04 December 2020

Between 10 and 15 per cent of all couples who want children are involuntarily childless. Every year in Sweden, some 6000 children are born to parents who have received medical assistance with having children.

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“More people are being treated, but we don’t know if the number of involuntarily childless is increasing. There are various reasons why people contact us – one of which is legislation granting new groups access to assistance. Also, many wait to get pregnant, so due to their age they have difficulty getting pregnant, and need help because of this.”

Gunilla Sydsjö has worked with childless couples for 35 years. She is professor of psychosocial obstetrics and gynaecology. In her day-to-day work she is an active researcher, but she also meets patients, and people who want to be egg or sperm donors.

Various reasons for infertility

Gunilla SydsjöGunilla Sydsjö Photo credit Anna NilsenFamilies these days are different to families of previous generations, she explains.

“It’s true that the majority are still nuclear families, but many people get divorced, and as a result we see half-siblings and new family constellations. Families with two mothers or fathers are also increasingly common. The number of children who are conceived by way of sperm or egg donation is rising. Another option is double donation, where neither egg nor sperm comes from the parents, instead an embryo is implanted in the woman’s uterus.”

Can’t help everyone

Some 30 per cent of infertility cases have causes relating to the man, e.g. poor sperm production, and some 30 per cent relate to the woman, e.g. variation in egg quality. And in 30 per cent of the cases there is no explanation. For both the men and women, lifestyle factors such as overweight, medications, smoking, drugs and age can affect fertility.

“We can help many people, but not everyone. In this field, the healthcare sector has made fantastic progress.”

When IVF, in-vitro fertilisation, was introduced in Sweden in 1986, about 5 per cent of the couples who used the method had children. Today this figure is about 40 to 45 per cent.

“In those cases where we don’t succeed, we try to help the patients find strategies to move forward in their lives. For instance, for some people, adoption isn’t an option due to age, and they have to rethink their lives.


Some milestones in Swedish public healthcare:

1983: Women in heterosexual couples gained access to IVF.

2003: Egg donation became legal.

2005: Lesbian couples gained access to donor treatment.

2016: Single women gained access to donor treatment.

2019: IVF with double donation of both sperm and egg, i.e. where the child has no genetic link to its parents, became legal.

Surrogate motherhood

Photo credit Anna NilsenSome men and women have children by way of surrogate mothers abroad. Surrogate motherhood means that a woman goes through a pregnancy and birth on behalf of others. In Sweden it is illegal, not least because of ethical matters relating to the surrogate mother.

Women are winners here. Homosexual or single men aren’t able to get help via the public healthcare system.

What are your thoughts on that?

“It can be seen as an inequality, absolutely. Men’s desire for children can be just as strong as women’s”.

The child comes first

She has enormous respect for people’s desire to have children, and their despair in not being able to have any. But there’s a term she keeps coming back to: the child’s perspective. If possible, she has even more respect for it.

“As healthcare workers we must constantly keep in mind what we do, and why. We want so much to help the people who come to us, but sometimes you can wonder if it’s the right time for the couple or the woman to have a child. Will the child have good opportunities in life? Will anyone be at risk? For instance, are the parents too old?”

But the same questions can be asked of parents who have children the natural way.

“Yes, but the difference here is that this is done through the public healthcare system. We carry out a medical intervention. This means we have a duty to provide complete information, that we receive correct information about our patients’ life situation and health status, and that the parents know what they’re doing. Having a child is irreversible; you can’t change your mind.”

Single women and lesbian couples are studied

An infant's foot, Photo credit ChoreographIn her research, Gunilla Sydsjö and her colleagues study different aspects of donor treatments.

“Now, in collaboration with Uppsala University and Karolinska Institutet, we’re working on a study where we follow the single women who have received help with sperm donation through the healthcare system. About 500 women apply for help with this every year in Sweden. Most are a bit over 35, and would prefer to have a partner for their child, but they haven’t found anyone suitable. Within one or two years we hope to have more information about how these mothers are doing – with their child, their financial situation, their network and their social support.”


In another long-term study, the lesbian couples and their children are followed up.

“What we can see is that the divorce rate among these couples is considerably higher than for heterosexual couples who have had assisted fertilisation. We don’t know if this has consequences for the children; it will take many years to determine that.”

Study of egg and sperm donors

In yet another study, the researchers follow the egg and sperm donors. These donors are examined carefully before they are approved; the selection process takes about one year. Previous research shows that the donors are well established in society; as a rule they come from secure circumstances, and simply want to help childless couples.

The donors are not allowed to remain anonymous. If the child, from the age of 18, wants to find out who donated the egg or sperm, he or she has a right to know.

“The donors must be prepared to be contacted by a 20-year-old who wants to know more about their genetic origins.”

Gunilla Sydsjö and her research colleagues now plan to discover how the donors experience being contacted by the donor child. They will also investigate the adult child’s experience of making contact with the donor.

Few children seek contact

“It’s uncommon for donors to be contacted. Of 1100 children who were conceived by way of sperm donation, just 40 or so contacted the clinic to find out the donor’s name and contact details. If this is because the children didn’t want to know, or that they don’t know how they were conceived, we can’t say. And no clinic has experience of how young adults conceived by way of egg donation view gaining information about their donor.”

So, what does Gunilla Sydsjö see in her crystal ball?

“That we get used to the fact that family constellations vary a lot. Children see different parental arrangements, and the healthcare system gets better at treating childless people. Advances in medicine will provide more answers to the question of why some people become infertile, so that they can, if they wish, receive preventive treatment.”

But many questions remain, not least ethical ones. How much should the public healthcare systems pay, at the expense of other medical treatment? Is having children a right? What will be the view of surrogate motherhood in a few years?

“There are strong lobby groups who aim to make surrogate motherhood legal in Sweden. But that door is closed. For now.”

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