1 Department of Womens and Childrens Health, Uppsala University Hospital, S-751 85 Uppsala, 2 Department of Public Health and Caring Sciences, Uppsala University, Uppsala and 3 Carl von Linné Kliniken, Uppsala, Sweden
4 To whom correspondence should be addressed. e-mail: skoog.svanberg{at}swipnet.se
![]() |
Abstract |
---|
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() |
---|
Key words: attitude/disclosure/gender/oocyte donation/public
![]() |
Introduction |
---|
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() |
---|
Most couples have a strong desire to have children of their own, and women in particular have been reported to attach great importance to biological motherhood (Ravin et al., 1997). Several studies have shown how infertility affects women and men psychologically (Möller, 1985
; Wright et al., 1989
; Connolly et al., 1992
; Wirtberg, 1992
). To judge from womens and mens reactions to, and attitudes towards, infertility, they seem to cope in different ways (Möller, 1985
; Collins et al., 1992
; Wirtberg, 1992
; Hjelmstedt et al., 1999
). In contrast, there seem to be similarities between the genders in the pattern of distress and optimistic reactions during the procedure of IVF (Boivin et al., 1998
). A few comparisons of womens and mens attitudes towards oocyte donation have shown that more men than women consider the genetic tie to be of importance (Appelgarth et al., 1995
; Ravin et al., 1997
). In addition, the attitudes of women and men towards gamete donation tend to be related to their personal experience of infertility (Braverman and Corson, 1995
; Kazem et al., 1995
).
In the area of assisted reproductive technology, the public have rarely had the opportunity to voice an opinion and there are few examples of studies on this issue (Lessor et al., 1990; Bolton et al., 1991
; Genuis et al., 1993
; Bowman and Saunders, 1994
). The public appear to have more reservations on this subject than infertility patients, and to be more concerned about the status and welfare of the donor (Bolton et al., 1991
). Many of the studies have also included groups that have already been involved in assisted reproduction and most studies have been made on small or selected groups (Bowman and Saunders, 1994
; Broderick and Walker, 1995
; Kazem et al., 1995
; Westlander et al., 1998
). Against this background, our overall aim was to investigate the attitudes towards different aspects of oocyte donation among a large group of the Swedish general public. Our interest was mainly focused on possible differences with regard to gender. We wished to answer the following specific research questions: (i) Are there significant differences between the attitudes of women and men towards (a) different aspects of oocyte donation, (b) disclosure of information regarding the genetic origin to the offspring, and (c) the importance of parenthood and the genetic tie between parent and child? (ii) Are there any differences with respect to these attitudes between subgroups formed on the basis of personal experience of infertility, or their own experience of parenthood? (iii) To what extent are women and men willing to participate in oocyte donation, either as a donor (or partner of a donor) or as a recipient?
![]() |
Materials and methods |
---|
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() |
---|
Participants
The study population comprised 1000 women aged 2535 years and 1000 men aged 2540 years. These particular age groups were chosen because they roughly represented the populations of potential oocyte donors and recipients, and their partners. Participants were randomly selected from the national tax registration record. A total of 729 of the 1000 women (73%) and 556 of the 1000 men (56%) completed the questionnaire. Fifty-six (2.8%) returned the envelopes for the following reasons: mentally handicapped, difficulties in understanding Swedish, living abroad, and moved without giving a new address. As the third reminder included a shorter version, 37 women (3.7%) and 43 men (4.3%) answered only some of the questions. Demographic data for the respondents are presented in Table I.
|
The instrument
A study-specific questionnaire was constructed on the basis of earlier research and of exploratory interviews of eight women and two men. A pool of items was formulated, covering attitudes towards various aspects of oocyte donation. Relevant items were selected in order to measure attitudes towards oocyte donation in general, specific aspects of donors and recipients, informing offspring of their origin, parenthood, and the importance of having the genetic tie between parents and child. A pilot study was performed on a group of student nurses (n = 25). Based on these results and comments from these students, the questionnaire was revised. The final version included four subscales measuring attitudes towards oocyte donation in general (five items), information to offspring (six items), parenthood (six items), and the importance of the genetic tie (four items). Satisfactory internal validity was indicated by a finding of Cronbach alpha values of 0.67, 0.80, 0.86 and 0.78 respectively (Cronbach, 1990) The respondents were asked to indicate to what extent each attitude statement applied to them on a 5-point scale with the following anchor points: strongly agree, agree somewhat, neutral, disagree somewhat and strongly disagree. For each statement it was possible to respond cannot form an opinion. The womens willingness to donate oocytes anonymously in the future (or in the case of men the willingness to support such donation) was assessed by the responses yes, probably, no or perhaps/I do not know. Multiple responses were used for questions concerning what methods the responders would consider turning to in the event of infertility. In addition, the questionnaire included items measuring different aspects of womens willingness to donate, results of which will be reported elsewhere.
When compiled in tables, the responses were organized into three categories. The two positive attitudes strongly agree and agree somewhat and the two negative attitudes disagree somewhat and strongly disagree were collapsed into two groups, agree and disagree. The attitude neutral remained single (Tables II, III and IV).
|
|
|
![]() |
Results |
---|
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() |
---|
Disclosure to the child
A majority of both women and men considered that children conceived through egg donation should have the right to know about their genetic origin and that parents should be honest with their children with regard to their genetic origin (Table IV); however, women agreed significantly more strongly with the statements (P < 0.01). Women and men expressed a similar attitude towards the statement as an adult, the child should be able to find out the identity of the egg donor. Almost half of the respondents agreed with this and about one-third disagreed. Overall, women had a significantly more positive attitude towards disclosure to the child compared with men (subscale P < 0.001). Respondents who had received information about oocyte donation before the survey were more in favour of letting the children be told about their origin than respondents without such information (subscale P < 0.05).
The importance of the genetic tie
The men placed significantly more importance on the genetic tie than did the women (subscale P < 0.001). The statements the genetic link between father and child is important and the genetic link between mother and child is important were agreed with by 40% of the men and 30% of the women. Forty-five per cent of the women and 33% of the men disagreed with these statements that the genetic tie was important (P < 0.001). Women and men had similar attitudes concerning the importance that the child should resemble them physically and in terms of behaviour (20 and 23% respectively were in agreement with this).
The importance of parenthood
A majority of the respondents agreed with the two statements having children is the most important thing in life (women 78%, men 67%; P < 0.001) and a child is an expression of love shared by two people (women 79%, men 69%), although women agreed more strongly (P < 0.001). Women were significantly more positive to the idea that having a child is the whole purpose of life compared with men (63 and 46% respectively; P < 0.001). A majority of both women and men were negative to the two statements having children means losing your freedom (women 71%, men 60%; P < 0.001) and self-fulfilment is difficult to attain if you have children (women 78%, men 68%; P < 0.01). Overall, different aspects of having children were of significantly greater importance to women than to men (subscale P < 0.001). In addition, respondents with experience of infertility were significantly more positive concerning the importance of having children compared with those without such experience (subscale P < 0.01). Respondents with children of their own had more positive attitudes towards having children than those without children (subscale P < 0.001).
The willingness to participate in donation in the future
Seventeen per cent of the women would consider donating oocytes anonymously to another woman in the future, whereas 56% of the men would support their girl-friend/wife if she wanted to donate. Thirty-nine per cent of the women were opposed to the idea of being donors themselves, while 18% of the men were opposed to supporting a donation by their partner. The rest of the women (44%) and 25% of the men felt unsure or could not form an opinion. Neither experience of infertility nor having children of their own was associated with womens willingness to donate.
Regarding what methods the subjects would turn to in the event of difficulties in having a child of their own (Table V), a larger proportion of men than of women considered that anonymous oocyte donation was acceptable (P < 0.001). Donated oocytes from a friend/relative were favoured less frequently by both women and men.
|
![]() |
Discussion |
---|
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() |
---|
Disclosure or non-disclosure to the children
A great majority of the respondents considered that the children should be told about their origin. This number was larger compared with those earlier reported by other authors for recipients, donors or potential donors (Appelgarth et al., 1995; Nachtigall et al., 1997
; Abdalla et al., 1998
; Greenfield et al., 1998
; Söderström-Anttila et al., 1998
; Rumball and Adair, 1999
; Gottlieb et al., 2000
; Hovatta, 2000
; Lindblad et al., 2000
; McWhinnie, 2001
; Golombok et al., 2002
). Most psychologists and therapists familiar with these issues recommend openness with the child to ensure a harmonious relationship between the parents and their child. It might be more difficult, however, to tell the child if information about the donor is not available. Our results confirm an earlier finding that women were more positive towards telling the child than men were (Braverman and Corson, 1995
). Women and men did not differ in their opinion as to whether the child should receive information on the identity of the oocyte donor. More important was the finding that, half of the women and men were positive to the idea that offspring from oocyte donation should receive identifying information, in agreement with previous reports (Söderström-Anttila et al., 1998
; Urdapilleta et al., 2001
). However, one-third of the respondents were opposed to this. A recent follow-up study of donor insemination in Sweden showed that only a minor proportion of the recipient couples had in fact told the child of its origin (Gottlieb et al., 2000
). These researchers concluded that there is a need to stimulate ethical discussions within the responsible professional groups. Doctors, midwives and laboratory staff working at clinics probably have an important impact on the couples attitudes towards disclosure. Among our respondents, those who had received some information about oocyte donation before our survey were more in favour of telling the child of its origin than those without such information. Those respondents might have had more time to think over the question of donation and with time might have become more concerned about the childs point of view. Arguments in favour of telling the children have been based on experiences from studies of adopted children, who have emphasized the need for and desire to obtain knowledge about their heritage. Other arguments for disclosure are based on fear that the donation might be exposed by external events or by comments to the children later on in life, since results from research have shown that recipient couples do tell others about the donation (Gottlieb et al., 2000
).
The importance of parenthood
The social and biological drive to reproduce, coupled with social institutions that promote having children, makes a diagnosis of infertility particularly stressful. Not surprisingly, in the current study both women and men with experience of infertility or of having children of their own were more positive towards having children. Moreover, the present results showed that women valued parenthood more than men, which is in line with previous observations that women reacted more strongly than men to their infertility (Hjelmstedt et al., 1999). There have been reports on gender differences with regard to coping with infertility (Newton et al., 1990
; Beaurepaire et al., 1994
; Edelmann et al., 1994
) and attitudes towards donation (Braverman and Corson, 1995
; Kazem et al., 1995
). The gender differences observed in previous studies have been attributed to general social and biological factors and also to a general discrepancy in emotional profile.
The willingness to donate and receive oocytes, and the importance of the genetic tie
Among the respondents in our investigation, one in six of the women considered donating oocytes in the future to women they did not know. However, womens hypothetical willingness to donate oocytes expressed in a questionnaire are likely to differ from their actual behaviour, as suggested by earlier reported difficulties in recruiting non-related donors (Gorrill et al., 2001). The finding that a majority of the men would support their partners decision to donate oocytes was somewhat surprising, considering the fact that they placed more importance on the genetic tie between parent and child than did the women. In addition, men were also more positive than women towards receiving oocytes if they and their partner were experiencing infertility. Possible explanations for this include the fact that the mens physical efforts in regard to donating or receiving oocytes are much smaller than the womens, and that it is not mens genetic material that is being donated or replaced by some one elses. While it is likely that peoples willingness to receive oocytes is related to their status of fertility, there were no significant differences regarding this issue between respondents with and without personal experience of infertility. The positive attitudes expressed towards oocyte donation may be due to the fact that it implies a biological link between the child and both parents. Whereas the man is genetically linked, the recipient woman carries the fetus biologically and nurses the baby. If this were true, one would also expect less favourable attitudes towards anonymous sperm donation, which was in fact confirmed in the present study. It has also been discussed whether women choose the gestational tie to realize their body capacity for pregnancy and childbirth. When women and men were asked what methods they would consider acceptable for their own treatment, a surprisingly large proportion chose known donation. This indicates that the wish to have knowledge of the genetic origin of the oocyte might be stronger from the point of view of recipients (Baetens et al., 2000
). In view of the new possibilities of identifying and treating genetic diseases, the question about genetic heritage may become increasingly important.
Limitations of the study
In this report we present attitude data concerning new medical technology, compiled for a large, randomized sample of the Swedish population. Considering the topic of the present study, we expected a higher response rate among women than among men. Nevertheless, the relatively low response rate among men limits the conclusions that can be drawn from the results for the male sample. In addition, there were indications of response bias with respect to educational level, geographical setting and ethnic background (a large proportion of foreign names among non-respondents). Separate analyses (data not shown) indicated that respondents born outside Sweden were significantly less positive towards oocyte donation in general and disclosure to the child than were respondents born in Sweden. However, there was no group difference with regard to womens willingness to donate oocytes. The questionnaire was constructed specially for this survey in order to ask questions appropriate for the current legal circumstances. The use of non-standardized questions limits the possibilities of validating the questionnaire and the generalizability of the results. For this reason the study results should be regarded as trends among the Swedish public.
![]() |
Conclusion |
---|
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() |
---|
The rapid development of new methods in assisted reproduction has created expectations in and demands from infertile couples, and treatment with donated gametes has become more widely available. Nowadays it seems not to be a question of whether, but how, the assisted reproductive technology should be used. The Swedish public seems to agree with the law regarding the offsprings right to obtain information about his or her origin. However, it is important to keep in mind that not all of the participants were convinced that the offspring should have identifying information about the donor. This could have implications regarding the way information on this important issue is given to the recipient couples at the infertility clinics. Our study results indicate that the recipient couples should be given time and opportunities to discuss with the staff all the possible consequences of donation.
![]() |
Acknowledgements |
---|
![]() |
References |
---|
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() |
---|
Ahuja, K.K., Simons, E.G., Mostyn, B.J. and Bowen-Simpkins, P. (1998) An assessment of the motives and morals of egg share donors: policy of payments to egg donors requires a fair review. Hum. Reprod., 13, 26712678.
Appelgarth, L., Goldberg, N., Cholst, I., Mcgoff, N., Fantini, D., Zellers, N., Black, A. and Rosenwaks, Z. (1995) Families created through ovum donation: a preliminary investigation of obstetrical outcome and psychosocial adjustment. J. Assist. Reprod. Genet., 12, 574580.[ISI][Medline]
Baetens, P., Devroey, P., Camus, M., Van Steirteghem, A.C. and Ponjaert-Kristoffersen, I. (2000) Counselling couples and donors for oocyte donation: the decision to use either known or anonymous oocytes. Hum. Reprod., 15, 476484.
Beaurepaire, J., Jones, M., Thiering, P., Saunders, D. and Tennant, C. (1994) Psychosocial adjustment to infertility and its treatment: male and female responses at different stages of IVF/ET treatment. J. Psychosom. Res., 38, 229240.[CrossRef][ISI][Medline]
Boivin, J., Andersson, L., Skoog Svanberg, A., Hjelmstedt, A., Collins, A. and Bergh, T. (1998) Psychological reactions during in-vitro fertilization: similar response pattern in husbands and wives. Hum. Reprod., 13, 32623267.[Abstract]
Bolton, V., Golombok, R., Cook, A., Bish, A. and Rust, J. (1991) A comparative study of attitudes toward donor insemination and egg donation in recipients, potential donors and the public. J. Psychosom. Obstet. Gynecol., 12, 217228.[ISI]
Bowman, M.C. and Saunders, D.M. (1994) Community attitudes to maternal age and pregnancy after assisted reproductive technology: too old at 50 years? Hum. Reprod., 9, 167171.[Abstract]
Braverman, A.M. and Corson, S.L. (1995) Factors related to preferences in gamete donor sources. Fertil. Steril., 63, 543549.[ISI][Medline]
Broderick, P. and Walker, I. (1995) Information access and donated gametes: how much do we know about who wants to know? Hum. Reprod., 10, 33383341.[Abstract]
Collins, A., Freeman, E.W., Boxer, A.S. and Tureck, R. (1992) Perceptions of infertility and treatment stress in females as compared with males entering in vitro fertilization treatment. Fertil. Steril., 57, 350356.[ISI][Medline]
Connolly, K.J., Edelmann, R.J., Cooke, I.D. and Robson, J. (1992) The impact of infertility on psychological functioning. J. Psychosom. Res., 36, 459468.[CrossRef][ISI][Medline]
Cronbach, L.J. (1990) Essentials of Psychological Testing. Harper & Row, New York.
Edelmann, R.J., Connolly, K.J. and Bartlett, H. (1994) Coping strategies and psychological adjustment of couples presenting for IVF. J. Psychosom. Res., 38, 355364.[CrossRef][ISI][Medline]
Englert, Y., Rodesch, C., Van den Bergh, M. and Bertrand, E. (1996) Oocyte shortage for donation may be overcome in a program with anonymous permutation of related donors. Hum. Reprod., 11, 24252428.[Abstract]
Fielding, D., Handley, S., Duqueno, L., Weaver, S. and Lui, S. (1998) Motivation, attitudes and experience of donation: a follow-up of women donating eggs in assisted conception treatment. J. Commun. Appl. Soc. Psychol., 8, 273287.[CrossRef][ISI]
Genuis, S.J., Chang, W.C. and Genuis, S.K. (1993) Public attitudes in Edmonton toward assisted reproductive technology. Can. Med. Assoc. J., 149, 153161.[Abstract]
German, E.K., Mukherjee, T., Osborne, D. and Copperman, A.B. (2001) Does increasing ovum donor compensation lead to differences in donor characteristics? Fertil. Steril., 76, 7579.[CrossRef][ISI][Medline]
Golombok, S., Murray, C., Brinsden, P. and Abdalla, H. (1999) Social versus biological parenting: family functioning and the socio emotional development of children conceived by egg or sperm donation. J. Child Psychol. Psychiat., 40, 519527.[CrossRef][ISI][Medline]
Golombok, S., Brewaeys, A., Giavazzi, M.T., Guerra, D., MacCallum, F. and Rust, J. (2002) The European study of assisted reproduction families: the transition to adolescence. Hum. Reprod., 17, 830840.
Gorrill, M.J., Johnson, L.K., Patton, P.E. and Burry, K.A. (2001) Oocyte donor screening: the selection process and cost analysis. Fertil. Steril., 75, 400404.[CrossRef][ISI][Medline]
Gottlieb, C., Lalos, O. and Lindblad, F. (2000) Disclosure of donor insemination to the child: the impact of Swedish legislation on couples attitudes. Hum. Reprod., 15, 20522056.
Greenfeld, D.A. (2002) Changing attitudes towards third-party reproductive techniques. Curr. Opin. Obstet. Gynecol., 14, 289292.[CrossRef][ISI][Medline]
Greenfield, D.A., Greenfield, D.G., Mazure, C.M., Keefe, D.L. and Olive, D.L. (1998) Do attitudes toward disclosure in donor oocyte recipients predict the use of anonymous versus directed donation? Fertil. Steril., 70, 10091014.[CrossRef][ISI][Medline]
Greenfield, D.A., Mazure, C.M., Olive, D.L. and Keefe, D.L. (1995) Similarities and differences between anonymous and directed candidates for oocyte donation. J. Assist. Reprod. Genet., 12, 118122.[ISI][Medline]
Hazekamp, J.T. (1996) Current differences and consequences of legislation on practice of assisted reproductive technology in the Nordic countries. Acta Obstet. Gynecol. Scand., 75, 198200.[ISI][Medline]
Hjelmstedt, A., Andersson, L., Skoog Svanberg, A., Bergh, T., Boivin, J. and Collins, A. (1999) Gender differences in psychological reactions to infertility among couples seeking IVF- and ICSI-treatment. Acta Obstet. Gynecol. Scand., 78, 4248.[CrossRef][ISI][Medline]
Hovatta, O. (2000) Ethical aspects of oocyte donation, in vitro fertilization surrogacy and reproductive cloning. Acta Obstet. Gynecol. Scand., 79, 921924.[CrossRef][ISI][Medline]
Kalfoglou, A. and Geller, G. (2000) A follow-up study with oocyte donors exploring their experiences, knowledge and attitudes about the use of their oocytes and the outcome of the donation. Fertil. Steril., 74, 660667.[CrossRef][ISI][Medline]
Kazem, R., Thompson, L.A., Hamilton, M.P. and Templeton, A. (1995) Current attitudes towards egg donation among men and women. Hum. Reprod., 10, 15431548.[Abstract]
Khamsi, F., Endman, M., Lacanna, I.C. and Wong, J. (1997) Some psychological aspects of oocyte donation from known donors on altruistic basis. Fertil. Steril., 68, 323327.[CrossRef][ISI][Medline]
Leiblum, S.R. and Aviv, A.L. (1997) Disclosure issues and decisions of couples who conceived via donor insemination. J. Psychosom. Obstet. Gynecol., 18, 292300.[ISI][Medline]
Lessor, R., Reitz, K., Balmaceda, J. and Asch, R. (1990) A survey of public attitudes toward oocyte donation between sisters. Hum. Reprod., 5, 889892.[Abstract]
Lindblad, F., Gottlieb, C. and Lalos, O. (2000) To tell or not to tellwhat parents think about telling their children that they were born following donor insemination. J. Psychosom. Obstet. Gynecol., 21, 193203.[ISI][Medline]
Lyall, H., Murray, E., Glasier, A. and Baird, D.T. (1995) Donated ovarian tissue in embryo research and assisted conceptionthe view of women of reproductive age. Hum. Reprod., 10, 12421245.[Abstract]
Lyall, H., Gould, G.W. and Cameron, I.T. (1998) Should sperm donors be paid? A survey of the attitudes of the general public. Hum. Reprod., 13, 771775.[Abstract]
McWhinnie, A. (2001) Gamete donation and anonymity: should offspring from donated gametes continue to be denied knowledge of their origins and antecedents? Hum. Reprod., 16, 807817.
Möller, A. (1985) Psykologiska aspekter på infertilitet. Thesis, Göteborgs Universitet, Göteborg.
Nachtigall, R.D., Tschann, J.M., Quiroga, S.S., Pitcher, L. and Becker, G. (1997) Stigma, disclosure, and family functioning among parents of children conceived through donor insemination. Fertil. Steril., 68, 8389.[CrossRef][ISI][Medline]
Newton, C.R., Hearn, M.T. and Yuzpe, A.A. (1990) Psychological assessment and follow-up after in vitro fertilization: assessing the impact of failure. Fertil. Steril., 54, 879886.[ISI][Medline]
Ravin, A.J., Mahowald, M.B. and Stocking, C.B. (1997) Genes or gestation? Attitudes of women and men about biologic ties to children. J. Womens Health, 6, 639647.[ISI][Medline]
Rumball, A. and Adair, V. (1999) Telling the story: parents scripts for donor offspring. Hum. Reprod., 14, 13921399.
Sauer, M.V., Rodi, I.A., Scrooc, M., Bustillo, M. and Buster, J.E. (1988) Survey of attitudes regarding the use of siblings for gamete donation. Fertil. Steril., 49, 721722.[ISI][Medline]
SFS (1984) Svensk författningssamling. Swedish law formal statute.
Shenfield, F. and Steele, S.J. (1995) Why gamete donors should not be paid. Hum. Reprod., 10, 253255.[ISI][Medline]
Shenfield, F. and Steele, S.J. (1997) What are the effects of anonymity and secrecy on the welfare of the child in gamete donation? Hum. Reprod., 12, 392395.[Abstract]
Svensson, E. (2001) Construction of a single global scale for multi-item assessments of the same variable. Statist. Med., 20, 38313846.[CrossRef][ISI]
Söderström-Anttila, V., Sajaniemi, N., Tiitinen, A. and Hovatta, O. (1998) Health and development of children born after oocyte donation compared with that of those born after in-vitro fertilization, and parents attitudes regarding secrecy. Hum. Reprod., 13, 20092015.[Abstract]
Söderström-Anttila, V., Foudila, T. and Hovatta, O. (2001) Oocyte donation in infertility treatment: a review. Acta Obstet. Gynecol. Scand., 80, 191199.[CrossRef][ISI][Medline]
Urdapilleta, L., Chillik, C. and Fernández, D. (2001) Do fertile and infertile people think differently about ovum donation? J. Assist. Reprod. Genet., 18, 17.[CrossRef][ISI][Medline]
Weil, E., Cornet, D., Sibony, C., Mandelbaum, J. and Salat-Baroux, J. (1994) Psychological aspects in anonymous and non-anonymous oocyte donation. Hum. Reprod., 9, 13441347.[Abstract]
Westlander, G., Janson, P.O., Tagnfors, U. and Bergh, C. (1998) Attitudes of different groups of women in Sweden to oocyte donation and oocyte research. Acta Obstet. Gynecol. Scand., 77, 317321.[CrossRef][ISI][Medline]
Wirtberg, I. (1992) His and her childlessness. Thesis, Karolinska Institutet, Stockholm.
Wright, J., Allard, M., Lecours, A. and Sabourin, S. (1989) Psychosocial distress and infertility: a review of controlled research. Int. J. Fertil., 34, 126142.[ISI][Medline]
Submitted on November 8, 2002; accepted on January 29, 2003.