La educación como derecho fundamental

Although the samples included in this research are clearly not representative o f all couples who are undergoing or have undergone treatment, it perhaps begins to pave

the way for more openness in this field. It is essential that couples have the

opportunity to hear fi*om couples who have told their child, the consequences of doing so, and the ways in which it is done. It is perhaps only then that some o f the damaging stigma and secrecy surrounding all those involved in DI, the donor, consultants, recipient couple and any offspring can start to be dismantled. This study has illustrated the benefits o f talking to others about DI, the majority not responding negatively, and making it easier to utilise support during what can be stressful treatment. As one male participant stated; “The more people I told, the easier it became”.

Research and resources need to be channelled into helping couples who endure the problems o f infertility and do not conceive after DI treatment; thus helping them accept their infertility and move into other areas o f their life. As Koval and Scutt (Scutt, 1990) suggest, the continual emphasis on a successful pregnancy for those undergoing many unsuccessful treatment cycles, “perpetuates the cycle o f depression, despair, hope” (Scutt, 1990, p53.)

One o f the confusions in the field o f reproductive technologies and in maintaining psychological support for those who undertake treatments is reflected on by Shaw (in Davis & Fallowfield, 1991). As she points out:

“The impetus o f reproductive innovations has raced ahead regardless o f the size and complexity o f the psychological dimensions associated with the state o f childlessness”. (Shaw in Davis & Fallowfield, 1991 p i 71).

She also points to the difficulties currently faced in the NHS where doctors and nurses in fertility clinics may be faced with being both the “medical and emotional caretakers” o f patients, as there is a shortage o f trained psychologists or counsellors. So clearly as reproductive methods advance and couples are faced with an ever- increasing number o f decisions, it is essential that emotional and psychological support be integrated at all stages. This might perhaps involve counselling in the initial stages at diagnosis, through the investigations, treatment and if the treatment fails. DI also calls for the need for ongoing support and advice for couples who do succeed in having children in this way and thinking about the future implications for the child. This needs to be integrated with the medical care o f couples, as DI in particular arouses many ethical dilemmas, such as the extent o f non-identifying information about the donor that a DI child and their parents have a right to. Due to the difficulties providing support for couples undergoing treatment it is also important to address the dilemma regarding how to offer counselling so that it is not seen as part of an assessment. This research has highlighted the different needs of couples and ideally one might envisage a service that can provide information, counselling, as well as the opportunities for couples to meet with other men and women undergoing treatment.

It is also important to address the feelings o f the male partner throughout the DI process, increasing his involvement, and acknowledging his feelings about his infertility and any future child bom as a result o f DI. In particular, little is known

about how these families deal with, and speak about DI after the child has been bom, so organisations such as the DI Network play an essential part in the arena of infertility and DI, providing information and resources for men and women and their families. However it is also worth considering how to provide support for couples who may be less well educated and who do not seek out organisations such as the DI Network.

Clearly the decision o f secrecy or openness is not easy, and whilst there seems to be a move towards more openness in this field, this needs to be done carefully and sensitively, taking into account the personal difficulties for men and women who use DI. Openness and the path to breaking down the stigma and secrecy in the field of DI needs to be balanced with adequate resources and psychological support, taking into account at all times the needs of the family as a whole. For those couples who have tried DI treatment unsuccessfully, there needs to be more focused attention on the needs o f this group and priority given to their psychological as well as medical needs. Finally, there is also a need to move away from polarising the two decisions regarding telling your child or not, as these decisions are by no means clear-cut. Both positions have their complications, and options must be made available for the couples to consider what it the ‘best’ decision for them and their families. Given that this is a field where the dynamics o f DI treatment are challenging and anxiety levels approach clinical significance it is essential to address the psychological needs of men and women, both during treatment and afterwards, despite the outcome.

Perhaps as clinicians, psychologists and counsellors work hand in hand a fully comprehensive package o f care can be provided, addressing the needs o f all those who undertake DI treatment, not forgetting the needs o f the potential child.