Document Type : Original Article
Authors
Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedical, ACECR, Tehran, Iran
Abstract
Keywords
Since 1980s, oocyte donation (OD) has become an increasingly
more accepted method of assisted reproduction, leading
to a high number of OD children being born every year worldwide
(
As the use of OD increases, so do the concerns about its
psychological, social and ethical impacts on the children
created in this way. Parents of OD children face important
challenges during the treatment, bearing and the development
of their child. These challenges include making
decisions on selecting known or anonymous donors, and
whether to tell others and/or the child about his or her
oocyte origin (
However, in recent years, particularly in developed countries,
there has been a trend of couples delaying parenthood
well into their fourth decade (
Compared to Iran, much more is known about a couple’s
attitude regarding OD in the rest of the world (
A questionnaire-based study was carried out between October and December of 2014. Participants were randomly selected from medical and law students who attended in the largest university, which has two schools of law and medical together, in Tehran (capital of Iran). We used stratified sampling, in which 4th year and above medical students and 3rd and 4th year law students were stratified by the number of years of education in each field. Then, simple random sampling was done in each stratum.
An analytical cross-sectional study was constructed on the basis of an earlier qualitative research on infertile couples who had referred to Royan Institute, the largest referral fertility clinic in Iran. Based on the existing literature, a pool of domains and statements was designed.
The final version of the tool for measuring attitudes towards OD, entitled attitude toward donation-oocyte (ATOD-O), contained 52 questions in 12 domains, including the importance of having children (2 statements), decision making and acceptance of oocyte donation (7 statements), playing the role of oocyte donor (5 statements), characteristics of the donor (8 statements), characteristics of the recipient (8 statements), being an anonymous child toward the donor (4 statements), disclosure of the use of this treatment method with others (3 statements), legal issues (4 statements), tendency to the use of different methods of OD (2 statements), the parents-child relationship (4 statements), and ownership of the child (2 statements).
For each statement, the responses were on a 5-point Likert
scale, strongly disagree, disagree, somewhat, agree, and
strongly agree (scoring 1 to 5, respectively). More detailed
information on measuring the validity and reliability of
ATOD-O questionnaire qualitatively has been published
(
It was necessary to provide information on the OD process for the participants because attitude measurement is useless without awareness about the subject. Before distribution of the questionnaires, training was conducted for about 15 to 20 minutes by a trained expert. Initially, a brief history of OD in Iran as well as in the rest of the world, was given to the students.
The process was then explained and the characteristics of potential candidate donors and recipients were described: which couples are candidates for OD (e.g., women with old age, early menopause, and who have no high quality oocytes), general characteristics of recipients and donors (donor: age from 21upto 34 years, preferably having a child/children, similar physical specifications to a recipient according to skin, eye, and hair color and the body, lack of genetic diseases even in her family history, syphilis, gonorrhea, hepatitis, and AIDS; recipient: up to 35 years, general physical examination, routine laboratory tests before pregnancy, determining the blood type and Rh, human immunodeficiency virus (HIV), hepatitis, pelvic exams, ultrasound evaluation of the uterine cavity to measure the size of the uterus, and a history of hysteroscopy, laparoscopy and spermiogram examination).
Ethical approval to conduct the study was obtained by the Ethics Committee of Royan Institute. The aims of the study were clearly explained for all participants prior to the investigation. Voluntarily filling the questionnaire was considered as consent. Participants were also made assure about their confidentiality and anonymity for attending this investigation.
Statistical analyses were carried out using SPSS version
22.0 (SPSS Inc, Chicago, IL, USA). Questionnaires with
missing values were not considered in the analyses. Continuous
variables were expressed as mean ± SD and categorical
variables as number (percentage). In this paper, responses
(as 4-point Likert scale, ranging from 1 to 4) to women’s
and men’s attitude and medical and law students’ attitude
questions were compared using independent samples t test.
Heeren and D'Agostino, in 1987, demonstrated that the t test
is robust even once the outcome variable is assessed as ordinal
scaled data. More details were explained elsewhere (
In this study, 345 medical and law students participated. Of them, 57.7% (199 participants) were women and 42.3% (146 participants) men. About 344 participants (99.7%) were urban and 93.9% (234 participants) single. The mean age was 21.66 ± 2.07 years. Approximately 226 students (65.5%) were in medical school and 34.5% (119 participants) in law school. General characteristics of the participants are shown in Table 1.
General characteristics of the participants
Demographic variables | Women n=199 | Men n=146 | |
---|---|---|---|
Marital Status | |||
Single | 183 (92) | 16 (8) | |
Married | 141 (96.6) | 5 (3.4) | |
Field | |||
Medicine | 123 (61.8) | 76 (38.2) | |
Law | 103 (70.5) | 43 (29.5) | |
Values in parentheses are percentages.
Male and female respondents were in favor of OD as the
last choice of infertility treatment, while there was a significant
difference between medical and law students (3.23
± 1.18 vs. 3.53 ± 1.15, respectively, P=0.025). The difference
between male and female students with regards to the
recipient relationship to the donor was not significant (2.68 ± 1.17 vs. 2.67 ± 1.06, P=0.924). The difference between
law and medical students with regards to supportive of
relatives donating and receiving oocytes was not significant
(2.58 ± 1.09 vs. 2.72 ± 1.11, P =0.275). Women were
more supportive of receiving donated oocytes from their
sisters compared to men. Men, on the other hand, received
a question about their wife’s sister rather than their own sister
(3.01 vs. 2.58, P=0.002), but in both fields there was no
significant mean difference regarding this statement (2.98
± 1.29 vs. 2.75 ± 1.30, P=0.118,
The difference between male and female participants with regards to the statement “anonymity of the donor and the recipient to one another” was not significant (3.93 ± 1.20 vs. 3.86 ± 1.17, P=0.580). Similarly, a significant mean difference was not found between the students of the two fields. However, most of the women and the men in both fields believed that disclosure of some of the donor’s characteristics, such as age, ethnicity and religion, to the recipient couple was necessary. However, a significant difference was not observed between the groups that were compared (P=0.165 for gender groups and P=0.620 for education groups).
Medical and law students had similar attitudes towards an
OD child’s anonymity to the donor before 18 years (2.67 ±
1.24 vs. 2.55 ± 1.38, P=0.421), and there was no significant
difference between men and women regarding the same
statement (2.67 ± 1.30 vs. 2.57 ± 1.28, P=0.487). The mean
scores obtained by the students in both genders and both
fields indicated that the participants had relatively negative
attitudes towards the statement “The child can meet
the genetic or biologic mother after 18 years” (P=0.527 for
gender groups and P=0.802 for education groups (
Female participants than male respondents believed that
an oocyte recipient (the mother) naturally likes that OD child
(4.21 ± 0.88 vs. 3.82 ± 1.07, P<0.0001). They also believed
that the husband of the oocyte recipient (the father), naturally
likes the child (4.17 ± 0.91 vs. 3.79 ± 1.01, P<0.0001).
Compared to the men, the women had a more positive attitude
towards the two statements regarding “the child will
naturally like the mother (oocyte recipient) if oocyte donation
is disclosed” and “the child will naturally like the father
(the husband of an oocyte recipient) if oocyte donation is
disclosed” (3.95 ± 1.07 vs. 3.59 ± 1.02, P=0.002 and 4.08 ±
0.96 vs3.66 ± 1.01, P<0.0001, respectively,
Attitudes towards decision making on oocyte donation
Statement | Women Mean ± SD | Men Mean ± SD | P value | Medicine Mean ± SD | Law Mean ± SD | P value |
---|---|---|---|---|---|---|
I am ready to use oocyte donation treatment if there are no other treatments for infertility | 3.33 ± 1.20 | 3.36 ± 1.14 | 0.849 | 3.23 ± 1.18 | 3.53 ± 1.15 | 0.025* |
Psychological conditions of my spouse are important for oocyte donation | 4.31 ± 0.92 | 4.21 ± 0.99 | 0.364 | 4.23 ± 0.99 | 4.33 ± 0.87 | 0.388 |
I support a decision on oocyte donation by my relatives or friends | 2.67 ± 1.06 | 2.68 ± 1.17 | 0.924 | 2.72 ± 1.11 | 2.58 ± 1.09 | 0.275 |
Donated oocyte from my sister is acceptable for me | 3.01 ± 1.35 | 2.58 ± 1.20 | 0.002* | 2.75 ± 1.30 | 2.98 ± 1.29 | 0.118 |
*; P<0.05 was considered significant statistically.
Attitudes towards disclosure or secrecy of oocyte donation
Statement | Women Mean ± SD | Men Mean ± SD | P value | Medicine Mean ± SD | Law Mean ± SD | P value |
---|---|---|---|---|---|---|
The donor and the recipient should be anonymous to each other | 3.93 ± 1.20 | 3.86 ± 1.17 | 0.580 | 3.82 ± 1.19 | 4.05 ± 1.16 | 0.097 |
Donor’s characteristics (such as age, ethnicity, and religion) can be given to the recipient | 4.19 ± 1.02 | 4.04 ± 1.01 | 0.165 | 4.11 ± 1.05 | 4.17 ± 0.98 | 0.620 |
Recipient‘s characteristics (such as age, ethnicity, and religion) can be given to the donor | 3.96 ± 1.16 | 3.88 ± 1.06 | 0.532 | 3.89 ± 1.11 | 4.00 ± 1.11 | 0.383 |
The child should be aware of his/her own genetic origin after 18 years | 2.67 ± 1.30 | 2.57 ± 1.28 | 0.487 | 2.67 ± 1.24 | 2.55 ± 1.38 | 0.421 |
The child can meet the genetic or biologic mother after 18 years | 2.10 ± 1.15 | 2.18 ± 1.51 | 0.527 | 2.15 ± 1.09 | 2.11 ± 1.25 | 0.802 |
Attitudes towards the parent-child relationship
Statement | Women Mean ± SD | Men Mean ± SD | P value | Medicine Mean ± SD | Law Mean ± SD | P value |
---|---|---|---|---|---|---|
Oocyte recipient (the mother), naturally likes the child | 4.21 ± 0.88 | 3.82 ± 1.07 | 0.000* | 4.02 ± 0.94 | 4.08 ± 1.06 | 0.607 |
The husband of oocyte recipient(the father), naturally likes the child | 4.17 ± 0.91 | 3.79 ± 1.01 | 0.000* | 3.95 ± 0.95 | 4.12 ± 1.00 | 0.105 |
The child naturally will like the mother (oocyte recipient) if oocyte donation is disclosed | 3.95 ± 1.07 | 3.59 ± 1.02 | 0.002* | 3.76 ± 1.03 | 3.86 ± 1.12 | 0.408 |
The child naturally will like the father (the husband of oocyte recipient) if oocyte donation is disclosed | 4.08 ± 0.96 | 3.66 ± 1.01 | 0.000* | 3.88 ± 0.98 | 3.95 ± 1.04 | 0.498 |
*; P<0.05 was considered significant statistically.
The present findings revealed that law and medical
students who participated in this study support OD as
an alternative way of childbearing and starting a family.
A study on attitudes of Christians and Muslims to an
oocyte donation program in Iran also revealed that 74%
of Christians and 59% of Muslims supported the OD for
infertile couples (
Another survey on public opinion regarding OD in
Sweden suggested that the majority of the participants
believed that OD is a good way to help childless couples.
However, in contrast to the findings of the present study,
the Swedish women were more supportive of friends to
become oocyte donors and recipients compared to the
Swedish men (
In the present study, the law students were significantly
more in favor of this idea compared to the medical students.
Interestingly, in conservative or religious societies,
such as in Islamic countries, legal rights are usually
consistent with the religious commands or recommendations,
which are obtained from religious authorities (
The finding that the responders thought that the oocyte
donor and the receiving couple should be anonymous
(unknown) to one another was a line with earlier
studies (
Women also had more tendency to receiving donated
oocyte from their sisters than men. Yee et al. (
Importantly, disclosure or non-disclosure of the genetic
origin to the children is a challenging issue in OD families
(
In a questionnaire-based study, Laruelle et al. (
Motivations towards disclosure included matters such
as to give honesty in the relationship with the child, to
prevent accidental disclosure by others, to give the child
potential access to his/her origins and the opportunity to
meet the donor (specially the known donation group), and
to avoid potential disadvantageous effects of secrecy on
the parent-child relationship (
In a study on increasing openness in oocyte donation
families regarding disclosure over 15 years, it was concluded
that the professionals have more and more actively
encouraged the parents to inform their presumptive children
of their conceptions (
Surprisingly, in this study, women valued parenthood more than men and they believed that the OD child will naturally like her/his family member (the mother and the father or recipient couple), even if oocyte donation is disclosed. Since the participants of the current study were from two schools in the country, a more extensive study will on both law and medical students will help in achieving more comprehensive results.
This was the first report on the attitudes of medical and law students towards OD in a Muslim country. The present findings indicated that a great majority of law and medical students support OD as an alternative way of starting a family. There is an interest amongst female students in donating oocytes anonymously. The majority of the participants believed in the importance of the relationship between parents and their child. They were concerned about the oocyte recipient family loving their OD child and vice versa naturally. We truly believe that these studies may potentially influence the law and medical students in a positive manner.