Disclosure and child exploration of surrogacy origins in gay father families: Fathers' Adult Attachment Interview coherence of mind matters

OBJECTIVE

The present study aimed at investigating whether gay fathers' coherence of mind within the Adult Attachment Interview (AAI) moderated the influence of parental disclosure on children's exploration of their surrogacy origins during middle childhood and early adolescence.

BACKGROUND

Once children of gay fathers are disclosed to about their surrogacy conception, they may start exploring the meanings and implications of their conception. Very little is known about the factors that may enhance such exploration in gay father families.

METHOD

A home-visit study was conducted with 60 White, cisgender, gay fathers and their 30 children born through gestational surrogacy, all residing in Italy and with medium to high socioeconomic status. At time 1, when children were aged 6-12 years (M = 8.31, SD = 1.68), fathers were rated for AAI coherence of mind and interviewed about their disclosure of the surrogacy origins to their child. At time 2, approximately 18 months later (M = 9.87, SD = 1.69), children were interviewed about their exploration of their surrogacy origins.

RESULTS

In the context of more information disclosed about the child conception, only children whose fathers showed greater AAI coherence of mind explored their surrogacy origins in more depth.

CONCLUSION

Gay fathers' ability to show an internally consistent, but not emotionally overwrought, state of mind regarding their own attachment experiences impacted the extent to which their children felt safe and legitimated in sharing their curiosity about their conception.

Parents' disclosure to their donor-conceived children in the last 10 years and factors affecting disclosure: a narrative review

BACKGROUND

Disclosure of donor conception has been advocated in several jurisdictions in recent years, especially in those that practice identity-release donation. However, research on disclosure decisions has not been consolidated systematically in the last 10 years to review if parents are telling and what factors may be impacting their decisions.

OBJECTIVE AND RATIONALE

Are parents disclosing to their donor-conceived children, and what factors have influenced their disclosure decisions across different contexts and family forms in the last 10 years?

SEARCH METHODS

A bibliographic search of English-language, peer-reviewed journal articles published between 2012 and 2022 from seven databases was undertaken. References cited in included articles were manually scrutinized to identify additional references and references that cited the included articles were also manually searched. Inclusion criteria were articles focused on parents (including heterosexual, single mothers by choice, same-sex couples, and transsexual) of donor-conceived persons in both jurisdictions with or without identity-release provisions. Studies focused solely on surrogacy, donors, donor-conceived persons, or medical/fertility staff were excluded as were studies where it was not possible to extract donor-recipient parents' data separately. Both quantitative and qualitative studies were included. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed and Joanna Briggs Institute Critical Appraisal Tools for Systematic Reviews were used to assess article quality and bias.

OUTCOMES

Thirty-seven articles met the inclusion criteria representing 34 studies and 4248 parents (including heterosexual, single, same-sex, and transsexual parents although the majority were heterosexual) from countries with anonymous donation and those with identity-release provisions or who had subsequently enacted these provisions (Australia, Belgium, Finland, France, Hong Kong, Middle East, Spain, Sweden, the UK, and the USA) A general trend towards disclosure was noted across these groups of parents with most disclosing to their donor-conceived children before the age of 10 years. Further, the majority of those who had not yet told, reported planning to disclose, although delayed decisions were also associated with lower disclosure overall. Same-sex and single parents were more likely to disclose than heterosexual parents. There was recognition of disclosure as a process involving ongoing conversations and that decisions were impacted by multiple interacting intrapersonal, interpersonal, and external contextual and social factors. Methodological limitations, such as the different population groups and contexts from which participants were drawn (including that those parents who choose not to disclose may be less likely to participate in research), are acknowledged in integrating findings.

WIDER IMPLICATIONS

This review has reinforced the need for a theoretical model to explain parents' disclosure decisions and research exploring the role of legislative provisions, culture, and donor/family type in decision-making. Greater ongoing access to psychological support around disclosure may be important to promote parent and family 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.

Direct-to-consumer genetic testing and the changing landscape of gamete donor conception: key issues for practitioners and stakeholders

RESEARCH QUESTION

What effect does direct-to-consumer genetic testing (DTCGT) have on information finding and sharing in relation to gamete donor conception?

DESIGN

This study used in-depth qualitative interviews with parents through donor conception, donors, the relatives of donors and donor-conceived people who have used, or considered using, DTCGT. Interviews were conducted between September 2021 and February 2023. Sixty people defined themselves as having been affected by donor conception and DTCGT. Fifty-seven of these were resident in the UK at the time of interview. The final sample included 19 (spermatozoa, egg or embryo) donors, 25 donor-conceived people, 20 parents through donor conception and two relatives of donors. Five participants occupied more than one of these roles.

RESULTS

The rise of DTCGT is affecting how information about donor conception is managed: it shifts patterns of knowledge about donor conception; increases flexibility regarding the age of access to information about donor relatives; can lead to a growing role for non-professionals, including wider family members, in gatekeeping information about donor conception; accentuates the effect of donor conception for donors' and the relatives of donor-conceived people; and shapes, and is shaped, by the formal regulatory donor information management systems.

CONCLUSION

Fertility professionals should inform people using, or considering, donor conception, or (potential) donors, about the different ways DTCGT can affect sharing information about donor conception. Support is needed for those affected by these changes.

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.

Families created via identity-release egg donation: disclosure and an exploration of donor threat in early childhood

RESEARCH QUESTION

What are mothers' disclosure intentions and practices from infancy to early childhood, and is perceived donor threat associated with disclosure in identity-release egg donation families when the children are aged 5 years?

DESIGN

This longitudinal study included 73 heterosexual-couple families with infants born following IVF-egg donation at phase one, and 61 families with 5-year-old children at phase two. At both phases, mothers were interviewed about their disclosure intentions and practices. At phase two, mothers were interviewed about their feelings about future donor-child contact.

RESULTS

Most mothers (75.3%) intended to disclose their use of egg donation to their children at phase one; half had begun to do so when their children were aged 5. Most remaining mothers planned to tell, although a minority were uncertain or planned not to disclose. When the child was aged 5, four mothers had started telling them that they could access their donor's identifying information at age 18, and most (84%) intended to do so in the future. Most couples agreed on a disclosure strategy at phase two. Most mothers perceived at least some threat from future donor-child contact, but this was unrelated to their disclosure practices.

CONCLUSIONS

Disclosure intentions in infancy are borne out in early childhood. Despite perceiving some threat from future donor-child contact, most mothers intended telling their child that they could access the donor's identifying information at age 18. Revisiting these families as the children grow older will be important to understand how the mothers' perceived donor threat may change over time, and how this is related to family processes.

Development of the Tool to Empower Parental Telling and Talking (TELL Tool): A digital decision aid intervention about children's origins from donated gametes or embryos

Objective

This study aimed to create and develop a well-designed, theoretically driven, evidence-based, digital, decision Tool to Empower Parental Telling and Talking (TELL Tool) prototype.

Methods

This developmental study used an inclusive, systematic, and iterative process to formulate a prototype TELL Tool: the first digital decision aid for parents who have children 1 to 16 years of age and used donated gametes or embryos to establish their families. Recommendations from the International Patient Decision Aids Standards Collaboration and from experts in decision aid development, digital health interventions, design thinking, and instructional design guided the process.

Results

The extensive developmental process incorporated researchers, clinicians, parents, children, and other stakeholders, including donor-conceived adults. We determined the scope and target audience of the decision aid and formed a steering group. During design work, we used the decision-making process model as the guiding framework for selecting content. Parents' views and decisional needs were incorporated into the prototype through empirical research and review, appraisal, and synthesis of the literature. Clinicians' perspectives and insights were also incorporated. We used the experiential learning theory to guide the delivery of the content through a digital distribution plan. Following creation of initial content, including storyboards and scripts, an early prototype was redrafted and redesigned based on feedback from the steering group. A final TELL Tool prototype was then developed for alpha testing.

Conclusions

Detailing our early developmental processes provides transparency that can benefit the donor-conceived community as well as clinicians and researchers, especially those designing digital decision aids. Future research to evaluate the efficacy of the TELL Tool is planned.

'Doing' kinship: heterosexual parents' experiences of non-genetic parenthood through donor conception

RESEARCH QUESTION

How do Dutch heterosexual parents who achieved parenthood through donor conception navigate non-genetic parenthood and kinship?

DESIGN

A qualitative in-depth semi-structured interview study was performed between September 2018 and January 2019 with both partners of 13 Dutch heterosexual couples where the male partner suffered from infertility and who conceived a child with the help of a sperm donor. Interview questions were based on literature and clinical experiences of experts in the field of donor conception. Interviews were transcribed and analysed using thematic analysis.

RESULTS

All parents navigated non-genetic parenthood through 'doing' kinship: they negotiated the importance of nature versus nurture with regards to donor conception and non-genetic parenthood. Most parents perceived genetics as irrelevant for experiencing parenthood, bonding with their children and the preferred role of the donor in their future lives. Yet most of them found genetics relevant for generating similarities between the father and the child, and for wanting the same donor for all their children to ensure a full genetic relation among them. Additionally, based on the donor's genetic bond with the child, some men were anxious about the donor's role in the child's future life and the consequences for their position as a non-genetic father. A few women perceived genetics as relevant in terms of possible inherited illnesses from the donor.

CONCLUSIONS

Parents experienced several ambiguities regarding the role of genetics in donor conception and navigated 'doing' kinship in various ways. These aspects need to be taken into consideration during the counselling of prospective parents planning to conceive with donor conception.

Alpha Test of the Donor Conception Tool to Empower Parental Telling and Talking

OBJECTIVE

To conduct an alpha test of the prototype of a digital decision aid to help parents disclose donor conception to their children, the Donor Conception Tool to Empower Parental Telling and Talking (TELL Tool).

DESIGN

Convergent mixed-methods design.

SETTING

Virtual interviews in places convenient to the participants.

PARTICIPANTS

A purposeful sample (N = 16) of nine gamete-donor and embryo-recipient parents and eight clinicians, as one parent was also a clinician.

METHODS

We conducted cognitive interviews to explore participants' perceptions about the TELL Tool prototype and observe patterns of use. The International Patient Decision Aid Standards (i.e., usability, comprehensibility, and acceptability) guided the development of the qualitative interview guide and directed the qualitative analysis. We also collected data about participants' perceptions and ratings of the helpfulness of each of the prototype's webpages regarding parents' decision making about disclosure. Descriptive statistics were used to analyze the helpfulness ratings before we merged the two data sets to optimize understanding.

RESULTS

Participants reported that the TELL Tool was a helpful digital decision aid to help parents tell their children how they were conceived. Most (93.7%) webpage rating scores indicated that the content was very helpful or helpful. The participants identified content and technical areas that needed refinement and provided specific recommendations such as adding concise instructions (usability), tailoring adolescent language (comprehensibility), and softening verbiage (acceptability).

CONCLUSION

Alpha testing guided by the International Patient Decision Aid standards was an essential step in refining and improving the TELL Tool prototype before beta testing.

Medical ethics when moving towards non-anonymous gamete donation: the views of donors and recipients

Drawing on the views of donors and recipients about anonymity in a country that is experiencing a transition towards non-anonymous gamete donation mandated by the Constitutional Court, we explore how the intersection between rights-based approaches and an empirical framework enhances recommendations for ethical policy and healthcare. Between July 2017 and April 2018, 69 donors and 147 recipients, recruited at the Portuguese Public Bank of Gametes, participated in this cross-sectional study. Position towards anonymity was assessed through an open-ended question in a self-report questionnaire, which was subject to content analysis. Preference for an anonymous donation regime was mentioned by 82.6% of donors and 89.8% of recipients; and all those with children. Instead of the rights-based reasoning used by the Constitutional Court, donors highlighted concerns over future relationships and recipients focused on socioethical values linked with the safeguard of safety, privacy and confidentiality. The remaining participants advocated the choice between anonymity or non-anonymity (double-track policy), invoking respect for their autonomy. The complex, diverse ethical views and reasoning of donors and recipients expand a traditionally dichotomous discussion. Their perspectives challenge the transition towards non-anonymity and international guidelines, raising awareness to the need for their involvement in the design of policies to enable choice according to their values and preferences, and of psychosocial counselling responsive to their socioethical concerns and sensitive to their parental status. Empirical frameworks complement rights-based approaches to uphold justice, fairness and equal respect, and to incorporate utility, beneficence and non-maleficence in policymaking and healthcare in the transition towards non-anonymity.

The impact of the method of genetic identity disclosure on the donor conceived adult

Aim: 106 donor conceived people (DCP) responded to an anonymous survey study that examined the impact of the method of genetic identity disclosure and age at the time of the disclosure on their emotional wellbeing, familial relations, and perceptions of donor conception practices.Methods: Participants were asked to select the way in which they were informed they are DCP and the age group at which this occurred, and then were asked to select strongly agree, agree, neither agree or disagree, disagree, or strongly disagree in response to 26 statements that examined their perceptions of the topics listed above. Responses were grouped based on the age of genetic identity disclosure and the method of genetic identity disclosure, then numerically compared by assigning each type of response a number. Statistical analysis using repeatedmeasures ANOVA was performed to identify differences among these factors.Results: This analysis revealed that most participants 18 ≥ years and most participants who discovered their genetic identity through means other than through their parent(s) had worse emotional wellbeing and familial relations. However, most participants among all categories had a negative perception of donor conception practices.Conclusion: Continued work is needed to understand and support the growing DCP population.

Shifting to a model of donor conception that entails a communication agreement among the parents, donor, and offspring

Background

Some persons conceived with donor gametes react negatively when they found their birth via donor conception. They request access to information about and seek to communicate with the donor. However, some countries mandate donor anonymity. Other countries allow donor-conceived persons to access donor information, but they can only use this access if their parents have disclosed donor conception to them. We investigated a thorny issue of donor conception: whether donor conception should be shifted from an anonymous basis to a non-anonymous basis.

Methods

We review the issues and concerns regarding donor conception. We then consider the impact of direct-to-consumer genetic testing on donor conception, as well as the influence of donor conception on offspring’s identity and the potential of different types of donors. To discuss the future policy of donor conception, the policies on the anonymity of gamete donors were investigated using publicly-available documents in 15 countries.

Results

The aim of mandating donor anonymity is to protect the privacy of the donor and intended parents. However, the diffusion of direct-to-consumer genetic testing may make it impossible to maintain anonymity. Birth via donor conception shapes the offspring’s identity, and the donor may further influence the development of offspring’s identity through communications. It remains important to disclose donor conception to donor-conceived offspring and to provide them with donor information. However, that information might be insufficient for some donor-conceived persons. Here are benefits to having open-identity donors and known donors. Such donors can make an agreement with the parents regarding future communication with the offspring, although both sides should respect privacy. Subsequent counseling for all parties involved can result in better tripartite communication agreements.

Conclusions

In sum, ethical and practical issues that complicate donor anonymity are driving a shift to non-anonymous donor conception, in which all parties come to a communication agreement. To pave the way for such a donor conception system, transitional measures can be put into place. For countries that already adopted non-anonymous donor conception, ensuring the communication agreements is important to protect the rights of parents, donor, and offspring.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12910-022-00756-1.

Telling donor-conceived children about their conception: Evaluation of the use of the Donor Conception Network children's books

If parents have used donated gametes, it is a personal choice whether they disclose to their children. For those that do, there is, however, little advice on how to tell their children. The Donor Conception Network (DCN) has made a series of books to help parents disclose. This study evaluated parents' experience of using these books. An online survey with both quantitative and qualitative questions was used. The DCN membership and social media were used to publicize the survey, and 108 responses were analysed. At the time of conception, the parents' family types were mainly mother and father (56.5%) and solo mothers (36.1%). The method of conception was mainly donor spermatozoa (55.6%) followed by donor egg (38.0%), double donation (8.3%) and one case of surrogacy. Most parents had read the book to their children before 2 years of age (76.9%). Before reading the books, some of the parents had some confidence in telling (43.5%) or were very confident in telling (30.6%). After reading the books, 60.2% reported having much more confidence in telling. Most parents felt their children had no understanding (76.8%) or only some understanding (22.3%) of donor conception before reading the books. After reading the books most parents felt their children's understanding had increased (71.3%). Most parents felt that reading the books had given them more confidence in using donor conception language (90.7%). The use of books to tell children about their conception may be a useful resource for parents wishing to be open with their children.

A Systematic Review of Qualitative Studies Investigating Motives and Experiences of Recipients of Anonymous Gamete Donation

The decision to use an anonymous gamete donation in fertility treatment could have significant long-term psychological and social effects for all stakeholders involved. In light of the growing recognition of donor-conceived children's right to know their genetic parentage, this entails profound ethical implications. This review aims to carve out the full spectrum of recipients' motives and experiences related to donor anonymity which could serve as an analytical framework for future ethical and sociological research on issues of donor anonymity. This review was conducted following a seven-step approach for systematic reviews of empirical bioethics literature. The characteristics and quality of the studies included in this review were reported. Data analysis was conducted using qualitative content analysis and was informed by sociological functionalist theorizations of ignorance. The 53 studies selected showed a diverse spectrum of characteristics concerning date and country of study, methodology, family type of participants, sample size, and the timing of data collection in relation to the stage of treatment. A total of 22 categories of motives and experiences of recipients concerning donor anonymity were identified inductively and grouped into five main categories. Donor anonymity was identified as a eufunctional form of ignorance, by which the recipients experienced or intended to control, regulate, or protect inter-stakeholder relations. Interpreting recipients' motives and experiences concerning donor anonymity as a form of ignorance directed toward particular stakeholders helps reframe the discourse on donor anonymity. It is a fruitful approach that can be refined further and applied in future research. This review identified possible directions for future investigations on motives for donor anonymity: the need for more thorough inquiries into the change in recipients' preferences over time, such as in the form of longitudinal studies and research on the perspective of non-biological parents.

Characteristics and intentions of heterosexual couples comprising a transgender man awaiting sperm donation to conceive a child

BACKGROUND

More than half of transgender (TG) men wish to have children. Until recently, TG people in France were rarely offered gamete donation, mainly because the Bioethics Law allows the use of assisted reproductive technologies (ART) only in infertile couples. The only option currently available for heterosexual couples with a TG man is ART with sperm donation. The Center for Study and Preservation of Eggs and Sperm (CECOS) of the Cochin Hospital is the first French center to propose sperm donation to such couples, and has done so since 1999.

OBJECTIVES

To determine the main characteristics and intentions of 43 couples, including a TG man and his cisgender female partner awaiting sperm donation.

MATERIALS AND METHODS

A retrospective analysis was carried out on the records from October 2010 to December 2019, of 43 couples with a TG man who applied for sperm donation at the CECOS of the Cochin Hospital (Paris, France).

RESULTS

The mean age of TG men and cisgender women was 32 ± 6.6 and 29.7 ± 4.6 years, respectively. In 77% of cases, the couple met before the man's transition. Eighty-one percent of the couples were in a stable relationship for at least 3 years, and 94% wished to have a child for no more than 5 years. Almost all of the couples (95%) intended to inform their child of their conception by sperm donation and the father's transidentity (92%).

DISCUSSION

Due to restrictive French legislation, the profile of our couples probably does not reflect that of all couples consisting of a TG man and a cisgender woman. The study took place over a long period of time and the characteristics of the couples could probably change over time.

CONCLUSION

The couples often met before the man's transition, cohabited for several years, intended to inform their child of sperm donation and the father's transidentity.

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

The Impact of Third Party Reproduction on Family and Kinship

The development of in vitro fertilization (IVF) in the UK, in 1978, proved a major breakthrough in the process of human reproduction, which had remained constant in human history. The impact of IVF and the ensuing assisted reproductive technologies (ARTs) has not been limited in revolutionizing the "natural" practice of biological reproduction, but has reached out to and affected almost every institution in society. Family and kinship, as the social expression of reproduction and the institutions which are the most transparently structured realm of human life are those most profoundly affected by ARTs. Although literature on the implications of ARTs is in general abundant, this article presents new insights on their impact on family and kinship in Iran, which remains a unique case in the Muslim world. It explores the particular way ARTs, especially third-party donation, have been endorsed and practiced in Iran, and their consequences for the family, the infertile individuals, and their position vis-à-vis their kin and social group. The conclusion points to the lack of clarity concerning the initial rulings by the Islamic jurists, who allowed the practice of ARTs, and which has led to a number of unintended consequences regarding the legal, religious, cultural, and ethical issues, affecting the family, its structure and the relationship between the kin group. These consequences range, inter alia, from the question of the anonymity of third-party donor, to the permissibility of gamete donation between blood relatives, and to the absence of enforceable legislation.

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.

Conversation Orientation Moderates the Relationship between Information Sharing of Medically Assisted Reproduction and Child Adjustment

Parents who experienced infertility have increasingly used medically assisted reproduction (MAR) to add children to their families over the past few decades. These parents will need to decide if they will tell their children about being conceived using MAR. Although MAR information sharing operates within family contexts, little is known about the role of conversation orientation-one family contextual factor-in child outcomes associated with MAR information sharing in middle childhood. Derived from the Family Communication Patterns Theory, this study proposes that conversation orientation moderates the associations between MAR information sharing and children's psychosocial adjustment. This proposal was tested using a sample of 81 6- to 12-year-old MAR-conceived children from 55 families and a structured observational measure of conversation orientation. Multiple regression analyses showed that MAR information sharing interacted with conversation orientation to influence children's behavioral and attention problems but not emotional problems. In families with high conversation orientation, MAR information sharing was not significantly associated with children's behavioral and attention problems. In families with low conversation orientation, MAR information sharing was significantly associated with an increase in children's behavioral and attention problems. Results of this exploratory study demonstrate the potential significance of general communication orientation in understanding child outcomes of MAR information sharing and highlight the needed family context nuances in MAR research.

Family Secrecy in Family Therapy Practice: An Explorative Focus Group Study

The aim of this focus group study was to explore the experiences of family therapists working with family secrecy. Our study highlights that family secrets present important and compelling challenges for family therapists. Furthermore, our study reveals that there seem to be some basic strategies family therapists use in dealing with these challenges in therapy sessions. One basic strategy is that family therapists try to guard their position of being a trustworthy therapist for each family member by avoiding becoming stuck in family secrecy. Furthermore, therapists explore ways to guide the family toward the disclosure of the secret in order to alleviate the toxicity of the secrecy. This highlights the importance of the systemic model and how influential this perspective is in family therapy practice. Some participants, however, have in addition a second strategy they sometimes use: talking with the family about secrecy without aiming to disclose the secret. In the discussion section of the article we reflect on the possibility that in the strategic choices family therapists make conceptual issues might be involved. Furthermore, we stress the importance of further research.

Psychosocial counselling for intended parents who opt for donor sperm treatment: which topics do they find relevant?

Objective: This study aimed to explore which topics intended parents who opt for donor sperm treatment find relevant to discuss in psychosocial counselling. Background: The choice for donor sperm treatment has psychosocial implications for intended parents and therefore psychosocial counselling is advised as an integral part of DST. To date, little is known about which topics intended parents find relevant to discuss in psychosocial counselling. Methods: We conducted 25 semi-structured in-depth interviews between 2015 and 2017 with heterosexual men and women, lesbian women and single women who opted for donor sperm treatment and had a counselling session as part of their intake. They were recruited through three Dutch fertility centres, three network organisations and by snowball sampling. Results: Intended parents found it relevant to discuss the following seven topics in psychosocial counselling: the decision to opt for donor sperm treatment, choosing a sperm donor, coping with questions from family and friends, non-genetic parenthood, single motherhood, openness and disclosure, and future contact between the child and half-siblings. Conclusion: We recommend that counsellors take a more active role in bringing up the topics found in our study and that a clear distinction is made between counselling with the aim to screen intended parents and counselling with the aim to offer guidance.

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.

Child sexual abuse, disclosure and PTSD: A systematic and critical review

BACKGROUND

Child sexual abuse (CSA) is a prevalent exposure with potentially serious, negative health consequences, including post-traumatic stress disorder (PTSD) and its symptomatology.

OBJECTIVE

To conduct a systematic and critical review in order to investigate the relationship between CSA disclosure patterns and PTSD.

PARTICIPANTS AND SETTING

Studies included clinical, college and community-based samples of adults' and children's experiences of CSA.

METHODS

We conducted systematic searches in five databases (Medline, Embase, PyscINFO, CINAHL, ERIC, Sociological Abstracts) from database inception to October 17, 2017 using index terms and keywords for CSA, disclosure, and PTSD. We included any English-language, primary studies involving children or adults with experiences of CSA that used quantitative research designs to explore the relationship between disclosure and PTSD. We used systematic critical review methodology in order to investigate the relationship between disclosure and PTSD symptoms and disorders. We also investigated factors that explained the relationship between disclosure and PTSD, such as individual, exposure or environmental factors.

RESULTS

Twenty-two articles reporting 20 studies were included in this review. Studies assessing the relationship between CSA and PTSD tended to account for personal (e.g., gender) and CSA exposure variables (e.g., severity of CSA) only. While authors generally used validated measures to assess for PTSD symptoms and disorders, they tended to use author-generated or unvalidated measures to assess for disclosure process variables.

CONCLUSION

The relationship between factors that affect disclosure, and responses to disclosure, are not well theorized in quantitative literature. Study findings suggest important avenues for future research, such as the need to assess disclosure longitudinally.

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.

Oocyte donation disclosure decisions: a longitudinal follow-up at middle childhood

Few studies have captured oocyte donation (OD) parents' decision processes about intended and actual disclosure over time. Likewise, OD children's perceptions about their family composition during middle childhood are underexplored. To address these gaps, a longitudinally followed cohort of OD recipient families was invited to participate in a qualitative, follow-up study. With an 86% response rate after 12 years, families were composed of oocyte recipient mothers (n = 6) and biological fathers (n = 6) representing 12 donor-oocyte conceived children (10.33 ± 1.23 years; mean ± SD). Of the 12 children, two that were aware and two that were unaware of their conceptual origins completed conversational interviews. Only one family in the initial cohort had disclosed OD to their children by the 12-year follow-up, despite 43% of parents intending to disclose and another 43% undecided about disclosure during pregnancy. Four parental disclosure patterns emerged at 12 years: (i) wanting to disclose; (ii) conflicted about disclosure; (iii) not planning to disclose; and (iv) having disclosed. Children that were unaware of their conceptual origins displayed no knowledge of their method of conception. There is a need for family-centric interventions to assist 'wanting to disclose' parents in their disclosure process and 'conflicted about disclosure' parents in their decision-making process post-OD treatment.

Doação de gametas: questões sociais e éticas (não) respondidas em Portugal

Resumo: Conhecer a discussão em torno dos desafios sociais e éticos da doação de gametas é fundamental para a boa governança das técnicas de reprodução assistida. Neste artigo, analisam-se os tópicos que orientaram o debate nas organizações de ética portuguesas, discutindo as suas conexões com os temas abordados internacionalmente. Para tal, em março de 2018, pesquisamos sistematicamente os websites do Conselho Nacional de Procriação Medicamente Assistida e do Conselho Nacional de Ética para as Ciências da Vida. Procedemos à análise de conteúdo temática de 25 documentos. Os resultados indicam que o debate se centrou na acessibilidade, no anonimato e na compensação de doadores e, em menor extensão, nas responsabilidades profissionais. Observaram-se posicionamentos heterogêneos e tensões entre múltiplos direitos e princípios éticos associados a receptores, a pessoas nascidas com recurso à doação de gametas e a doadores. Esses têm em comum três alegações: a escassez de evidência científica; as experiências de outros países; e regulamentações oriundas de entidades internacionais. Na literatura abordam-se tópicos adicionais, nomeadamente: uma via dupla que conjugue anonimato/identificação de doadores; implementação de sistemas de registo reprodutivo para receptores e doadores; limites do rastreio genético a doadores; doação por familiares/conhecidos; e o papel dos doadores na decisão quanto ao destino de embriões criopreservados e na escolha das características dos receptores dos seus gametas. Há espaço para expandir o debate e promover a pesquisa em torno das implicações sociais e éticas da doação de gametas, considerando a participação de todos os cidadãos.

"I want us to be a normal family": Toward an understanding of the functions of anonymity among U.S. oocyte donors and recipients

BACKGROUND

Anonymity remains the more common practice in gamete donations, but legislation prohibiting anonymity with a goal of protecting donor-conceived children's right to know their genetic origins is becoming more common. However, given the dearth of research investigating the function of anonymity for donors and recipients, it is unclear whether these policies will accomplish their goals. The aim of this study was to explore experiences with anonymity among oocyte donors and recipients who participated in an anonymous donor oocyte program and to understand the ways in which anonymity functions for them.

METHODS

Semistructured interviews were conducted with 50 women: 28 oocyte donors and 22 recipients who were recruited from an academic center for reproductive medicine in the United States.

RESULTS

Donors and recipients view anonymity both as a mechanism to protect the interests of all parties (recipients, donors, and donor-conceived children) and as a point of conflict. Specifically, three key areas were identified where both donors and recipients saw anonymity as having an important role: relieving anxieties about family structures and obligations; protecting their interests and those of donor-conceived children (while acknowledging where interests conflict); and managing the future.

CONCLUSION

As gamete donation increasingly moves away from the practice of anonymity, examining why anonymity matters to stakeholders will be helpful in devising strategies to successfully implement identity-release options.

The interaction between donor-conceived families and their environment: parents' perceptions of societal understanding and attitudes regarding their family-building

Disclosure issues in relation to donor conception have mainly been examined in the context of relationships and interaction within donor-conceived families, whilst influences from outside the family, for example societal ones, have been little researched. This study explored the societal experiences of individuals who build their family with the help of donor conception (i.e. donor-conceived families), specifically, where and how parents and society interact and the presence and influence of cultural beliefs and values regarding the family. Belgian (n = 89) and Swedish (n = 56) donor-conceiving parents completed an online-survey focusing on their experiences with societal perceptions and attitudes and behaviour and responses from friends, healthcare professionals and teachers. Descriptive and comparative statistical analyses were conducted. Results showed that donor-conceiving parents were challenged by societal representations, responses from friends, healthcare professionals and teachers, and cultural norms and values. Parents had to cope with lack of knowledge and understanding of donor-conceived families and colliding views on the relevance of genes in kinship. They needed to be able to explain and defend themselves, correct others and handle emotions and sensitivity when managing these interactions. Through psycho-education health-care professionals can help families anticipate potential reactions and manage societal responses by strengthening parents' coping mechanisms. These findings also call for awareness of the presence of cultural norms and values even when counsellor and patient share the same culture because counsellor and donor-conceiving parents can relate differently to (collide or conform with them) the shared cultural norms, which can impact on parents' experience.

Sperm donor regulation and disclosure intentions: Results from a nationwide multi-centre study in France

Gamete donation in Europe is not regulated by a common legal framework. Different laws regarding donor anonymity and remuneration exist in different countries. In France, gamete donation is characterized by a stable legal framework - the existing system of anonymous and non-remunerated donation remained unchanged following a period of public and parliamentary debate in 2011 - but little evidence is available concerning recipients' views and experiences of gamete donation. This article describes findings from a questionnaire completed individually by 714 heterosexual couple members undergoing a donor conception procedure at one of 20 national fertility centres in France. Participants were invited to report their attitudes towards the French legal framework, their perceptions of the anonymous donor, and their intentions to disclose donor conception to their child and to other people. The majority of respondents (93%) approved of the current legal framework. Participants indicated that they thought about the sperm donor in ways that emphasized his act of donation without describing him as a specific individual. A majority (71%) also stated that they intended to tell their child about their donor conception. Given that this is the largest nationwide study of French recipients of donor sperm, the findings make an important contribution to the research evidence currently available about prospective parents' perspectives in the increasingly uncommon context of donor anonymity in Europe.

Survey shows that Swedish healthcare professionals have a positive attitude towards surrogacy but the health of the child is a concern

AIM

In February 2016, Sweden upheld its ban on surrogacy following a Government enquiry. This survey investigated attitudes towards surrogacy among primary health professionals working with children and their experiences of working with families following surrogacy abroad.

METHODS

From April to November 2016, nurses, physicians and psychologist working in primary child health care in four counties in Sweden were invited to participate in a cross-sectional online survey about surrogacy.

RESULTS

The mean age of the 208 participants was 49.2 years (range 27-68) and nearly 91% were women. Approximately 60% supported legalised surrogacy. Wanting a conscience clause to be introduced in Sweden was associated with not supporting surrogacy for any groups, while personal experiences of infertility and clinical experiences with families following surrogacy were associated with positive attitudes towards surrogacy for heterosexual couples. The majority (64%) disagreed that surrogate children were as healthy as other children, and many believed that they risked worse mental health (21%) and social stigmatisation (21%).

CONCLUSION

We found that 60% supported legalised surrogacy, but many expressed concerns about the children's health and greater knowledge about the medical and psychosocial consequences of surrogacy is needed.

The attitudes of IVF patients treated in the Czech Republic towards informing children born after gamete donation

BACKGROUND

In recent decades gamete donation has received growing attention. Data from the Czech National Registry of Assisted Reproduction show that the number of cycles using donated oocytes has been increasing every year. According to Czech law, gamete donation is anonymous. Since 2011, some members of the Czech parliament have repeatedly made requests to revoke the anonymity but anonymity is one of the preconditions for such donation in this country. The aim of this study was to find out how the gamete recipients feel towards informing their child about the circumstances of their conception and their access to the identity of the donor.

METHODS

A total of 195 recipients (122 women undergoing treatment - 43 Czechs, 79 foreigners (Western Europe and the USA) and 73 male partners - 28 Czechs, 45 foreigners) participated in this survey. The data were obtained by anonymous questionnaire.

RESULTS

A significant difference between the attitude of the future Czech and foreign parents regarding disclosing the mode of conception was found (P = 0.003). The vast majority of Czechs were against disclosure. The foreign recipients were somewhat more divided. Regarding the donor's identity, there was no difference in atttitude between the groups. Recipients rarely consider that the knowledge of the donor's identity will be important for their child. The recipients overall, were convinced that the psychological aspects of parenting are far more important to the child than genetics, and see no reasons for disclosing the donor´s identity.

CONCLUSION

While the the foreign recipients were less adamant about non-disclosure, the overall finding was in accord with the current Czech law on anonymity and not in agreement with the proposed abolition. The recipient's attitudes towards disclosing were also culturally determined. The fact that some countries have revised their rules towards open idendity is not a rationale for such change in the Czech Republic.

Process and Pitfalls of Sperm Cryopreservation

Sperm cryopreservation has been utilized routinely for over 40 years to preserve fertility in men undergoing cancer therapy and allow conception for infertile couples. This article provides a concise and up-to-date review of the literature and covers the latest advances in sperm cryopreservation and its array of clinical indications. Over recent years, the scope of clinical indications used for sperm cryopreservation has expanded widely. Consequently, more patient groups are eligible for sperm freezing, requiring specialist resources and higher running costs. Although sperm cryopreservation prior to cancer therapy is readily available in many countries, referral rates by oncology specialists and levels of patient engagement with cryopreservation services are both reported as low. Furthermore, sperm banking continues to raise ethical issues such whether sperm donation should be anonymous and whether sperm can be utilized posthumously by the surviving partner without consent from the patient. This review focuses on the technological advances and ethical controversies in sperm cryopreservation, and how better understanding of these issues could lead to improved access to fertility preserving treatment for patients.

Parenting stress and its association with perceived agreement about the disclosure decision in parents following donor conception

INTRODUCTION

For many donor-conceiving heterosexual parents, the process of deciding whether and what to tell children about their genetic origin is challenging. We hypothesized that incomplete couple agreement about disclosure could be associated with parenting stress. The aim of the study was to investigate: (1) parenting stress levels among heterosexual parents of young children following gamete donation and (2) whether parenting stress is related to perceived agreement about disclosure of the donor conception to the children.

MATERIAL AND METHODS

This study is part of the longitudinal multicenter Swedish Study on Gamete Donation and included a total of 213 heterosexual parents with children aged 1-4 years following oocyte donation (n = 103) and sperm donation (n = 110). Parents individually completed a questionnaire that included validated instruments on parenting stress (SPSQ) and relationship quality (ENRICH), as well as a study-specific measure on disclosure agreement. Multiple regression analysis was applied.

RESULTS

Incomplete couple agreement on disclosure to the children was not statistically significantly associated with increased levels of parenting stress. Relationship satisfaction consistently and significantly accounted for variation in parenting stress levels, indicating that relationship satisfaction had a buffering impact on parenting stress.

CONCLUSIONS

Parental stress does not appear to be negatively influenced by incomplete couple agreement about disclosure to children. As children grow up, reaching agreement about what to tell the child about the donor conception might become more relevant for couples' stress related to parenthood.

How best to protect the vital interests of donor-conceived individuals: prohibiting or mandating anonymity in gamete donations?

Anonymous gamete donation continues to be practised in most jurisdictions around the world, but this practice has come under increased scrutiny. Thus, several countries now mandate that donors be identifiable to their genetic offspring. Critics contend that anonymous gamete donation harms the interests of donor-conceived individuals and that protection of these interests calls for legal prohibition of anonymous donations. Among the vital interests that critics claim are thwarted by anonymous donation are an interest in having a strong family relationship, health interests, and an interest in forming a healthy identity. This article discusses each of these interests and examines what they could involve. The legislation in two countries is considered: Spain, which mandates anonymous gamete donation, and the UK, which prohibits such practice, to assess how these different legislations might or might not protect these vital interests.

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.

Disclosure of sperm donation: a comparison between solo mother and two-parent families with identifiable donors

Disclosure of donor conception to children was compared between solo mother and two-parent families with children aged 4–8 years conceived since the removal of donor anonymity in the UK. Semi-structured interviews were conducted with 31 heterosexual solo mothers and 47 heterosexual mothers with partners to investigate their decisions and experiences about identifiable donation and disclosure to their children. No significant difference was found in the proportion of mothers in each family type who had told their children about their donor conception (solo mothers 54.8%; partnered mothers 36.2%). Of those who had not told, a significantly higher proportion of solo mothers than partnered mothers intended to disclose (P < 0.05). Partnered mothers were more likely than solo mothers to feel neutral, ambivalent or negative about having used an identifiable donor (P < 0.05), and were less likely to consider children's knowledge of their genetic origins as extremely important (P < 0.05). These findings are relevant to provision of counselling services as it cannot be assumed that parents will tell their children about their origins or their entitlement to request the identity of their donor at the age of 18 years. Further qualitative research would increase understanding of solo mothers' attitudes towards disclosure.

Industry is not the dark side, but an essential partner to make progress in reproductive health

For the last 20 years, Thomas D'Hooghe has been coordinator of the Leuven University Fertility Center at Leuven University Hospitals, Belgium, one of the largest teaching hospitals in Europe. Since 1995, he has also been Professor of Reproductive Medicine and Biology at KU Leuven (University of Leuven) and Adjunct Professor at Yale University, USA. Since 1 October 2015, he has been the Vice President and Head of Global Medical Affairs Fertility at Merck's headquarters in Darmstadt, Germany. He has published nearly 300 papers in internationally peer-reviewed journals and has contributed to reproductive health serving major international organizations such as the WHO, the European Society of Human Reproduction and Embryology, the Society of Reproductive Investigation and the World Endometriosis Research Foundation.

It takes two to tango: information-sharing with offspring among heterosexual parents following identity-release sperm donation

STUDY QUESTION

How do heterosexual parents reason about and experience information-sharing with offspring following identity-release sperm donation?

SUMMARY ANSWER

Sharing information about using donor-conception with offspring is a complex process at several levels, with the parent's personal beliefs and the child's responses serving as driving or impeding forces for the information-sharing process.

WHAT IS KNOWN ALREADY

The overall view of disclosure in gamete donation has shifted from secrecy to openness, but there is still uncertainty among parents concerning how and when to tell the child about his/her genetic origin. Most research on donor-conceived families has focused on donation treatment under anonymous or known circumstances, and there is a lack of studies in settings with identity-release donations.

STUDY DESIGN, SIZE, DURATION

A qualitative interview study among 30 parents following identity-release sperm donation treatment. Interviews were conducted from February 2014 to March 2015.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The present study is part of the prospective longitudinal Swedish Study on Gamete Donation (SSGD), including all fertility clinics performing gamete donation in Sweden. A sample of participants in the SSGD, consisting of heterosexual parents with children aged 7–8 years following identity-release sperm donation, participated in individual semi-structured interviews.

MAIN RESULTS AND THE ROLE OF CHANCE

The analysis revealed one main theme: information-sharing is a process, with three subthemes; (i) the parent as process manager, (ii) the child as force or friction and (iii) being in the process. The first two subthemes were viewed as being linked together and their content served as driving or impeding forces in the information-sharing process.

LIMITATIONS, REASONS FOR CAUTION

The fact that the study was performed within the context of the Swedish legislation on identity-release donation must be taken into consideration as regards transferability to other populations, as this may affect parents' reasoning concerning their information-sharing with the child.

WIDER IMPLICATIONS OF THE FINDINGS

The present findings highlight the role of the donor-conceived child in the information-sharing process and may contribute to develop counselling that increases parents' confidence in handling children's reactions to information about their genetic origin.

STUDY FUNDING/COMPETING INTEREST(S)

Financial support from The Swedish Research Council, The Family Planning Fund in Uppsala and Ferring Pharmaceuticals. There are no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

N/A.

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.

Motivations and experiences of patients seeking cross-border reproductive care: the Australian and New Zealand context

OBJECTIVE

To explore the motivations, clinical care, counseling, and support experiences of Australian and New Zealand participants considering or having participated in cross-border reproductive care (CBRC).

DESIGN

Questionnaire-based study.

SETTING

Not applicable.

PATIENT(S)

One hundred thirty-seven Australian and New Zealand participants aged 23-53 years.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURES(S)

Quantitative and qualitative responses to an anonymously completed online questionnaire.

RESULT(S)

Quantitative responses from participants indicated that motivations for engaging in CBRC included limited availability of gamete donors in their home state, difficulty in meeting treatment eligibility criteria, and treatment being legally prohibited. Experiences of CBRC were generally rated positively in terms of medical needs (91.2%), safety (89.4%), and costs (85.7%), although rated more conservatively to emotional needs being met (57.9%). Less than half the sample (47.5%) had accessed some form of CBRC-related counseling. Themes identified in qualitative analysis reflected gamete supply and demand issues, the importance of donor information and disclosure, the personal impact of legislation, and ongoing support needs after CBRC treatment.

CONCLUSION(S)

A greater percentage of participants agreed that their CBRC clinic satisfied their overall medical needs and treatment expectations in comparison with overall emotional needs. Participants indicated access to post-treatment support counseling particularly with regard to their emotional well-being and disclosure issues to donor-conceived children would be useful. The implications of our findings for the provision of best-practice psychosocial counseling support and development of counseling guidelines are highlighted.

[Donor in conception stories: narrative practices by parents conceiving with donated spermatozoa]

Little is known about the parents of donor-conceived offspring in France, where the anonymity of the donor prevails. The present study associates quantitative data informing the attitudes and decisions of parents towards disclosure and qualitative data related to their experience of being parents of a donor-conceived offspring. The quantitative results about the becoming of the conception narratives (n=929 requesting people, including 216 parents) confirmed that most parents decided to tell their child about the donor conception. The analysis of the semi-structured interviews of 37 parents defined the existence of a paradox between the conception stories mentioning the donor, who is objectified as a seed, and the representational project parents mostly pursue, which is anchored in a normalisation process.