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The integration of genetic screening technology and assisted reproductive technology (ART) has expanded at an accelerating rate and as a result fertility treatment centers now routinely incorporate genetic testing as a complement to diagnosis and treatment of their patients. The medical aspects of reproductive genetic screening have been well described in the literature but a greater examination of the psychological impact and emotional demands of screening for ART patients is needed. This chapter describes selected reproductive genetic tests and their psychological concomitants, with illustrative cases provided. Where needed, the differentiation between genetic counseling and psychological counseling is identified as their roles may overlap but are mutually beneficial.

This review provides an overview of the historical significance of assisted reproduction for gay men and women, discusses current reproductive options for same-sex couples, addresses psychosocial considerations unique to these couples, and reviews the current literature addressing medical and psychosocial aspects of same-sex reproduction.Growing numbers of men and women openly self-identify as gay and lesbian. Accompanying this openness is an increased public acceptance of same-sex relationships and same-sex marriage. The combination of gay/lesbian self-determination and mounting public acceptance of same-sex unions has led these individuals and couples to increasingly seek parenthood through assisted reproduction. Recent studies describe relationship satisfaction in gay couples after assisted reproduction and more positive functioning and less stress associated with parenthood when compared with heterosexual parents.Motivations for parenthood are the same for same-sex couples and heterosexual couples alike. However, achieving the goal of parenthood can be a much greater endeavor medically and psychologically for same-sex couples. Fertility treatment centers increasingly recognize issues unique to gay men and women and are increasingly welcoming.

Third-party reproduction has introduced a host of changing family constellations. Research has shown that children conceived through third-party reproduction are doing well psychologically and developmentally, but what about their parents? How have they coped with the transition to third-party reproduction? Has the experience impacted their marital stability or the quality of their parenting? This review will address parents of children conceived through oocyte donation, parents of children conceived through gestational surrogacy, and gay male parents of children conceived through oocyte donation and gestational surrogacy.

PURPOSE OF REVIEW To summarize the recent studies addressing psychosocial aspects of advanced parental age in oocyte donation including treatment risks, motivations for participation, and impact on the children. RECENT FINDINGS It is recommended that women aged 45 and older have a rigorous medical screening before participation in oocyte donation, but the risk of pregnancy complications for that age group remains a concern. There is insufficient evidence to demonstrate that paternal age has an unfavorable impact on assisted reproduction outcomes. Although there are limited data on the effect of parental age on the psychological wellbeing of children conceived through assisted reproduction, a recent study found that children of older mothers appear to be thriving as well as children born to younger mothers. SUMMARY The trend toward delayed parenthood has resulted in a growing number of older couples entering oocyte donation programs. The literature has begun to address this phenomenon, but we need to learn more about psychosocial issues unique to older intended parents and their oocyte donation conceived children.

The average age of childbearing has been increasing in industrialized nations, including the United States. As a result, more women in their late 30s to early 40s are seeking their first pregnancy than ever before. Unfortunately, fertility declines with increasing female age. In addition, success of infertility treatments including those using assisted reproductive technologies (ART) decreases as the age of the female partner advances. Third party reproduction involves using gametes or the uterus of a third person to achieve pregnancy. Oocyte donation is a common form of third party reproduction, associated with significant success rates, which gives aging couples an opportunity to bear children. For safety and success, all the participants must be extensively screened medically and psychologically. In addition, a detailed understanding of the process by all parties involved should be achieved. While third party reproduction through oocyte donation is a long and labor intensive process with a significant amount of emotional, financial, and physical involvement from all parties, it is quite often a gratifying experience for everyone involved which include, oocyte donors, recipients, social workers, nurses and physicians.

Purpose of review The present review examines recent publications that provide insight into how the trend toward nonanonymity and disclosure in gamete donation impacts donors, intended parents, and their donor-conceived children. Recent findings Recent findings show an increase in donor programs that offer open-identity between donors and offspring. The psychological needs of gamete donors and their attitudes toward disclosure are increasingly given consideration. Qualitative research on how parents of donor gamete offspring make decisions about disclosure reveals that even when couples initially disagree about disclosing to offspring, most ultimately come to a united disclosure decision. The literature on the impact of disclosure on donor gamete offspring has extended to include children conceived through embryo donation and children born as a result of surrogacy. The absence of genetic or gestational link between parents and their child does not have a negative impact on parent-child relationships. Parents through surrogacy tend to disclose the method of family creation to their child, whereas parents through embryo donation tend to be secretive about their child's origins. Summary The trend toward greater openness in gamete donation has been accompanied by an increase in programs offering open-identity donation. In addition, the psychological needs of gamete donors and their attitudes toward disclosure are increasingly being given consideration. Parents of donor gamete offspring give careful thought to their disclosure decisions, and the psychological well being of donor-conceived children does not seem to be impacted by those decisions.

Purpose of review Same sex couples are steadily becoming more open about their relationships. One consequence of this growing openness is that more couples of the same sex are choosing to have children and infertility treatment centers are increasingly faced with requests for assistance in creating these families. The aim of this review is to address new trends in reproduction in same sex couples, to consider the quality of parenting in lesbian mother and gay father households, and to review the literature on the development of children raised by same sex couples. Recent findings The current literature on these families is limited by small sample sizes and a predominance of studies of lesbian mothers and their children, with few studies of gay fathers and their children. A recent study of adolescents living with same sex parents recruited from a large national sample supports the notion that adolescents raised by same sex couples are doing well psychologically and are not more likely to be homosexual. The authors concluded that it was the quality of parenting, not parental sexual orientation that accounted for developmental differences. Summary The literature supports the notion that children of lesbian mothers and gay fathers are not more likely to become homosexual and are not measurably different from children raised by heterosexual parents in terms of personality development, psychological development, and gender identity. Larger longitudinal studies of same sex parents, particularly gay men, are needed, including those who choose to become parents through the use of assisted reproduction.

BACKGROUND: Oocyte donation is a popular treatment option among women with ovarian dysfunction. Little is known about the amount of information recipients have about their donors and if the amount of information the couple has relates to their plans to disclose. The purpose of this study was to assess the amount of information recipients had about their donors and their disclosure plans. METHODS: Sixty-two sets of oocyte donation parents from five programmes completed a self-report questionnaire. RESULTS: Ninety percent of both men and women knew their donor’s age, ethnicity, hair colour, eye colour, height, weight, education and medical history. Significantly more women than men told others about using a donor to conceive, but two-thirds of women and men would not tell others if they had to do it over again. Fifty-nine percent of women and 52% of men planned to or had told their child; 34% of women and 41% of men do not plan to tell. The amount of information known about the donor was related to plans to tell the child for men only. CONCLUSION: Approximately half of couples plan to tell their child of their oocyte donor origin and a majority have told others but many regret having done so. Knowledge about the donor is related to disclosure for men only.

A growing number of children around the world are conceived through third-party reproductive techniques. The increased demand for these programs has resulted in an ongoing trend towards greater openness and less anonymity in gamete donation. This has led to changes in public policy regarding the identity of donors, to a greater concern for the well-being of donors, and to calls for disclosure to offspring about their donor gamete conception.

Objective: To determine whether women who get pregnant as a result of IVF differ psychologically from pregnant women who conceived naturally. Design: Prospective, longitudinal study. Setting: Healthy volunteers from outpatient infertility and obstetrics practices. Patient(s): Seventy-four women who became pregnant via IVF and 40 women conceiving without medical intervention. Intervention(s): Subjects completed self-report questionnaires about demographic and reproductive history, rewards and concerns of pregnancy, self-esteem, marital adjustment, depressive symptoms, and anxiety at 12 and 28 weeks' gestational age. Main Outcome Measure(s): Self-esteem, depression, and anxiety scores. Result(s): There were no significant differences between groups on any of the outcome measures assessing psychological status at the two assessment times. Differences were found on specific items assessing the rewards and concerns of pregnancy. Within-group changes over time indicated that IVF women, not controls, showed an increase in self-esteem and a decrease in anxiety during pregnancy. Conclusion(s): Pregnant IVF women are similar psychologically to women who become pregnant naturally on dimensions of self-esteem, depression, and anxiety at 12 and 28 weeks' gestational age. The IVF group, not controls, reported improved self-esteem and decreased anxiety as the pregnancy progressed.

Objective: To compare the demographic and psychological characteristics of oocyte recipients and to determine whether the issue of disclosure about the use of a donor is a correlate of the decision to use an anonymous or directed donor. Design: Cross-sectional study. Setting: University teaching hospital. Patient(s): Ninety consecutive recipients of donated oocytes (64 of whom used anonymous donors and 26 of whom used directed donors). Intervention(s): Pretreatment psychosocial evaluation. Main Outcome Measure(s): Recipient opinions and attitudes regarding the choice of donor type and disclosure to others as determined through a semistructured interview. Result(s): There were no statistically significant differences with regard to demographic characteristics between recipients who used anonymous and directed donors. There were statistically significant differences between the groups with regard to the issue of disclosure. Recipients who used directed donors were more likely to have told others about using an oocyte donor and were more likely to indicate that they intended to inform the child about the nature of his or her conception. Conclusion(s): Oocyte recipients who use known donors differ significantly from those who use anonymous donors with regard to the issue of disclosure to others. Further studies are needed to determine the causal direction of this relation.

To determine whether surgical treatment of chronic pelvic pain is associated with changes in personality profile.Prospective clinical trial (Canadian Task Force classification II-2).University-affiliated tertiary referral center.Sixteen women undergoing laparoscopic surgery for evaluation and treatment of chronic pelvic pain.Before and 3 months after surgery all subjects completed the Minnesota multiphasic personality inventory-2 and the West Haven-Yale multidimensional pain inventory.Laparoscopic surgery for chronic pelvic pain was associated with a postoperative decrease in pain severity score by 53% (p0.001), increase in activity level score by 24% (p0.001), decrease in hypochondriasis score by 6% (p = 0.049), decrease in depression score by 12% (p = 0.007), and decrease in conversion hysteria score by 7% (p = 0.02). Improvements in pain severity and activity level were comparable in women with abnormal and normal preoperative scores of hypochondriasis, depression, and conversion hysteria.Improvement in chronic pelvic pain is associated with an improvement in personality profile. Abnormal versus normal preoperative scores for hypochondriasis, depression, or conversion hysteria scales are not predictive of change in pain or activity level after surgery.

SUMMARY The inability to conceive a pregnancy can cause disruption and anguish to individuals and couples sharing that experience. The treatments for infertility, especially those involving assisted reproductive technology such as in vitro fertilization, can be physically, financially and emotionally stressful for participants. The impact of infertility and its treatment has introduced a new venue for perinatal social worker services to counsel, educate and support these patients.

Use of gestational carriers is a growing technology that offers hope and promise to a new cohort of potential parents. Women without a uterus or those who have other contraindications for pregnancy as well as single men and gay male couples who lack the biologic capability to carry a pregnancy can now become parents with the help of a gestational carrier. Increasing numbers of young women are choosing to become gestational carriers, and post procedure most report the experience as positive. Preliminary research on children born by a gestational carrier indicates that they are developing normally. This chapter will describe the psychological aspects of the use of gestational carriers for intended parents, gestational carriers, and the children born as a result.

Infertility frequently has a profound and long-lasting psychological impact on individuals and couples attempting to conceive. The psychological responses to infertility vary, but typically include loss of self-esteem, depression, anger, and guilt. Psychotherapy, although not a cure for infertility, can help couples cope with the pain and emotional distress that infertility may cause. This article describes common responses to infertility and includes a case illustration of the psychological impact of infertility. Mahlstedt's (1985) theory of infertility as a series of losses is used to provide a theoretical framework for understanding and structuring psychotherapeutic interventions for both immediate and long-term reactions. © 1996 John Wiley & Sons, Inc.

In recent years a growing recognition of same sex unions as culturally and socially acceptable has led inevitably to a parallel acceptance of such unions as a foundation for family. Advances in gay rights, the liberalization of legal restraints, and the increasing availability of assisted reproduction have led to more men and women being open about their homosexuality, open about their relationships, and open about their desire to become parents within the context of a same sex relationship. As a result, fertility programs have experienced a growing demand for service from same sex couples seeking parenthood through alternative reproductive techniques. This movement has culminated in a phenomenon commonly referred to as the “gay baby boom”.

To compare anonymous and directed candidates for oocyte donation within a single program.75 consecutive candidates for oocyte donation (49 anonymous and 26 directed) were studied using a semistructured interview to collect data on demographics, psychosocial history, motivation, and candidate views on disclosure to a potential child.Donor groups were similar with regard to race, religion and education. Anonymous donors (mean age 27.33 years, SD 4.17) were significantly younger than directed donors (mean age 37.54 years, SD 4.94), (t = -4.83, df = 73, p0.001). Marital duration was significantly longer for directed donors (6.92 years, SD 5.64) versus (2.57 years, SD 3.96) for anonymous donors (t = -3.50, df = 38.47, p = .001). Forty-one percent of anonymous and 69% of directed donors had previous pregnancies (X2 = 4.60, p.05). A greater percentage of anonymous donors (34.7%) felt that the potential child should be informed of his or her origins, compared to 19% of directed donors, but this difference fell short of statistical significance.There were more similarities than differences among groups of potential donors with the exception of age, marital status, and previous pregnancies. Differing views about disclosure were suggested in both groups with anonymous donors tending to opt for disclosure.

Young women are increasingly treated successfully for cancer. When the treatment or the cancer itself leaves them with limited or no reproductive capacity, but not without the desire for children, they increasingly seek motherhood through third-party reproduction, such as oocyte donation or gestational surrogacy, or through adoption. Fortunately, there are a number of resources available for guidance and support in making the transition to parenthood through third-party reproduction or adoption.

Objective To medically and psychologically assess gay men seeking parenthood through assisted reproduction and to provide guidelines for the assessment. Design Qualitative observational study. Setting Academic medical center. Patient(s) Thirty gay males (15 couples) presenting for assisted reproduction using an oocyte donor and a gestational carrier. Intervention(s) Semistructured interview and medical evaluation. Main Outcome Measure(s) Determination of psychological and medical eligibility for treatment. Result(s) The average age of men was 38.4 years. All couples were in a committed relationship and had been together for an average 6.4 years. All met medical and psychological criteria for acceptance. Conclusion(s) Gay men increasingly choose fatherhood through assisted reproduction. Counseling these couples on the medical and emotional demands of in vitro fertilization with a gestational carrier and an oocyte donor is a vital component of pretreatment preparation.

Gay male couples seeking fatherhood through assisted reproduction deserve the same attention to care that other couples, lesbian and heterosexual, receive at fertility centers throughout the country.

Three questions obsess infertile patients. “Am I ever going to be pregnant?” is heard with great frequency by physicians working with this population. Though patients may dread the answer, their longing for pregnancy and their fears that parenthood is forever out of reach compel them to ask the question. The other two questions are usually unspoken but are fueled by the ceaseless distress and anxiety patients suffer because of their inability to conceive: “Am I losing my mind?” and even more frightening “Is the distress that I feel preventing me from getting pregnant?” Physicians working with infertile individual(s) serve their patients well when they anticipate all three questions and when they include psychological support and counseling as an integral part of a comprehensive treatment plan.

Objective The purpose of this study was to compare anonymous and known donor mothers' demographics, knowledge about the donor, and disclosure attitudes. Design Cross-sectional survey of oocyte donation parents. Setting Academic medical centers. Patient(s) Women having a child through oocyte donation in the past 12 years. Intervention(s) Subjects completed a survey regarding their oocyte donation experience. Main outcome measure(s) Donor characteristics and disclosure behavior. Result(s) Questionnaires were sent to 524 individuals (262 couples); 157 (92 women and 65 men) were returned yielding a response rate of 31.4% (157/500). The average age of the women was 44.7 years and the average age of the child was 2.89 years. Seventy women used anonymous donors and 20 women used known donors. Significantly more known recipients knew their donors' religion, number of children, hobbies, profession, and photograph. Eighty percent of both groups told others about using a donor to conceive. Regarding telling the child, there were also no significant differences with approximately 10% who have told, 49% plan to tell, 31% are not telling, and 10% are unsure. Conclusion(s) Contrary to conventional wisdom we found no differences in plans to inform the child based on the use of a known or an anonymous donor.

Chronic pelvic pain (CPP), defined as pelvic pain that is noncyclic and has persisted for more than 6 months, can be frustrating and demoralizing for the patient and is often a particularly enigmatic problem for the medical team. There are a number of gynecological conditions that can contribute to pelvic pain (e.g., endometriosis, pelvic adhesions, vulvovaginitis, vulvar vestibulitis, adenomyosis, and pelvic relaxation) as well as nongynecological conditions (e.g., irritable bowel syndrome, interstitial cystitis, urethral syndrome, and myofascial syndrome). Some patients will alternatively present with chronic pelvic pain but the medical workup may fail to determine a clear-cut etiology.

New reproductive technologies such as in vitro fertilization (IVF) offer much hope to infertile couples, yet the odds for success are not high. In this study we examine the experiences of a cohort of women undergoing IVF or a related technology at three points in time: before technological intervention, approximately one month after the first failed cycle, and six months later. We consider the women's expectations and experiences and discuss implications of the findings for social work practice.

This paper reports on couples1 experiences with in vitro fertilization from a phenomenological perspective.1 It discusses how the couples created the reality of the experience for themselves—how they shaped what they went through, and what the meaning of the experience was for them. It presents the results of separate telephone interviews with 20 husbands and wives who went through the IVF/ET Program, successfully and unsuccessfully, at Yale-New Haven Hospital in Connecticut in 1983-84.,The questions addressed by this study were: First, what is the social meaning of IVF as a medical experience; and second, what is the social usefulness or latent function of IVF for couples who want a child?

Many couples enter an IVF/ET program without a clear idea of how many treatment cycles they intend to undergo. Others are determined to continue treatment as long as necessary to achieve a successful outcome. However, following review of patient performance the treatment team may conclude that continued attempts are not advisable. Reasons for recommending discontinuation of IVF/ET treatment include failure to conceive due to lack of response to ovarian stimulation, failed fertilization, and age factors.

The role of the clinical social worker in the In-Vitro fertilization Program is to help provide patients with an environment that includes realistic expectation and emphasizes the emotional spectrum of euphoria, anxiety and dysphoria that can accompany the demanding protocol. The literature supports the need for counseling and supportive psychotherapy in the infertility clinic but has not dealt specifically with the psychological demands of In-Vitro fertilization. This paper addresses the emotional stress of in-vitro fertilization and emphasizes the role of social worker as counselor, educator and guide.

It has been widely reported that in-vitro fertilization (IVF) is a particularly stressful experience for women. In particular, it appears that when IVF fails, a small number of women suffer a grief reaction that may be quite disruptive to their lives. The symptoms manifested by this grief response mirror the symptoms of women suffering a pregnancy loss. Clinical observation suggests that the intensity of grief reactions is greatest after a failed first cycle of the treatment and that, to a limited extent, this response can be predicted by observing the degree of the IVF patient's attachment to the expected pregnancy. The authors describe significant grief reactions which occurred in 3 of 97 women who failed to achieve pregnancy after a first cycle of IVF. It appears that the impressive IVF technology can inadvertently foster and intensify IVF patient's attachment to the expected pregnancy by creating unreasonable expectations of successful treatment of infertility.

There are certainly no definitive answers to the questions raised by the use of donor gametes in reproduction, as there are no definitive answers to any of life's most difficult questions. The loss of fertility is usually an unexpected, invisible, deeply painful wound for those couples who are considering the use of donor gametes. As they address the psychological issues of these techniques, they must also heal the wounds created by infertility. This type of grieving and examination of feelings takes time and information. The medical community needs to encourage each couple to resolve the issues around infertility and to use available personal, professional, and written resources to address the dilemmas raised by the use of donor gametes prior to embarking on this type of treatment. In so doing, the couple will reduce the likelihood that the means of conceiving their children will become a source of major conflict in their family. In 1932 Aldous Huxley prophesied the destructive consequences of scientific accomplishment without social involvement and psychological guidance. He said: "The sciences of matter can be applied in such a way that they will destroy life or make the living of it impossibly complex and uncomfortable...unless used as instruments by biologists and psychologists." It is our concern that the procedures for enabling infertile couples to become parents may, if not accompanied by acknowledgment of the unique challenges which they create for all participants in the process, make the living of life "impossibly complex and uncomfortable" for the very families we are trying to help.

During the last decade, reproductive endocrinology has provided new technologies for treatment of infertility--one of which is in vitro fertilization/embryo transfer (IVF/ET). The use of this technology has been accompanied by considerable interest in understanding the psychology of those seeking IVF/ET and in understanding psychological reactions during and after IVF/ET. This paper reviews the psychological research within the IVF/ET literature as divided into three major areas: first, psychological profiles of women and their partners requesting IVF/ET; second, clinical reports which describe the psychological experience of IVF/ET and provide recommendations for counseling both before and during IVF/ET; and third, follow-up studies of IVF/ET participants. This paper is designed to highlight initial findings in these three areas of research and thus provide a context for future research directions. Specific suggestions for future study include redirecting research effort from investigations of psychopathology to detecting stress which may affect IVF/ET outcome.

The psychological impact of the new reproductive technology should not be understated. The history of infertility treatment and failure to achieve pregnancy that most couples bring to the program, along with their hopes and expectations for success, makes them extremely vulnerable to anxiety, unrealistic expectations, and grief reactions. When a cycle of IVF fails, the intensity of the experience and the disappointment may be overwhelming for a while, but most couples are willing to try it again. One patient wrote about her feelings after IVF treatment after having read comments in a popular magazine which implied that medical science was taking control of reproduction. Those of us who go through in-vitro fertilization think long and hard about what we are doing. Most of us weigh the pros and cons very thoroughly. We weigh the risks to our potential children just as people who have genetically linked diseases do before they conceive. (Our fetuses are not "bombarded" by ultrasound procedures any more than many other pregnant women's fetuses are these days.) Most of us are thankful that the technology is now available to us, if we choose to participate. Physicians who work with IVF patients do realize that the procedure is stressful. Often the stress is viewed as primarily the patients', and we are asked to study the level of stress. To a large extent that is the subject matter of this chapter. Nevertheless, the stress is perceived because the physicians and staff are also under stress. The failure of an IVF cycle is immediately known to the health care givers.(ABSTRACT TRUNCATED AT 250 WORDS)

Infertility affects 1 in 6 couples in the United States during their childbearing years. The causes are sociological, medical and environmental. The new reproductive technology such as in-vitro fertilization and the alternatives to biological parenting such as surrogate motherhood raise legal and ethical issues as they raise the hopes of those couples previously unable to have a baby. As expectations have risen and treatment options become more complex, the social worker has become an essential member of the treatment team.