Arch Gynecol Obstet (2007) 275:113–116 DOI 10.1007/s00404-006-0224-1

O RI G I NAL ART I C LE

Images of children born following infertility treatment Simone Ferrero · Luiza H. Abbamonte · Valentino Remorgida · Paola Anserini · Nicola Ragni

Received: 22 July 2006 / Accepted: 25 July 2006 / Published online: 22 August 2006 © Springer-Verlag 2006

Abstract Objective This cross-sectional survey investigates patients’ attitudes towards the use of photos of children born following infertility treatment. Materials and methods Each partner of 270 infertile couples independently completed a standardized questionnaire investigating patients’ attitudes towards the presence of photos of children born following infertility treatment in fertility clinics, Internet websites, brochure, and videos. Results Subjects (77.4%) were pleased to provide a photo of their child to hang on the walls of the fertility centre, a lower percentage of subjects desired to exhibit the photo in the fertility centre website, brochure, and video. Among subjects wishing to hang the photo of their child in the infertility centre, 60.3% wanted the name of the child on the photo and 15.3% wanted both the name and surname of the child on the photo. If a photo is explicitly requested by a member of the fertility team, 30.9% of the subjects feel to have the duty to give it. No signiWcant diVerence was observed in the desire to provide a photo of the child to hang on the walls of the fertility centre according to sex of the patient. Conclusion The majority of infertile patients are pleased to exhibit a photo of their babies in the fertility centre. Members of the fertility team should avoid

asking explicitly the photo because parents may feel to have the duty to give it. Keywords Brochure · Infertility centres · Internet websites · Photos

Introduction The main aim of an infertility service is to achieve a successful pregnancy in infertile couples. However, psychosocial and emotional issues should be addressed during treatment [1] and a friendly environment may improve the experience of infertility investigations and therapy. Despite the high number of fertility clinics showing images of children born following assisted reproductive technologies (ART) in their institutes, websites and videos, patients’ reactions to these images have never been investigated. This survey examines patients’ attitudes towards a practice common to many fertility clinics: exhibiting photographs of children conceived through assisted reproduction.

Materials and methods Study population

S. Ferrero (&) · L. H. Abbamonte · V. Remorgida · P. Anserini · N. Ragni Department of Obstetrics and Gynaecology, San Martino Hospital and University of Genoa, Largo R. Benzi 1, 16132 Genoa, Italy e-mail: [email protected]

Between January 2004 and December 2004 all couples undergoing the Wrst consultation at the Infertility Unit of San Martino Hospital, University of Genoa were invited to participate in this survey. Couples were included in the present study only if they had at least

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1 year of infertility. Exclusion criteria for the study were presence of only one partner of the couple at the Wrst consultation. Before the consultation, an interviewer described the study to the couple, checked that the couple was eligible and then asked them to participate. If the couple agreed to participate, both the female and male partner completed a written questionnaire; the partners were asked to sit in two diVerent rooms while completing the questionnaire. Questionnaire We developed this questionnaire to evaluate patients’ attitudes towards the use of images of children born following ART. A draft questionnaire was tested on the Wrst 15 couples and it was modiWed to improve its comprehensibility; these patients were not included in the current study. The questionnaire comprised several types of questions. The Wrst section ascertained demographic information and infertility history; in addition the general interest in photographing was investigated. The second section of the questionnaire included items to evaluate patients’ attitudes towards the presence of photos of children born to IVF in fertility clinics, Internet websites and videos. The third section aimed at deWning whether the couple, in case of successful pregnancy, would give a photo of their child to exhibit in the fertility centre; also this section examined patients’ reactions to the explicit request of a member of the fertility team of donating a photo of their newborns. Additional questions were prepared for patients accepting to provide images of their newborns. In particular, these subjects were asked whether they would prefer to provide photos accompanied by the name of the newborn, the name and surname, or anonymous. They were also asked whether they would provide a picture of themselves with the newborn and whether they would provide a picture of their child at 5 years of age. The questions were answered either on a 5-point Likert’s scale (where 1 = “strongly disagree” and 5 = “strongly agree”) or ticking a particular statement best Wtting the feelings of the subject. Ethical approval for this study was obtained from the local Institutional Review Board and each participant gave written informed consent to the study. Statistical analysis Data were analysed with the
2-test to compare observed and expected events. All calculations were performed using the SPSS software package (release

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10.0.5, SPSS Inc., Chicago, IL, USA). A P value less than 0.05 was considered statistically signiWcant.

Results Out of 312 infertile couples Wtting the inclusion criteria and approached for the study, 270 couples gave their consent to participate and completed the questionnaire, yielding a response rate of 86.5%. The demographic characteristics of the study population are listed in Table 1. In the study population, 372 subjects declared to like taking photos, 106 declared to love taking photos, 36 did not like taking photos, and 26 subjects preferred not answering this question. The majority of the subjects declared that hanging photos of babies born following ART on the walls of the fertility centre is a good idea; less frequently they agreed with the use of children photos in the fertility centre website, brochure, and video (Table 2). In case of successful pregnancy, 77.4% of the subjects were pleased to provide a photo of their child to hang on the walls of the fertility centre (Table 3). Patients not wishing to exhibit their children’s photos in the fertility centre (n = 30) were asked the reason for this decision; 16 (53.3%) subjects did not want to disclose that they had received an infertility treatment, 8 (26.7%) said that the child could be unhappy to have his photo in an infertility unit, 3 (10.0%) did like phoTable 1 Demographic characteristics of the study population

Age (years, mean § SD) Having a previous child [n (%)] Years trying to conceive (mean § SD) Having received previous infertility treatment in other centres [n (%)] Education [n (%)] ·8 years Between 9 and 13 years ¸14 years Marital status [n (%)] Married Living together First infertility treatment received at our unita Ovulation induction Intrauterine insemination IVF and ICSI

Female partner (n = 270)

Male partner (n = 270)

34.7 § 3.5 23 (8.5%)

35.7 § 3.4 25 (9.3%) 2.2 § 1.4

57 (21.1%)

102 (37.8%) 128 (47.4%) 40 (14.8%)

78 (28.9%) 138 (51.1%) 54 (20.0%)

229 (84.8%) 41 (15.2%)

85 (31.5%) 134 (49.6%) 44 (16.3%)

a Two couples conceived spontaneously before receiving the infertility treatment, Wve couples were lost at follow-up after the Wrst consultation

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Table 2 General opinion on the use of photos of babies born following ART

Exhibiting photos of children conceived through ART on the walls of the fertility centre Exhibiting photos of children conceived through ART in fertility centre website Exhibiting photos of children conceived through ART in the fertility centre brochure Exhibiting photos of children conceived through ART in the fertility centre video

Table 3 Personal attitude on the use of photos of babies born following ART

Table 4 Additional answers of subjects wishing to provide a photo of their child to hang on the walls of the fertility centre (n = 418)

Good idea

Uncertain

Bad idea

82.0% (n = 443)

13.1% (n = 71)

4.8% (n = 26)

47.6% (n = 257)

30.9% (n = 167)

21.5% (n = 116)

60.7% (n = 328)

27.2% (n = 147)

12.0% (n = 65)

56.5% (n = 305)

27.0% (n = 146)

16.5% (n = 89)

Yes Would you provide a photo of your child to hang on the walls of the fertility centre? Would you provide a photo of your child to show in fertility centre website? Would you provide a photo of your child to show in the fertility centre brochure? Would you provide a photo of your child to show in the fertility centre demonstrative video?

Uncertain

77.4% (n = 418) 17.0% (n = 92)

No 5.6% (n = 30)

39.3% (n = 212) 30.4% (n = 164) 30.4% (n = 164) 51.9% (n = 280) 29.4% (n = 159) 18.7% (n = 101) 52.0% (n = 281) 31.1% (n = 168) 16.9% (n = 91)

Agree [n (%)] Uncertain [n (%)] Disagree [n (%)] If I will have a child I would love to give a photo of my child, my partner, and me to hang on the walls of the fertility centre If I will have a child I would love to give a photo of my child at 5 years of age to hang on the walls of the fertility centre

tos in general, and the remaining 3 (10.0%) subjects did not provide a reason for their answer. No signiWcant diVerence was observed in the desire to provide a photo of the child to hang on the walls of the fertility centre according to sex of the patient (P = 0.821); 212 (78.5%) women and 206 (76.3%) men were pleased to give it. Subjects were divided according to the Wrst infertility treatment received at our unit; a similar portion of patients desired to provide a photo of the child to hang on the walls of the fertility centre among subjects undergoing ovulation induction (80.0%), intrauterine insemination (78.4%), and IVFICSI (76.1%; P = 0.771). Similarly, no signiWcant diVerence was observed in the desire to provide a photo of the child according to years of education and length of infertility. Interestingly, subjects loving or liking photography were signiWcantly more likely to be pleased to provide a photo of their child to hang in the fertility centre than subjects who did not like taking photos (P < 0.001). In only 1.5% (n = 4) of the couples one partner wanted and one did not want to provide the photo, in 14.1% (n = 38) of the cases one partner was uncertain

204 (48.8%)

100 (23.9%)

114 (27.3%)

293 (70.1%)

73 (17.5%)

52 (12.4%)

while the other wanted or did not want to provide the photo. Among subjects wishing to hang the photo of their child on the walls of the fertility centre (n = 418), 60.3% wanted the name of the child on the photo, 19.1% wanted the photo to be anonymous, 15.3% wanted both the name and surname of the child on the photo, and 5.3% declared to be uncertain about this. Among subjects wishing to hang the photo of their child on the walls of the fertility centre, 48.8% of the subjects wanted both the parents to appear in the photo with the newborn and 70.1% agreed to give a second photo of the child at 5 years of age (Table 4). Table 5 shows patients’ answers to the explicit request of a member of the infertility team to send a photo of the child to hang in the unit.

Conclusions To the best of our knowledge, this is the Wrst study examining patients’ attitudes towards the use of images of children conceived through ART. This survey

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Table 5 Answers to the question: “Which would be your reaction if, after getting pregnant, a member of the infertility team explicitly request you to send a photo of your child to hang in the unit?” All subjects I would be pleased to give the photo I feel to have the duty to give it I am uncertain I would feel irritated and would not give it I would not give it

40.0% (n = 216) 30.9% (n = 167) 20.4% (n = 110) 7.2% (n = 39) 1.5% (n = 8)

Subjects wishing to provide a photo of the child (n = 418) I would be pleased to give the photo 47.8% (n = 200) I feel to have the duty to give it 33.7% (n = 141) I am uncertain 17.2% (n = 72) I would feel irritated and would not give it 0.5% (n = 2) I would not give it 0.7% (n = 3)

reveals that over 75% of the couples want to provide a photo of their baby to hang on the walls of the fertility centre; less frequently they accept to provide a photo for the fertility centre brochure, video, and website. However, asking parents to provide a photo may be perceived as coercive and members of the fertility unit should avoid explicitly requesting it. We are aware that the current survey is characterized by some limitations. Firstly, the study was not performed after a successful infertility treatment. On the contrary, patients’ attitudes were investigated before the treatment. Therefore, we cannot exclude that the idea of having the long-time desired child could have positively

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aVected the answers; in addition we did not evaluate whether patients’ answers were conWrmed after a successful pregnancy. Secondly, the decision of providing the photo of a child is taken by both the members of the couple. In the current survey, the partners were asked to independently complete the questionnaire, and no questionnaire was administered to both male and female at the same time. However, only 15.6% of the couples did not agree on the decision to provide a photo. Gaining data about parental attitudes regarding the provision of children photos may be useful in addressing emotional issues raised during the infertility treatment. Members of the infertility unit should be aware that asking the parents to provide a photo may be perceived as coercive; this request may aVect patients’ opinion on the infertility clinic and it may have an impact on the decision to return to the unit for another child. However, the majority of infertile patients are pleased to see children’s photos in the fertility centres.

Reference 1. Boivin J, Appleton TC, Baetens P, Baron J, Bitzer J, Corrigan E, Daniels KR, Darwish J, Guerra-Diaz D, Hammar M, McWhinnie A, Strauss B, Thorn P, Wischmann T, Kentenich H, European Society of Human Reproduction, Embryology (2001) Guidelines for counselling in infertility: outline version. Hum Reprod 16:1301–1304