Infertility, Assisted Reproductive Technology & Parenting Flashcards
What is the WHO definition of infertility
the failure to conceive after 12 months of trying
what percentage is infertility due to female factors only
34%
what percentage is due to male factors only
28%
what percentage is due to male and female combined
14%
what percentage of infertility is unexplained
22%
what are some western cultural changes that have effected having babies
- contraception
- male/female roles redefined
- fewer marriages
- more divorces
- emphasis on careers for women
- postponement of first child
discuss choice/control over having babies
women & men are choosing to not have babies BUT later ages in deciding to have children means infertility is more common
What did the early psychological research on infertility suggest, how has this evolved
that women were psychologically to blame for their infertility - proposed psychogenic origins
-recently growing awareness of the male factor in infertility
in 2011, what percentage of aus babies were a result of IVF
3.8% - one child in each classsroom
discuss Verhaak et al., 2006 systematic review of the psychological components of infertility
- few differences b/w ART women and “norms” at treatment outset
- unsuccessful treatment cycles did increase negative emotions, but most adjust well
- less is known about long-term adjustment after unsuccessful
what are the 5 different treatments for infertility
- IVF
- ICSI - intra-cytoplasmic sperm injection
- donor sperm, eggs, gamtes
- embryo adoption
- surrogacy
what’s involved in IVF
- medical investigations
- ovulation stimulation
- ultrasound & blood monitoring of egg maturity
- further hormonal stimulation via injection
- laparaoscopic egg collection & collection of a sperm sample from the male partner
- fertilised embryo is transferred to the uterus
discuss ICSI
- the sperm sample is modified
- they get a tiny needle and inject the sperm into the egg
discuss a diagnosis of infertility as a life crisis
- salient feelings of loss of control
- desire for a child & life plan is thwarted
- challenges to relationship
discuss the impact of infertility on individuals
- self-esteem
- sexuality
- emotional state
- stigmatised identity - isolation/social networks
- general health & wellbeing - physical demands & side effects of drugs
- moderated by pre-existing emotional problems & individual differences*
discuss the impact on self-esteem for men
men are supposed to be manly
what can infertility be conceptualised as?
a chronic disease/chronic health problem
in regards to health & wellbeing, what is longterm infertility associated with
- associated with lower quality of life & wellbeing for men & women
- depression & anxiety elevated, more health complaints
discuss the impact of infertility treatment on lifestyle
- economic costs
- impact on career, women may put careers on hold, men may need to alter schedules
- process & practical demands
can the treatment process be addictive
yes
discuss the relationship stressors that infertility can have
- women “cover” for partners
- sexual difficulties - performance pressure
- emotional intensity of experience of infertility is unequal?
- disagreement regarding treatment
- using donor gametes may be threatening
what were some of the problems predicted with the rise of ART by ‘Life: 1969 Science and Sex’
- removing biological foundations of morality
- diff meanings of decoupling sex, love, procreations
- end of institutions of marriage, family
- virgin births may be common
- mothers unable to love children they haven’t carried
what is the clinical anecdote associated with IVF parents
“highly anxious, perfectionist parents” - evidence doesn’t support
what are some hypotheses regarding parenting after conception through ART
- depleted psychologically
- unrealistic expectations, vulnerable to depression
- overprotective, intrusive parenting
- devoted, highly motivated parents, optimal parenting
discuss what the studies found on IVF and non-IVF mother’s adjustment to pregnancy
- IVF mothers reported higher anxiety regarding outcome of pregnancy
- differences in fetal attachment: shown mothers conceiving through IVF have a more intense attachment, less intense because of anxiety & no difference
what overall did they find about pregnancy re qualitative/quantitative measures
no differences in quantitative measures b/w IVF pregnancies & normal, but there are qualitative differences
discuss qualitative differences in IVF & normal pregnancies
- coping strategies mean very different path to parenthood
- IVF mothers are less likely to prepare a nursery
- afraid to speculate about baby
- less likely to attend antenatal classes
- kept pregnancy secret for longer
discuss the significant differences IVF mothers have in comparison to normal in their adjustment to parenting at 4 & 12 mths
- lower self-esteem for IVF mothers
- more concerns about child’s behaviour but this has changed (better temperament)
- thought their children were more vulnerable at 12 mths
- tendency to view child as ‘special’ 12 mths
what were there no differences in at age 4 & 12 mths of IVF parents & normal
-mood state, competence, work patterns
when investigating the difference between IVF and non-IVF mothers parent-child relationship what were the observational methods used
- still-face procedure
- strange situation procedure
- emotional availability during free play
what were the differences found in parent-child relationship between IVF at 4 & 12 mths
- no differences between observed sensitivity, security of attachment, maternal sensitivity or child responsiveness at 12 months,
- no differences more difficult child behaviour
discuss differences found in parent-child relationship for IVF & non-IVF at child 5 years
- no differences in mood state, marital adjustment, child behaviour problems
- IVF parents report lower parenting stress than comparison older first-time parents
discuss some conclusions from the reviews on parents
IVF parents:
- lower self-esteem, self-efficacy early on
- more likely to seek help with early parenting
- more protective - child viewed as more vulnerable, less child autonomy
discuss some conclusions from reviews on child neurodevelopment
epidemiological
studies:
- increased relative birth defects
-multiple birth more common, perinatal risks
-epigenetics
neurodevelopmental outcomes:
-not associated with cerebral palsy
-are associated with higher preterm birth & multibirth (and those are related to increase handicap)
-not associated with neurodevelopmental disorders
what did they find regarding longer-term outcomes of young adults conceived by ART compared with not
n = 659, young adults aged 18-29 years who were conceived by ART had similar quality of life BMI & pubertal development to non-ART children
-self-report only
ART women are ___ times more likely to have a ____
1.5 times more likely to have a preterm birth
what percentage of ART births are pre-term compared to non ART
10% = ART 6.8% = non-ART
ART mothers are…
older, more socio–economically advantaged & less likely to smoke
-more likely to have hyper-tension & complications during pregnancy
discuss some issues for children conceived with donor gametes in heterosexual families & same-sex couples - Golombok et al.
-impact of secrecy (child not told father is not father etc.)
-no genetic link b/w father & child
-“genealogical bewilderment”
same sex couples:
-absence of male or female role model
-stigma
what did Golombok et al. find
- DI & IVF parents showed greater warmth & emotional involvement with children at 4 & 11 mths
- no differences re fathering problems
- no differences re marital problems or child adjustment
- BUT none had told the children about their origins at middle childhood & only 2 by adolescence
when Golombok et al. studied 4 groups of children (natural conceiving, ED, DI & surrogacy) what did she find regarding the children
-no differences overall compared with SC children
what did golombok et al. find regarding children produced by a surrogate, what does it suggest
- children born through surrogacy had more difficulties aged 7
- suggests that lack of gestational link may be more problematic than lack of genetic
what are the research findings in general about lesbian parenting
- consistent evidence mothers in fatherless families expressed greater warmth & interacted more with children
- no differences in child emotional/behaviour or gender role development
- lesbian co-mothers more involved than typical fathers
- some evidence for positive psychological development
- generally no better no worse
what was found about the differences between lesbian families created through DI than heterosexual families
-less secrecy than heterosexual couples
discuss gay men choosing parenthood generally
- its a growing phenomenon
- usually involved an egg donor and gestational carrier: often international
- most are in committed relationships and have thought a great deal about it
- most have supportive families
- more research needed
what are donor issues
- child’s right to know genetic origins
- implications of commercial egg & sperm donation
- potential exploitation of surrogate mothers
- reproductive tourism
how many frozen embryos were in storage in 2011 in Aus
> 120,000
what are the factors influencing decision making of what to do with remaining frozen embryos
- success or failure in meeting reproductive goals
- fears and fantasies about donation of genetic offspring
- altruism
what did the research find regarding remaining frozen embryos
-many opt to put decision off as long as possible
->90% think of embryos as potential child & potential sibling of existing children
<10% intend to donate to research or other couples
discuss the percentages found regarding conditional donation
- 4% indicated they would donate to other couples
- 48% thought donors should be able to specify characteristics of recipients
- 41% indicated they would be more likely to donate if donation was conditional
What is the most common reason women are having babies later
had to wait to find a partner who wanted to commit to having a baby as well
what did the big study (n=592) regarding older women’s pregnancy find
- less pregnancy and anxiety symptoms
- lower fetal attachment
what did the big study (n=592) regarding older women’s pregnancy find was more important than age
-personality (hardiness) and context factors
what was associated with more complex pregnancy adjustment regardless of age
ART conception
what did the big study (n=592) regarding postpartum adjustment for older women find
- adjustment generally better
- maturity associated with more positive experience of motherhood
- no evidence of increased PND for older mothers
what did the big study find for mothers conceiving through ART and postnatal depression/child’s temperament
- no evidence of increased PND for mothers who conceived through ART
- ART mothers report less difficult temperament
