Anne-Maria Suikkari

Increasing openness in oocyte donation families regarding disclosure over 15 years

BACKGROUNDnWorldwide there is an increasing number of families created by oocyte donation (OD). The aim of this study was to gather information about parents plans of disclosure to their child and to other people, as well as parents attitudes and level of satisfaction up to 15 years after their OD treatment.nnnMETHODSnA questionnaire with separate material for each partner was sent to all parents (167 mothers, 163 fathers) who had had a child after treatment with donated oocytes at Väestöliitto Fertility Clinics in Helsinki during 1992-2006. These parents had a total of 231 children aged 1-14 years. Parents were asked if they had told or intended to tell their child about his/her origin and how and when they had done so and about the reasons to disclose or not. Other questions were about openness towards other people, concerns about donor characteristics, counselling and feelings towards the child.nnnRESULTSnOf the mothers, 61.1%, and of the fathers, 60.0%, had told or intended to tell the child of his/her conception. Of children over 3 years of age, 26% had already been informed. There was a statistically significant difference between parental telling in different age groups of children (P = 0.011, χ(2)). In the youngest age group (1-3 years), 83.3% of parents were inclined to disclosure compared with 44.4% in the oldest age group (13-14 years). A high proportion of mothers (86.7%) and fathers (71.0%) had told other people about the nature of their childs conception. The majority of parents did not have much concern about the characteristics of the donor. A higher proportion of the mothers (24%) compared with fathers (11%) thought that the psychological support had been insufficient. They thought that discussions with health professionals should be arranged routinely after delivery or when it was time to inform the child.nnnCONCLUSIONSnParents with young OD children are clearly more inclined to disclosure compared with parents with older children.

Influence of oocytes and spermatozoa on early embryonic development

OBJECTIVEnTo evaluate the effect of oocytes and spermatozoa on early embryonic development.nnnDESIGNnRetrospective study.nnnSETTINGnInfertility Clinic, the Family Federation of Finland.nnnPATIENT(S)nFifty-nine oocyte donation cycles with oocytes shared among 118 recipient couples.nnnINTERVENTION(S)nCulture of all fertilized oocytes.nnnMAIN OUTCOME MEASURE(S)nStandard sperm (concentration, progressive motility, and morphology according to Tygerberg strict criteria) and embryo (morphology and cleavage stage) characteristics.nnnRESULT(S)nA marked effect of the oocyte on both embryo morphology and blastomere cleavage rate was demonstrated. In addition, a significant sperm effect on blastomere cleavage rate was found. Sperm morphology as determined according to strict criteria rather than sperm count or progressive motility was positively associated with the blastomere cleavage rate. None of the measured sperm characteristics influenced embryo morphology.nnnCONCLUSION(S)nEmbryo morphology, i.e., fragmentation and blastomere uniformity, are predominantly determined by oocyte quality, whereas both the oocyte and spermatozoa influence the blastomere cleavage rate.

Attitudes and disclosure decisions of Finnish parents with children conceived using donor sperm

STUDY QUESTIONnWhat are disclosure intentions and experiences of heterosexual parents with children born after assisted donor insemination (DI) or IVF with donor sperm (dIVF)?nnnSUMMARY ANSWERnOnly 16.5% of Finnish DI/dIVF heterosexual parents had told their child of his/her origin; 18% of all children above 3 years of age had received the information. Parents with older children were more unwilling to tell or were more uncertain regarding what to do than parents with younger children.nnnWHAT IS KNOWN ALREADYnIn general, 10-35% of parents of DI offspring are willing to inform their child about their conception. Men who need donor sperm to become a father are more secretive than women who need donated oocytes and are less willing to participate in counselling about parenthood. In the past, couples conceiving through gamete donation were adviced to maintain secrecy or sufficient advice on information sharing was not available. Evidence suggests that parental attitudes are moving towards greater openness. In 2007, Finland enacted a law on assisted fertility treatments (1237/2006) stating that gamete donors have to register their identifying information in a registry so that at the age of 18 years, offspring can obtain information about their donor.nnnSTUDY DESIGN, SIZE AND DURATIONnThis retrospective questionnaire study included 139 mothers and 127 fathers with altogether 240 children born after DI or dIVF during 1992-2007.nnnPARTICIPANTS, SETTING AND METHODSnQuestionnaires were sent to heterosexual couples who had undergone DI/dIVF treatment at the Väestöliitto Fertility Clinic in Helsinki resulting in live birth (n = 277, 252 mothers and 239 fathers). The parents were asked to report their disclosure intentions towards the child and towards other people about the decision to use donated sperm, their concerns about donor characteristics, their evaluation of the counselling that they received and their views about the current Finnish assisted reproduction law.nnnMAIN RESULTS AND THE ROLE OF CHANCEnThe response rate was 55% (139/252) among the mothers and 53% (127/239) among the fathers. Answers provided information on 58% (240/415) of the children born, 91% of whom were at least 3 years old at the time. Of all parents, 16.5% reported that they had already told their child of his/her conception. Of all 240 children, 16.3% had already received information about their conception. The children had been between 3 and 14 years of age (mean 6.8 years) when they were told. Parents of older children were significantly more unwilling to tell their child than parents of younger children (P < 0.005). No difference in disclosure between DI and dIVF emerged. Less than half of the parents (42%) had been satisfied with the psychological support offered to them, with parents of older children having been most dissatisfied.nnnLIMITATIONS, REASONS FOR CAUTIONnAlthough the response rate was relatively high, more than 40% of the parents chose not to participate. As has been shown before, it is likely that those who do not take part are less inclined to disclose and this should be taken into consideration when conclusions are drawn.nnnWIDER IMPLICATIONS OF THE FINDINGSnOur results on disclosure rates are in agreement with previous studies. General attitudes have moved towards greater openness about the use of donated gametes. Furthermore, the availability of psychological counselling before treatment has increased the understanding of the importance of disclosure. People who have become parents after DI or dIVF should also be offered counselling after the child has been born.nnnSTUDY FUNDING/COMPETING INTERESTSnThis study was supported by grants from the Wilhelm and Else Stockmann Foundation and the Medical Society Life and Health. There are no competing interests to disclose.nnnTRIAL REGISTRATION NUMBERnNone.

Short- and long-term health consequences and current satisfaction levels for altruistic anonymous, identity-release and known oocyte donors

STUDY QUESTIONnWhat are the short- and long-term health consequences and current satisfaction of altruistic oocyte donors?nnnSUMMARY ANSWERnDonating oocytes in the majority (>90%) of donation cycles is not associated with harmful long-term general or reproductive health effects.nnnWHAT IS KNOWN ALREADYnKnowledge of long-term health effects of oocyte donation on donors is sparse and follow-up studies have usually been carried out on commercial donors. Thus far, no major long-term harmful effects have been demonstrated. Most studies have reported a high level of donor satisfaction, but also less favorable experiences have been published.nnnSTUDY DESIGN, SIZE AND DURATIONnA retrospective cross-sectional survey of all women who had donated oocytes between 1990 and 2012 at three fertility clinics was carried out in spring 2013. A self-administered questionnaire was sent out to a total of 569 former oocyte donors.nnnPARTICIPANTS, SETTING, METHODSnIn all, 428 past donors answered the questionnaire assessing donors demographic characteristics, short- and long-term medical and psychological experiences and satisfaction related to donations. Of the donors, 87% (371/428) were unknown and 13% (57/428) were known to the recipient. The mean follow-up time after the donation was 11.2 years (range from 0.5 to 23 years) and the mean age of the respondents was 42 years at the time of the study. To learn whether the demographic profile of donors was affected by the Finnish Assisted Reproduction Technology (ART) Act of 2007, we divided the 428 respondents into two groups: (i) women whose first donation took place between 1990 and 2007 (79% of the respondents) and (ii) women whose first donation took place between 2008 and 2012 (21% of the respondents). Before 2008, donors were non-identifiable (anonymous) but after 2008 persons born as a result of gamete donation could, from the age of 18, receive on request information identifying the donor.nnnMAIN RESULTS AND THE ROLE OF CHANCEnThe response rate was 75% (428/569). The mean age of the donors did not differ between the two time periods, but there was a higher proportion of donors in the youngest age group (20-24 years) and more childless donors (P < 0.05) after 2008 than between 1990 and 2007. Immediate complications occurred in 7.2% (42/582) of the donation cycles and the most common complication was ovarian hyperstimulation syndrome (OHSS) in 5.0% (29/582) of the treatments. There were no reports of ovarian or uterine cancer and only one case of breast cancer. After the donation, 11.5% of the donors experienced unsuccessful attempts to become pregnant. Almost all donors (99%) were satisfied or very satisfied with their decision to donate and 95% would warmly recommend it to other women. There were no differences between the known and unknown donors in this respect, or between the two time periods (before or after the ART Act in 2008). Four donors (1%) had regretted donation, and 7% would have wanted to have more support before and 14% after the donation.nnnLIMITATIONS, REASON FOR CAUTIONnAlthough the response rate was high, 25% of all former donors in the three participating clinics could not be included due to lack of response. The results are based on self-reported assessment of the experiences of former donors, and it is not possible to estimate the influence of recall bias.nnnWIDER IMPLICATIONS OF THE FINDINGSnTo our knowledge, this is the largest study of health consequences and satisfaction levels on oocyte donors. Data from this study can be used to inform donor candidates about the medical aspects involved in the treatment and it provides information on how to support these women during and after the donation.nnnSTUDY FUNDING/COMPETING INTERESTSnThis study was supported by grants from the Medical Society Life and Health, and from the Otto A. Malm Foundation. There are no competing interests to report.

The Effect of Hysterectomy on Serum CA-125 Levels in Patients with Adenomyosis and Uterine Fibroids

The human endometrium has been reported to release CA 125 in tissue culture, and elevated levels have been found in patients with endometriosis and adenomyosis. The serum levels of CA 125 were measured in 22 women undergoing hysterectomy for adenomyosis (n = 11) or fibroids (n = 11) of the uterus. In 20 patients (91%) the pre-operative CA 125 level was normal (less than 35 U/ml). All patients with adenomyosis had a normal pre-operative serum CA 125 concentration. Five weeks after the operation the CA 125 levels did not differ from the pre-operative levels. Our results show that the uterine contribution to the serum CA 125 level is minimal, and do not confirm the initial enthusiasm concerning the possible use of levels as an aid in the diagnosis of adenomyosis.