Donor insemination: a question of rights

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 long path to pregnancy: early experience with dual anonymous gamete donation in a European in vitro fertilisation referral centre

Background

This investigation describes features of patients undergoing in vitro fertilisation (IVF) and embryo transfer (ET) where both gametes were obtained from anonymous donors.

Methods

Gamete unsuitability or loss was confirmed in both members of seven otherwise healthy couples presenting for reproductive endocrinology consultation over a 12-month interval in Ireland. IVF was undertaken with fresh oocytes provided by anonymous donors in Ukraine; frozen sperm (anonymous donor) was obtained from a licensed tissue establishment. For recipients, saline-enhanced sonography was used to assess intrauterine contour with endometrial preparation via transdermal estrogen.

Results

Among commissioning couples, mean±SD female and male age was 41.9 ± 3.7 and 44.6 ± 3.5 yrs, respectively. During this period, female age for non dual anonymous gamete donation IVF patients was 37.9 ± 3 yrs (p < 0.001). Infertility duration was ≥3 yrs for couples enrolling in dual gamete donation, and each had ≥2 prior failed fertility treatments using native oocytes. All seven recipient couples proceeded to embryo transfer, although one patient had two transfers. Clinical pregnancy was achieved for 5/7 (71.4%) patients. Non-transferred cryopreserved embryos were available for all seven couples.

Conclusions

Mean age of females undergoing dual anonymous donor gamete donation with IVF is significantly higher than the background IVF patient population. Even when neither partner is able to contribute any gametes for IVF, the clinical pregnancy rate per transfer can be satisfactory if both anonymous egg and sperm donation are used concurrently. Our report emphasises the role of pre-treatment counselling in dual anonymous gamete donation, and presents a coordinated screening and treatment approach in IVF where this option may be contemplated.

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.

From a social issue to policy: Social work's advocacy for the rights of donor conceived people to genetic origins information in the United Kingdom

This paper outlines a 22 year campaign to introduce openness into the arena of donor conception in the UK. It identifies key aspects of the development of an advocacy based approach to such work and argues that social work values and principles can prove key to identifying structural inequalities which are not necessarily based in socio-economic disadvantage. Donor conceived people may find themselves in families which enjoy material privilege but whose exposure to a legislative framework and dominant professional cultures within the treatment centres encourages secrecy around genetic origins. Social workers' experience of adoption and family work leads them to recognise the danger of such secrets within families. Turning such social issues into policy changes requires vision, strategic long term advocacy and partnership with those directly affected.

Policy formation in gamete donation and egg sharing in the UK—a critical appraisal

This article considers two key policy documents concerning donor-assisted conception in the UK, The British Fertility Society's Recommendations for Good Practice on the Screening of Egg and Embryo Donors and the Human Fertilisation and Embryology Authority's Guidance for Egg Sharing Arrangements. It discusses both the process and the evidence used in formulating those sections of the documents which relate to donor anonymity. The paper concludes that psycho-social policy developments in assisted conception, such as those relating to donor anonymity, should be subjected to comparable levels of rigour and scrutiny to those that are applied in the formulation of medical and scientific policies.

To tell or not to tell: the decision-making process of egg-donation parents

Little research has examined the views of parents of children conceived as a result of the use of donated eggs (egg-donation parents) on whether, what and how to tell their children about the way in which they were conceived. Thus, the aim of the present study was to assess the pattern of disclosure in egg-donation families. A representative sample of 17 egg-donation families with a 3-8-year-old child was recruited through UK fertility clinics. All mothers were administered a standardized interview assessing the extent of their disclosure and the main reasons for their decision. Content analysis was carried out on the transcripts from the interviews with the mothers. Not one set of parents had told their child at this stage, and 47% had no intention of telling their child about the way in which they were conceived. Twenty-nine per cent intended to tell their child in the future. Nearly two-thirds had told a friend or family member. Non-disclosure largely stemmed from a desire to protect the child, a belief that there was no need to tell, and a desire to protect the mother. Reasons for intending to disclose to the child included the belief that he or she had a right to know, and to avoid disclosure from someone else. Egg-donation parents with a 3-8-year-old child appear to resemble donor insemination parents in that they tend to favour a position of non-disclosure. The findings demonstrate the importance of understanding the views of egg-donation parents themselves, if openness is to be encouraged in these families.

Using and not losing the messages from the adoption experience for donor-assisted conception

The debate about the information needs of donor-conceived people is reaching an important stage. The recent Government consultation about providing information on sperm, egg and embryo donors (Department of Health, 2001) has meant that the subject is receiving much public attention. More importantly, it is becoming increasingly evident that donor-conceived people themselves are beginning to have a voice about their experience of not being able to access basic information about their genealogical heritage. Gollancz (2001) raised some pertinent issues about the rights and needs of donor-conceived people to have access to identifying information about their genetic parents. Recent research is also providing powerful messages about the information needs of donor-conceived people. For example, the study by Turner and Coyle (2000) of 16 donor-conceived adults between the ages of 26 and 55 asked about identity experience, including issues of secrecy and disclosure of their donor-conceived status, and also investigated the experience of trying to trace and search for a genetic father (the donor), the current perception of donor insemination and how families could manage openness versus secrecy. The findings identify many similarities between adopted and donor-conceived people. But in what ways is adoption similar to donor conception? And can donor conception learn anything from adoption? This paper will explore some of the relevant lessons learned from adoption to draw out some of the issues, experiences and dilemmas shared by adopted people, donor-conceived people and their families, using the findings of The Children's Society's research study.

Information on genetic origins in donor-assisted conception: is knowing who you are a human rights issue?

It was not by my choice that my ancestral home is nothing more than a sample jar. (Whipp, 2000) There can be few more basic rights than a right to one's identity...a right not to be deceived about one's true origins. (Freeman, 1996) This article provides an overview of existing arrangements for the management of information on genetic origins in donor-assisted conception, that is, treatment involving sperm, eggs or embryo donation. The balance of this article reflects the fact that much of the debate on information on genetic origins in donor-assisted conception has been dominated by sperm donation. A detailed discussion of the rather different issues of egg and embryo donation would have added significantly to its complexity and length. The article considers what donor-conceived people wish to know about their genetic origins and how this might be seen as a human rights issue. The possibility of conflict between the interests and rights of donors and recipients of donated gametes or embryos is discussed, and possible policy and legislative options are outlined. The paper concludes that a donor-conceived person's own definition of their best interests should form the basis for the facilitation of access to information about their genetic origins.