Single fathers' experiences of using egg donation and surrogacy to start a family

STUDY QUESTION

What are the experiences of single men using egg donation and surrogacy as a route to parenthood?

SUMMARY ANSWER

The fathers mainly had a positive relationship with the surrogate and simultaneously exercised agency, and experienced challenges, during the process of surrogacy.

WHAT IS KNOWN ALREADY

Little is known about single men's experiences of egg donation and surrogacy arrangements. Studies have focused on single men's decision-making processes about the use of surrogacy and family functioning once these families are formed. Questions remain about how fathers experience and navigate the process of surrogacy as a single man.

STUDY DESIGN, SIZE, DURATION

The study is an international, in-depth qualitative study of fathers who chose to begin a family and parent alone. Data were collected between 2018 and 2021 as part of a larger study of solo fathers with different routes to parenthood. The present study reports on 21 fathers who used surrogacy and egg donation to begin their family. The average age of the fathers was 44 years, the fathers had young children aged 6 years or younger, and lived in countries across Australia, Europe, and North America.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Purposive sampling was used to recruit participants. In-depth semi-structured interviews were conducted. Interview topics included fathers' experiences of the process of using egg donation and surrogacy, and navigating the relationship with the surrogate. The audio-recorded interviews lasted around 2 hours and were subsequently transcribed verbatim.

MAIN RESULTS AND THE ROLE OF CHANCE

Data were analysed using reflexive thematic analysis and qualitative content analysis. Most of the fathers chose an identifiable egg donor. Regarding the relationship with the surrogate, many fathers had remained in contact with her, but to differing degrees, and they generally reported positive relationships. Thematic analysis led to the identification of three themes relating to the fathers' experiences of choosing surrogacy as a single man: the ability to make choices; challenges and constraints; and special relationship.

LIMITATIONS, REASONS FOR CAUTION

Due to the variation between different countries regarding laws on surrogacy, contextual factors may have impacted on the experiences of single fathers, and the sample size was small. However, the research provides new insights into an area with little academic literature.

WIDER IMPLICATIONS OF THE FINDINGS

Given the growing trend of single men having children through surrogacy, the findings suggest that this new path to parenthood can be both rewarding and challenging. Single men may benefit from tailored support and counselling to help them navigate the surrogacy journey.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by the Wellcome Trust (grant number 208013/Z/17/Z). The authors have no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

n/a.

O-212 Single fathers by choice: experiences of surrogacy and thoughts and feelings about disclosure

Study question

What are the experiences of single men regarding (i) the process of surrogacy (ii) their relationship with the surrogate (iii) disclosing surrogacy to their child?

Summary answer

The fathers reported a variety of experiences of surrogacy and all fathers had either disclosed or intended to disclose using surrogacy to their child.

What is known already

Very little is known about single men’s experiences of surrogacy arrangements and how they think and feel about disclosing their use of surrogacy and egg donation to their child. Studies have focused on the decision-making process of using surrogacy as a single man and family functioning once these families are formed. Yet questions remain about how fathers experience and navigate the process of surrogacy as a single man and how they communicate to their child about their surrogacy story.

Study design, size, duration

The study is an international, multi-disciplinary, qualitative study of fathers who chose to begin a family and parent alone. Data were collected by two researchers between 2018 and 2021 and form part of a larger study of single fathers by choice with different routes to parenthood. The present study reports on twenty-one fathers who used surrogacy and egg donation to begin their family. The children were aged between 0-6 years.

Participants/materials, setting, methods

Purposive sampling was used to recruit participants. In-depth semi-structured interviews were conducted with the single fathers. The interview topics covered fathers’ motivations for pursuing single parenthood, experiences of the process of using egg donation and surrogacy, surrogacy arrangements including location, navigating the relationship with the surrogate, and fathers' decisions around disclosing their route to parenthood to their child. The audio-recorded interviews mostly lasted around two hours and verbatim transcripts were produced afterwards.

Main results and the role of chance

Data were analysed using reflexive thematic analysis and qualitative content analysis. Preliminary analysis indicated that the fathers reported a variety of experiences of surrogacy and had differing experiences in terms of the length of time it took to begin the surrogacy journey and the ease with which arrangements were made. Many of the fathers had remained in contact with the surrogate, but to differing degrees. Clinics were placed as both facilitators and gatekeepers of the process, pointing to the complexities of the surrogacy process.

Regarding disclosure, it was found that the fathers thought more about when to disclose, rather than whether to disclose. All the fathers stated an intention to tell their child about their surrogacy story, but carefully considered which age was best and wanted to use child-led methods of disclosure. The fathers reported that it was hard to hide their route to parenthood and expressed a motivation to talk openly to their children about the way in which they built their family. Many fathers described either using books or creating their own book as a disclosure aid for their child.

Limitations, reasons for caution

Due to the variation between different countries regarding laws on surrogacy, the findings may not be representative of experiences of surrogacy in different contexts from the ones studied. The sample size was relatively small; however, the research provides new insights into an area with little academic literature.

Wider implications of the findings

The study findings contribute a new understanding of the experiences of single fathers who use surrogacy to begin a family. The disclosure findings largely reflect those of studies of single mothers through sperm donation showing that single parents are very likely to disclose and many disclose at an early age.

Trial registration number

N / A

Characterization of the treatment-naive immune microenvironment in melanoma with BRAF mutation

Background

Patients with BRAF-mutant and wild-type melanoma have different response rates to immune checkpoint blockade therapy. However, the reasons for this remain unknown. To address this issue, we investigated the precise immune composition resulting from BRAF mutation in treatment-naive melanoma to determine whether this may be a driver for different response to immunotherapy.

Methods

In this study, we characterized the treatment-naive immune context in patients with BRAF-mutant and BRAF wild-type (BRAF-wt) melanoma using data from single-cell RNA sequencing, bulk RNA sequencing, flow cytometry and immunohistochemistry (IHC).

Results

In single-cell data, BRAF-mutant melanoma displayed a significantly reduced infiltration of CD8⁺ T cells and macrophages but also increased B cells, natural killer (NK) cells and NKT cells. We then validated this finding using bulk RNA-seq data from the skin cutaneous melanoma cohort in The Cancer Genome Atlas and deconvoluted the data using seven different algorithms. Interestingly, BRAF-mutant tumors had more CD4⁺ T cells than BRAF-wt samples in both primary and metastatic cohorts. In the metastatic cohort, BRAF-mutant melanoma demonstrated more B cells but less CD8⁺ T cell infiltration when compared with BRAF-wt samples. In addition, we further investigated the immune cell infiltrate using flow cytometry and multiplex IHC techniques. We confirmed that BRAF-mutant melanoma metastases were enriched for CD4⁺ T cells and B cells and had a co-existing decrease in CD8⁺ T cells. Furthermore, we then identified B cells were associated with a trend for improved survival (p=0.078) in the BRAF-mutant samples and Th2 cells were associated with prolonged survival in the BRAF-wt samples.

Conclusions

In conclusion, treatment-naive BRAF-mutant melanoma has a distinct immune context compared with BRAF-wt melanoma, with significantly decreased CD8⁺ T cells and increased B cells and CD4⁺ T cells in the tumor microenvironment. These findings indicate that further mechanistic studies are warranted to reveal how this difference in immune context leads to improved outcome to combination immune checkpoint blockade in BRAF-mutant melanoma.

TEMPO® TVC for the Enumeration of Aerobic Mesophilic Flora in Foods: Collaborative Study

The automated system for enumeration of total viable count (TVC) in foods, TEMPO® TVC, uses a dehydrated culture medium and an enumeration card containing 48 wells across 3 different dilutions for the automatic determination of the most probable number (MPN). The alternative method was compared in a multilaboratory collaborative study to AOAC Method 966.23 for determination of aerobic plate count for nondairy products and the Standard Methods for the Examination of Dairy Products (SMEDP) Standard Plate Count for dairy products. Five food types, raw ground beef, raw ground chicken, cooked whitefish fillets, bagged lettuce, and milk, were analyzed for TVC by 14 collaborating laboratories throughout the United States and Canada. Three lots of naturally contaminated food products representing a wide range of counts were tested for each of the 5 food types. The study demonstrated that the overall repeatability, reproducibility, and mean log counts of the TEMPO TVC method were statistically comparable to those of the 2 standard methods at the 5 level.

The perspectives of adolescents conceived using surrogacy, egg or sperm donation

STUDY QUESTION

What are the perspectives of adolescents conceived using surrogacy, egg or sperm donation regarding their conception and the third party involved?

SUMMARY ANSWER

The majority of adolescents described feeling indifferent about their conception, and yet simultaneously reported an interest in the third party involved, or were in contact with them.

WHAT IS KNOWN ALREADY

There is an assumption that children conceived through reproductive donation will feel negatively about their origins in adolescence. However, little is known about the views of adolescents who have been conceived through different types of reproductive donation.

STUDY DESIGN, SIZE, DURATION

Forty-four adolescents, all of whom had been told about their conception in childhood, participated in a semi-structured interview as part of the sixth phase of a longitudinal, multi-method, multi-informant study of assisted reproduction families in the UK.

PARTICIPANTS/MATERIALS, SETTING, METHODS

All adolescents were aged 14 years, had been conceived using surrogacy (n = 22), egg donation (n = 13) or sperm donation (n = 9) to heterosexual couples, and varied in terms of their information about, and contact with, the third party involved in their conception. Semi-structured interviews were conducted in participants' homes. Interviews were analysed qualitatively to determine adolescents' perceptions of their conception, and their thoughts and feelings about the surrogate or donor involved.

MAIN RESULTS AND THE ROLE OF CHANCE

Adolescents were found to feel positive (n = 7), indifferent (n = 32) or ambivalent (n = 5) about their conception. Amongst adolescents not in contact with the surrogate or donor, most were interested (n = 16) in the surrogate or donor, and others were ambivalent (n = 4), or not interested (n = 6) in them. Adolescents in contact with the surrogate or donor expressed positive (n = 14), ambivalent (n = 1) or negative (n = 1) feelings about them.

LIMITATIONS, REASONS FOR CAUTION

Of 56 adolescents invited to take part in the study, 47 consented to take part, giving a response rate of 84%. It was not possible to obtain information from adolescents who do not know about their conception.

WIDER IMPLICATIONS OF THE FINDINGS

The findings contradict the assumption that children conceived through reproductive donation will feel negatively about their origins in adolescence and suggest that it may be helpful to draw a distinction between adolescents' feelings about their conception in general, and their feelings about the surrogate or donor in particular.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by the Wellcome Trust [097857/Z/11/Z]. The authors have no conflicts of interest to declare.

Sperm donor regulation and disclosure intentions: Results from a nationwide multi-centre study in France

Gamete donation in Europe is not regulated by a common legal framework. Different laws regarding donor anonymity and remuneration exist in different countries. In France, gamete donation is characterized by a stable legal framework - the existing system of anonymous and non-remunerated donation remained unchanged following a period of public and parliamentary debate in 2011 - but little evidence is available concerning recipients' views and experiences of gamete donation. This article describes findings from a questionnaire completed individually by 714 heterosexual couple members undergoing a donor conception procedure at one of 20 national fertility centres in France. Participants were invited to report their attitudes towards the French legal framework, their perceptions of the anonymous donor, and their intentions to disclose donor conception to their child and to other people. The majority of respondents (93%) approved of the current legal framework. Participants indicated that they thought about the sperm donor in ways that emphasized his act of donation without describing him as a specific individual. A majority (71%) also stated that they intended to tell their child about their donor conception. Given that this is the largest nationwide study of French recipients of donor sperm, the findings make an important contribution to the research evidence currently available about prospective parents' perspectives in the increasingly uncommon context of donor anonymity in Europe.

Children's thoughts and feelings about their donor and security of attachment to their solo mothers in middle childhood

STUDY QUESTION

What is the relationship between children's thoughts and feelings about their donor and their security of attachment to their solo mothers in middle childhood?

SUMMARY ANSWER

Children with higher levels of secure–autonomous attachment to their mothers were more likely to have positive perceptions of the donor, and those with higher levels of insecure–disorganized attachment to their mothers were more likely to perceive him negatively.

WHAT IS KNOWN ALREADY

There is limited understanding of the factors that contribute to children's thoughts and feelings about their donor in solo mother families. In adolescence, an association was found between adolescents’ curiosity about donor conception and their security of attachment to their mothers.

STUDY DESIGN, SIZE, DURATION

19 children were administered the Friends and Family Interview and Donor Conception Interview between December 2015 and March 2016 as part of the second phase of a longitudinal, multi-method, multi-informant study of solo mother families.

PARTICIPANTS/MATERIALS, SETTING, METHODS

All children were aged between 7 and 13 years and had been conceived by donor insemination to solo mothers. Interviews were conducted in participants’ homes. The Friends and Family Interview was rated according to a standardized coding scheme designed to measure security of attachment in terms of secure–autonomous, insecure–dismissing, insecure–preoccupied and insecure–disorganized attachment patterns. Quantitative analyses of the Donor Conception Interview yielded two factors: interest in the donor and perceptions of the donor. Qualitative analyses of the Donor Conception Interview were conducted using qualitative content analysis and thematic analysis.

MAIN RESULTS AND THE ROLE OF CHANCE

Statistically significant associations were found between the perception of the donor scale and the secure–autonomous and insecure–disorganized attachment ratings. Children with higher levels of secure–autonomous attachment to their mothers were more likely to have positive perceptions of the donor (r = 0.549, P = 0.015), and those with higher levels of insecure–disorganized attachment to their mothers were more likely to perceive him negatively (r = −0.632, P = 0.004). Children's narratives about the donor depicted him as a stranger (n = 8), a biological father (n = 4), a social parent (n = 3), or in ambivalent terms (n = 4).

LIMITATIONS, REASONS FOR CAUTION

Findings are limited by the wide age range of children within a small overall sample size. Participants were those willing and able to take part in research on donor conception families. The statistical significance of correlation coefficients was not corrected for multiple comparisons.

WIDER IMPLICATIONS OF THE FINDINGS

Findings highlight the importance of situating children's ideas about the donor within family contexts. It is recommended that those working with donor conception families consider this when advising parents about whether, what and how to tell children about donor conception.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by the Wellcome Trust [097857/Z/11/Z]. The authors have no conflicts of interest to declare.

The perceived influence of childhood cancer on the parents' relationship

OBJECTIVE

When a child is diagnosed with cancer, parents are faced with many practical and emotional challenges that can significantly affect their relationship. This study explores how having a child with cancer affects the quality of the parents' relationship, categorizes time points and events during the child's treatment when the relationship becomes most stressed and/or strengthened, identifies factors that help couples remain emotionally engaged throughout their child's cancer treatment, and assesses parental interest in a counseling intervention.

METHODS

This is a cross-sectional, multicenter study conducted via a semistructured self-administered questionnaire that included the Revised Dyadic Adjustment Scale.

RESULTS

One hundred ninety-two parents of children diagnosed between the ages of 1 and 21 participated. Forty percent felt their relationship moved in a negative direction. Diagnosis and relapse of disease were cited as the most individually stressful time points in the disease trajectory, with hospitalizations and relapse being most stressful on the relationship. Participants felt most emotionally connected at diagnosis and least emotionally connected at the start and end of treatment. The majority of couples indicated interest in counseling to address ways to support their relationship. Soon after diagnosis and during treatment was reported as the preferred time to offer these interventions.

CONCLUSION

This study identified specific events and parent behaviors that strain the couples' relationship during the childhood cancer trajectory. This information can inform the development of a couple's intervention. Prospective research is needed to better understand how childhood cancer affects caregivers' partnerships through survivorship and beyond.

From 'Virgin Births' to 'Octomom': Representations of Single Motherhood via Sperm Donation in the UK News

The use of sperm donation by single women has provoked public, professional and political debate. Newspapers serve as a critical means of both broadcasting this debate and effecting a representation of this user group within the public sphere. This study uses the theory of social representations to examine how single motherhood by sperm donation has been represented in the UK news over time. The study sampled news coverage on this topic in eight British newspapers during three 4-year periods between the years 1988 and 2012. The dataset of news reports (n = 406) was analysed using a qualitative approach. Findings indicated that UK media reports of single women using donor sperm are underpinned by conventional categories of the 'personal', the 'traditional' and the 'natural' that when paired with their corollaries produce a representation of this user group as the social 'other'. The amount of coverage on this topic over time was found to vary according to the political orientation of different media sources. Using key concepts from social representations theory, this article discusses the relationship between themata and anchoring in the maintenance of representations of the social 'other' in mass mediated communication. Findings are explained in relation to theoretical conceptions of the mass media and its position within the public sphere. It is argued that the use of personal narratives in news reports of single mothers by sperm donation may have significant implications for public understandings of this social group. © 2016 The Authors. Journal of Community & Applied Social Psychology published by John Wiley & Sons Ltd.

Absence or presence? Complexities in the donor narratives of single mothers using sperm donation

STUDY QUESTION

How do single mothers who have conceived a child via anonymous or identity-release sperm donation represent the donor?

SUMMARY ANSWER

While the majority of mothers described their anonymous and identity-release donors as symbolically significant to their families, others were more likely to emphasize that their lack of information limited their thoughts about him.

WHAT IS KNOWN ALREADY

There is limited understanding of the factors that impact upon how single mothers represent the donor, and whether or not they are determined by specific donor programmes (anonymous or identity-release).

STUDY DESIGN, SIZE, DURATION

Qualitative interviews were conducted with 46 women who had treatment at a UK licensed fertility clinic during the years 2003–2009. Twenty mothers (43%) had used an anonymous donor, and 26 (57%) had used an identity-release donor.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Among the 46 mothers interviewed, all had at least one child conceived via donor insemination who was between the ages of 4 and 9 years. Mothers were heterosexual and were currently without a live-in and/or long-term partner. Interview data were analysed qualitatively according to the principles of thematic analysis.

MAIN RESULTS AND THE ROLE OF CHANCE

Findings indicated marked diversity in single mothers' representations of the donor. Most (n = 27) mothers talked about the donor as symbolically significant to family life and were likely to describe the donor as (i) a gift-giver, (ii) a gene-giver and (iii) a potential partner. Others (n = 16) talked about the donor as (i) unknown, (ii) part of a process and (iii) out of sight and out of mind. There were mothers with anonymous and identity-release donors in each group. Several mothers explained that their feelings about the donor had changed over time.

LIMITATIONS, REASONS FOR CAUTION

All mothers conceived at a licensed fertility clinic in the UK. Findings are limited to individuals willing and able to take part in research on donor conception.

WIDER IMPLICATIONS OF THE FINDINGS

The study offers greater insight into the factors influencing the donor narratives produced in single-mother families. It has implications for the counselling and treatment of single women seeking fertility treatment with donor gametes in both anonymous and identity-release programmes. Given that the number of clinics offering identity-release programmes worldwide seems to be increasing, the finding that single women may have varying preferences with regard to donor type, and varying interest levels with regard to donor information, is important. It is recommended that clinicians and other fertility clinic staff guard against making assumptions about such preferences and any thoughts and feelings about the donor or donor information on the basis of marital status.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by the Wellcome Trust [097857/Z/11/Z]. The authors have no conflicts of interest to declare.

Is Participating in Psychological Research a Benefit, Burden, or Both for Medically Ill Youth and Their Caregivers?

Few data exist pertaining to the perceived burdens or benefits of medically ill children participating in psychological research studies, particularly in outpatient pediatric settings. As part of a larger study that involved completing self-report questionnaires, this study assessed whether participation was burdensome and/or beneficial to 271 children undergoing treatment for cancer, NF1, sickle cell, HIV, primary immune deficiencies, and Li Fraumeni and to their caregivers. The majority of patients (83%) and their caregivers (93%) did not find participating burdensome. Moreover, the majority of patients (85%) and caregivers (95%) found at least some benefit to participation, including finding it helpful to be asked about issues that affect their life and feeling good about helping others. The data suggest that resistance to psychological research based on the belief that such research is intrusive and potentially harmful overestimates the negative aspects and potentially impedes progress studying positive psychosocial outcomes in outpatient pediatric research.

Outcome following multiple lines of salvage chemotherapy prior to autologous stem cell transplant for relapsed or refractory diffuse large B-cell lymphoma (DLBCL)

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Background: The standard of care for chemosensitive relapsed or refractory DLBCL is autologous stem cell transplant (ASCT). There is no standard approach for patients (pts) whose disease fails to respond to platinum-based salvage chemotherapy (pSC) although pts who undergo further salvage chemotherapy to demonstrate chemosensitivity may benefit from ASCT (Chen, et al, BMT 2002). We analyzed the overall response rate (ORR) to each line of salvage therapy for pts with relapsed or refractory DLBCL and the impact of the number of salvage regimens necessary to demonstrate chemosensitivity on overall and progression-free survival (OS and PFS) post-ASCT. Methods: We retrospectively reviewed our computerized database and charts between Jan 1/99 - Dec 31/05 and identified 203 pts relapsed after or refractory to anthracycline-based chemo treated with pSC. Pts typically received 2–3 cycles of pSC to assess chemotherapy sensitivity. Responding patients received etoposide 60 mg/kg and melphalan 160 mg/m2 supported by autologous PBSCs. Pts with stable or progressive disease following first line salvage chemotherapy (SC1) were offered alternate non-cross resistant second-line salvage chemotherapy (SC2) and proceeded to ASCT if chemosensitive. Results: Pt characteristics: Median age at time of salvage chemotherapy: 52 years (range 21–65); primary refractory: 48%; advanced stage disease at salvage: 50%; prior rituximab: 17%; prior radiation 26%. 119/203 pts did not respond to SC1, 81 pts received SC2 and 10 pts received 3 salvage regimens (SC3). ORRs to salvage were: SC1: 40%, SC2: 14%, SC3: 10%. Pts able to proceed to ASCT were: SC1: 37%, SC2: 14%, SC3: 0. With a median follow-up of 1.8 years, the 2-year OS post ASCT for the SC1 and SC2 groups was 69% and 56% respectively. The 2-year PFS post ASCT for the SC1 and SC2 groups were 58% and 40%. Conclusions: The ORR to platinum-based SC is low in this cohort of primary refractory/relapsed patients (40%), and only 14% of pts who received SC2 after pSC responded. Although some have prolonged PFS following SC2 and ASCT, additional strategies should be investigated in these patients.

No significant financial relationships to disclose.