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

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

Embryo donation: motivations, experiences, parenting, and child adjustment

Embryo donation raises unique challenges for donors, recipients, and the resultant child, yet little is known about the outcomes for those involved. This review summarizes research on the motivations for donating and receiving embryos from others and the experiences that follow, including the outcomes for parenting and child adjustment. Research has shown that given the varied ways in which embryo donation is practiced, understanding the outcomes within different legislative and cultural contexts is vital. The lack of information on outcomes means that counselors and psychologists have little empirical evidence to guide them. Gaps in existing knowledge are identified as well as areas for future research.

Formal and informal support and counselling for embryo donation and receipt: An Australian qualitative study

Despite growing numbers of people engaging in embryo donation for the purposes of family building, public access to information about the process may be limited. As such, support and counselling - both formal (i.e. through clinics) and informal (i.e. through online communities) - can play an important role in information provision. This article draws on a sub-sample of nine people from a qualitative study of embryo donation and receipt in Australia undertaken in 2017-2018. Themes developed suggest that formal support and counselling provided by clinics can be useful, though can require persistence to access and may not sufficiently address needs. In terms of informal support, themes developed suggest that sharing lived experiences in online communities can be important; however, there may also be challenges associated with differing viewpoints and threats to anonymity. The article concludes with a discussion of the ongoing importance of formal support and counselling while also suggesting that informal support is an avenue requiring further investigation.

Embryo donation and counselling for the welfare of donors, recipients, their families and children

STUDY QUESTION

How do counsellors facilitating known 'open' embryo donation (ED) experience their roles and responsibilities?

SUMMARY ANSWER

Counsellors regard counselling for ED as entailing significant responsibility to ensure that the longer-term implications of the practice are understood and that positive relationships are established that will promote the well-being of donors, recipients, their families and the children involved.

WHAT IS KNOWN ALREADY

While counselling is frequently recommended in third-party assisted reproduction, there has been little research into the experiences of counsellors and their perceptions of their roles and responsibilities.

STUDY DESIGN, SIZE, DURATION

Fertility counsellors were interviewed between March and October 2012 as to their experiences and perceptions of their roles and responsibilities.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Fertility counsellors were recruited from across New Zealand and interviews were conducted with all nine counsellors involved in ED counselling. Interview data were analysed thematically to identify main themes.

MAIN RESULTS AND THE ROLE OF CHANCE

Counsellors regard ED as a complex practice with enduring implications arising from the genetic link between donors and offspring, which is seen to bestow immutable social ties. They see their role as the provision of implications counselling and the facilitation of ongoing positive relationships between donors and recipients in an 'open' context. Counsellors express concern about their responsibility for promoting the welfare of all parties--including that of the child--the limitations of counselling, and the conflation of assessment and counselling roles.

LIMITATIONS, REASONS FOR CAUTION

Experiences of counselling for ED may change over time as longer-term outcomes become more apparent.

WIDER IMPLICATIONS OF THE FINDINGS

Further consideration needs to be given as to how the welfare principle may best be operationalised in counselling practice, particularly in contexts of 'open' donation.

STUDY FUNDING/COMPETING INTERESTS

This study was funded by an AUT University Faculty of Health and Environmental Sciences research grant. The authors have no conflicts of interest to declare.

LGB-parent families: the current state of the research and directions for the future

Over the past several decades, lesbian, gay, and bisexual (LGB) parenting has grown more visible. Alongside this enhanced visibility, research on the experiences of LGB parents and their children has proliferated. The current chapter addresses this research, focusing on several main content areas: family building by LGB people, the transition to parenthood for LGB parents, and functioning and experiences of LGB parents and their children. In the context of discussing what we know about LGB-parent families, we highlight gaps in our knowledge and point to key areas that future research should aim to answer, including how race, ethnicity, social class, and geographic factors shape the experiences of LGB-parent families.

Attitudes toward embryo donation among staff at in vitro fertilization clinics

OBJECTIVE

To examine attitudes towards embryo donation among staff at in vitro fertilization clinics in Sweden.

DESIGN

Descriptive questionnaire study.

SETTING

University-based in vitro fertilization clinic.

SAMPLE

Study participants were the staff at all in vitro fertilization clinics in Sweden.

METHODS

A questionnaire with questions regarding different aspects of embryo donation was sent to the 338 healthcare professionals working at Swedish in vitro fertilization clinics.

MAIN OUTCOME MEASURES

Attitudes towards embryo donation.

RESULTS

A total of 207 persons (61%) responded to the questionnaire. A majority of the respondents (77%) considered that embryo donation to infertile couples should be permitted in Sweden. Most respondents (76%), and especially the men (96%), stated that it should be possible to donate surplus embryos for research. Forty-two percent of the respondents agreed with embryo donation to single women. A majority of respondents stated that special requirements with regard to the recipient's age, medical condition and criminal background should potentially be considered. The women stated that there should be special demands made concerning recipients' tobacco (48%) and alcohol abuse (92%). A majority considered that donors should be anonymous to the recipients (66%), but not to the child (9%).

CONCLUSIONS

Swedish in vitro fertilization staff have positive attitudes concerning embryo donation to infertile couples and also the use of surplus embryos for research.

Origins and originators: lesbian couples negotiating parental identities and sperm donor conception

Donor conception challenges conventional kinship idioms: the involvement of a gamete donor culturally raises questions about parentage and also the meaning of genetic heritage. Although there is now a growing body of literature exploring how people resorting to donor conception negotiate kinship and connectedness, this predominantly focuses on heterosexual couples. Little is yet known about how lesbian couples navigate these processes. This paper builds on a qualitative interview study comprising 25 lesbian couples in England and Wales with experiences of pursuing donor conception in the context of their couple relationship to explore how these couples negotiate the contribution of the donor. It explores how couples negotiate meanings of parenthood, genetic origins and the bodily process of conception. The paper argues that lesbian couples negotiate parental identities, biogenetic relationships and also the meaning of conception by disassembling and reassembling the meaning of kinship, parenthood, creation, origin and originator. Findings suggest that lesbian couples weave together old and new understandings of relatedness in complex patterns and that this enables them to assert authority as parents.