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New realities for the practice of egg donation: a family-building perspective

  • Lauri A. Pasch
    Correspondence
    Reprint requests: Lauri A. Pasch, Ph.D., UCSF Center for Reproductive Health, 499 Illinois St., 6th floor, San Francisco, CA 94158.
    Affiliations
    Departments of Psychiatry and Obstetrics, Gynecology, and Reproductive Science, University of California, San Francisco, California
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      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.

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      References

        • Kushnir V.A.
        • Darmon S.K.
        • Shapiro A.J.
        • Albertini D.F.
        • Barad D.H.
        • Gleicher N.
        Utilization of third-party in vitro fertilization in the United States.
        Am J Obstet Gynecol. 2017; 216: 266.e1-266.e10
        • Sauer M.V.
        Revisiting the early days of oocyte and embryo donation: relevance to contemporary clinical practice.
        Fertil Steril. 2018; 110: 981-987
        • Daniels K.R.
        • Lewis G.M.
        • Gillett W.
        Telling donor insemination offspring about their conception: the nature of couples’ decision-making.
        Soc Sci Med. 1995; 40: 1213-1220
        • Nachtigall R.D.
        • Becker G.
        • Quiroga S.S.
        • Tschann J.M.
        The disclosure decision: concerns and issues of parents of children conceived through donor insemination.
        Am J Obstet Gynecol. 1998; 178: 1165-1170
        • Mahlstedt P.P.
        • Greenfeld D.A.
        Assisted reproductive technology with donor gametes: the need for patient preparation.
        Fertil Steril. 1989; 52: 908-914
        • McWhinnie A.
        Gamete donation and anonymity: should offspring from donated gametes continue to be denied knowledge of their origins and antecedents?.
        Hum Reprod. 2001; 16: 807-817
        • Hershberger P.
        • Klock S.C.
        • Barnes R.B.
        Disclosure decisions among pregnant women who received donor oocytes: a phenomenological study.
        Fertil Steril. 2007; 87: 288-296
        • Shehab D.
        • Duff J.
        • Pasch L.A.
        • Mac Dougall K.
        • Scheib J.E.
        • Nachtigall R.D.
        How parents whose children have been conceived with donor gametes make their disclosure decision: contexts, influences, and couple dynamics.
        Fertil Steril. 2008; 89: 179-187
        • Imrie S.
        • Golombok S.
        Long-term outcomes of children conceived through egg donation and their parents: a review of the literature.
        Fertil Steril. 2018; 110: 1187-1193
        • Jadva V.
        • Freeman T.
        • Kramer W.
        • Golombok S.
        The experiences of adolescents and adults conceived by sperm donation: comparisons by age of disclosure and family type.
        Hum Reprod. 2009; 24: 1909-1919
        • Turner A.J.
        • Coyle A.
        Secrecy and openness in donor offspring.
        Hum Reprod. 2001; 16: 2245-2246
        • Scheib J.E.
        • Riordan M.
        • Rubin S.
        Adolescents with open-identity sperm donors: reports from 12–17 year olds.
        Hum Reprod. 2005; 20: 239-252
        • Beeson D.R.
        • Jennings P.K.
        • Kramer W.
        Offspring searching for their sperm donors: how family type shapes the process.
        Hum Reprod. 2011; 26: 2415-2424
        • Bos H.M.
        • Gartrell N.K.
        Adolescents of the US National Longitudinal Lesbian Family Study: the impact of having a known or an unknown donor on the stability of psychological adjustment.
        Hum Reprod. 2011; 26: 630-637
        • Zadeh S.
        • Ilioi E.C.
        • Jadva V.
        • Golombok S.
        The perspectives of adolescents conceived using surrogacy, egg or sperm donation.
        Hum Reprod. 2018; 33: 1099-1106
        • Daniels K.R.
        • Grace V.M.
        • Gillett W.R.
        Factors associated with parents’ decisions to tell their adult offspring about the offspring’s donor conception.
        Hum Reprod. 2011; 26: 2783-2790
        • Blyth E.
        • Crawshaw M.
        • Frith L.
        • Jones C.
        Donor-conceived people’s views and experiences of their genetic origins: a critical analysis of the research evidence.
        J Law Med. 2012; 19: 769-789
        • Mac Dougall K.
        • Becker G.
        • Scheib J.E.
        • Nachtigall R.D.
        Strategies for disclosure: how parents approach telling their children that they were conceived with donor gametes.
        Fertil Steril. 2007; 87: 524-533
        • Lycett E.
        • Daniels K.
        • Curson R.
        • Golombok S.
        School-aged children of donor insemination: a study of parents’ disclosure patterns.
        Hum Reprod. 2005; 20: 810-819
        • Golombok S.
        Disclosure and donor-conceived children.
        Hum Reprod. 2017; 32: 1532-1536
        • Golombok S.
        Parenting in new family forms.
        Curr Opin Psychol. 2017; 15: 76-80
        • Ilioi E.
        • Blake L.
        • Jadva V.
        • Roman G.
        • Golombok S.
        The role of age of disclosure of biological origins in the psychological wellbeing of adolescents conceived by reproductive donation: a longitudinal study from age 1 to age 14.
        J Child Psychol Psychiatry. 2017; 58: 315-324
        • Isaksson S.
        • Skoog Svanberg A.
        • Sydsjö G.
        • Thurin-Kjellberg A.
        • Karlström P.-O.
        • Solensten N.-G.
        • et al.
        Two decades after legislation on identifiable donors in Sweden: are recipient couples ready to be open about using gamete donation?.
        Hum Reprod. 2011; 26: 853-860
        • Ethics Committee of the American Society for Reproductive Medicine
        Informing offspring of their conception by gamete donation.
        Fertil Steril. 2004; 81: 527-531
        • Ethics Committee of the American Society for Reproductive Medicine
        Informing offspring of their conception by gamete or embryo donation: an Ethics Committee opinion.
        Fertil Steril. 2018; 109: 601-605
        • Pasch L.A.
        • Benward J.
        • Scheib J.E.
        • Woodward J.T.
        Donor-conceived children: the view ahead.
        Hum Reprod. 2017; 32: 1534
        • McGovern P.G.
        • Schlaff W.D.
        Sperm donor anonymity: a concept rendered obsolete by modern technology.
        Fertil Steril. 2018; 109: 230-231
        • Harper J.C.
        • Kennett D.
        • Reisel D.
        The end of donor anonymity: how genetic testing is likely to drive anonymous gamete donation out of business.
        Hum Reprod. 2016; 31: 1135-1140
        • Borry P.
        • Rusu O.
        • Dondorp W.
        • de Wert G.
        • Knoppers B.M.
        • Howard H.C.
        Anonymity 2.0: direct-to-consumer genetic testing and donor conception.
        Fertil Steril. 2014; 101: 630-632
        • Daniels K.
        • Kramer W.
        Genetic and health issues emerging from sperm donation—the experiences and views of donors.
        Adv Reprod Sci. 2013; 1: 15-20
        • Woodward J.T.
        Third-party reproduction in the internet age: the new, patient-centered landscape.
        Fertil Steril. 2015; 104: 525-530
        • Klotz M.
        Wayward relations: novel searches of the donor-conceived for genetic kinship.
        Med Anthropol. 2016; 35: 45-57
        • Crawshaw M.
        Direct-to-consumer DNA testing: the fallout for individuals and their families unexpectedly learning of their donor conception origins.
        Hum Fertil (Camb). 2017; : 1-4
        • Blyth E.
        • Kramer W.
        • Schneider J.
        Perspectives, experiences, and choices of parents of children conceived following oocyte donation.
        Reprod Biomed Online. 2013; 26: 179-188
        • Scheib J.E.
        • Ruby A.
        • Benward J.
        Who requests their sperm donor’s identity? The first ten years of information releases to adults with open-identity donors.
        Fertil Steril. 2017; 107: 483-493
        • Schrijvers A.
        • Bos H.
        • van Rooij F.
        • Gerrits T.
        • van der Veen F.
        • Mochtar M.
        • et al.
        Being a donor-child: wishes for parental support, peer support and counseling.
        J Psychosom Obstet Gynaecol. 2017; : 1-9
        • Nelson M.K.
        • Hertz R.
        • Kramer W.
        Gamete donor anonymity and limits on numbers of offspring: the views of three stakeholders.
        J Law Biosci. 2016; 3: 39-67
        • Freeman T.
        Gamete donation, information sharing and the best interests of the child: an overview of the psychosocial evidence.
        Monash Bioeth Rev. 2015; 33: 45-63
        • Ravitsky V.
        Autonomous choice and the right to know one’s genetic origins.
        Hastings Cent Rep. 2014; 44: 36-37
        • Mahlstedt P.P.
        • LaBounty K.
        • Kennedy W.T.
        The views of adult offspring of sperm donation: essential feedback for the development of ethical guidelines within the practice of assisted reproductive technology in the United States.
        Fertil Steril. 2010; 93: 2236-2246
        • Jadva V.
        • Freeman T.
        • Kramer W.
        • Golombok S.
        Sperm and oocyte donors’ experiences of anonymous donation and subsequent contact with their donor offspring.
        Hum Reprod. 2011; 26: 638-645
        • van den Akker O.B.
        • Crawshaw M.A.
        • Blyth E.D.
        • Frith L.J.
        Expectations and experiences of gamete donors and donor-conceived adults searching for genetic relatives using DNA linking through a voluntary register.
        Hum Reprod. 2015; 30: 111-121
        • Hertz R.
        • Nelson M.K.
        • Kramer W.
        Donor sibling networks as a vehicle for expanding kinship: a replication and extension.
        J Fam Issues. 2017; 38: 248-284
        • Scheib J.E.
        • Ruby A.
        Contact among families who share the same sperm donor.
        Fertil Steril. 2008; 90: 33-43
        • Daniels K.R.
        • Kramer W.
        • Perez-y-Perez M.V.
        Semen donors who are open to contact with their offspring: issues and implications for them and their families.
        Reprod Biomed Online. 2012; 25: 670-677
        • Bracewell-Milnes T.
        • Saso S.
        • Bora S.
        • Ismail A.M.
        • Al-Memar M.
        • Hamed A.H.
        • et al.
        Investigating psychosocial attitudes, motivations and experiences of oocyte donors, recipients and egg sharers: a systematic review.
        Hum Reprod Update. 2016; 22: 450-465
        • Lampic C.
        • Skoog Svanberg A.
        • Sydsjo G.
        Attitudes toward disclosure and relationship to donor offspring among a national cohort of identity-release oocyte and sperm donors.
        Hum Reprod. 2014; 29: 1978-1986
        • Klock S.C.
        • Stout J.E.
        • Davidson M.
        Psychological characteristics and factors related to willingness to donate again among anonymous oocyte donors.
        Fertil Steril. 2003; 79: 1312-1316
        • Purewal S.
        • van den Akker O.B.
        Systematic review of oocyte donation: investigating attitudes, motivations and experiences.
        Hum Reprod Update. 2009; 15: 499-515
        • Isaksson S.
        • Sydsjo G.
        • Skoog Svanberg A.
        • Lampic C.
        Preferences and needs regarding future contact with donation offspring among identity-release gamete donors: results from the Swedish Study on Gamete Donation.
        Fertil Steril. 2014; 102: 1160-1166
        • Blyth E.
        • Crawshaw M.
        • Frith L.
        • van den Akker O.
        Gamete donors’ reasons for, and expectations and experiences of, registration with a voluntary donor linking register.
        Hum Fertil (Camb). 2017; 20: 268-278
        • Kirkman M.
        • Bourne K.
        • Fisher J.
        • Johnson L.
        • Hammarberg K.
        Gamete donors’ expectations and experiences of contact with their donor offspring.
        Hum Reprod. 2014; 29: 731-738
        • Daniels K.
        Anonymity and openness and the recruitment of gamete donors. Part 2: oocyte donors.
        Hum Fertil. 2007; 10: 223-231
      1. Human Fertilisation and Embryology Authority (HFEA). Facts and figures: number of sperm and egg donors, 2012–2013. https://ifqtesting.blob.core.windows.net/umbraco-website/1783/fertility-treatment-2014-trends-and-figures.pdf.

        • Frith L.
        • Blyth E.
        • Farrand A.
        UK gamete donors’ reflections on the removal of anonymity: implications for recruitment.
        Hum Reprod. 2007; 22: 1675-1680
        • Braverman A.M.
        • Corson S.L.
        A comparison of oocyte donors’ and gestational carriers/surrogates’ attitudes toward third party reproduction.
        J Assist Reprod Genet. 2002; 19: 462-469
        • Scheib J.E.
        • Cushing R.A.
        Open-identity donor insemination in the United States: is it on the rise?.
        Fertil Steril. 2007; 88: 231-232
        • Daniels K.R.
        • Thorn P.
        Sharing information with donor insemination offspring. A child-conception versus a family-building approach.
        Hum Reprod. 2001; 16: 1792-1796
        • Daniels K.R.
        Toward a family-building approach to donor insemination.
        J Obstet Gynaecol Can. 2002; 24: 17-21
        • Readings J.
        • Blake L.
        • Casey P.
        • Jadva V.
        • Golombok S.
        Secrecy, disclosure and everything in-between: decisions of parents of children conceived by donor insemination, egg donation and surrogacy.
        Reprod Biomed Online. 2011; 22: 485-495
        • Daniels K.
        The semen providers.
        in: Daniels K. Haimes E. Donor insemination: international social science perspectives. Cambridge University Press, Cambridge, United Kingdom1998: 76-104
        • Cattapan A.R.
        Good eggs? Evaluating consent forms for egg donation.
        J Med Ethics. 2016; : 455-459
        • Ethics Committee of the American Society for Reproductive Medicine
        Interests, obligations, and rights in gamete donation: a committee opinion.
        Fertil Steril. 2014; 102: 675-681
        • Zweifel J.E.
        Donor conception from the viewpoint of the child: positives, negatives, and promoting the welfare of the child.
        Fertil Steril. 2015; 104: 513-519
        • Braverman A.M.
        Mental health counseling in third-party reproduction in the United States: evaluation, psychoeducation, or ethical gatekeeping?.
        Fertil Steril. 2015; 104: 501-506
        • Benward J.
        Mandatory counseling for gamete donation recipients: ethical dilemmas.
        Fertil Steril. 2015; 104: 507-512
      2. Crawshaw M, Daniels K. Revisiting the use of “counselling” as a means of preparing prospective parents to meet the emerging psychosocial needs of families that have used gamete donation. Fam Relatsh Soc. In press.

        • Hammarberg K.
        • Carmichael M.
        • Tinney L.
        • Mulder A.
        Gamete donors’ and recipients’ evaluation of donor counselling: a prospective longitudinal cohort study.
        Aust N Z J Obstet Gynaecol. 2008; 48: 601-606
        • Visser M.
        • Kop P.A.
        • van Wely M.
        • van der Veen F.
        • Gerrits G.J.
        • van Zwieten M.C.
        Counselling on disclosure of gamete donation to donor offspring:a search for facts.
        Facts Views Vis Obgyn. 2012; 4: 159-172
        • Indekeu A.
        • Dierickx K.
        • Schotsmans P.
        • Daniels K.R.
        • Rober P.
        • D’Hooghe T.
        Factors contributing to parental decision-making in disclosing donor conception: a systematic review.
        Hum Reprod Update. 2013; 19: 714-733
        • Soderstrom-Anttila V.
        • Salevaara M.
        • Suikkari A.M.
        Increasing openness in oocyte donation families regarding disclosure over 15 years.
        Hum Reprod. 2010; 25: 2535-2542
        • Visser M.
        • Gerrits T.
        • Kop F.
        • van der Veen F.
        • Mochtar M.
        Exploring parents’ feelings about counseling in donor sperm treatment.
        J Psychosom Obstet Gynaecol. 2016; 37: 156-163
        • de Lacey S.L.
        • Peterson K.
        • McMillan J.
        Child interests in assisted reproductive technology: how is the welfare principle applied in practice?.
        Hum Reprod. 2015; 30: 616-624
        • Foa E.B.
        • Kozak M.J.
        Emotional processing of fear: exposure to corrective information.
        Psychol Bull. 1986; 99: 20-35
        • Daniels K.
        • Thorn P.
        • Westerbrooke R.
        Confidence in the use of donor insemination: an evaluation of the impact of participating in a group preparation programme.
        Hum Fertil (Camb). 2007; 10: 13-20
        • Benward J.M.
        Helping families talk about assisted reproduction.
        in: Covington S.N. Fertility counseling: clinical guide and case studies. Cambridge University Press, New York2015: 252
        • Machin L.
        A hierarchy of needs? Embryo donation, in vitro fertilisation and the provision of infertility counselling.
        Patient Educ Couns. 2011; 85: 264-268
        • Tallandini M.A.
        • Zanchettin L.
        • Gronchi G.
        • Morsan V.
        Parental disclosure of assisted reproductive technology (ART) conception to their children: a systematic and meta-analytic review.
        Hum Reprod. 2016; 31: 1275-1287
        • Applegarth L.D.
        • Kaufman N.L.
        • Josephs-Sohan M.
        • Christos P.J.
        • Rosenwaks Z.
        Parental disclosure to offspring created with oocyte donation: intentions versus reality.
        Hum Reprod. 2016; 31: 1809-1815
        • Hahn S.J.
        • Craft-Rosenberg M.
        The disclosure decisions of parents who conceive children using donor eggs.
        J Obstet Gynecol Neonatal Nurs. 2002; 31: 283-293
        • Hargreaves K.
        • Daniels K.
        Parents dilemmas in sharing donor insemination conception stories with their children.
        Child Soc. 2007; 21: 420-431
        • Crawshaw M.
        • Montuschi O.
        It “did what it said on the tin”—participant’s views of the content and process of donor conception parenthood preparation workshops.
        Hum Fertil (Camb). 2014; 17: 11-20
        • Sälevaara M.
        • Suikkari A.-M.
        • Söderström-Anttila V.
        Attitudes and disclosure decisions of Finnish parents with children conceived using donor sperm.
        Hum Reprod. 2013; 28: 2746-2754
        • van Berkel D.
        • Candido A.
        • Pijffers W.
        Becoming a mother by nonanonymous egg donation: secrecy and the relationship between egg recipient, egg donor and egg donation child.
        J Psychosom Obstet Gynecol. 2007; 28: 97-104
        • Hunter M.
        • Salter-Ling N.
        • Glover L.
        Donor insemination: telling children about their origins.
        Child Psychol Psychiatry Rev. 2000; 5: 157-163
        • Zadeh S.
        Disclosure of donor conception in the era of nonanonymity: safeguarding and promoting the interests of donor-conceived individuals?.
        Hum Reprod. 2016; 31: 2416-2420
        • Rueter M.
        • Connor J.
        • Pasch L.
        • Anderson K.
        • Scheib J.
        • Koerner A.
        • et al.
        Sharing information with children conceived using in vitro fertilisation: the effect of parents’ privacy orientation.
        J Reprod Infant Psychol. 2016; 34: 90-102
        • Johnson L.
        • Bourne K.
        • Hammarberg K.
        Donor conception legislation in Victoria, Australia: the “Time to Tell” campaign, donor-linking and implications for clinical practice.
        J Law Med. 2012; 19: 803-819
        • Kalfoglou A.L.
        • Gittelsohn J.
        A qualitative follow-up study of women’s experiences with oocyte donation.
        Hum Reprod. 2000; 15: 798-805
        • Svanberg A.S.
        • Lampic C.
        • Gejerwall A.L.
        • Gudmundsson J.
        • Karlström P.O.
        • Solensten N.G.
        • et al.
        Gamete donors’ satisfaction; gender differences and similarities among oocyte and sperm donors in a national sample.
        Acta Obstet Gynecol Scand. 2013; 92: 1049-1056
        • Kenney N.J.
        • McGowan M.L.
        Looking back: egg donors’ retrospective evaluations of their motivations, expectations, and experiences during their first donation cycle.
        Fertil Steril. 2010; 93: 455-466
        • Skillern A.A.
        • Cedars M.I.
        • Huddleston H.G.
        Oocyte donors’ comprehension as assessed by the EDICT (Egg Donor Informed Consent Tool).
        Fertil Steril. 2014; 101: 248-251
        • Crawshaw M.
        • Daniels K.
        • Adams D.
        • Bourne K.
        • van Hooff J.A.P.
        • Kramer W.
        • et al.
        Emerging models for facilitating contact between people genetically related through donor conception: a preliminary analysis and discussion.
        Reprod Biomed Soc Online. 2015; 1: 71-80
        • Elster N.R.
        • Braverman A.
        The future is now: a voluntary gamete donor registry is feasible.
        DePaul J Health Care Law. 2009; 12: 195
        • Kelly F.J.
        • Dempsey D.J.
        Experiences and motives of australian single mothers by choice who make early contact with their child’s donor relatives.
        Med Law Rev. 2016; 24: 571-590
        • Cushing A.L.
        “I just want more information about who I am”: the search experience of sperm-donor offspring, searching for information about their donors and genetic heritage.
        Inf Res. 2010; 15: 1
        • Freeman T.
        • Bourne K.
        • Jadva V.
        • Smith S.
        Making connections: contact between sperm donor relations.
        in: Freeman F. Graham S. Ebtejah F. Richards M. Relatedness in assisted reproduction. Cambridge University Press, Cambridge, United Kingdom2014: 270-295
        • Crawshaw M.
        • Frith L.
        • van den Akker O.
        • Blyth E.
        Voluntary DNA-based information exchange and contact services following donor conception: an analysis of service users’ needs.
        New Genet Soc. 2016; 35: 372-392
        • Pasch L.A.
        • Holley S.R.
        • Bleil M.E.
        • Shehab D.
        • Katz P.P.
        • Adler N.E.
        Addressing the needs of fertility treatment patients and their partners: are they informed of and do they receive mental health services?.
        Fertil Steril. 2016; 106: 209-215.e2
        • Scheib J.E.
        • Ruby A.
        Beyond consanguinity risk: developing donor birth limits that consider psychosocial risk factors.
        Fertil Steril. 2009; 91 (author reply e3): e12
        • Goldberg A.E.
        • Scheib J.E.
        Female-partnered and single women’s contact motivations and experiences with donor-linked families.
        Hum Reprod. 2015; 30: 1375-1385
        • Storgaard M.
        • Loft A.
        • Bergh C.
        • Wennerholm U.B.
        • Soderstrom-Anttila V.
        • Romundstad L.B.
        • et al.
        Obstetric and neonatal complications in pregnancies conceived after oocyte donation: a systematic review and meta-analysis.
        BJOG. 2017; 124: 561-572
        • Greenfeld D.A.
        The impact of disclosure on donor gamete participants: donors, intended parents and offspring.
        Curr Opin Obstet Gynecol. 2008; 20: 265-268
        • Gupta S.
        • Fox N.S.
        • Rebarber A.
        • Saltzman D.H.
        • Klauser C.K.
        • Roman A.S.
        Biochemical screening for aneuploidy in patients with donor oocyte pregnancies compared with autologous pregnancies.
        J Matern Fetal Neonatal Med. 2014; 27: 1418-1421
        • Sanschagrin M.L.
        • Humber E.B.
        • Speirs C.C.
        • Duder S.
        A survey of Quebec pediatricians’ attitudes toward donor insemination.
        Clin Pediatr (Phila). 1993; 32: 226-230
        • Jones V.F.
        • Schulte E.E.
        The pediatrician’s role in supporting adoptive families.
        Pediatrics. 2012; 130: 1040-1049