[Parenthood challenged by cystic fibrosis. Experience of affected parents]. / La parentalité à l'épreuve de la mucoviscidose. Expérience des parents atteints.

INTRODUCTION: Medical progress affords patients with cystic fibrosis (CF) the opportunity to become parents. OBJECTIVE: To assess the psychological issues of parenthood in persons with cystic fibrosis. MATERIAL AND METHODS: Semi-structured interviews on parenthood, conducted by a psychologist with CF parents treated at the Cystic Fibrosis Center and the Transplantation Center of Foch hospital (Suresnes, France). RESULTS: Twenty-one (21) fathers and 22 mothers participated ; 84 % had become parents through pregnancy, 14% via adoption and one woman by means of surrogacy; 73% of the women and 67% of the men had done so prior to lung transplantation, while 25% had achieved parenthood without or against medical advice. As parents, they suffered from a lack of familial and medical support for their parental projects and a lack of recognition of their reproductive difficulties. CONCLUSION: While the desire for a child may be initially repressed by potentially life-threatening risks, a loving couple with a satisfying sexual life may in many instances surmount the repression and express the desire, which is not only the desire for a potentially life-bearing body, but also the desire to start a family.

[The destiny of cryopreserved embryos]. / Le destin des embryons congelés.

OBJECTIVES: To know the psychological motivations of couples who keep their embryos so long (five years and more) and do not make a decision about them. PATIENTS AND METHODS: We studied 84 couples refrained from making a decision on their cryopreserved embryos for at least five years. They were invited to fill out a questionnaire focusing on three points: the reasons of the indecision, their own representation of the cryopreserved embryos and their choice for the future: donation to another couple, to research, pregnancy or no solution for the moment. RESULTS: Mean (S.D.) women's and men's age were respectively, 38.8 (2.5)- and 41.3 (2.5)-years old. On average, three (1-9) embryos are preserved since 7.5 (5-12) years. Most of couples are parents. Four major reasons explain their attitudes: feeling of being too aged (25%), fear of a multiple pregnancy (45%), disagreement between members of couple (20%) and fear of failure (42.5%). Multiple choices were given to the future of the embryos: 25% wanted a pregnancy, 8% wanted to give them to infertile couples, 20% to research and 27.5% did not find any solution. Twenty percent were hesitating. The representation of those embryos is more symbolic than material. Most of the time, they see them like a potential child, a hope for the future or a brother or sister of their alive children. DISCUSSION AND CONCLUSION: Those embryos are symbolized. They are a proof of fertility, a hope for another child. So, whatever the legal statement, couples will be in a dilemma because it is never easy for an infertile person to renounce to embryos, and the hope for children.

[Talking about adoption during IVF]. / Parler d'adoption en AMP.

OBJECTIVES: This article deals with the place of adoption for couples involved in a medical help for procreation. The question is: do these couples wait for their gynaecologist's advice before beginning a procedure of adoption or do they launch such a procedure before? PATIENTS AND METHODS: We have questioned 90 couples, on the first day of their treatment in our unity, about the place of adoption in their desire for a child. Are they in favour or against adoption? Have they already begun or not to think, to read, to make a decision about adoption? RESULTS: In this research, 49% of theses couples are not in favour of adoption, especially when they have already had children through medical help. 84.5% thought about adoption as soon as they received the announcement of the infertility. 69% have shown their interest in adoption by reading books, watching TV or by speaking with adoptive parents or adopted children. 29% have begun a procedure of adoption but only 18% really intend to adopt a child. DISCUSSION AND CONCLUSION: Most of the infertile couples do not wait for their clinician's advice to be interested in adoption. But they probably have to hear from their clinician that the treatments are definitively finished to become completely involved in the adoption process. Some of them will prefer to stay even so without children or to think about the gamete's donation.

[Oocyte donation: parents's secrets and lies]. / Don d'ovocytes: secrets et mensonges.

BACKGROUND: Since 1994, oocyte donation in France must be organized anonymously, in compliance with the bioethics law. The donation is free and any publicity to enrol donors is forbidden. In this system, the recipients are encouraged to incite a donor to visit the recipient's fertility unit. These donors are called "symbolic" donors, since they allow the recipient to be entitred to receive oocytes from another anonymous donor. According to the law, this procedure can be performed both anonymously and non-anonymously. OBJECTIVES: We wanted to study the implication of the anonymous system, focusing on the secret of the child's conception and on the relationship between the recipient family and the "symbolic" donor. MATERIAL AND METHODS: We contacted all the patients (n=83) who had children with oocyte donation in our center between 1988 and 1998. These patients participated in an interview conducted with a standardized questionnaire. RESULTS: Fourteen (17.8%) of the couples were lost to follow-up and three declined to participate. Five recipient couples preferred a non-anonymous donation. In all, 70% of the couples had not yet told their child about the donation. They had mentioned the IVF but not the donation despite of the fact that 50% of symbolic donors came from the family of the recipients, 34% from their friends, or 6% from their professional environment; 10% were not related to the recipients. Long after the child's birth, 25% of the recipients had no contact with the symbolic donor but 41% had selected her as the child's godmother and 15% of symbolic donors were the first to be informed of the birth of the child. After the donation, a gift was offered to the "symbolic" donor by 57% of couples, 33% did not know how to thank them (retribution is forbidden by law) and 10% of couples mentioned that their donor refused any gift. Concerning the donor whose oocytes were used, 63% of recipients did not want to know anything about her. 20% would have liked to have medical information and 13% would like to have all kind of information about her. Only 2% of recipients would have liked to know her identity and 2% would have liked to meet her. CONCLUSION: In agreement with earlier reports in the literature, the majority (70%) of the parents did not inform their child about the oocyte donation even though the symbolic donor was in contact with the child (being his aunt or his godmother for example). The French system has created a double debt: one related to the real donor and another related to the symbolic donor. In the long run, the parents have found a way to humanize this technique: they have given a symbolic place of godmother to the volunteer donor.

[Psychological approach to hyperemis gravidarum]. / L'approche psychologique des vomissements incoercibles gravidiques.

INTRODUCTION: Hyperemesis gravidarum is a phenomenon that concerns only 1 or 2% of pregnant women who require hospitalization if their anorectic behavior does not cease. The treatment consists in complete isolation, anti-vomit drugs and rehydration therapy. OBJECTS: Isolation has been practiced existed since 1914, and is based on the belief that these women were simulating pain in order to obtain abortion. By isolating them from their family environment, the medical staff hopes this secret desire will be revealed. We tried to evaluate the reality of this analysis. MATERIAL AND METHOD: Two psychological interviews were conducted by a questionnaire addressed to 23 pregnant women at the time of their hospitalization for hyperemesis gravidarum in a level 3 gynecology-obstetric unit. All patients were submitted to the described treatment. RESULTS: Four groups were found. In the first group (n=6) women were submerged by a present and conscious conflict concerning their pregnancy, which found and easy solution. In the second group (n=7), the women had lost a pregnancy a short time before the present one. These patients were suffering from this loss and could not easily accept their new baby. The third group (n=6) concerned women who were afraid of a living a dramatic event that their mother had experienced in the past. This worry, held far from their consciousness, could be recalled during the interviews. In the last group (n=4), the women had passed through major difficulties in their relationship with their mothers during childhood. Becoming a mother themselves, they feared they would reproduce the same attitudes toward their own babies. Within this group, only one woman finally asked for an abortion that was performed. CONCLUSION: It would not appear that the patients have to be isolated for them to reveal their desire for abortion. Conversely, a psychological interview allows better understanding of the ambivalent attitudes of pregnant women and thus can be useful in avoiding systematic abortion.