Who is fit to be a parent?

Reactions to infertility -
context



Social construction of infertility



biological parenthood valued higher



childbearing more important for a
woman



progress in medicine and surgery
offers new treatment methods



social pressure to “do something about
it”, ie. to find the proper treatment

FEMALE / MALE reactions

to infertility



Men respond with less emotions than
women



Is it always true?



Inconclusive findings - dramatic differences
vs. no differences - WHY?



persons with different types of diagnosis



assessment in different stage of diagnosis and
treatment



wrong instruments

FEMALE / MALE reactions

to infertility



Women more often question their self-

worth



Women more likely to be labeled by

themselves and by others as responsible



Women more likely to believe that their

behaviour caused infertility



Women more likely to take responsibility

to protect their husbands’ self-esteem

Gender differences in coping

with infertility (Jordan &

Reverson, 1999)



Meta-Analysis of 8 studies with infertile
couples



Wives used most often coping
strategies like: Seeking Social Support,
Escape/Aviodance, Positive Reappraisal



Wives used mainly emotion-focused
coping strategies

Cyclical model of infertility

(van Balen, 2002 - modified)

Illness,
genes,
trauma,
chance

Involuntary

childlessness

Psychological

problems

Somatic

mechanism

Infertility

treatment

Options available to a

couple

Infertility

Remain

childless

Adoption

Traditional

treatment

New

reproductive

technology

New Reproductive Technology

(NRT)

Assisted Reproductive Technology

(ART)



In vitro fertilization (IVF) - embryo transfer
(ET)

IVF - ET



Gamete intra-fallopian transfer GIFT



Zygote intra-fallopian transfer ZIFT



Intracytoplasmic sperm injection ICSI



Donor insemination DI



Surrogacy



Gestational



Genetic

Challenges / controversies
of NRT



Are they accepted within the society?



Are they available…?



…technically



…economically



…legally



Are they safe…?



…for comissioning women and men



…for resulting children



Are they effective?



Are they ethical?

Success rate in NRT

(Jacobs i O’Donohue, 2007)

Technique

% of live birth in 1st
treatment cycle

IVF with ICSI

33,4%

IVF

31,9%

GIFT

20,8%

ZIFT

25,9%

IVF with GIFT/ZIFT

28,3%

Opinions on NRT

study by U. Tomczyńska (1999)



SUBJECTS



180 students



69 males, 111
females



4th year of
medicine,
psychology,
management



23-25 years of
age



METHOD



questionnaire to
measure



the knowledge
on NRT



the level of
acceptance of
NRT

Experience with infertility and

acceptance of NRT(M. Stefanek,

2005)



3 gropus of couples



No children, with children, treated for infertility



Attitudes towards 3 methods of infertility
treatment



IVF, DI, Surrogacy



Findings



Out of 3 methods -

IVF most often accepted

surrogacy least accepted



Infertile couples - highest level of acceptance



High concordance of wives’ and husbands’ opinons

Opinions of infertile couples

(DI)

study by J. Janczak (2002)



Diagnosis of male infertility



Anger – 36% M



Surprise – 33% M



Grief – 31% M

95% F



Immediate decision to perform DI



65 % M;

54% F



Others needed some time to think and decide



Will I love a „donor’s child”?

33% M



Church view on DI not important 93% M & F

Copules’ motives (DI)

(study by Janczak)

Women



Strong desire to have
a child



Perform parental role



A possibility to go
through pregnancy
and labour



Deception of a
partner’s infertility



Possibility to find a
donor resembling a
husband

Men



Strong desire to
have a child



Perform parental role



A woman can go
through pregnancy
and labour



Compensation for
a partner



A child at least
partly genetically
related

Attitudes toward DI

(by E. Bielawska-Batorowicz,

1994)



TRAITS OF THE DONOR



good health

82%



physically like husband

57%



lack of addictions

20%



proven fertility

14%



husband’s blood group

14%



high intelligence



Catholic religion



anyone could be a donor 12%

Attitudes toward DI

(Bielawska-Batorowicz, 1994)



HOW LONG to continue



as long as necessary to conceive

43%



up to 2 years

37%



up to the doctor’s decision to stop 20%



Risk connected with DI



possible risk

15%



DI safe

85%

Attitudes toward DI

(Bielawska-Batorowicz, 1994)



DI versus adoption



better

100%



child genetically related 85%



women experience a pregnancy

85%



adoption can’t be kept in secret

54%



Secrecy around DI



should be kept secret

94%



should be revealed to



family (6%)



child (3%)

Availability of NRT in
Poland

Technically & financially



All NRT methods

available



17 IVF centres



2000 cycles per year



Signals about surrogacy



Costs



IVF 1300 Euro



ICSI 1700 Euro



DI 450 Euro



Average wage 600 Euro



Treatment not

subsidized

Legally



No legal solutions on

the national level



Supreme Court

decisions in specific

cases



„Conservative”

professional

guidelines



Heterosexual couples in

stable relationships



No posthumous, no

postmenopausal

conceptions



Maximum of 2 embryos

transfered (3 above 35

yrs)

Safety of NRT - parents

Women



Diagnostic procedures



Ovarian stimulation



Egg retrival



Embryo transfer



Perfect timing



Waiting for results



„Emotional

rollercoaster”



Treatment even if fertile

Men



Diagnostic

procedures



Sperm collection



Perfect timing



Sex on demand



Waiting for results

Safety of NRT - children



During pregnancy



Increased risk of



Chromosomal abnormalities (in ICSI)



Low birth weight



Premature birth



Cesarean section



Risk related to infertility, general health

and not to NRT



In the family



Parent-child relationships

Reasons to discontinue IVF
treatment
(Akyuz & Sever, 2009) – Turkish
example



Women



Unsuccessful treatment
and fear of coping –
53,7%



Psychological and
physical burden – 29,6%



Depletion of financial
resources – 7,4%



Causes related to the
treatment centre – 9,3%



Men



Unsuccessful treatment
and fear of coping –
29,1%



Psychological and
physical burden –
25,5%



Depletion of financial
resources – 45,5 %



Causes related to the
treatment centre – 0 %

Parent - child relationships

after NRT

Golombok et al., 2004, McMahon et

al.., 2003



IVF



Parenting stress as in other parents



Gamete donation



More positive parent-child relations in
comparison to natural conception families



Surrogacy



Greater warmth and attachment in
comparison to natural conception families

Possible psychological problems in
families created through gamete
donation

(D. Ehrensaft, 2005)



The effect of the „Birth other” (a third parent)



Who is a parent



Important: an intention to parent / rise up a child



The concept of the birth other



The effect of his/her traits on a child’s characteristics



The myths related to donors



Ignoring the existence of a donor vs. Exagerating a donor’s role



Phantasies on relationships between a donor, a partner, a family



The danger of a donor „claiming back” the child



The information about conception – when & in
what way



To a child



To other persons

Semen Donors



Usually anonymous, children have no
access to identifying data



Identifying data on donors available in
Sweden, Austria and New Zealand



The effect of availability of donors’ data



less donors (!) - no previous records to
compare



different donors (!) - more mature with
stable family life

Why did I become a semen

donor?

(Bielawska-Batorowicz, 1996)



Knowledge on DI



mass media (33%), friends (50%), medical
doctor (8%)



DI accepted in Poland - 25%



Motives



financial

92%



test for fertility

67%



help for infertile couples

50%

Why did I become a donor?

(Bielawska-Batorowicz, 1996) - 2



Want to know the outcome 50%



Asked about the outcome 16%



Donor’s right and obligations



none 100%



a recipient woman’s partner is legal a father
of a child

83%



think about a child

92%

Why did I become a donor?

(Bielawska-Batorowicz, 1996) - 3



Secrecy and management of a donor’s

data



anonymity should be kept



only general data available (education,

hobby, personality)



I would quit the programme if my personal

data were recorded and available 58%



children should never know about DI



children should never have access to

donor’s data

Why did I become a donor?

(Bielawska-Batorowicz, 1996) - 4



Who can be a recipient couple



married couple

100%



unmarried couple

58%



single woman

67%



divorced woman

42%



widow

67%



lesbian woman

25%

Infertility and NRT –
summary



Infertility – a recognized disease (WHO)



Incidence – relatively high (ca 20%)



Information on new ways of treatment may

provoke more people to search for treatment



Inconsistent views concerning NRT effects on

families and children



Suffering connected with NRT



Controversies around NRT as options for

same sex couples and people in post-

reproductive age

I AM…

(a poem by 12 years old girl born with IVF and
surrogacy)

(Kirkman i Kirkman, 2002, s.145)

„I am
Eating up inside like an apple with a worm
I am
Hibernating, hiding like a bear, hiding the real

me from the world outside

I am
What I am, and everything more
I am
Like a caterpillar in a chrysalis, waiting for the

butterfly to come out.”

Document Outline