Parents' disclosure to their donor-conceived children in the last 10 years and factors affecting disclosure: a narrative review

BACKGROUND

Disclosure of donor conception has been advocated in several jurisdictions in recent years, especially in those that practice identity-release donation. However, research on disclosure decisions has not been consolidated systematically in the last 10 years to review if parents are telling and what factors may be impacting their decisions.

OBJECTIVE AND RATIONALE

Are parents disclosing to their donor-conceived children, and what factors have influenced their disclosure decisions across different contexts and family forms in the last 10 years?

SEARCH METHODS

A bibliographic search of English-language, peer-reviewed journal articles published between 2012 and 2022 from seven databases was undertaken. References cited in included articles were manually scrutinized to identify additional references and references that cited the included articles were also manually searched. Inclusion criteria were articles focused on parents (including heterosexual, single mothers by choice, same-sex couples, and transsexual) of donor-conceived persons in both jurisdictions with or without identity-release provisions. Studies focused solely on surrogacy, donors, donor-conceived persons, or medical/fertility staff were excluded as were studies where it was not possible to extract donor-recipient parents' data separately. Both quantitative and qualitative studies were included. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed and Joanna Briggs Institute Critical Appraisal Tools for Systematic Reviews were used to assess article quality and bias.

OUTCOMES

Thirty-seven articles met the inclusion criteria representing 34 studies and 4248 parents (including heterosexual, single, same-sex, and transsexual parents although the majority were heterosexual) from countries with anonymous donation and those with identity-release provisions or who had subsequently enacted these provisions (Australia, Belgium, Finland, France, Hong Kong, Middle East, Spain, Sweden, the UK, and the USA) A general trend towards disclosure was noted across these groups of parents with most disclosing to their donor-conceived children before the age of 10 years. Further, the majority of those who had not yet told, reported planning to disclose, although delayed decisions were also associated with lower disclosure overall. Same-sex and single parents were more likely to disclose than heterosexual parents. There was recognition of disclosure as a process involving ongoing conversations and that decisions were impacted by multiple interacting intrapersonal, interpersonal, and external contextual and social factors. Methodological limitations, such as the different population groups and contexts from which participants were drawn (including that those parents who choose not to disclose may be less likely to participate in research), are acknowledged in integrating findings.

WIDER IMPLICATIONS

This review has reinforced the need for a theoretical model to explain parents' disclosure decisions and research exploring the role of legislative provisions, culture, and donor/family type in decision-making. Greater ongoing access to psychological support around disclosure may be important to promote parent and family well-being.

Direct-to-consumer DNA testing: the perspectives and experiences of donor conceived young adults in the UK

RESEARCH QUESTION

What meanings do donor conceived young adults give to direct-to-consumer DNA testing, and how does direct-to-consumer DNA testing relate to their lived experiences?

DESIGN

Thirty-three young adults participated in in-depth interviews in November 2020 and September 2021 as part of a study of donor conceived people in the UK that focuses on the period of young adulthood. All participants were aged between 18 and 31 years, had been conceived by sperm donation at a time of legal donor anonymity, and were mainly resident in the UK. Interviews were analysed using reflexive thematic analysis.

RESULTS

Nineteen participants (58%) had used at least one direct-to-consumer DNA test, and 14 (46%) had not. Three participants (9%) had learned about their donor conception inadvertently through a direct-to-consumer DNA test. Twelve participants (36%) had matched with their donor, someone conceived using the same donor, or both. Four related themes that capture participants' perspectives and experiences of direct-to-consumer DNA testing were identified: ruptures, disclosures, webs and temporalities.

CONCLUSIONS

To the authors' knowledge, this is the first study to evidence both active interest and disinterest in direct-to-consumer DNA testing among individuals who are donor conceived. The meanings ascribed to, and uses of, direct-to-consumer DNA testing vary significantly among donor conceived young adults. Findings relating to the relationship between 'informal' and 'formal' information systems, and the absence of guidance and support for those using direct-to-consumer DNA tests, should be considered carefully by practitioners, regulatory bodies and policymakers going forward.

A systematic review of assisted and third-party reproduction guidelines regarding management and care of donors

BACKGROUND

Gamete and embryo donors face complex challenges affecting their health and quality of life. Healthcare providers need access to well-structured, evidence-based, and needs-based guidance to care for gamete and embryo donors. Therefore, this systematic review aimed to synthesize current assisted and third-party reproduction guidelines regarding management and care of donors.

METHODS

The databases of ISI, PubMed, Scopus, and websites of organizations related to the assisted reproduction were searched using the keywords of "third party reproduction", "gamete donation", "embryo donation", "guidelines", "committee opinion", and "best practice", without time limit up to July 2023. All the clinical or ethical guidelines and best practice statements regarding management and care for gamete and embryo donors written in the English language were included in the study. Quality assessment was carried using AGREE II tool. Included documents were reviewed and extracted data were narratively synthesized.

RESULTS

In this systematic review 14 related documents were reviewed of which eight were guidelines, three were practice codes and three were committee opinions. Five documents were developed in the United States, three in Canada, two in the United Kingdom, one in Australia, and one in Australia and New Zealand. Also, two guidelines developed by the European Society of Human Reproduction and Embryology were found. Management and care provided for donors were classified into four categories including screening, counseling, information provision, and ethical considerations.

CONCLUSION

While the current guidelines include some recommendations regarding the management and care of gamete/embryo donors in screening, counseling, information provision, and ethical considerations, nevertheless some shortcomings need to be addressed including donors' psychosocial needs, long-term effects of donation, donors' follow-up cares, and legal and human rights aspects of donation. Therefore, it is needed to conduct robust and well-designed research studies to fill the knowledge gap about gamete and embryo donors' needs, to inform current practices by developing evidence-based guidelines.

Addressing Privacy Concerns Surrounding Oocyte Donation in the United States: Gone With Anonymity

Oocyte donation has greatly expanded in the past several decades since the first procedure was performed in 1983. According to the Centers for Disease Control, the number of cycles using donor oocytes increased from 18,011 cycles in 2010 to 27,131 cycles in 2019. Oocyte donation has become an important reproductive option for women with diminished ovarian reserve, recurrent failed in vitro fertilization, or heritable genetic conditions. It is also particularly important for single men, same-sex male couples, and men with a transgender woman partner. More recently, societal changes accompanying the expansion of social media and broader access to direct-to-consumer DNA testing have raised concerns about privacy and anonymity. In this article, we review two specific aspects of donor privacy: privacy related to personal identifiers provided by clinics or donor egg bank websites and privacy related to direct-to-consumer genetic testing. We also provide clinical recommendations specific to the United States for working with oocyte donors and donor oocyte recipients.

The Landscape of Direct-To-Consumer Genetic Testing in Reproductive Health Contexts: An Analytical Framework of Stakeholders and Their Competing Motivations

We propose a theoretical framework that identifies (a) the different categories of stakeholders and (b) the normative values that drive their attitudes toward direct-to-consumer genetic testing, with an emphasis on the reproductive health contexts. We conducted a literature search using varied combinations of search terms, including direct-to-consumer genetic testing, decision-making, reproductive health, and policy. Using a grounded theory approach to existing literature and in combination with a narrative review, we present a systematic framework of five categories of stakeholders (i.e., genome-driven stakeholders, industry-driven stakeholders, history-driven stakeholders, value-driven stakeholders, and social justice-driven stakeholders) that shape the public's discourse. Moving beyond the dialectical ethics that have governed the public discourse, we also identify the normative values and interests that motivate different stakeholders' attitudes and decision-making through theoretical sampling under the grounded theory. We investigate the competing and conflicting values within the same category of stakeholders. For example, despite being industry-driven stakeholders, medical professionals' attitudes are driven by concerns about standards of care; in contrast, health insurance companies' concerns are centered on profit. We further explore the tensions between these stakeholders that impact their strategic alliances and pose challenges to the practices of direct-to-consumer genetic testing. Finally, we examine how these stakeholders and their corresponding values may shape future development and policies of direct-to-consumer genetic testing in the context of reproductive health.

Direct-to-consumer genetic testing and the changing landscape of gamete donor conception: key issues for practitioners and stakeholders

RESEARCH QUESTION

What effect does direct-to-consumer genetic testing (DTCGT) have on information finding and sharing in relation to gamete donor conception?

DESIGN

This study used in-depth qualitative interviews with parents through donor conception, donors, the relatives of donors and donor-conceived people who have used, or considered using, DTCGT. Interviews were conducted between September 2021 and February 2023. Sixty people defined themselves as having been affected by donor conception and DTCGT. Fifty-seven of these were resident in the UK at the time of interview. The final sample included 19 (spermatozoa, egg or embryo) donors, 25 donor-conceived people, 20 parents through donor conception and two relatives of donors. Five participants occupied more than one of these roles.

RESULTS

The rise of DTCGT is affecting how information about donor conception is managed: it shifts patterns of knowledge about donor conception; increases flexibility regarding the age of access to information about donor relatives; can lead to a growing role for non-professionals, including wider family members, in gatekeeping information about donor conception; accentuates the effect of donor conception for donors' and the relatives of donor-conceived people; and shapes, and is shaped, by the formal regulatory donor information management systems.

CONCLUSION

Fertility professionals should inform people using, or considering, donor conception, or (potential) donors, about the different ways DTCGT can affect sharing information about donor conception. Support is needed for those affected by these changes.

Non-identified and directed embryo donation: a questionnaire study on donor and recipient perspectives

With the growing challenge of abandoned surplus embryos in the ART arena, and the limited traction of embryo donation as a viable embryo disposition choice, it is important to better understand barriers to wider adoption of this opportunity. We aim to learn about perspectives and experience of participants in directed and non-identified embryo donation programmes. This was a longitudinal cohort survey study, of all participants in an embryo donation programme in a single university affiliated clinic between 2016 and 2020. Clinical data were extracted from counselling reports. Based on these data, non-identified online questionnaires were constructed and refined via Delphi procedure for face and content validity. Sixty-five online questionnaires were emailed between March-April 2021. Descriptive statistics, cross-tabulation, Fisher's exact test and t-test were used for analyses. Source of patient awareness, factors influencing the decision-making process, patient perspective and satisfaction were explored. The response rate was 67.2%. Most participants in the non-identified programme learned of it through their treating physicians, whereas most participants in the directed programme learned of it online. The main driver to donate across both cohorts was wanting to give others the opportunity to experience the joy of parenthood. Overall, 45% described moderate to marked difficulty in decision making related to donating their embryos, and this did not differ between cohorts. Non-identified donors reported feeling highly attached to the donated embryos more often than directed donors. Level of satisfaction was higher in the directed donation programme. Participants were more satisfied following directed than non-identified donation, and some even consider their counterparts as extended family. Our findings should be validated in various settings, and on larger samples.

The case for reframing known donation

Contemporary UK egg and sperm donation exists in two predominant forms: (i) clinic-based, identity-release donation; and (ii) known donation, which can take place either inside or outside of the clinic context. Regulatory and clinical discussions of the latter currently focus, almost exclusively, on risk whereas identity-release is widely presented as the default route for both donors and recipients. Consequently, there is little support available for those potential donors and recipient parents who might prefer a known donor arrangement. In this commentary, we reflect on our sociological research with donors and parents through donor conception and argue that there are a number of reasons why known donation may, in some contexts, offer advantages over identity-release donation. Whilst this research also demonstrates that there can be challenges involved in known donation, these are not inevitable nor are challenges absent from identity-release routes. It is timely and important to question whether the current de-valuing of known donation compared with identity-release donation holds up to academic scrutiny. We argue for a more balanced approach in which the benefits and challenges of both known and identity-release routes are discussed with donors and recipients and for increased support for known donation in clinics and by regulatory bodies.

Lessons from 10 years' experience running the Fiom KID-DNA database, a voluntary DNA-linking register for donor-conceived people and donors in The Netherlands

Worldwide, there is increasing acknowledgment of the importance of getting access to ancestry information. More and more countries facilitate access to this information through law changes and voluntary contact-services. In the Netherlands, the state-funded Fiom KID-DNA database was established in 2010 to facilitate information and/or contact exchange between those people who are genetically related as a result of donor-assisted conception. By the end of 2021, 846 donors and 2355 donor-conceived people are registered in the database. For 25% of the donors a link was found with one or more donor-conceived people, and 39% of the donor-conceived people were linked to a donor-profile. Fiom offers support by professionally qualified staff throughout the entire process from registration to contact to donor-conceived people, donors and their relatives. During the period of more than 10 years several challenges emerged; how does a state-funded DNA database function in the area of commercial DNA databases?; what can be learned from the continuous growing donor-conceived half-siblings networks?; how to deal with malpractices from the past and how to cope with ageing donors?

Motivational stimuli to donate sperm among non-donor students

BACKGROUND

Sperm banks face a continuously evolving gap between the increasing demand for sperm donation (SD) vs. limited available reserve. To improve donors' recruitment and increase supply, motivations towards SD should be investigated specifically among young men who have the potential to become donors. Our aim was to evaluate factors which increase and decrease predisposition to donate sperm among non-donor students, who represent a "potential pool" for possible donors' recruitment.

RESULTS

Ninety-three men fulfilled the questionnaire with mean age of 28.2 ± 4.5 years. The most powerful incentive to donate sperm was financial reward followed by a willingness to help others to build a family (3.8 and 3.4, respectively). The most dominant consideration to decline donation was the fear of anonymity loss and future regret (4 and 3.8). While participants' willingness for anonymous SD was fair (2.8), the open-identity donation was rated significantly lower (1.75, p < 0.01). Familiarity with recipients and offspring had lower scores (1.9-2.2) as well.

CONCLUSIONS

Young single men represent a suitable cohort for anonymous donation. Financial reward and willingness to help others are important positive incentives while anonymity preservation is crucial to maintain their willingness towards SD. Regulatory shifting towards open-identity SD necessitates the establishment of an alternative "potential pool" population as a reliable source to recruit donors.

Single fathers' experiences of using egg donation and surrogacy to start a family

STUDY QUESTION

What are the experiences of single men using egg donation and surrogacy as a route to parenthood?

SUMMARY ANSWER

The fathers mainly had a positive relationship with the surrogate and simultaneously exercised agency, and experienced challenges, during the process of surrogacy.

WHAT IS KNOWN ALREADY

Little is known about single men's experiences of egg donation and surrogacy arrangements. Studies have focused on single men's decision-making processes about the use of surrogacy and family functioning once these families are formed. Questions remain about how fathers experience and navigate the process of surrogacy as a single man.

STUDY DESIGN, SIZE, DURATION

The study is an international, in-depth qualitative study of fathers who chose to begin a family and parent alone. Data were collected between 2018 and 2021 as part of a larger study of solo fathers with different routes to parenthood. The present study reports on 21 fathers who used surrogacy and egg donation to begin their family. The average age of the fathers was 44 years, the fathers had young children aged 6 years or younger, and lived in countries across Australia, Europe, and North America.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Purposive sampling was used to recruit participants. In-depth semi-structured interviews were conducted. Interview topics included fathers' experiences of the process of using egg donation and surrogacy, and navigating the relationship with the surrogate. The audio-recorded interviews lasted around 2 hours and were subsequently transcribed verbatim.

MAIN RESULTS AND THE ROLE OF CHANCE

Data were analysed using reflexive thematic analysis and qualitative content analysis. Most of the fathers chose an identifiable egg donor. Regarding the relationship with the surrogate, many fathers had remained in contact with her, but to differing degrees, and they generally reported positive relationships. Thematic analysis led to the identification of three themes relating to the fathers' experiences of choosing surrogacy as a single man: the ability to make choices; challenges and constraints; and special relationship.

LIMITATIONS, REASONS FOR CAUTION

Due to the variation between different countries regarding laws on surrogacy, contextual factors may have impacted on the experiences of single fathers, and the sample size was small. However, the research provides new insights into an area with little academic literature.

WIDER IMPLICATIONS OF THE FINDINGS

Given the growing trend of single men having children through surrogacy, the findings suggest that this new path to parenthood can be both rewarding and challenging. Single men may benefit from tailored support and counselling to help them navigate the surrogacy journey.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by the Wellcome Trust (grant number 208013/Z/17/Z). The authors have no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

n/a.

Families created via identity-release egg donation: disclosure and an exploration of donor threat in early childhood

RESEARCH QUESTION

What are mothers' disclosure intentions and practices from infancy to early childhood, and is perceived donor threat associated with disclosure in identity-release egg donation families when the children are aged 5 years?

DESIGN

This longitudinal study included 73 heterosexual-couple families with infants born following IVF-egg donation at phase one, and 61 families with 5-year-old children at phase two. At both phases, mothers were interviewed about their disclosure intentions and practices. At phase two, mothers were interviewed about their feelings about future donor-child contact.

RESULTS

Most mothers (75.3%) intended to disclose their use of egg donation to their children at phase one; half had begun to do so when their children were aged 5. Most remaining mothers planned to tell, although a minority were uncertain or planned not to disclose. When the child was aged 5, four mothers had started telling them that they could access their donor's identifying information at age 18, and most (84%) intended to do so in the future. Most couples agreed on a disclosure strategy at phase two. Most mothers perceived at least some threat from future donor-child contact, but this was unrelated to their disclosure practices.

CONCLUSIONS

Disclosure intentions in infancy are borne out in early childhood. Despite perceiving some threat from future donor-child contact, most mothers intended telling their child that they could access the donor's identifying information at age 18. Revisiting these families as the children grow older will be important to understand how the mothers' perceived donor threat may change over time, and how this is related to family processes.

Who's your daddy? An ethical argument for disclosure to donor conceived children

To our knowledge, there have been few discussions in the andrology literature regarding the ethics of disclosure to donor conceived children. Our goal in this paper is to summarize the main reasons in favor of disclosure to engender more conversations about the ethics of donor conception in andrology circles. Specifically, we argue (1) transparency regarding gamete donation upholds the ethical principle of beneficence by improving the psychological health of donor conceived children; and (2) based on the ethical principle of autonomy, donor conceived children should have the right to know their donor status.

An Ethical Examination of Donor Anonymity and a Defence of a Legal Ban on Anonymous Donation and the Establishment of a Central Register

Many if not most sperm donors in the early years of IVF donated under conditions of anonymity. There is, however, a growing awareness of the ethical cost of withholding identifying parental information from donor children. Today, anonymous donation is illegal in many jurisdictions, and some jurisdictions have gone as far as retrospectively invalidating contracts whereby donors were guaranteed anonymity. This article provides a critical evaluation of the ethics and legality of anonymous donation. We defend Australian and British legislation that has outlawed donor anonymity, and we argue for the establishment of a central registry that provides donor children with the ability to easily and reliably access identifying information about their donor parents.

Third-party reproduction: a treatment that grows with societal changes

Third-party reproduction refers to the use of eggs, sperm, or embryos that have been donated by a third person (the donor) to enable individuals or couples (the intended parents) with infertility to have a child. This differs from the traditional father-mother family model with no third parties involved. Third-party reproduction is also used by couples that are unable to reproduce by traditional means, same-sex couples, and men and women without a partner. This has emerged as a treatment option with great success rates in a scene of changing family constellations. Consequently, this therapeutic alternative has become a realistic solution which has brought great satisfaction and happiness to people who otherwise would have not been able to achieve parenthood if these options were not medically and legally available.

University students' opinion on gamete donor identification regimes

PURPOSE

This study aims to evaluate the opinion of university students about the identification or nonidentification of gamete donation and the probability of donation according to the different regimes.

METHODS

This was a cross-sectional observational study based on an online anonymous survey including questions about sociodemographic data, reasons for considering donations, information about the donation process and legislation, and their opinions about the different regimes and how they would influence donations.

RESULTS

In total, 1393 valid responses were obtained, with a mean age of 24.0 years (SD = 4.8), most of the respondents being female (68.5%), living in a relationship (56.7%), and without children (88.4%). The main reasons for considering donation would be altruism and monetary compensation. Overall, it was found that participants were poorly informed about the donation procedure and legislation. Students revealed preference for nonidentified donation, and they were less likely to donate in an open identity regime.

CONCLUSION

Most university students consider themselves poorly informed about gamete donation, express a preference for nonidentified gamete donation, and would less likely donate on an open identity basis. Thus, an identified regime may be less attractive to potential donors and lead to a decrease in the availability of gamete donors.

Sperm donor attitudes and experiences with direct-to-consumer genetic testing

Objective

To identify factors influencing sperm donor willingness to participate in direct-to-consumer genetic testing, comfort with sharing genetically identifiable data in commercial genetic testing databases, and likelihood to donate sperm again.

Design

Cross-sectional online anonymous survey.

Setting

Multicenter, 2 large American sperm banks from July 1, 2020 to July10, 2021.

Patients

Sperm donors from 1980 to 2020.

Interventions

None.

Main outcome measures

Associations between donor demographic characteristics, donation history, and attitudes toward direct-to-consumer genetic testing.

Results

A total of 396 donors completed the survey. Most donations (61.5%) occurred from 2010 to 2020, and 34.3% were nonidentified donations. Nonidentified donors were less comfortable with their genetic data being shared than open-identity donors (25.4% vs. 43.8%) and were less likely than open-identity donors to donate sperm again (43.3% vs. 72.1%). Donors who donated after the inception of direct-to-consumer genetic testing in 2007 were less likely to participate in commercial genetic testing than those who donated before 2007 (25.8% vs. 37.1%). Most donors (87.4%) have disclosed their donation(s) to current partners, but fewer have disclosed them to their families (56.6%) or children (30.5%). Of the donors who had been contacted by donor-conceived persons, 79.5% were identified via direct-to-consumer genetic testing. Overall, 61.1% of donors would donate again regardless of direct-to-consumer genetic testing.

Conclusions

Direct-to-consumer genetic testing is playing a dynamic role in sperm donor identification, but donors seem willing to donate again. Implication counseling regarding future linkage and contact from donor-conceived persons needs to be standardized for potential donors before donation.

The influence of avoidant attachment and perceived support on disclosure about involvement in donor-assisted conception to family and friends

STUDY QUESTION

Do the attachment-related dimensions Anxiety and Avoidance and perceived partner and social support in recipients and donors influence disclosure to others about their involvement in donor-assisted conception (DAC)?

SUMMARY ANSWER

A higher global score on attachment Avoidance was associated with greater non-disclosure about involvement in DAC by participants to relationship-specific others.

WHAT IS KNOWN ALREADY

Within the context of DAC, the topic of disclosure has been investigated in terms of the 'if', 'when', and the 'how' to disclose about circumstances of conception. Less focus, however, has been directed to investigating psychological theoretical frameworks that influence disclosure decisions to others, i.e. to whom information is disclosed and to what extent details are transparently revealed about the donor programme.

STUDY DESIGN, SIZE, DURATION

The study was of a cross-sectional design and utilized a sample of 301 participants who were, or had been, involved in DAC, and were recruited across states of Australia. An online self-report questionnaire was completed between June 2014 and June 2017.

PARTICIPANTS/MATERIALS, SETTING, METHODS

English speaking participants consisting of 209 female recipients and 92 donors (36 sperm; 48 egg; 8 embryo donors). Of the recipients, 104 had successfully conceived children via donated gametes (68 sperm, 23 eggs, 6 embryos, and 7 recipients where both gametes were donated from 2 donors to create the embryo). Participants anonymously completed an online questionnaire consisting of five sections: Demographics, Donor Conception and Disclosure Practices, the Experiences in Close Relationships-Relationships Structure, the Quality of Relationship Inventory, and the Multidimensional Scale of Perceived Social Support. Pearson correlations, independent samples t-tests, Chi-square, and ANOVA were used to explore the association between attachment Anxiety and Avoidance scores and disclosure about involvement in a DAC programme to significant others (i.e. parents, siblings, in-laws, and friends).

MAIN RESULTS AND THE ROLE OF CHANCE

Compared to published community cohort data, participants reported lower global scores on attachment Anxiety and Avoidance and high levels of romantic partner and social network support, suggestive of secure relationships in the overall study sample. A higher score on attachment Avoidance was associated with less disclosure to significant others in their social network (i.e. parents, siblings, in-laws, and close friends), even in the presence of strong partner support (partial r = -0.248, P = 0.005). Higher scores on attachment Avoidance were inversely associated with level of perceived partner and social network support (all P < 0.05). Irrespective of attachment scores, more than 90% of all participants agreed that a child born of DAC should be told about mode of conception.

LIMITATIONS, REASONS FOR CAUTION

This study utilized a cross-sectional design precluding causal inferences between dimensions of insecure attachment and disclosure practices. Participants were required to self-report on the quality of their relationships with the potential for social desirability respondent bias. The study's self-selecting sample may limit generalization to participants who were dis-inclined to participate. Specifically, respondents who have an Avoidant attachment style, may have elected not to participate in the study.

WIDER IMPLICATIONS OF THE FINDINGS

Given the increased use of biotechnology and digital facial recognition enabling self-discovery of the donor and the donor's extended family, non-disclosure about involvement in DAC may have consequences. An 'Avoidant' attachment style is important to assess as a potential risk factor for non-disclosure about involvement in DAC across different relational contexts (e.g. close family members and friends). Fertility counsellors should consider introducing a measure of attachment screening as a pre-emptive psychoeducational strategy during donor implications counselling. This information could be used to offer patients insight into concerns they have about DAC disclosures to key important relationships, providing a target of clinical intervention.

STUDY FUNDING/COMPETING INTEREST(S)

No external funds were sought for this work. None of the authors have any competing interests to declare.

TRIAL REGISTRATION NUMBER

N/A.

Development of the Tool to Empower Parental Telling and Talking (TELL Tool): A digital decision aid intervention about children's origins from donated gametes or embryos

Objective

This study aimed to create and develop a well-designed, theoretically driven, evidence-based, digital, decision Tool to Empower Parental Telling and Talking (TELL Tool) prototype.

Methods

This developmental study used an inclusive, systematic, and iterative process to formulate a prototype TELL Tool: the first digital decision aid for parents who have children 1 to 16 years of age and used donated gametes or embryos to establish their families. Recommendations from the International Patient Decision Aids Standards Collaboration and from experts in decision aid development, digital health interventions, design thinking, and instructional design guided the process.

Results

The extensive developmental process incorporated researchers, clinicians, parents, children, and other stakeholders, including donor-conceived adults. We determined the scope and target audience of the decision aid and formed a steering group. During design work, we used the decision-making process model as the guiding framework for selecting content. Parents' views and decisional needs were incorporated into the prototype through empirical research and review, appraisal, and synthesis of the literature. Clinicians' perspectives and insights were also incorporated. We used the experiential learning theory to guide the delivery of the content through a digital distribution plan. Following creation of initial content, including storyboards and scripts, an early prototype was redrafted and redesigned based on feedback from the steering group. A final TELL Tool prototype was then developed for alpha testing.

Conclusions

Detailing our early developmental processes provides transparency that can benefit the donor-conceived community as well as clinicians and researchers, especially those designing digital decision aids. Future research to evaluate the efficacy of the TELL Tool is planned.

Adolescent Development and the Parent-Adolescent Relationship in Diverse Family Forms Created by Assisted Reproduction

Assisted reproduction techniques (ARTs) are employed by single individuals and couples who are not otherwise able to conceive spontaneously. While the use of ARTs is increasing, research is lacking on the attempts made by adolescent offspring conceived via ARTs to integrate their ART conception into their identity and negotiate a connection with, and autonomy from, their parents. The present article reviews studies investigating adolescent development and the parent-adolescent relationship in diverse family forms created by ARTs (mainly heterosexual and lesbian parent families), and discusses the results in light of attachment, identity development, and emotional distance regulation theories. Overall, the results indicate that the psychological adjustment of adolescents conceived via ARTs is not undermined by the manner of their conception, and that they enjoy positive relationships with their parents with no difference from those enjoyed by spontaneously conceived adolescents. However, it remains unknown whether the development of a reproductive identity in adolescence is likely to influence adolescents' interest in searching for or contacting their donors, surrogates, and/or donor siblings. The results suggest the relevance of considering the parent-adolescent relationship, disclosure, and identity formation issues when planning psychological counseling and support interventions with ART parents and their adolescent offspring, and emphasize the need to further investigate these aspects in diverse ART families, including single-, gay-, bisexual-, and trans*-parent families.

Counselling challenges associated with donor conception and surrogacy treatments - time for debate

Fertility counselling services have had to respond to significant developments in fertility treatments in recent years, prompting increasingly complex personal and professional ethical challenges. This Commentary focuses on those rising from donor conception and/or surrogacy. The profile of those seeking such treatments has changed to include growing numbers of same sex couples, single people, people who are transitioning or have done, people seeking posthumous use of gametes, and people using cross-border services. Alongside, awareness has grown of life-span implications, the impact of commercial DNA testing, and the need for 'later-life' support. Responses vary internationally and the time for debate is overdue. Who should provide fertility counselling and how? Should specialist qualifications, training, continuing professional development, and regulation be required? Should counsellors play a role in assessing suitability to parents? What aspects of different contractual arrangements and conflicts of interest need attention? Has the time come for counselling to be mandatory as part of pre-treatment pathways? What should be the relationship between fertility counsellors and multi-disciplinary clinic teams? How might fertility counsellors be represented nationally and internationally? What should be their relationship to 'later life' professional support? What place should professional knowledge hold in the evidence base?

Alpha Test of the Donor Conception Tool to Empower Parental Telling and Talking

OBJECTIVE

To conduct an alpha test of the prototype of a digital decision aid to help parents disclose donor conception to their children, the Donor Conception Tool to Empower Parental Telling and Talking (TELL Tool).

DESIGN

Convergent mixed-methods design.

SETTING

Virtual interviews in places convenient to the participants.

PARTICIPANTS

A purposeful sample (N = 16) of nine gamete-donor and embryo-recipient parents and eight clinicians, as one parent was also a clinician.

METHODS

We conducted cognitive interviews to explore participants' perceptions about the TELL Tool prototype and observe patterns of use. The International Patient Decision Aid Standards (i.e., usability, comprehensibility, and acceptability) guided the development of the qualitative interview guide and directed the qualitative analysis. We also collected data about participants' perceptions and ratings of the helpfulness of each of the prototype's webpages regarding parents' decision making about disclosure. Descriptive statistics were used to analyze the helpfulness ratings before we merged the two data sets to optimize understanding.

RESULTS

Participants reported that the TELL Tool was a helpful digital decision aid to help parents tell their children how they were conceived. Most (93.7%) webpage rating scores indicated that the content was very helpful or helpful. The participants identified content and technical areas that needed refinement and provided specific recommendations such as adding concise instructions (usability), tailoring adolescent language (comprehensibility), and softening verbiage (acceptability).

CONCLUSION

Alpha testing guided by the International Patient Decision Aid standards was an essential step in refining and improving the TELL Tool prototype before beta testing.

Medical ethics when moving towards non-anonymous gamete donation: the views of donors and recipients

Drawing on the views of donors and recipients about anonymity in a country that is experiencing a transition towards non-anonymous gamete donation mandated by the Constitutional Court, we explore how the intersection between rights-based approaches and an empirical framework enhances recommendations for ethical policy and healthcare. Between July 2017 and April 2018, 69 donors and 147 recipients, recruited at the Portuguese Public Bank of Gametes, participated in this cross-sectional study. Position towards anonymity was assessed through an open-ended question in a self-report questionnaire, which was subject to content analysis. Preference for an anonymous donation regime was mentioned by 82.6% of donors and 89.8% of recipients; and all those with children. Instead of the rights-based reasoning used by the Constitutional Court, donors highlighted concerns over future relationships and recipients focused on socioethical values linked with the safeguard of safety, privacy and confidentiality. The remaining participants advocated the choice between anonymity or non-anonymity (double-track policy), invoking respect for their autonomy. The complex, diverse ethical views and reasoning of donors and recipients expand a traditionally dichotomous discussion. Their perspectives challenge the transition towards non-anonymity and international guidelines, raising awareness to the need for their involvement in the design of policies to enable choice according to their values and preferences, and of psychosocial counselling responsive to their socioethical concerns and sensitive to their parental status. Empirical frameworks complement rights-based approaches to uphold justice, fairness and equal respect, and to incorporate utility, beneficence and non-maleficence in policymaking and healthcare in the transition towards non-anonymity.

The impact of the method of genetic identity disclosure on the donor conceived adult

Aim: 106 donor conceived people (DCP) responded to an anonymous survey study that examined the impact of the method of genetic identity disclosure and age at the time of the disclosure on their emotional wellbeing, familial relations, and perceptions of donor conception practices.Methods: Participants were asked to select the way in which they were informed they are DCP and the age group at which this occurred, and then were asked to select strongly agree, agree, neither agree or disagree, disagree, or strongly disagree in response to 26 statements that examined their perceptions of the topics listed above. Responses were grouped based on the age of genetic identity disclosure and the method of genetic identity disclosure, then numerically compared by assigning each type of response a number. Statistical analysis using repeatedmeasures ANOVA was performed to identify differences among these factors.Results: This analysis revealed that most participants 18 ≥ years and most participants who discovered their genetic identity through means other than through their parent(s) had worse emotional wellbeing and familial relations. However, most participants among all categories had a negative perception of donor conception practices.Conclusion: Continued work is needed to understand and support the growing DCP population.

Singapore needs to update regulation of frozen egg donation after permitting social egg freezing

With social egg freezing being permitted in Singapore, there is expected to be an accumulated surplus of unused frozen eggs (vitrified oocytes) available for donation in coming years. A comprehensive update of current healthcare regulations pertaining to frozen egg donation is needed to resolve various pertinent ethical issues. In particular, the issue of egg donor anonymity should be addressed, together with the lack of sharing of medical and family information about the donor to prospective recipient patients and donor-conceived offspring. Rigorous and comprehensive genetic testing of prospective egg donors must be mandated to protect the welfare of recipient patients. Older women above 35 years of age should be required to have at least one child, before being allowed to donate their unused frozen eggs, to prevent any future regret and psychological problems of remaining childless, while being unsure of whether they have an unknown genetic offspring out there. New regulations drafted to address these ethical issues must also prevent potential conflicts of interests. For example, fertility doctors soliciting and encouraging former patients to donate their unused frozen eggs face an obvious conflict of interest, because additional medical fees will be earned by performing the egg donation procedure on other patients. A centralized donor registry should be established by the Singapore government to oversee the distribution and allocation of donated unused frozen eggs to infertile IVF patients. Such a registry could also facilitate sharing of vital health information about the donor to recipient patients and donor-conceived offspring.

Openness in donor conception families

Dempsey, Nordqvist and Kelly’s recent publication in BioSocieties highlights the complexity of disclosure in donor conception, which is legally, ethically, and morally challenging. However, contemporary society means that donor-conceived people’s awareness of their conception history can no longer be controlled by their parents. Late, accidental, and non-parent disclosure is becoming more prevalent and can be distressing. Research has consistently found that openness in donor conception families from an early age is optimal, and that disclosure positively impacts rather than threatens family relationships. Despite this, disclosure can be difficult for parents, particularly if they perceive an unsupportive social context. Both donor conception and adoption literature has found more positive outcomes among disclosing families compared to non-disclosing families and interestingly, parents who have chosen to disclose have not reported regret. This response briefly discussed these important considerations and also notes some instances of inaccurate reporting and misleading information in their article.

Shifting to a model of donor conception that entails a communication agreement among the parents, donor, and offspring

Background

Some persons conceived with donor gametes react negatively when they found their birth via donor conception. They request access to information about and seek to communicate with the donor. However, some countries mandate donor anonymity. Other countries allow donor-conceived persons to access donor information, but they can only use this access if their parents have disclosed donor conception to them. We investigated a thorny issue of donor conception: whether donor conception should be shifted from an anonymous basis to a non-anonymous basis.

Methods

We review the issues and concerns regarding donor conception. We then consider the impact of direct-to-consumer genetic testing on donor conception, as well as the influence of donor conception on offspring’s identity and the potential of different types of donors. To discuss the future policy of donor conception, the policies on the anonymity of gamete donors were investigated using publicly-available documents in 15 countries.

Results

The aim of mandating donor anonymity is to protect the privacy of the donor and intended parents. However, the diffusion of direct-to-consumer genetic testing may make it impossible to maintain anonymity. Birth via donor conception shapes the offspring’s identity, and the donor may further influence the development of offspring’s identity through communications. It remains important to disclose donor conception to donor-conceived offspring and to provide them with donor information. However, that information might be insufficient for some donor-conceived persons. Here are benefits to having open-identity donors and known donors. Such donors can make an agreement with the parents regarding future communication with the offspring, although both sides should respect privacy. Subsequent counseling for all parties involved can result in better tripartite communication agreements.

Conclusions

In sum, ethical and practical issues that complicate donor anonymity are driving a shift to non-anonymous donor conception, in which all parties come to a communication agreement. To pave the way for such a donor conception system, transitional measures can be put into place. For countries that already adopted non-anonymous donor conception, ensuring the communication agreements is important to protect the rights of parents, donor, and offspring.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12910-022-00756-1.

Family secrets: Experiences and outcomes of participating in direct-to-consumer genetic relative-finder services

In recent decades, genetic genealogy has become popular as a result of direct-to-consumer (DTC) genetic testing. Some DTC genetic testing companies offer genetic relative-finder (GRF) services that compare the DNA of consenting participants to identify genetic relatives among them and provide each participant a list of their relative matches. We surveyed a convenience sample of GRF service participants to understand the prevalence of discoveries and associated experiences. Almost half (46%) of the 23,196 respondents had participated in GRF services only for non-specific reasons that included interest in building family trees and general curiosity. However, most (82%) also learned the identity of at least one genetic relative. Separately, most respondents (61%) reported learning something new about themselves or their relatives, including potentially disruptive information such as that a person they believed to be their biological parent is in fact not or that they have a sibling they had not known about. Respondents generally reported that discovering this new information had a neutral or positive impact on their lives, and most had low regret regarding their decision to participate in GRF services. Yet some reported making life changes as a result of their discoveries. Compared to respondents making other types of discoveries, those who learned that they were donor conceived reported the highest decisional regret and represented the largest proportion reporting net-negative consequences for themselves. Our findings indicate that discoveries from GRF services may be common and that the consequences for individuals, while generally positive, can be far-reaching and complex.

Fertility stakeholders' concerns regarding payment for egg and sperm donation in New Zealand and Australia

New Zealand and Australia are countries which currently prohibit donor payment and require open-identity forms of donation. This study explored the concerns of fertility stakeholders regarding payment which would constitute financial reward for gamete donation, and factors predicting such concerns. A total of 434 participants from across New Zealand and Australia completed an online survey anonymously. Participants included those with infertility and treatment experience, donors, recipients, donor-conceived people and clinic professionals. Results indicated that participants' concerns related to their assumptions about the type of donor motivated by financial reward, and the possibility that, if paid, donors might conceal information relevant to treatment and the donor-conceived person. Furthermore, participants were concerned about increasing recipient costs. Participants with personal experience of infertility held stronger concerns overall. Professionals expressed concerns of clinical relevance, such as the withholding of donor information relevant to treatment outcomes. The lowest levels of concern were expressed in relation to payment devaluing the meaning of human life. Qualitatively, themes highlighted concerns regarding payment enticing the 'wrong' type of donor, increased cost to recipients, and concern about the wellbeing of donor-offspring. Collectively, such concerns must be understood against the New Zealand and Australia open-identity donation context which enables the possibility of contact between donors and offspring. These findings indicate that donor recruitment campaigns need to account for different stakeholder concerns, and consider ways to address donor shortages effectively while remaining compliant with legislative requirements.

Telling donor-conceived children about their conception: Evaluation of the use of the Donor Conception Network children's books

If parents have used donated gametes, it is a personal choice whether they disclose to their children. For those that do, there is, however, little advice on how to tell their children. The Donor Conception Network (DCN) has made a series of books to help parents disclose. This study evaluated parents' experience of using these books. An online survey with both quantitative and qualitative questions was used. The DCN membership and social media were used to publicize the survey, and 108 responses were analysed. At the time of conception, the parents' family types were mainly mother and father (56.5%) and solo mothers (36.1%). The method of conception was mainly donor spermatozoa (55.6%) followed by donor egg (38.0%), double donation (8.3%) and one case of surrogacy. Most parents had read the book to their children before 2 years of age (76.9%). Before reading the books, some of the parents had some confidence in telling (43.5%) or were very confident in telling (30.6%). After reading the books, 60.2% reported having much more confidence in telling. Most parents felt their children had no understanding (76.8%) or only some understanding (22.3%) of donor conception before reading the books. After reading the books most parents felt their children's understanding had increased (71.3%). Most parents felt that reading the books had given them more confidence in using donor conception language (90.7%). The use of books to tell children about their conception may be a useful resource for parents wishing to be open with their children.

OUP accepted manuscript

STUDY QUESTION

What information and support should be offered to donors, intended parents and donor-conceived people, in general and in consideration of the availability of direct-to-consumer genetic testing and matching services?

SUMMARY ANSWER

For donors, intended parents and donor-conceived offspring, recommendations are made that cover information needs and informed consent, psychosocial implications and disclosure.

WHAT IS KNOWN ALREADY

Trends indicate that the use of donor-assisted conception is growing and guidance is needed to help these recipients/intended parents, the donors and offspring, navigate the rapidly changing environment in which donor-assisted conception takes place.

STUDY DESIGN, SIZE, DURATION

A working group (WG) collaborated on writing recommendations based, where available, on evidence collected from a literature search and expert opinion. Draft recommendations were published for stakeholder review and adapted where relevant based on the comments received.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Papers retrieved from PUBMED were included from 1 January 2014 up to 31 August 2020, focusing on studies published since direct-to-consumer genetic testing has become more widespread and accessible. The current paper is limited to reproductive donation performed in medically assisted reproduction (MAR) centres (and gamete banks): donation outside the medical context was not considered.

MAIN RESULTS AND THE ROLE OF CHANCE

In total, 32 recommendations were made for information provision and support to donors, 32 for intended parents and 27 for donor-conceived offspring requesting information/support.

LIMITATIONS, REASONS FOR CAUTION

The available evidence in the area of reproductive donation is limited and diverse with regards to the context and types of donation. General conclusions and recommendations are largely based on expert opinion and may need to be adapted in light of future research.

WIDER IMPLICATIONS OF THE FINDINGS

These recommendations provide guidance to MAR centres and gamete banks on good practice in information provision and support but should also be considered by regulatory bodies and policymakers at a national and international level to guide regulatory and legislative efforts towards the protection of donors and donor-conceived offspring.

STUDY FUNDING/COMPETING INTEREST(S)

The development of this good practice paper was funded by European Society of Human Reproduction and Embryology (ESHRE), covering expenses associated with the WG meetings, the literature searches and dissemination. The WG members did not receive any payment. The authors have no conflicts of interest to declare.

DISCLAIMER

This document represents the views of ESHRE, which are the result of consensus between the relevant ESHRE stakeholders and where relevant based on the scientific evidence available at the time of preparation.

The recommendations should be used for informational and educational purposes. They should not be interpreted as setting a standard of care, or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. They do not replace the need for application of clinical judgement to each individual presentation, nor variations based on locality and facility type.

^†ESHRE pages content is not externally peer reviewed. The manuscript has been approved by the Executive Committee of ESHRE.

Attitudes of sperm donors towards offspring, identity release and extended genetic screening

RESEARCH QUESTION

What is sperm donors' attitude towards offspring, anonymity and extended genetic screening?

DESIGN

An online questionnaire for sperm donors was administered at Cryos International in the USA and Denmark between 9 and 30 September 2020. A total of 233 donors (37 in the USA and 196 in Denmark) completed the questionnaire. This study is unique because it was performed in a setting that allows donors to choose to be either ID-release or non-ID-release donors.

RESULTS

Most donors had two motives to donate: helping childless people and/or financial compensation. ID-release donors differed significantly from non-ID-release donors in numerous aspects of the donation, including relationships with the offspring, information sharing with others and wanting information about offspring. In general, donors had a very positive attitude towards genetic testing and extended genetic screening.

CONCLUSIONS

Offering the possibility for donors to be either ID-release or non-ID-release allows more donors to be recruited than if only one option were available. The multiple differences between the two donor types suggests that these are groups with profoundly different attitudes towards donation. The general attitude of donors towards genetic testing and expanded genetic screening is very positive but further studies on the attitude of candidate donors are needed.

'Genes versus children': if the goal is parenthood, are we using the optimal approach?

First medical contact for couples trying for a child will usually emphasise the array of assistance available to ‘help them have their own child’, usually with options involving ART, after diagnosis. For many poorer prognosis couples, this means repetitive unsuccessful cycles of invasive and stressful treatment. What is sometimes lost at this stage is a reflection on the likelihood of success of different options, which may lead patients to focus on hoping for their own ‘genetic’ progeny, but failing to consider the alternative and potentially more successful other options, including donation and adoption, for achieving parenthood of a child. Factors not only such as female age but also advanced requirements such as preimplantation genetic testing or even mitochondrial replacement therapies all have reduced chances of success but further tend to reinforce the importance of a genetic link. The financial, physical and psychosocial burden associated with cumulative failure also lead to a higher probability of dropout and consequently an even higher probability of remaining in involuntary childlessness. We advocate formulation of a detailed roadmap for discussion of parenthood, with reference explanation to genetics and epigenetics, which gives due consideration to the psychological effects from the beginning to end of the treatment process, alongside a balanced consideration of the likelihood of treatment success and discussion of other options. Only when we provide patients with the service of a clear and transparent discussion of these matters, we will really realise the true potential of our field, which may then be better considered as assisted families.

The motivations of donor-conceived adults for seeking information about, and contact with, sperm donors

RESEARCH QUESTION

How do the demographic characteristics, mental health experiences and disclosure experiences of donor-conceived adults shape motivations for seeking information about their sperm donors, contact with them, or both?

DESIGN

Sixty-nine Australian adults who conceived through sperm donors completed an online survey. Uniquely, information and contact seeking were investigated as two distinct concepts.

RESULTS

Participants reported a variety of demographic, mental health, disclosure and discovery experiences. Most had been motivated to seek information about their donor (88%), contact with them (71%), or both. The most commonly reported motivations for each act were for medical information, expanding their identity and curiosity. Logistic regression findings were significant for wanting medical information as a motivation for seeking donor information (P = 0.03). Endorsement of this motivation was associated with self-reported anxiety (P = 0.02) and less likely as participant age increased (P = 0.02). Motivation to contact donors for medical information was associated with self-reported anxiety (P = 0.02) and depression (P = 0.01), and more likely when the participant was raised in a household that included the recipient co-parent (P = 0.04). As years since disclosure or discovery increased, participants were less likely to report wanting medical information as a motivation (P = 0.02).

CONCLUSION

Overall, participants were motivated to obtain information and seek contact with sperm donors. Motivations for each were similar despite participants varying in age and reporting a range of circumstances regarding disclosure, some of which were adverse.

Secondary Data Usage in Direct-to-Consumer Genetic Testing: To What Extent Are Customers Aware and Concerned?

INTRODUCTION

Customer data from direct-to-consumer genetic testing (DTC GT) are often used for secondary purposes beyond providing the customer with test results.

OBJECTIVE

The goals of this study were to determine customer knowledge of secondary uses of data, to understand their perception of risks associated with these uses, and to determine the extent of customer concerns about privacy.

METHODS

Twenty DTC GT customers were interviewed about their experiences. The semi-structured interviews were transcribed, coded, and analyzed for common themes.

RESULTS

Most participants were aware of some secondary uses of data. All participants felt that data usage for research was acceptable, but acceptability for non-research purposes varied across participants. The majority of participants were aware of the existence of a privacy policy, but few read the majority of the privacy statement. When previously unconsidered uses of data were discussed, some participants expressed concern over privacy protections for their data.

CONCLUSION

When exposed to new information on secondary uses of data, customers express concerns and a desire to improve consent with transparency, more opt-out options, improved readability, and more information on future uses and potential risks from direct-to-consumer companies. Effective ways to improve readership about the secondary use, risk of use, and protection of customer data should be investigated and the findings implemented by DTC companies to protect public trust in these practices.

The stability of psychological adjustment among donor-conceived offspring in the U.S. National Longitudinal Lesbian Family Study from childhood to adulthood: differences by donor type

OBJECTIVE

To study differences by sperm donor type in the psychological adjustment of the U.S. National Longitudinal Lesbian Family Study (NLLFS) offspring across three time periods from childhood to adulthood.

DESIGN

U.S.-based prospective cohort study.

SETTING

Paper-and-pencil questionnaires and protected online surveys.

PATIENT(S)

A cohort of 74 offspring conceived by lesbian parents using an anonymous (n = 26), a known (n = 26), or an open-identity (n = 22) sperm donor. Data were reported when offspring were ages 10 (wave 4), 17 (wave 5), and 25 (wave 6).

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Achenbach Child Behavior Checklist administered to lesbian parents when offspring were ages 10 and 17 and the Achenbach Adult Self-Report administered to offspring at age 25.

RESULT(S)

In both relative and absolute stability, no differences were found in internalizing, externalizing, and total problem behaviors by donor type over 15 years. However, both externalizing and total problem behaviors significantly declined from age 10 to 17 and then increased from age 17 to 25. Irrespective of donor type, among the 74 offspring, the large majority scored continuously within the normal range on internalizing (n = 62, 83.8%), externalizing (n = 62, 83.8%), and total problem behaviors (n = 60, 81.1%).

CONCLUSION(S)

The results reassure prospective lesbian parents and provide policy makers and reproductive medicine practitioners with empirical evidence that psychological adjustment in offspring raised by lesbian parents is unrelated to donor type in the long term.

Investigative genetic genealogy: Current methods, knowledge and practice

Investigative genetic genealogy (IGG) has emerged as a new, rapidly growing field of forensic science. We describe the process whereby dense SNP data, commonly comprising more than half a million markers, are employed to infer distant relationships. By distant we refer to degrees of relatedness exceeding that of first cousins. We review how methods of relationship matching and SNP analysis on an enlarged scale are used in a forensic setting to identify a suspect in a criminal investigation or a missing person. There is currently a strong need in forensic genetics not only to understand the underlying models to infer relatedness but also to fully explore the DNA technologies and data used in IGG. This review brings together many of the topics and examines their effectiveness and operational limits, while suggesting future directions for their forensic validation. We further investigated the methods used by the major direct-to-consumer (DTC) genetic ancestry testing companies as well as submitting a questionnaire where providers of forensic genetic genealogy summarized their operation/services. Although most of the DTC market, and genetic genealogy in general, has undisclosed, proprietary algorithms we review the current knowledge where information has been discussed and published more openly.

Understanding parents' intention to disclose the donor conception to their child by application of the theory of planned behaviour

STUDY QUESTION

Does the theory of planned behaviour (TPB) contribute to understanding parents’ intention to share information about genetic origin with their donor-conceived child?

SUMMARY ANSWER

Parents’ intention to start disclosure was associated with beliefs that disclosure would have desired consequences and a desire to act in accordance to societal norms.

WHAT IS KNOWN ALREADY

Despite a growing consensus on donor-conceived offspring’s right to information about their genetic origin, disclosure to the child remains a challenge for many parents, particularly heterosexual couples. TPB has successfully been applied to many health-related contexts and may contribute to increase understanding of parents’ decision-making about disclosing the genetic origin to their children.

STUDY DESIGN, SIZE, DURATION

A cross-sectional survey study of heterosexual couples with children aged 7–8 years following identity-release oocyte donation (OD, n = 83) or sperm donation (SD, n = 113).

PARTICIPANTS/MATERIALS, SETTING, METHODS

The study is part of the prospective longitudinal Swedish Study on Gamete Donation. Couples accepted for oocyte or sperm donation treatment at seven fertility clinics were recruited in 2005–2008 and requested to complete four postal surveys in the following 10 years. The present study sample includes heterosexual couples with donor-conceived children aged 7–8 years. Data were collected with the study-specific TPB Disclosure Questionnaire and analysed with path analysis.

MAIN RESULTS AND THE ROLE OF CHANCE

More than half of parents following OD or SD had already disclosed the donor conception to their child (OD 61%, SD 58%). Among parents who had not yet started the disclosure process, the belief that disclosure would have desired consequences (P < 0.05) and a desire to act in accordance to social norms favouring disclosure (P < 0.01) were positively associated with their intention to talk with their child about the donor conception during the upcoming year. In contrast, perceived confidence to talk with the child about his/her genetic origin was found to be negatively associated with the intention to start the disclosure process (P < 0.05). Type of treatment (OD/SD) and the existence or absence of a genetic link to the child were not directly associated with parents’ disclosure intentions.

LIMITATIONS, REASONS FOR CAUTION

The study was performed with heterosexual couples within the context of the Swedish legislation on identity-release donation, which limits the generalizability to other populations. Also, attrition may have introduced selection bias to the study findings. Future studies using the TPB Disclosure Questionnaire (TPB-DQ) with larger samples are needed to validate this measure.

WIDER IMPLICATIONS OF THE FINDINGS

Application of the theory of planned behaviour highlighted the importance of attitudes and social norms for parents’ intention to share information about the donor conception with their child. The present results add to the complexity of disclosure of donor conception, and may contribute to promote open communication and support family life following donor conception.

STUDY FUNDING/COMPETING INTEREST(S)

Financial support from the Swedish Research Council. There are no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

N/A

[Comparative survey of French oocyte donor's profile and motivations between nulliparous and multiparous donors, 2017-2018]

OBJECTIVES

Since the authorization of French nulliparous women to donate oocytes, who are the new donors? What are the similar and differential points with the initial donors who have already procreated?

METHODS

Retrospective multicenter cohort study using a questionnaire.

RESULTS

The return rate is 90.7% with 248 donor files from 5 French assisted reproductive technology (ART) centers, included between 1 January 2017 and 31 December 2018. The average age is 31,0 years. More than two thirds of women have a higher educational level than the license. Donation is spontaneous or relational in 69% and 25% of cases, respectively. Among nulliparous donors, 37% don't know the possibility of self-preservation but after information, 80% wish to benefit from it versus 32% of multiparous women if they were given the opportunity.

CONCLUSIONS

This study by the Study Group for Egg Donation (GEDO) highlights the particularities of French oocytes donors. The 2015 decree allowed to diversify the origin of the donation, which remains mainly altruistic but the possibility of self-preservation for nulliparous donors also seems to motivate women. This link between donation and self-preservation poses an ethical problem that needs to be approached and resolved in the next Bioethics Law framing Assisted Reproductive Technologies (ART).

Absence of laws regarding sperm and oocyte donation in Japan and the impacts on donors, parents, and the people born as a result

An absence of any statutory law in Japan regarding donor conception creates uncertainty about the status of donors in relation to the child(ren) born as a result. Laws that provide for certainty regarding the status of the donor are called for, as are laws that address donor anonymity. It would be pragmatic to introduce a prospective system that requires open donation, allowing information to be recorded and released to donor-conceived people upon request. For past donations, a voluntary register should be established, which would allow those people who are seeking information to register this.

[Anonymity of gamete donation and genetic testing]

Development of genetic testing direct-to-consumer (DTC) for recreational purposes, although prohibited in France, is a real challenge to the current practice of gamete donation. Indeed, anonymity is a fundamental principle contributing to the ethics of donation. This principle is weakened due to the availability to the general public of these tests on the Internet. Several thousands of people are conceived by gamete donation worldwide, some of whom do not know how they were conceived. Gamete donors should be informed that their anonymity is no longer guaranteed, as they can be found by homologies of their DNA, or that of a parent or a child, potentially available in databases. Thus, adults conceived by gamete donation but not informed by their parents can discover their way of conception. Recipients of gamete donation should also be informed that their child's DNA will establish the biological discrepancy and they should be encouraged to disclose the conception to their child. Several countries now allow children conceived by donation to obtain donor's identity. In France, the Bioethics Law is currently being finalized and will now allow access to donor's identity for people conceived by gamete donation.

Psychosocial aspects of identity-release gamete donation - perspectives of donors, recipients, and offspring

Donor conception creates families with varying genetic linkage between family members. This may have short-term as well as lifelong psychosocial consequences for all involved. Gamete donors have traditionally been anonymous to recipients and offspring, but there is a growing trend towards identity-release donor programmes that give offspring the right to obtain the donor's identity. This review aims to provide an overview of the perspectives of donors and recipients and offspring involved in identity-release donation. The results show that both oocyte and sperm donors have primarily altruistic motives, and recipients, in particular lesbian and single women, are generally open about the donation to their offspring. The few existing studies on offspring perspectives indicate that those who are aware of their donor conception appear to be interested in contact with the donor, and most donors are open to such contact. Investigations of donors and recipients indicate a need for more counselling and support to manage family life with varying genetic linkage within and outside the family unit. This includes preparing for and managing future contact between the donor and his/her family and donor offspring and their family, as well as between donor siblings and their respective families.

Children's Exploration of Their Surrogacy Origins in Gay Two-Father Families: Longitudinal Associations With Child Attachment Security and Parental Scaffolding During Discussions About Conception

Evidence is lacking about the factors that are pivotal in enhancing the exploration of surrogacy origins in children of gay fathers during middle childhood. The present study examined the separate and combined influences of child attachment security and parental scaffolding (i.e., fathers' attempts to accept, encourage, and emotionally support their children's expression of thoughts and feelings) during discussions about conception on children's exploration of their surrogacy origins in 30 Italian children born to gay fathers through gestational surrogacy. Within each family, both father-child dyads (n = 60) participated in a 5-minute videotaped conversation regarding an aspect of the child's conception when children were mean aged 8.3 years (t1). At this time, children were also administered the Security Scale Questionnaire to evaluate their attachment security. Approximately 18 months later (t2; M age = 9.9 years), children were interviewed about their surrogacy origins. Linear mixed models (LMMs) for longitudinal data indicated that, with higher levels of parental scaffolding, only children who perceived greater attachment security reported greater exploration of their surrogacy origins. The findings are the first to underscore the importance of conversations about surrogacy within the context of parent-child attachment relationships, as well as the importance of fathers sensitively supporting their children as they explore their origins during middle childhood. In doing so, it is expected that fathers will likely facilitate their children's positive integration of their surrogacy conception into a coherent sense of identity during adolescence.