Olga van den Akker

The socio-cultural and biological meaning of parenthood.

Parenting a child is one of the most universal, common and fundamental assumptions the majority of men and women make from an early age about their future. This common and historic assumption was challenged in modernized Western societies in the 1960s with the opportunities for ‘mass control’ of reproduction and then again supported in the 1980s with the advance of ‘mass enhancement’ of reproduction. This study qualitatively assessed the meaning of parenthood of post modern British individuals of different ages, gender, cultural backgrounds and parity. The results of the Interpretative Phenomenological Analyses revealed a number of common ideologies about parenthood, and a number of specific age, gender, parity and cultural differences in how individuals interpret and experience parenthood. These individual differences play a significant part in the quality of life of people gaining or losing the opportunity to parent, as has been discussed ‘around the globe’ by Frank van Balen and his team, and must be considered in counselling people faced with decisions which challenge their personal and universal assumptions to parent a genetically related child.

Genetic and gestational surrogate mothers' experience of surrogacy

The psychological characteristics, motivations and experiences of surrogate mothers have not received much research attention, yet their reproductive role has significant psychological, social, theoretical and politico-legal implications. Questionnaire data are presented for 24 surrogate [11 gestational (IVF), 13 genetic (AI)] mothers. Semi-structured and open-ended questions relating to motivations, experiences, support, knowledge, information, confidence, concerns, genetic link, disclosure and relinquishment issues, and standardized questionnaires assessing quality of life and psychopathology were included. It was hypothesized that genetic and gestational surrogates would differ on these measures, but few differences between groups were observed. The importance of a genetic link differed significantly between groups, substantiating the belief that surrogacy type specific cognitive restructuring is taking place to prepare them for the relinquishment process. Worries and concerns differed somewhat between genetic and gestational surrogates. In general, the experience of surrogacy was important and very positive for most surrogates, though some negative experiences were also reported. One surrogate reported some psychopathology but no significant differences in quality of life were apparent between the groups. The implications of the lack of substantial differences between these two types of surrogates are discussed, and provide some of the evidence needed to support current debates informing legislation, information and counselling.The psychological characteristics, motivations and experiences of surrogate mothers have not received much research attention, yet their reproductive role has significant psychological, social, theoretical and politico-legal implications. Questionnaire data are presented for 24 surrogate [11 gestational (IVF), 13 genetic (AI)] mothers. Semi-structured and open-ended questions relating to motivations, experiences, support, knowledge, information, confidence, concerns, genetic link, disclosure and relinquishment issues, and standardized questionnaires assessing quality of life and psychopathology were included. It was hypothesized that genetic and gestational surrogates would differ on these measures, but few differences between groups were observed. The importance of a genetic link differed significantly between groups, substantiating the belief that surrogacy type specific cognitive restructuring is taking place to prepare them for the relinquishment process. Worries and concerns differed somewhat between...

The Quality of Life of renal dialysis patients: trying to find the missing measurement

The physiological status of the individual renal patient is monitored regularly to ensure adequate dialysis is maintained, however, the psychosocial status of the renal patient is not subject to the same amount of attention. This study aimed to determine the Quality of Life and psychosocial needs of a sample of renal dialysis patients (n = 170), and to consider methods of routine clinical assessment and evaluation. Difficulties with psychosocial adjustment and physical symptoms were demonstrated. These findings provide evidence for the need to routinely assess psychosocial status in this patient population. There are some scales which could be incorporated into standard settings and used as outcome measures to assess the effectiveness of interventions, and for planning and resource allocation purposes.

The changing profile of surrogacy in the UK – Implications for national and international policy and practice

Since 2007, the numbers of UK Parental Orders granted following surrogacy have markedly increased. More recently, eligibility criteria have been extended to unmarried heterosexual couples and same-sex couples rather than only married couples. Numbers seeking fertility treatments, including through surrogates, outside their country of residence have also increased. This paper presents the limited data currently available – from UK General Register Offices, Child and Family Court Advisory and Support Service for England and the UK surrogacy agencies: COTS, Surrogacy UK, British Surrogacy Centre – to consider potential reasons for the increase and to consider policy and practice implications. It charts the apparent decline in involvement of surrogacy agencies and suggests the potential for exploitation where scrutiny of arrangements and follow up are limited. It recommends improvements to data collection and argues the need for a more integrated approach to review of surrogacy arrangements both nationally and internationally.

The acceptable face of parenthood: The relative status of biological and cultural interpretations of offspring in infertility treatment

The aim of this exploratory study was to investigate a small group of infertile womens perceptions of their need to create a family within current postmodern societal family practices. The relative weightings of biological relatedness and cultural conformity are interpreted within theoretical models of parenthood, and the need for cognitive consistency. Forty-two women attending infertility clinics for treatment to overcome childlessness were given a retrospective questionnaire to determine what the effects of the infertility diagnosis were. The importance of a genetic link was assessed in relation to choices made on treatment options to overcome infertility. Half the sample was devastated by their inability to have a child, and nearly two-thirds could not foresee a future without a family. Preparedness to disclose the mode of starting a family through adoption, IVF and surrogacy was prevalent, although fewer individuals would be willing to disclose egg and particularly sperm donation to the child, famil...

A longitudinal pre-pregnancy to post-delivery comparison of genetic and gestational surrogate and intended mothers: Confidence and genealogy

For women opting to use surrogacy to overcome subfertility, a choice can be made to have a genetically related or unrelated baby. Similarly, women opting to become surrogate mothers also have to choose to gestate and relinquish a genetically related or unrelated baby. This study explored the cognitions behind the initial choices made and determined the strength of those cognitions six months post-delivery of the surrogate baby. Surrogate and Intended mothers (N=81) undergoing Artificial Insemination (AI, genetic) or Embryo Transfer (ET, gestational) were studied separately (four groups) at the start of their surrogate arrangement and those with a positive outcome (n=34) were re-interviewed at six months post-relinquishment. There were significant differences between surrogate and intended mothers in their confidence about the arrangement. Beliefs about the importance of a genetic link were predictors of ET arrangements. Responses were consistent over a one and a half-year study period. The ethical and clinical implications of the results are discussed in relation to appropriate self-selection and confidence with the surrogate process and the importance of genetic offspring.For women opting to use surrogacy to overcome subfertility, a choice can be made to have a genetically related or unrelated baby. Similarly, women opting to become surrogate mothers also have to choose to gestate and relinquish a genetically related or unrelated baby. This study explored the cognitions behind the initial choices made and determined the strength of those cognitions six months post-delivery of the surrogate baby. Surrogate and Intended mothers (N=81) undergoing Artificial Insemination (AI, genetic) or Embryo Transfer (ET, gestational) were studied separately (four groups) at the start of their surrogate arrangement and those with a positive outcome (n=34) were re-interviewed at six months post-relinquishment. There were significant differences between surrogate and intended mothers in their confidence about the arrangement. Beliefs about the importance of a genetic link were predictors of ET arrangements. Responses were consistent over a one and a half-year study period. The ethical and clinical implications of the results are discussed in relation to appropriate self-selection and confidence with the surrogate process and the importance of genetic offspring.

Posttraumatic Stress and Posttraumatic Stress Disorder after Termination of Pregnancy and Reproductive Loss: A Systematic Review

Objective. The aims of this systematic review were to integrate the research on posttraumatic stress (PTS) and posttraumatic stress disorder (PTSD) after termination of pregnancy (TOP), miscarriage, perinatal death, stillbirth, neonatal death, and failed in vitro fertilisation (IVF). Methods. Electronic databases (AMED, British Nursing Index, CINAHL, MEDLINE, SPORTDiscus, PsycINFO, PubMEd, ScienceDirect) were searched for articles using PRISMA guidelines. Results. Data from 48 studies were included. Quality of the research was generally good. PTS/PTSD has been investigated in TOP and miscarriage more than perinatal loss, stillbirth, and neonatal death. In all reproductive losses and TOPs, the prevalence of PTS was greater than PTSD, both decreased over time, and longer gestational age is associated with higher levels of PTS/PTSD. Women have generally reported more PTS or PTSD than men. Sociodemographic characteristics (e.g., younger age, lower education, and history of previous traumas or mental health problems) and psychsocial factors influence PTS and PTSD after TOP and reproductive loss. Conclusions. This systematic review is the first to investigate PTS/PTSD after reproductive loss. Patients with advanced pregnancies, a history of previous traumas, mental health problems, and adverse psychosocial profiles should be considered as high risk for developing PTS or PTSD following reproductive loss.

Psychophysiological responses in women reporting severe premenstrual symptoms

&NA; Sixteen women attending a Premenstrual Tension Clinic and eight control women were tested experimentally in the premenstrual and postmenstrual phases with assessments of heart rate, skin conductance level, and neck electromyogram during rest, relaxation, an emotionally upsetting film, and performance of mental arithmetic and video game tasks. All participants completed daily symptom assessments for two menstrual cycles prior to the study. The clinic attenders were divided into eight (Clinic+) who showed marked increases in symptoms premenstrually, and eight (Clinic‐) who recorded only modest changes in symptom severity across the menstrual cycle. There were no marked differences in resting autonomic activity. During relaxation, skin conductance level decreased to a greater extent in the premenstrual than in the postmenstrual phase, while neck electromyogram showed the reverse pattern. Heart rate reactions to the mental arithmetic and video game tasks were smaller in the premenstrual than in the postmenstrual phase in Controls and Clinic‐ groups, but not in the Clinic+ group. Possible explanations of these results are discussed.

Attitudes and intentions towards volunteer oocyte donation

There is an acute shortage of donated oocytes in the UK and clinics are largely relying on shared donation. Shared donation of oocytes is not without its ethical and moral concerns. The aims of this study were therefore to investigate non-patient population attitudes towards oocyte donation and examine the link between oocyte donation intentions and reasons for parenthood using structural equation modelling (SEM). The survey population consisted of 349 women aged 27.8 +/- 4.7 years. Results revealed that approximately one-third of woman would consider donating their oocytes as identifiable donors. SEM analyses indicated a significant direct effect of positive attitudes towards oocyte donation, high levels of social support and endorsement of less conventional reasons for parenthood to intentions to donate. Age, education and attitudes towards less conventional perceptions of parenthood coincided with their positive beliefs about the importance of parenthood and children. Thus, results indicated that attitudes towards parenthood are an important factor underpinning the motivation for potential oocyte donation.

Contribution of generalized negative affect to elevated menstrual cycle symptom reporting.

We investigated womens belief that they suffered from premenstrual syndrome (PMS) by monitoring patterns of symptom reporting over a 5-week period in relation to the underlying trait of negative affect. We expected that women reporting high negative affect would be more likely to report menstrual cycle distress than those reporting low negative affect. One hundred twenty-one women rated the typical occurrence and severity of premenstrual changes on a retrospective questionnaire and then made daily ratings of their changes for the duration of one cycle. In addition, they completed a questionnaire measuring positive and negative affect. Data analysis revealed a clear subgroup whose retrospective reports of premenstrual change were not substantiated by the cycle of their daily ratings. Although this subgroup also reported more negative affect, the magnitude of the effect was relatively small. The possible contribution of both negative outlook and the meaning of the self-identified label of PMS are discussed.