Petra Thorn

(Male) infertility: what does it mean to men? New evidence from quantitative and qualitative studies

Scientific knowledge of the emotional repercussions of infertility on men remains limited and has only recently become the focus of social science research. Firstly, the current developments in research on the psychosocial impact of infertility on men through a search of the literature over the last 10 years are outlined in this paper. In the second section, issues raised in pretreatment counselling for men and their partner who consider donor insemination are described as this treatment typically raises many emotional issues. The results of more recent studies with sophisticated methodological design show that the emotional impact of infertility may be nearly balanced, suggesting that men do suffer as well and that they have to be addressed in infertility counselling too. The emotional and clinical aspects of donor insemination support the hypothesis that the emotional repercussions of infertility affect both sexes. In general, male factor infertility seems to be more stigmatized than other infertility diagnoses. Forthcoming studies have to differentiate between the psychological impact of infertility on women and men and their respective abilities to communicate easily about this distress. More studies on infertile men in non-Western societies need to be conducted in order to understand the cultural impact on infertility.

Counselling in infertility: individual, couple and group interventions.

OBJECTIVE Infertility is considered a biopsychosocial crisis and infertility counselling is recommended as an integral part of a multidisciplinary approach. This article will outline the theoretical background and describe common interventions used in infertility counselling for individuals, couples and in a group setting. METHODS This article summarizes the proceedings of the first campus workshop of the Special interest group of Psychology and Counselling of the European Society for Human Reproduction and Embryology (ESHRE). RESULTS Infertility counselling offers the opportunity to explore, discover and clarify ways of living more satisfyingly and resourcefully when fertility impairments have been diagnosed. The Heidelberg Fertility Consultation Service is presented as a framework for individual and couples counselling and highlights important issues in counselling patients. For group work a number of steps to set up a group within an infertility framework are discussed. CONCLUSION In recent years, infertility counselling has become a specialist form of counselling requiring professional expertise and qualification. Key issues and common interventions are presented to raise awareness for the specific counselling needs of individuals and couples experiencing infertility and undergoing medical treatment. PRACTICE IMPLICATIONS Mental health professionals new to the field of reproductive technologies as well as those in other areas of mental health counselling clients with fertility disorders can benefit from the topics addressed.

An introduction to infertility counseling: a guide for mental health and medical professionals.

The practice of infertility counseling delivered by mental health and medical professionals has become more sophisticated and widespread over the past decade. This paper summarizes information presented at the second campus workshop of the Special Interest Group of Psychology and Counseling of the European Society of Human Reproduction and Embryology (ESHRE). This group is dedicated to improving infertility services by creating meaningful connections between mental health and medical professionals. The paper identifies key issues that infertility counselors must consider in their work with couples experiencing infertility. The use of supportive psychosocial interventions and treatments are highlighted. The paper also details the process for choosing the most appropriate type of infertility counseling, and the use of assessment tools that assist in understanding infertility related symptoms. Infertility counselors should also consider gender differences, the impact of infertility on a couple’s sexual relationship, and the unique challenges couples face regarding third-party conception. Finally, the paper addresses specific recommendations for infertility counselors in mental health and medical settings.

German guidelines for psychosocial counselling in the area of gamete donation

Building a family using donated gametes (semen, oocytes or embryos) is associated with specific issues which differ from building a family with gametes from both intended parents, the resulting family comprising separated biological and social parenthood. To respect the welfare of all parties involved, the ‘Beratungsnetzwerk Kinderwunsch Deutschland e.V.’ (Infertility Counselling Network Germany) has developed guidelines for psychosocial counselling in this area. The following article summarizes international developments and introduces the German guidelines.

Cross-border reproductive services – suggestions for ethically based minimum standards of care in Europe

Cross-border reproductive services (CBRS) is a phenomenon discussed worldwide. The major challenges associated with CBRS are the lack of data on the number of patients travelling for treatment and lack of transparency regarding the quality and safety of treatment procedures, especially in countries that have not yet introduced legislation or binding professional guidelines. This has given rise to practices that range from dubious to irresponsible treatment. Given that pan-European (let alone globally encompassing) legislation or guidelines are unlikely to appear quickly if at all, the authors suggest the implementation of ethically based minimum standards of care to which clinics and service providers can adhere on a voluntary basis. Such minimum standards of care can result in providing infertility treatment that is transparent, accountable and carried out responsibly for all parties involved.

A group-work approach in family building by donor insemination: Empowering the marginalized

Family building with donor insemination (DI) is often perceived as stigmatizing and the secrecy surrounding the practice contributes to this perception. In recent years, patient organizations in several countries have started to challenge this stigma and marginalization. This paper reports on a professional group-work approach for couples in Germany using DI. Participants of four seminars with a total of 74 participants and a return rate of 89% were asked to report on their expectations of and experiences during the seminars. Participants were asked to comment on their views and perspectives regarding DI practice. The results indicate a need for more information on DI and for the opportunity to meet other couples in the same situation. Participants also argued for normalization and social acceptance for families built by DI. The group-work approach described in this paper contributes significantly towards fulfilling the needs of couples involved in DI.

Evolving minimum standards in responsible international sperm donor offspring quota

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.

Disclosure and donor-conceived children

Sir, Guido Pennings’ views on favouring donor anonymity are well known. However we were very concerned at your decision to publish and then highlight his article Disclosure of donor conception, age of disclosure and the well-being of donor offspring (Pennings, 2017) which, in our view, fell significantly short of the academic rigour we expect of Human Reproduction and its peer review and editorial processes. The signatories to this letter come from the fields of academia, professional practice, parent/family/ donor-conceived support groups and donor registry services. The research evidence concerning the impact of disclosure and age of disclosure on donor-conceived people and their family members is very limited, both in terms of numbers and range of participants, numbers of research teams working in this field and methodologies used, including sampling across all studies. There are to date no large-scale studies. This was not made clear: more than this, Pennings considered that the evidence was in fact sufficient to make claims based on it, not least through disproportionately weighting selected studies and ones which used primarily parental reports (which form the bulk of existing studies) over those from donor-conceived individuals, which he claimed used biased samples. He went on to attribute morality (‘parents should disclose’) rather than knowledge as the reason Kovacs et al. (2015) and the Nuffield Report (2013) recommended disclosing. In doing so, he ignored Nuffield’s emphasis on adolescent psychological development as a key plank of their decision and Kovacs et al.’s attention to the Australian cultural context. With regard to the latter, Pennings instead chose to represent this approach as being so at odds with their findings as to question their motivation as researchers (‘One wonders why they have done the study in the first place’) rather than acknowledge its validity. Unlike Pennings, some of those he singled out for criticism thoughtfully discuss the complexity of measuring outcomes as evidenced by, for example, Freeman and Golombok (2012) when they said: ‘However, differences between disclosing and nondisclosing families cannot be directly attributed to parents’ disclosure decisions and may reflect other differences between these families’. Both for these reasons and because research evidence only forms one part of what informs theory, policy and practice in any field—and perhaps especially where human relationships are concerned—the basic premise of Pennings’ paper is in our view academically flawed. Pennings omitted any reference at all to human rights, despite this being a key influence on change in this field as shown in current legislative moves in Germany, and dismissed personal experiences when captured through the grey literature or professional experience. Finally, and importantly, Pennings ignored the actual and potential impact of recent rises in DNA testing, including direct-to-consumer DNA testing, on the ability to maintain secrecy about involvement in donor conception given the resulting increased likelihood of unplanned disclosure and its associated risks (risks which Pennings chose largely to ignore). This despite a paper by Harper et al. (2016) ‘The end of donor anonymity: how genetic testing is likely to drive anonymous gamete donation out of business being an earlier Human Reproduction ‘Editor’s Highlight’ in 2016. Pennings went on to make critical remarks about counsellors and psychologists, ironically without citing any evidence to substantiate his claims and in the process minimizing multi-disciplinary support for openness as evidenced though such professional bodies’ guidelines as the American Society of Reproductive Medicine, the British Fertility Society, and the Australian and New Zealand Infertility Counsellors Association (ANZICA). His suggestion that counsellors and psychologists should be training parents who do not wish to disclose to ‘build a coherent and easy to maintain story’ is especially troubling; it is one thing to be expected to respect parents’ decisions (which psychosocial professionals do, in our experience), it is entirely another to expect them to teach parents how to lie to their children. Of course academics have the right to prompt debate and discussion on such important topics as disclosure and anonymity and we strongly respect that right; our concern here is that this paper has not met the standards that we would have expected from Human Reproduction.

The shift from biological to social fatherhood – counselling men and their partners considering donor insemination

Abstract Men and women are likely to suffer from infertility in similar ways, but gender differences account for different ways in revealing – and not revealing – this emotional pain. The following article is based on this understanding. It seeks to describe counselling tasks and interventions that support men and their partners considering donor insemination. This pre-treatment counselling comprises a range of issues, including the provision of medical and legal information, supporting the grieving process, managing the taboo and stigma surrounding donor insemination, supporting disclosure, and last but not least raising awareness of the needs of the future child. The aim of counselling is to explore the short- and long-term implications and thus facilitate the shift from biological to social fatherhood for men and their partners.

German guidelines for psychosocial counselling in the area of “cross border reproductive services”

An increasing number of couples and individuals with a desire for a child travel abroad for assisted reproductive technologies that are not available in their home country. This trend has been coined “cross border reproductive services” (CBRS), often comprising third party reproduction. In order to respect the welfare of all parties involved, the German Society for Fertility Counselling has developed guidelines for psychosocial counselling in this area in 2010. The following article raises some of the controversies in CBRS and introduces these guidelines.