Parents’ contributions to the narrative identity of offspring of donor-assisted conception

Comparing the psychological outcomes of donor and non-donor conceived people: A systematic review

BACKGROUND

Over 70 000 donor-conceived (DC) people have been born in the UK since 1991. Little is known about their long-term psychological outcomes and no systematic review has assessed these.

OBJECTIVES

To conduct a systematic review of the psychological experiences of DC people through childhood and adulthood (Prospero: CRD42021257863).

SEARCH STRATEGY

Searches of Cumulative Index to Nursing and Allied Health Literature (CINHAL), the Excerpta Medica database (Embase), MEDLINE® and PsycINFO, conducted on 4 January 2024.

SELECTION CRITERIA

Quantitative and qualitative studies were included if: there were five or more participants; they were peer reviewed; and any DC psychological outcomes were assessed. No limits on date, language or country were applied.

DATA COLLECTION AND ANALYSIS

Double screening, selection, data extraction and quality assessment were performed, using Joanna Briggs Institute (JBI) scoring.

MAIN RESULTS

Fifty studies (with 4666 DC participants), mostly from high-income anglophone countries, with heterogeneity of design, populations and outcome measures, were included. Of 19 comparative studies, 14 found no difference in outcomes between DC and non-DC people, ten found better outcomes (in health, well-being, self-esteem and emotional warmth) and six found worse outcomes (increased autism spectrum disorder and attention deficit hyperactivity disorder, addiction issues, mental illness, disruptive behaviour and identity problems). Qualitative data revealed common themes relating to identity formation, mistrust and concerns regarding genetic heritage. The evidence regarding adulthood outcomes was very limited.

CONCLUSIONS

The research on DC individuals presents a nuanced picture, with most studies suggesting comparable or improved outcomes in terms of well-being and relationships, but with a notable minority indicating higher rates of mental health and identity struggles. Qualitative findings underscore common negative experiences, whereas the early disclosure of DC status appears beneficial for psychological well-being.

Using the theory of planned behavior to predict parents' disclosure of donor conception to their children: a longitudinal study

STUDY QUESTION

Can the application of the theory of planned behavior (TPB) help predict heterosexual parents' disclosure of donor conception to their children?

SUMMARY ANSWER

Parents with a stronger will to act in accordance with social norms favoring disclosure were more likely to start the disclosure process within the next 5-9 years.

WHAT IS KNOWN ALREADY

In contrast to single mothers by choice and same-sex couples, heterosexual couples need to make an active decision to disclose their use of donor conception to their child. While disclosure at an early age is encouraged by international guidelines, many heterosexual-couple parents struggle with this. A previous study has found an association between parental scores of TPB factors and disclosure intention, but so far, no study has applied the TPB to predict parents' disclosure behavior.

STUDY DESIGN, SIZE, DURATION

The present study is based on the fourth and fifth waves of data collection (T4 and T5) in a nation-wide longitudinal study. Participating parents had conceived through identity-release oocyte donation (n = 68, response rate 65%) and sperm donation (n = 62, response rate 56%) as part of a heterosexual couple.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The present study is part of the prospective longitudinal Swedish Study on Gamete Donation (SSGD). Consecutive recruitment of couples starting oocyte or sperm donation treatment was conducted at all seven fertility clinics providing gamete donation in Sweden during a 3-year period (2005-2008). Participants were requested to complete postal surveys at five time points. The present study includes heterosexual-couple parents following oocyte or sperm donation who participated at the two latest time points when their children were 7-8 years old (T4), and 13-17 years old (T5). At T4, participants completed the study-specific TPB Disclosure Questionnaire (TPB-DQ) measuring attitudes and intentions to disclose the donor conception to the child, and disclosure behavior was assessed at both T4 and T5. Data from those participants who had not yet disclosed at T4 were analyzed using survival analysis with Cox regressions.

MAIN RESULTS AND THE ROLE OF CHANCE

Forty participants had not disclosed the donor conception to their children at T4 and, out of these, 13 had still not disclosed at T5. We found a significant association between scores of the TPB factor Subjective norms at T4 and their subsequent disclosure behavior at T5 (HR = 2.019; 95% CI: 1.36-3.01). None of the other factors were significantly associated with disclosure behavior.

LIMITATIONS, REASONS FOR CAUTION

The present study concerns heterosexual-couple parents with children conceived following treatment with gametes from open-identity donors, which limits the generalizability of our findings to other groups and contexts. Other limitations include the risk of systematic attrition due to the longitudinal study design and decreased statistical power due to few participants.

WIDER IMPLICATIONS OF THE FINDINGS

Our findings highlight the importance of perceived subjective norms for parents' disclosure behavior and indicate that the co-parent's opinion about disclosure is of particular relevance in this regard. Counselors should focus on supporting prospective parents to initiate and maintain a healthy and open dialogue about concerns around building a family with donor conception.

STUDY FUNDING/COMPETING INTEREST(S)

The study was funded by the Swedish Research Council. The authors have no competing interests to declare.

TRIAL REGISTRATION NUMBER

N/A.

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.

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

'Is blood thicker than water?' Donor conceived offspring's subjective experiences of the donor: a systematic narrative review

The aim of this study was to provide a systematic narrative review of the published research articles on donor conceived offspring's subjective experiences of their donor. A systematic search of electronic databases (PsycINFO and PubMed) provided 29 published quantitative and qualitative studies matching the inclusion criteria. The analysis of the studies outcomes led to the identification of four main themes: (i) views/representations of the donor; (ii) desire to contact the donor (in terms of desire to meet the donor, reasons for wanting to contact the donor, type and frequency of contact); (iii) reactions to discovering the donor's identity and contacting the donor; (iv) identity issues. The findings revealed that genetic ties do matter to donor conceived people, especially during adolescence or adulthood. Many donor conceived people were interested in contacting the donor and all of them needed to make meaning of the role of the donor, as well as to integrate it into their family life and self-concept. Besides curiosity and medical reasons, many people reported wanting to contact the donor to see what he/she looked like, and to have access to their own ancestry and genetic history.

'No daddy', 'A kind of daddy': words used by donor conceived children and (aspiring) parents to refer to the sperm donor

Research has shown that the recipients of donor sperm can experience difficulties finding appropriate language to refer to the donor. Based on two qualitative analysis techniques, namely word count and empirical discourse analysis, we studied the words used to refer to the donor in heterosexual and lesbian (aspiring) parents and in donor conceived children. Findings show that the words used in these households are highly diverse and have at least four different interlinked functions: (1) to position the donor in relation to the nuclear family; (2) to safeguard the role of the social parent; (3) to clarify family structure; and (4) to present a positive picture of the donor. Both parents and children consciously reflect on what words to use to refer to the donor. Although parents try to keep words like 'father' and 'daddy' out of the family narrative, children use these words. These findings show that it is important for healthcare personnel and policy makers to reflect on the careful use of terminology when they address questions around sperm donation because the terminology invokes specific meanings that have an effect on how the recipients and their children perceive the role of the donor.

Counsellors' practices in donor sperm treatment

When intended parents choose to have donor sperm treatment (DST), this may entail wide-ranging and long-lasting psychosocial implications related to the social parent not having a genetic tie with the child, how to disclose donor-conception and future donor contact. Counselling by qualified professionals is recommended to help intended parents cope with these implications. The objective of this study is to present findings and insights about how counsellors execute their counselling practices. We performed a qualitative study that included 13 counsellors working in the 11 clinics offering DST in the Netherlands. We held a focus group discussion and individual face-to-face semi-structured interviews, which were fully transcribed and analysed using thematic analysis. The counsellors combined screening for eligibility and guidance within one session. They acted according to their individual knowledge and clinical experience and had different opinions on the issues they discussed with intended parents, which resulted in large practice variations. The counsellors were dependent on the admission policies of the clinics, which were mainly limited to regulating access to psychosocial counselling, which also lead to a variety of counselling practices. This means that evidence-based guidelines on counselling in DST need to be developed to provide consistent counselling with less practice variation.

Narrative Identity in Third Party Reproduction: Normative Aspects and Ethical Challenges

In the last few decades, assisted reproduction has introduced new challenges to the way people conceive and build their families. While the numbers of donor-conceived (DC) individuals have increased worldwide, there are still many controversies concerning access to donor information. Is there a fundamental moral right to know one's genetic background? What does identity in DC families mean? Is there any relationship between identity formation and disclosure of genetic origins? These questions are addressed by analysing core regulatory discourse (ethical recommendations and codes of practice). This analysis shows that the notion of narrative identity is suitable for defining and answering these questions. This review analyses the meaning of resemblance in DC families and the way donors are selected following affinity-ties and discusses disclosure strategies and agreements. As a preliminary conclusion, it could be said that, in the field of third-party reproduction, knowing about the donor conception significantly contributes towards the development of a narrative identity and also serves as a moral basis for the child's right to know.

"Telling" and assent: Parents' attitudes towards children's participation in a birth cohort study

INTRODUCTION

One of the ethical issues surrounding birth cohort studies is how to obtain informed assent from children as they grow up. What and how parents tell their children affects children's future choices about the study, yet few studies have focused on parents' influence on children.

OBJECTIVE

This study examines parents' attitudes towards telling their children about their participation in a specific birth cohort study.

METHODS

We conducted surveys and in-depth interviews with the parents of children who participated in the "Japan Environment and Children's Study" (JECS), which follows children from the foetal stage to age 13.

RESULTS

Forty-four mothers and 23 fathers answered the survey, and 11 mothers and 3 fathers participated in in-depth interviews. Parents' attitudes towards "telling" were categorized into 3 communication styles depending on their perception of the risk/benefits for their children. Most parents predicted that the study would benefit their children and preferred "directive telling," which we divided into "empowered telling" (provides children with a positive identity as participants) and "persuasive telling" (attempts to persuade children even if they express reluctance as they grow). A few parents, weighing the study's potential risk, preferred "non-directive telling," which respects children's choices even if that means withdrawing from the study.

DISCUSSION

While "directive telling" may lead children to have positive associations with the study, children should also be told about the risks. Investigators can provide materials that support parents and give children age-appropriate information about their participation, as well as ensure opportunities for children to express their feelings.

The right to know one's genetic origins and cross-border medically assisted reproduction

The use of donor sperm or egg for reproduction raises the issue of the right of donor-conceived individuals to know their genetic origins. This paper argues in favor of acknowledging such a right and explores the challenges that cross-border medically assisted reproduction would raise in relation to it. It first explores possible justifications for such a right by discerning its possible conceptual and empirical groundings. It describes some key ethical and policy implications of the removal of donor anonymity. It then argues that novel technologies such as mitochondrial replacement and gene editing raise new concerns in this area and may expand the scope of such a right. Finally, it argues that while many barriers to accessing information about genetic origins already exist at national levels, cross-border medically assisted reproduction may exacerbate a reality in which many individuals conceived through third-party participation are deprived of information that may be crucial to their future well-being for medical or psycho-social reasons.

Donor Conception Disclosure: Directive or Non-Directive Counselling?

It is widely agreed among health professionals that couples using donor insemination should be offered counselling on the topic of donor conception disclosure. However, it is clear from the literature that there has long been a lack of agreement about which counselling approach should be used in this case: a directive or a non-directive approach. In this paper we investigate which approach is ethically justifiable by balancing the two underlying principles of autonomy (non-directive approach) and beneficence (directive approach). To overrule one principle in favour of another, six conditions should be fulfilled. We analyse the arguments in favour of the beneficence principle, and consequently, a directive approach. This analysis shows that two conditions are not met; the principle of autonomy should not be overridden. Therefore, at this moment, a directive counselling approach on donor conception disclosure cannot be ethically justified.

Defining Ourselves: Personal Bioinformation as a Tool of Narrative Self-Conception

Where ethical or regulatory questions arise about an individual's interests in accessing bioinformation about herself (such as findings from screening or health research), the value of this information has traditionally been construed in terms of its clinical utility. It is increasingly argued, however, that the "personal utility" of findings should also be taken into account. This article characterizes one particular aspect of personal utility: that derived from the role of personal bioinformation in identity construction. The suggestion that some kinds of information are relevant to identity is not in itself new. However, the account outlined here seeks to advance the debate by proposing a conception of the relationship between bioinformation and identity that does not depend on essentialist assumptions and applies beyond the narrow genetic contexts in which identity is customarily invoked. The proposal is that the identity-value of personal bioinformation may be understood in terms of its instrumental role in the construction of our narrative identities, specifically that its value lies in helping us to develop self-narratives that support us in navigating our embodied existences. I argue that this narrative conception provides useful insights that are pertinent to the ethical governance of personal bioinformation. It illuminates a wider range of ethical considerations in relation to information access; it accounts for variations in the utility of different kinds of information; and it highlights that the context in which information is conveyed can be as important as whether it is disclosed at all. These arguments are illustrated using an example drawn from psychiatric neuroimaging research.

Absence or presence? Complexities in the donor narratives of single mothers using sperm donation

STUDY QUESTION

How do single mothers who have conceived a child via anonymous or identity-release sperm donation represent the donor?

SUMMARY ANSWER

While the majority of mothers described their anonymous and identity-release donors as symbolically significant to their families, others were more likely to emphasize that their lack of information limited their thoughts about him.

WHAT IS KNOWN ALREADY

There is limited understanding of the factors that impact upon how single mothers represent the donor, and whether or not they are determined by specific donor programmes (anonymous or identity-release).

STUDY DESIGN, SIZE, DURATION

Qualitative interviews were conducted with 46 women who had treatment at a UK licensed fertility clinic during the years 2003–2009. Twenty mothers (43%) had used an anonymous donor, and 26 (57%) had used an identity-release donor.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Among the 46 mothers interviewed, all had at least one child conceived via donor insemination who was between the ages of 4 and 9 years. Mothers were heterosexual and were currently without a live-in and/or long-term partner. Interview data were analysed qualitatively according to the principles of thematic analysis.

MAIN RESULTS AND THE ROLE OF CHANCE

Findings indicated marked diversity in single mothers' representations of the donor. Most (n = 27) mothers talked about the donor as symbolically significant to family life and were likely to describe the donor as (i) a gift-giver, (ii) a gene-giver and (iii) a potential partner. Others (n = 16) talked about the donor as (i) unknown, (ii) part of a process and (iii) out of sight and out of mind. There were mothers with anonymous and identity-release donors in each group. Several mothers explained that their feelings about the donor had changed over time.

LIMITATIONS, REASONS FOR CAUTION

All mothers conceived at a licensed fertility clinic in the UK. Findings are limited to individuals willing and able to take part in research on donor conception.

WIDER IMPLICATIONS OF THE FINDINGS

The study offers greater insight into the factors influencing the donor narratives produced in single-mother families. It has implications for the counselling and treatment of single women seeking fertility treatment with donor gametes in both anonymous and identity-release programmes. Given that the number of clinics offering identity-release programmes worldwide seems to be increasing, the finding that single women may have varying preferences with regard to donor type, and varying interest levels with regard to donor information, is important. It is recommended that clinicians and other fertility clinic staff guard against making assumptions about such preferences and any thoughts and feelings about the donor or donor information on the basis of marital status.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by the Wellcome Trust [097857/Z/11/Z]. The authors have no conflicts of interest to declare.

Experiences of Family Relationships Among Donor-Conceived Families: A Meta-Ethnography

In this qualitative evidence synthesis, we explore how family relationships are experienced by parents who used gamete donation to conceive. We systematically searched four databases (PubMed, Web of Science, PsycINFO, and ProQuest) for literature related to this topic and retrieved 25 studies. Through the analysis of the qualitative studies, a comprehensive synthesis and framework was constructed. Following the meta-ethnography approach of Noblit and Hare, four main themes were identified: (a) balancing the importance of genetic and social ties, (b) normalizing and legitimizing the family, (c) building strong family ties, and (d) minimizing the role of the donor. Underlying these four main themes, a sense of being "different" and "similar" at the same time was apparent. Findings are discussed in terms of their implications for studying and counseling donor-conceived families.

Evolving minimum standards in responsible international sperm donor offspring quota

An international working group was established with the aim of making recommendations on the number of offspring for a sperm donor that should be allowable in cases of international use of his sperm. Considerations from genetic, psychosocial, operational and ethical points of view were debated. For these considerations, it was assumed that current developments in genetic testing and Internet possibilities mean that, now, all donors are potentially identifiable by their offspring, so no distinction was made between anonymous and non-anonymous donation. Genetic considerations did not lead to restrictive limits (indicating that up to 200 offspring or more per donor may be acceptable except in isolated social-minority situations). Psychosocial considerations on the other hand led to proposals of rather restrictive limits (10 families per donor or less). Operational and ethical considerations did not lead to more or less concrete limits per donor, but seemed to lie in-between those resulting from the aforementioned ways of viewing the issue. In the end, no unifying agreed figure could be reached; however the consensus was that the number should never exceed 100 families. The conclusions of the group are summarized in three recommendations.

Gamete donors' expectations and experiences of contact with their donor offspring

STUDY QUESTION

What are the expectations and experiences of anonymous gamete donors about contact with their donor offspring?

SUMMARY ANSWER

Rather than consistently wanting to remain distant from their donor offspring, donors' expectations and experiences of contact with donor offspring ranged from none to a close personal relationship.

WHAT IS KNOWN ALREADY

Donor conception is part of assisted reproduction in many countries, but little is known about its continuing influence on gamete donors' lives.

STUDY DESIGN, SIZE, DURATION

A qualitative research model appropriate for understanding participants' views was employed; semi-structured interviews were conducted during January–March 2013.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Before 1998, gamete donors in Victoria, Australia, were subject to evolving legislation that allowed them to remain anonymous or (from 1988) to consent to the release of identifying information. An opportunity to increase knowledge of donors' expectations and experiences of contact with their donor offspring recently arose in Victoria when a recommendation was made to introduce mandatory identification of donors on request from their donor offspring, with retrospective effect. Pre-1998 donors were invited through an advertising campaign to be interviewed about their views, experiences and expectations; 36 sperm donors and 6 egg donors participated.

MAIN RESULTS AND THE ROLE OF CHANCE

This research is unusual in achieving participation by donors who would not normally identify themselves to researchers or government inquiries. Qualitative thematic analysis revealed that most donors did not characterize themselves as parents of their donor offspring. Donors' expectations and experiences of contact with donor offspring ranged from none to a close personal relationship.

LIMITATIONS, REASONS FOR CAUTION

It is not possible to establish whether participants were representative of all pre-1998 donors.

WIDER IMPLICATIONS OF THE FINDINGS

Anonymous donors' needs and desires are not homogeneous; policy and practice should be sensitive and responsive to a wide range of circumstances and preferences. Decisions made to restrict or facilitate contact or the exchange of information have ramifications for donors as well as for donor-conceived people.

STUDY FUNDING/COMPETING INTEREST(S)

The study was funded by the Victorian Department of Health. The authors have no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

Not applicable.

Proposed legislative change mandating retrospective release of identifying information: consultation with donors and Government response

STUDY QUESTION

How do gamete donors who presumed they could remain anonymous respond to proposed legislation to retrospectively remove anonymity?

SUMMARY ANSWER

A little more than half of the donors opposed the recommendation to introduce legislation to remove donor anonymity with retrospective effect.

WHAT IS KNOWN ALREADY

An increasing proportion of parents disclose their origins to their donor-conceived children and growing numbers of donor-conceived adults are aware of how they were conceived. Research indicates that access to information about the donor is important to donor-conceived people. However, worldwide most donor-conceived people are unable to find any identifying information about the donor because of the practice of anonymous gamete donation.

STUDY DESIGN, SIZE, DURATION

This study adopted a qualitative research model using semi-structured interviews with gamete donors that included open questions. Interviews with 42 volunteers were conducted between December 2012 and February 2013.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Before 1998 gamete donors in Victoria, Australia, were able to remain anonymous. Pre-1998 donors were invited through an advertising campaign to be interviewed about their views on a recommendation that legislation mandating retrospective release of identifying information be introduced.

MAIN RESULTS AND THE ROLE OF CHANCE

Donors were almost evenly split between those who supported and those who rejected the recommendation to introduce legislation to remove donor anonymity with retrospective effect. About half of the donors who rejected the recommendation suggested the compromise of persuading donors voluntarily to release information (whether identifying or non-identifying) to donor-conceived people. These donors were themselves willing to supply information to their donor offspring. The findings of this study informed the Victorian Government's response to the proposed legislative change. While acknowledging donor-conceived people's right of access to information about their donors, the Government decided that identifying information should be released only with the consent of donors and that donors should be encouraged to allow themselves to be identifiable to their donor offspring.

LIMITATIONS, REASONS FOR CAUTION

There is no way of knowing whether participants were representative of all pre-1998 donors.

WIDER IMPLICATIONS OF THE FINDINGS

The balancing of donors' and donor-conceived people's rights requires utmost sensitivity. All over the world, increasing numbers of donor-conceived people are reaching adulthood; of those who are aware of their mode of conception, some are likely to have a strong wish to know the identity of their donors. Legislators and policy-makers in jurisdictions permitting anonymous gamete donations will need to respond when these desires are expressed, and may choose to be guided by the model of consultation described in this paper.

STUDY FUNDING/COMPETING INTERESTS

The study was funded by the Victorian Department of Health. The authors have no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

Not applicable.

Conceptualising a child-centric paradigm : do we have freedom of choice in donor conception reproduction?

Since its inception, donor conception practices have been a reproductive choice for the infertile. Past and current practices have the potential to cause significant and lifelong harm to the offspring through loss of kinship, heritage, identity, and family health history, and possibly through introducing physical problems. Legislation and regulation in Australia that specifies that the welfare of the child born as a consequence of donor conception is paramount may therefore be in conflict with the outcomes. Altering the paradigm to a child-centric model, however, impinges on reproductive choice and rights of adults involved in the process. With some lobby groups pushing for increased reproductive choice while others emphasise offspring rights there is a dichotomy of interests that society and legislators need to address. Concepts pertaining to a shift toward a child-centric paradigm are discussed.

The right to know your genetic parents: from open-identity gamete donation to routine paternity testing

Over the years a number of countries have abolished anonymous gamete donation and shifted toward open-identity policies. Donor-conceived children are said to have a fundamental "right to know" the identity of their donor. In this article, we trace the arguments that underlie this claim and question its implications. We argue that, given the status attributed to the right to know one's gamete donor, it would be discriminatory not to extend this right to naturally conceived children with misattributed paternity. One way to facilitate this would be through routine paternity testing at birth. While this proposal is likely to raise concerns about the conflicting interests and rights of other people involved, we show that similar concerns apply to the context of open-identity gamete donation. Unless one can identify a rational basis for treating the two groups differently, one's stance toward both cases should be the same.

Offspring searching for their sperm donors: how family type shapes the process

BACKGROUND

This study examines the findings from the largest survey to date of donor-inseminated (DI) offspring and focuses on respondents' learning of the method of their conception and their desire to contact their donor.

METHODS

Online questionnaires were completed by 741 DI offspring, of whom 61.8% have heterosexual parents and 38.2% have lesbian parents. Respondents were recruited via the Donor Sibling Registry, a non-profit US-based international registry that facilitates communication between donor-conceived offspring and their non-biological and biological relatives. Data were collected on family composition, offspring's feelings regarding the method of their conception, communication within families, donor anonymity and their search for their donors. This investigation focuses on the relationship between family type (single or dual-parent and lesbian or heterosexual parent/s) and offspring's reactions to learning of their DI conception.

RESULTS

Offspring of lesbian parents learned of their DI origins at earlier ages than offspring of heterosexual parents. In the latter families, disclosure tended to occur earlier in single-parent than in dual-parent families. Disclosure was most likely to be confusing to offspring of heterosexual parents, particularly when it occurred at an older age. The vast majority of offspring in all types of families desired contact with their donor; however, comfort in expressing curiosity regarding one's donor was lowest in dual-parent heterosexual families, with about one-quarter reporting an inability to discuss their origins with their social father.

CONCLUSIONS

Although the findings are not based on a random sample, the desire among offspring surveyed here is for greater openness and contact with their donor. A variety of strategies are needed for offspring of heterosexual couples to benefit optimally from the general trend toward openness in gamete donation.

To name or not to name? An overview of the social and ethical issues raised by removing anonymity from sperm donors

The aim of this paper is to focus on the ethical issues raised by the removal of anonymity from sperm donors. The increasing currency of a 'right to genetic truth' is clearly visible in the drive to revise the legislation on donor anonymity in Western and European countries. The ethical debate is polarized between the 'right to privacy' of the donor or parent and the 'right to know' of the prospective child. However, it is evident that religious, social and cultural attitudes have an overarching impact on attitudes towards sperm donation generally and anonymity specifically. In Asian countries, the social and cultural heritage is hugely diverse and different from those of the West. This review considers the research exploring the complexity of ethical issues informing this debate, and argues that parent's decisions to reveal donor insemination origins to their children are highly complex and relate to a range of social and cultural attitudes that have not been addressed within the policy to remove anonymity from sperm donors.

Disclosure of donor conception in single-mother families: views and concerns

BACKGROUND

Despite the prevalence of donor conception and the worldwide trend towards openness, there has been little research on whether parents do disclose the nature of the conception to their donor-conceived children. This analysis focuses on whether and how older Israeli single mothers disclose to their children that were conceived using a donor and whether the donor conception causes concern for them.

METHODS

Sixty-two single mothers of donor-conceived children in Israel were asked whether they would like to know the identity of the sperm donor; whether they would like their children to know the identity of the sperm donor when reaching the age of 18, whether they disclosed the circumstances of conception to their children or intend to do so in the future; and whether the sperm donation causes concern to them.

RESULTS

The mothers were divided on whether they wanted to know the identity of the sperm donor. However, less than one-fifth of them did not want their children to have identifying information about the genetic father at the age of 18. About two-thirds of the mothers had not yet disclosed the donor conception to their children but intended to do so in the future. A total of 77.4% of the mothers reported being concerned about the donor conception: for the psychosocial development of the child, fear of genetic disorders, fear of incest and lack of certainty of access to genetic information when needed.

CONCLUSIONS

The tendency to postpone the disclosure reveals the difficulty of these mothers in finding the appropriate way of sharing the information about the conception with their children. Given the importance attached to the age of disclosure and the mothers' concern for the psychosocial development of their children, more professional counselling in this area is warranted.

Prospective parents' intentions regarding disclosure following the removal of donor anonymity

This short survey of UK infertility counsellors was designed to determine whether the removal of donor anonymity resulted in noticeable changes in prospective parents' stated intentions regarding disclosure of their origins to any children conceived through donor conception. Members of the British Infertility Counselling Association working in Human Fertilisation and Embryology Authority (HFEA) -- licensed centres, before and after the legal changes, were sent a short questionnaire that included space for free comments (take-up: 62%). Three-quarters reported changes. Of these, two-thirds said prospective parents were more likely to say they would disclose, while less than a tenth said prospective parents were less likely do so. Where no changes were noted, this was primarily because the majority of prospective parents had stated their intention to be open even prior to the legal changes. Possible influences on intentions included: the culture within the centre, moves towards openness within the wider society, and parents' lack of confidence regarding how to go about disclosure. Follow-up studies are needed to improve understanding of whether influences on decision making carry through to patterns of actual disclosure; whether involvement in counselling affects outcomes; and whether access to professional assistance at the time of planned disclosure is helpful.

Families working it out: adolescents' views on communicating about donor-assisted conception

BACKGROUND

Prompted by legislation in Victoria, Australia, permitting gamete donors to seek identifying details of people conceived from their gametes, this research investigated the views of adolescents from the general population on how parents can best talk to their donor-conceived adolescent children about their conception.

METHODS

Qualitative interviews (six group discussions, n = two to six per group, and one individual interview) lasting c. 50 min with 25 secondary school students.

RESULTS

Naïve adolescents had views largely consistent with those of donor-conceived adults, for example, urging parental honesty, adaptation to individual children, and family cohesion. They identified the social father as the parent while acknowledging the significance of genetic connection to the donor. A minority asserted a preference for non-disclosure; all said that, if disclosed, it should be by parents.

CONCLUSIONS

This small study contributes to increasing understanding of communication within families about donor-assisted conception.

Consequences of IVF among women: 10 years post-treatment

Between 2.1% and 4.2% of all children born in Scandinavian countries are conceived with the help of assisted reproductive technology. The present study is one of the first to have followed up infertile women over a long period. Data on outcomes, satisfaction and the perceived consequences of IVF treatment were collected by means of a questionnaire among a random sample of women (response rate 42%; N = 66) who had undergone IVF at a tertiary referral university hospital in Norway. It was found that 10 years post-treatment, the majority of the women had children, whether through adoption, spontaneous pregnancy or IVF. A remarkable number of the women neither had told nor intended to tell their children that they had been conceived through IVF. Although most of the women said that they regard the treatment period as a painful one, they also said that it was now in the past and no longer affected their lives in a devastating way: they had found a way to cope with this difficult period in their life.

Strategies for disclosure: how parents approach telling their children that they were conceived with donor gametes

OBJECTIVE

To describe how parents envision, plan, and enact disclosing to their children that they were conceived with donor gametes.

DESIGN

In-depth ethnographic interviews.

SETTING

Participants were recruited from 11 medical infertility practices and 1 sperm bank in Northern California.

PATIENT(S)

A total of 141 married couples who had conceived a child using donor gametes (62 with donor sperm and 79 with donor oocytes).

INTERVENTION(S)

Husbands and wives were interviewed together and separately.

MAIN OUTCOME MEASURE(S)

Thematic analysis of interview transcripts.

RESULT(S)

Disclosing parents predominantly subscribed to one of two disclosure strategies: the conviction that early disclosure is of paramount importance so that the child "always knows," or the belief that later disclosure is preferable after family routines have been established and the child has the maturity to understand biologic concepts and has developed a sense of discretion. No parent regretted disclosing, and many expressed relief.

CONCLUSION(S)

Parents choosing early disclosure were more at ease with the disclosure process, whereas parents choosing later disclosure reported greater uncertainty about how and when to disclose. Parents wished for more peer and/or professional support and guidance to assist them with disclosure, not only initially but continuing long after their children were born.

Disclosure decisions among pregnant women who received donor oocytes: a phenomenological study

OBJECTIVE

To investigate the controversy surrounding disclosure among donor oocyte recipients. This controversy is escalating worldwide, yet little research has sought to understand the disclosure experience of pregnant, donor oocyte recipient women. This study aims to provide an in-depth description of the disclosure experience, and identify factors that were significant to recipient women which influenced their reasoning as they formulated disclosure decisions.

DESIGN

Qualitative, naturalistic design, using a phenomenological approach.

SETTING

The home or private office of the recipient woman.

PATIENT(S)

Donor oocyte recipient women between 9-23 weeks of gestation.

RESULT(S)

Disclosure decisions were influenced by multiple factors emerging from the women's values and beliefs and their social and cultural environment. Values and beliefs consisted of the right to know and the duty to protect. Social and cultural factors included social support, culture of the family, evolution of the social process, and personal testimonials. Women's age and selection of donor type were interrelated with disclosure decisions.

CONCLUSION(S)

Disclosing women voiced the right of the child to know, and perceived social and cultural factors as conducive to disclosure. Nondisclosing and undecided women emphasized protecting normative relationships, perceived a social stigma, and were unable to identify a benefit to disclosing. Women's age and choice of oocyte donor should be considered when counseling recipient women.

A retrospective study of New Zealand case law involving assisted reproduction technology and the social recognition of ‘new’ family

The New Zealand Human Assisted Reproductive Technology (HART) Act became law in 2004. In this article, we provide a retrospective analysis of New Zealand case law from September 1990 to March 2004, leading up to the creation of the HART Act. We examine the new understandings of parenting (developed through the routine use of ART in New Zealand) which the case law attempted to test. We examine these concepts against the previous understandings of family enshrined in the pre-existing legislation, which formed the basis for judicial rulings in the various cases to which we refer. In conclusion, we provide a brief summary of the 2004 HART legislation and draw comparisons between the old and new legislative and bureaucratic frameworks that define and support New Zealand family structure. We suggest that a change in cultural backdrop is occurring from the traditional western ideology of the nuclear family towards the traditional Maori concept of family formation, which includes a well-accepted traditional practice of guardianship and a more open and extended family structure. This 'new' structure reflects the contemporary lived experience of family kinship in western societies as individualized and open to choice.

Gamete donation: a question of anonymity

The key global issue surrounding gamete donation is not the well-rehearsed known vs. anonymous donation argument but rather one of providing patients with a flexible dual-track system (i.e., ability to know or not to know donor identity), complete with psychosocial support and education that enables them to make well-informed choices that benefits all stakeholders present and future.

A review of family donor constructs: current research and future directions

This review addresses research on gamete donors, recipients, and offspring and demonstrates that the foci on all three within the triad are largely directed at disclosure or anonymity; and each in turn centers on the perceived importance of the genetic link. The importance attached to genetics has led some countries to review the ethics of anonymous gamete donation (e.g. New Zealand's 'open system' of information sharing) and has led other countries (Sweden, Austria, Victoria, Australia; the Netherlands, the UK) to change their laws allowing donor gamete offspring the right to obtain identifying information about their genetic parent. This review demonstrates that genealogical inconsistencies between and within members of the triad are common regardless of legislation. A discussion of future trends and concerns, relating to the use of gamete donation and the effects legislation is likely to have on the donor triads in the UK following 2005, is provided. The review also addresses the importance of testing theoretical models within future research, and argues this would lead to a better understanding of the underlying problems encountered at a psychosocial level, such as continued preference for anonymity in donors and denial in large numbers of users of the involvement of a donor in conception. Lack of disclosure effectively prevents true implementation of legislation; if a child is not informed, it is the result of donated gametes, it cannot take up the legally available option of finding out identifiable information about their genetic parent(s).

Parental coping with sudden infant death after donor insemination: case report

We report the case of an artificial donor insemination couple experiencing sudden infant death of their 8-month-old child. Six months after the incident, the couple were investigated by means of an extensive interview, a repertory grid investigation and the Family Assessment Measure, as well as at 6 years after the incident by an extensive interview. The results show the importance of the diagnosis of male infertility and the preceding fertility treatment for coping with the death of their child. Six months after the incident, acute feelings associated with bereavement are mixed with feelings of anger and shame, apparently due to the experience of infertility. However, secrecy and shame associated with male infertility and donor insemination make it impossible for the couple to communicate their feelings to each other or to friends and relatives; furthermore, they decline psychological counselling. Repertory grid investigation and the Family Assessment Measure point to significant problems within the partnership. Six years after the incident, the couple's relationship is destabilized and both partners plan to divorce. We suggest a possible link between donor insemination secrecy and difficulties with coping. We discuss implications for couple counselling and emphasize the necessity for an improved legal framework for donor insemination in Germany.

Anonymous or identity-registered sperm donors? A study of Dutch recipients' choices

BACKGROUND

The aim of the present study was to gain insight into parents' own donor preferences within a system offering the choice between an anonymous and identity-registered donor. A comparison was made between recipients choosing for an anonymous donor (AD choosers) and those choosing for an identifiable donor (ID choosers) with regard to their sexual orientation, demographic characteristics, disclosure issues and infertility distress.

METHODS

Data from 105 couples (61% heterosexual, 39% lesbian) were registered on a standardized form during implication counselling sessions previous to treatment.

RESULTS

Sixty-three per cent of the heterosexual couples and 98% of the lesbian couples had chosen an ID donor. Major differences between ID and AD choosers were identified. Among the ID choosers secrecy towards the child was no option, whereas 83% of the AD choosers did not intend to inform their child. Compared with heterosexual ID choosers, AD choosers were more distressed about their infertility and had a lower educational level.

CONCLUSION

Legislation imposing ID donors appears to be acceptable for the majority of this study population. For a vulnerable group of heterosexual couples, who remained secretive about the use of a donor, adaptation to the new system is not self-evident.