Sharing genetic origins information in donor assisted conception: views from licensed centres on HFEA donor information form (91) 4

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.

Producing sperm, egg and embryo donors' pen portraits and other personal information for later use by donor offspring: an exploratory study of professional practices

This study considered professional input into collecting personalized donor information for later release to donor offspring. Existing studies report the importance of such information for identity completion, to satisfy curiosity, and to allay anxiety about genetic inheritance. The study used a three-pronged approach: a literature search of professional practices in this and related fields; key informant telephone interviews with donor-conceived adults, sperm and egg donors, and professionals and a postal survey of UK clinics' practices and views. The literature revealed only one previous study, which suggested gendered approaches to pen portraits were used in commercial donor banks. Key informants agreed on the importance of information for offspring well-being and the need for support services in its compilation and on release. Donors reported inadequate professional assistance to date. The postal survey of clinics revealed variable practices in the process of acquiring and storing later life information and variable success in achieving its completion. Respondents identified factors that hinder completion (donor anxiety, lack of guidance, shortage of staff time) and factors that help (donor belief in the importance of later life information, staff belief, dedicated staff time). Further research, including intervention studies, is needed into the processes and skills involved in collecting later life information.

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.

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.

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.

'Not so wrong that we are prepared to threaten the entire service': the regulation of reproductive technologies in the UK

In the UK human embryo research and infertility treatments are regulated by the Human Fertilisation and Embryology Authority (HFEA), a national statutory body set up in 1991. Clinics are required by law to be licensed by the HFEA and open to inspection. In 1999 there were 107 clinics licensed to carry out IVF and/or donor insemination. There are regional variations in National Health Service funding and seventy-five percent of those treated pay for most of their treatment, usually to avoid long waiting lists or because they do not meet the eligibility criteria set by their local health authority. Having described the code of practice laid down by the HFEA the paper discusses the implications of new reproductive technologies from a social science perspective, focusing on three topics which continue to be debated by the media, the regulatory authorities, health professionals and 'lay' people. First, age limits and other criteria for assisted reproduction which raise the question 'who should be allowed to reproduce?' Second, donor anonymity and the question of payment for donors. Finally, the screening and selection of embryos for implantation and the recurring theme in the media of 'designer babies'. The HFEA can be seen to fulfill its intended role, mediating between the infertility professionals, patients and the wider general public. It seeks to allay public fears while supporting professionals by avoiding restrictions on research and treatment and by consulting with the public as to when extensions to research will be acceptable.

Gamete donation and anonymity: should offspring from donated gametes continue to be denied knowledge of their origins and antecedents?

This paper presents the case for a change from the current practice of anonymity and secrecy in the use of donated gametes in medically assisted conception. It does so by describing history of the practice, various committees of enquiry over the years, their recommendations for consideration of the children created and the need for follow-up of the outcome; presenting the evidence from outcome studies both about child development and family relationships where secrecy is maintained about the child's origin and those where the practice is openly to acknowledge their origins. This is followed by an analysis of the experience and views of these children once they are adults. In discussion of the composite findings recurring themes emerge. From this it is concluded that offspring from donated gametes should not continue to be denied knowledge of their origins and antecedents. In the public debate, four schools of thought are identified. Possible practical scenarios to implement change are discussed. This paper argues that the fundamental issue regarding any of these remains-that priority in decision-making should be the lifelong well-being of the children being created.