Psychological aspects of donor insemination: Evaluation and follow-up of recipient couples

Objective: To evaluate the utility of psychological screening for couples entering a donor insemination program. Design: Each spouse completed questionnaires. A psychologist reviewed them and rated the psychological fitness of the couple for participation in the program. Follow-up questionnaires were sent to each couple at a mean of 11 months after entry into the program. Setting: Applicants for donor insemination were studied in an infertility program in a large, tertiary referral center. Patients, Participants: Consecutive applicants to enter the donor insemination program were required to participate in the initial evaluation. Interventions: Couples judged by the psychologist to be at risk for a poor psychological outcome had an assessment and counseling interview with the psychologist before proceeding with insemination. Main Outcome Measures: Initially, the Stress and Infertility Questionnaire measured specific anxieties related to donor insemination, marital and sexual impact, and attitudes about confidentiality; the Brief Symptom Inventory measured psychological distress; and the Dyadic Adjustment Inventory assessed marital satisfaction. At follow- up, 48% of couples returned a modified version of the Stress and Infertility Questionnaire and the other two questionnaires. Results: The psychologist's rating was predictive of pregnancy rates (59% for excellent candidates, 41% for acceptable couples, and 14% for couples psychologically at risk). At-risk couples were more likely to drop out of the program (50% versus only 20% of other couples). Sexual problems were reported by 59% of women and 53% of men. Couples believed that a child should not be told of the donor insemination (74% of wives and 80% of husbands). Initially, 64% of wives and 70% of husbands chose total secrecy with families or friends, and these attitudes shifted little over time. Conclusion: This screening procedure is cost- effective and suggests that psychological intervention should be attempted with at-risk couples.