Robert D. Nachtigall

Stigma, disclosure, and family functioning among parents of children conceived through donor insemination

OBJECTIVE To examine the influence of gender, male infertility factor, and other demographic variables on stigma and whether parents tell their children that they were conceived by donor insemination (DI) and to ascertain if stigma and the disclosure decision affect parental bonding with the child or the quality of the interparental relationship. DESIGN One hundred eighty-four San Francisco Bay Area couples who had become parents by DI were asked to complete a self-administered questionnaire. SETTING A private infertility practice. PATIENT(S) Eighty-two men and 94 women who completed the questionnaire. MAIN OUTCOME MEASURE A questionnaire assessing disclosure, stigma, parental bonding, and the quality of the interparental relationship. RESULT(S) Factors that increased the couples likelihood of disclosure included younger age, azoospermia, lower stigma scores, and having more than one DI child. Fathers who scored higher on stigma reported less parental warmth and parental fostering of independence. CONCLUSION(S) Because the decision regarding disclosure of DI treatment was not linked to parental bonding with the child or to the quality of the interparental relationship, we cannot conclude that nondisclosure is harmful to family relationships or is a symptom of family problems. The husbands perceptions of stigma however, may affect the father--child relationship adversely.

The use of complementary and alternative fertility treatment in couples seeking fertility care: data from a prospective cohort in the United States

OBJECTIVE To determine the prevalence of complementary and alternative medicine (CAM) use among couples seeking fertility care and to identify the predictors of CAM use in this population. DESIGN Prospective cohort study. SETTING Eight community and academic infertility practices. PATIENT(S) A total of 428 couples presenting for an infertility evaluation. INTERVENTION(S) Interviews and questionnaires. MAIN OUTCOME MEASURE(S) Prevalence of complementary and alternative medicine therapy. RESULT(S) After 18 months of observation, 29% of the couples had utilized a CAM modality for treatment of infertility; 22% had tried acupuncture, 17% herbal therapy, 5% a form of body work, and 1% meditation. An annual household income of > or =

The disclosure decision: Concerns and issues of parents of children conceived through donor insemination

200,000 (odds ratio 2.8, relative to couples earning <

Costs of infertility treatment: results from an 18-month prospective cohort study

100,000), not achieving a pregnancy (odds ratio 2.3), and a positive attitude toward CAM use at baseline were independently associated with CAM use. CONCLUSION(S) A substantial minority of infertile couples use CAM treatments. CAM was chosen most commonly by wealthier couples, those not achieving a pregnancy, and those with a baseline belief in the effectiveness of CAM treatments.

The challenge of providing infertility services to a low-income immigrant Latino population.

OBJECTIVE The purpose of our study was to examine the disclosure decision by parents of children conceived by donor insemination. STUDY DESIGN A qualitative component of a self-administered questionnaire mailed to 184 couples who had become parents by donor insemination encouraged respondents to volunteer their written comments, concerns, or opinions about their disclosure decision. RESULTS A total of 70 men and 86 women submitted written comments indicating that 54% did not plan to disclose the donor insemination treatment (nondisclosers), 30% indicated they would (disclosers), and 16% remained undecided. The only significant relationship between the disclosure decision and expressed concern was with regard to confidentiality and honesty (chi2 = 99.9, p < 0.05). CONCLUSIONS Whether parents viewed the disclosure issue as one of honesty (disclosers) or confidentiality (nondisclosers) was the major determinant in the decision of whether to tell children about their donor insemination origin. There was no association between disclosure status or gender and expressed concerns about parenting, children, or family relations.

Predictors of not pursuing infertility treatment after an infertility diagnosis: examination of a prospective U.S. cohort

OBJECTIVE To examine resource use (costs) by women presenting for infertility evaluation and treatment over 18 months, regardless of treatment pursued. DESIGN Prospective cohort study in which women were followed for 18 months. SETTING Eight infertility practices. PATIENT(S) Three hundred ninety-eight women recruited from infertility practices. INTERVENTION(S) Women completed interviews and questionnaires at baseline and after 4, 10, and 18 months of follow-up. Medical records were abstracted after 18 months to obtain details of services used. MAIN OUTCOME MEASURE(S) Per-person and per-successful-outcome costs. RESULT(S) Treatment groups were defined as highest intensity treatment use. Twenty percent of women did not pursue cycle-based treatment; approximately half pursued IVF. Median per-person costs ranged from

Fertility treatments and outcomes among couples seeking fertility care: data from a prospective fertility cohort in the United States

1,182 for medications only to

Prolactin-secreting pituitary adenomas in women: VI. Absence of demonstrable adenomas in patients with altered menstrual function and abnormal sellar polytomography

24,373 and

Nonreproductive Technologies : Remediating Kin Structure with Donor Gametes

38,015 for IVF and IVF-donor egg groups, respectively. Estimates of costs of successful outcomes (delivery or ongoing pregnancy by 18 months) were higher--

The Experience of Infertility by Low-Income Immigrant Latino Couples: Attitudes Toward Adoption

61,377 for IVF, for example--reflecting treatment success rates. Within the time frame of the study, costs were not significantly different for women whose outcomes were successful and women whose outcomes were not. CONCLUSION(S) Although individual patient costs vary, these cost estimates developed from actual patient treatment experiences may provide patients with realistic estimates to consider when initiating infertility treatment.