Routes to Parenthood Flashcards
Process of IVF
- 9 to 12 days of self-injection with fertility drugs to stimulate egg production
- Egg retrieval via transvaginal ultrasonography
- Fertilisation in the lab
- Transfer of embryo to the uterus
- Success of transplantation known after around 2 to 3 weeks
Single vs. Multiple Embryo Transfer
- Some Scandinavian countries have adopted single-embryo transfer (SET) as the norm
- In Sweden, multiple birth rates have been reduced to around 5%, with no impact on the 30-40% likelihood of pregnancy (Bergh et al., 2005)
- A systematic review concluded that pregnancy rates did not differ between SET versus dual- embryo transfer (Pandian et al., 2005)
- Preterm delivery, low birth weight and neonatal unit admission were all lower following SET vs. DET (Kjellberg et al., 2006)
Dealing with IVF
- Patients expect IVF to be stressful (e.g., Boivin & Takefman, 1995)
- 30% of couples with end treatment prematurely because of its psychological burden (Olivius et al., 2004)
Psychological factors relating to ART success
- Boivin et al., (2011) Meta-analysis of 14 found that pretreatment emotional distress was not related to outcome after a cycle of ART
- Matthiesen et al., (2011) meta-analysis of 31 studies found small but significant effects for clinical pregnancy rates and stress, trait anxiety and state anxiety but not depression, but no associations between psychological factors and pregnancy test results
Congenital Abnormalities
- Several meta-analyses concluded that children born following ART were at an increased risk (29-41%) of major congenital abnormalities (McDonald et al., 2005; Hansen et al., 2005, Rimm et al., 2004)
- However, Sutcliffe and Ludwig (2007) highlighted numerous methodological shortcomings of this research
- Zhu et al. (2006) conducted a well-controlled Danish cohort study showing that singletons born to infertile couples had a higher rate of congenital abnormalities when conceived spontaneously or after ART when maternal age, BMI, smoking and other confounders were controlled
- Suggests increased risk in ART children is due to parental factors associated with ART rather than ART per se
Cognitive Development
- Follow-up studies at ages 5, 8 and 10 comparing ART children to matched controls indicate no differences in cognitive performance (Leunens et al., 2006; Ponjaert- Kristoffersen et al., 2005, 2008)
- Bay et al. (2016) reported similar null findings in a large cohort study wrt school grades at ages 16 and 17 and IQ test scores at 19
Psychological Outcomes
• Follow-up data into adolescence shows no differences in parents’ psychological wellbeing, parent–child relationships, children’s peer relationships and child behaviour in ART children cf. controls (e.g., Golombok et al., 2002; Ponjaert-Kristoffersen et al., 2004)
Illioi & Golombok (2014)
- Systematic review found that ART children were equally well adjusted and showed no differences in the quality of parent–child relationships (with some suggestion of better relationships in parents who conceived using IVF)
- Moderated by ART method and age of disclosure
- Donor insemination led to warmth of father-adolescent relationship lower, fathers less involved in discipline
- Later age of disclosure was associated with poorer-parent-adolescent relationships - does this reflect the positive impact of open communication style on quality of relationships?
Prevalence of Pregnancy Loss
• 12–24% of detected pregnancies fail to result in a living infant
• Rates of miscarriage increase with maternal age
– By age 42, 43% of detected pregnancies are lost before 20 weeks (IVF-Worldwide, 2012)
• Duration of pregnancy has not been found to predict the level of distress following pregnancy loss (e.g., Klier et al., 2000)
Psychological Response to Pregnancy Loss
• Tendency of the medical profession to view pregnancy loss as a ‘non-event’
• However, pregnancy loss is related to increased risk of psychological illness
– 10% of pregnancy losses followed by major depression (Sham et al., 2010)
– Elevated suicide rate following miscarriage (18.1 per 100,000) cf. general popula8on (11.3) and live birth mothers (5.9) (Gissler et al., 1996)
– 10–25% of pregnancy losses followed by PTSD 1m post loss (Bowles et al., 2000, 2006; Engelhard et al., 2001)
Grief Reactions
• Brier’s (2008) review concluded that grief reac8ons to pregnancy loss are not qualita8vely different from other types of grief
– Intense reac8ons in the early weeks post loss
– Decline in reac8ons around 6 months post loss
– Large individual differences in the length of 8me people are affected by grief
Complicated Grief
- Lobb et al. (2010) defined complicated grief as the chronic persistence of intense grief reac8ons (shock, loss of sleep and appe8te, preoccupa8on with the baby, extreme sadness, anger, shame or guilt) to the point where they adversely affect func8oning
- Es8mated complicated grief occurs in 10–20% of bereavements
- Brier (2008) argued that the same prevalence was observed in rela8on to pregnancy loss reac8ons
Father’s Response to Pregnancy Loss
- Badenhorst et al.’s (2006) review concluded that fathers also experienced grief responses, anxiety and depression post loss, but at lower levels than mothers
- Fathers’ responses were also less focused on guilt
- Zeanah et al. (1995) iden8fied a sub-group of 25% of couples where fathers’ grief was higher than that of mothers
- These men had less social support and more stressful life events than men whose reac8ons were less severe than those of their partners
Effects of Pregnancy Loss
- Research in this area suffers from various methodological shortcomings, and findings are inconsistent
- Pregnancy-focused anxiety (and not general anxiety and depression) are elevated in pregnancies following miscarriage (e.g., Bergner et al., 2008)
- Following stillbirth, increased psychopathology in subsequent pregnancy was reported particularly for mothers who were pregnant within a year of the stillbirth (Turton et al., 2001), whereas others have reported elevated depression in mothers who have failed to conceive within a year (Swanson, 2000)
- Because pregnancy loss is so common, unless it is the specific focus of the study, it won’t be investigated in relation to other variables
Motivations for routes to parethood
- In a UK sample, the vast majority of gay men (87%) and the majority of lesbian women (55%) preferred adop8on as their route to parenthood (Jennings et al., 2014)
- Gay men tend to want to avoid the imbalance in gene8c relatedness associated with surrogacy
- Lesbian mothers chose to use donor insemina8on because of a desire to experience pregnancy and birth (e.g., Lingiardi et al., 2016) or due to concerns rela8ng to adop8on (Goldberg & Scheib, 2015)
