Anonymous Donors Research Articles

Sperm donor relations among adult offspring conceived via insemination by lesbian parents

ABSTRACT Aim The present study examined how adult offspring of lesbian parents relate to their anonymous, open-identity, or known donors. Design An online survey of 75 donor-conceived offspring of lesbian parents, aged 30–33 years, participating in Wave 7 of a U.S. 36-year longitudinal study of planned lesbian-parent families was conducted. Offspring were asked about donor type, motivations for contacting the donor, terminology for the donor, relationship quality, means of relationship maintenance, impact of donor contact on offspring’s other family members, and their feelings about the donor. Results Twenty offspring with anonymous donors and 15 with open-identity donors whom they had not contacted felt comfortable not knowing their donors. Forty offspring knew their donors – anonymous, contacted through an online registry (n = 7), open-identity, contacted (n = 9), or known since childhood (n = 24). Offspring who had contacted their donor since age 18 had their motivations fulfilled after contact, got along well with him, did not view him as a relative, and had told most family members about their contact, without detriment. Whether the donor was unknown or known at this stage of their lives, most offspring were satisfied with their contact level. Conclusion This cohort of donor-conceived offspring of lesbian parents was among the first to reach adulthood during a time of technological advances in DNA testing, giving access to anonymous donors via online registries. The results inform donors, families, mental health providers, medical providers and public policymakers, on whether, how, and to what degree donor-conceived offspring optimally make donor contact.

P-579 Preliminary data on family relations in anonymous oocyte donation families: children’s perspectives at age 5 to 7 years

Abstract Study question Do children born in oocyte donation families perceive their relationships with their parents differently than children conceived trough ICSI? Summary answer No significant differences were found in the family relationships between children born in oocyte donation families (OACC) compared with controls (ICSI). What is known already Majority of the previous research concerning relationships in families using oocyte donation focused on the mothers’ perspective. Little is known about how children in these families view their family relationships. Studies investigating young children’s perspectives in donor-families (5-10 years old) indicate good parent-child relationships (Imrie, et al., 2021; Blake, et al., 2013; Casey, et al., 2013). Few of these studies involve young children conceived using anonymous oocyte donation. Study design, size, duration This study included 17 children born through anonymous oocyte donation in heterosexual parents and a comparison group of 13 children conceived ICSI using the heterosexual parents’ own gametes. Data were collected between August 2021 and January 2023. The sample is part of a larger ongoing case-control-study investigating family relationships and the wellbeing of both parents and their children in families created by anonymous oocyte donation. Participants/materials, setting, methods Children were 5 to 7 years old (M = 6.13; SD = 0.5) and had been born after assisted reproduction (ICSI with or without using anonymous oocytes) with their two heterosexual parents. All children were invited to the hospital to undergo biomedical and psychological testing, including the Family Relationship Test (FRT; English version: Bene and Anthony, 1985; Dutch version: Baarda and van Londen, 1985). Multiple blind evaluators were used. Main results and the role of chance No significant differences were found between children born in oocyte donation families (OACC) compared with controls (ICSI). Two-sampled-T-tests show no significant differences for (1) positive feelings (towards and received by children) to their mothers (OACC: M = 6.65, SD = 4; ICSI:M=8.85, SD = 4), fathers (OACC: M = 5.06, SD = 0; ICSI: M = 5.08, SD = 0) or themselves (OACC: M = 0.35, SD = 0.5; ICSI: M = 0.77, SD = 0), (2) negative feelings (towards and received by children) to their mothers (OACC: M = 1.47, SD = 0.5; ICSI: M = 1.92, SD = 4), fathers (OACC: M = 2.06, SD = 0; ICSI: M = 2.31, SD = 0.5) or themselves (OACC: M = 0.76, SD = 0; ICSI: M = 0.38, SD = 0) and (3) dependency to their mothers (OACC: M = 4.29, SD = 3; ICSI: M = 4.54, SD = 0), fathers (OACC: M = 2.82, SD = 1; ICSI: M = 2.69, SD = 2) or themselves (OACC: M = 0.53, SD = 0.5; ICSI: M = 0.85, SD = 0.5). Limitations, reasons for caution This study used multiple evaluators, which may induce a potential evaluators bias. The small sample size limits the validity of our findings to a whole population. As the study is still ongoing, the data to be presented will expand. Wider implications of the findings The findings are relevant to clinics offering anonymous oocyte donation, to (future) parents who used or who considerate using anonymous oocyte donation to create a family. Trial registration number not applicable

P-434 Anonymous sperm recipients in Spain. What are their perspectives?

Abstract Study question What are the perspectives regarding sperm donor anonymity among Spanish recipients? Summary answer 56.6% of the patients who undergo treatment with donated sperm in a Spanish population would like to choose between the type of anonymity. What is known already Spain is one of the few European countries that still maintains the donor anonymity. Spain is the main gamete provider for all European countries. Among other reasons (cross border legislation, donor limitations in other countries, etc.), the Spanish Society of Fertility defend that the anonymity of their donors is the main reason for such high demand from other countries, as well as within the Spanish patients. However, information regarding patient preference and intention to disclose is scarce and contradictory. Study design, size, duration A prospective study performed at the only public hospital with own sperm bank within a large territory in Spain. From September 2021 to October 2022. A questionnaire was provided to all women who required sperm donor. A total of 106 women responded the questionnaire. Participants/materials, setting, methods The questionnaire included socio-demographic characteristics, as well as their perspectives towards donor anonymity, donor selection, intention to disclose towards the child and opinion on the support received by professionals and relatives/inner circle. Data were analysed using IBM SPSS Statistic programme (V26). P < 0.05 was considered significant. Main results and the role of chance A total of 46/106 (43.4%) patients were intended solo mothers, 50.9% (54/106) had a female partner and 5.7% (6/106) had a male partner. Mean age was 35.9, 34.3 and 28.8, respectively. There was no statistical difference between level of education among groups. Only 34.9% of the patients live in Barcelona city, whereas 65% have to travel a mean of 1.15 hours to reach the Hospital. Overall, 56.6% of the patients would like to choose between the type of anonymity. Among them, 58.7% are solo mothers, 57.4% female couples and 33.3% heterosexual couples. A total of 76.4% of the patients would like to choose their donor. More than half (61.3%) do not wish to have any relationship with the donor. The rest of them would only want contact if the child asked for it or in the case of a genetic disease. Most patients (96.2%) have intention to disclose the genetic origin of their child, and more than half (58.5%) intend to do so during the age of 0 to 5 years old. Fifty patients (47.2%) feel a lack of support during the process and only 6.6% perceive a negative impact on their reproductive project from the Covid-19 pandemic. Limitations, reasons for caution The main limitation is that the study is from a single, public centre and that the questionnaire was self-administered. Also, the questionnaire was limited to women patients, excluding the perspective of donors, men, children and other relatives. Wider implications of the findings The ethical, psychological and economical aspects of requiring gamete donation have an important impact on our societies. Some claim that the era of donor anonymity has reached an end, because of direct to consumer DNA testing. Others believe that anonymity protects donors and allows recipients to fulfil their reproductive project. Trial registration number Not applicable

P-446 Sperm Donors’ Identity Disclosure: Is It REALLY Crucial? For Whom?

Abstract Study question What is the actual preference of sperm donors with identity disclosure vs. anonymous donors among recipient patients? Does this selection affect clinical outcomes? Summary answer Identity disclosure donation is important for certain sections, while almost half of the patients used anonymous donation. An Identity disclosure-only policy should be considered carefully. What is known already A major shift over the last decades focuses on sperm donation identity disclosure. Opposed to historic anonymity, related to heterosexual parents’ tendency to avoid conception disclosure to their children, the growing proportion of single women and same-sex lesbian couples has raised this issue to high priority. Recipients’ perceptions of anonymity vs. identity disclosure are influenced by family structure. Study design, size, duration Israeli regulations permit two sets of sperm donation - local and imported. Israeli sperm donors is anonymous only, while imported sperm donors may be anonymous donors or identity disclosure. This retrospective study included only patients who chose imported sperm donors during 2017-2021. Participants/materials, setting, methods This retrospective study included patients who chose imported sperm donation during 2017-2021. 526 and 43 patients who used autologous eggs and egg donation, respectively. The primary endpoint was the type of chosen donor – ID vs. AD. We examined the tendency towards identity disclosure according to demographic parameters and the theoretical impact of donor type selection on reproductive outcome and compared patients who performed autologous treatments vs. egg donation. Main results and the role of chance Among patients who used autologous eggs, 385 (73.2%) were single (368 never married and 17 divorced) while 57 (10.8%) and 84 (16%) had same-sex and heterosexual relationships, respectively. 270 (51.3%) patients chose ID compared to 256 (48.7%) who selected AD. Single women had a significantly higher probability to choose ID compared to heterosexual couples (55.6% vs. 33.3%, OR 2.5, 95 CI 1.52-4.11, p < 0.001). Same-sex couples were also more likely to choose ID (49.1%) compared to heterosexual couples with a statistical trend (OR 1.93, CI 95% 0.97-3.85, p = 0.06). 2501 vials were imported, 698 IUI and 812 IVF cycles were performed, respectively, resulting in 283 pregnancies without differences between patients who chose ID vs. AD. To assess donor type selection stability over time we explored 105 patients' selection who changed their donor. 81.9% of patients preserved their initial preference (46 and 40 who chose ID and AD, respectively, p > 0.05). ID selection among ED patients was 44.2% compared to 51.3% among autologous patients without reaching statistical significance. Limitations, reasons for caution Religious and cultural aspects, which differ from societies and countries, contribute to patients’ perspectives and preferences. Implementation of current findings to other societies may be challenging. Research retrospective design may be attributed as an additional limitation. Wider implications of the findings An Identity disclosure only policy may result in a global sperm donations shortage which will impact a substantial fraction of recipients who do not select or seek contact with ID. A double path policy, seems like an optimal and preferable solution in this era. Trial registration number not applicable

P-386 The impact of cross-border surrogacy practices on the welfare of children

Abstract Study question What are the clinical characteristics and medical outcomes of cross-border surrogacy (CBS) arrangements? Summary answer CBS practices commonly involve anonymously donated oocytes and multiple embryo transfers which can adversely impact the psychological and physical welfare of the children born. What is known already Intended parents may seek CBS when surrogacy in their home country is prohibited or when access is restricted to heterosexual couples, or when they cannot find a surrogate in their home country. Standards of clinical care can differ between the parents' home country and the CBS destination. Surrogacy is generally unregulated in CBS destinations, making it difficult to monitor clinical practices and the outcomes for the children born. In Australia, where this study is set, anonymous gamete donation and multiple embryo transfers for patients engaged in surrogacy is prohibited. The rate of twin surrogacy deliveries is 2.2%. Study design, size, duration This cross-sectional study collected data through an online, anonymous survey open between April and November 2021. Participants/materials, setting, methods A survey with predominantly fixed-choice questions was developed and informed by the authors’ prior research, the literature, and one author’s experience of surrogacy and surrogacy advocacy. Questions were refined through an iterative process involving consultation with parents through surrogacy. Australian parents through surrogacy were eligible to participate and the study was advertised to personal contacts, members of a surrogacy non-profit organisation and members of a surrogacy related Facebook group. Data were analysed descriptively. Main results and the role of chance One hundred and eight Australian parents through CBS completed the survey. Surrogacy was undertaken in twelve destinations, with approximately half of respondents completing surrogacy in the United States of America (34%, n = 37) or Canada (17%, n = 18). Almost all respondents reported the pregnancy was a result of an embryo transfer (92%, n = 98) and not artificial insemination (8%, n = 10). Of those reporting embryo transfer, 41% reported the transfer of multiple embryos (n = 40) and 79% reported the use of donor oocytes (n = 77). Of the respondents that used donor oocytes, almost half were from an anonymous donor (47%, n = 36) and all but one noted their intent to disclose the use of donor oocytes to their child (97%, n = 76). Pregnancy or birth complications were reported by 29% of respondents (n = 31). There were 12 twin births (11%), 22 preterm births (20%) and 24 births requiring neonatal intensive care (22%). The median time spent in the neonatal intensive care unit was 6 days (range 1-60). All but one twin birth arose from pregnancies resulting from a multiple embryo transfer and the majority were preterm (75%, n = 9) and required neonatal intensive care (59%, n = 7). Limitations, reasons for caution It is not known if those who completed the survey are representative of all parents through CBS. However, the respondents’ sociodemographic characteristics and motivations for surrogacy were similar to those in previously conducted studies, both within Australia and internationally. Wider implications of the findings The welfare of children born through surrogacy can be protected by addressing the barriers to undertaking surrogacy domestically and thereby reducing the number of people crossing borders, and by promoting identity release or known donation and single embryo transfer as best practice in surrogacy internationally. Trial registration number Not applicable

P-565 Egg donor perceptions of anonymity and ancestry testing in the United States and Spain

Abstract Study question How do compensated egg donors in two different cultural and regulatory settings view anonymous donation and understand the implications of consumer ancestry testing? Summary answer Spanish and U.S. egg donors differ in their desire for anonymity, awareness of consumer ancestry testing, and the implications of ancestry testing for maintaining anonymity. What is known already In the literature, many have expressed concern that without the promise of anonymity people would be unwilling to donate eggs and sperm. A related concern is that the rise in consumer ancestry testing will mean the end of anonymous donation and therefore contribute to a reduction in donors. Study design, size, duration This is a mixed-methods study drawing upon surveys and interviews with oocyte donors in the United States (341) and Spain (126). The study was conducted between the years of 2018 and 2022 and included participants from multiple fertility clinics throughout Spain and the United States. Participants/materials, setting, methods This is a multi-sited study. Participants include current and former compensated oocyte donors who completed an online REDCap survey. Text boxes were provided in the survey so the participant could elaborate where appropriate. A subset of donors (200 U.S. and 76 Spain) in each location agreed to participate in a semi-structured, open-ended interview with one of the investigators. Interviews were conducted in person or over Zoom in the participant’s language of choice. Main results and the role of chance Of 341 U.S. respondents, nearly two-thirds (214, 63%) preferred that open or known donation rather than anonymous. Of the Spanish respondents, 38% stated they would prefer non-anonymous donation, 50% were unsure, and 11% stated they would not want non-anonymous donation. Both groups, 178 US (52%) and 57 Spain (51.4%), equally expressed a desire to someday meet the people born from their eggs or would be open to contact to share medical information. Of the U.S. donors, only 17 (5%) expressed a desire for no future contact with the people born from their donations, while 9 (8.7%) of the Spanish donors expressed desire for no future contact. U.S. donors were almost unanimously aware of the existence of consumer ancestry testing and 66 (19%) had attempted to use such tests to either find their donor-conceived offspring or make themselves available to be found. Among 111 Spanish respondents, 24 (21.6%) were not aware that consumer ancestry testing exists or that it could be used to find them, but 57 (51.35%) expressed a desire to be found if it were to become more widely used in Spain. Findings indicate that egg donors in both locations are mostly open to the idea of non-anonymous donation. Limitations, reasons for caution Study limitations include a potential bias in the survey sample as it is possible that people who participate in research might be more open than those who do not. We attempted to ameliorate this possibility by recruiting participants from a wide range of clinics, practices, and other sources. Wider implications of the findings Findings indicate that concerns surrounding the impact of consumer ancestry testing and the loss of anonymity for donors are overestimated. While there are cultural differences surrounding donation in the U.S. and Spain, assumptions surrounding oocyte donors’ desires for anonymity are not well-aligned with donor sentiments in either location. Trial registration number not applicable

P-107 MICROFLUIDIC SPERM SEXING: An XLD (X-linked Disorder) model for preventing genetic disorders in newborns

Abstract Study question Can sperm sexing based on unique surface membrane markers – enable genotypic sperm sorting by allosomal content to prevent certain X-linked disorders in newborns? Summary answer In an X-Linked-Disorder prevention model, we utilized a microfluidic device functionalized with H-Y monoclonal antibodies attached to magnetic beads to enrich Y-chromosome bearing sperm sorts. What is known already About 4% of newborns are at risk of being born with an X-linked disease such as Fragile X Syndrome. The current clinically approved mitigation plan for preventing such genetic disorders is to consider Preimplantation Genetic Testing for Monogenetic diseases (PGT-M) which involves an invasive microsurgical procedure on fragile embryos. To minimize this invasiveness, we proposed a less invasive microsurgical exclusion approach to prevent such genetic disorders by genotypically sorting sperm cells that can be used for IUI/IVF/ICSI – with microfluidics – using their allosomal characteristics. Study design, size, duration Semen samples purchased from FairFax Cryobank from anonymous donors were used in immuno-magnetic microfluidic sorting protocols with the use of phycoerythrin (PE) binding Tetrameric Antibody Complexes (TAC) coupled with magnetic beads to tag H-Y monoclonal antibody (mab) binding activities on the sperm surface membrane. Participants/materials, setting, methods Immuno-magnetic sorting was conducted with specially fabricated microfluidic-sperm-sorting (MSS) chips. Sort yield and purities of positively selected sperm populations were assessed by flow-cytometry, immunofluorescence, fluorescent-in-situ-hybridization (FISH) and by quantitative-PCR (qPCR – Cq & Tm). Quantitative experiments were run in triplicates and the results were expressed as absolute means for comparison between paired variables. Statistical analyses were performed using Student’s t-test and a p-value of less than 0.05 was considered to be statistically significant. Main results and the role of chance For the assessment of H-Y sperm sorts, our preliminary data showed that flow cytometry was able to confirm the positive sperm selection (which were mostly Y-chromosome bearing sperm cells) in a sperm genotyping protocol – initially utilizing immuno-magnetic sort tubes prior to flowing through microfluidic chips. Both immuno-magnetic sort tubes and the microfluidic chips were able to optimally confirm from qPCR-Cq means – the negative selection – being the X-chromosome bearing sperm that may have been largely unselected by the H-Y-mab. Values for Cq means compared under H-Y-qPCR data sets were statistically significant with a p value of 0.000023 (p values is significant at < 0.05). Our study was able to elucidate a potential less invasive clinical application of genotypically sorting sperm cells with mab-functionalized microfluidic chips for an XLD-model. Molecular down stream applications like flow cytometry may therefore be utilized to experimentally confirm sort purities of positively selected sperm populations (with H-Y markers) – based on the utility of the SMCX and SMCY gene in the X and Y sperm chromosome bearing sperm cells respectively. Limitations, reasons for caution Physiological effect of magnetic fields of varying tesla or gauss strengths on sperm selected with immuno-magnetic beads may warrant further safety studies prior to actual clinical applications. Optimal selection results may be achieved with the use of freshly collected normospermic rather than frozen-thawed samples. Wider implications of the findings Although we had de-emphasized the clinical application of the microfluidic sperm sexing protocol for legitimate use in sex selection and gender balancing, this study design was solely focused on adapting a less invasive method of preventing X-linked genetic disorders with the potential exclusion of microsurgical procedures leading to PGT-M. Trial registration number NA

O-219 Surplus Frozen Eggs Lay to Waste Opportunities for Research and Treatment

Abstract Study question Is there a moral duty to donate surplus frozen eggs (SFEs)? Summary answer SFEs are a valuable resource with the potential to mitigate harm and improve well-being and should be donated where the costs to donors are small. What is known already In Victoria, Australia, eggs can be stored for up to 10 years, after which SFEs must be discarded, donated to research or to others. Our research shows that many people do not return to use their frozen eggs, many are left in storage and most SFEs are then discarded. At the same time, there is a serious shortage of donated gametes and a high demand for eggs for both research and reproductive treatments. The recent legalisation of mitochondrial donation in Australia has added to the demand for eggs for training, research, and clinical purposes. Study design, size, duration This paper considers whether donation of SFEs can be grounded on ‘the duty of easy rescue’, broadly defined as a moral duty to help others when the harm that might be averted is sufficiently great, and the costs are sufficiently small. Participants/materials, setting, methods We present an ethical analysis of the harms that could be mitigated by egg donation and the costs to donors associated with donation to both research and to others. Main results and the role of chance The harms associated with prolonged infertility, long waiting lists for donor eggs, and gamete donation in less regulated settings are well known. In addition, the use of donated eggs for mitochondrial replacement offers the possibility of avoiding the transmission of serious disease. Our research shows that many SFEs are abandoned or discarded but little is known about why people discard SFEs. Among the ‘costs’ to donors, there are logistical barriers such as the time needed, and the physical and emotional demands associated with donor eligibility screening. There may be additional emotional and ethical costs associated with donation to others; concerns about donor anonymity, the parental status of donors, and the meaning of genetic relationships have been cited as barriers to embryo donation and may also factor in egg donation. We suggest that while donation of SFEs to others may have costs, there are opportunities to facilitate this option, such as offering donor screening at the time of egg freezing, providing education about the current demand for SFEs, and greater discussion and critical reflection about the moral status of donors. We reason that donating to research does not incur the same ‘costs’ and in most cases, represents an ‘easy rescue’. Limitations, reasons for caution This analysis considers ‘costs’ to donors and ‘harms’ relating to the shortfall of donor eggs. However, donors and recipients are not the only actors involved in egg donation. There may be other morally relevant considerations, such as the experience of donor-conceived people, that complicate assessments of costs, harms, and benefits. Wider implications of the findings The large number of SFEs abandoned and discarded suggests the need for more serious consideration about the disposition of SFEs, prior to egg freezing. In addition, more information should be provided to would-be users about the current fate of and demand for eggs. Trial registration number n/a

P-772 Three-dimensional folliculometry (SonoAVC) provides a better estimation of total and mature oocyte yields compared to conventional two-dimensional assessment in oocyte donors: a prospective, cohort study

Abstract Study question Does three-dimensional folliculometry (using SonoAVC) provide a better estimate of the number of retrieved and mature oocytes in egg donors compared to conventional two-dimensional assessment? Summary answer Three-dimensional folliculometry was superior to the two-dimensional ultrasound assessment and provided an excellent prediction (+/-20%) of total oocyte yield in almost two-thirds of participants. What is known already When used for monitoring ovarian stimulation, 3-D folliculometry has been shown to reduce inter-, and intra-observer variability and was significantly faster than conventional, two-dimensional ultrasound assessment (Vandekerchove F, 2014, Rei 2019). Although so far, no study has demonstrated improved clinical outcomes in IVF patients, the impact of 3D-folliculometry was not yet thoroughly evaluated in oocyte donation programmes, where expected total and mature oocyte yield is a crucial variable. Study design, size, duration Ninety-one consecutive oocyte donors were prospectively evaluated using three-dimensional folliculometry with SonoAVC software (E8, General Electric). A single operator (DB) performed all 3D ultrasound measurements immediately before starting oocyte retrieval and the oocyte retrieval procedure too. Two-dimensional measurement of follicles (average of two perpendicular diameters) was performed two days before egg retrieval by a single operator (NR) (Mindray DC7). Oocyte donors’ age (26.2±3.7 years), BMI (23.8±3.9), and baseline AMH (4.6±2.3 ng/mL) were also registered. Participants/materials, setting, methods Voluntary, anonymous oocyte donors were stimulated with a GnRH antagonist protocol and triggered with a GnRH agonist. Good, moderate, and poor prediction by ultrasound were defined as an oocyte/follicle count ratio of 80-120% (+/-0-20%), 60-79% or 121-140% (+/- 21-40%), and less than 60% or more than 140% (+/- more than 40%), respectively. For total oocyte yield, a threshold of all follicles 13 mm or above was used, both for the two- and three-dimensional assessment. Main results and the role of chance The number of total and mature oocytes retrieved was 22.2±9.4 and 19.0±8.3, respectively with an excellent average maturity rate of 86% (range: 44-100%). No donors were excluded from the study due to suboptimal visualization of ovaries with SonoAVC. For total oocyte yield; good, moderate, and poor prediction was achieved in 37, 44, 19% of donors with two-dimensional and in 63, 29, 8% of participants with three-dimensional folliculometry, respectively (p = 0.002). Significant underestimation of total oocyte yield (defined as more than 6 „missing” total oocytes) was less frequent with 3D assessment (12 versus 25% p = 0.022). For total oocyte yield, linear regression analysis showed a significantly higher r-square value with three-dimensional assessment (0.676 vs 0.278). For mature oocytes, the prediction was less precise than for total oocyte yield. Good, moderate, and poor prediction was achieved in 40, 30, 30% of donors with two-dimensional and in 55, 30, 15% of participants with three-dimensional folliculometry, respectively (p = 0.031). For mature oocytes, linear regression analysis showed a significantly higher r-square value with three-dimensional assessment (0.664 vs 0.282). The best SonoAVC threshold to predict total and mature oocyte yields was the sum of all follicles equal or above 13 mm and total follicle count between 24-13 mm, respectively. Limitations, reasons for caution Due to practical reasons, three- and two-dimensional measurements were not performed on the same day or with the same ultrasound equipment. In future studies, 3D-folliculometry could be used at the egg collection scheduling (2-3 days before the procedure) so that predictive information on oocyte yield would be available earlier. Wider implications of the findings Apart from reducing inter-observer variability and diminishing discomfort (faster examination time), 3D-folliculometry might have a significant role in the management of OD programmes by improving the prediction of total/mature oocyte yields. 3D-measurements performed before the procedure could also play a role in the quality control of the egg collection procedure. Trial registration number Not applicable

Children’s Emerging Understanding of Anonymity Does Not Predict Reputation Enhancing Generosity

ABSTRACT Young children tend to behave more generously when their actions are identified than when they are anonymous, yet we know little about the cognitive foundations required for anonymity to impact generosity. In three studies we examined Canadian children’s understanding of anonymity and its impact on sharing in anonymous and identified contexts. Study 1 assessed whether 3- and 5-year-old children (N = 100, 51 female) understood anonymous and identified sharing, and whether age-related changes in their understanding corresponded to sharing behavior. We found that understanding of anonymity improved with age, but anonymity did not influence sharing. Study 2 assessed 5-year-old children’s (N = 60, 30 female) judgments about how others would share in these contexts and their preferences for receiving donations from identified or anonymous donors. We found that children preferred to receive from identified donors and believed that identified donors were more generous. Study 3 assessed whether 5-year-old children (N = 60, 30 female) preferred to share as anonymous or identified donors themselves, and whether their choice influenced sharing behavior. We found that while participants preferred to share as identified donors, this choice did not influence sharing. Overall, our findings suggest that although 5-year-old Canadian children have a robust understanding of the implications of anonymous and identified sharing, this understanding is not sufficient to motivate increased generosity.

The Pandora's box of transparency opened by direct-to-consumer genetic testing.

With the increasing use of direct-to-consumer (DTC) genetic testing, several cases of fertility fraud have been uncovered throughout the world. A review of newspaper articles and specialized literature was made to analyze the issue of fertility fraud. The most famous cases, some of which are narrated in this article, became a scandal because they were committed by the doctors who treated the patients in question as a routine procedure in their medical practice. Some have been widely exposed in documentaries on streaming platforms, thereby raising awareness about a grave problem. The discussion focuses on the ambiguous regulation on the anonymity of donors, which has been one of the elements of the deception committed against the families using these services. Anonymity nowadays collides with the fascinating Pandora's box of transparency in genetic information that has been opened by DTC genetic testing.

Lowering the age limit of access to the identity of the gamete donor by donor offspring: the argument against

Countries that abolished donor anonymity have imposed age limits for access to certain types of information by donor offspring. In the UK and the Netherlands, a debate has started on...

« I believe that children should know how they were conceived »

The decision to become a donor is an altruistic one. It allows infertile couples wishing to have a child to realize their dream. Although there have been developments in recent years concerning the lifting of donor anonymity, there is still progress to be made. Joseph Geantet is one of the people who have chosen to donate sperm. He shares his experience.

Zero or 18

Zero or 18

Reflections of unspecified anonymous kidney donors on their motivation and the impact of donation on their mental health: A qualitative study

Reflections of unspecified anonymous kidney donors on their motivation and the impact of donation on their mental health: A qualitative study

Fecal Microbiota Transplantation

Fecal Microbiota Transplantation (FMT) involves a noninvasive technique of transferring fecal microbiota in patients from healthy donors. Donors are generally chosen from spouses or relatives, though the anonymous donation is also common. FMT is particularly useful in diseases like recurrent clostridium difficile infection, ulcerative colitis, hepatic encephalopathy, metabolic syndrome, autism spectrum disorders, anxiety, graft versus host disease, multiple sclerosis, multi drug resistance etc. FMT is gradually being adapted in India in the major cities but there are various regulatory challenges. Despite the promising nature of FMT in different pathologies, the different barriers ranging from the selection of a healthy donor, high quality control, uniform protocol maintenance, to ensuring effective mode of administration have to be addressed for FMT to become a widely accepted modality of therapy.

Pravo deteta na identitet u kontekstu pravila o anonimnosti donora

The right of the child to identity has been gaining importance in the efforts to revise legislation on donor anonymity in a large number of European countries. However, certain national legislations are still in favor of the concept of the identity disclosure prohibition, while some envision a mixed model, with the aim of balancing conflicting interests. The debate is centered on the donor and parent’s right to privacy and the child’s right to know their biological origins. An analysis of solutions from various European states, as well as the positions of the authorities overseeing the implementation of the most important treaties, has led to the development of guidelines when weighing interests in a conflict. Although an ideal solution is difficult to imagine, a system that protects the interests of all parties, focusing on the protection of the child’s rights, could be satisfactory.

'I know it's not normal but it's normal to me, and that's all that matters': experiences of young adults conceived through egg donation, sperm donation, and surrogacy.

What are thoughts and feelings of young adults born following egg donation, sperm donation, and surrogacy? Young adults felt either unconcerned or positive about the method of their conception. Much of what we know about adults born to heterosexual couples following anonymous donation has come from samples of donor conceived people who had found out about their origins during adulthood. There have been no studies of how young adults born through surrogacy feel about their conception and towards their surrogate. Thirty-five young adults were interviewed as part of the seventh phase of a larger multi-method, multi-informant longitudinal study of assisted conception families in the UK. Adults were conceived using either egg donation, sperm donation, gestational surrogacy, or genetic surrogacy and were raised in households headed by heterosexual couples. Participants had a mean age of 20 years and were born following traditional surrogacy (n = 10), gestational surrogacy (n = 5), egg donation (n = 11), or sperm donation (n = 9). All young adults born following sperm donation and most (n = 10) born from egg donation had an anonymous donor. In all surrogacy arrangements, the parents had met the surrogate prior to treatment. The majority of young adults were told about their conception by the age of 4 years. Participants were interviewed over the internet using a semi-structured interview. Interviews were transcribed verbatim and analysed using qualitative content analysis to understand young adults' thoughts and experiences related to their conception and whether they were interested in meeting their donor or surrogate. Fourteen (40%) young adults felt their conception made them feel special or unique, with the remainder feeling either neutral or unconcerned (n = 21, 60%). A higher proportion of young adults conceived using egg donation (n = 8, 73%) felt unique/special compared to young adults born following sperm donation and surrogacy. For 10 of the young adults, their feelings about their conception had changed over time, with most becoming more positive (n = 9, 26%). For most young adults (n = 22, 63%), conception was rarely or infrequently discussed with others. However, when it was, these conversations were largely conducted with ease. Most (n = 25, 71%) did not know other individuals born through the same method of conception as themselves, and the vast majority (n = 34, 97%) were not members of any support groups. For the 25 young adults not in contact with their donor or surrogate, 11 wished to meet them, 8 did not want to have contact, and 6 were unsure. Young adults in contact with their donor or surrogate had varying levels of closeness to them. Only one young adult had searched for the identity of their donor. Of the 47 young adults invited to participate in the present study, 35 agreed to take part resulting in a response rate of 74%. It is therefore not known how those who did not take part felt about their conception. Given that the families reported here had been taking part in this longitudinal study from when the target child was aged 1 year, they may have been more likely to discuss the child's conception than other families. The study also utilized self-report measures, which may have been prone to social desirability, with donor conceived young adults wanting to present their experiences in a positive light. The findings suggest that young adults born through surrogacy and donor conception do not feel negatively about their birth and this may be a consequence of the young age at which they found out about their conception. Although some young adults said they wished to meet their donor, this did not necessarily mean they were actively searching for them. The study was funded by the Wellcome Trust [grant number 208013/Z/17/Z]. The authors have no conflicts of interest to declare. N/A.

Ludmila of Bohemia (ca. 860–921): Multidisciplinary considerations on her facial approximation

Ludmila of Bohemia or Saint Ludmila (ca. 860–921) is a popular religious figure from the Czech Republic. In 2021, the reliquary containing part of her skull was scanned and the missing portion of the structure was digitally reconstructed using references from anthropological studies carried out in the late 1990s by Dr. Emanuel Vlček, Ph.D. (1925–2006). From the completed skull, an estimation of facial hard tissue made a forensic facial approximation possible. The present study aims to present the sequence of methodological analysis, the development of new techniques and procedures used in this case that can become tools to facilitate the task of digitally restoring skulls with missing structures that can be applied in archeological and surgical context. The cranial hard tissue from an anonymous donor of a CT-Scan exam was “deformed” to fit onto the remains of the historical skull of Ludmila of Bohemia. The estimated facial proportions were tested by several methods that correlate the proportions of cranial structures. The reconstruction was performed based on several scientific parameters and the resulting structures were also consistent to predictors commonly used in the forensic field. The cranial deformation method provided a hard tissue estimation and gave reference to a facial approximation of a historical figure. Its development and testing may inspire future research to support a wide range of applications that goes from archaeology to medical usage.

Circumstances Leading To Finding Out about Being Donor-Conceived and Its Perceived Impact on Family Relationships: A Survey of Adults Conceived via Anonymous Donor Insemination in Germany

Recent empirical research on the psychosocial implications of donor insemination is increasingly based on data directly obtained from donor-conceived persons. This descriptive study on donor-conceived adults in Germany inquires into their experience of finding out about being donor-conceived and answers the following research question: how do German adults conceived via anonymous donor insemination find out about the means of their conception and how do they experience family relationships post finding out? An online self-administered questionnaire targeting German donor-conceived adults to obtain qualitative and quantitative data was administered between September and November 2020. Fifty-nine donor-conceived adults were recruited via the support and advocacy group Verein Spenderkinder. Participants had been born in heterosexual-couple-parented families, were between 21 and 46 years old, and found out about the circumstances of their conception between 5 and 46 years of age. A broad spectrum of contexts and circumstances in which participants learned about being donor-conceived were reported, such as discovery via medical records, through disclosure as a result of parental consideration of the child’s current life situation or through direct-to-consumer DNA testing. Finding out about the means of their conception was experienced by participants as affecting their relationships with their family members to different degrees and in various ways. This first systematic inquiry into German donor-conceived adults’ experiences expands the literature and provides basic data for further research. Direct-to-consumer DNA testing is identified as one emerging trigger for finding out, warranting future research. The heuristic value of further in-depth inquiry into donor-conceived adults’ relationship with family members other than their parents, in particular their siblings, is highlighted.