Satvinder Purewal

Systematic review of oocyte donation: investigating attitudes, motivations and experiences

BACKGROUND The social and psychological factors determining intentions to donate gametes are important for clinics, policy-makers and recruitment campaigns. The aims of this systematic review were therefore to integrate the research findings regarding the psychosocial determinants of oocyte donation and extrapolate womens experiences of donation. METHODS A bibliographic search of English language publications of four computerized databases was undertaken with no time restriction set for publications. RESULTS A total of 64 studies met the inclusion criteria and were included in the review. The research syntheses revealed there were distinct differences between patient and non-patient (known, commercial, volunteer and potential) donors on demographic characteristics, motives for donation, and issues relating to disclosure and attitudes towards the resultant offspring. Further, studies have found that a significant proportion of oocyte donors and women from the general population were prepared to donate their oocytes as identifiable donors. Studies which have examined the experiences of donors report positive experiences of oocyte donation. However, a number of methodological limitations relating to the oocyte donation research literature have been identified in this systematic review. CONCLUSION Differences between donor groups on a range of factors highlight the need for tailored psychosocial evaluation and counselling. The review has demonstrated that it is not useful to generalize across donor groups on various factors relating to oocyte donation.

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.

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.

Elective single-embryo transfer: persuasive communication strategies can affect choice in a young British population

This study tested the effectiveness of the framing effect and fear appeals to inform young people about the risks of multiple births and the option of selecting elective single-embryo transfer (eSET). A non-patient student sample (age (mean±SD) 23±5.5 years; n=321) were randomly allocated to one of seven groups: (1) framing effect: (1a) gain and (1b) loss frame; (2) fear appeal: (2a) high, (2b) medium and (2c) low fear; or (3) a control group: (3a) education and (3b) non-education. The primary outcome measure was the Attitudes towards Single Embryo Transfer questionnaire, before exposure to the messages (time 1) and immediately afterwards (time 2). Results revealed participants in the high fear, medium fear and gain condition demonstrated the most positive and significant differences (P<0.001 to P<0.05) in their knowledge, hypothetical intentions and modest changes in attitudes towards eSET than the low fear, loss frame and education and non-education messages. The results demonstrate that the use of complex persuasive communication techniques on a student population to promote immediate and hypothetical eSET preferences is more successful at promoting eSET than merely reporting educational content. Future research should investigate its application in a clinical population. A multiple pregnancy is a health risk to both infant and mother following IVF treatment. The aims of this study were to test the effectiveness of two persuasive communication techniques (the framing effect and fear appeals) to inform young people about the risks of multiple births and the hypothetical option of selecting elective single-embryo transfer (eSET) (i.e., only one embryo is transferred to the uterus using IVF treatment). A total of 321 non-patient student sample (mean age 23) were randomly allocated to read a message from one of seven groups: (1) framing effect: (1a) gain and (1b) loss frame; (2) fear appeal: (2a) high, (2b) medium and (2c) low fear; or (3) a control group: education (3a) and (3b) non-education. Participants completed the Attitudes towards Single Embryo Transfer questionnaire, before exposure to the messages (time 1) and immediately afterwards (time 2). Results revealed that participants in the high fear, medium fear and gain condition demonstrated the most positive and significant differences in their knowledge, hypothetical intentions and modest changes in attitudes towards eSET than the low fear, loss frame and education and non-education messages. This study recommends that health promotion based on the framing effect and fear appeals should be tested in clinical (patient) samples in the future.

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.

Attitudes and intention to donate oocytes for research

OBJECTIVE In 2007, the Human Fertilization and Embryology Authority permitted oocyte donation for research through voluntary donation or within an oocyte share model. The aims of this study were to investigate volunteer (nonpatient) womens attitudes and intentions to donate using components of the Theory of Planned Behavior and their attitudes toward parenthood through structural equation modeling. DESIGN Questionnaires. SETTING Online. PATIENT(S) A total of 253 nonpatient women. MAIN OUTCOME MEASURE(S) Attitudes towards oocyte donation for research and reasons for parenthood scale. RESULT(S) Of the 253 respondents, 94 were potential donors, 98 were possible donors, and 61 were non-donors. Most potential donors (68%) reported no preference towards donating their oocytes for research or an infertile couple. Structural equation modeling revealed that age (beta = -.03) and components of the TPB (beta = .16) had a statistically significant direct effect on intentions to donate for research. Attitudes toward parenthood was not linked to intentions to donate for research. CONCLUSION(S) There appears to be a strong altruistic motive along with the theoretical underpinnings of positive attitudes, feeling supported, and accepting the consequences of oocyte donation for research, suggesting these have the potential to inform recruitment practices and tailor clinical services.

‘I feel like they were mine and I should be looking after them’: an exploration of non-patient women's attitudes towards oocyte donation

The aims of this study were to qualitatively assess the meaning of oocytes and oocyte donation for treatment and research among non-patient women in the UK using Interpretative Phenomenological Analysis. This study also assessed the application of components of the Theory of Planned Behaviour (TPB) in intentions and attitudes towards oocyte donation. Eight parous and nulliparous women from White and South Asian backgrounds, who reported no fertility problems, were interviewed. Four interrelated super-ordinate themes were identified: (1) oocytes as ‘Just a cell’ and ‘Potential life’; (2) oocyte donation as ‘Altruism’ and ‘Not normal behaviour’; (3) ‘Importance of motherhood’ and the ‘Importance of a genetic link’. Ethnic differences were observed in the final theme (4) which identified the importance of ‘Social Support’ and ‘Reproductive Control’ in womens discourses of oocyte donation. Analysis revealed participants beliefs and thoughts about oocyte donation were complex, interwoven and paradoxical. Previous quantitative studies that have assessed components of the TPB in relation to oocyte donation have failed to identity important alternative explanations of oocyte donation and subtle complexities in attitudes.

Completing the surrogate motherhood process: Parental order reporters’ attitudes towards surrogacy arrangements, role ambiguity and role conflict

This study investigated the attitudes of parental order reporters (PORs) towards their work with surrogacy arrangements and their experiences of role conflict and role ambiguity. A questionnaire was used to assess PORs’ perceptions of their role in parental order [PO] applications, attitudes towards surrogacy arrangements and the legal process and the influence of role ambiguity or conflict. Questionnaires were distributed to all PORs employed by the Children and Family Court Advisory and Support Service in England. Thirty-three PORs participated (response rate 46%) who, on average, had each completed five PO applications (range 1–40). Positive attitudes towards surrogacy and the child’s needs for openness about origins were found. Concerns about the inadequacy of preparation and assessment arrangements, overseas arrangements and non-regulation of surrogacy agencies were evident. PORs with high-role ambiguity were more likely to report less positive attitudes towards the emotional consequence of surrogacy on offspring. High scores on role ambiguity and role conflict were reflected in less positive attitudes towards the parties’ preparation towards parenthood. These results have implications for training, policy and practice in this area.

Maternal psychosocial consequences of twins and multiple births following assisted and natural conception: a meta-analysis.

The aim of this meta-analysis is to provide new evidence on the effects on maternal health of multiple births due to assisted reproductive technology (ART). A bibliographic search was undertaken using PubMed, PsycINFO, CINAHL and Science Direct. Data extraction was completed using Cochrane Review recommendations, and the review was performed following PRISMA and MOOSE guidelines. Meta-analytic data were analysed using random effects models. Eight papers (2993 mothers) were included. Mothers of ART multiple births were significantly more likely to experience depression (standardized mean difference [SMD] d = 0.198, 95% CI 0.050 - 0.345, z = 2.623, P = 0.009; heterogeneity I(2) = 36.47%), and stress (SMD d = 0.177, 95% CI 0.049 - 0.305, P = 0.007; heterogeneity I(2) = 0.01%) than mothers of ART singletons. No difference in psychosocial distress (combined stress and depression) (SMD d = 0.371, 95% CI -0.153 - 0.895; I(2) = 86.962%, P = 0.001) or depression (d = 0.152, 95% CI -0.179 - 0.483: z = 0.901; I(2) = 36.918%) were found between mothers of ART and naturally conceived multiple births. In conclusion, mothers of ART multiple births were significantly more likely to have depression and stress than mothers of ART singletons, but were no different from mothers of naturally conceived multiples.

A systematic review of the traits and cognitions associated with use of and belief in complementary and alternative medicine (CAM)

Abstract Complementary and alternative medicine (CAM) use is widespread despite the controversy over its effectiveness. Although previous reviews have examined the demographics and attitudes of CAM users, there is no existing review on the traits or cognitions which characterise either CAM users or those who believe in CAM effectiveness. The current systematic review set out to address these gaps in the literature by applying a narrative synthesis. A bibliographic search and manual searches were undertaken and key authors were contacted. Twenty-three papers were selected. The trait openness to experience was positively associated with CAM use but not CAM belief. Absorption and various types of coping were also positively associated with CAM use and belief. No other trait was reliably associated with CAM use or belief. Intuitive thinking and ontological confusions were positively associated with belief in CAM effectiveness; intuitive thinking was also positively associated with CAM use. Studies researching cognitions in CAM use/belief were mostly on non-clinical samples, whilst studies on traits and CAM use/belief were mostly on patients. The quality of studies varied but unrepresentative samples, untested outcome measures and simplistic statistical analyses were the most common flaws. Traits and cognition might be important correlates of CAM use and also of faith in CAM.