STUDY QUESTION Which decision-making factors influence family building among permanently infertile couples? SUMMARY ANSWER Ethical, legal, and financial considerations outweigh genetic relatedness in decision-making, favouring domestic gestational surrogacy, if this were possible, over international options. WHAT IS KNOWN ALREADY Permanent infertility affects 4-5% of people in the fertile age. Their family-building options include adoption, surrogacy, uterus transplantation, foster care, and intentional multiple parenthood. However, in most countries, including Denmark, legal barriers constrain these methods due to surrogacy restrictions, suspended international adoptions, and the experimental status of uterus transplantation. Despite existing research on surrogacy, adoption, and specific causes of permanent infertility, a significant gap remains in our understanding of how couples with permanent infertility make family-building decisions within these limited frameworks. STUDY DESIGN, SIZE, DURATION This cross-sectional study with 150 permanently infertile Danish participants was conducted from June to November 2023 using an online questionnaire. Multiple strategies, such as online forums, fertility clinics, hospital departments, and snowballing, were used to recruit a diverse sample. PARTICIPANTS/MATERIALS, SETTING, METHODS The study included couples aged 26-50 years facing permanent infertility due to the following primary causes: women without a uterus (15%), women with a non-functional uterus (47%) or women for whom pregnancy would be life-threatening (9%), male couples (16%), transgender partner couples (2%), and other causes (11%). The survey collected data on demographics, reproductive history, family-building choices, and communication strategies. Closed questions were analysed using descriptive statistics. MAIN RESULTS AND THE ROLE OF CHANCE Among 150 respondents, 41% had used transnational surrogacy, 27% adoption, 14% chose to remain childless, and 19% were undecided. Critical factors on family-building decisions were ethical, legal, and financial concerns which ranked higher than genetic relatedness. Despite the complexity of family building, most participants were open about their child's origin and received social support. If all family-building methods were legal and available in Denmark, domestic gestational surrogacy would be the preferred method, with uterus transplantation and remaining childless being least popular. LIMITATIONS, REASONS FOR CAUTION The sample size is relatively small, despite the use of a variety of recruitment strategies. Nevertheless, this has ensured a diverse cohort representing the different reasons for infertility and family-building choices. It is important to note that the strategies may have favoured individuals achieving parenthood. WIDER IMPLICATIONS OF THE FINDINGS The finding of our study reveals a notable gap between available family-building options in Denmark and the preferences of couples facing permanent infertility. These insights could be instrumental for organizations reviewing and developing family-building frameworks. Furthermore, for healthcare professionals guiding couples experiencing infertility issues in their attempts to build a family, an understanding of these preferences is essential to facilitate informed decisions about their future family plans. STUDY FUNDING/COMPETING INTEREST(S) The project was financed by the Independent Research Fund Denmark. The authors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER N/A.

中文翻译：

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永久不孕夫妇和家庭建设 - 丹麦的横断面调查。


研究问题 哪些决策因素会影响永久不孕夫妇的家庭建设？摘要 答案 在决策中，道德、法律和财务考虑超过了遗传相关性，如果可能的话，有利于国内代孕而不是国际选择。已知的是永久性不孕症影响了 4-5% 的生育年龄人群。他们的家庭建设选择包括收养、代孕、子宫移植、寄养和有意多亲。然而，在包括丹麦在内的大多数国家，由于代孕限制、暂停国际收养和子宫移植的实验状态，法律障碍限制了这些方法。尽管已经对代孕、收养和永久性不孕症的具体原因进行了研究，但我们对永久性不孕症夫妇如何在这些有限的框架内做出家庭建设决定的理解仍然存在重大差距。研究设计、规模、持续时间 这项横断面研究于 2023 年 6 月至 11 月使用在线问卷对 150 名永久不育的丹麦参与者进行。使用多种策略，例如在线论坛、生育诊所、医院科室和滚雪球，来招募不同的样本。参与者/材料、设置、方法 该研究包括 26-50 岁的夫妇，他们因以下主要原因而面临永久性不孕症：没有子宫的妇女 （15%）、子宫无功能的女性 （47%） 或怀孕会危及生命的妇女 （9%）、男性夫妇 （16%）、跨性别伴侣夫妇 （2%） 和其他原因 （11%）。该调查收集了有关人口统计学、生育史、家庭建设选择和沟通策略的数据。 使用描述性统计分析封闭式问题。主要结果和机会的作用在 150 名受访者中，41% 使用过跨国代孕，27% 的人收养，14% 的人选择无孩子，19% 的人尚未决定。家庭建设决策的关键因素是道德、法律和财务问题，其排名高于遗传相关性。尽管家庭建设很复杂，但大多数参与者都对孩子的出身持开放态度，并获得了社会支持。如果所有建立家庭的方法在丹麦都是合法的并且可用，那么国内妊娠代孕将是首选方法，子宫移植和保持无子女最不受欢迎。局限性，谨慎的原因 尽管使用了多种招募策略，但样本量相对较小。尽管如此，这确保了代表不孕症和建立家庭选择的不同原因的多元化群体。重要的是要注意，这些策略可能有利于个人实现父母身份。研究结果的更广泛影响我们的研究结果表明，丹麦可用的家庭建设选择与面临永久性不孕症的夫妇的偏好之间存在显着差距。这些见解可能有助于组织审查和开发家族建设框架。此外，对于指导遇到不孕症问题的夫妇尝试建立家庭的医疗保健专业人员来说，了解这些偏好对于促进他们未来家庭计划的明智决定至关重要。研究资金/竞争利益 该项目由丹麦独立研究基金资助。作者没有需要声明的利益冲突。试验注册号 N/A。