Attitudes toward oocyte donation among medical and nursing students and couples who have recently become parents: A Swedish study

Abstract

Aim:  The aim of the present study was to investigate attitudes toward oocyte donation and receiving oocytes in relation to gender, demographic variables and other factors that could influence these attitudes, such as anonymity of the donor and financial compensation.

Methods:  The study population consisted of 595 subjects divided into two groups; one group contained men and women who had recently become parents and the other group consisted of medical and nursing students. All subjects were asked to answer a study‐specific questionnaire.

Results:  The proportions of respondents positive toward oocyte donation were 32% in the student group and 37% in the parental group. Of the respondents in the student group, 87% were positive toward donating organs other than oocytes compared with 78% in the parental group (P < 0.05). In the parental group, the respondents that were positive toward organ donation in general were also more positive toward donating/partner donating and receiving/partner receiving oocytes (P < 0.001 and P < 0.01, respectively). The majority of the respondents stated that their attitudes were not affected by anonymity of the donation, financial compensation or knowing the outcome of the donation.

Conclusion:  Respondents’ attitudes were unaffected by anonymity of the donation, financial compensation and knowing the outcome of the donation. However, the data suggest that respondents who were positive toward organ donation in general were also more positive toward donating/partner donating and receiving/partner receiving oocytes. (Reprod Med Biol 2008; 7: 161–168)

INTRODUCTION

LEGISLATION CONCERNING OOCYTE donation varies throughout the world, as do opinions regarding anonymity, secrecy, the age limits placed on recipients and compensation for donors. ¹ , ² , ³ , ⁴ , ⁵ The number of oocyte donations is increasing yearly, and this seems to have led to greater openness regarding discussion of these issues. ⁵ In Sweden, oocyte donation has been permitted since 2003. ⁶

Opinions are divided in the literature regarding the question of whether the donor should be anonymous, and the donor's role in the treatment has therefore been investigated and discussed in a number of studies. ⁷ , ⁸ , ⁹ , ¹⁰ A donor might be anonymous or might be known to the recipient. Studies show that a woman's motives for participating in the oocyte donation process differ from person to person. It is also considered an advantage if the donor has already had children and is currently living in a stable relationship. ¹¹

Women usually cite altruistic motives as the reason for donating oocytes, ¹² , ¹³ whether they are anonymous or known donors. An American study ¹⁴ has shown that the donor's financial motivation is greater in cases where the donor is receiving compensation substantially in excess of the compensation provided in Sweden (see below). Women who receive compensation equivalent to or even less than that provided to Swedish donors have expressed a more altruistic motivation. In Sweden, the current financial compensation for the donor is limited to compensation for loss of income, travel costs and medical costs.

In many countries it is believed that children should be informed that they are the result of an oocyte donation from a woman to the child's mother. Going beyond this, and not only informing the child that he or she is the result of a donation, but also providing the child with the identity of the donor, is considered to be a major step. ¹⁵ We have only limited knowledge about emotional well‐being and possible concerns regarding genetic origins among children who are the results of gamete donation. ¹⁶ , ¹⁷ The Swedish law passed in 1985 states that the child has the right to know his/her genetic origins, ¹⁸ but the donor has no right to know the outcome of the donation.

Subgroups of Swedish female patients have expressed a preference for donor anonymity, in contrast to the sense of the prevailing legislation concerning the donation of gametes. ³ Results from other Swedish studies have shown that the majority of both women and men support oocyte donation as a means of infertility treatment, but that fewer would consider actually donating or allowing their partner to donate. ¹⁹

We wanted to test if men and women who have had the experience of parenthood express different attitudes toward gamete donation compared with a group of men and women who were presumed not to have experienced parenthood (i.e. students), but who have a good knowledge of reproductive matters. The aim of the present study was to investigate attitudes toward oocyte donation and receiving oocytes in relation to gender, demographic variables and other factors that could influence these attitudes, such as anonymity of the donor and financial compensation, in a group of medical and nursing students and among couples who had recently become parents.

MATERIALS AND METHODS

Participants

THE STUDY POPULATION consisted of 595 subjects divided into two groups; one group consisted of men and women who had recently (approximately 6 months after delivery) become parents and the other group consisted of medical and nursing students. The parental group consisted of 224 men and 247 women consecutively collected from the local birth register at University Hospital in Linköping. The student group consisted of 72 medical students and 52 nursing students. The parental group received the questionnaire by mail in March 2004, along with a covering letter briefly describing the study and a postage‐paid return envelope. No reminder was sent. For the student group, the questionnaires were handed out in person in connection with a lecture in two classes at the end of the medical students’ seventh semester, and during the nursing students’ sixth semester. When the questionnaires were handed out all students had taken a gynecology course and therefore presumably have sufficient knowledge of reproductive matters. The students were asked to fill out the questionnaires and return them in person when complete. All participants were informed of the voluntary and confidential aspects of the study.

In the parental group, a total of 163 women (66%) and 123 men (55%) returned the questionnaire. No analysis regarding the characteristics of the non‐respondents was made because the questionnaires had no identifying information. In the student group, two medical students and one nursing student declined to participate. This resulted in a group of 70 medical students (42 women and 28 men) and 51 nursing students (47 women and four men), that is, 121 students in total. Demographic data on the two study groups are presented in Table 1. As a result of partial drop‐outs, the total numbers in both groups might vary slightly.

Table 1.

Background characteristics of the two study groups

	Student group		Parental group		P
	n	%	n	%
Gender†					0.002
Men	32	26	123	43
Women	89	74	163	57
Age‡	26.7	5.46	32.3	4.94	<0.001
Marital status†					<0.001
Single	40	33	7	3
Co‐habiting	58	49	112	39
Married	21	18	166	58
States that family is completed					<0.001
Yes	14	12	93	33
No	92	76	120	42
Uncertain	15	12	73	26

^† Group differences were tested using χ²‐tests.

^‡ Mean ± standard deviation are presented. Group differences were tested using a Student's t‐test.

The instrument

The questionnaire was specific to the study and contained 16 questions. The questions for men were identical to those for women, but the men were asked about their attitudes toward the scenario of their partner donating or receiving oocytes. Information relevant to the questions was included in the questionnaire, namely the legislation regarding oocyte donation that came into force in January 2003, the right of the offspring to obtain information identifying the donor, current secrecy regarding the outcome of the donation, and the current level of financial compensation.

The questionnaire covered three main areas: (i) five questions about the background characteristics of the respondents, such as age and marital status; (ii) six questions regarding general attitudes toward oocyte donation and donation in general; and (iii) five questions on more specific details of the oocyte donation procedure, such as anonymity, the right to know the outcome and financial compensation.

Statistics

χ²‐tests were used to compare gender differences and group differences and Student's t‐tests were used to compute the differences in quantitative variables, such as age. Statistical significance was defined as a two‐sided P‐value ≤0.05.

RESULTS

DEMOGRAPHIC DATA ON the two study groups are presented in Table 1. The respondents in the student group were younger, female and single to a greater extent than the respondents in the parental group. In the parental group, 27 respondents (10%) were students, and among the students, 30 respondents (25%) were parents.

The proportions of respondents positive toward donation were 32% in the student group and 37% in the parental group. The men were more positive than the women toward oocyte donation, both among the students and in the parental group (P < 0.001) (Table 2). The respondents were also asked if they would consider receiving or having their partner receive oocytes in the hypothetical case of infertility, but no gender differences were found. The overall attitude toward oocyte donation is shown in Table 3.

Table 2.

Attitude toward donating or receiving oocytes (or partner donating or receiving oocytes) in relation to gender in the two study groups

	Student group						P †	Parental group						P †
	Men		Women		Total			Women		Men		Total
	n	%	n	%	n	%		n	%	n	%	n	%
Attitude toward donating/partner donating oocytes							<0.001							<0.001
Positive	21	23.6	18	56.3	39	32.2		43	26.5	61	49.6	104	36.5
Negative	24	27.0	8	25.0	32	26.4		53	32.7	30	24.4	83	29.1
Uncertain	44	49.4	6	18.8	50	41.3		66	40.7	32	26.0	98	34.4
Attitude toward receiving/partner receiving oocytes							n.s.							n.s.
Positive	34	38.2	15	46.9	49	40.5		68	41.7	56	45.9	124	43.5
Negative	12	13.5	3	9.4	15	12.4		27	16.6	27	22.1	54	18.9
Uncertain	43	48.3	14	43.8	57	47.1		68	41.7	39	32.0	107	37.5

^† Gender differences were tested tested using a χ²‐test.

n.s., not significant.

Table 3.

Overall attitudes of the study populations to oocyte donation

	Attitude toward donating/partner donating oocytes		Attitude toward receiving/partner receiving oocytes
	n	%	n	%
Positive	143	35.2	173	42.6
Negative	115	28.3	69	17.0
Uncertain	148	36.5	164	40.4
Total	406	100.0	406	100.0

Of the respondents in the student group, 87% were positive toward donating organs other than oocytes compared with 78% in the parental group (P < 0.05) (Table 4). In the parental group, the respondents positive toward organ donation in general were also more positive toward donating/partner donating and receiving/partner receiving oocytes (P < 0.001 and P < 0.01, respectively).

Table 4.

Attitude toward donating organs other than oocytes

	Student group		Parental group		P †
	n	%	n	%
					<0.05
Positive	105	86.8	224	78.3
Negative	1	0.8	18	6.3
Uncertain	15	12.4	44	15.4

^† Group differences were tested tested using a χ²‐test.

Table 5 shows the figures for donating organs other than oocytes in relation to the respondant's attitude toward donating or receiving oocytes.

Table 5.

Attitude toward donating organs other than oocytes in relation to attitude toward donating or receiving oocytes

	Attitude toward organ donation
	Student group						P †	Parental group						P †
	Positive		Negative		Uncertain			Positive		Negative		Uncertain
	n	%	n	%	n	%		n	%	n	%	n	%
Attitude toward donating/partner donating oocytes							n.s.							<0.001
Positive	36	34.3	0	0.0	3	20.0		95	42.6	1	5.6	8	18.2
Negative	27	25.7	1	100.0	4	26.7		60	26.9	13	72.2	10	22.7
Uncertain	42	40.0	0	0.0	8	53.3		68	30.5	4	22.2	26	59.1
Attitude toward receiving/partner receiving oocytes							n.s.							<0.01
Positive	45	42.9	0	0.0	4	26.7		107	48.0	4	22.2	13	29.5
Negative	10	9.5	0	0.0	5	33.3		39	17.5	8	44.4	7	15.9
Uncertain	50	47.6	1	100.0	6	40.0		77	34.5	6	33.3	24	54.5

^† Differences were tested tested using a χ²‐test.

n.s., not significant.

Less than half of the respondents (40% of students and 35% of parents) had any knowledge of the legislation in question before the survey. Students who had prior knowledge of the legislation tended to be more positive toward oocyte donation compared with students who had no prior knowledge.

Neither marital status nor parenthood influenced the attitudes in the two study groups (data not shown). Parents aged 30 years or younger were more positive toward receiving/partner receiving oocytes compared with parents older than 30 years (57 and 35%, respectively, P < 0.01) (Table 6). In addition, in the parental group, the respondents who planned on having more children were more positive toward receiving/partner receiving oocytes compared with respondents who did not plan on having more children (58 and 39%, respectively, P < 0.05).

Table 6.

Attitude toward donating/receiving oocytes in relation to age

	Student group				P †	Parent group				P †
	≤30 years		>30 years			≤30 years		>30 years
	n	%	n	%		n	%	n	%
Attitude toward donating/partner donating oocytes					n.s.					n.s.
Positive	30	30.9	9	39.1		49	42.6	55	32.5
Negative	27	27.8	5	21.7		31	27.0	51	30.2
Uncertain	40	41.2	9	39.1		35	30.4	63	37.3
Total	97	100.0	23	100.0		115	100.0	169	100.0
Attitude toward receiving/partner receiving oocytes					n.s.					<0.01
Positive	38	39.2	11	47.8		65	56.5	59	34.9
Negative	13	13.4	2	8.7		17	14.8	37	21.9
Uncertain	46	47.4	10	43.5		33	28.7	73	43.2
Total	97	100.0	23	100.0		115	100.0	169	100.0

^† Age differences were tested tested using a χ²‐test.

n.s., not significant.

There were no gender differences concerning the attitude of donating/partner donating oocytes specifically to a relative or a friend compared with donation when the recipient was not specified (Table 7). The majority of the respondents among both students and parents stated that their attitudes were not affected by anonymity of the donation, financial compensation or knowing the outcome of the donation. However, in the student group, the women were more positive than the men toward donating oocytes in the case where the donor would be informed of the outcome of the donation (P < 0.05). In total, 57 respondents said their attitude would be more positive if there was financial compensation. Of these, 39 estimated their preferred amount of financial compensation. The median value was 7500 SEK (790 Euro) (range 100–100 000 SEK).

Table 7.

Possible factors affecting the attitude of donating/partner donating oocytes in relation to gender in the two study groups

	Student group				P †	Parental group				P †
	Women		Men			Women		Men
	n	%	n	%		n	%	n	%
Donation to a relative/friend					n.s.					n.s.
Positive	34	38	16	52		68	42	56	46
Negative	23	26	5	16		41	25	40	33
Uncertain	32	36	10	21		53	33	27	22
Anonymous donation					n.s.					n.s.
More positive	29	33	8	27		39	24	39	32
More negative	5	6	2	7		6	4	7	6
Opinion unchanged	54	61	20	67		118	72	76	62
Knowing the outcome of the donation					<0.05					n.s.
More positive	15	17	1	3		51	31	31	25
More negative	7	8	6	19		7	4	6	5
Opinion unchanged	67	75	24	77		105	64	85	70
Financial compensation					n.s.					n.s.
More positive	7	8	4	13		21	13	25	21
More negative	8	9	5	16		4	3	7	6
Opinion unchanged	74	83	22	71		138	85	90	74

^† Gender differences were tested tested using a χ²‐test.

n.s., not significant.

DISCUSSION

Attitudes regarding participating in gamete donation

IN THE PRESENT study, approximately one‐third of the respondents were positive toward oocyte donation, while approximately 40% were positive toward receiving/partner receiving oocytes. Men were more positive toward their partner donating oocytes, which is in line with earlier findings, ¹⁹ while no gender differences were evident in the case of receiving/partner receiving oocytes. A considerably higher percentage of participants were willing to donate organs other than oocytes, and respondents positive toward organ donation in general were also more positive toward donating/partner donating and receiving/partner receiving oocytes. An altruistic personality or altruistic motivations have often been mentioned as reasons for donating. The dominant attitude in European countries has been that donation must occur on altruistic grounds, and that donors should not be compensated financially. Moreover, there is evidence to suggest that young parents (i.e. aged 30 years or less) were more positive toward receiving/partner receiving oocytes, and also that parents planning on having more children were more positive toward receiving/partner receiving oocytes. This might be explained by the fact that the number of procedures involving oocyte donation increases every year, which seems to have led to greater openness regarding these issues. ⁵ In addition, it might be the case that by debating and rendering familiar that which originally was seen as strange and threatening to the public, people are helped to become mentally familiar with the issues. ²⁰ We could see a tendency whereby respondents who, at the time of the survey, had previous knowledge about Swedish legislation on oocyte donation were more positive toward donation. It remains to be investigated whether or not this reflects the belief that it is easier to take a stand on an issue when you have had relatively more time to consider it. Moreover, we do not know if the respondents who stated that they had previous knowledge of the legislation were in fact familiar with the actual medical procedure.

One of the findings in our study was that men could consider their partner donating to a greater extent than women could consider donating their oocytes. One recent Swedish study showed that while a majority supported oocyte donation as a means of infertility treatment, only 17% of the women would consider donating in the future, while 56% of the men would support their partner's decision to donate. ¹⁹ These findings are in agreement with the results from our study and might reflect a supportive attitude among men toward their partner rather than a positive opinion toward oocyte donation. Another reason might be that women are primarily involved in the process, and it might be easier to support someone else's decision to donate rather than to donate oneself. It might also be easier for a woman to understand the effort required for the actual physical procedure. Interestingly, men were somewhat more positive about their partner donating than about their partner receiving oocytes, while the women were more positive toward receiving oocytes than toward donating. This might reflect the obvious fact that for the individual woman, receiving oocytes is something very different from donating oocytes and in this aspect there is a gender difference that merits further research. Furthermore, our results also suggest that it is easier to consider donating organs other than oocytes. In future studies, it would be interesting to find out if this reflects a view of oocytes as future human beings rather than merely cells. There are of course great ethical and moral aspects of gamet donation versus organ donation in general and also differences in the type of organ donation, that is, ‘end of life’ donation compared with living‐donor organ donation. In living‐donor donation one mostly donates to a relative, a sister, brother or mother to daughter. This is an act where the donor is involved and the donor will live to see the hopefully positive results. In ‘end of life’ donation relatives have to decide if they are willing to donate their dead loved one's organs or to decide if they are willing to accept the dead persons wish to be a donor even if it is against the close relative's moral and ethical beliefs. When it comes to gametes it's even more complicated because there are three parties involved; the recipient couple, the donor and the offspring. The gamete donor is donating to a recipient couple that he/she usually does not know and/or will never know. Burr and Reynolds 2008 ²¹ stated that genetic information raises problems that are irresolvable when attempting to balance the rights of the donor, parents and donor offspring, particularly for the internal dynamics of families. Studies have revealed that parents have a strong preference for anonymous donors and results from follow‐up studies have shown that the majority of couples did not reveal information to their offspring and that most parents would have liked only non‐identifying information about the donor. Burr and Reynolds ²¹ concluded that the debate on genetic inheritance has been polarized between the ‘right to privacy’ of the donor or parent and the ‘right to know’ of the prospective offspring. This debate reflects the contradictions implicit in a liberal approach to ethical judgement on the basis of conflicting individual rights. This prompts two concerns: how diametrically opposed individual rights and claims for social justice can be reconciled; and how social justice can run alongside the integrity of donor‐assisted conception systems where donation is a central feature. ²¹

Whether or not the participants had children was not a significant factor for considering oocyte donation, and this is in line with the results of another Swedish study. ¹⁹ In current practice, women who have already had children are preferred as donors. ²¹ Young parents, as well as parents planning on having more children, were more positive toward donating and/or receiving oocytes, while marital status had no effect.

The majority of the respondents stated that their attitude toward oocyte donation was not affected by anonymity of the donation, financial compensation or knowing the outcome of the donation. In current practice in Sweden, the use of a relative or other known donor is not recommended, although it is not forbidden. With this in mind, it is interesting to see that a somewhat higher proportion of women would consider donating oocytes to a relative or a friend than donating to an unknown recipient, whereas men tended to be less positive. This differs from the results of a recent study, ¹⁹ but agrees with findings from other studies. ⁷ , ²² We also found that approximately one‐third of the respondents would be more positive toward donating if the donor's identity was not revealed to the child. This finding is consistent with results from other studies. Yet, for the majority, revealing or not revealing the identity of the donor did not affect their opinion, regardless of their overall attitude toward oocyte donation. The current Swedish law concerning the rights of children to know their origin is based on the premise that children must be given the opportunity to develop their own identity based on the truth about their genetic origins. Therefore, the possibility that a child might attempt to contact the donor might be a factor explaining why women are more reluctant than men to have this information disclosed.

Limitations

As the parental group and the student group responded to the questionnaire under different circumstances, the response rate varied between the two groups. However, the response rate in the parental group (66% of the women, 55% of the men) is satisfactory considering that no reminder letter was sent. In comparison, the average response rate after one dispatch in questionnaire‐based surveys carried out by Statistics Sweden is 35%. ²⁴ A recent Swedish study similar to the present study had a response rate of 73% among women and 56% among men after three reminders. ¹⁹ As the questionnaires had no identifying information, we can only speculate on the differences between the respondents and non‐respondents in the parental group. Women had a higher response rate than men, which might reflect a higher interest in these issues because women are more directly concerned with donating/receiving oocytes. Language difficulties, lack of interest or a general negative attitude might also have contributed to the drop‐out rate.

In conclusion, we found that there are gender differences in attitudes toward oocyte donation. The respondents’ attitudes were unaffected by anonymity of the donation, financial compensation and knowing the outcome of the donation. However, some of the data suggest that respondents who were positive toward organ donation in general were also more positive toward donating/partner donating and receiving/partner receiving oocytes. In addition, young parents and parents planning on having more children were more positive toward receiving/partner receiving oocytes.