THE LIMITATIONS OF THIS STUDY

There were a number o f methodological difficulties with this study, which are discussed below, with a view to improving and developing research in this area. The two groups o f participants in this study were drawn from different samples and while they did not differ in terms o f most demographic variables or distress measures they differed in terms o f educational qualification, the DI Network group was more qualified than the hospital clinic group. They may also differ in other respects uncontrolled for in this study. As the groups were significantly different in terms of educational qualification, if repeated, this should be controlled for. However, in trying to access the hospital clinic sample, due to HFEA guidelines it was difficult for the researchers to gain access directly to the participants. There was a low response rate from the clinic (36% opted in) and it may have been that some couples had anxieties in completing the ‘opt-in’ form due to a fear that clinic staff might access their questionnaires. Reports from several women to staff at the clinic suggests that they found it difficult to complete the questionnaire due to not wanting to tell someone outside the family about their DI treatments and the issue o f telling the child or not. Staff at the clinic confirmed this stating that the majority o f couples attending for treatment wish to keep it secret.

This is a problem inherent in research into DI where there are difficulties accessing clinical populations undertaking DI as the majority plan not to tell their child. It is perhaps likely that having to write down and describe the experience o f DI is a barrier to those who have not spoken to anyone about their DI to participation in research such as this. Thus where secrecy in DI perhaps equals non-participation in research, this presents a dilemma for researchers, who may have to seek other ways to recruit a representative DI sample. Lee (in Emmy Jennings, 1995) estimates that approximately 90% o f couples wish to keep the DI a secret, perhaps only sharing it with close family. One might expect that those couples who have told no one and plan never to tell the child would not perhaps wish to take part in such a study. Thus, it may be that those who did respond and participate in this study are those who are slightly more undecided about telling and more comfortable in talking about their DI treatment.

It is important to consider the methodology o f this research, and although it provided some insight into the quantitative ratings o f men and women in areas such as distress, mood and concerns, it is clear that this field would also lend itself to qualitative research. One area for future research, given the two very different settings used in this study is to examine in greater depth the discourses used in various clinics, in

terms o f secrecy and long-term issues o f telling. This might be done using

interviews with staff and clients, applying discourse analysis to examine language. This would support previous work by Daniels (1996) which suggests that clinics and their different approaches to secrecy have a vital role to play in increasing openness in this field. However, the issue o f confidentiality and secrecy in DI obviously plays

a part in preventing participants from coming forward, which is why the DI Network were approached since they could provide some insight into couples who believe in greater openness. It was difficult to find couples who could be compared on the basis o f telling versus secrecy, which would have been a preferred approach.

This study explored the views of predominantly ‘white’ couples undergoing or

having completed treatment. Whilst ‘non-white’ couples perhaps face greater

cultural stigma regarding fertility treatments and DI, the bias towards ‘white’ couples possibly also reflects the difficulties in providing DI for different ethnic groups, in terms o f a shortage o f donor sperm. It also selected only heterosexual couples, and there is no doubt that there is also a need to research other groups who use DI. For example, the DI Network also has as its members a number o f single women or lesbian couples who use DI. Although one might anticipate that there might be similarities between these groups in terms o f levels o f distress and concerns, these groups may also face other difficulties, such as isolation, or the stigma and reaction o f others towards them and their child. One has only to cast one’s mind back to the beginning o f this study to recall the hostility in the news debate aimed at women who decide to have a child through DI without being in a relationship with a man. Although this study has to a certain degree focused on the difficulties faced by men and coming to terms with their infertility, for those families who are viewed in society as ‘atypical’ equally painful dilemmas have to be confronted. As most countries have no law about who can or cannot have DI (Sweden currently only allows DI between married or cohabiting heterosexual couples), each clinic is left to make its own decision. Thus decisions about suitability for treatment are varied but

also reflect social stereotypes about parenthood. DiLapi (1989) discusses the motherhood hierarchy, which consists o f women who are defined as most, marginally or least appropriate to bear and raise children. Lesbian and single women who thus seek DI are perhaps viewed within this conceptual framework when approaching clinics for treatment. However, Downie (1988) draws attention to the hurdles the lesbian or single woman will have had to go through in order to have a child through DI, arguing that the child may be much wanted, perhaps making the woman a 'better mother'.

Another group who have not been studied consequently are those couples who have difficulty coming to terms with their infertility and those who do not conceive. This is an area rarely explored, perhaps as it is difficult to access those couples who give up treatment, so little is known about their adjustment to their fertility status or their reactions to DI treatment (Edelmann & Connolly 1986 in Woollett 1991). This is an essential aspect o f DI that needs further study, bearing in mind that the success rates o f DI are only 8.7% (HFEA, 1995) and the length o f time couples undergo treatment, as well as findings from this research o f the psychological impact o f repeated unsuccessful cycles.