The Fertility Clinic, Skive Regional Hospital, Skive, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.
Hum Reprod. 2024 Nov 1;39(11):2525-2536. doi: 10.1093/humrep/deae208.
Which decision-making factors influence family building among permanently infertile couples?
Ethical, legal, and financial considerations outweigh genetic relatedness in decision-making, favouring domestic gestational surrogacy, if this were possible, over international options.
Permanent infertility affects 4-5% of people in the fertile age. Their family-building options include adoption, surrogacy, uterus transplantation, foster care, and intentional multiple parenthood. However, in most countries, including Denmark, legal barriers constrain these methods due to surrogacy restrictions, suspended international adoptions, and the experimental status of uterus transplantation. Despite existing research on surrogacy, adoption, and specific causes of permanent infertility, a significant gap remains in our understanding of how couples with permanent infertility make family-building decisions within these limited frameworks.
STUDY DESIGN, SIZE, DURATION: This cross-sectional study with 150 permanently infertile Danish participants was conducted from June to November 2023 using an online questionnaire. Multiple strategies, such as online forums, fertility clinics, hospital departments, and snowballing, were used to recruit a diverse sample.
PARTICIPANTS/MATERIALS, SETTING, METHODS: The study included couples aged 26-50 years facing permanent infertility due to the following primary causes: women without a uterus (15%), women with a non-functional uterus (47%) or women for whom pregnancy would be life-threatening (9%), male couples (16%), transgender partner couples (2%), and other causes (11%). The survey collected data on demographics, reproductive history, family-building choices, and communication strategies. Closed questions were analysed using descriptive statistics.
Among 150 respondents, 41% had used transnational surrogacy, 27% adoption, 14% chose to remain childless, and 19% were undecided. Critical factors on family-building decisions were ethical, legal, and financial concerns which ranked higher than genetic relatedness. Despite the complexity of family building, most participants were open about their child's origin and received social support. If all family-building methods were legal and available in Denmark, domestic gestational surrogacy would be the preferred method, with uterus transplantation and remaining childless being least popular.
LIMITATIONS, REASONS FOR CAUTION: The sample size is relatively small, despite the use of a variety of recruitment strategies. Nevertheless, this has ensured a diverse cohort representing the different reasons for infertility and family-building choices. It is important to note that the strategies may have favoured individuals achieving parenthood.
The finding of our study reveals a notable gap between available family-building options in Denmark and the preferences of couples facing permanent infertility. These insights could be instrumental for organizations reviewing and developing family-building frameworks. Furthermore, for healthcare professionals guiding couples experiencing infertility issues in their attempts to build a family, an understanding of these preferences is essential to facilitate informed decisions about their future family plans.
STUDY FUNDING/COMPETING INTEREST(S): The project was financed by the Independent Research Fund Denmark. The authors have no conflict of interest to declare.
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哪些决策因素会影响永久性不孕夫妇的生育计划？
在决策中，伦理、法律和财务因素比遗传关系更重要，如果可能的话，国内代孕会优先于国际选择。
永久性不孕影响了 26-50 岁有生育能力的人中的 4-5%。他们的生育选择包括收养、代孕、子宫移植、寄养和有意的多亲生育。然而，在包括丹麦在内的大多数国家，由于代孕限制、暂停国际收养以及子宫移植的实验性地位，法律障碍限制了这些方法。尽管有关于代孕、收养和永久性不孕具体原因的现有研究，但我们对永久性不孕夫妇在这些有限框架内做出生育决策的理解仍存在很大差距。
研究设计、大小和持续时间：这是一项横断面研究，共有 150 名丹麦永久性不孕的参与者参加，于 2023 年 6 月至 11 月期间使用在线问卷进行。采用了多种策略，如在线论坛、生育诊所、医院科室和滚雪球，以招募多样化的样本。
参与者/材料、设置和方法：该研究包括因以下主要原因而面临永久性不孕的 26-50 岁的夫妇：没有子宫的女性（15%）、子宫功能不全的女性（47%）或怀孕对其生命有威胁的女性（9%）、男同性恋夫妇（16%）、跨性别伴侣夫妇（2%）和其他原因（11%）。该调查收集了参与者的人口统计学、生殖史、生育计划选择和沟通策略方面的数据。使用描述性统计分析封闭问题。
在 150 名受访者中，41%的人使用过跨国代孕，27%的人选择了收养，14%的人选择了保持无子状态，19%的人未做出决定。家庭建设决策的关键因素是伦理、法律和财务问题，这些因素比遗传关系更重要。尽管家庭建设很复杂，但大多数参与者都对孩子的出身持开放态度，并得到了社会支持。如果所有的生育方法在丹麦都是合法和可用的，那么国内的代孕将是首选方法，而子宫移植和保持无子状态则最不受欢迎。
局限性、谨慎的原因：尽管采用了多种招募策略，但样本量相对较小。然而，这确保了一个多样化的队列，代表了不同的不孕原因和生育计划选择。需要注意的是，这些策略可能有利于那些已经实现生育的人。
我们研究的结果揭示了丹麦现有的生育选择与面临永久性不孕的夫妇的偏好之间存在显著差距。这些发现对于审查和制定生育框架的组织具有重要意义。此外，对于在试图建立家庭的过程中指导不孕夫妇的医疗保健专业人员来说，了解这些偏好对于促进他们对未来家庭计划的知情决策至关重要。
研究资金/利益冲突：该项目由丹麦独立研究基金会资助。作者没有利益冲突需要申报。
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