IVF News

The On-line Masters Degree in Clinical Embryology and Andrology offered by The Jones Institute for Reproductive Medicine at Eastern Virginia Medical School is open for applications with a deadline of December 1, 2005. A limited number of positions are available for the next class that begins May 2006. This is a two-year Masters Degree program designed to meet the needs of embryologists, andrologists, physicians, and others who seek in-depth training in the scientific basis and practice of assisted reproduction. Courses include: cell and molecular biology, reproductive endocrinology, andrology, ART laboratory, quality assurance, genetics, cryopreservation, and ethics and law.



Meet us in Montreal October 17th, 2005!
We will be holding an informational session in Montreal at the joint meeting of the American Society for Reproductive Medicine/Canadian Fertility and Andrology Society (ASRM/CFAS). If you would like to learn more about how our program may benefit you or your laboratory staff, please plan to attend:

Le Centre Sheraton, Salon 6 and 7

Montreal, Quebec, Canada

8:00-10:00 a.m. Monday October 17, 2005



Please RSVP: [email protected]



If you cannot attend this session and would like to set up another time to discuss our program, Jake Mayer PhD, Helena Russell MS and Sue Gitlin PhD are available in Montreal from October 16-19th to meet with you.



For details about our degree program, please see: http://www.evms.edu/hlthprof/embryology/index.html

According to the UK's Sunday Times newspaper, a high proportion of couples seeking fertility treatments ask the clinic to help them have twins, rather than have one baby at a time. The Sunday Times describes this as producing 'an instant family with just one pregnancy'.



One clinic that the newspaper spoke to said that as many as ten per cent of its clients ask specifically for twins. Doctors are reported as saying that many women believe that they are too old to have a second baby at a later date, or that they will have further difficulties conceiving a second child in the future. Many people come to fertility treatment at a fairly late stage in their reproductive lives, because, apart from a rise in the average age at which a woman has her first child, the diagnosis and initial treatments when infertility or subfertility is discovered may take some time. This means that a few years can have passed before treatments such as IVF are arrived at. However, some clinics said that some women who want two children choose twins to minimise disruption to their career.



Paul Rainsbury, a fertility doctor from the Bupa Roding hospital in Ilford, East London, specialises in the treatment of older women. He told the Sunday Times that 20 couples have requested twins at his clinic in the past year, about 10 per cent of all patients seeking IVF at the clinic. Professor Gedis Grudzinskas, medical director of the private Bridge Fertility, Gynaecology and Genetics Centre in London, said that one or two women a year request twins. 'They are patients of all ages saying twins would be good because that means they'll get their whole family out of the way', he said. He added that his staff will advise women on the risk of having twins, but said 'if they don't object to the risk, they've gone through our normal clinical and counselling procedures and we accept them, then we will carry out the transfer of two embryos which could create twins'.



The Human Fertilisation and Embryology Authority (HFEA), which regulates fertility treatments in the UK, commented that it was unaware of IVF patients routinely asking for twins, but pointed out that under the HFEA Code of Practice, 'clinics are entitled to implant two embryos', adding 'people are free to make choices about their own bodies'.



Meanwhile, doctors in Southern China have warned women to stop taking fertility drugs to increase the likelihood of having twins, enabling them to get around the state's one-child policy. Evidence shows that the number of twins born last year has doubled in a number of hospitals across the region, raising suspicion that prosperous couples are exploiting a loophole in the law to have more than one baby at once. Under the one-child policy, there is no sanction for multiple pregnancies but, when it was put in place in 1979, few Chinese had access to fertility drugs. According to the Sunday Times, the trade in imported fertility drugs and traditional remedies is booming in the Southern Chinese provinces bordering Hong Kong. Women with no fertility problems are reported to be buying the drugs to enable them to have more than one child at a time.

Three new independent studies have provided further evidence that embryos stored using slow-freezing techniques may be better than fresh for IVF. The studies were presented at the American Society for Reproductive Medicine conference in San Francisco, US, last week. The studies indicate that using frozen embryos rather than fresh embryos reduces the risk of stillbirth and premature delivery.

It is unclear why this is the case; there are several theories. Some experts have suggested that when fresh embryos are used women may still be suffering from the effects of the powerful drugs that are used to stimulate the ovaries, temporarily disrupting any IVF attempt shortly afterwards. Dr Allan Pacey, from the University of Sheffield and secretary of the British Fertility Society (BFS), said: 'These findings are really quite interesting. It kind of defies logic to a certain extent, because the stimulation drugs and anaesthetics that are used in egg collection have worn off by the time fresh embryo transfers are done. It seems to be an issue with the formation of the placenta, but how it has an effect isn't known.' Another theory is that only the 'best' embryos surviving the freezing and thawing processes, which can damage the embryo either as the result of ice crystals forming or of an increase in the concentration of solutes as progressively more ice is formed.

The three large, independent studies took place in Finland, Australia and the US. The Finnish study, found that babies born from fresh embryos were 35 per cent more likely to be premature and 64 per cent more likely to have a low birth weight when compared to those born from frozen embryos. The research that took place in Melbourne, Australia, showed that 11 per cent of babies born from fresh embryos had a low birth weight, compared to 6.5 per cent of those born from frozen embryos. They also found that 12.3 per cent of babies born from fresh embryos were premature, compared with 9.4 per cent of those born from frozen embryos. Also, 1.9 per cent of babies from fresh embryos died a few days after birth, compared to 1.2 per cent from frozen embryos. Similar findings were reported in June this year from a Danish study.

Typical IVF treatment involves stimulating a woman's ovaries with hormones to produce eggs which are then collected and fertilised in the laboratory, with one or two embryos being transplanted into the womb two days later. The remaining embryos can be slow-frozen and then stored, to be used later if the initial cycle fails.

The new data may provide a dilemma for IVF clinics, as although frozen embryos seem to result in a healthier pregnancy, the pregnancy rate is less successful. Commenting on this, Dr Pacey said: 'Frozen embryo transfers are not as successful as fresh ones in terms of getting a pregnancy. So it may be that we have to balance the health of children against chance of success.'

Elective single embryo transfer (eSET) policy implementation has raised many issues among patients, IVF experts and fund holders. The main concern in relation to this policy is that we do not know how much, and by what percentage, it will reduce the pregnancy rate in our patients. The policy says that the purpose of eSET is to safeguard any future outcome failures. But is it fair on patients?

One in about eight women nationwide seeks help for infertility. Among these infertile women 10 to 15 per cent of patients get pregnant having being treated with Clomid, IUI or ovulation induction, or even naturally. Women who go through IVF or ICSI treatments have been targeted for this eSET policy.

In 2006, HFEA figures showed that approximately 45,000 IVF/ICSI cycles were performed in the UK. 94 per cent of treatment cycles were completed with two embryo transfers. The overall pregnancy rate for women under 37 yrs was 28 per cent. The singleton live birth rate for under 35 year olds was 22 per cent and for 35 to 37 year olds was 20 per cent. The twin pregnancy live birth rate was 8 per cent and 5.7 per cent respectively. These figures for twin live birth rates are acceptable. We should not forget the non-pregnancy figure with two embryo transfer is 70-75 per cent.

The eSET policy consultation document has produced the twin pregnancy rates by calculating the number of overall pregnancies versus the number of twin pregnancies to give a figure of 25 per cent. I strongly believe the twin pregnancy rate should be calculated using the number of total cycles (pregnant and non pregnant cycles) performed with two embryo transfers versus the number of twin pregnancies achieved.

For example:

If a centre has performed 200 cycles (IVF/ICSI) of two embryo transfers and achieved 60 pregnancies in which 40 were singletons and 20 were twins, then the overall pregnancy rate would be 30 per cent. But using the HFEA's method, the multiple pregnancy rate would be calculated as 20/60x100 = 33 per cent and the centre would therefore be penalised for having a higher twinning rate.

But assuming two embryo transfers per singleton pregnancy, as is the current practice in most centres, the calculation would be 20/200x100 = 10 per cent. Employing eSET will therefore reduce the overall pregnancy rates, regardless of whether the procedure is 'elected' or not.

As a qualified scientist with 20 years experience in the field, we have always selected the best two embryos for transfer, and yet approximately 70 per cent of our patients do not get pregnant. When this happens we modify the technique to increase the chances of getting pregnant by growing the embryos to blastocyst stage or using assisted hatching or PGS for the following cycles, long before the SET workshops organised by the Association for Clinical Embryologists. I welcome these schemes and agree that they will expand our scientific knowledge for improving success rates in our centres, but disagree that this should lead us to impose eSET on patients.

eSET for patients under 37 years who are undergoing their first cycle of IVF is recommended in the new policy. However, we have always limited the use of SET to patients who have medical complications and are therefore not suitable for two embryo transfer. This has been practiced in centres long before this SET policy.

While NHS centres will be forced to apply this recommendation to their patients it is unlikely to be accepted by patients undergoing IVF in private centres, who pay large sums of money both for their treatment and for the storage of any excess embryos which they may need for future cycles. Patients with only a small number of embryos may prefer to have two embryos transferred rather than incurring extra cost through storing excess embryos, as well as risking damage to embryos during the unfreezing process.

Recipients in egg sharing schemes are also in a difficult position under the new policy. The majority are over 37 years old at the time of the treatment, making them more prone to implantation problems. They may already have waited months and years to have donor eggs and find it hard to accept SET even though they are counselled about it before starting their cycle. 

NHS/PCT funding per patient can be stretched (3 cycles) by doing eSET followed by frozen embryo replacement cycles. However, the chances of getting pregnant by fresh cycles will be reduced.

What sort of number of twin pregnancies are we talking about with IVF patients?

HFEA figures for 2006 show 737,679 births for the year (natural and all fertility treatments) and about 11,100 multiple births (less than two per cent). For IVF/ICSI the figure is 10,242 (1.39 per cent of all live births).

Patients who have IVF/ICSI treatments are infertile patients. It is not fair to restrict their chances of having a baby or expect them to have a baby in natural way like the normal population when they know they have infertility problems. We are making an issue out of a mere 1.39 per cent of all UK births (singleton and multiple). Among the 1.39 per cent of all UK live births resulting from IVF/ICSI, the multiple pregnancy rate is about 20 per cent. This number may look high but it is a minor fraction of total UK live birth numbers. 

I feel it is unnecessary to waste money, energy and time on meetings and consultations with regard to SET policy to NHS and private patients. Funding for IVF/ICSI patients for three fresh cycles is very costly to PCT/NHS trusts. This SET policy will stretch the funds and time, providing financial benefit to the trust, but at the expense of its patients and the centre's performance.

Vasanti Jadva a,*, Tabitha Freeman a, Wendy Kramer b, Susan Golombok a

a Centre for Family Research, University of Cambridge, Free School Lane, Cambridge CB2 3RF, UK; b Donor Sibling Registry, PO Box 1571, Nederland, CO 80466, USA

* Corresponding author. E-mail address: [email protected] (V Jadva).

Vasanti Jadva was awarded a BSc and a PhD in Psychology at City University, London, UK, where she also worked as a Research Assistant at the Family and Child Psychology Research Centre. At present, she is a Research Associate at the Centre for Family Research, University of Cambridge, UK. She is currently working on a longitudinal study of families created using donor insemination, egg donation and surrogacy. She is also involved with a project examining individuals’ experiences of searching for, and finding, their (or their child’s) donor relations and on a study of single mothers who have chosen to parent alone from the outset.

Abstract

This study investigates a new phenomenon whereby individuals conceived by donor insemination are searching for and contacting their donor and/or ‘donor siblings’ (i.e. donor offspring conceived by the same donor who are their genetic half siblings). On-line questionnaires were completed by members of the Donor Sibling Registry (DSR), a US-based registry that facilitates contact between donor conception families who share the same donor. Of the 165 donor offspring who completed the survey, 15% were searching for their donor siblings, 13% were searching for their donor, and 64% were searching for both. Differences were found according to family type and age of disclosure. Fewer offspring from heterosexual couple families had told their father about their search when compared with offspring from lesbian couple families who had told their co-parent. Offspring who had found out about their conception after age 18 were more likely to be searching for medical reasons, whereas those who had found out before age 18 tended to be searching out of curiosity. Some offspring had discovered large numbers of half siblings (maximum = 13). The majority of offspring who had found their donor relations reported positive experiences and remained in regular contact with them.

RBMOnline © 2010, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

KEYWORDS: donor conception, donor siblings, donor searching, DSR, offspring

Introduction 

Recent years have seen the development of a new phenomenon whereby large numbers of donor offspring conceived using anonymous sperm donation are searching for and contacting their donors and donor siblings (i.e. other offspring conceived using the same donor and who are their genetic half siblings). Searching for these genetic relations has gained popularity due in part to the accessibility of a specifically designed website called the Donor Sibling Registry (DSR). The DSR, a US-based worldwide registry, was founded in 2000 by Wendy Kramer and her donor-conceived son in order to help others, who like them, wished to find their donor relations. In the United States clinics assign each donor a unique ID number enabling members of the DSR website to search for others whose donor ID number matches their own. Anyone can browse the site to see if they have a match, but only fee-paying members can post their information and contact any matches. The DSR is a non-profit organisation funded through donations and membership fees and it currently (July 2009) has over 24,000 members, including parents of donor-conceived children, donor-conceived individuals and donors. To date, the DSR has helped connect over 6000 individuals with their donor relations. Despite attracting much media attention, the consequences of searching for and contacting donor relations has received little empirical investigation, and therefore not much is known about the reasons for searching for donor relations or, more importantly, what the consequences are of making these connections.

It is not only donor offspring who are using the DSR, the majority of members are parents of donor-conceived children who are searching for their child’s half siblings or donor. Freeman et al. (2009) reported findings from 791 parents, of whom 87% were searching for or had contacted their child’s donor or donor siblings. It was found that parents’ main motivation for searching for donor siblings was curiosity, and their main reason for searching for the donor was to enhance their child’s sense of identity. Most parents who had contacted their child’s donor relations reported this to be a positive experience. However many of the children of these parents were still very young; the mean age of the oldest or only child was 8 years old and many children were not aware of their parents’ search. Findings reported by Scheib and Ruby (2008) in their study of 14 parents of young children (aged from 6 months to 9 years) who had contacted families who shared the same donor, also found contact to be a positive experience. These parents hoped that contact with their child’s half siblings would give their child a sense of kinship. Both of these studies highlight the way in which donor conception is resulting in the creation of new family formations that are based purely on genetic relatedness.

The few studies that have asked donor offspring themselves about their conception have revealed the frustration and anger that some feel about the lack of information about their donor (e.g. Turner and Coyle, 2000). Acknowledgement that offspring may feel a need to know the identity of their donor has led some countries to remove donor anonymity. In the UK, for example, all donor offspring born after April 2005 can access identifying information about their donor when they reach 18 years of age. Even in countries where anonymous sperm donation is available, such as the USA, some clinics offer ‘open-identity donors’, where the identity of the donor can be given to the child once she/he reaches the age of 18 (Scheib and Cushing, 2007).

As yet, no study has looked at the experiences of searching for genetic relations from the perspective of the offspring themselves. However Scheib et al. (2005) asked 29 donor offspring (aged 12–17 years) from an identity release programme, whether they were planning to ask for their donor’s identity. The majority said they were moderately to highly likely to request this information. Differences were found between offspring from different family types, with offspring from single mother families more likely than those from lesbian couple families to be interested in their donor’s identity. Offspring from heterosexual couple families expected their parents to react less positively to their request for their donor’s identity compared with offspring from single mother or lesbian couple families. However, it is not known how these findings may translate to the experiences of offspring who are conceived using anonymous donations. Such offspring have to face the likelihood that they may never learn of their donor’s identity and for those who are successful in their search, their experiences of contacting a donor who provided an anonymous donation may differ from contacting a donor who participated in an identity release programme.

It has been suggested that the adoption literature provides valuable insight into how donor-conceived offspring may feel about searching for and contacting their genetic relations (Crawshaw, 2002, Feast, 2003; Haimes, 1988). Crawshaw (2002) reported that female adoptees were more likely than male adoptees to search for their birth relatives and that their search was triggered by certain life events including starting a family or death of their adoptive parent(s). Reasons for searching included an attempt to gain a more complete sense of identity, although this did not necessarily mean that adoptees wished to form relationships with their birth relatives. Howe and Feast (2000) investigated the experiences of adopted individuals who had found information about their origins (either through searching for or being found by birth relatives). They reported that the majority of adopted individuals felt that this process had helped them gain a better sense of identity and wellbeing. For those who had contacted their birth relative(s), most had found the reunion process to be a positive experience (Howe and Feast, 2000).

Whilst some have argued that the adoption experience may shed light on donor-conceived individuals’ experiences of searching, it is important to bear in mind that there are notable differences between the two groups. Donor-conceived individuals are usually genetically related to one of their parents and have not been relinquished by a birth parent. Also, with adoption, parents are expected and encouraged to be honest and open with their child about his/her origins. This is not the case with donor conception. Whilst there is now greater openness within donor-conceived families, many parents, particularly those from families headed by heterosexual couples, still choose to keep this information secret from the child. Donor-conceived individuals are thus more likely to learn of their origins at a later age than adopted individuals, which could have important implications for their experiences of searching for their genetic relations.

The present study is the first to obtain systematic data from individuals conceived using anonymous sperm donation on their experiences of searching for and contacting their genetic relations. Participants were recruited through the Donor Sibling Registry (DSR). Access to this unique sample has enabled us to examine for the first time, offspring’s motivations for, and experiences of, searching for and contacting their donor and donor siblings.

Materials and methods

The participants were all conceived by donor insemination. They were either members of the DSR or children of parents who were members of the DSR. E-mails were sent to all DSR members inviting them to take part in an online survey. For parents of donor-conceived offspring the e-mail asked if they were willing to allow their 13- to 17-year-old child to take part. The survey was also advertised on the front page of the DSR website. Ethical approval for this study was obtained from the Cambridge University Psychology Research Ethics Committee. Procedures were put in place to ensure that children were unable to participate without their parent’s consent.

Data for the current study were collected in two phases. The first phase, open to offspring aged 18 and over, was online for 11 weeks between April and June 2007. The second phase, open to offspring aged 13 and over, was online for 11 weeks between December and February 2008. Sixty-three donor offspring participated in the first phase and 102 donor offspring participated in the second phase, giving a total of 165 participants.

The response rate for the first phase was calculated using the total number of offspring who were active members at the beginning of the study (336), thus yielding a response rate of 19%. For the second phase, 456 e-mails were successfully sent to parents of 13- to 17-year-old donor children and to adult donor offspring who had not already taken part in phase 1, giving a response rate of 22%. These response rates, whilst relatively low, are in line with studies that use on-line survey methods (Cook et al., 2000, Couper, 2000, Kaplowitz et al., 2004) and need to be considered alongside the advantages of carrying out on-line surveys including the ability to target large or difficult to reach samples (Couper, 2000, Freeman et al., 2009, Wright, 2005).

Measures

The on-line questionnaire consisted of two sections. The first asked offspring about their experiences of donor conception and the second asked about their experiences of searching for their donor and donor siblings. This paper reports findings from the second section only. The findings on experiences of donor conception are presented elsewhere (Jadva et al., 2009).

Questions included multiple choice and open-ended items. For the multiple choice questions, respondents were asked to tick boxes with different response options including an option for ‘other, please specify’. These questions were analysed quantitatively to provide descriptive data in the form of frequencies and percentages. Where possible, Fisher’s exact tests were computed to examine associations with family type and with age of disclosure. Respondents were also given an opportunity to elaborate on their answers and these open-ended responses were used to help illustrate and better understand the findings from the quantitative data analysis. The questionnaire examined two key areas.

Searching for genetic relations 

Information was obtained on (i) whom offspring were searching for (i.e. their donor and/or their donor siblings), (ii) whom offspring had told about their search, (iii) the impact of searching on their relationship with their parents, (iv) their reasons for searching for their donor and/or donor siblings, and (v) whether there were any triggers to initiating their search for their donor or donor siblings.

Finding and contacting genetic relations

Information was gathered on: (i) how many offspring had found their donor and/or donor sibling(s); (ii) how fre- quently they were in contact with them; and (iii) their expe- riences of making contact.

Participants

The sample consisted of 165 offspring conceived by sperm donation. They were aged from 13 to 61 years (median=17 years, mean=22 years, SD=10). Just over half (82) were aged between 13 and 17 (median=15 years, mean=15 years, SD=1) and the others (81) were aged 18 or over (median=26 years, mean=28 years, SD=10). Seventy-five percent (123) were female and 25% (42) were male. The majority (90%, 148) of respondents were currently living in the US with the remainder living in Canada (4%, 7), the UK (2%, 4), Australia (2, 1%) and South Korea (0.6%, 1) 2% (3) did not state their location. With regard to ethnicity, the vast majority (95%, 157) classified themselves as ‘White’, 4% (5) as mixed race, and 0.6% (1) as ‘American Indian/Alaska Native’, and 1% (2) did not say. Thirty-one percent (51) had yet to complete high school education, 21% (35) had been, or were currently being, educated to community college level, 8% (14) to undergraduate level and 17% (28) had a postgraduate (Masters or Ph.D.) degree. Twenty-two percent (37) did not specify their educational background. Twenty-five percent (42) of offspring currently had a partner and 12% (19) had children of their own.

Fifty-eight percent (96) of offspring reported their parents to be a heterosexual couple, 23% (38) a single mother and 15% (25) a lesbian couple. The majority of offspring from heterosexual couple families were aged over 18 (64%, 61), compared with 29% (11) of offspring from single mother families and 28% (7) of offspring from lesbian couple families. All offspring from single mother and lesbian couple families and 67% (64) of offspring from heterosexual couple families had found out about their conception before age 18. Thus, all offspring (19%, 32) who had found out about their conception after age 18 were from heterosexual couple families.

Results

It should be noted that not all offspring answered every question, and for some of the questions respondents could tick multiple responses, therefore the numbers do not always add up to 100%. Where relevant, data were examined by family type and age of disclosure.

Searching for genetic relations 

Number of offspring searching for donor siblings/donor 

Fifteen percent (24) of offspring were searching for their donor siblings, 13% (22) were searching for their donor, and 64% (105) were searching for both. Thus, in total 78% (129) were searching for their donor siblings and 77% (127) were searching for their donor. Eight percent (14) were not searching for either their donor siblings or their donor. The most common reasons for not searching included ‘no reason’ and ‘don’t feel the need to’ although some offspring stated that they did not have enough information to search. Of those searching for their donor siblings, 57% (74) were from heterosexual couple families, 25% (32) were from single mother families and 14% (18) were from lesbian couple families (4%, 5 did not say). Of those searching for their donor, 63% (80) were from heterosexual couple families, 20% (25) were from single mother families and 13% (17) were from lesbian couple families (4%, 5 did not say). Of those searching for donor siblings, 75% (97) had found out about their conception before age 18 and 22% (29) had found out about their conception after age 18 (2%, 3 did not state their age of disclosure). Of those searching for their donor, 76% (97) had found out about their conception before age 18, and 23% (29) had found out after age 18 (1 did not state their age of disclosure). Thus the distribution by family type and age of disclosure was similar between offspring who were searching for their donor siblings and those who were searching for their donor.

Telling others about their search 

Donor siblings 

Offspring were asked whom they had told about their search for donor siblings (see Table 1). The majority (78%, 101) had told their mother and 60% (77) had told friends. Twenty six percent (33) stated that they would tell anyone about their search. Eighty-nine percent (16/18) of offspring from lesbian couple families had told their co-parent compared with only 22% (16/74) of offspring from heterosexual couple families who had told their father.

Table 1. Whom offspring had told about their search for their donor siblings and/or donor.
 Click on image for full size.

Impact of searching on relationship with parents

Table 2. Impact of searching for donor siblings on offspring’s relationship with parents, by family type.
 Click on image for full size.

Table 3. Impact of searching for donor on offspring’s relationship with parents, by family type.
 Click on image for full size.

Reasons for searching

Table 4. Reasons for searching for donor siblings.

Table 5. Reasons for searching for donor.
Click on image for full size.

Fisher’s exact tests carried out to examine associations between family type and offspring’s reasons for searching for their donor were not significant. However, significant associations were found between age of disclosure and offspring stating medical reasons (Fisher’s exact test, P=0.043), with a greater proportion of offspring told after age 18 giving this as their main reason. Those told before age 18 were more likely to want to meet their donor (Fisher’s exact test, P=0.042).

In the open-ended questions, many of the offspring wrote about the importance of knowing their genetic or ancestral history, and the sense of frustration they felt at not being able to access this information. As one offspring said:

“All I ever wanted was a picture…and I may never in my life have that. I love my mother and I respect her choice. I’m thankful for my donor for giving me life and giving my mother her biggest wish. But it’s just not enough for me” (19-year-old female, from single mother family).

Wanting to find the donor did not necessarily mean that offspring wanted to form a relationship with him:

“I don’t expect any ‘father–daughter’ relationship. I would be fine with just an exchange of pictures and a letter possibly” (18-year-old female, from lesbian couple family).

For some offspring, the search for their donor was prompted by having children of their own. One woman was searching for her donor: “So my children could know him… It has always been extremely important to me to find my biological father but became even more so after I had children. It wasn’t about me anymore…” (40-year-old female, from heterosexual couple family).

Others were searching for their donor so that they could express their gratitude:

“When someone gives you a gift, you don’t hunt them down to get another one. You hunt them down to thank them for such a wonderful present, for the lovely intention, for giving” (24-year-old female, from heterosexual couple family).

Triggers to initiating a search 

Donor siblings 

Thirty percent (39) of offspring reported that their search was prompted by a change in their personal circumstances or a life event. Of these, 31% (12) stated ‘becoming a teenager’, 10% (4) selected ‘becoming an adult’, 13% (5) selected ‘a personal crisis’, 10% (4) selected ‘getting married or forming a long-term relationship’, 5% (2) selected ‘an illness or other medical condition’ and 3% (1) selected ‘planning to have children or having children’.

Donor 

Twenty-eight percent (36) of offspring stated that the search for their donor was prompted by a change in their personal circumstances or a life event. Of these, 36% (13) selected ‘becoming a teenager’, 17% (6) selected ‘becoming an adult’, 11% (4) selected ‘planning to have children or having children’, 8% (3) selected ‘getting married or forming a long-term relationship’, 6% (2) selected ‘a personal crisis’ and 3% (1) selected ‘an illness or other medical condition’.

Finding and contacting genetic relations: frequency of contact

Donor siblings 

Thirty-three percent (42) of offspring who were searching had found their donor siblings, and of those who had found their siblings 95% (40) had been in contact with them. The average number of siblings found was four and the highest number found was 13, with 29% (12) having found five or more. Fifty-two percent (35) of offspring aged under 18 had found their siblings compared with 12% (7) of offspring aged over 18 (Fisher’s exact test, P<0.001). Of the 40 offspring who had been in contact with their siblings, 43% (17) were from heterosexual couple families, 20% (8) were from lesbian couple families, and 35% (14) were from single mother families. Offspring were asked how often they were in contact with their siblings. Half (50%, 20) were in contact at least once a month, 23% (9) once every 1–3 months and 25% (10) less than once every 3 months.

Donor

Nine percent (11) of offspring who were searching for their donor had found him, and 8% (10) had been in contact with him. No association was found between current age and whether or not offspring had found their donor. Of those who had been in contact, 30% (3) were from heterosexual couple families, 50% (5) were from lesbian couple families and 20% (2) were from single mother families. In terms of frequency of contact, 50% (5) were in contact with their do- nor at least once a month, 40% (4) were in contact once every 1–3 months and 10% (1) were in contact less than once every 3 months.

Experience of contact

Donor siblings 

Offspring were asked what kind of overall experience meeting their donor siblings had been (see Table 6). The majority (60%, 24) reported it to be a ‘very positive’ experience. Looking at the breakdown by family type, offspring from lesbian couple families were most likely to report a ‘fairly positive’ or ‘very positive’ experience, although the number in each group were too low to assess if this difference was statistically significant.

Offspring were given the opportunity to provide additional comments about their experiences of contacting their donor siblings. Here is one example from an offspring who had met six of his donor siblings:

“It has become like a common occurrence and I don’t expect any of the meetings to go badly, because it is like we have known each other all our lives even though we did not grow up together” (16-year-old male, from heterosexual couple family).

Some commented on how they did not see their donor siblings in the same way as their full siblings.

“I still think of my full-blood sister as more of a sister than my 2 donor siblings. But then again, I have had my full-blood sister in my life since the day I was born, so there’s just a stronger feeling of connection and understanding in the relationship. My donor siblings are not quite in the ‘family fold’’’ (19-year-old female, from lesbian couple family).

Table 6. Experience of contact with donor siblings and donor by family type.
Click on image for full size.

Donor 

The majority (70%, 7) of those who met their donor described this as very positive (see Table 6) with all offspring of lesbian couple and single mother families reporting a ‘fairly positive’ or ‘very positive’ experience.

The offspring were given the opportunity to comment further on their experiences of meeting their donor. Examples of a positive experience are:

“I am so glad that I met him, and would not trade the world for the experience I had. We communicate in some form or another at least every other day, and he is one of the most important people in my life to this day” (13-year-old male, from heterosexual couple family).

“I used to think of the donor as sort of a super-human... perfect in a lot of ways (based on knowing he was chosen out of a catalogue). Now I know he’s just a normal guy” (19-year-old female, from lesbian couple family).

The one offspring who reported that contact with her donor had been a negative experience commented:

“I did not meet my biological father. I only exchanged a few letters with him. His responses were clear that although he’s glad that I was born, he is not proud to have participated in donor conception… It is a pretty bad feeling that my life has been such a source of shame and embarrassment, through no fault of my own, by the people who brought me into the world” (40-year-old female, from heterosexual couple family).

It is important to note that contact does not always stop with the donor; offspring may meet the donor’s family, who are also genetically related to them.

As this young woman wrote:

“In addition to the donor, I have met one of his children from his marriage, his mother, one of his brothers, sister-in-law, niece, and 2 other half siblings and their respective mothers” (15-year-old female, from single mother family).

Discussion

This study shows that some donor offspring are successfully finding, and contacting, their donor and/or donor siblings, and that when these connections are made they are gener- ally positive. The majority of offspring who choose to search for their donor relations are open about their search, often having told their parents and friends, and most reported that their search did not impact negatively on their relation- ship with their parents. Whilst the main reason for offspring searching for their donor and their donor siblings was curios- ity, gaining a better understanding of their genetic identity was also important. For those offspring who had children of their own, searching was a way of providing an ancestral his- tory for their children who were also missing a part of their genetic background. Thus, the importance of genetic iden- tity was found to go beyond the donor–offspring relation- ship to include others genetically related to the offspring.

Differences were found between offspring from different family types and also between offspring who had found out about their conception as children or as adults. Family type is an important factor to consider when evaluating off- spring’s experiences of searching for their genetic relations. In Freeman et al.’s (2009) study of parents searching for their child’s half siblings, the majority of parents searching were single mothers or lesbian couples, suggesting that these families may be more open than heterosexual couple families to searching for and contacting their child’s genetic relations. However, it is possible that children of heterosex- ual parents may be less likely to search for their genetic relations because they do not wish to upset their parents or perhaps because their parents have asked them not to search. In the present study, only 29% of offspring from het- erosexual couple families had told their father they were searching compared with 89% of offspring from lesbian cou- ple families who had told their co-parent. Single mothers and lesbian couples are more open about their child’s donor conception than are heterosexual couples (Brewaeys, 2001), as they have to explain the absence of a father, and it is possible that this extends to a more general openness to- wards all aspects of donor conception, including the child’s desire to seek out their donor relations.

Differences in reasons for searching were found between two-parent families and single mother families. More off- spring from single mother families were searching for their siblings to find new family members. Whilst this could sug- gest that offspring in single mother families may be more interested in forming links with kin beyond their immediate family, it is also possible that offspring from heterosexual couple families and lesbian couple families were less likely to state these reasons because they did not wish to upset their non-genetic parent.

Comparisons by age of disclosure found that those off- spring who had found out about their conception during adult- hood were more likely to search for their donor siblings and their donor for medical reasons compared with those who had found out before age 18. Offspring who found out before age 18 were more likely to be searching for their siblings out of curiosity and for their donor because they wished to meet him. It is important to bear in mind that age of disclosure was confounded in the present study with the current age and family type of offspring. Offspring who had found out at a young age were also more likely to be younger at the time of completing the survey and all offspring who had found out about their conception after age 18 were from heterosex- ual couple families. Nevertheless, the age at which offspring learn of their donor conception appears to be an important factor to consider when examining the reasons for offspring searching for their donor relations.

The findings from this study of donor offspring are similar to those of adopted individuals in that searching for their donor relations was prompted by a change in their personal circumstance or a life event that included reaching a develop- mental milestone, such as becoming a teenager, an adult, getting married or having children (Crawshaw, 2002). Also, donor offspring, like adopted individuals, wanted to gain a more complete sense of identity (Crawshaw, 2002; Haimes and Timms, 1985). The current study had a high proportion of female participants (75% female versus 25% male). Whilst this could have been due to females being more likely to take part in the study, it could also be a result of women being more interested than men in searching for their genetic relations. This latter reason is in line with findings from adop- tion studies (e.g. Howe and Feast, 2000), which have also revealed women’s greater interest in searching for their birth family. One-third of offspring had found their donor siblings and a smaller proportion (9%) had found their donor. Contact with donor siblings and donors once initiated was fairly fre- quent and donor offspring were also in contact with their donors’ family, including the donor’s children and parents who are effectively the offspring’s half siblings and grandpar- ents, respectively. Thus contact did not just take place with siblings or the donor, but branched out from these linear rela- tionships. Donor offspring viewed these individuals as mem- bers of their extended family. Thus the practice of donor conception is in some cases leading to new family relation- ships based on genetic connections and between individuals who had grown up apart (Freeman et al., 2009).

Some offspring stressed how important it was for them to know the identity of their donor siblings so that they would not accidentally form incestuous relationships with them. In this study, the average number of siblings found was four, with a maximum of 13. Freeman et al. (2009) reported one parent had found 55 of their child’s half siblings through the DSR website, and in March 2009 the largest sibling group on the DSR was estimated to be 120 (Kramer, personal communi- cation, March 26, 2009). In the UK, the number of families cre- ated from any one donor is limited to 10 although the same donor can be used to create siblings for any existing children. In the US, guidelines of the American Society for Reproductive Medicine suggest a limit of 25 live births per population area of 850,000. However, these guidelines are neither monitored nor enforced by law, thus explaining the large number of donor siblings found in the US (Freeman et al. 2009). In the present study, only offspring aged over 13 could take part, whereas in Freeman et al.’s study, the majority of parents had children who were much younger (mean age 8). Thus these larger sibling groups appear to consist of much younger children. It will not be possible to assess the impact of such high numbers of donor siblings until the children are much older. It is also important to bear in mind that some sibling groups are concentrated in specific areas, and therefore unknowingly meeting a donor sibling is a genuine possibility.

It is essential that the views of offspring belonging to these larger sibling groups are obtained if it is possible to fully understand the psychological impact of having such unusually high numbers of genetic half siblings.

It is important to note that the sample in the present study may not be representative of all donor-conceived individuals, specifically those who are not curious about their donor rela- tions. Furthermore, the response rate in the current study was low and thus the sample may not be representative of all members of the DSR. Nevertheless, this study provides the first detailed examination of the reasons why some off- spring search for their donor and donor siblings and what hap- pens when they are successful in making contact, thus providing insight into this previously unstudied phenomenon.

Whilst the DSR is a specially designed website that enables individuals conceived using donor gametes to con- tact their donor, it is important to bear in mind that offspring may be able to find the identity of their donor in other ways. With the increasing amount of personal information that individuals make accessible on the internet, it is possible for offspring to search for their donor using an internet search engine and the information provided on their donor profile (given to their parents at the time of treatment). It is also possible for male offspring to find their donor through the use of a genealogical DNA test, where a male offspring’s paternal surname can be traced using the DNA on his Y chro- mosome. Whilst the DSR only enables members to find donors who are registered on the website, the latter two methods allow offspring to search for donors who may not wish to be found. It is impossible to know how many offspring have found their donor using these other methods. Although the number is expected to be small at the present time, it is likely to increase in the years to come.

References

Brewaeys, A., 2001. Review: parent–child relationships and child development in donor insemination families. Hum. Reprod. Update 7, 38–46.

Cook, C., Heath, F., Thompson, R.L., 2000. A meta-analysis of response rates in web- or internet-based surveys. Educ. Psychol. Measur. 60, 821–836.

Couper, M.P., 2000. Web surveys: a review of issues and approaches. Public Opin. Quarterly 64, 464–494.

Crawshaw, M., 2002. Lessons from a recent adoption study to identify some of the service needs of, and issues for, donor offspring wanting to know about their donors. Hum. Fertil. 5, 6–12.

Feast, J., 2003. Using and not losing the messages from the adoption experience for donor-assisted conception. Hum. Fertil. 6, 41–45.

Freeman, T., Jadva, V., Kramer, W., Golombok, S., 2009. Gamete donation: parents’ experiences of searching for their child’s donor siblings and donor. Hum. Reprod. 24, 505–516.

Haimes, E., 1988. Secrecy: what can artificial reproduction learn from adoption? Int. J. Law Policy Fam. 2, 46–61.

Haimes, E., Timms, N., 1985. Adoption, Identity and Social Policy: The Search for Distant Relatives. Aldershot, Gower.

Howe, D., Feast, J., 2000. Adoption, search and reunion: the long- term experience of adopted adults. The Children’s Society, London.

Jadva, V., Freeman, T., Kramer, W., Golombok, S., 2009. The experiences of adolescents and adults conceived by sperm donation: comparisons by age of disclosure and family type. Hum. Reprod. 24, 1909–1919.

Kaplowitz, M.D., Hadloc, T.D., Levine, R.A., 2004. Comparison of web and mail survey responses. Public Opin. Quarterly 68, 94–101.

Scheib, J.E., Cushing, R.A., 2007. Open-identity donor insemination in the USA: is it on the rise? Fertil. Steril. 88, 231–232.

Scheib, J.E., Ruby, A., 2008. Contact among families who share the same sperm donor. Fertil. Steril. 90, 33–43.

Scheib, J.E., Riordan, M., Rubin, S., 2005. Adolescents with open- identity sperm donors: reports from 12–17 year olds. Hum. Reprod. 20, 239–252.

Turner, A.J., Coyle, A., 2000. What does it mean to be a donor offspring? The identity experiences of adults conceived by donor insemination and the implications for counselling and therapy. Hum. Reprod. 15, 2041–2051.

Wright, K.B., 2005. Researching Internet-based populations: advan- tages and disadvantages of online survey research, online questionnaire authoring software packages, and web survey services. J. Comput. Mediated Commun. 10 (article 11).

Institute of Bio-Medical Research (DSIR Recognized) in association with SRM University (India's No.1 Private University) invites applications to pursue PhD Programme (Full-time) in the fields of Clinical Embryology, Reproductive Genetics, Stem Cell Biology and Regenerative Medicine.  

Kanmani Fertility Centre Pvt Ltd is one of the leading and pioneer fertility centres in Tamilnadu.  It was established in the year 1996 by Dr. S.S. Muthiah (www.drssmuthiah.com), an Eminent Embryologist with 26 yrs of experience in the field of Human Embryology.  Now the centre  has successfully completed its 19 years of service with excellence in the field of human reproduction. 

To proceed with academic and research activities, Kanmani Fertility Centre Pvt Ltd (www.kanmanifertilitycentre.com) has established a separate R&D wing ‘Institute of Biomedical Research’ in the year 2010 at T. Nagar, Chennai. ‘Institute of Biomedical Research’ (www.ibmr-india.com) has been recognized by the Department of Scientific and Industrial Research (DSIR), Ministry of Science and Technology, Government of India to carry out research in the emerging fields of biomedical sciences with special reference to human reproduction.  In addition, the institute is also recognized and enrolled under National Registry of ART Clinics and Banks in India by Indian Council of Medical Research. 

Essential Educational Qualification

MD - Obs & Gyn/Microbiology/Biochemistry

MS - Urology

M Tech - Biotechnology

M Sc - Life Sciences

Desirable Candidates with Fellowship from CSIR / ICMR 

Resumes should be sent (on or before 29th February 2016) - [email protected]

Scientists from Yale University, US, have developed a new technique to improve IVF efficiency from a current success rate of around 34 per cent, to more than 80 per cent in a pilot study. Fertility clinics usually study newly fertilised embryos under a microscope to determine if they are developing in a normal way and to see which seem the most likely to successfully implant. Emre Seli and his team have developed a more advanced method of analysing which embryos are healthy by studying cell metabolism. The team sample a small amount of the fluid embryos grow in before they are transferred into the woman and then perform a type of spectral analysis to detect levels of free radicals, a by-product of normal metabolism. Embryos with normal metabolism have higher levels of free radicals than unhealthy ones.

In a study of 108 embryos tested three days after fertilisation, Seli's team predicted which ones would implant successfully with 80 to 83 per cent accuracy. It is hoped that in addition to improving the overall success rate of IVF, this work could help to reduce multiple pregnancies which is associated with higher risks during pregnancy and childbirth. As success rates can be so low using IVF, multiple embryos may be transferred to the uterus, a practice which is particularly common in the US where there are fewer restrictions than in Europe. The work was presented at the recent annual conference of the American Society for Reproductive Medicine (ASRM) in New Orleans; a large follow up study is now underway.

In related research, a team from the Fertility Centers of New England in Reading, Massachusetts, has begun analysing respiration rates from eggs or newly fertilised embryos to identify the best candidates for fertilisation and implantation. The eggs or embryos are placed into narrow wells so that the air above the nutrient fluid can easily be tested for oxygen levels. A healthily respiring embryo or egg should have depleted oxygen levels above the fluid. In normal development the cells begin to differentiate around five days after fertilisation, with an associated increase in respiration levels. In unhealthy embryos respiration slows or stops. The test has already been used to select viable eggs or embryos in cattle and fertilisation rates increased by 50 per cent. Lead researcher Lynette Scott has confirmed that the technique also works in humans. 'I think this could be a godsend', she commented. The technique could be particularly important for countries such as Italy where selection for implantation is made before fertilisation for ethical reasons.

New research published in the journal Human Reproduction has found that consuming low-fat dairy food may lead to a higher risk of infertility. The study found no difference between women who ate the most dairy food and those who ate little or none. However, differences in fertility were revealed when the type of dairy food being consumed was considered.

Dr Jorge Chavarro of the Harvard School of Public Health in Boston used data from the Nurses Health Study, an ongoing survey of thousands of women who fill out regular questionnaires about their diet, activity and health. Records of 18,555 nurses aged between 24 and 42 who had tried to become pregnant, or had become pregnant between 1991 and 1999 were analysed.

The study found that women who ate two or more servings of low-fat dairy food a day had an 85 per cent higher risk of developing a type of infertility called anovulatory infertility, where the body fails to produce enough egg cells. Women who ate one serving of high-fat dairy food a day were 27 per cent less likely to be infertile than women who avoided full-fat dairy foods.

Dr Chavarro admitted there was a scarcity of information in this area and that more research needed to be carried out into the association between low-fat dairy foods and anovulatory infertility, however, he suggested that women trying to get pregnant should think about their diets. 'They should consider changing low-fat dairy foods for high-fat dairy foods; for instance by swapping skimmed milk for whole milk and eating ice cream, not low fat yoghurt'. However, he also pointed out that benefits could be gained from as little as one serving of high-fat dairy food per day and that it was important for women to maintain their normal calorie intake and limit their overall consumption of saturated fats in order to maintain general good health. But critics have pointed out that women with this type of ovulatory failure make up a relatively small proportion of cases of female infertility. Dr Richard Fleming from the Glasgow Centre for Human Reproduction told the BBC: 'I am not convinced that there is any reason for women who are trying to conceive to alter their diet unless they are obese, and I would not advise any woman to do this'.

Researchers at the University of Southampton and Princess Anne Hospital in Southampton, UK, have found that women undergoing acupuncture at the same time as IVF increased their chances of having a baby from one in five to one in three.

The research, published on the Cochrane Library's online database, involved looking at 13 studies comprising 2,000 women worldwide, who underwent acupuncture at the same time as a course of IVF. 

Every year 33,000 women undergo IVF, when an embryo that has been fertilised in a laboratory is transferred into the womb. Acupuncture, the practice of inserting fine needles into specific points on the body corresponding to qi energy channels, was found to significantly increase a woman's chance of successful embryo implantation if it was undergone around the same time as the embryo transfer. However, the procedure was not found to have an effect if it was performed after the embryo transfer. 

Ying Cheong, lead researcher of the study, stated that 'whether acupuncture helps women achieve a live birth is a controversial issue, and opinion has been divided upon it'. She added that the study shows 'that acupuncture performed at the right stage can have significant benefit. A woman who does so has a much greater chance of having a live birth than a woman who doesn't have acupuncture'. The study revealed that acupuncture around the time of embryo transfer ruled in a live birth rate of 35 per cent, as compared to 22 per cent without acupuncture. 

The research contrasts with the recent findings by Dr Sesh Kamal Sunkara, who lead a team of scientists from Guy's and St Thomas' NHS Trust. In July, his presentation to the European Society of Human Reproduction and Embryology (ESHRE) conference in Barcelona cast doubt upon the efficacy of acupuncture in increasing success rates of IVF.

Studying close to 2,500 women in 13 trials, Dr Sunkara and his team concluded that there was no link between the acupuncture and IVF success rates. Paul Robin, chairman of the Acupuncture Society, stated that the findings did not support his own experience of treating patients, commenting at the time, 'in my experience treatment does seem to improve their chances of becoming pregnant'.

Professor Peter Braude, who supervised Dr Sunkara's team said, 'we can't turn around and say it does not work, but there is no evidence it does and hand on heart we can't come out and recommend it'.

However, the latest research supporting the efficacy of acupuncture in conjunction with IVF has been welcomed by fertility experts, with Susan Seenan of Infertility Network UK commenting that 'anything that helps improve success rates for people going through infertility treatment is good news. Many of our members report that alternative therapies, such as acupuncture, can help them to cope with the treatment and the general stress'.

Certificate  course in Reproductive Medicine Nursing.

Nurses form the backbone of any health care delivery system. Reproductive Medicine services are being offered all over the world, often with nurses with no special training in Reproductive Medicine. This course is tailor made to fill up this lacuna.

Objectives:

Train nurses to help doctors establish and run an efficient, cost effective and ethical reproductive medicine unit.

At the end of the course, candidates will

1.be able to counsel reproductive medical problems both in men and women.

2.have good working knowledge in the field of and reproductive medicine.

3.assist in reproductive medical procedures.

Eligibility:

Postgraduate Degree or degree or diploma in nursing.

Duration:

6 months.

Mode of Teaching:

Lectures, Power point presentations and interactive sessions.

Practical demonstrations. Hands on – wherever applicable

Frequent examinations conducted throughout the course. MCQ’s, Short notes and Essay type Questions.

The students will not receive any stipend or any other form of financial support from the institution. However they may utilize the existing infrastructure in the department and institution.

Contact: [email protected]