Short communication: previous semen donors and their views regarding the sharing of information with offspring.

BACKGROUND: The UK government has decided to introduce, from 2005, rules that will allow donor-conceived persons to have access to identifying information concerning their donor. This has led to many concerns regarding future gamete donor recruitment. METHODS: Semen donors who had been recruited between 1988 and 2002 were invited to take part in a telephone interview. The interview sought these previous donors' views on issues associated with recruitment, attitudes regarding information sharing and views concerning the offspring. Responses regarding information sharing were compared with their views recorded at the time of recruitment. RESULTS: All 32 donors were recruited altruistically. Eighteen (56%) held the same views concerning the provision of identifying information as they did at the time of recruitment. Of those who had changed their views, eight (25%) expressed a willingness to be more open and four (12%) now wished to be anonymous having previously been unsure. Half of the donors would still have donated if they had been required to be identified to offspring, one-quarter would not have and one-quarter were undecided, although the majority of these said they may have donated under an open system. CONCLUSION: The study shows that it is possible to recruit identifiable donors at this clinic and this suggests that it may be possible for other clinics to do likewise.

School-aged children of donor insemination: a study of parents' disclosure patterns.

BACKGROUND: A major concern in relation to donor insemination (DI) is whether children should be told about their genetic origins. This study compared the thoughts, feelings and experiences of DI parents who were inclined towards openness with those who were inclined towards non-disclosure. METHODS: Forty-six families with a 4- to 8-year-old DI-conceived child were interviewed about their decision, their reasons and subsequent concerns regarding disclosure. RESULTS: Thirty-nine percent of parents were inclined towards disclosure whilst the remaining 61% were not. The two main reasons for favouring disclosure were to avoid accidental discovery and a desire for openness. Non-disclosing parents felt that there was no reason to tell and wished to protect family members. The children who had been told reacted with either curiosity or disinterest. CONCLUSIONS: In spite of donor anonymity, parents who were intending to tell their child in the future had optimistic expectations of their child's reaction. Parents who had already told their child generally described the telling experience as a positive one.

Information sharing in semen donation: the views of donors.

The authors report on a comparative questionnaire study of semen donors at two London clinics offering donor insemination (DI). Results presented here include donors' attitudes towards the storage of identifying information on the UK Human Fertilisation and Embryology Authority's central register, the importance of anonymity when donating, feelings about being traced by DI offspring, and views on the release of identifying donor information to mature offspring. Donors from the two clinics were found to differ on some, although not all, of the above points; in particular, donors from one clinic offered more support for the eventual release of identifying information to DI offspring. The discussion brings in the results of other studies and highlights the complexity of the anonymity question. The authors conclude that some donors may be willing to move towards greater openness of information under controlled conditions using the existing central register and a "veto" system.

Semen donor recruitment: a study of donors in two clinics.

We report on a comparative study of semen donors at two London (UK) clinics which have different recruitment and payment policies. Results presented here include data on the demographic characteristics, motivations, means of recruitment and attitudes towards payments of the donors, as well as their disclosure to others about the donation. Donors from the two clinics were found to differ on the above points. Comparisons with other studies are made and implications for donors recruitment are discussed.

A prospective randomized study comparing needles of different diameters for transvaginal ultrasound-directed follicle aspiration.

OBJECTIVE: To determine whether the use of smaller diameter needles at oocyte collection reduces pain without jeopardizing the treatment outcome. DESIGN: Prospective randomized study. SETTING: The Assisted Conception Unit, Kings College Hospital, United Kingdom. PATIENTS: One hundred twelve patients undergoing an IVF-ET treatment cycle. INTERVENTIONS: Study patients were aged < or = 38 years and had at least six follicles > 14 mm on the day of oocyte collection. Patients were randomized to follicle aspiration with a 15- (n = 34), 17- (n = 41), or 18- (n = 37) gauge (g) single channel needle. Intravenous pethidine and diazepam were used for analgesia and sedation. Pain was quantified by means of questionnaires completed by the patient and by her partner postoperatively. RESULTS: A greater proportion of patients reported severe to unbearable pain with the 15-gauge compared with the 17-gauge (44% versus 22%) or 18-gauge (44% versus 16%) needles. Partners' perception of severe pain experienced by patients showed the same trend when the 15-gauge was compared with the 17- (62% versus 29%) and 18-gauge (62% versus 22%) needles. There was no significant difference between the needles regarding the oocyte collection rate, fertilization rate, proportion of oocytes with fractured zonae, cleavage rate, implantation rate, and pregnancy rate per cycle. CONCLUSIONS: Reducing the size of the needle used for oocyte collection from 15 to 17 or 18 gauge reduces pain without affecting the number of oocytes collected, their quality, or the clinical pregnancy rate.

Excess concepti compared with number of embryos transferred in in vitro fertilization.

To reduce the risk of multiple pregnancy, most in vitro fertilization programs limit the number of embryos transferred; because monozygotic twinning may occur, it is possible that more concepti are produced than the number of embryos transferred. To quantify the prevalence of this phenomenon, 1820 clinical pregnancies generated from 11,601 in vitro fertilization treatment cycles were reviewed. Two patients conceived four fetuses each after having had three embryos transferred, while one conceived three fetuses after having had two embryos transferred. The overall prevalence rate was, therefore, one in 607 cases. The obstetric details of these three pregnancies are reported.

Transabdominal versus transvaginal ultrasound scanning of ovarian follicles: are they comparable?

The results of this study show that ultrasound measurements by the transabdominal and transvaginal routes are statistically comparable and reproducible between observers. The somewhat larger standard deviations found with transabdominal scanning suggest that the transvaginal route may be more accurate in the daily monitoring of follicular development.

The outcome of pregnancy in previously infertile women.

212 consecutive pregnancies are reviewed in previously infertile women. 96 had conceived following treatment, 21 in a "rest cycle" after treatment, 60 during investigations and 35 before investigations were started. There were 25 miscarriages (11.8%), 13 following hormone treatment. There were 7 multiple pregnancies, 2 sets of triplets and 5 sets of twins. The multiple pregnancy rate with Clomiphene was 3.9% and with gonadotrophins 30%. Pregnancy after the first trimester was normal, 82 (44%) were induced, 79% laboured for less than 12 hours. Spontaneous vaginal delivery occurred in 107 patients (55%), forceps delivery in 34%, breach 5.6% and caesarean section 6.1%. Only 20 babies weighed less than 2500 grams (10.5%) and 168 (88%) had an apgar score greater than 5. These infertile patients were matched with a control group of our normal obstetric population. There was no significant difference between the control and infertile patients except for a higher induction rate (p less than 0.0005) and higher forceps rate (p less than 0.001) in the infertile patients. We conclude that pregnancy following infertility is associated with a higher spontaneous miscarriage rate, but otherwise is normal.

Endocrine assessment of post-pill amenorrhoea.

PIP: 24 cases of postpill amenorrhea are presented. The patients were 17-34 years of age and the length of amenorrhea was 6-60 months with a mean of 13.4 months. There was no relationship between the type of contraceptive pill, length of usage, and the incidence of amenorrhea which suggests that the mechanism of action is general rather than due to a specific combination of steroid hormones. The basal endocrine status of the thyroid and adrenal was normal. 14 of the patients had low estrogen and gonadotropins and of these only 4 had a positive clomiphene pituitary reserve test. These 4 patients subsequently restarted normal cycles and luteinizing hormone/follicle stimulating hormone-releasing hormone tests showed normal pituitary function, indicating that the others probably had some derangement of hypothalamic pituitary function.^ieng