INFERTILITY

Psychological problems
linked to new
reproductive
technologies

What is infertility ?



Inability to conceive a
pregnancy after one year of
engaging in sexual intercourse
without contraception
(Radwan, 2003)



A problem for 10 - 20 %
couples

Infertility

Reaction as stages of

mourning



DENIAL - the couple doesn’t accept the
possibility of having a problem



ANGER - looking for reasons of a
problem, blaming oneself or others



BARGAINING - efforts to find successful
treatment



GRIEF - somatic distress, feeling of guilt



ACCEPTANCE - new concept of the
future

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 mostly 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?

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

Knowledge on NRT in

relation to area of studies

Knowledge and NRT
acceptance

Gender and NRT

acceptance

Religion and NRT
acceptance

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

9%



Catholic religion

6%



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

Attitudes to pregnancy / child in

IVF and GIFT couples

(Braverman, 1998)



373 couples - postal questionnaire



Disclosure about NRT



81.5% to parents



73,5% to in-laws



80,4% did not tell the child



When the child knows



62,9% interested



24,2% happy



Disclosure when a child is 3 or 4-6 yrs old

Attitudes to pregnancy / child in
IVF and GIFT couples
(Braverman, 1998)



F/M anxious during pregnancy



transition to parenthood not difficult



appreciated the child more than most
parents



satisfying parenting, not overprotective



relation with the partner improved during
pregnancy, some stress in the first 6
months after delivery

Attitudes to parenting in IVF
and GIFT couples (Gibson, 2000)



IVF couples not different form controls on
measures of depression, marital satisfaction,



A tendency for lower self-esteem in IVF
mothers



Lower self-esteem in IVF fathers



A tendency for less positive experience of
parenthood in IVF mothers



No differences in attachment to a child



IVF and control mothers more protective

Psychological adjustment

in IVF pregnancy (Klock,

2000)



IVF women not different from controls on



self-esteem, depression, anxiety,



IVF women - lower marital satisfaction



Changes over time



IVF - improvement in self-esteem, decrease in
state anxiety, decrease in rating of a marriage



non-IVF - decrease in ratings of a marriage

Parent - child relationships

after NRT

Golombok et al., 2004, McMahon et

al.., 2003



IVF



Parenting stress as in other parents



Gamete donation



More positive paterent-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