Emerging models for facilitating contact between people genetically related through donor conception: a preliminary analysis and discussion

Donor-linking provisions in New Zealand: counselling roles, concerns and needs

Donor-linking where those genetically related through donor conception (e.g. donor-conceived persons (DCP), donors and siblings), or recipient parents, search for and connect with each other, is increasingly common, both in identity-release jurisdictions where donors' identifying information may be released to DCP, usually when they become adults - and in anonymous jurisdictions, e.g. as a result of direct-to-consumer DNA testing. In this paper, we explore New Zealand fertility clinic counsellors' views regarding their donor-linking roles and their concerns and needs in relation to current and anticipated service provision. Counsellors believed that fertility service providers had a longer-term responsibility to offer donor-linking services to ensure the wellbeing of all parties affected by donor conception. They perceived their role as complex and multifaceted, encompassing psychoeducation, mediation, advocacy, facilitation, relationship counselling, and therapeutic intervention. They identified significant service provision challenges however, including inadequate staffing, training, time and prioritisation of donor-linking, and inadequate legislative provisions to support practice. Counsellors called for clarity in legislation addressing different contexts of donation and providing measures to ensure the recording of and access to identifying information. They expressed a need for comprehensive, funded donor-linking services, therefore facilitating choice, and services staffed by professionally trained and supported staff.

Embodied sociotechnical imaginaries: how donor-conceived people imagine identity, family and reprodigital futures beyond regulation

Sociological scholarship has begun to explore imaginaries of family and reproduction, yet less work has focused on the emerging social form of the donor family. In this article, we consider the embodied sociotechnical imaginaries of donor-conceived people, exploring their reflections, judgements, hopes, and predictions regarding donor conception. Combining reflexive thematic analysis of free-text survey responses from sperm donor-conceived (n = 90) and egg donor-conceived (n = 1) and data from semi-structured interviews with sperm donor-conceived people (n = 28), conceived in both clinical and non-clinical contexts in Australia, we analyse donor-conceived people's imaginings of family, identity, and the practice of donor conception in the digital age. Our analysis centres the donor-conceived body that imagines, and in doing so, highlights the entanglements of reproductive and digital technologies, and the humans and institutions that drive their uptake. We argue that leveraging the imaginative and political capacities of donor-conceived people is a productive approach that illuminates possible (re)directions of the assisted reproduction industry as well as illustrating potential policy futures.

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?

Meeting multiple same-donor offspring: psychosocial challenges

Debates regarding donor-conceived people's rights to genetic information have caused some jurisdictions to abolish donor anonymity. Moreover, voluntary services have been established whose primary focus is providing possibilities to find information about the donor. A less discussed consequence is that donor-conceived people also find information about donor half-siblings: people conceived through the same donor. In the recent climate of openness and online DNA tests, there is an increased chance of finding multiple donor half-siblings. This study explored how donor-conceived people experience meeting multiple same-donor offspring in a group setting. Second, the study investigated donor-conceived people's need for support when meeting multiple donor half-siblings. A qualitative approach was used. Nineteen donor-conceived offspring who participated in donor half-sibling network meetings were interviewed. Using a grounded theory approach three themes were identified regarding group aspects: (i) defining group membership; (ii) regulating closeness and distance; and (iii) managing group dynamics. Professional support needs in relation to these themes were also analysed. While establishing relationships between donor half-siblings are viewed as generally more beneficial than connecting with a donor, this study showed that these new relationships also come with their challenges, and counselling may need to be refined towards a more specific same donor-offspring relationships' framework.

Finding people like me: contact among young adults who share an open-identity sperm donor

STUDY QUESTION

What interests and experiences do donor-conceived adults have with respect to same-donor peers/siblings, when they share an open-identity sperm donor?

SUMMARY ANSWER

Donor-conceived young adults report considerable interest in, and primarily positive experiences with, their same-donor peers, with some finding ‘people like me’.

WHAT IS KNOWN ALREADY

Through mutual-consent contact registries, director-to-consumer DNA testing and other means, donor-conceived people with anonymous (i.e. closed-identity) sperm donors are gaining identity-related information from, and establishing relationships with, people who share their donor.

STUDY DESIGN, SIZE, DURATION

Semi-structured, in depth telephone and Skype interviews with 47 donor-conceived young adults were carried out over a 31-month period. Inclusion criteria were being one of the first adults for each donor to obtain their identity and being at least 1-year post donor-information release.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Participants (aged 19–29 years, 68.1% women) were born to female same-sex couple parents (46.8%), a single mother (29.8%) or heterosexual couple parents (23.4%); all parents had conceived through the same US open-identity sperm donation program. The dataset was analyzed thematically and included interviews from only one participant per family. Each participant had a different donor.

MAIN RESULTS AND THE ROLE OF CHANCE

Interest in, and experiences with, same-donor peers suggested that they occupy a unique position in the lives of donor-conceived young adults who share their open-identity donor. Contact can provide identity-relevant information and support through the availability of relationships (whether actualized or potential), shared experiences, and easier relationships than with their donor. Most donor-conceived young adults felt positively about their contact experiences. Of those not yet linked, almost all expressed an interest to do so. Some had met the children raised by their donor. When asked, all expressed an interest in doing so.

LIMITATIONS, REASONS FOR CAUTION

Interviews were conducted with donor-conceived young adults who were uncommon in their generation in terms of: having an open-identity sperm donor; the majority knowing about their family’s origins from childhood; and having parents that accessed at the time one of the only open-identity sperm donation programs. Further research is needed to assess applicability to all donor-conceived adults; findings may be more relevant to the growing number of people who have an open-identity donor and learned in childhood about their family’s origins.

WIDER IMPLICATIONS OF THE FINDINGS

Participants were among the first generation of donor-conceived adults with an open-identity sperm donor. Their experiences and perspectives can provide essential guidance to programs and others with similar origins. Early disclosure of family origins and identifying the donor did not diminish the young adults’ interest in their same-donor peers. Positive experiences suggest that the benefits of contact include not only identity-relevant information (through shared traits and experiences), but also relationships with and support from people who understand the uncommon experience of being donor conceived. Implications include the need to educate families and intended parents about the potential benefits of knowing others who are donor conceived, and the risk of unexpected linking across families by donors, regardless of donor-conceived person or family interest.

STUDY FUNDING/COMPETING INTEREST(S)

The study was funded by the Lesbian Health Fund of GLMA: Health Professionals Advancing LGBTQ Equality. The authors have no conflict of interest to declare.

A comparison of the characteristics, motivations, preferences and expectations of men donating sperm online or through a sperm bank

STUDY QUESTION

How do the demographic characteristics, motivations, experiences and expectations of unregulated sperm donors (men donating sperm online through a connection website) compare to sperm donors in the regulated sector (men donating through a registered UK sperm bank)?

SUMMARY ANSWER

Online donors were more likely to be older, married and have children of their own than sperm bank donors, were more varied in their preferences and expectations of sperm donation, and had more concerns about being a sperm donor.

WHAT IS KNOWN ALREADY

While studies have examined motivations and experiences of both regulated sperm bank, and unregulated online sperm donors, no study has directly compared these two groups of donors.

STUDY DESIGN, SIZE, DURATION

An email was sent to the 576 men who were registered sperm donors at the London Sperm Bank, the UK’s largest sperm bank regulated by the Human Fertilisation and Embryology Authority (HFEA), who had commenced donation between January 2010 and December 2016, and had consented to be contacted for research. The online survey, which contained multiple choice and open-ended questions, was completed by 168 men over a 7-week period. The responses were compared to those of sperm donors registered on Pride Angel, a large UK-based connection website for donors and recipients of sperm: our research team had already collected these data. In total, 5299 sperm donors were on Pride Angel at time of data capture and 400 men had completed a similar survey. The responses of 70 actual online sperm donors (i.e. those whose sperm had been used to conceive at least one child) were used for comparison with the sperm bank donors.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The survey obtained data on the sperm donors’ demographic characteristics, motivations, experiences and expectations of sperm donation. Data from sperm bank donors were compared to online donors to examine differences between the two groups. The study compared online and clinic donors who had all been accepted as sperm donors: online donors who had been ‘vetted’ by recipients and sperm bank donors who had passed the rigorous screening criteria set by the clinic.

MAIN RESULTS AND THE ROLE OF CHANCE

A response rate of 29% was obtained from the sperm bank donors. Online donors were significantly older than sperm bank donors (mean ± SD: 38.7 ± 8.4 versus 32.9 ± 6.8 years, respectively) and were more likely to have their own children (p < 0.001 for both characteristics). Both groups rated the motivation ‘I want to help others’ as very important. Online donors rated ‘I don’t want to have children myself’, ‘to have children/procreate’ and ‘to enable others to enjoy parenting as I have myself’ as more important than sperm bank donors, whereas sperm bank donors rated financial payment as more important than online donors, as well as confirmation of own fertility. Most (93.9%) online donors had donated their sperm elsewhere, through other connection sites, fertility clinics, sperm banks or friends and family, compared to only 2.4% of sperm bank donors (p < 0.001). There was a significant difference in how donors viewed their relationship to the child, with online donors much less likely than sperm bank donors to see their relationship as a ‘genetic relationship only’. Online donors had more concerns about being a donor (p < 0.001), for example, being concerned about ‘legal uncertainty and child financial support’ and ‘future contact and uncertainty about relationship with donor-conceived child’.

LIMITATIONS, REASONS FOR CAUTION

Findings may not be representative of all sperm donors as only one online connection site and one HFEA registered sperm bank were used for recruitment.

WIDER IMPLICATIONS OF THE FINDINGS

Despite concern regarding shortages of sperm donors in licensed clinics and unease regarding the growing popularity of unregulated connection websites, this is the first study to directly compare online and sperm bank donors. It highlights the importance of considering ways to incorporate unregulated online sperm donors into the regulated sector. With many online donors well aware of the legal risks they undertake when donating in the unregulated online market, this would both increase the number of sperm donors available at clinics but also provide legal protection and support for donors.

STUDY FUNDING/COMPETING INTEREST(S)

This study was supported by the Wellcome Trust Grants 104 385/Z/14/Z and 097857/Z/11/Z. The authors have no conflicts of interest.

Applications to statutory donor registers in Victoria, Australia: information sought and expectations of contact

Knowledge of genetic origins is widely believed to have consequences for health, family belonging and personal identity. Donor linking is the process by which donors, recipient parents (RP) and donor-conceived people (DCP) gain access to identifying information about each other. This paper reports on the information and contact sought by donor-linking applicants to the central and voluntary registers in the state of Victoria, Australia, which has one of the most comprehensive donor-linking legislative frameworks in the world. Applicants to the Victorian registers complete a statement of reasons (SOR), a written document that is given to the subject of the application, outlining their reasons for applying and their short- and long-term goals. SOR written by applicants between 29 June 2015 and 28 February 2017 who had agreed to be recontacted for research were analysed. Forty-two of 93 eligible applicants took part (45%). All applications pertained to donor sperm. RP were the largest applicant group (n = 19) followed by DCP (n = 17) and donors (n = 6). All applicants wanted personal information and most expressed a desire for contact. Single mothers of young children used the registers more than any other parent group, indicating that family structure may influence application patterns. While it is apparent that all applicants are eager for information and some form of interpersonal contact, further research is needed on how the legal and policy landscape of different jurisdictions influences expectations, as well as what happens after parties are linked.

Emerging Views of Kinships Created Through Oocyte Donation

BACKGROUND

The United States has the highest number of oocyte donation cycles, which account for an estimated one-quarter of all worldwide oocyte donation cycles. Although there has been a steady rise in oocyte donation treatment, understanding the kinship views of those intimately involved is lacking. These include women oocyte donors and parents who received donor oocytes to establish a pregnancy.

PURPOSE

To explore the views and perspectives about genetic relationships and lineages among women who were oocyte donors and parents who received donated oocytes 10 to 12 years after donors and parents underwent oocyte donation procedures to establish a pregnancy.

STUDY DESIGN AND METHODS

A longitudinal cohort of pregnant women who received donor oocytes participated in an expanded, follow-up study 12 years postpregnancy that included the women's heterosexual partners and biological fathers. Women who donated oocytes anonymously 10 to 12 years prior also participated. Qualitative content analysis was used to analyze participants' in-depth interviews.

RESULTS

Six women who received donor oocytes and their heterosexual partners and biological fathers (n = 6), representing 12 children conceived by oocyte donation, and 3 women who donated oocytes anonymously representing 3 children participated. Themes that emerged from the women oocyte donors included a reexamination of anonymity and contact with recipient families, managing disclosure to their own children about possible half-siblings, and potential for consanguinity. For recipient parents, there was an overwhelming sense of gratitude to the women oocyte donors, concerns about navigating genetic information gaps, and contemplating future contact with the donors and/or half-siblings.

CLINICAL IMPLICATIONS

Nurses can play a vital role in supporting and educating women oocyte donors and recipient parents about navigating complex relationship issues in donor kinships.

New realities for the practice of egg donation: a family-building perspective

The practice of egg donation in the United States has been based on assumptions about secrecy, anonymity, and contact among the parties that require reexamination. This article argues for the need to acknowledge that secrecy and anonymity are no longer viable assumptions and that all parties may have a strong interest in contact and connection. A shift in the narrative for the practice of egg donation from a purely medical perspective to a broader family-building perspective is described. Significant practice changes to accommodate the new realities, rooted in a family-building perspective, are outlined in the arenas of medical record retention, informed consent, recipient and donor preparation and counseling, facilitation of contact among the parties, and outreach to other medical professionals, with the goal of promoting not only healthy pregnancy, but also long-term positive family functioning.

Anonymous Dutch sperm donors releasing their identity

This study examined the motivations of anonymous Dutch sperm donors to release their identity. It aimed to increase knowledge and encourage donors to become identifiable through a more informed decision, allowing more donor-conceived persons to contact their donors. Since 2010, anonymous sperm donors in the Netherlands can register in the Fiom KID-DNA Database developed by Fiom and Canisius Wilhelmina Hospital (CWZ). An online survey was sent to donors who registered in the database (May 2015-August 2017). A total of 179 male respondents participated in this study. The motives of most donors to register in the database were child-oriented: donors believe that their offspring are entitled to their physical and social details and/or they want to give their offspring the chance to contact them. Other motives are donor-oriented, such as the curiosity about the number of offspring, their well-being and the desire to establish contact. This research showed that, to encourage anonymous donors to release their identity, one should focus on providing information about the existence of DNA databases. As well as increasing the donor's awareness of problems donor-conceived persons can experience by the lack of knowledge about their descent, answering questions and concerns from donors, and exploring the curiosity about their offspring.

Secrets and disclosure in donor conception

This article considers the disclosure, sharing and exchange of information on being donor conceived within families, drawing on data from a study undertaken with donor-conceived adults registered with UK Donor Link (a voluntary DNA-linking register). This paper considers the narratives of how respondents found out they were donor-conceived and what events triggered disclosure of this information. This paper then goes on to examine the role secrecy played in their family life and uses the concept of 'display' to explore how secrecy affected their relationships with their immediate and extended family. Secrets are notoriously 'leaky' and we found complex patterns of knowing and uncertainty about whom in the family knew that the person was donor-conceived. We argue that what is kept secret and from whom provides insights into the multifaceted web of social relationships that can be created by donor-conception, and how knowledge can be managed and controlled in attempts to display and maintain family narratives of biogenetic connection.

Adolescents Conceived through Donor Insemination in Mother-Headed Families: A Qualitative Study of Motivations and Experiences of Contacting and Meeting Same-donor Offspring

This study interviewed adolescents conceived using sperm donation to examine their experiences of contacting and meeting 'same-donor offspring' (i.e. donor-conceived offspring raised in different families who share the same donor), their motivations for this contact, and how they make meaning of these relationships. This in-depth qualitative study involved semi-structured interviews with 23 young people aged 12-19 years (mean = 14 years). Interviewees were motivated by curiosity about their biological relations and by wanting to extend their family. Contact with same-donor offspring was described as being either normal/neutral or as a unique experience that was integrated into their identity. This study highlights the importance of contact between same donor offspring, particularly during adolescence, a developmental stage associated with identity formation. The findings have important policy implications as they suggest that donor-conceived individuals may benefit from contact with others conceived using the same donor prior to the age of 18 years.

Who requests their sperm donor's identity? The first ten years of information releases to adults with open-identity donors

OBJECTIVE

To report findings from 10 years of requests from adults eligible to obtain their open-identity sperm donor's information.

DESIGN

Analysis of archived family and donor data. Semistructured interviews at information releases.

SETTING

Not applicable.

PATIENT(S)

A total of 85 DI adults requesting 43 donor identities; program data on 256 DI families.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

We identified [1] demographic predictors of requesting donor identities, [2] information release timing and length, and [3] request motives.

RESULT(S)

Just >35% of eligible DI adults requested their donor's identity. Adults ranged from 18-27 years, requesting at median age 18 years. More women than men requested. Proportionally fewer adults requested when they had heterosexual-couple parents, and proportionally more when they had one rather than two parents. In interviews, the common theme was wanting to know more about the donor, especially about shared characteristics. Most adults planned to contact their donor. More than 94% of adults had donors who were open to contact; adults expressed modest expectations about this contact.

CONCLUSION(S)

In 2001, the first adults became eligible to obtain their open-identity sperm donor's information. Ten years of identity requests at one program indicates that information about one's donor is important to a significant proportion of these DI adults. Most requested their donor's identity soon after becoming eligible, suggesting some urgency to wanting the information. Interview data highlighted the role of donor information in helping adults better understand themselves and their ancestry. Findings hold important implications for practice and policy.

Disclosure of donor conception in the era of non-anonymity: safeguarding and promoting the interests of donor-conceived individuals?

This article responds to a debate article published in Human Reproduction earlier this year. In that article, the authors suggested that parents should be encouraged to disclose the use of donor gametes to their children given rapid and widespread advances in genetic testing and sequencing. However, there is an urgent need to engage with the assertion that in this context, telling children about their donor conception both safeguards and promotes their interests, particularly if such disclosure is motivated by parents' anxieties about accidental discovery. Disclosure that is motivated by the notion of non-anonymity may also encourage parents to share misinformation about donors and encourage their children to have unrealistic expectations. Fertility professionals must remain mindful of these outcomes when discussing disclosure and the future implications of increasing access to genetic information with both prospective and current parents. It is strongly advised that future discussions about the end of donor anonymity are not conflated with the debate on disclosure.