The kind of genetic counselling provided with regards to psychological, social and ethical problems varies depending on whether pre-pregnancy or prenatal diagnosis is being given. The first problem we face when we start pre-pregnancy genetic counselling concerns the type of information patients already have about the disease which is very often fragmentary and distorted. Therefore, it is necessary to go over the information from both a medical and a psychological point of view. In our laboratory the blood samples of 757 women, members of 277 families with cases of hemophilia A were tested. About 40% of the consultations were carried out only on blood samples sent from other centres without any contact with the patients. The remaining 60% of the patients had an interview with the genetic consultant at the beginning of the consultation and again when the diagnosis was communicated. Among these patients, about 50% of cases involved a direct telephone contact with the subject tested, while the remaining 50% received the report at their own centres. Therefore, we were not able to verify how effective the information given was. When counselling is over, the diagnosis is given to the subject involved and, at this point, if the subject is at risk we always deal with the problem of providing him/her with information about possible alternatives. The range of possible alternatives is broad and includes: not starting a pregnancy; starting one and waiting for prenatal diagnosis; determining the sex of the unborn child; taking advantage of donated ovum. Actually, the small number of adequate structures which exist in our country and the difficulty in obtaining specific information often automatically lead to either not beginning a pregnancy at all or starting one and waiting for prenatal diagnosis before deciding what to do. When prenatal diagnosis is requested and results show that the fetus is male and is affected by the disease (margin of error from 2% to 5% depending on the tests carried out) the choice is limited to abortion or continuation of pregnancy. 90 prenatal diagnoses were carried out on 72 women: 35 females and 23 healthy males were diagnosed, while 15 were affected males. In 3 cases diagnosis was not possible, in 9 cases the carrier status of the mother was excluded after CVS and 5 miscarried before CVS. Among women carrying affected males, 13 out of 15 decided to interrupt their pregnancy. The main reason for interrupting the pregnancy was guilt feelings for having transmitted the disease. Therefore, abortion was a way of punishing themselves for their inadequacy as mother. In some situations, additional feeling of anxiety were caused by the experience of having lived with a family member, most often a brother, on whom hemophilia had had disruptive physical and psychological effects, such as invalidity up to becoming HIV/HCV positive. Of the two women who decided to continue their pregnancy, the first one was supported by a favourable experience of a family member affectd by a benign disease and the second one had a generally positive attitude towards life.