Donor insemination disclosure in social networks: heterosexual couples' experiences

The way in which heterosexual couples manage information about infertility and donor insemination within their social networks has not yet been explored in-depth. This study focuses on how parents and aspiring parents manage information about infertility and donor insemination within their social networks. Fifteen Belgian couples were interviewed as part of a parenthood research project. Thematic analysis resulted in the identification of four themes. The first of these reveals how the social context can best be understood as a continuous confrontation with social expectations. A second theme highlights the diverse ways in which couples manage personal information in this confronting context. The third theme stresses how couples manage information about donor insemination so as to be treated as a 'normal' family. The final theme shows how emotional regulation within the context of the extended family plays a role in couples' decisions about how to manage information with relatives. Results are analysed using the concept of 'systemic emotion management' and the importance of being seen by others as a 'normal' family. Study findings signal the importance of managing information within social networks and are of relevance to a range of practitioners.

Psychological well-being of identity-release egg donation parents with infants

STUDY QUESTION

What are the psychological health, relationship quality and perceived social support outcomes of heterosexual couples who have conceived an infant through identity-release egg donation?

SUMMARY ANSWER

Parents' scores on all measures were within the normal range. Egg donation mothers had poorer perceived social support, and egg donation fathers had less optimal psychological health than a comparison group of IVF parents, although these differences were associated with the older age of egg donation parents, rather than being an effect of family type.

WHAT IS KNOWN ALREADY

There is limited understanding of the psychological health and couple relationship quality of egg donation parents, and no empirical data on parents' social support, during the first year of parenthood. No studies have included families who have used an identity-release egg donor. The study offers the first examination of the psychological well-being of identity-release egg donation parents.

STUDY DESIGN, SIZE, DURATION

This study included 57 families created through identity-release egg donation, and a comparison group of 56 families who had used IVF with their own gametes, recruited through UK fertility clinics. Families were visited at home between October 2013 and June 2015. The sample forms part of a larger study examining family functioning in families created following fertility treatment.

PARTICIPANTS/MATERIALS, SETTING, METHOD

All families were heterosexual two-parent families with an infant aged 6-18 months. Mothers and fathers were administered standardised questionnaires assessing psychological health (Edinburgh Postnatal Depression Scale, Trait Anxiety Inventory and Parenting Stress Index-short form), couple relationship quality (Golombok Rust Inventory of Marital State) and perceived social support (Multidimensional Scale of Perceived Social Support).

MAIN RESULTS AND THE ROLE OF CHANCE

Scores from the egg donation and IVF parents were within the normal range on all measures. Significant differences were found between the groups indicating less optimal social support in egg donation mothers compared to IVF mothers, and poorer psychological health in egg donation fathers compared to IVF fathers. These differences appeared to be related to the older age of egg donation parents or to twin parenthood, rather than to egg donation per se. No differences were found between the groups in the parents' relationship quality.

LIMITATIONS, REASONS FOR CAUTION

It is possible that families who were managing the transition to parenthood less well may have been less likely to participate in research. Fewer IVF than egg donation fathers participated in the study, so the statistical power was lower for comparisons between fathers.

WIDER IMPLICATIONS OF THE FINDINGS

The findings are of relevance to UK clinics offering identity-release egg donation. That scores of egg donation parents on measures of psychological well-being were more similar than different to those of IVF parents should prove reassuring to individuals considering this treatment type. As less optimal outcomes were found for egg donation parents on several measures, and these were associated with parental age rather than conception type, it is recommended that clinics discuss with older patients how they may establish a social support network and signpost patients to appropriate post-natal support.

STUDY FUNDING, COMPETING INTERESTS

This research was supported by a Wellcome Trust Senior Investigator Award [097857/Z/11/Z] and a CHESS-ESRC studentship. The authors have no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

N/A.

Mater semper certa est: motherhood is always certain

The development of oocyte donation has led to a reexamination of the facets of motherhood: the genetic, gestational, and psychosocial contributions. In addition, the practice of oocyte donation has prompted a consideration of the unique psychosocial and legal aspects of this form of family building. In this section of Views and Reviews a summary and discussion of the long-term psychosocial adjustment of oocyte donor-conceived children and their parents is presented. Next, the current permeability around donor anonymity is investigated and questions regarding whether donor anonymity can still exist is discussed. Third, the evolution of oocyte cryopreservation and banking is reviewed and the future of oocyte banking is explored. Finally, as oocyte donation continues to grow and evolve, so too does the legal landscape in which it is practiced. Seminal legal cases are presented to describe the legal landscape that has shaped the practice of oocyte donation.

Donor Conception and "Passing," or; Why Australian Parents of Donor-Conceived Children Want Donors Who Look Like Them

This article explores the processes through which Australian recipients select unknown donors for use in assisted reproductive technologies and speculates on how those processes may affect the future life of the donor-conceived person. I will suggest that trust is an integral part of the exchange between donors, recipients, and gamete agencies in donor conception and heavily informs concepts of relatedness, race, ethnicity, kinship, class, and visibility. The decision to be transparent (or not) about a child's genetic parentage affects recipient parents' choices of donor, about who is allowed to "know" children's genetic backgrounds, and how important it is to be able to "pass" as an unassisted conception. In this way, recipients must trust the process, institutions, and individuals involved in their treatment, as well as place trust in the future they imagine for their child. The current market for donor gametes reproduces normative conceptions of the nuclear family, kinship, and relatedness by facilitating "matching" donors to recipients by phenotype and cultural affinities. Recipient parents who choose not to prioritize "matching," and actively disclose the process of children's conceptions, may embark on a project of queering heteronormative family structures and place great trust in both their own children and changing social attitudes to reduce stigma and generate acceptance for non-traditional families.

The Meaning of the Sperm Donor for Heterosexual Couples: Confirming the Position of the Father

In the literature, relatively little attention has been paid to the meaning of donor involvement in the intimate couple dyad. The current study aimed to enrich our understanding of couples' meaning-making regarding the anonymous sperm donor and how they dealt with the donor involvement. Semi-structured interviews were conducted with nine couples, who had at least one child conceived through sperm donation. Our thematic analysis showed that the donor conception was seen as a different path to create a normal family. Once the family was formed, most couples avoided talking about the donor because it was perceived as disrupting men's growing confidence in their position as father. Participants tried to confirm the position of the father to protect the family relationships. Uncertainties about how they were perceived as parents showed the continuing dominance of genetic ties within our social discourse. Participants also dealt with reminders of the donor in their daily life. Overall, they tried to manage the space taken up by the donor and to protect the position of the father. We relate our findings to literature on topic avoidance and shared obliviousness in families. For counseling practice, it could be useful to explore couples' meaning-making about the donor as this seemed to serve family functioning.

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.

Lesbian couples' views about and experiences of not being able to choose their sperm donor

In this qualitative study, we explore how lesbian recipients view and experience the selection of their anonymous sperm donor. The study was conducted in Belgium, where fertility centres follow a legal protocol that severely restricts personal choice in donor selection. While previous studies have shown that recipients want greater control and input in the selection of their sperm donor, this was not a main concern for most women in the present study. They generally acknowledged their lack of control on the selection outcome and accepted this as part and parcel of an anonymous donation policy that provides an opportunity to have a child. They actively and passively downplayed initial concerns about the donor selection procedure and felt they did not have or need a right to further control over the donor selection. In adopting this 'subordinate' position, they felt they should trust the hospital, which they hoped would fulfil rather high screening standards. Those who did want more choice were nuanced and careful about their motivations: they focused on selecting traits that would facilitate normal child development or increase family coherence. The findings shed light on how these patients perceive their position in this third-party reproduction setting.

Numerical limits in donor conception regimes: genetic links and 'extended family' in the era of identity disclosure

This article critically examines the setting of limits on the number of children or family groups that may be formed with a single donor in assisted conception regimes. Originally, under conditions of anonymity, numerical limits were said to contain the risk of inadvertent consanguinity between offspring who would not know, and could not know, that they were genetic half siblings, and also between donor and offspring. The increasing embrace of identity disclosure regimes has led to calls for stricter numerical limits based on the purported harm of being exposed to 'too many' genetic relatives in the future. This article asks: how many is too many? And how do we know? The UK and Australian positions are examined, and placed alongside a discussion of qualitative research involving interviews with twenty parents of donor conceived children.

(Male) infertility: what does it mean to men? New evidence from quantitative and qualitative studies

Scientific knowledge of the emotional repercussions of infertility on men remains limited and has only recently become the focus of social science research. Firstly, the current developments in research on the psychosocial impact of infertility on men through a search of the literature over the last 10 years are outlined in this paper. In the second section, issues raised in pretreatment counselling for men and their partner who consider donor insemination are described as this treatment typically raises many emotional issues. The results of more recent studies with sophisticated methodological design show that the emotional impact of infertility may be nearly balanced, suggesting that men do suffer as well and that they have to be addressed in infertility counselling too. The emotional and clinical aspects of donor insemination support the hypothesis that the emotional repercussions of infertility affect both sexes. In general, male factor infertility seems to be more stigmatized than other infertility diagnoses. Forthcoming studies have to differentiate between the psychological impact of infertility on women and men and their respective abilities to communicate easily about this distress. More studies on infertile men in non-Western societies need to be conducted in order to understand the cultural impact on infertility.

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.

Investigating environmental links between parent depression and child depressive/anxiety symptoms using an assisted conception design

OBJECTIVE

Links between maternal and offspring depression symptoms could arise from inherited factors, direct environmental exposure, or shared adversity. A novel genetically sensitive design was used to test the extent of environmental links between maternal depression symptoms and child depression/anxiety symptoms, accounting for inherited effects, shared adversity, and child age and gender.

METHOD

Eight hundred fifty-two families with a child born by assisted conception provided questionnaire data. Mothers and fathers were genetically related or unrelated to the child depending on conception method. Parental depression symptoms were assessed using the Hospital Anxiety and Depression Scale. Child depression/anxiety symptoms were assessed using the Short Mood and Feelings questionnaire and six items tapping generalized anxiety disorder symptoms. Associations between maternal and child symptoms were examined separately for genetically unrelated and related mother-child pairs, adjusting for three measurements of shared adversity: negative life events, family income, and socioeconomic status. Analyses were then run separately for boys and girls and for children and adolescents, and the role of paternal depression symptoms was also examined.

RESULTS

Significant associations between parent and child symptoms were found for genetically unrelated mother-child (r = 0.32, p < .001) and father-child (r = 0.17, p < .05) pairs and genetically related mother-child (r = 0.31, p < .001) and father-child (r = 0.23, p < .001) pairs and were not explained by the shared adversity measurements. Environmental links were present for children and adolescents and were stronger for girls.

CONCLUSIONS

The transmission of depression symptoms is due in part to environmental processes independent of inherited effects and is not accounted for by shared adversity measurements. Girls may be more sensitive to the negative effects of maternal depression symptoms than boys through environmental processes.

Children conceived by gamete donation: psychological adjustment and mother-child relationships at age 7

An increasing number of babies are being born using donated sperm, where the child lacks a genetic link to the father, or donated eggs, where the child lacks a genetic link to the mother. This study examined the impact of telling children about their donor conception on mother-child relationships and children's psychological adjustment. Assessments of maternal positivity, maternal negativity, mother-child interaction, and child adjustment were administered to 32 egg donation, 36 donor insemination, and 54 natural conception families with a 7-year-old child. Although no differences were found for maternal negativity or child adjustment, mothers in nondisclosing gamete donation families showed less positive interaction than mothers in natural conception families, suggesting that families may benefit from openness about the child's genetic origins.

Adolescents of the USA National Longitudinal Lesbian Family Study: can family characteristics counteract the negative effects of stigmatization?

This investigation examines the impact of homophobic stigmatization on the well-being of 17-year-old adolescents who were conceived through donor insemination and whose mothers enrolled before they were born in the largest, longest-running, prospective study of lesbian families, with a 93% retention rate to date. The data for the current report were collected through questionnaires completed by the adolescents and their mothers. The adolescents (39 girls and 39 boys) were queried about family connection and compatibility. They were also asked to indicate if they had experienced discrimination based on their mothers' sexual orientation. Adolescent well-being was assessed through the parental report of the Child Behavior Checklist/6-18. Forty-one percent of the adolescents had experienced stigmatization based on homophobia. Hierarchical, multiple-regression analyses revealed that stigmatization was associated with more problem behavior in these adolescents, but that family compatibility neutralized this negative influence. The results indicate that adolescents who have close, positive relationships with their lesbian mothers demonstrate resilience in response to stigmatization.

Children of the new reproductive technologies: social and genetic parenthood

OBJECTIVE

To review empirical studies on families created by new reproductive technologies (NRT) in which only one parent has a genetic link to the child.

METHODOLOGY

Literature search was conducted among computerized databases. Inclusion criteria were that studies should focus on childrearing or parenting, as well as on the psychological adjustment of children in: heterosexual families formed through artificial insemination with donated semen (AID), single-mother AID families, oocyte-donation families, planned lesbian-mother families, planned gay-father families, and partial surrogacy families.

RESULTS

Compared to natural-conception parents, parents in these NRT families have better relationships with their children, and their children are functioning well.

CONCLUSION

Although several studies show that parents in NRT families are more emotionally involved in their parenting than are parents in naturally conceived families, no empirical evidence was found that the psychological adjustment of children in NRT families differs from that of their counterparts in natural-conception families. PRACTICAL IMPLICATION: The results inform counselors and infertile couples that concerns regarding the use of NRT in relation to negative consequences for the parent-child relationship or the psychological adjustment of the child are till now unfounded.

Sharing information with adults conceived as a result of donor insemination

A growing number of jurisdictions have introduced legislation to give children the right to information about, and identity of, 'their' gamete donor. This has been accompanied by a reduction in the social stigma associated with infertility and building families with the assistance of donated gametes. This changing culture has meant that an increasing number of parents are seeking assistance regarding how to share their family history, including the donor insemination conception story. The literature suggests that the sharing of information is best undertaken when the children are young. There is virtually no literature available for parents who wish to share their family history with adult offspring, or for those professionals whose guidance they may seek. This paper addresses this emerging area of practice. It is suggested that there are three main areas that will be of assistance with any attempt to understand the individual and family dynamics involved: identity and self-image, stigma and power. Strategies and suggestions emerging from each of these areas of knowledge are outlined. This paper aims to generate discussion and to encourage others to share their clinical experiences in this area.

Confidence in the use of donor insemination: an evaluation of the impact of participating in a group preparation programme

This paper argues that infertility can result in a range of negative emotional reactions, including a lack of confidence. This is more marked when donor insemination (DI) is used because of the additional shame this is associated with. Parents who do not feel confident may be less likely to share information about their use of DI with others and their child. Legislation in several countries has been introduced to abolish donor anonymity, but this has does not necessarily have an impact on parental confidence. In order to evaluate whether educational preparation programmes can impact on parental confidence and their intention to share information about DI, the confidence levels of 60 participants of three seminars were examined at three different points in time: before, immediately after and several months after attending the programme. Results indicate that most participants' confidence increased markedly as a result of attending an educational seminar. Furthermore, this increased confidence also impacted positively on the intention to share information about DI with future children. Both remained high several months after having attended the programme. These results point out that group preparation programmes can enhance levels of confidence, both as treatment is begun and as family building is undertaken.

Fear, fascination and the sperm donor as 'abjection' in interviews with heterosexual recipients of donor insemination

The background to this article is the medical regulation of sperm donation in the UK and the recent policy change so that children born from sperm, eggs or embryos donated after April 2005 have the right to know their donor's identity. I draw upon data from interviews with ten women and seven joint interviews with couples who received donor insemination from an anonymous sperm donor and were the parents of donor insemination children. I explore the symbolic presence of the donor and his potential to disrupt social and physical boundaries using the theoretical conceptions of boundaries and pollution as articulated by Mary Douglas and Julia Kristeva. I present data to argue that the anonymous donor manifests in various figures; the shadowy and ambiguous figure of 'another man'; the intelligent medical student; the donor as a family man, with children of his own who wants to help infertile men father children. In addition participants perceive the donor's physical characteristics, but also see their husband's physical characteristics, in their children. In conclusion I argue that anonymisation preserves features of conventional family life, maintains the idea of exclusivity within the heterosexual relationship and affirms the legal father's insecurity about his infertility.

Imagination and integrity: decision-making among lesbian couples to use medically provided donor insemination

This paper reports findings from a pilot study of lesbian parents in the UK who used medicalised donor insemination (DI) with unknown donors. It focuses on decision-making processes in family construction: this includes lesbian parents' experiences with clinicians and their family stories as told to clinicians and to their young children. Findings reveal that parents' understanding of family, particularly the centrality of the lesbian couple as the key parenting relationship, is crucial. We suggest that this group of parents make considered decisions about how their family might be created. It is their perception of what family means and their desire to protect the integrity of their family that leads them to negotiate social questions, particularly in relation to the presence of a 'father' and the familial role/relationship of the non-biological parent. The study calls attention to the process of respondents' reflexivity about family and their 'doing' of family and highlights the integrity and imagination central to becoming lesbian parents.

Thinking ethically about genetic inheritance: liberal rights, communitarianism and the right to privacy for parents of donor insemination children

The issue of genetic inheritance, and particularly the contradictory rights of donors, recipients and donor offspring as to the disclosure of donor identities, is ethically complicated. Donors, donor offspring and parents of donor offspring may appeal to individual rights for confidentiality or disclosure within legal systems based on liberal rights discourse. This paper explores the ethical issues of non-disclosure of genetic inheritance by contrasting two principle models used to articulate the problem--liberal and communitarian ethical models. It argues that whilst the latter provides a more constructive avenue to providing an ethics for donation than the competing and contradictory positions represented in a liberal rights approach, it raises issues of ethical judgement and authority that remain problematic. This ethical discussion is supported by a field study, funded by the Wellcome Trust, exploring the perceptions and experiences of recipients of donor sperm and their partners towards donor anonymity. The field study provides the empirical basis of an argument for making ethical judgements on the grounds of the community good rather than individual rights, that nevertheless recognises that both are inherently problematic.

The (ir)relevance of genetics: engendering parallel worlds of procreation and reproduction

Informing offspring of the nature of their conception when conceived via donated gametes such as donor sperm, is increasingly considered by professionals and policy makers to be desirable for many reasons. The aim of this research is to explore and understand processes within families that either facilitate or hinder the telling of children about their conception. This exploration includes analysing the complexity of sociocultural processes surrounding parents' attempts to make sense of, and construct meanings of 'family'. We analyse the stories of a group of New Zealand parents, representing 41 families, who have formed their families with the assistance of donor insemination. The analysis takes its point of departure from current sociological and anthropological debates in the field of kinship, or family studies. We argue that parents generate a parallel construct whereby genetic inheritance is seen to be simultaneously irrelevant (to the constitution of the family), and yet at the same time relevant (in highly bounded domains, for example related to medically specified conditions). We analyse the ambiguities of interpreting this construct as one reflecting a separation of procreation from the process of reproduction, and reflect on the implications for information-sharing.

Topic avoidance and family functioning in families conceived with donor insemination

BACKGROUND

While a move away from non-disclosure and secrecy toward more openness is demonstrated in the changing practices of donor insemination worldwide, scholars and practitioners continue to debate the effects of disclosure versus secrecy. This study examines if an association exists between adult donor offspring's perceptions of their parents' use of topic avoidance to maintain secrecy, and their perceptions of their family's functioning.

METHODS

Using a cross-sectional design, a convenience sample of 69 young adult donor offspring completed a demographic questionnaire, a topic avoidance scale relative to each of their rearing parents, and the Beavers Self Report Family Instrument.

RESULTS

There was a moderate significant inverse correlation between family functioning and topic avoidance in general, as well as for donor insemination-related topics, for both mothers (r = -0.55, r = -0.40, respectively, P <or= 0.01) and fathers (r = -0.53, r = -0.50, respectively, P <or= 0.01), even after controlling for demographic variables. Disclosure by both parents jointly was associated with higher family functioning than disclosure under other circumstances.

CONCLUSIONS

While this study is limited by the convenience sampling, the correlational design and measuring offspring's subjective perceptions, findings suggest that the information about donor conception should not be held secret from offspring and that the parents should disclose jointly.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Becoming a mother by non-anonymous egg donation: secrecy and the relationship between egg recipient, egg donor and egg donation child

The object of the study was to investigate secrecy in non-anonymous egg donation, to explore some characteristics of this kind of egg donation arrangement and the relationship of the recipient with her non-genetic child. Forty-four egg recipients and 62 IVF patients with a child conceived through egg donation and/or IVF were recruited. A semi-structured questionnaire was sent to all the participants. Chi-square and T-tests were used to examine the differences between the groups. There were no significant differences on the following aspects. The same high proportion of egg donation mothers (77%) and IVF mothers (87%) had the intention of telling their child about the conception but most women thought disclosure at a later time preferable. Two thirds of the recipients and IVF mothers said the way of conception had no influence on the relationship with their child. The two groups differed however in their argumentation about secrecy and named different feelings. Egg donation mothers expressed more denial and showed more defensive reactions, anxieties and uncertainty. It is suggested that recognition of a certain difference between a natural conception and egg donation could be helpful in early disclosure and could help to diminish anxieties in egg donation mothers.

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

OBJECTIVE

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

DESIGN

In-depth ethnographic interviews.

SETTING

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

PATIENT(S)

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

INTERVENTION(S)

Husbands and wives were interviewed together and separately.

MAIN OUTCOME MEASURE(S)

Thematic analysis of interview transcripts.

RESULT(S)

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

CONCLUSION(S)

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

Constructing families and kinship through donor insemination

This paper presents some central findings of an exploratory qualitative study of New Zealand families with children conceived by donor insemination (DI). Drawing on social anthropological and sociological theorising about kinship and contemporary Western families, the paper explores the ways in which parents and their kin actively construct parent-child relationships and kin connections through the notions of biological and social ties, nature and nurture. The paper discusses three major themes emerging from the data: the social construction of the 'natural facts' of procreation, physical resemblance, and the construction of families through choice, not biology. Whilst the primacy of biological or genetic connection is a powerful cultural theme, particularly evident in the ambiguities and uncertainties for social fathers and their kin, these families also deconstruct this notion. Drawing simultaneously on the power of social and biological connection, using biology as a metaphor for social relations, or by privileging social ties and the formation of families through choice, over time these families strategically establish themselves as the sole parents and kin of their children conceived by DI.

Non-genetic and non-gestational parenthood: consequences for parent-child relationships and the psychological well-being of mothers, fathers and children at age 3

BACKGROUND

Findings are presented of the third phase of a longitudinal study of children conceived by assisted reproduction procedures involving surrogacy and/or donor conception.

METHODS

At the time of the child's third birthday, 34 surrogacy families, 41 donor insemination families and 41 oocyte donation families were compared with 67 natural conception families on standardized interview and questionnaire measures of the psychological well-being of the parents, mother-child relationships and the psychological well-being of the child.

RESULTS

The differences found between family types reflected higher levels of warmth and interaction between mothers and their 3-year-old children in assisted reproduction families than in families with a naturally conceived child. A higher proportion of surrogacy parents than donor conception parents had told their children about the nature of their birth.

CONCLUSIONS

It appears that the absence of a genetic and/or gestational link between parents and their child does not have a negative impact on parent-child relationships or the psychological well-being of mothers, fathers or children at age 3.

Helping parents to tell their children about the use of donor insemination (DI) and determining their opinions about open-identity sperm donors

OBJECTIVE

To look at the level of compliance with Swedish law whether or not parents intend to tell their child about donor insemination. We also wanted to look at the parents' attitudes towards open-identity sperm donors and at relationships within the family.

METHOD

All parents who were treated and gave birth to a child through donor insemination from 1997 to 2003 were included in the study. Sixteen of 20 couples (80%) were willing to take part in an interview, where the men and women were interviewed separately. The children of these couples had an average age of 2.9 years.

RESULTS

Three of the 16 couples had told their child about donor insemination and 9 couples intended to tell the child when he/she was older. Thus 12 couples (75%) had disclosed or planned to inform their child in the future. Fourteen of 16 couples had told others about the donor insemination. The majority (21 of 31 individuals) had a positive attitude towards open-identity for sperm donors and 16 of 31 would have chosen an open-identity sperm donor if they had had the choice between that and an anonymous donor. All the parents felt they had an equal relationship with their child.

CONCLUSION

Couples who conceived a child through donor insemination are open about the donor insemination, both to other people in their surroundings and in their intention to tell the child. These families seem to be functioning well with relaxed attitudes towards the donor insemination process.

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.

Is blood really thicker than water? Assisted reproduction and its impact on our thinking about family

The traditional notion that a family is built around and based on blood or genetic ties is challenged when assisted human reproduction utilizing donor gametes is used. A focus on the family--in contrast to the individual--requires from medicine an extension of thinking in which a model that incorporates treating infertility and building a family becomes the norm. Such a model will require that attention is given to the psychological and social needs of the would-be parents, thus enabling them to approach their family building with confidence. This confidence is expected to carry through to their sharing with their offspring the nature of their family building and thus avoid the stigma that leads to secrecy. Research relating to dimensions of family building when donor insemination has been used is reviewed. The impact of professional attitudes, along with the policies adopted by governments concerning access to genetic information for offspring, significantly influences the families built with assistance of donor gametes or embryos. The evolution of professional thinking in this area is reviewed, along with the increasing involvement of governments.

The national lesbian family study: 4. Interviews with the 10-year-old children

This 4th report from a longitudinal study of U.S. lesbian families presents data from 78 families in which the children were conceived by donor insemination. Results indicate that the prevalence of physical and sexual abuse in these children was lower than national norms. In social and psychological development, the children were comparable to children raised in heterosexual families. Children of unknown donors were indistinguishable from those with known donors in psychological adjustment. In total, 57% of the children were completely out to their peers, and 43% had experienced homophobia. The children demonstrated a sophisticated understanding of diversity and tolerance.

Solo mothers and their donor insemination infants: follow-up at age 2 years

BACKGROUND

Findings are presented of the second phase of a longitudinal study of solo-mother families created through donor insemination (DI).

METHODS

At the time of the child's second birthday, 21 solo DI mother families were compared with 46 married DI families on standardized interview and questionnaire measures of the psychological well being of the mothers, mother-child relationships and the psychological development of the child.

RESULTS

The solo DI mothers showed greater pleasure in their child and lower levels of anger accompanied by a perception of their child as less 'clingy'. Fewer emotional and behavioural difficulties were shown by children of solo than married DI mothers.

CONCLUSIONS

The findings from this first cohort of solo DI families to be studied lend further weight to the view that these women represent a distinct subgroup of single parents, who, out of a strong desire for a child, have made the active choice to go it alone. Moreover, this route to parenthood does not necessarily seem to have an adverse effect on mothers' parenting ability or the psychological adjustment of the child.

Families created by gamete donation: follow-up at age 2

BACKGROUND

Findings are presented of the second phase of a longitudinal study of families created through gamete donation.

METHODS

At the time of the child's second birthday, 46 donor insemination families and 48 egg donation families were compared with 68 natural conception families on standardized interview and questionnaire measures of the psychological well being of the parents, parent-child relationships and the psychological development of the child.

RESULTS

The gamete donation mothers showed a trend towards greater pleasure in their child accompanied by a perception of their child as more vulnerable, with egg donation mothers tending towards greater pleasure and donor insemination mothers tending towards greater concern. The fathers did not differ on any of the variables under study.

CONCLUSIONS

The findings from this recent cohort add further weight to the growing body of research showing that the absence of a genetic link between a parent and a child does not necessarily jeopardize the development of a positive relationship between them.

Adolescents with open-identity sperm donors: reports from 12–17 year olds

BACKGROUND

Donor insemination programs can include 'open-identity' sperm donors, who are willing to release their identities to adult offspring. We report findings from adolescent offspring who have open-identity donors.

METHODS

Using mail-back questionnaires, youths from 29 households (41.4% headed by lesbian couples, 37.9% by single women, 20.7% by heterosexual couples) reported their experience growing up knowing how they were conceived and their interest in the donor's identity.

RESULTS

Most youths (75.9%) reported always knowing, and were somewhat to very comfortable with their conception origins. All but one felt knowing had a neutral to positive impact on their relationship with their birth mother and, separately, co-parent. The youths' top question about the donor was, 'What's he like?' and >80% felt at least moderately likely to request his identity and pursue contact. Finally, of those who might contact the donor, 82.8% would do so to learn more about him, with many believing it would help them learn more about themselves. No youth reported wanting money and few (6.9%) wanted a father/child relationship. We also discuss differences found among youths from different household types.

CONCLUSIONS

The majority of the youths felt comfortable with their origins and planned to obtain their donor's identity, although not necessarily at age 18.

Parenting infants conceived by gamete donation

In recent years, concerns have been raised regarding the potentially negative consequences of gamete donation for parent-child relationships. Findings are presented of a study of families with an infant conceived by gamete donation. Fifty donor insemination families and 51 egg donation families were compared with 80 natural conception families on standardized interview and questionnaire measures of the psychological well-being of the parents, the quality of parent-child relationships, and infant temperament. The differences that were identified indicated more positive parent-child relationships among the gamete donation than the natural conception parents, accompanied by greater emotional involvement with the child. Comparisons were also carried out between the donor insemination and the egg donation parents on their experiences of gamete donation. In contrast to the findings of earlier investigations, the donor insemination and egg donation parents appeared to be more open toward disclosing the donor conception to the child. It was concluded that infants conceived by egg or sperm donation did not appear to be at risk for parenting difficulties.

Donor insemination: the secret experiment

This paper gives an overview of the research that has been done into people created by donor insemination (DI) (note 1), shows how the secretive way DI is carried out makes objective knowledge of their situation impossible to obtain and describes how doctors support this secrecy. It argues that DI is a social experiment whose potential justifications are implicit theories that have either been falsified or are unfalsifiable, and that consequently DI is conducted unscientifically and unethically. In conclusion, it questions the integrity of the industry and the institutions that support it, and considers where we should go from here.

Why adoption is not an option in India: the visibility of infertility, the secrecy of donor insemination, and other cultural complexities

Child adoption in the face of reproduction gone awry continues to remain an under researched aspect of contemporary Indian reality. This paper seeks to unpack some of the critical cultural issues underscoring the deep-seated reluctance towards adoption. Drawing on a larger multi-sited research project examining the experience of infertility and assisted conception in India, the paper sheds light on the state of current adoption practices in India. Thus, when faced with infertility, couples in this research emerged as favouring secret gamete donation as a means of bypassing infertility rather than the option of adoption. Invoking the concept of systematic misrecognition, the paper situates the modalities of salvaging infertility, either through medically assisted conception or adoption, as structuring infertile people's quest for children. The paper relates the perceived stigma associated with infertility treatment and adoption with the inclusion of a "third party" that fractures the culturally conceptualized boundaries of family as inextricably tied to the conjugal bond. It is therefore argued that secrecy is born out of a need to obfuscate a "public and visible" violation of a culturally priced ideal that views an intimate connection between the "married body" and the progeny. Adoption continues to remain an undesirable option because the links between an adopted child and the social parent become a public, vocal, and visible admission of infertility that cannot be subsumed, like donated gamete conception, under a conspiracy of silence.

A group-work approach in family building by donor insemination: empowering the marginalized

Family building with donor insemination (DI) is often perceived as stigmatizing and the secrecy surrounding the practice contributes to this perception. In recent years, patient organizations in several countries have started to challenge this stigma and marginalization. This paper reports on a professional group-work approach for couples in Germany using DI. Participants of four seminars with a total of 74 participants and a return rate of 89% were asked to report on their expectations of and experiences during the seminars. Participants were asked to comment on their views and perspectives regarding DI practice. The results indicate a need for more information on DI and for the opportunity to meet other couples in the same situation. Participants also argued for normalization and social acceptance for families built by DI. The group-work approach described in this paper contributes significantly towards fulfilling the needs of couples involved in DI.

Counselling lesbian couples: requests for donor insemination on social grounds

Fertility centres are increasingly involved in dealing with requests from lesbian couples for donor insemination (DI). Data were collected on 95 Belgian lesbian couples who applied for DI. The majority of couples were well integrated in a social environment (family, friends and work) that consisted mainly of heterosexuals. They tended to be open about their homosexuality and most couples considered the social environment to be tolerant towards their homosexual orientation. Couples who considered alternatives to DI would have liked to have had more information on the donor and were more inclined to introduce a 'godfather' who would take special interest in the child. Couples who considered DI to be the best solution considered the absence of a father to be less of a problem for the child and wished to have no information at all as regards the donor. Approximately half the couples considered their family a two-mother unit. For the other couples, the family unit consisted of a mother and her partner who shared parental responsibility for the child equally. The issues that are considered important to cope with and on which lesbian couples should be counselled are presented in the discussion.

What does it mean for youngsters to grow up in a lesbian family created by means of donor insemination?

In many countries fertility services still refuse to inseminate lesbian couples because they believe the child's welfare would be at stake. One of their concerns is that these children will be stigmatized because of their non-traditional family structure. In this follow-up study, we interviewed children from lesbian donor insemination (DI) families about how they present their 'non-traditional' family to people in their immediate social environment. We also explored whether or not children were teased or harassed about their lesbian family and whether or not coping with a non-traditional family constellation was reflected in their psychological well-being. According to this study, almost all children from lesbian DI families share the fact that they live in a two-mother unit spontaneously with close friends who react positively. Others are only informed about the non-traditional family structure when they ask questions about it. From the children's answers, we can conclude that for some peers it is hard to understand that someone can have two mothers without having a father somewhere. Compared with children from heterosexual families, these DI children are not more likely to be teased but they are more prone to family-related teasing incidents. However, introducing their non-traditional family into their peer group does not seem to interfere with their psychological well-being. Nonetheless, teachers indicate that children from lesbian families experience more attention problems compared with children from heterosexual households.