Dorothy A. Greenfeld

Psychological studies of in vitro fertilization/embryo transfer participants

During the last decade, reproductive endocrinology has provided new technologies for treatment of infertilityone of which is in vitro fertilization/embryo transfer (IVF/ET). The use of this technology has been accompanied by considerable interest in understanding the psychology of those seeking IVF/ET and in understanding psychological reactions during and after IVF/ET. This paper reviews the psychological research within the IVF/ET literature as divided into three major areas: first, psychological profiles of women and their partners requesting IVF/ET; second, clinical reports which describe the psychological experience of IVF/ET and provide recommendations for counseling both before and during IVF/ET; and third, follow-up studies of IVF/ET participants. This paper is designed to highlight initial findings in these three areas of research and thus provide a context for future research directions. Specific suggestions for future study include redirecting research effort from investigations of psychopathology to detecting stress which may affect IVF/ET outcome.

Grief reactions following in-vitro fertilization treatment

It has been widely reported that in-vitro fertilization (IVF) is a particularly stressful experience for women. In particular, it appears that when IVF fails, a small number of women suffer a grief reaction that may be quite disruptive to their lives. The symptoms manifested by this grief response mirror the symptoms of women suffering a pregnancy loss. Clinical observation suggests that the intensity of grief reactions is greatest after a failed first cycle of the treatment and that, to a limited extent, this response can be predicted by observing the degree of the IVF patients attachment to the expected pregnancy. The authors describe significant grief reactions which occurred in 3 of 97 women who failed to achieve pregnancy after a first cycle of IVF. It appears that the impressive IVF technology can inadvertently foster and intensify IVF patients attachment to the expected pregnancy by creating unreasonable expectations of successful treatment of infertility.

Attitudes of IVF parents regarding the IVF experience and their children.

AbstractPurpose: to assess parental attitudes regarding the IVF experience, the IVF pregnancy, and issues associated with raising their IVF child(ren). Method: parents (184 couples) of IVF children born between 1982 and 1992 were mailed individual anonymous questionnaires. Results: (31%) parents responded: 62 mothers and 41 fathers. One hundred-three (41%) of the mothers felt that our staff could have been more helpful during their pregnancy. Half the women subjects (52%) stated that they wished they had contact with other IVF couples during pregnancy. Fifty-two percent of the mothers reported that IVF created special feelings of attachment to the child, causing some difficulty with their initial separation. This was comparatively less an issue for fathers, with only 19% reporting similar difficulties (X2=8.39, P<0.01). Ninety-eight percent of the subjects have told someone else about the IVF experience. Interestingly, 25% of the parents remained uncertain about whether they would tell the child. Sixteen couples (15%) had already told the child, and of the 57 (66%) who intended to tell the child later, they varied greatly in their views about which age would be appropriate (mean, 7.3 years; SD, 6.5 years; range, 2–21 years). Conclusions: The results suggest that women undergoing IVF might profit from greater contact with staff during pregnancy and, again, later when dealing with issues of separation. A substantial proportion of couples expressed some concerns about the issue of disclosure to the child and might profit from counseling when they feel the issue is current.

Gay men choosing parenthood through assisted reproduction: medical and psychosocial considerations

OBJECTIVE To medically and psychologically assess gay men seeking parenthood through assisted reproduction and to provide guidelines for the assessment. DESIGN Qualitative observational study. SETTING Academic medical center. PATIENT(S) Thirty gay males (15 couples) presenting for assisted reproduction using an oocyte donor and a gestational carrier. INTERVENTION(S) Semistructured interview and medical evaluation. MAIN OUTCOME MEASURE(S) Determination of psychological and medical eligibility for treatment. RESULT(S) The average age of men was 38.4 years. All couples were in a committed relationship and had been together for an average 6.4 years. All met medical and psychological criteria for acceptance. CONCLUSION(S) Gay men increasingly choose fatherhood through assisted reproduction. Counseling these couples on the medical and emotional demands of in vitro fertilization with a gestational carrier and an oocyte donor is a vital component of pretreatment preparation.

The course of infertility: Immediate and long-term reactions

Infertility frequently has a profound and long-lasting psychological impact on individuals and couples attempting to conceive. The psychological responses to infertility vary, but typically include loss of self-esteem, depression, anger, and guilt. Psychotherapy, although not a cure for infertility, can help couples cope with the pain and emotional distress that infertility may cause. This article describes common responses to infertility and includes a case illustration of the psychological impact of infertility. Mahlstedts (1985) theory of infertility as a series of losses is used to provide a theoretical framework for understanding and structuring psychotherapeutic interventions for both immediate and long-term reactions.

Do attitudes toward disclosure in donor oocyte recipients predict the use of anonymous versus directed donation

OBJECTIVE To compare the demographic and psychological characteristics of oocyte recipients and to determine whether the issue of disclosure about the use of a donor is a correlate of the decision to use an anonymous or directed donor. DESIGN Cross-sectional study. SETTING University teaching hospital. PATIENT(S) Ninety consecutive recipients of donated oocytes (64 of whom used anonymous donors and 26 of whom used directed donors). INTERVENTION(S) Pretreatment psychosocial evaluation. MAIN OUTCOME MEASURE(S) Recipient opinions and attitudes regarding the choice of donor type and disclosure to others as determined through a semistructured interview. RESULT(S) There were no statistically significant differences with regard to demographic characteristics between recipients who used anonymous and directed donors. There were statistically significant differences between the groups with regard to the issue of disclosure. Recipients who used directed donors were more likely to have told others about using an oocyte donor and were more likely to indicate that they intended to inform the child about the nature of his or her conception. CONCLUSION(S) Oocyte recipients who use known donors differ significantly from those who use anonymous donors with regard to the issue of disclosure to others. Further studies are needed to determine the causal direction of this relation.

Does psychological support and counseling reduce the stress experienced by couples involved in assisted reproductive technology

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The impact of disclosure on donor gamete participants: donors, intended parents and offspring.

Purpose of review The present review examines recent publications that provide insight into how the trend toward nonanonymity and disclosure in gamete donation impacts donors, intended parents, and their donor-conceived children. Recent findings Recent findings show an increase in donor programs that offer open-identity between donors and offspring. The psychological needs of gamete donors and their attitudes toward disclosure are increasingly given consideration. Qualitative research on how parents of donor gamete offspring make decisions about disclosure reveals that even when couples initially disagree about disclosing to offspring, most ultimately come to a united disclosure decision. The literature on the impact of disclosure on donor gamete offspring has extended to include children conceived through embryo donation and children born as a result of surrogacy. The absence of genetic or gestational link between parents and their child does not have a negative impact on parent–child relationships. Parents through surrogacy tend to disclose the method of family creation to their child, whereas parents through embryo donation tend to be secretive about their childs origins. Summary The trend toward greater openness in gamete donation has been accompanied by an increase in programs offering open-identity donation. In addition, the psychological needs of gamete donors and their attitudes toward disclosure are increasingly being given consideration. Parents of donor gamete offspring give careful thought to their disclosure decisions, and the psychological well being of donor-conceived children does not seem to be impacted by those decisions.

Similarities and differences between anonymous and directed candidates for oocyte donation

PurposeTo compare anonymous and directed candidates for oocyte donation within a single program.Methods75 consecutive candidates for oocyte donation (49 anonymous and 26 directed) were studied using a semistructured interview to collect data on demographics, psychosocial history, motivation, and candidate views on disclosure to a potential child.ResultsDonor groups were similar with regard to race, religion and education. Anonymous donors (mean age 27.33 years, SD 4.17) were significantly younger than directed donors (mean age 37.54 years, SD 4.94), (t=−4.83, df=73, p<0.001). Marital duration was significantly longer for directed donors (6.92 years, SD 5.64) versus (2.57 years, SD 3.96) for anonymous donors (t=−3.50, df=38.47, p=.001). Forty-one percent of anonymous and 69% of directed donors had previous pregnancies (x2=4.60, p<.05). A greater percentage of anonymous donors (34.7%) felt that the potential child should be informed of his or her origins, compared to 19% of directed donors, but this difference fell short of statistical significance.ConclusionsThere were more similarities than differences among groups of potential donors with the exception of age, marital status, and previous pregnancies. Differing views about disclosure were suggested in both groups with anonymous donors tending to opt for disclosure.

Changing attitudes towards third-party reproductive techniques.

A growing number of children around the world are conceived through third-party reproductive techniques. The increased demand for these programs has resulted in an ongoing trend towards greater openness and less anonymity in gamete donation. This has led to changes in public policy regarding the identity of donors, to a greater concern for the well-being of donors, and to calls for disclosure to offspring about their donor gamete conception.