Clinical Review ABC of subfertility

Intractable infertility

BMJ 2003; 327 doi: (Published 06 November 2003) Cite this as: BMJ 2003;327:1098
  1. Alison Bagshawe,
  2. Alison Taylor


    It is rare for any of the options available for couples with intractable infertility to be seen as a first choice. For many couples in this situation infertility is like bereavement and causes great emotional distress. However, with help, people may be able to accept their position and see the opportunity to start a new life. To embrace any of the following options and to cope with the complications and frustrations of each, psychological strength and stamina are needed, plus help from a skilled independent counsellor.

    Egg, sperm, and embryo donation

    Counselling for gamete and embryo donation

    Counselling for those receiving donor gametes or embryos encourages them to explore concerns and feelings related to their infertility before considering the social and emotional issues that may arise from non-genetic parenthood. The emotional impact and implications of donation can cause problems for recipients. Men and women often have different thoughts and feelings about the donors and about accepting donated gametes or embryos.

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    For many couples, facing the situation of intractable infertility is extremely distressing and help from a counsellor may be needed

    Short and long term implications of donation are influenced by the attitude, beliefs, and personal and social situation of the individuals concerned. Sperm, egg, and embryo donation can be from an anonymous or a known donor, and each has different implications. Counselling can be relatively straightforward or complex depending on the circumstances, and the counselling sessions will vary in length and intensity accordingly. Counselling explores the implications of a person's reasoning and challenges their assumptions and preconceptions. Issues such as openness or secrecy must be considered, as well as the questions of whether to tell the potential future child about their genetic background, and what, how, and when to tell both the child and the wider family.

    Fig 1

    Donor insemination

    Selection and screening of donors

    Information is given about the selection and screening of donors. Gamete donors …

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