Donor insemination: Dutch parents' opinions about confidentiality and donor anonymity and the emotional adjustment of their children.

Results from a comparative study investigating 38 donor insemination (DI) Dutch families with 4-8 year old children are presented. The aims of this study were to investigate parents' opinions on the issues of confidentiality and donor anonymity, to assess the emotional development of the children, and to examine in DI families the association between secrecy with regard to the use of a donor and the emotional adjustment of the children. The DI families were compared to families with a child conceived by in-vitro fertilization (IVF) and to families with a naturally conceived child. Secrecy appeared to be associated with DI and not with IVF: 74% of the DI parents intended not to inform the child about the way in which she/he was conceived, whereas none of the IVF parents intended to keep the secret. Only one set of DI parents and two sets of IVF parents had actually told the child. As to donor anonymity, a spread of opinions appeared among DI parents; 57% preferred an anonymous donor, 31% would have liked non-identifying information about the donor, 9% preferred the donor's identity to be registered and 3% remained unsure. Parents' major concern was to know more about the medical/genetic background of the donor. Mothers and fathers in the DI families differed in their opinions concerning the issues of confidentiality and donor anonymity: fathers, more often than mothers, were secretive with regard to the use of a donor and husbands, more often than their wives, were in favour of donor anonymity. With regard to the emotional development of the children, more emotional/behavioural problems were revealed among DI children than among children who were naturally conceived. No association was found between secrecy and the emotional/behavioural adjustment of the children.

Donor insemination: child development and family functioning in lesbian mother families.

Findings are presented of a comparative study investigating the family relationships and the emotional and gender development of children raised in lesbian mother families. A total of 30 lesbian mother families with 4-8 year old children created as a result of donor insemination (DI) were compared with 38 heterosexual families with a DI child and with 30 heterosexual families who had a naturally conceived child. A variety of assessment measures, including a standardized interview and questionnaires from the parents and psychological testing of the child were used to collect the data. The quality of the couples' relationships and the quality of the mother-child interaction did not differ between lesbian mother families and either of the heterosexual family groups. The quality of the interaction between the social mother and the child in lesbian families was superior to that between the father and the child in both groups of heterosexual families. Childrens' own perception of their parents was similar in all family types; the social mother in lesbian families was regarded by the child to be as much a 'parent' as the father in both types of heterosexual families. With regard to their emotional/behavioural development, boys and girls raised in lesbian mother families were well adjusted and their gender role development did not differ from that of children raised in heterosexual families. These results indicate that child and family development in lesbian mother families is similar to that of heterosexual families.

Lesbian motherhood: the impact on child development and family functioning.

The wide variety of lesbian families who became visible during the past 20 years gave rise to important practical and theoretical questions. Up to now society has treated lesbian mothers differently with regard to a number of child-issues. In the past, divorcing lesbian mothers were often denied child custody because of their sexual orientation and the majority of fertility centers still refuse lesbian couples in their donor insemination programs. The present article reviews whether there is any theoretical and empirical evidence for the most widespread assumptions on which such decisions have been based. A number of psychological theories, such as psychoanalytic theory, social and cognitive learning theory and attachment theory are discussed with regard to the two most salient features of lesbian families; the absence of a father and the homosexual orientation of the mother. Meanwhile, there is a growing body of empirical research investigating a variety of aspects of child development, such as gender development, emotional/behavioral adjustment and social competence. Most of these studies involved children of divorced lesbian mothers who spent their early years in a heterosexual household. More recently, however, studies were sporadically carried out among children who were raised from birth in a lesbian relationship. As early childhood experiences are believed to have an important impact on future development, the study of these newly created families provides a challenge for existing psychological theories. Although many important research questions have yet to be addressed, the results of all reviewed studies were unanimous; none of the investigations could identify an adverse effect of lesbian motherhood on child development.

[Sexual problems and experiences with sexual and physical violence in gynecological patients]. / Seksuele klachten en ervaringen met seksueel en fysiek geweld bij gynaecologische patiënten.

OBJECTIVE: To determine the frequency of sexual difficulties and of sexual and physical abuse. DESIGN: Descriptive survey study. SETTING: Outpatient gynaecology clinic of the University Hospital of Leiden, the Netherlands. PATIENTS AND METHOD: During 3 months, December 1994-February 1995, all consecutive new female patients were questioned by the gynaecologist by means of a short standardised questionnaire. Oncology patients and non-Dutch-speaking patients were excluded. Data were analysed with descriptive statistical procedures; relationships among variables were tested with the chi 2 test with Yates' correction or Fisher's exact test. RESULTS: Of 325 patients 34.2% reported sexual difficulties, 15.4% reported sexual abuse and 7.4% physical molestation. Age of the patient and presence or absence of the partner during the consultation were not associated with differences in the patients' reports. 18.8% of the patients with these complaints answered affirmatively when asked if they needed specialised help. CONCLUSION: Sexual difficulties and sexual and physical abuse were common among gynaecology patients. Less than one-fifth of them required specialised help.

Lesbian mothers who conceived after donor insemination: a follow-up study.

This study investigated the development of family relationships in lesbian families who conceived after donor insemination (DI). The main characteristics of this unknown family structure were analysed. An anonymous donor was used to conceive, the family unit consisted of two mothers and a father was non-existent, and both women had a homosexual orientation. A total of 50 lesbian couples who conceived after DI with children aged between 1 and 2 years participated in this study, using a standardized interview created for this study. After the birth of their child, 56% of the lesbian mothers (n = 100) would have wanted the identity of the donor to be registered, while 10% would have done so at the time of the insemination. Opinions differed in 12 of the 50 couples: the biological mother was in favour of identity registration while the social mother was not. Both women considered themselves a parent of the child with equally shared responsibilities. Mothers were open about the special features of their family structure with children and within their immediate social network. Only 30% disclosed their lesbian identity in a broader social environment. The features of these newly created families may influence the psychological development of the children and therefore make long-term follow-up studies indispensable.

Hormone-dependent spinal leiomyoma.

A 43-year-old woman underwent subtotal removal of a cervical spinal leiomyoma in 1980 and 1981. When her (cyclic) symptoms recurred and tumor growth was demonstrated, she was treated with a synthetic anti-gonadotropic hormone (Danazol; Danatrol) until menopause, when medication could be discontinued without further recurrence of her symptoms or increase in size of the residual tumor.

Psychosexual functioning in women with complete testicular feminization: is androgen replacement therapy preferable to estrogen?

Effects of oral testosterone undecanoate (Andriol) on blood hormone levels, moods, sociosexual functioning and self-image of the body were studied in four gonadectomized patients with complete testicular feminization. In a double-blind cross-over experiment, patients were treated with oral testosterone undecanoate (120 mg/day) or placebo for four weeks. Peripheral blood was taken for hormone assays at the end of each four-week period. Psychosexual functioning was reported once weekly, mood scales twice weekly. In three patients testosterone treatment resulted in adult male blood levels of testosterone and estradiol. One patient did not show increased steroid levels, possibly because of hyperthyroxinaemia. No systematic effects were found on coitus, masturbation, sexual thoughts, scores on desire for bodily contact, and on attention for physical appearance. In one patient there was a marked and sustained rise in the positive moods and a fall in negative moods during androgen treatment. These results do not demonstrate that androgen therapy is preferable to estrogen in gonadectomized women with complete testicular feminization with regard to psychosexual functioning.

Findings in 200 consecutive asymptomatic women, having a laparoscopic sterilization.

Laparoscopic findings in 200 asymptomatic, healthy women having a sterilization were recorded; 148 patients (74%) had no abnormality and 52 patients had abnormalities comprising pelvic adhesions (14%), uterine fibromyomas (5%), endometriosis (3%) and ovarian or parovarian cysts (2%).

PIP: To place diagnostic laparoscopy in perspective, laparoscopic findings in 200 consecutive healthy women having laparoscopic sterilization by clips or rings were recorded. The subjects all had regular menses and a normal pelvic exam. 148 had no pathology on laparoscopy. 52 remaining women had adhesions (28, 14%), hydrosalpinx (3), ovarian cyst (3), endometriosis (5), fibromyomas (10, 5%), parovarian cyst (1), benign bladder tumor (1), and carcinoid bowel tumor (1). 43% of the adhesions were moderate or severe; 26% were associated with history of appendectomy; 68% were located outside the small pelvis. These findings are comparable to those published in 2 other series. They are relevant to management to patients complaining of chronic pain or infertility.

In vitro fertilization at the Leiden Academic Hospital. Initial experiences.

At the Leiden University Hospital the first IVF treatment was initiated November 1st, 1985. In the following year 139 cycles with ovarian stimulation have been started with 75 patients. Thirty percent of these stimulations have been cancelled before oocyte retrieval due to suboptimal response. Totally 97 pick-ups have been carried out on 65 patients resulting in 78 embryo transfers to 54 patients. Fourteen clinical pregnancies were obtained. Four ended with a first trimester abortion, one was a tubal pregnancy and 9 are ongoing or have been already delivered.

Adhesion formation after tubal surgery: results of the eighth-day laparoscopy in 188 patients.

First-look laparoscopy (FL) on the eighth day after salpingostomy, fimbrioplasty, or adhesiolysis was performed in 188 patients. Behavior of postoperative adhesions and the occurrence of pregnancy after tubal surgery were compared with a similar group of 127 patients in whom no FL was performed. In greater than 50% of the cases (104/188), adhesions were found on the eighth postoperative day around both adnexa or the only remaining adnexum. Adhesions were mainly located between the ampulla and the ovary and between the ovary and the lateral pelvic wall or broad ligament. More than half of the adhesions that were separated at FL did not recur. It was concluded that FL significantly diminished the occurrence of permanent pelvic adhesions. The incidence of ectopic pregnancy after salpingostomy was significantly lower when FL was performed. FL on the eighth postoperative day can be regarded as a well-accepted procedure with few complications.

PIP: 1st-look laparoscopy (FL) on the 8th day after salpingostomy, fimbrioplasty, or adhesiolysis was peformed in 188 patients. Behavior of postoperative adhesions and the occurrence of pregnancy after tubal surgery were compared with a similar group of 127 patients in whom no FL was performed. In 50% of the cases (104/188), adhesions were found on the 8th postoperative day around both adnexa or only the remaining adnexum. Adhesions were mainly located between the ampulla and the ovary and between the ovary and the lateral pelvic wall or broad ligament. More than 1/2 of the adhesions that were separated at FL did not recur. It was concluded that FL significantly diminished the occurrence of permanent pelvic adhesions. The incidence of ectopic pregnancy after salpingostomy was significantly lower when FL was performed. FL on the 8th postoperative day can be considered a well-accepted procedure with few complications.

Placental-site trophoblastic tumor: diagnosis, treatment, and biological behavior.

The clinical history of a patient with a placental-site trophoblastic tumor is presented. The diagnostic and therapeutic value of dilatation and curettage, the human chorionic gonadotropin titer, hysteroscopy, laparoscopy, chemotherapy, and hysterectomy is discussed, as well as the possibility of metastatic disease. In this patient there was radiological evidence of pulmonary metastasis with apparent spontaneous regression. A proposal is made to change the name of this disease to gestational trophoblastic neoplasia of low potential malignancy.

Pregnancy rates after laparoscopy for infertility.

To obtain prognostic data on the likelihood of pregnancy in infertile women with no observable abnormalities at diagnostic laparoscopy, the occurrence of pregnancy was studied in a series of 229 patients. The cumulative conception rate during a follow-up period of at most 5 yr was 50%. The probability of pregnancy proved to decline with age and duration of infertility. The cumulative conception rate during the first year after laparoscopy was approx. 30%, and there was no significant difference between the patients that were treated with respect to other sub-optimal fertility factors (subfertile group) and the patients in whom no rational treatment could be instituted (unexplained infertility group). Implications of these findings with respect to the treatment of long-term infertility are discussed. Knowledge of pregnancy rates after infertility laparoscopy seems important for the evaluation of results of therapy in unexplained infertility.

Reliability of cytological follow-up after conization of the cervix; a comparison of three surgical techniques.

A retrospective analysis was made of 154 consecutive conizations between 1974 and 1982. Three surgical methods were compared: (A) Sturmdorf sutures; (B) interrupted vertical sutures; and (C) an 'open' method using only cauterization and no additional stitches. The mean blood loss during conization was not reduced by ligation of descending branches of the uterine arteries. Post-conization haemorrhage occurred in only 3% and did not differ between the three groups. Cervical smears with only ectocervical squamous epithelium or too little material to allow diagnosis were considered inadequate. Unreliable follow-up was defined as inadequacy of more than 25% of a patient's smears. Thirty per cent of all follow-up smears were inadequate (group A 33%; B 41%; C 16%). In 46% of the patients, cytological follow-up was unreliable (group A 48%; B 61%; C 18%) and additional measures such as dilatation of the cervix, endocervical curettage, or hysterectomy were required. The differences between group C and the other two groups were statistically significant (P less than 0.01; chi 2 test).