Bloque II. Así es cómo me siento en mi trabajo actual

Recipients were invited to participate in 2 aspects of this study: observations and interviews. Donors were also invited to participate in the observational phase of this study. Details of the ethical conduct by which the recruitment of patients took place were outlined in Section 3.3 (above).

Observations

At both clinics, matching-related activities took place during patient consultations.

During the ‘Initial Donor Consultation’ clinicians classified donors’ physical and social characteristics and during the ‘Initial Recipient Consultation’ clinicians classified the characteristics of recipients’ (and their partners) and recipients’

preferences for donor characteristics; these consultations were often the first time that patients were attending the clinic. During the ‘Donor Offering Consultations’ a nurse offered donors to recipients in a face-face/ telephone consultation and recipients accepted or declined the donor(s) under offer.

Whilst ‘Initial Donor Consultations’ were relatively easy to identify this was less the case with ‘Initial Recipient Consultations’, where it was sometimes difficult to single out which consultations to attend, particularly when the women themselves did not

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specify or know their reason for attending. For example, on several occasions I observed consultations in which women wanted a ‘fertility check-up’, to use a known egg donor or to use their own eggs, and therefore recipients’ characteristics or preference for donors were not recorded. After consulting with doctors and receptionists at both clinics the inclusion criteria for potential recipient consultations was restricted to women in their mid-late 40s, who are the main users of egg donation (HFEA, 2014b). The process of inviting donors and recipients to have their consultations observed was similar at each clinic. All recipients and donors were approached on my behalf by a clinician from the clinic in the first instance (as explained in ‘Informed Consent’ in Section 3.3 above).

Interviews

The inclusion criteria for recipient interviewees was to (a) have accepted a donor during the period of fieldwork at each clinic and (b) be able to provide informed consent and speak English or Gujarati (researcher’s spoken languages). The stage of having accepted donors was chosen because this allowed recipients’ experiences and practices throughout the matching process (albeit retrospectively at times) to be captured, e.g. of stating their preferences, of declining donors, of deciding to accept a donor and donor information. Given that the majority of recipients in previous studies on matching have predominantly explored the views of white, middle-class women (Konrad, 2005; Mamo; 2005; Bonaccorso, 2009; Nordqvist, 2010; Klotz, 2014; Rubin et al. 2015), the intention in this study was to over-sample BME recipients.

Recipients of donor eggs were identified and approached with the help of nurses and doctors in the clinics. The recruitment of recipients for interview differed at each clinic, reflecting the individual perspectives of the nurses at each clinic (themselves influenced by other dynamics, such as the size of the clinic). At Creative Fertility,

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nurses felt uncomfortable with approaching recipients for an interview whilst they were still having treatment at the clinic. Therefore, it was agreed that nurses would only contact recipients who had agreed to participate in research on their HFEA consent forms (all of whom had finished treatment at the clinic). From the 65 recipient consent forms considered, 14 recipients had agreed to being contacted, 4 recipients were deemed by nurses as being “too anxious” to approach. This led to 10 recipients being invited for an interview; two recipients did not respond and one recipient originally agreed but then stopped contact. This process resulted in a sample of 7 recipients being interviewed, including one couple (i.e. recipient and partner).

At The Fertility Centre, some recipients were approached for interview after I had observed their consultation with a clinician and some were approached by the head Nurse (who did feel comfortable approaching recipients on my behalf). All of the recipients who were invited for interviews at The Fertility Centre were therefore still in the process of having treatment and were regularly attending the clinic, often as a couple. Nine recipients were recruited through ethnographic observations (by me) and three recipients were approached by my primary gatekeeper. These processes resulted in a higher rate of interviews, with 12 recipients in total, including 12 couples.

All recipients were provided with an Information Sheet prior to having an interview and after explaining this information to recipients verbally I obtained written consent from all individuals before the interview took place (as explained in the section on

‘Informed Consent’ above). The difference in partner attendance in interviews at each clinic could have been the result of the method of recruitment used at each clinic. That is, at Creative Fertility, couples were no longer attending the clinic and so it may have been inconvenient for them to attend. At The Fertility Centre on the other hand, the

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majority of recipients were still having treatment at the clinic, and so this may have made it more convenient for recipients’ partners to attend the interview.

Recipients (and Partners): Interviewee Characteristics

In total, 19 recipients were interviewed. This comprised 7 recipients at Creative Fertility and 12 recipients at The Fertility Centre. The majority of recipients at both clinics were using egg donation due to age-related infertility (n=15), and the average age of the whole sample of recipients was 44 years. One recipient at each clinic was using egg donation due to pre-mature ovarian failure and were each in their mid-thirties (n=2), and one recipient at each clinic was a male same-sex couple (n=2).

Twelve recipients identified as white and seven recipients identified as BME.

However, there was a noteworthy difference in how the ethnicity of recipients was distributed across each clinic. At Creative Fertility the vast majority of recipients self-defined as white (n=6) whilst at The Fertility Centre recipients came from a diverse mix of ethnic backgrounds; while 50% of interviewees self-defined as white (n=6) the other 50% came from BME backgrounds (n=6). All of the recipients were in a relationship. The majority of recipients were in a relationship with a partner from a similar ethnic (or rather racial) background to themselves (n=14) whereas 5 recipients were in a relationship with a partner of a different ethnicity to themselves. Four BME recipients had a white partner and one white British recipient had a black African partner. With the exception of one recipient (from France at Creative Fertility) all interviewees lived in the UK.

All but one of the recipients who were interviewed had accepted a donor. At The Fertility Centre one couple was interviewed at the stage of stating their preferences in the hope of interviewing them again when they had been offered a donor, but delays to this couples’ treatment meant that the second interview did not take place. In one

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case of a male same-sex couple at Creative Fertility (Dirk, see below), the partner of the recipient was interviewed but not the recipient himself. Below, Table 3.3 (Creative Fertility) and Table 3.4 (The Fertility Centre) outline the relevant characteristics of the recipients (and their partners) who were interviewed.

Table 3.3 Creative Fertility: Recipient Characteristics (Interviews)

Recipient

Pakistani White British Pregnant Middle Caroline 47 White British White South

African Miscarried Working Helen 48 White British White British Pregnant Middle Wendy 45 White British White British Pregnant Middle Brenda &

Roger 44 White British White British Pregnant Middle Camille 47 White French White British Pregnant Middle Dirk [Partner

Table 3.4 The Fertility Centre: Recipient Characteristics (Interviews)

Recipient

Jonathan 41 Chinese White British Accepted

Donor Working Dipti 32 British Indian White British Accepted

Donor Middle Rada & Faris 44 Iranian Iranian Accepted

Donor Working Dan & Tina 44 White British White British Accepted

Donor Middle

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Betty & Nick 48 White British White British Accepted

Donor Middle Linda & Tim 45 White

German White British Pregnant Middle Joanne &

The social class of recipients were also different. Social class is an ambiguous concept and can include a multitude of facets (Nazroo, 1998; Lareau, 2008). In this study, the socio-economic background of recipients was determined through their educational background, their occupation, the occupation of their partner and the way in which recipients talked about their ability to afford treatment. On the whole, recipients who came from middle-class backgrounds also had a higher education degree. At Creative Fertility the majority of recipients were classed as coming from middle-class background (n=6).

At The Fertility Centre on the other hand, recipients came from a mixture of socio-economic backgrounds. The majority of recipients came from working-class backgrounds (n=7), including 5 recipients from a BME background. On the other hand, 5 recipients came from a middle-class background, including 1 recipient from a BME background.