26371710 DOI: 10.1016/j.rbmo.2015.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 08/09/2015] [Accepted: 08/11/2015] [Indexed: 11/24/2022]
Abstract
Cross-border reproductive care (CBRC) is becoming increasingly common. Little is known about the motivations and information and support needs of people who cross borders to access surrogacy. This study aimed to explore: how those considering or undertaking extraterritorial surrogacy reach their decision; what other avenues they have considered and tried to have children; their sources of information and support; and perceptions of how others view their decision. Members of two Australian parenting support forums completed an anonymous online survey. Of the 249 respondents, 51% were gay men, 43% heterosexual women and 7% heterosexual men. Most heterosexual respondents had tried to conceive spontaneously and with assisted reproductive technology before considering surrogacy. Most respondents felt supported in their decision to try extraterritorial surrogacy by close family and friends. Surrogacy-related information was mostly sourced online and from other parents through surrogacy. Few sought information from a local general practitioner or IVF clinic and those who did reported IVF clinic staff were significantly (P < 0.001) more likely than other groups to communicate negative reactions to their decision to seek surrogacy. The apparent negative attitudes to cross-border surrogacy among health professionals warrants further research into health professionals' knowledge, beliefs and attitudes relating to surrogacy.
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Affiliation(s)
- Karin Hammarberg
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; Victorian Assisted Reproductive Treatment Authority, Victoria, Australia.
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Janssens PMW, Thorn P, Castilla JA, Frith L, Crawshaw M, Mochtar M, Bjorndahl L, Kvist U, Kirkman-Brown JC. Evolving minimum standards in responsible international sperm donor offspring quota. Reprod Biomed Online 2015; 30:568-80. [PMID: 25817048 DOI: 10.1016/j.rbmo.2015.01.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 01/28/2015] [Accepted: 01/29/2015] [Indexed: 11/26/2022]
Abstract
An international working group was established with the aim of making recommendations on the number of offspring for a sperm donor that should be allowable in cases of international use of his sperm. Considerations from genetic, psychosocial, operational and ethical points of view were debated. For these considerations, it was assumed that current developments in genetic testing and Internet possibilities mean that, now, all donors are potentially identifiable by their offspring, so no distinction was made between anonymous and non-anonymous donation. Genetic considerations did not lead to restrictive limits (indicating that up to 200 offspring or more per donor may be acceptable except in isolated social-minority situations). Psychosocial considerations on the other hand led to proposals of rather restrictive limits (10 families per donor or less). Operational and ethical considerations did not lead to more or less concrete limits per donor, but seemed to lie in-between those resulting from the aforementioned ways of viewing the issue. In the end, no unifying agreed figure could be reached; however the consensus was that the number should never exceed 100 families. The conclusions of the group are summarized in three recommendations.
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Affiliation(s)
- Pim M W Janssens
- Chairman of the Working Group, Department of Clinical Chemistry and Haematology, Semen Bank, Rijnstate Hospital, Arnhem, The Netherlands.
| | - Petra Thorn
- Praxis für Paar-und Familientherapie, Mörfelden, Germany
| | - Jose A Castilla
- U. Reproducción, UGC de Obstetricia y Ginecología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Clinica MasVida Reproducción, Sevilla, Spain
| | - Lucy Frith
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Marilyn Crawshaw
- Department of Social Policy and Social Work, University of York and Independent Researcher, York, UK
| | - Monique Mochtar
- Centrum voor Voortplantingsgeneeskunde, Academic Medical Centre, Amsterdam, The Netherlands
| | - Lars Bjorndahl
- Centre for Andrology and Sexual Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrik Kvist
- Department of Physiology, Karolinska Institute, Stockholm, Sweden
| | - Jackson C Kirkman-Brown
- Centre for Human Reproductive Science (ChRS), Birmingham Women's NHS Foundation Trust, Birmingham, UK; School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
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Martin D, Kane S. National self-sufficiency in reproductive resources: An innovative response to transnational reproductive travel. INTERNATIONAL JOURNAL OF FEMINIST APPROACHES TO BIOETHICS 2014. [DOI: 10.3138/ijfab.7.2.0010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Transnational reproductive travel is symptomatic of insufficient supplies of reproductive resources, including donor gametes and gestational surrogacy services, and inequities in access to these within domestic health-care jurisdictions. Here, we argue that an innovative approach to domestic policy making using the framework of the National Self-Sufficiency paradigm represents the best solution to domestic challenges and the ethical hazards of the global marketplace in reproductive resources.
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Thorn P, Wischmann T. German guidelines for psychosocial counselling in the area of “cross border reproductive services”. Arch Gynecol Obstet 2012; 287:599-606. [DOI: 10.1007/s00404-012-2599-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 10/09/2012] [Indexed: 11/28/2022]
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