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The average treatment estimation framework was used to estimate the actual and potential adoption rates of artificial insemination technology in pig and their determinants using responses of 390 randomly selected pig farmers. The sample adoption rate of artificial insemination technology in pig is estimated to be 16% while the potential adoption rate is estimated at 47%. Incomplete diffusion or exposure of the technology in the population has lead to significant adoption gap of 31%. Result of the average treatment estimation probit model for determinants of adoption revealed the existence of significant difference in the coefficients and magnitude of marginal effects compared to the classic adoption model. Results showed that variables such as age of household head, piggery farming experience, maximum number of pigs reared in a year during the last 5 years, number of breeding sows, distance to artificial insemination provider centre, access to extension services and participation in training and demonstration programmes on pig were the significant determinants for adoption of artificial insemination technology in small-scale pig production system.

Assisted reproductive technologies (ARTs) are often considered luxury services by policy-makers and the general population, which are always susceptible of removal from public funding of health care. The analysis of the economic aspects of this scope seems essential due to the high prevalence of infertility in Iran and the high costs of infertility treatments. This study aimed to investigate the value put on IUI and IVF treatments by communities in Iran and the affordability of services based on community preferences. A cost-benefit analysis (CBA) was performed based on the WTP approach, and the contingent valuation method (CVM) was used to estimate WTP for IUI and IVF using a researcher-made survey in two cities of Kerman and Isfahan, Iran, in 2016-17. The sample size was 604, and the study sample frame to estimate WTP included two groups of couples who were/were not aware of their fertility statuses. The costs of one cycle of IUI and IVF were calculated according to the treatment protocols, tariffs of 2016-17, and medical information records of patients. The mean direct and indirect medical costs of one cycle of IUI and IVF were equivalent to 19561140 and 60897610 IRR, respectively. Also, the mean WTP for IUI and IVF treatments were obtained of 15941061 and 28870833 IRR, respectively. The demand for IUI and IVF treatments was elastic and the community was sensitive to price changes of these treatment methods. IUI and IVF treatments brought no positive net benefits, and economic variables had the highest impact on the WTP and community preferences, indicating the significant role of financial constraints in the community's valuation for advanced infertility treatments in Iran., Competing Interests: The authors have declared that no competing interests exist.

Historically, psychoanalysis has positioned the Oedipus complex as its focal point, based on a parental configuration of two-parent families consisting of a (male) father and a (female) mother. The modern era allows, albeit highly ambivalently, for the diversity of marital and parental configurations, reflecting cultural change as well as advances in the medical-technology of in vitro fertilization and of sperm and egg donations. The author discusses the analyses of two lesbian women who have chosen to mother a baby via an anonymous sperm donation. The author then takes up the question of whether unconscious oedipal conflicts influenced the decisions these patients made. She also questions whether the father in contemporary analytic thinking needs be a (male) "father" who is the "third," the "other." The work of Freud, Loewald, Searles, Poland, Ogden, and others will be brought to bear on these questions.

Objective: To study patient and provider feedback on how a multimedia platform (EngagedMD) helps patients to understand the risks and consequences of in vitro fertilization (IVF), ovulation induction (OI), and intrauterine insemination (IUI) treatments and the impact of the informed consent process., Design: Prospective survey study., Setting: IVF units in the United States., Patient(s): Six-thousand three-hundred and thirty-three patients who viewed the multimedia platform before IVF or OI-IUI treatment at 13 U.S. IVF centers and 128 providers., Intervention(s): Quantitative survey with 17 questions., Main Outcome Measure(s): Assessment of the impact of a multimedia platform on patient anxiety, comprehension, and satisfaction and provider/nurse feedback related to the informed consent process., Result(s): The survey was completed by 3,097 respondents (66% IVF treatment; 34% OI-IUI treatment) and 44 providers. Overall, 93% felt the media platform was intuitive, and 90% and 95% felt it had appropriate duration and detail, respectively. Most agreed/strongly agreed it better prepared them to consent (88%), increased their comfort in pursuing treatment (77%) and increased their satisfaction with their care (83%). Compared with the OI-IUI group, statistically significantly more participants who viewed the IVF media platform strongly agreed that the comprehension questions reinforced key concepts (47% vs. 40%), educated them about treatment risks (55% vs. 44%), helped them ask providers informed questions (45% vs. 36%), and better prepared them to sign consent forms (46% vs. 37%). Overall, 63% of providers felt that the media platform improved patient learning, made patients more accountable, and standardized information dissemination., Conclusion(s): The EngagedMD media platform improves patient knowledge, satisfaction, and control over medical decision making and better prepares patients to give informed consent. Furthermore, it is well-liked by providers and is easily implemented., (Copyright © 2018 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Ethical and bioethical problems, which are typical of the practice of surrogate motherhood, refer to its protagonists: the couple that orders it, due to its demand to satisfy the desire of paternity and maternity and the promptness of having a female body to fulfill its aspirations; the expectant mother, and the physical and psychic repercussions coming from the role performed in the surrogacy contract, as well as the risks of manipulation and exploitation, related to her position; the baby and his right to grow counting on the certainty of his parental relationships and on the preservation of his emotional balance. The human and anthropological importance of these issues, along with the growing development of this practice in the world, has questioned our moral conscience. In this context, the expectant mother, the weakest and the most affected part among the parts involved in the surrogacy contract, demands a particular attention. In this sense, the aim of this work is to lead a phenomenological analysis of the different steps of the practice of surrogacy, from the first stage of collection and classification of the information referring to the candidates, to the stage of the insemination and of its consequences about to the private life of the expectant. On the other hand, this work tries to justify the existence of a parallelism, as for the exploitation of the female body, between the practice of surrogate motherhood and prostitution. Finally, the issue relating to the effective social emancipation of the surrogate women in poor countries, the real autonomy and the freedom of their decision, as well as the typical features of the desire of paternity of the ordering couple are dealt with. The carried out study has allowed to conclude that this practice always implies a degree of physical, psychic and moral exploitation of the expectant mother, which suggests its prohibition at global level.

Study Question: How do single mothers who have conceived a child via anonymous or identity-release sperm donation represent the donor?, Summary Answer: While the majority of mothers described their anonymous and identity-release donors as symbolically significant to their families, others were more likely to emphasize that their lack of information limited their thoughts about him., What Is Known Already: There is limited understanding of the factors that impact upon how single mothers represent the donor, and whether or not they are determined by specific donor programmes (anonymous or identity-release)., Study Design, Size, Duration: Qualitative interviews were conducted with 46 women who had treatment at a UK licensed fertility clinic during the years 2003-2009. Twenty mothers (43%) had used an anonymous donor, and 26 (57%) had used an identity-release donor., Participants/materials, Setting, Methods: Among the 46 mothers interviewed, all had at least one child conceived via donor insemination who was between the ages of 4 and 9 years. Mothers were heterosexual and were currently without a live-in and/or long-term partner. Interview data were analysed qualitatively according to the principles of thematic analysis., Main Results and the Role of Chance: Findings indicated marked diversity in single mothers' representations of the donor. Most (n = 27) mothers talked about the donor as symbolically significant to family life and were likely to describe the donor as (i) a gift-giver, (ii) a gene-giver and (iii) a potential partner. Others (n = 16) talked about the donor as (i) unknown, (ii) part of a process and (iii) out of sight and out of mind. There were mothers with anonymous and identity-release donors in each group. Several mothers explained that their feelings about the donor had changed over time., Limitations, Reasons for Caution: All mothers conceived at a licensed fertility clinic in the UK. Findings are limited to individuals willing and able to take part in research on donor conception., Wider Implications of the Findings: The study offers greater insight into the factors influencing the donor narratives produced in single-mother families. It has implications for the counselling and treatment of single women seeking fertility treatment with donor gametes in both anonymous and identity-release programmes. Given that the number of clinics offering identity-release programmes worldwide seems to be increasing, the finding that single women may have varying preferences with regard to donor type, and varying interest levels with regard to donor information, is important. It is recommended that clinicians and other fertility clinic staff guard against making assumptions about such preferences and any thoughts and feelings about the donor or donor information on the basis of marital status., Study Funding/competing Interests: This study was funded by the Wellcome Trust [097857/Z/11/Z]. The authors have no conflicts of interest to declare., (© The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology.)

One consequence of the legal diversity in Europe is that legal restrictions on treatments can be evaded by going abroad. Many French lesbian couples and single women are crossing the border to Belgium because they are denied access to treatments with donor sperm at home. This is the first qualitative research study into the experiences and moral perspectives of these women. Between June 2012 and May 2013, 11 lesbian couples and 2 single women were recruited at the department of reproductive medicine at Ghent University Hospital. The data from the semi-structured interviews was analysed using inductive thematic analysis. The results show that these women face several additional challenges to the already difficult process of cross-border treatment. Before they can start the treatment, they can only obtain information from the internet or from stories of friends who also went abroad for treatment with donor sperm. During the treatment, they need to find local clinics or physicians to monitor their cycle. Several women managed to game the French system to ensure partial reimbursement for their treatment when they were successful in finding a physician who was willing to prescribe drugs and perform tests. Most women had difficulties justifying their absence from work. In general these women felt that they were discriminated against and that their rights were not protected because of who they are. In that regard, the lack of legal recognition of the genetically unrelated partner in their country was particularly hard to cope with for the lesbian couples. These women have to develop many different strategies to deal with the difficulties they face during cross-border reproductive care. It is concluded that it is very important that they find a physician who is willing to support them in their 'baby project'., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

This study investigated the effect of lifestyle on the quality of life among couples undergoing infertility treatment. The research universe consisted of 200 couples undergoing infertility treatment in Akdeniz University's Center of Reproductive Endocrinology and Assisted Reproductive Techniques. The data collection tools the authors used were a personal information form requesting sociodemographic characteristics and history of infertility, the SF-36 Quality of Life Scale, and the Healthy Lifestyle Behaviors Scale. This study revealed that the quality of life of the women in the study was lower than that of the men. The authors also found that the couples' quality of life was reduced by variables such as advanced age, low education level, unemployment status, lower income, long duration of infertility, high body mass index, history of andrological surgery, and previous experience of assisted reproduction techniques three or more times. Last, it was determined that the couples' quality of life improved as their healthy lifestyle behaviors increased. Demonstrating positive health behavior is likely to improve the quality of life of couples undergoing infertility treatment.

Background: Despite evidence that psychological distress manifests itself in underreported and atypical ways, few studies have assessed these symptoms in women who have experienced intrauterine insemination (IUI)., Purpose: The aim of this study was to examine the prevalence of psychological distress and explore the relationships among psychological distress, various demographic characteristics, and somatic symptoms in women who had received IUI treatment in Taiwan., Methods: A cross-sectional study design was used in this study. The 117 participants were recruited from a teaching hospital in northern Taiwan. The brief symptom rating scale (BSRS-5) was used as the measurement instrument, and scores of more than 5 on the BSRS-5 were used to mark the boundary between milder and more severe psychological distress. Demographic characteristics and somatic symptoms of IUI that contributed most significantly to psychological distress were identified from the data., Results: Thirty-eight (32.5%) participants experienced psychological distress. Psychological distress was most common in participants (a) with husbands who were an only son, (b) who had taken medication during the previous week, (c) with an education level below college or university, and (d) who reported feeling faint., Conclusions/implications for Practice: The factors studied are important to understand psychological distress in women who have undergone IUI treatment.

Background: As pregnancy and childbirth have long been considered women's issues and male infertility has long been surrounded by taboo, limited research has focused on the experience of infertile men. The purpose of this study was to compare male motives for parenthood, male well-being and disclosure patterns concerning the method of conception among men from couples starting treatment with IUI using their own sperm (autologous sperm recipient, ASR) or donor sperm (donor sperm recipient, DSR)., Methods: This prospective study included 46 DSR- and 151 ASR-couples. Self-report questionnaires assessing parenthood motives, well-being and disclosure patterns concerning the method of conception were administered to both men and women prior to treatment. Unpaired T-tests and Fisher's exact tests were used to test for significant differences., Results: When compared with ASR-men, DSR-men expect more positive effects from parenthood on relationships and feelings of fulfilment, and report less negative effects of infertility on sexuality, but a lower self-image and more guilt. DSR-men plan to disclose the method of conception less frequently and have so far disclosed to a lesser degree than ASR-men., Conclusions: DSR-men feel differently about parenthood and infertility compared with ASR-men, and their higher expectations combined with lower self-esteem need (more) attention during counselling.

Objective: To study the decision to have a child alone, the experience of gamete donation, the issue of disclosure of the donor link to the child, conception-related health and sociodemographic characteristics of the mothers, children's socioemotional development, and mother-child relationships., Design: Qualitative study., Setting: Prior clients of a sperm bank., Participant(s): Eleven single women in their late forties who gave birth to children aided by IVF involving both egg and sperm donation, i.e., the children are not genetically related to the mothers., Result(s): Not only were there differences among the participants, but they also differed from the only previous study focusing on single women becoming mothers by choice and using advanced reproductive technologies., Conclusion(s): Similarly to previous studies, we generally found that the impact of assisted conception on parenting and child development gives no undue cause for concern while the children are still young. However, the young age of the children in our sample prevented us from answering many questions about the children's socioemotional development and about disclosure of donor conception to children born to older single women using double gamete donation and IVF.

Background: Personality differences between surrogate mothers (SMs) who gestate and relinquish and intended mothers (IMs) who commission a genetically related or unrelated baby have been unexplored in the UK. Furthermore, the psychological effects of the arrangement have not been determined in a prospective longitudinal study, making this the first quantitative report of psychological functioning in SMs and IMs., Methods: SMs and IMs (n = 81: 61 surrogate, 20 intended) undergoing genetic or gestational surrogacy (4 groups) were assessed by postal questionnaire during the first, second and third trimesters of pregnancy. Those with a positive outcome were assessed again in the first week, at 6 weeks and 6 months post-delivery of the surrogate baby., Results: There were no significant differences between or within SM and IM groups on personality characteristics. Social support, marital harmony and state anxiety differed significantly (to P < 0.01) between SMs and IMs at different stages of the arrangement. Differences in attitudes towards the pregnancy and the baby were also observed between groups during pregnancy (to P < 0.001), but there was no evidence of post-natal depression amongst the groups studied., Conclusions: These results are important because they demonstrate psychological effects of the surrogate arrangement are notable and occur over an extended period of time. It also shows that psychological screening and support prior to, during and following surrogacy is indicated.

We report the case of an artificial donor insemination couple experiencing sudden infant death of their 8-month-old child. Six months after the incident, the couple were investigated by means of an extensive interview, a repertory grid investigation and the Family Assessment Measure, as well as at 6 years after the incident by an extensive interview. The results show the importance of the diagnosis of male infertility and the preceding fertility treatment for coping with the death of their child. Six months after the incident, acute feelings associated with bereavement are mixed with feelings of anger and shame, apparently due to the experience of infertility. However, secrecy and shame associated with male infertility and donor insemination make it impossible for the couple to communicate their feelings to each other or to friends and relatives; furthermore, they decline psychological counselling. Repertory grid investigation and the Family Assessment Measure point to significant problems within the partnership. Six years after the incident, the couple's relationship is destabilized and both partners plan to divorce. We suggest a possible link between donor insemination secrecy and difficulties with coping. We discuss implications for couple counselling and emphasize the necessity for an improved legal framework for donor insemination in Germany.

In this study, we focus on the donor origin of youngster who are raised in lesbian donor insemination (DI) families. The aim was to explore why some of these DI children like to know more about the donor while others do not, these data were gathered by means of a semi-structured interview. Secondly, we investigated, by means of several questionnaires, whether psychological variables such as global self-esteem, emotional and behavioral adjustment and children's perception of the quality of the parent-child relationship were in some way linked to whether or not they wanted to know more about the donor. In our study the majority of the children who preferred to have no information about the donor expressed their loyalty towards the social mother. For the majority of the children who opted for donor information, curiosity was the most salient motive. No differences were found with regard to the psychological variables between the two groups considered. In conclusion, the wish to know more about the donor or the absence of such a need is not reflected in the child's well-being and is not linked to the quality of the parent-child interaction.

The quantitative and qualitative data of this study on family functioning in lesbian donor insemination families reveal that according to both parents and children, the quality of children's relationship with the social mother is comparable to that with the biological mother. Unlike fathers in heterosexual families, the lesbian social mother is as much involved in child activities as is the biological mother. Furthermore, the lesbian social mother has as much authority as does the father in heterosexual families.

Objective: Determination of the emotional burden of the first IVF or ICSI treatment cycle, the effect of the treatment on the marital relationship, and the course of the treatment following a failed and a successful first attempt., Design: Descriptive longitudinal study with repeated measures before and after the first treatment cycle., Method: 240 women and 219 men filled in questionnaires both before and after the first treatment cycle in the area of anxiety, depression, and the marital relationship (as measured with the 'Spielberger state trait anxiety inventory' (STAI), the 'Beck depression inventory for primary care' (BDI-PC) and the 'Maudsley marital questionnaire' (MMQ), respectively), as well as their plans for further treatment., Results: After a first failed treatment cycle, both women and men showed an increase in depression, while women also showed increased anxiety. No differences were found between pre- and post-treatment levels of anxiety and depression after a successful treatment. After the first failed cycle, almost 13% of the women showed clinically relevant forms of depression. There was an increase in dissatisfaction with the sexual relationship in both men and women regardless of the success of the treatment. Before the start of the first treatment cycle, 2% of the couples had no intention to undergo further treatment if the first cycle failed; none of these couples started a new cycle. Ultimately, 18% of the couples refrained from further treatment following a failed first treatment cycle., Conclusion: After a failed first treatment cycle the couples showed an increase in depression and one in eight women had a clinically relevant form of depression. More than one out of every 6 couples decided to refrain from further treatment after a failed first cycle.

The purpose of this research was to explore the following objectives for infertile couples receiving infertility treatment: Differences between wives and husbands in their emotional reactions and coping behaviors. This research, using structured questionnaires, was based on 120 infertile couples attending the Intrauterine Insemination (IUI) or the In Vitro Fertilization-Embryo Transfer (IVF-ET) program. The research instruments consisted of Demographic Data Form, Profile of Mood States (POMS), and Ways of Coping Questionnaire. The research results showed that infertile wives experienced more emotional disturbance than husbands did, as shown in the four subscales of Tension-Anxiety, Depression-Dejection, Anger-Hostility, and Fatigue-Inertia, as well as the total scale of POMS. It was also shown that wives adopted more coping behaviors to deal with infertility and treatment than husbands did, as revealed in the subscales of Self-Controlling, Seeking Social Support and Escape-Avoidance and the total scale of the Ways of Coping Questionnaire. All of the above reached significant statistical differences. The emotional reactions of infertile couples varied with the differences in education levels, duration of treatment, number of treatments received, and numbers of existing children. The emotional reactions of infertile husbands had a significantly positive correlation with the factors Confronting, Accepting Responsibility, and Escape-Avoidance. The emotional reactions of wives had a significantly negative correlation with Positive Reappraisal. The research results can provide clinical staff with a correct understanding of the differences between husbands and wives in emotional reactions and coping behavior, as well as related factors, to help them to provide better medical treatment.

This study presents the outcome of a 7-year psychotherapy of a girl who was born after donor insemination (DI) and who became ill with a compulsive disorder at the age of 8 years. Our demonstration supplements the present existing statistical data about families into which children have been born with the aid of DI. Aspects of child development, communication within the family, and family dynamics related to this specific constellation will be pointed out. This case study shows important aspects of the individual and the development of the family with regard to DI-constellations. Our paper emphasizes, in contrast to constellations of foster care or adoption, the impact on the parents' conscious knowledge and the child's unconscious knowledge of an absent--as well as less-known--family member (here: the invisible father) on the child's emotional development, health and competence of tying bonds. We also examine the relationship between the parents and their relationship with their DI child. Implications for individual therapy and therapeutic management of the family will be discussed, covering development of bonding and identity of the DI child, the father's role, dynamics of the couple, and the incognito of the 'invisible father'.

This paper draws on some of the major findings of a recent large-scale study of over 400 adult adopted people, who either searched for origins information or were sought out by birth relatives, to identify the potential profile of donor offspring seeking origins information. It is predicted that more women than men will search, that people who search will be in their twenties or older, and that the age at which searching begins may be delayed by the effects of the social stigma attached to gamete donation and by the greater likelihood of accidental disclosure in adulthood resulting from the higher incidence of secrecy about donor assisted conception. Two of the single triggers for adopted people to begin searching (as opposed to multiple triggers) - becoming a parent and the death of adoptive parents - may also be among the triggers for donor offspring to begin searching. The search may be complicated further when undertaken after accidental disclosure. Finally, it is argued that some donor offspring will experience a normative urge for identity completion and seeking relationships similar to that experienced by adopted people. This urge may stem from the fact that some donor offspring attach an identity to their donor that extends beyond needing factual details about their physical characteristics (though not necessarily a desire to establish a relationship). Some donor offspring are likely to encounter a desire for face-to-face contact, regardless of whether a face-to-face meeting was the original intention. The need for services to help donor offspring, donors, family members and others affected by the situation is identified.

Pioneering legislation regarding donor insemination was introduced in Sweden in 1985. The law gives the child, upon reaching sufficient maturity, the right to obtain information about the donor and his identity. One hundred and forty-eight Swedish couples with children conceived through donor insemination after the law was introduced have answered questions about disclosure and donation in a questionnaire. This article addresses the reasoning employed by individual couples in their decision whether or not to inform the children about their origin. Parental reflections on their decision and the children's reactions to receiving this information are also presented. Five categories of parental arguments are reported. These included 'reasons to tell', 'reasons not to tell', 'reasons why the question about telling or not would not be answered at all', 'inconclusive types of reasoning, that can still influence the fundamental decision' and 'context-dependent reasons associated with actual circumstances'. Through this meta-classification of arguments it was possible to identify clues to how professionals could facilitate parental decision-making and promote disclosure. Parents who had informed their children did not regret their decision. All of the parents who responded to the question of whether it had been beneficial to the child to tell answered 'yes'.

Reports were based on 23 lesbian couples seeking therapeutic donor insemination (TDI). Seventeen single women and 14 heterosexual couples with known infertility, due to vasectomy, were recipient controls. No group differences were found on self-esteem, psychiatric symptomatology or dyadic adjustment, except that lesbians reported greater dyadic cohesion than heterosexuals. Lesbians and single women were likely to disclose their use of TDI to others and had planned to disclose this to any child conceived; married couples were divided on this issue. Groups were alike in what they wanted to know about the donor (principally health variables and medical history), and in their concerns about the use of TDI (genetic and medical history). Groups differed in the reasons they elected to use TDI, with lesbian couples and single women choosing TDI affirmatively, and married couples accepting it as a last resort.

By investigating egg donation families, donor insemination families, adoptive families, and families created by in vitro fertilization, the aim of the present study was to examine parents' emotional well-being, the quality of parenting, and childrens' socioemotional development in families with a child who is genetically unrelated to the mother or the father. The differences that were found to exist between families according to the presence or absence of genetic ties between parents and their children reflected greater psychological well-being among mothers and fathers in families where there was no genetic link between the mother and the child. The families did not differ with respect to the quality of parenting or the psychological adjustment of the child.

The authors examined whether being adopted or semi-adopted (born of artificial insemination with donor sperm and genetically linked to the mother but not to the social father) is a stigmatizing attribute affecting evaluations made of a child, and whether the gender of the rater moderates the effects of adoptive status on evaluations of children. Participants included 129 undergraduate students from the United States who were presented with written scenarios describing a child's adoptive status. They were asked to evaluate the child on a number of attributes. Results showed that adoptive status did not affect evaluations of children, although rater gender moderated the effects of adoptive status.

The number of medically assisted conceptions involving donors is increasing. At the same time, due to advances in medicine, greater emphasis has been placed on an individual's genetic origins. This trend places individuals who have no access to information on their genetic origins in a vulnerable position. Because of the secrecy and anonymity that has surrounded donor inseminations, many individuals who were so conceived are irreversibly cut off from any possible contact with or even knowledge about their genetic fathers, who will also never have the opportunity to meet their offspring. In view of the accumulated evidence concerning the detrimental effect of secrecy, anonymity and deception in donor insemination, this paper argues that these practices are not only psychologically and socially harmful but also ethically unacceptable.

Disclosing the use of donor insemination (DI) to family, friends, and offspring poses a quandary for many DI patients. A cross-sectional survey was conducted to determine whether couples opted to share information about conception via donor sperm with their children, as well as the issues and concerns that arose for parents once infertility treatment was completed. Twenty-seven married heterosexual infertile husbands and wives who had used DI to conceive completed a follow-up questionnaire asking them about disclosure decisions as well as thoughts about DI as a reproductive option. Results revealed that nearly three-quarters of the sample had not disclosed to their child and did not plan to, although 85% had told at least one other person about conception via DI. With few exceptions, husbands and wives agreed about how to handle disclosure. Notably, 32% of the mothers reported not knowing when or how to disclose. However, the majority of couples were not offered psychological counseling prior or subsequent to DI. It is suggested that mental health professionals should be aware of the divergence of opinion between what they believe about the benefits of disclosure/counseling, the beliefs of infertile couples about disclosure and what is actually known about the benefits of full disclosure among all involved parties.

In this paper I discuss whether or not biographical information concerning the sperm donor should be disclosed to children conceived through donor insemination. Policies of disclosure for example in the context of adoption, have been justified on the basis of a notion of identity which emphasizes genetic ties. This notion of identity and the policies of disclosure of information concerning biological parents based on it, have been criticized by many writers, including feminists, as reinforcing explanations of human organization and development based on biological determinism rather than on ideas such as social construction. Further, this notion of identity is seen to emphasize the importance of genetic parenthood over the commitment involved in bringing up a child as a social parent. While agreeing with these criticisms of that particular notion of identity, I argue that the notion of identity as a whole should not be summarily rejected. Rather, it should be re-interpreted using a sociological approach incorporating the notion of narrative. This second narrative notion of identity is developed with reference to the situation of some groups of children, who like those born from donor insemination, generally do not have any knowledge of their biological parent[s], for example adoptees, the children of the disappeared in Argentina and child migrants. In this paper, policies of disclosure which allow these children to gain some knowledge of their biological parents are discussed in light of the two notions of identity. It is argued that disclosure may be justified on the basis of a narrative notion of identity. This allows for the rigid dichotomy created between biological determinism and social construction: the importance of social parents to the child is emphasized, however the desire a child may have to know something about her or his biological parent is not denied or dismissed.

The issue of openness and secrecy in the use of donor gametes is the subject of considerable disagreement and debate, not only for social scientists and health professionals, but also for the recipients of donor gametes. This paper has its origins in a study of 58 couples who had a child/children as a result of donor insemination (DI) at the Dunedin Infertility Clinic. Respondents completed questionnaires and took part in an interview during which they were asked whether they intended to tell their offspring about their DI conception. The nature of agreement/disagreement between partners on this issue, the dynamics operating between couples that may affect decision-making, and the views of couples in a time-frame perspective are the focus of this paper. Transcripts from some of the interviews are presented to illustrate the points made and commentary and discussion is provided.

The idea of maternity--and paternity as well--reaches far beyond the field of biological reproduction inasmuch as it implies a subject's desire, besides being regulated by the symbolic order: Language, myths, patterns and values of a given culture. From this point of view, infertility cannot be considered as a mere somatic illness, but as a human problem implying psychological and social aspects that require a search for solutions unlikely to be reduced to a sole medical operation. The development of the new reproductive technology is in keeping with the increasing medicalization of human lives, human sexuality, and human bodies.

It is suggested that infertility may be distressing because it results in an inability to fulfil traditional roles and thus those individuals who adhere to traditional sex roles may be more distressed by the experience of infertility. In order to examine the relationship between sex role and emotional well-being in infertility patients, 58 women attending a clinic for assisted conception procedures and 31 of their male partners completed questionnaires assessing sex-role type (i.e. masculine, feminine, androgynous or undifferentiated) and emotional, marital and sexual functioning. Women with a traditional feminine sex-role type were more anxious than those with a masculine sex-role type but there were no differences in depression or marital or sexual functioning. Men with an undifferentiated sex-role type were more anxious and depressed than those with other sex-role types. The findings are discussed in terms of the relationship between sex role and infertility, previous research into sex differences in distress amongst infertility patients, and the problems associated with measuring distress.

Studies of other animal species suggest that stimulation during copulation has important effects on the probability of conception. Thus appropriate stimulation during artificial insemination may improve rates of conception.

An anonymous questionnaire was circulated at two gamete donation clinics to survey the attitudes of donor insemination patients (n = 71; 89% response rate), sperm donors (n = 52; 85% response rate) and ovum donors (n = 5; 63% response rate) to the release of medical records with non-identifying information, or with identifying information of the donor involved. The majority of established sperm donors agreed to the release of medical records with or without identifying information. In the subset of potential sperm donors 85% would not enter a sperm donation programme unless anonymity was maintained, but 60% would agree to the release of non-identifying medical records. Sixty per cent of recipients of donated spermatozoa would agree to the release of medical records with identifying information of the donor, but 85% stated that they would not tell their children of their genetic origin. There is a significant difference between the attitudes of potential sperm donor recruits to these questions and those of established donors and recipients of donated spermatozoa. In conclusion, the results of this survey show that although established sperm donors would continue to donate spermatozoa if their status of anonymity was withdrawn, recruitment of new donors would be significantly reduced. This would be to the detriment of gamete donation programmes and to the subfertile couples who request this form of treatment.

Artificial insemination with donor (AID) forces the gynaecologist to face the problem of filiation with his patients. Here, the authors point out the pathogenic effect, both on the parents and the child, which may result from rigidly kept secret about 'AID filiation', and they discuss some conditions which could help to avoid this pathogenic effect, possibly allowing a non-traumatic revelation of his/her filiation to the child, in the future.

We evaluated the pregnancies of 427 women who conceived through artificial insemination by donor (AID) at our clinic over a 12-year period. Initial phone contact was followed by a questionnaire. Outcome was known for 594 of the 606 pregnancies, with a total of 502 live-born children including 15 sets of twins. The spontaneous abortion rate was 16.5%, with no difference between fresh- and frozen-semen pregnancies. Significant correlations were found between spontaneous abortion rate and maternal age (P less than .001) and spontaneous abortion rate and cycle of conception (P less than .025). Follow-up was completed on 481 children, among whom the following were found: one chromosomal anomaly, 22 major congenital anomalies, four children with possibly syndromic conditions, and 38 with minor congenital anomalies. Of the school-aged children, 5.8% had recognized learning disabilities and 10.5% were considered gifted by their schools. We also investigated the psychological impact of AID on each family. The majority of couples (71.7%) informed their obstetricians of the AID. Half of the couples did not tell any family or friends. Many couples did not (47%) or probably did not (14%) plan to tell their children of their origins. The divorce rate among those with AID children was 7.2%, which was significantly less (P less than .01) than that in a matched population. Psychological counseling specifically related to AID was sought by 2.8% of the couples. We conclude that AID children are at similar risk for congenital anomalies as normally conceived children, but they experience lower rates of family dissolution.

This descriptive study explored how self-identification as lesbian ("coming out") affected gynecological and childbearing needs and experiences. Twenty interviews were conducted using a researcher-designed interview schedule. The majority of lesbians disclosed their sexual/affectional identity to providers ostensibly to negate heterosexual assumptions. Fear and the unpleasantness of coming out influenced the majority to postpone gynecological care or to seek lesbian-sensitive providers. Half of the participants had gone to ob/gyn appointments accompanied by the partner. Traditional health history questions about marital status, sexual activity, and birth control elicited inaccurate information from participants. Participants believed important qualities in providers to be: sensitivity, knowledge about lesbian sexuality, and female gender. Providers need to learn clues of lesbian identification or coming out; they should also strive to use inclusive gender words and remove heterosexual assumptions. Seventy percent of participants desired children; alternative insemination was an accepted method of conception to most. Midwives can play a special role with lesbians desiring pregnancy and children.

Reports by others that stress surrounding AID alters the menstrual cycle has prompted some physicians to provide pharmacologic control to predict the day of ovulation. We studied the BBT charts of 47 women who had predictable menstrual cycles in the 2 months preceding AID in order to compare them with day of ovulation and length of luteal phase of the 1st month of AID. Although there was a significant difference in the day of ovulation between AID and non-AID months, the difference was less than 1 day. We did not find the large shift in ovulation day during the 1st month of AID reported by others.