Georgie Forshall

Donor conception has become an increasingly socially acceptable way to deal with issues of male sterility or as a means to start a family for single women and same-sex couples. Sperm banks and fertility clinics offer a range of treatments, privately and on the NHS, but issues of accessibility and choice have led many donors and recipients to contact one another directly through connection websites and social media. While such websites are not illegal, they are unregulated. Previous research (McQuoid, 2015) suggests that recipients of online sperm may be at risk of abuse or harassment from donors when using such sites. This thesis applies a narrative approach to explore the occurrence of ‘morally challenging behaviour’ that sperm donors and recipients may have observed or experienced within the online sperm donation community. The aims of the research are to: 1) learn about donor perceptions of the kinds of norms and values that are sanctioned by the ‘online sperm donation community’ and the degree to which they condone or reject these behaviours; and 2) to discuss any ‘less than positive’ experiences recipients may have had whilst engaging with online sperm donors, the way in which they respond to difficult or traumatic experiences, and the endurance of their sense of self in such scenarios. Three prolific donors from the UK, USA and Australia respectively, and five UK-based recipients were interviewed in two separate studies using an adaptation of Brown et al.’s (1989) Real Life Moral Choice and Conflict Interview and Wengraf’s (2004) Biographical Narrative Interpretive Method. The interviews were analysed using Carol Gilligan’s Listening Guide Method of Psychological Inquiry (2015), which included four ‘listenings’ covering ‘narrative events,’ ‘the self,’ and the ‘listenings’ for the existence of two conflicting or contrapuntal voices (i.e., voices in counterpoint). Issues raised as part of the third and fourth listenings for the donors related to a rejection of fertility clinics, sexual motivations of donors, recipient screening and anonymity and, for the recipients, related to the acceptance/mitigation of risks, exploitation, harassment, and safety. The findings of these studies support McQuoid’s (2015) research which suggests that recipients may be at risk of abusive, threatening, or coercive behaviours from sperm donors in an unregulated context. This highlights the need for safeguarding and regulatory frameworks to protect recipients seeking to obtain sperm online.

Background/Objectives: Pelvic organ prolapse (POP) is a common condition that significantly impacts quality of life. Research has focused largely on older women, while experiences of younger women remain relatively underexplored despite challenges unique to this population. Informed by the biopsychosocial model of illness, this study aims to assess the symptom burden, treatment goals, and information needs of younger women complaining of prolapse by analyzing questionnaire responses from an existing electronic Personal Assessment Questionnaire—Pelvic Floor (ePAQ-PF) dataset. Methods: Mixed-methods content analysis was conducted using free-text data from an anonymized multi-site ePAQ-PF dataset of 5717 responses collected across eight UK NHS trusts (2018–2022). A quantitative, deductive approach was first used to identify younger women (≤50 years old) with self-reported prolapse. ePAQ-PF scores for younger women with prolapse were compared with those aged >50 years, using Mann–Whitney tests. Free-text response data were analyzed inductively to qualitatively explore younger women’s symptom burden, treatment goals, and information needs. Results: Of the 1473 women with prolapse identified, 399 were aged ≤50 years. ePAQ-PF scores of the younger cohort demonstrated significantly greater symptom severity and bother than those aged >50, particularly in bowel, prolapse, vaginal, body image, and sexual health domains (p < adjusted threshold). Qualitative analysis undertaken to understand women’s concerns and priorities produced five health-related themes (physical health; functionality; psychosocial and emotional wellbeing; reproductive and sexual health; and healthcare journeys) and a sixth intersecting theme representing information needs. Conclusions: The findings highlight the substantial symptom burden of younger women with prolapse, as well as treatment goals and information needs specific to this population. The development of age-specific resources is identified as a requirement to support this group.

Introduction Online sperm donation allows those hoping to conceive a baby (“recipients”) to meet prospective sperm donors online, via “connection” websites or social media. These sites offer some advantages to clinical donation (including lower costs and greater choice over donation arrangements) but previous research has suggested that these sites may also pose risks and challenges to those who use them. Therefore, the aim of this exploratory research was to better understand online sperm donation communities and the experiences of both recipients and donors, particularly with respect to situations that could be “morally challenging” or involve harm. Methods Three prolific donors and five recipients were interviewed using an in-depth narrative approach. Carol Gilligan's Listening Guide was employed to analyse the data. Results The findings demonstrated that the donors sought to find ways to maintain autonomy in their donating practices and were concerned about the character and parenting abilities of recipients, as well as the potential for recipients to make unwarranted complaints. The recipients were concerned about their safety and finding a donor they could trust, discussing issues relating to donor “dishonesty”, online abuse, and a lack of support from connection sites and related authorities. Both donors and recipients identified “morally challenging” behaviour relating to donor anonymity (donor use of fake online profiles or aliases) and the sexual motivations or (mis)conduct of some donors. The participants each discussed the ways in which they managed perceived risks. Discussion The degree to which the participants voiced their acceptance or rejection of challenging behaviour in online sperm donation communities varied across and within participants, highlighting the complexity of the way in which people interact in this environment. Further research is required to understand how this form of sperm donation can be as safe and supportive as possible, while also respecting the importance to donors and recipients of autonomy and choice when making donation arrangements.

Background The National Institute of Health and Care Excellence in the United Kingdom have recommended the development of a patient-reported outcome measure (PROM) specific to surgery for pelvic organ prolapse (POP), stress urinary incontinence (SUI), and complications of pelvic mesh surgery (MC). Aims To identify all aspects of quality of life (QoL) that may be impacted by surgery for POP, SUI and MC, to inform the development of a new PROM. Method Thirty-one patients who had undergone surgery for POP, SUI and MC (ranging from &lt;6 months to &gt;5 years ago) were purposively recruited from various National Health Service (NHS) Trusts, as well as community support groups for the conditions. Semi-structured interviews were undertaken over the phone or via video-conferencing software, and a framework approach was employed to analyse the data. A Patient and Public Involvement group, comprising seven women who had undergone surgery for POP, SUI and/or MC, were consulted on various aspects of the study. Findings We identified nine themes for potential inclusion in the PROM. The themes are short-term impacts of surgery; long-term impacts on pre-surgery symptoms; pain and/or discomfort; impact on daily activities; social and leisure activities; emotional wellbeing; sexual activity; personal relationships; and work/education. While some participants showed improvements in these areas following surgery, it was also evident that for some, issues persisted, worsened, or developed post-surgery. Those in the sample who had previous surgery involving mesh reported worse QoL outcomes overall. Conclusion The impact of surgery for POP, SUI and MC on QoL is multidimensional and complex. It is recommended that a future PROM encompasses the potential for improvement of symptoms, the failure of surgery to improve symptoms, the development of new symptoms after surgery, and the consequential positive and negative impacts of surgery on activity, roles, psychological well-being and ultimately QoL, in both the short and long term.

Background This scoping review was undertaken as part of an NIHR-commissioned study, APPRAISE, to develop a patient-reported outcome measure (PROM) and experience measure (PREM) to assess outcomes relevant to surgery for pelvic organ prolapse (POP), stress urinary incontinence (SUI) and pelvic mesh complications surgery, with cross-cultural applicability. Objectives To identify PROMs and PREMs used to assess POP, SUI and mesh complication surgery; to compare the length, recall periods, response options of these tools and the outcomes/experiences assessed. Search Strategy Three databases searched from inception to September 2023 were screened by two independent reviewers. Selection Criteria Primary studies using subjective measures to assess POP, SUI and mesh complication surgery for women aged 16+ years were eligible for inclusion. Related systematic reviews were also reviewed. Data Collection and Analysis Data were extracted into a piloted electronic form by one reviewer and checked by a second. A narrative synthesis of the data was performed. Main Results Of the 2079 included primary studies, 1607 (77%) used a PROM with evidence of psychometric testing. Five hundred and twenty-two (25%) studies used one PROM; 1082 studies (52%) used two or more PROMs. One hundred and fifty-one measures were extracted; of these, condition-specific measures were the most highly cited. There was limited use of PROMs specific to surgery, mental health, body image and PREMs. Some outcomes (e.g., urinary symptoms, emotional wellbeing) are measured in a significantly higher proportion of PROMs than other outcomes. Conclusions Currently, no existing validated PROM evaluates all patient-reported outcomes relevant to surgery for POP, SUI or mesh complications.

In recent years, there has been an increase in people using websites, social media groups and mobile apps to connect with potential sperm donors or recipients. We undertook a systematic review of existing research which sought to: explore the characteristics, motivations and experiences of people who use online sperm donation platforms; assess the quality of the existing literature; identify gaps in the evidence base; and make recommendations for future research. Ten academic and grey literature databases and search engines (MEDLINE, CINAHL, PsycINFO, Scopus, Core, Google Scholar, Open Access Theses and Dissertations, NICE Evidence, Open Grey and Google) were searched in December 2019 and again in June 2024. The quality of the studies was assessed using the Mixed Methods Appraisal Tool and we undertook a thematic synthesis of the findings. The searches produced 18,614 results, of which 30 reports were included in the synthesis. The reports were published between 2010 and 2024, by authors from nine countries, and were qualitative (n = 19), quantitative (n = 7) and mixed methods (n = 4) in design. Four themes and two subthemes pertaining to participants’ motivations and experiences were constructed from the data. The themes demonstrate that OSD is an improvised practice that is laden with stigma and can produce imbalances of power between donors and recipients. The findings point to a need for further research, including prospective research, to be undertaken with more diverse samples, including populations in the Global South, Black and minority ethnic populations, and inexperienced donors.

People looking for sperm (‘recipients’) and people providing sperm (‘donors’) are increasingly connecting via informal online platforms, such as ‘connection websites’ and social networking sites. Typically, research has not focused on this route to conception. Little is known about how people involved in online sperm donation initiate, negotiate, sustain or end their relationships with each other, how power or influence operates within this context, or what the impacts of these influences might be. Previous research has suggested that abuses of power and morally challenging behaviour can occur. The first aim of this project is to explore the interpersonal relationships, power relations and potential abuses of power across the social ecology of online sperm donation. The second aim is to harness this new knowledge to explore the imagined ideal futures of those involved in online sperm donation and to work with them to start to realize these ideal futures. The project comprises three phases: (1) a two-year qualitative longitudinal study following the lives of prospective recipients, donors, and their partners via life story interviews, visual socio-ecological power narratives, and interaction logs; (2) a one-year digital ethnography of five online sperm donation sites; (3) action research workshops with recipients and their partners, donors and their partners, and platform owners, respectively. The multi-modal data will be analysed using narrative, discourse, and thematic analysis. The project will be carried out by a multi-disciplinary team, comprising academics and researchers with psychosocial, bioethical, medical, and legal expertise, and Public Involvement in Research members with lived experience of online sperm donation. The project will produce unique and holistic knowledge of online sperm donation and harness this knowledge to produce impacts across the social ecology that are identified by, and important to, those involved in online sperm donation.