effective psychosocial intervention. The demo offered sample information,coping skills, and support tools for individuals and couples dealing withinfertility. The goal of this support program is to facilitate a greater sense ofcontrol and resilience to the stresses of infertility treatment. Satisfactionresults suggest the need, viability and appeal for development of a com-pleted program.

Supported by: National Institutes of Health (NIH) Small Business Inno-vative Research (SBIR) grant 1R43HD39066–01.

Monday, October 14, 20022:15 P.M.

O-70

Deciding about IVF: What’s important to infertile couples? Susan G.Millstein, Patricia Katz, Lauri Pasch. Univ of CA, San Francisco, CA.

Objective: Assisted reproductive technology (ART) treatments have bothbenefits and risks. Little is known about the importance that patients assignto these benefits and risks, although this may be crucial in their decisionsabout undergoing treatment. We examined patients’ perceptions about whatwas most important to them in their decisions about infertility treatment.

Design: Prospective, observational study.Materials/Methods: Women and their male partners (n�238) were re-

cruited following an initial consultation with one of 7 infertility practices.Mean age of participants was 36.4 years (females) and 37.8 years (males).Most (71%) were Caucasian (non-Hispanic). Subjects were excluded if theyhad previously tried IVF, were not trying to have a baby with a male partner,had previously had an elective sterilization procedure, or did not speakEnglish. These data are drawn from written questionnaires from the firstwave of data collection. Participants rated the degree of importance of 32risks and benefits in their decisions about infertility treatment. Factoranalysis yielded 8 interpretable factors that were used to form scales: (1)traditional views of what it means to have children, such as pregnancy, birthand genetic linkages [�.91]; (2) treatment-related difficulties such as pain,stress and life disruption [�.80]; (3)having knowledge about the social andmedical history of ones’ child [ � 86]; (4) having regrets about fertility-related decisions [�.87]; (5) risks that the child will be taken from theparents[ � 79]; (6) resolving the infertility [ � 70]; (7) privacy issues [�.68]; (8) health of the child [ �.77]. Single items were used to assess theimportance of the financial cost of treatment, avoiding marital problems,avoiding miscarriage, and avoiding multiple births. Comparisons betweenmen and women were conducted using t-tests.

Results: Across the sample, the most important issues (in decreasingorder of importance) concerned: risks of the child being taken from them(via third party reproduction), experiencing marital problems, having a childwith medical or social/emotional problems, miscarriage, experiencing tra-ditional parenthood (pregnancy, birth and genetic linkages), knowing thechild’s medical and social history, avoiding regrets, and resolving theinfertility problem. Of least importance were the financial cost of treatmentand the possibility of multiple births. Compared to males, females gavesignificantly higher importance ratings to the importance of having children(p �.01), avoiding regrets(p �.0005), resolving the infertility problem (p�.0001) and avoiding multiple births (p �.01). Males gave significantlyhigher importance ratings for treatment-related problems such as life dis-ruption, stress and health risks for the woman (p �.0001).

Conclusions: Infertile couples have many issues to consider in decidingwhat treatment or non-treatment options to pursue. Variation in individuals’perceptions about the risks and benefits of treatment, as well as genderdifferences, are probably important in these decisions.

Supported by: NICHD (P01-HD-37074).

Monday, October 14, 20022:30 P.M.

O-71

Disclosure patterns in couples who have conceived via oocyte donation.Dorothy A. Greenfeld, Susan C. Klock, Deidra T. Rausch. Yale Univ Schof Medicine, New Haven, CT; Northwestern Univ Sch of Medicine, Chi-cago, IL; Indianapolis Infertility Ctr, Indianapolis, IN.

Objective: A growing number of children are conceived every yearthrough oocyte donation, yet little is known about what parents of thesechildren plan to tell family and friends, and what, if anything, they plan totell their children about their method of conception. The purpose of thecurrent study was to: 1) determine what characteristics were important tocouples in choosing a donor; and 2) compare the attitudes and beliefs ofmothers and fathers regarding disclosure of conception information toothers and, in particular, to the resulting offspring.

Design: A cross-sectional survey by mail of participants in three separateoocyte donation programs in the U. S.; one from the East Coast, and twofrom the Midwest.

Materials/Methods: A coded anonymous questionnaire with multiplechoice and open-ended questions regarding ooctye donation and disclosurewas mailed to all mothers and fathers with a current address on file in theseprograms who had a child via oocyte donation. The survey included demo-graphic information, donor characteristics, and disclosure to others andwhether they have told or intend to tell the child. The study was approvedby the Human Subject Review Board of each institution.

Results: Questionnaires were sent to 236 individuals (118 couples); 99questionnaires were returned by 56 women and 43 men (response rate 41%).The average age of respondents was 46 years. Respondents were predom-inantly Caucasian (90%) and well educated with 85% of women and 87%of men having a college degree or higher. 42% were Protestant, 27%Catholic, 17% Jewish, and 14% reported other religious affiliation. Therewere significantly more Jewish respondents from the East Coast program(X2 � 28.9, p �.0006). There were no other significant demographicdifferences between programs. Respondents had an average of 2 childrenwith the average age of the first donor child 3.6 years (range 0.5 to 8 years).Although 92% knew the donor’s medical history, subjects indicated a desirefor more medical history and genetic information about the donor. Tenpercent stated that they would like to see a photograph of the donor.Concerning disclosure to others, there were significant differences betweenmen and women. 50% of men told family or friends and 50% told no one,compared to 80% of women telling others and 16% telling no one (X2 �10.9, p �.009). When asked if they had it to do over again, 66% of womenand 79% of men said they would not tell others. Regarding disclosure to thechild, 8% of women and 5% of men said they had told; 42% of women and26% of men said they plan to tell; 39% of women and 60% of men said theyhave not and will not tell; and 10% of women and 8% of men don’t yetknow whether they will tell or not.

Conclusions: Recipient couples of oocyte donation are in agreement thatthey would like more medical and genetic information about the donor. Amajority of couples have not yet told offspring of their origin, althoughroughly half of the women and a quarter of the men say that they plan to tell.It may be beneficial to address disclosure discrepancies between men andwomen in pre-treatment counseling.

Supported by: None.

Monday, October 14, 20022:45 P.M.

O-72

Ethnic differences in presentation for infertility patients. Kris Bevilac-qua, Judi Chervenak, Barry Witt. Albert Einstein Coll of Medicine, Bronx,NY.

Objective: The goal of this study was to identify issues that may makeselect ethnic groups unique in their initial presentation which would influ-ence their medical and psychological needs as they access treatment forinfertility.

Design: At the time of their first appointment, subjects completed demo-graphic intake information, a questionnaire regarding their emotional expe-riences with infertility, and psychological assessment instruments.

Materials/Methods: A sample of 184 female infertility patients returnedcompleted questionnaires at a metropolitan reproductive endocrinologycenter. As part of the demographic information, patients were asked toidentify their ethnic background without being given predetermined cate-gories. The psychological measures included were the Spielberger State-Trait Anxiety Inventory, Profile of Mood Scale, and Symptom CheckList-90.

Results: Only women who identified their ethnicity and had a physicalexam were included in this analysis (n � 147). Ethnic groups were Amer-

FERTILITY & STERILITY� S27

ican-Black (n � 28), Caribbean-Black (n � 26), African-Black (n � 2),Indo-Pakistani (n � 9), Hispanic (n � 19), Asian (n � 8), and Caucasian(n � 58). Psychological instruments demonstrated that the majority of thesesubjects scored within the normal range on most psychological measures.Women of Hispanic and Asian background scored higher on the Somaticscale of the SCL-90 than did the other women. This suggests a style ofinterpreting psychological stresses rather than pathology. Black women,regardless of origin, fell within the normal range on psychological measuresbut were more likely than other ethnic groups to be overweight (BMI25–29) or obese (BMI �30). There was no correlation between weight andany psychological measures. Among all Black women, 50% were obese,36% were overweight, and 15% were at a healthy BMI. Of the Hispanicwomen 31% were obese, 47% were overweight and 15% were of a healthyweight. Among Caucasian women, 17% were obese, 29% were overweight,and 53% were at a healthy BMI.

Conclusions: Broad ethno-cultural factors as well as religious beliefs andgenetics can influence the outcome for women seeking infertility treatment.For Hispanic and Asian women the tendency to experience psychologicalissues through physiological symptoms may make symptom interpretationand patient management difficult. Recognition by staff that in certaincultures somaticization of psychological symptoms is normal may helpmedical staff not label patients as psychological ‘disturbed’ or ‘difficult’.Because obesity in Black women subjects did not influence psychologicalscores, it suggests that for these women being heavy is acceptable and notthe social deficit it may be in broader American culture. If psychologicalstress is not present it may be more difficult for a woman to becomemotivated to lose weight even when the goal is a desired pregnancy. Obesityhas been shown to lessen the chances of becoming pregnant, increasespontaneous abortions and is associated with complications of pregnancy.Recognition that excess weight is ego-syntonic for these cultures can givemedical professionals a supportive rather than critical role in patient care.Referrals to high-risk obstetricians for overweight or obese women whobecome pregnant through infertility treatment may help these women de-liver healthy newborn.

Supported by: Albert Einstein College of Medicine.

Monday, October 14, 20023:00 P.M.

O-73

The social impact of infertility. Patricia Katz, Susan Millstein, LauriPasch. Univ of CA, San Francisco, San Francisco, CA; UCSF, San Fran-cisco, CA.

Objective: There is some evidence of difficulties interacting with family,friends and co-workers, feelings of inadequate social support, and socialisolation as a result of infertility or the process of infertility treatment. Weexamined infertility patients’ perceptions of the effects of infertility onsocial relationships, including relationships and interactions with partners,family members, and friends.

Design: Prospective, observational study.Materials/Methods: Women and their male partners (n � 238) were

recruited following an initial consultation with one of 7 infertility practices.Mean age of participants was 36.4 years (females) and 37.8 years (males).Most (71%) were non-Hispanic Caucasian. Subjects were excluded if theyhad previously tried IVF, were not trying to have a baby with a male partner,had previously had an elective sterilization procedure, or did not speakEnglish. These data were drawn from written questionnaires. Social impactwas assessed with questions asking subjects to rate how frequently they feltuncomfortable in a variety of social situations because of their problemshaving a baby; how often they felt that their partners, families, or friends didnot understand what they were going through; how often they felt they couldnot talk to people about their problems having a baby; how often they hadavoided certain social situations because of problems having a baby; howsatisfied they were with their partners; and the effect of fertility problems ontheir sexual relationship with their partner. Each of these topics was mea-sured with multiple items, and scored as a scale. Each scale exhibitedacceptable internal consistency (Cronbach’s alpha �.80). Comparisonsbetween men and women, and between individuals with lower ($60,000/year or less; n � 24) and higher incomes (n � 214), were conducted usingt-tests. Multiple linear regression analyses were used to test the combinedeffects of sex and income.

Results: Women reported greater impact on their sexual relationship (p�.0001), greater discomfort around family (p �.0001), and greater discom-fort around friends (p �.0001) than men. Women also reported that theirpartners (p �.0001) and friends and families (p �.0001) were less under-standing, and reported a greater tendency to avoid social situations becauseof infertility (p �.0001). Individuals with lower incomes reported greaterimpact on sexual relationships (p �.0001), greater marital tension regardingdecisions surrounding infertility and infertility treatment (p �.05), greaterdiscomfort around family members because of their infertility (p �.05),greater discomfort around babies (p �.0006), and a greater tendency toavoid social situations (p �.02) than individuals with higher incomes.Lower income women (n�12) were particularly vulnerable, reportinggreater impact on sex (p �.02), greater marital tension (p �.01), morediscomfort around family (p �.01), and greater social avoidance than higherincome women.

Conclusions: Women and individuals with lower incomes report a greatersocial impact of infertility than men and higher income individuals, respec-tively. Lower income women report the greatest impact. These results mayreflect particular social pressures and unmet social needs perceived bywomen and individuals with lower incomes as a result of infertility.

Supported by: NICHD grant P01-HD-37074.

Monday, October 14, 20023:45 P.M.

O-74

Children conceived through ICSI and IVF at 5 years of age: Behavioraladjustment, parenting stress and attitudes: A comparative study.Frances L. Gibson, Catherine A. McMahon, Jennifer Cohen, Garth I. Leslie,Douglas M. Saunders. Dept Neonatology Royal North Shore Hosp, Syd-ney, Australia; Dept of Psychology Macquarie Univ, Sydney, Australia;Dept Psychological Medicine Royal North Shore Hosp, Sydney, Australia;Dept of Neonatology Royal North Shore Hosp, Univ of Sydney, Sydney,Australia; Dept Obstetrics & Gynecology, Royal North Shore Hosp, Univ ofSydney, Sydney, Australia.

Objective: Intracytoplasmic sperm injection (ICSI) is now an acceptedtreatment for male infertility. ICSI bypasses the natural selection processesof both traditional in vitro fertilization (IVF) and natural conception andthere are potentially more risks during fertilization. However, limited in-formation is available on the long-term outcome of children conceivedthrough ICSI. The objectives of this study were to examine 1) childbehavioral adjustment and, 2) parenting stress and attitudes in families whoconceived through ICSI compared to children conceived through traditionalIVF and natural conception.

Design: A prospective follow-up was conducted at 5 years of age for 99children conceived through ICSI, 80 conceived through IVF and 113non-IVF children conceived naturally.

Materials/Methods: At 5 years both parents completed questionnairesconcerning child behavior, temperament and development, and parentingstress and attitudes (protectiveness, child vulnerability). Teachers also com-pleted measures of behavior and development. Statistical analyses wereconducted controlling for salient demographic and child variables (parentage, education, language, child gender, twin).

Results: There were no significant between group differences in behaviorproblem scores based on mother, father or teacher report, nor in parentratings of temperament. However, IVF mothers more often expressed con-cern over child behaviors compared to ICSI and non-IVF mothers (p�.006). Non-IVF mothers rated their children’s development higher thanboth ICSI and IVF mothers (p �.033) and there was a trend in a similardirection for teacher ratings of non-IVF children (p �.067). There were nosignificant group differences in mothers and fathers parenting stress scores.While fathers reports of parenting attitudes did not differ between groups,both ICSI and IVF mothers reported more protective attitudes (dependence,control) compared to non-IVF mothers (p �.010). Examination of therelationship between parenting attitudes and behavior revealed that for thewhole sample more protective attitudes and perceptions of child vulnera-bility by mothers and fathers were related to parent report of more difficultchild behavior/temperament.

Conclusions: This study showed that both ICSI and IVF mothers expressmore protective parenting attitudes and IVF mothers express more concernover child behavior compared to non-IVF mothers. However, there were no

S28 Abstracts Vol. 78, No. 3, Suppl. 1, September 2002