Commitment Theory as the Theoretical Framework in Third-Party Reproduction.

Assisted reproductive technology (ART) and third-party reproduction provide the opportunity for infertile couples to have children through different genetic links. This type of treatment has created many challenges for infertile couples. With this treatment, the infertile couple will have a child who is biologically related to the gamete/embryo donor. Accordingly, the transformation that occurs in the structure of traditional families and the concept of parenthood is one of the main consequences and challenges which requires in-depth research. In spite of the successful expansion of infertility treatment and third-party reproduction, there is still no proper social context for implementing third-party infertility treatments in Iran. Therefore, despite the need to use the technology, some couples refuse the treatment unless their confidentiality is preserved. Many couples follow the practice surreptitiously by keeping the donation treatment confidential, to get rid of the existing social stigma and protect their identity, the child and the donor's identity. Commitment theory as a theoretical strategy is proposed to solve the problems of all parties involved in this type of "social and non-biological" parenting. Commitment theory in the context of third-party reproduction expresses the commitment to the contract accepted by the donor and the recipient of the gamete/embryo, based on which, the recipients consider the resulting child as their own, and are committed to all the related paternal-maternal rights and duties such as "alimony" and "inheritance". On the other hand, the donors undertake to waive all their paternal-maternal rights and duties by donating gamete/embryo.

Step-by-step decision-making process in third party assisted reproduction: a qualitative study.

This study explores the experience of decision-making about the third party assisted reproduction in Iranian infertile patients using a qualitative approach. Data were collected in 2017-2019 through in-depth interviews of 20 infertile participants (3 couples and 14 individuals) who became pregnant or had children through third-party reproduction and 12 specialists. The interviews were transcribed verbatim, the data were managed using the MAXQDA 10 and analysed using a conventional content analysis approach. The main category that emerged was 'step-by-step process of adjustment to third party assisted reproduction'. From this, five sub-categories were extracted: (i) 'parental preference for biological children over non-biological children'; (ii) 'parental preference for non-biological children over childlessness threats'; (iii) 'strong preference for having partial genetic link with children'; (iv) 'flexibility in removing or overcoming barriers to third party reproduction'; and (v) 'parental preference for adopted children over childlessness'. The findings in the present study suggest the importance of lineage and biological relatedness in Iranian culture. Patients adjusted to non-biological parenting as a treatment option only if they have to. Using a step-by-step decision-making process helped participants make more thoughtful decisions by organising relevant information and defining alternatives. The results of the present study can help healthcare providers with counselling regarding parenting with or without genetic ties.

The Impact of Third Party Reproduction on Family and Kinship.

The development of in vitro fertilization (IVF) in the UK, in 1978, proved a major breakthrough in the process of human reproduction, which had remained constant in human history. The impact of IVF and the ensuing assisted reproductive technologies (ARTs) has not been limited in revolutionizing the "natural" practice of biological reproduction, but has reached out to and affected almost every institution in society. Family and kinship, as the social expression of reproduction and the institutions which are the most transparently structured realm of human life are those most profoundly affected by ARTs. Although literature on the implications of ARTs is in general abundant, this article presents new insights on their impact on family and kinship in Iran, which remains a unique case in the Muslim world. It explores the particular way ARTs, especially third-party donation, have been endorsed and practiced in Iran, and their consequences for the family, the infertile individuals, and their position vis-à-vis their kin and social group. The conclusion points to the lack of clarity concerning the initial rulings by the Islamic jurists, who allowed the practice of ARTs, and which has led to a number of unintended consequences regarding the legal, religious, cultural, and ethical issues, affecting the family, its structure and the relationship between the kin group. These consequences range, inter alia, from the question of the anonymity of third-party donor, to the permissibility of gamete donation between blood relatives, and to the absence of enforceable legislation.

Sociological Study on the Transformation of Fertility and Childbearing Concept in Iran.

Fertility and childbearing, in addition to the biological aspects, has always been regarded as a social phenomenon and, therefore, to understand the incident, values and beliefs, norms, and in short, the culture of any society should be scrutinized. Since the concept, condition, and value of childbearing is associated with cultural, social, political and economic dimensions, it has undergone various transformations during passage of time from past to present. The sociological approach of the current study investigated the evolution of the concept and value of fertility and childbearing in light of historical, social, cultural and economic upheavals. This study shows that the methods of rationalizing and legitimizing decisions about fertility and childbearing are defined and specified in the context of society. The rational for selecting the decisions is intermingled with social, cultural, economic, and political evolutions of the society like modernization, urbanization and the level of development in human communities. Today, fertility, childbearing and the number of children are not only connected with the interpretations of the individuals about the conditions and micro and macro subjective and objective factors surrounding them, but they are also linked with factors such as family income, the amount of time parents allocate to their children, quality of child nurturing and other family variables.

An Evaluation of the Historical Importance of Fertility and Its Reflection in Ancient Mythology.

Myths are reflective of human concerns and needs during ancient times. By reviewing them, it turns out that many human problems today, have a historical background. Among the main themes of ancient mythologies, fertility and reproduction have various representations in ancient civilizations. The purpose of this paper was to review myths and common symbols of fertility and reproduction in ancient civilizations and evaluate the reasons of their continuous importance in different cultures. The data in this review study was obtained by scrutinizing the related literature. The gathered data indicated the multiplicity and variety of fertility symbols in ancient myths. Most ancient fertility symbols were inspired by the nature and some of them like earth and water were common in mythology of different civilizations. Therefore, the symbols consolidate the concept of conformity between human reproductive concerns and the nature's necessities.

Embryo Donation in Iranian Legal System: A Critical Review.

Recent developments and newly-discovered methods for infertility treatment including in vitro fertilization and third party reproduction raise many questions and challenges with different ethical, legal, sociological and psychological dimensions. In Islamic countries, despite great developments in using this technology, the questions concerned with recognition of IVF methods and third party reproduction and legalization of this method are still the challenging ones. The approach of a few Shiite clerics to this issue has facilitated the legalisation of infertility treatment in Iran. The Iranian Parliament, with reference to Shiite clerics' opinions (Fatwa), enacted the Act concerning Embryo Donation to Infertile Couples and its bylaw which can be considered as a successful example of legalization of third party reproduction in an Islamic country. The aforementioned Act permits embryo donation through artificial insemination from legally married couples to infertile couples. However, many of the legal aspects of this event are not specified in this Act and in many cases it added several uncertainties. This uncertainty, especially regarding the rights and duties of recipients and the child, causes important problems which generate more concerns. This article aimed to review the advantages and flaws of the Act. It is believed that the enactment of the aforementioned Act is an important step but an insufficient measure in this field. Important issues have been left unanswered and unclear in this Act which should be considered by legislators in any future revision of it.

Attitudes about Sex Selection and Sex Preference in Iranian Couples Referred for Sex Selection Technology.

BACKGROUND: Gender preference is prevalent in some communities and using medical techniques to choose the baby's sex may cause the gender discrimination and gender imbalance in communities. Therefore, evaluating the gender preferences and attitudes towards using sex selection technologies seems to be necessary. METHODS: This cross-sectional study was conducted in Avicenna Fertility Center. Participants were 100 women with one child who were referred for sex selection. Data were collected through self-developed questionnaires. The questions were designed by the researchers at the experts' panel. To determine the validity of the questionnaire, the viewpoints of professors specialized in these issues were obtained. The statistical analysis of the data was performed using SPSS software (Version 11.5), and p < 0.05 was considered significant. RESULTS: Tendency toward the male was more than female sex (55.5% male, 15.5% female and 28.5% no tendency). Majority of participants agreed with sex selection with medical reason and sex selection in order to balance the family. Women's level of education had positive effect on agreements to fetal sex selection with medical and non-medical reasons (p < 0.001). CONCLUSION: Although gender preferences were toward the male sex but this preference was not very strong. Most participants agreed with non-medical sex selection for balancing the sex composition of their children. It doesn't seem that non-medical sex selection for family balancing causes severe sex imbalance in Iran.

Fertility behaviour of Iranian women: a community-based, cross-sectional study.

BACKGROUND: The fertility behavior of Iranian women and their reproductive needs is changing and consequently, for providing good services, it is critical to monitor their reproductive behavior at a national level.  METHODS: This study was carried out by Avicenna Research Institute in the urban and rural parts of Iran between 2010 and 2011. Using cluster sampling, the reproductive history of 17,187 married women aged 20 - 40 years were recorded. The statistical analysis of the data was performed using SPSS software (Version 11.5), and P < 0.05 was considered significant.  RESULTS: The common methods of contraception at the time of interview were natural methods (29.8%). The first pregnancy was unwanted in 20.6% of the women. The average number of childbirth per 35 - 40 years woman was 2.4. The mean age of women at marriage date and the mean age at the first childbirth both have increased with time (p< 0.001).  CONCLUSION: Although the fertility rate has declined in Iran, the most important reproductive issues like unwanted pregnancy and use of non-reliable methods of contraception are not resolved yet. Increased mean age at first Childbirth and elevated numbers of couples with no childbirth, because of voluntarily childlessness or Infertility should be noticed more by policy makers. Then allocating enough resources for reproductive health services is vital in new family planning policies.

Prevalence of Primary Infertility in Iran in 2010.

BACKGROUND: Infertility is one of the most significant medical, as well as social problems that affect psychological health of families and societies. Determining the prevalence of infertility is important for evaluating the potential of fertility. There are different reports on the prevalence of infertility in Iran, but the current research employs fertility history in order to provide an unbiased estimation of primary infertility. METHODS: Data from a national survey of Iranian women aged 20-40 years was used in this study in year 2011. Totally, 1011 clusters were randomly selected according to post office codes, proportional to the population of the province. We evaluated the history of fertility as the basis for gathering information. Accordingly, we designed a questionnaire. Subsequently, we recruited and trained nurses and obstetricians to call on married women to fill the questionnaires. Primary infertility refers to a condition in which couples have not been able to conceive a child after one year of un-protected intercourse. RESULTS: In this research, we questioned 17187 women in 1011 clusters. The mean age of the women at the time of their marriage was 20.1, and that of their husbands was 25.4 years. The mean age of women at the time of their first pregnancy was 21.1. This research revealed the prevalence of primary infertility to be 20.2% in Iran. CONCLUSION: The prevalence of primary infertility in Iran seems to be higher than the world average. Therefore, it is crucially important to support the large number of couples who face this problem.