Donor-conceived Children Research Articles

Adopted and donor-conceived children hold reduced genetic-essentialist beliefs relative to traditionally-conceived children.

For three decades, researchers have assessed children's genetic essentialism through an "Adoption Task," probing their beliefs about whether adopted babies grow up to resemble their birthparents or adoptive parents. The present study investigates these beliefs among children who were themselves adopted or donor-conceived (i.e., who share genetic material with neither or one parent, respectively; "ADC"), comparing them with children who were traditionally-conceived (i.e., who share genetic material with two parents; "TC"). Children (n = 95, 4-8 years old, 30ADC/65TC, 34M/59F/2NB, 55 White / 35 of color / five did not report) completed five trials of an Adoption Task concerning five personal characteristics (hair color, spoken language, personality, interests, and intelligence). Across trials, ADC children made fewer essentialist judgments than TC children (ηp² = .07); the odds of an essentialist response were threefold greater among TC than ADC participants. Exploratory analyses revealed that with age, children's essentialist judgments became increasingly differentiated across different characteristics (e.g., increasingly divergent views of the genetic basis of hair color vs. spoken language), and that this differentiation was more pronounced in the ADC than the TC sample. No differences were observed in the genetic-essentialist views of ADC and TC children's parents, suggesting that the mechanism underlying effects was children's own sense-making capacities. Whereas nature and nurture are confounded for TC children, these factors are decoupled for ADC children, supporting them in building their causal theories. Cognitive, developmental, and social implications are discussed, along with translational implications for ADC children and their families. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Diagnosing a genetic disease in a donor-conceived child: case report and discussion of the ethical, legal, and practical issues.

We describe the unexpected challenges pediatricians may experience when children conceived with assisted reproduction are diagnosed with a rare genetic condition. A local case series triggered a dialogue between many stakeholders with varied expertise. Indeed, diagnosing a genetic disease in a child conceived by embryo, egg, or sperm donation is becoming more common now that genetic testing and in vitro fertilization (IVF) are readily accessible. However, how and whether to share that information with other stakeholders in the gamete donation process has not been fully explored, and the clinical responsibilities of the treating clinician remain ill-defined. This work centers on a patient with a confirmed diagnosis of X-linked nephrogenic diabetes insipidus. Ultimately, we found the same AVPR2 mutation in two children from two families conceived by egg donation. It led to multigenerational cascade diagnoses in the family of the shared, anonymous egg donor. First, we review current genetic testing practices in gamete donation and third-party reproduction. Then, we provide an overview of relevant genomic, ethical, legal, and psychosocial considerations for sharing relevant genomic information. Finally, and to maximize the best interests of genetic relatives, we discuss how a pediatrician can play a role in the early disclosure of relevant clinical information to all stakeholders in the gamete donation process, starting with the fertility clinic. While these clinical cases are cast in a Canadian context, we submit that its important lessons generally apply to medical systems of nearly all developed countries, broadly defined.

O-170 The next generation of adolescents will consider more and more multiparenthood, poliparenthood

Abstract Although there are a variety of ways in which people navigate their intimate lives, theories of human development and intimacy often implicitly assume a preference for monogamy to be universal (Seltzer, 2000; Conley et al., 2017; Moors et al., 2017). While many people around the globe indeed engage in serial monogamy, remarkable transformations in relationship and family demography have occurred over the past several decades (Glick, 1988; Fisher, 1989; Finkel et al., 2014; Foster, 2016, in Moors et al. 2021) Studies show that 1 out of 6 people (16.8%) desire to engage in polyamory, and 1 out of 9 people (10.7%) have engaged in polyamory at some point during their life. (Moors et al 2021). Besides seeking hypotheses on the reason for this change away from the monogamous relationship form, and based on these data, we can try to make a prediction about the willingness of people to also consider parenthood in consensual non-monogamous or polyamorous relationships and thus engage in polyparenthood in the future. In the fertility centre too, we are past an era in which heterosexual infertile couples form the majority of our patient population. The need for donor material is increasing, although demand grossly exceeds supply. In addition, in many countries donor anonymity is still enshrined in law, which poses a problem for a growing number of acceptors. Many patients desire information about the donor and an increasing number of patients anticipate the perspective of the future child, which has a right to know its origins. Other patients wish the donor would also include parental involvement, and fundamentally desire the genitor to be a co-parent for their child at some point. As a result, some patients seek refuge in non-regulated open donation arrangements outside the fertility clinic. Indeed, internet websites dedicated to facilitating contact between individuals who want to meet people with the common aim of having a child are mushrooming. Such websites make elective co-parenting accessible to large numbers of people, including both singles and those with partners. Furthermore, these websites are not restricted to LGBTQ+ individuals; heterosexual men and women can also become members and contact potential reproductive partners who may be of a different sexual orientation to themselves. This could trigger a paradigm shift in the fertility clinic; is co-parenting, multi-parenting and poly-parenting the future? It could resolve problems of donor shortage, and the often difficult search for roots still faced by donor-conceived children as a consequence of donor anonimity. At Brussels IVF, we anticipated this paradigm shift and developed a procedure to counsel candidates for co-parenting. Welfare of the child is the guiding principle leading to a joint parenting project worked out together with the co-parents. This procedure and counseling topics to be addressed by the fertility centre will be presented.

One size does not fit all: the personal nature of completed embryo donation.

To assess factors associated with embryo donation among individuals interested in donation in the United States. An invitation to complete the 123-item survey was emailed from June to September 2022 to patients at a private practice fertility clinic with interest in donation at the time of IVF. Survey questions included disposition decision, attitudes about embryo status and genetic relatedness, donation disclosure, ideal donation arrangement, and decision satisfaction. Three hundred thirty-seven completed the survey. Two hundred thirty donated to another person(s), 75 discarded embryos, 25 remained undecided, and disposition was unknown for 7 respondents. There were no demographic differences between groups based on final disposition or use of donor gametes. Few gamete recipients were interested in donation due to biological attachment to embryos. Final embryo disposition was associated with religious factors, not wanting to waste embryos, and storage fee concerns. Final disposition was also significantly associated with concern about donor-conceived children's (DCP) welfare, being denied the ability to complete donation, personal IVF outcomes, financial or legal issues, future contact with DCP, cognitive appraisal of disposition, beliefs about embryos, someone else raising their genetic child, anonymity, and beliefs about DCP not knowing genetic relationships (p < .001). Donation to others was associated with less regret and greater satisfaction with the emotional/medical aspects of donation and counseling compared to those who discarded embryos (p < .001). The decision to donate embryos to another person(s) is complex. Counseling that considers individual circumstances, values, and evolving dynamics may facilitate informed decision-making for those navigating infertility treatment, family building, and embryo disposition.

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

Disclosure of donor conception has been advocated in several jurisdictions in recent years, especially in those that practice identity-release donation. However, research on disclosure decisions has not been consolidated systematically in the last 10 years to review if parents are telling and what factors may be impacting their decisions. Are parents disclosing to their donor-conceived children, and what factors have influenced their disclosure decisions across different contexts and family forms in the last 10 years? A bibliographic search of English-language, peer-reviewed journal articles published between 2012 and 2022 from seven databases was undertaken. References cited in included articles were manually scrutinized to identify additional references and references that cited the included articles were also manually searched. Inclusion criteria were articles focused on parents (including heterosexual, single mothers by choice, same-sex couples, and transsexual) of donor-conceived persons in both jurisdictions with or without identity-release provisions. Studies focused solely on surrogacy, donors, donor-conceived persons, or medical/fertility staff were excluded as were studies where it was not possible to extract donor-recipient parents' data separately. Both quantitative and qualitative studies were included. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed and Joanna Briggs Institute Critical Appraisal Tools for Systematic Reviews were used to assess article quality and bias. Thirty-seven articles met the inclusion criteria representing 34 studies and 4248 parents (including heterosexual, single, same-sex, and transsexual parents although the majority were heterosexual) from countries with anonymous donation and those with identity-release provisions or who had subsequently enacted these provisions (Australia, Belgium, Finland, France, Hong Kong, Middle East, Spain, Sweden, the UK, and the USA) A general trend towards disclosure was noted across these groups of parents with most disclosing to their donor-conceived children before the age of 10 years. Further, the majority of those who had not yet told, reported planning to disclose, although delayed decisions were also associated with lower disclosure overall. Same-sex and single parents were more likely to disclose than heterosexual parents. There was recognition of disclosure as a process involving ongoing conversations and that decisions were impacted by multiple interacting intrapersonal, interpersonal, and external contextual and social factors. Methodological limitations, such as the different population groups and contexts from which participants were drawn (including that those parents who choose not to disclose may be less likely to participate in research), are acknowledged in integrating findings. This review has reinforced the need for a theoretical model to explain parents' disclosure decisions and research exploring the role of legislative provisions, culture, and donor/family type in decision-making. Greater ongoing access to psychological support around disclosure may be important to promote parent and family well-being.

Disciplined parents and autonomous children: information sharing as governing device in Swedish identity-release gamete donation

Abstract This article analyses shifts and continuities in Swedish regulation of information sharing in identity-release donor conception. At a time when families include both solo and same-sex parenting, I draw on a practice-oriented method to compare legal and pre-legislative documents from the early 1980s with those of the late 2010s as developed in a Swedish national context. Following the turn to openness in donor conception, I discuss the practical implications of framing access to information from the hospitals’ so-called ‘special medical record’ as a children’s right, when information is in fact only available after ‘maturity’ is reached. Furthermore, I show how a significant change in the understanding of child–parent relationships in donor-conceived families is articulated in the 2019 legislation. If early policy documents portrayed donor-conceived children as potentially problematic for not ‘knowing their origin’, I argue that now it is parents in donor-conceived families who are constructed as potentially problematic. Drawing on critical kinship theory, I conclude that Swedish policy-making on information sharing in donor conception relies on a symbolic rather than material understanding of genetic relatedness that fails to acknowledge how different family forms might have different needs. Based on these findings, I suggest that policymakers take into account the implications a changing view on family life and genetics have for children and parents following donor conception.

P-055 Four decades of sperm donation: Motivation and attitudes among donors

Abstract Study question How has the attitudes and motivation towards donation among sperm donors developed through the years from 1992, 2002, and 2012 to 2022? Summary answer Altruism and economic compensation remain the primary motivations, but there are significant changes in responses for certain life and attitude-questions from current to previous years. What is known already The growing application of medically-assisted reproduction (MAR) has made treatment with donor sperm commonplace, and in recent years more people have been seeking pregnancy using donor sperm. With the global shortage of sperm donors, it is important to seek the opinion of the donor population on the perspectives of anonymity, motivations, information-sharing, and feelings towards the donor-conceived children, as well as the psychological factors related to being a donor. Previous studies have shown that altruism is the primary motivation and changing aspects of the donor population is of interest to all who seek to maintain the application of sperm donation. Study design, size, duration The study was based on the same questionnaire from the three preceding decades with a few updated modifications in the 2022-setup. Active sperm donors from the Danish sperm bank Cryos International were invited by email to participate in the study in the period June 9th to July 1st 2022. This is one of the largest studies of its kind to seek the opinion of sperm donors. Participants/materials, setting, methods Results from 173 donors were compared with previous answers from donors in the same sperm bank: 1992 (n = 39), 2002 (n = 58), and 2012 (n = 91). In 2012 and 2022, donors could choose between being ID-release (formerly known as non-anonymous) and non-ID-release (anonymous). Anonymized answers provided from the questionnaires were analyzed statistically to compare ID-groups and investigate changes in responses from previous surveys with the use of Chi-Squared tests and logistic regression. Main results and the role of chance There was a significant increase in the proportion of donors being ID-release from 29% in 2012 to 54% in 2022. The altruistic motivation of helping childless people was the most important factor to both ID-release donors and non-ID-release donors. Still, economic compensation was an invariable term of condition. In general in 2022, donors were willing to donate sperm to same-sex couples (80%) and single women (68%), and 55% were positive towards donation to transgender males. Logistic regression showed that ID-release donors were more likely to want information about donor offspring (OR = 1.80, [95% CI 1.02, 3.16]), while there was no association with having a partner. Also, a positive association between ID-release status and intending to inform current or future children about their sperm donation (OR = 1.73, 95% CI 1.10, 6.85) was observed. Having a partner was not significantly associated with the chance of donors wanting to inform current or future children about donations (OR = 0.65, 95% CI 0.90, 1.05). The findings of this study presented evidence that the donor population was not homogeneous in relation to several aspects of donation and had diverse opinions towards mutual information sharing. Limitations, reasons for caution The number of participants increased from 39 in 1992 to 173 in 2022. In 1992, donors who were not yet approved for donation were included, unlike the following years. All donors were anonymous in 1992 and 2002 due to legislation. Only in 2012 and 2022, donors could differentiate between ID-types. Wider implications of the findings The questionnaire clearly shows that the needs and attitudes of donors have developed across years. Different attitudes between ID-release and non-ID-release donors suggest that donor profiles fit people with different requirements. It is advisable to continually update provided services to fit the donors’ needs and opinions concerning mutual information. Trial registration number Not applicable

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...

Zero or 18

Zero or 18

Is the Writing on the Wall for the Genetic Link Requirement in Surrogacy Agreements?

For a valid surrogate motherhood agreement, section 294 of the Children's Act 38 of 2005 provides that the child born of the surrogacy arrangement must be conceived with the gamete of at least one of the commissioning parents. This ensures that a genetic link exists between a commissioning parent and the resultant child. In 2015, in the case of AB v Minister of Social Development 2016 2 SA 27 (GP), the constitutionality of the impugned provision was successfully challenged in the High Court; however, the applicant failed to convince the majority in the Constitutional Court (AB v Minister of Social Development 2017 3 SA 570 (CC)) that the removal of the genetic-link requirement would be in the resultant child's best interests. In 2023 another "double-donor" surrogacy matter is set to be decided by the High Court. The applicant's situation raises the question of whether the genetic-link requirement between commissioning parents and the resultant child should be extended to include a "sibling link". This would be applicable in situations where parents will lack a genetic link with the resultant child, but the child will still share a genetic link with an existing sibling. This article assesses the merits of the "sibling link" argument by considering the latest psychological evidence. This evidence confirms that donor-conceived surrogate children are well-adjusted and exhibit high self-esteem, despite lacking a biological and gestational link to their parents. It is argued that the reading in of a "sibling clause" into section 294 may be too narrow, and instead a reading in of a sentence that will allow the court "on good cause shown" to dispose of the genetic link requirement should be preferred.

Stress and Resilience Experiences during the Transition to Parenthood among Belgian Lesbian Mothers through Donor Insemination.

The present research explored parenting, stress, and resilience experiences among 16 Belgian, lesbian, first-time parental couples with donor-conceived children aged 3-72 months. In each couple, both mothers participated in a conjoint, semi-structured interview focused on their parenthood desire; the impact of stigmatization and social support from families of origin, friends, and institutions; and couple and family resources. Interviews were audio recorded, transcribed, and analyzed using Braun and Clarke's reflective thematic analysis. Four themes were identified: (1) "The precious baby": Realizing the parenthood project; (2) "Can we show ourselves in public without prying eyes?": Family social visibility; (3) "It's complicated!": Parental legal recognition and role imbalance; and (4) "How can we handle this?": Family resilience. The themes indicated that the child's donor conception, the parents' coming out, the non-gestational mother's role, the legal obstacles encountered, and the need to find a balance between the two mothers in childcare tasks generated stress and required mothers to develop resilience strategies. The results suggest several potential areas for mental health practitioners to explore in clinical contexts when supporting intended lesbian mothers in their transition to parenthood through donor insemination.

Embryo donation: Counselling practice issues and dilemmas within the context of identity-release donor programmes

Embryo donation (ED) involves the donation of surplus embryos post family formation to others in need. Commensurate with Australian and New Zealand legislation and policy, ED is practiced as an identity-release programme shaped by four paramount principles. These include: the need to consider the longitudinal health and well-being of donor-conceived children born from assisted reproductive technologies (ART); recognition that offspring should be made aware of and be able to access information about their genetic origins; awareness that the short and long-term health and psychological welfare of other stakeholders (i.e., recipients and donors) should be ensured; and finally, that all donations are altruistic. Whilst embedded in ART legislation or professional guidelines, how these principles are operationalized through counselling in both countries remains variable. In this paper, we draw upon Australian and New Zealand research, legislation and policy shaping the counselling milieu. We highlight some of the key clinical issues that counsellors need to explore with participants of an ED arrangement and the implications of these as they apply to dilemmas within counselling practice such as counsellor roles and responsibilities.

Assessing Triadic Interactions and the Family Alliance among Belgian Lesbian Mothers and Their Donor-Conceived Children

Both empirical and clinical evidence with heterosexual parents and their biological children has shown the significant influence of early family interactions on children’s socioemotional and cognitive development during their first years. Yet, very little research has applied family-level assessment to families who are diverse with respect to parents’ gender and sexual orientation, and child’s method of conception. The present cross-sectional study compared 24 lesbian mother families with donor-conceived children and 24 heterosexual parent families with spontaneously conceived children with respect to triadic interaction quality and the family alliance (i.e., emotional and interactional coordination during family activities), as observed during the Lausanne Trilogue Play procedure. All parents were first-time parents, White, cisgender, residing in Belgium, had an upper-middle socioeconomic status, and a child aged 3–74 months (M = 21.00, SD = 17.72). Across family types, triadic interactions demonstrated similar scores in each family alliance dimension, characterized by appropriate levels of participation, organization, focalization, and affect sharing. The results have clinical implications for the use of the LTP as both a clinical assessment and a tool to reinforce and intervene with lesbian coparents. Family psychologists may find the results particularly informative when working to support coparenting relationships among diverse families.

Same-sex mothers' experiences of equal treatment, parenting stress and disclosure to offspring: a population-based study of parenthood following identity-release sperm donation.

What are the experiences of same-sex mothers following identity-release sperm donation regarding equal treatment in society, parenting stress and disclosure to child? Mothers predominantly reported equal treatment in society, low levels of parenting stress and early disclosure of the donor conception to the child, and half of the couples had also informed the child of his/her right to obtain the donor's identity. The number of two-mother families is increasing, and previous studies have reported about challenges related to heteronormativity, discrimination and the status of the non-birth mother. Same-sex mothers have been found to disclose the child's donor conception earlier than different-sex parents, but little is known regarding disclosure of the child's right to obtain identifying information about the donor. The present study concerns the fourth wave of data collection of a nation-wide longitudinal study. A total of 143 same-sex mothers (73% response rate) following identity-release sperm donation completed individual surveys when their donor-conceived child had reached age 7. These women represent a total of 82 couples who had undergone sperm donation treatment. The study is part of the longitudinal Swedish Study on Gamete Donation (SSGD). Couples accepted for gamete donation treatment at seven Swedish University hospitals were recruited between 2005 and 2008 and were requested to complete postal surveys during four waves of data collection. The present study sample includes same-sex mothers who completed a survey when their donor-conceived child had reached 7 years of age. Data were collected with the Swedish Parenting Stress Questionnaire (SPSQ), and study-specific items on experiences of treatment in society and disclosure behavior. Group comparisons (birth mothers vs non-birth mothers) were conducted using Chi2-tests, independent t-tests and Mann-Whitney U-tests, and written comments provided for open-response items were analyzed by qualitative content analysis. The mothers were generally open about the child's donor conception and the large majority (>80%) reported being treated positively and in the same way as other parents. However, satisfaction with treatment in health care settings was significantly lower than that reported in contacts with the child's school and recreational activities (P < 0.001) and open-response comments indicate that this may be related predominantly to heteronormative language and assumptions. Birth mothers and non-birth mothers reported similar treatment in society and similar levels of parenting stress. All but one couple had already talked with their 7-year-old child about his/her conception with donor sperm. Half of the couples had also informed the child about his/her opportunity to obtain identifying information about the donor, and remaining couples planned later disclosure. Children's reactions were generally described as neutral, positive or characterized by interest and curiosity. The present study was performed within the context of the Swedish legislation on identity-release donation, which limits the generalizability to same-sex couples using anonymous or known sperm donors. Although no evidence of attrition bias was found, it is possible that those couples who initially declined participation in the SSGD (23%) or dropped out at the fourth wave of data collection (27%) differ from the study sample in terms of variables that we were unable to control for. The present finding that most same-sex mothers in a population-based sample experience equal treatment in society is encouraging and validates previous results from predominantly qualitative studies. Nevertheless, the fact that a subgroup experiences discrimination and less favorable treatment indicates that further action is needed, particularly in child health care settings. The present study is the first to report on the timing of parents' disclosure of the child's right to identifying donor information and suggests that disclosure during preschool ages is feasible and does not appear to be related to negative consequences. In view of the increased availability and use of identity-release donation, there is a pressing need to investigate parents' intentions, behaviors and needs with regard to talking with their child about his/her opportunity to obtain the donor's identity. Financial support from the Swedish Research Council (2013-2712) and the Swedish Research Council for Health, Working Life and Welfare (2014-00876). There are no conflicts of interest to declare. N/A.

Random Families: Genetic Strangers, Sperm Donor Siblings and the Creation of New Kin

Unprecedented families formed by sperm donor siblings have grown up at the intersection of new reproductive technologies, social media, and the human desire for belonging. As the Internet has expanded, parents (and their children) who shared the same donor have discovered that they can connect. When they meet, they wonder: What does it mean to be a donor sibling? Do shared genes make you family? Does “family” even describe our relationship? In an era in which conventional families are shrinking, the idea of connecting with genetically related strangers offers opportunities and risks. Hertz will discuss the contemporary interplay of genetics, social interaction, and culture expectations in an effort to explain the emergence of web-based donor sibling networks. Funded by the U.S. National Science Foundation, her talk is based upon over 350 interviews with donor-conceived children, their parents and donors from her co-authored book, Random Families.

O-213 Experiences of Australian egg donors (EDs) who have early contact (before 18) with their donor conceived children (DCC) and recipient parents (RPs): implications for counselling

Study questionHow do Australian EDs, known and previously unknown, experience early contact with their DCC and/or RPs? (Early contact is when DCC are under 18 years).Summary answerAltruistic Australian EDs formed meaningful, ongoing relationships with their RPs and DCC. For participants, early contact was central to how they enacted egg donation.What is known alreadyIn Australia the dominant view is that DCC have the right to know the identity of their EDs, at least after the donor conceived person reaches the age of 18 and in some cases before the age of 18. The practice of early contact between EDs and their DCC is on the increase, particularly in a context where EDs liaise directly with their RPs and request that early contact occurs. There is a gap in the literature around how Australian EDs experience early contact and the significance that early contact plays in their self-identity as EDs.Study design, size, durationOver six months in 2020, a convenience sample of 29 altruistic Australian egg donors was recruited. Study participants had early contact with at least one DCC and agreed to participate in an hour long semi-structured interview about their motivation for donating and experience of early contact with their DCC and RPs. Interviews were conducted via telephone, as face-to-face interviews were not permitted due to Covid-19 restrictions in Melbourne, Australia. Narrative and thematic analysis was conductedParticipants/materials, setting, methodsSix EDs were knows, twenty-three were previously unknown to their RPs. Three volunteered via a fertility clinic, twenty were introduced to their RPs via an online platform. The number of DCC that an individual ED had varied: 1-3 (13); 4-7 (6); and 8 or more (10). All had early contact with at least one, most had contact with all their DCC. A subgroup (10) saw themselves as head of a network of several RP families.Main results and the role of chanceEarly contact was a significant aspect in the egg donation process for most study participants. EDs negotiated with their RPs to have early contact with their DCC and to facilitate future interactions if their DCC wanted information about their genetic background. Most were emotionally invested in the outcome of their egg donation, including during their RPs’ pregnancy and delivery. Most developed ongoing relationships with their recipient families. While they wanted contact, EDs were careful not to threaten the parental role of their RPs. EDs in Australia described positive experience of early contact. The relationships that they formed through early contact had a positive impact on their self-identity as EDs and contributed to some becoming highly motivated EDs (undergoing eight or more ED cycles). Highly motivated EDs underplayed possible consequences of donating, in part due to the positive experience of early contact. A few EDs were disappointed when a few RPs broke off contact, especially as they had little recourse to affect a change. Prospective Australian EDs and RPs should be counselled around the practice of early contact, which can be ongoing. The experience of Australian EDs may have relevance for other contexts were early contact is being considered.Limitations, reasons for cautionThe study was a cross-sectional analysis of Australian EDs who had early contact with their DCC. Interviews were conducted when the DCC were relatively young (average age 5 yrs) and did not include longitudinal follow-up. None of the study participants had chosen not to have early contact with their DCC.Wider implications of the findingsProspective Australian EDs and RPs need to be counselled around the practice of early contact. Counselling should include discussion around the expectations of early contact, how it is experienced and that for some, contact may be ongoing. Trial registration numberN/A

P-347 Gamete donation in Italy: Ethical and legal consideration on the lack of specific regulation

Abstract Study question Given cross border reproductive care, is the lack of specific regulation on egg and sperm donation in Italy ethically acceptable nowadays? Summary answer Nowadays Italy has no national clear legal frame for donors, recipients, and donor-conceived persons. This setting hinders an ethical protection of competing interests and rights. What is known already The Italian Law on ART (40/2004) has undergone major changes; after sperm and egg donation ban lift, the Italian law n. 40 has not been replaced. Gamete donation is therefore allowed, but without specific national regulation. Moreover, given the lack of public information on donation and consequently the shortage of donors, many people still opt for CBRC. In this context, the only legal certainty is that no filiation link arises between donor and donor-conceived children. Political and legal debate on the right to know one's origins is missing. Legally speaking, gamete donation in Italy is actually in half-light. Study design, size, duration -- -- Participants/materials, setting, methods When it comes to ART, national legal frame has to be considered in a comparative view, since CBRC is a fact. Therefore, questioning the lack of specific regulation on egg and sperm donation in Italy has required a comparative analysis with other European legal systems, such as France, Spain and United Kingdom. Main results and the role of chance -- -- Limitations, reasons for caution When advocating a legal change, it should be considered the surrounding political environment; among Italian institutions a growing mistrust of science might be spotted nowadays. This, combined with the very well know Catholic heritage, is undoubtedly a reason for caution Wider implications of the findings A legal change in Italy, backed by a promotion of public information on gamete donation, might entail also an increase in the number of donors and enabling many people to avoid CBRC. The rights of donors, recipients and donor-conceived persons would be protected and more patients could be treated. Trial registration number not applicable

P-722 Ending the anonymity of egg donors in shared donation programs could reduce the number of participants

Abstract Study question Loss of egg donor anonymity could affect shared donation programs in Brazil? Summary answer Yes. Approximately 20% of the women who participated in this study would drop out of the program, especially those with higher incomes. What is known already The Brazilian Federal Council of Medicine seems to be increasingly flexible with regard to maintaining mandatory secrecy on the identity of donors. The resolution regarding assisted reproduction techniques, approved in 2021, concerns the possibility of donation between family members, up to fourth degree relatives. The possibility to know and have access to this identity or even the search for half-brothers can be a reality in many countries for children born through access to reproductive technology but the opinion or behaviour of this population about the presence or absence of anonymity is limited to a few studies. Study design, size, duration Women (n = 800) who applied for enrolment in the shared egg donation program at a private IVF clinic were invited to participate in an electronic survey developed using the online Survio® tool. The invitation to participate was sent by email from June to November 2021. 279 women (34.8%, 20-35 years) responded to the survey. Participants/materials, setting, methods The information was obtained through questioning and gaining information about: socioeconomic profile of the donors, their motives, ambivalence in relation to the sharing of eggs and feelings about a possible end of anonymity. Thereafter, answers given to 10 specific questions were recorded. Furthermore, a correlation analysis was performed to assess the relationship between acceptance of the end of donor anonymity and various study parameters. Main results and the role of chance Approximately 61% of patients would want to become egg donors for two reasons: to reduce IVF costs and to help another woman. However, significantly younger women want to be part of the egg donation program just to reduce their treatment costs (P &amp;lt; 0.05). Approximately 71% of women do not want any contact with the child born from their eggs; 69% of them would not like to meet the recipients and 75% would not like to meet the child, even if only the recipient had become pregnant. If donors lost a child, they would not even want to meet the child who was born with their donated eggs (76%). Most participants also responded that they would be in the program even if the anonymity was not maintained (80%). However, women with higher income would drop out of the program if donor anonymity was not maintained (56.3%) compared to women with lower income (13.5%;P &amp;lt; 0.001). Limitations, reasons for caution Confounding variables related to the male partner's opinion cannot be excluded. Studies with larger samples are needed to confirm these findings. Wider implications of the findings A possible end to the anonymity of egg donors in Brazil would pose numerous challenges to the current practice of gamete donation. These concerns give rise to a broad discussion in society about how best to safeguard and promote the interests of donor-conceived children and protect the rights of donors. Trial registration number Not applicable.

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

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

Blood is Thicker Than Water, but is It Thicker Than Ink? An Analysis of Parenthood and Sperm Donor Agreements in the Wake of QG V CS (32200/2020) 2021 ZAGPPHC 366 (17 June 2021)

The recent case of QG v CS (32200/2020) 2021 ZAGPPHC 366 (17 June 2021) concerns a sperm donor who applied to the court for parental responsibilities and rights in respect of a child conceived with his sperm. This is despite the fact that he had concluded a written agreement with the child’s legal parents before the child’s conception which stipulated, inter alia, that he would have no such responsibilities and rights in respect of the child. The ruling of the High Court in this case is a significant development in South African reproductive law, as the first case that deals with the legal position of a sperm donor with regard to a donor-conceived child. The following important legal principles that were laid down in the case are identified and analysed. First, there is no prohibition on a sperm donor or his family members from approaching the court in terms of section 23 or 24 of the Children’s Act 38 of 2005 to acquire parental responsibilities and rights in respect of the donor-conceived child. However, if a sperm donor or his family members bring an application in terms of section 23 or 24, they cannot rely on their genetic link with the donor-conceived child. Secondly, sperm donor agreements are in principle legal and enforceable, but the court is not bound to enforce provisions dealing with parental responsibilities and rights if it is of the opinion that such provisions are not in the best interests of the child. A sperm donor agreement may, however, be informative regarding the parties’ intentions. Criticism is expressed about the way in which the court dealt with the issues of the locus standi of donors and the psychological evaluation of donors and recepients where known donors are used.