Donor Conception Research Articles

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

Research questionWhat effect does direct-to-consumer genetic testing (DTCGT) have on information finding and sharing in relation to gamete donor conception? DesignThis study used in-depth qualitative interviews with parents through donor conception, donors, the relatives of donors and donor-conceived people who have used, or considered using, DTCGT. Interviews were conducted between September 2021 and February 2023. Sixty people defined themselves as having been affected by donor conception and DTCGT. Fifty-seven of these were resident in the UK at the time of interview. The final sample included 19 (spermatozoa, egg or embryo) donors, 25 donor-conceived people, 20 parents through donor conception and two relatives of donors. Five participants occupied more than one of these roles. ResultsThe rise of DTCGT is affecting how information about donor conception is managed: it shifts patterns of knowledge about donor conception; increases flexibility regarding the age of access to information about donor relatives; can lead to a growing role for non-professionals, including wider family members, in gatekeeping information about donor conception; accentuates the effect of donor conception for donors’ and the relatives of donor-conceived people; and shapes, and is shaped, by the formal regulatory donor information management systems. ConclusionFertility professionals should inform people using, or considering, donor conception, or (potential) donors, about the different ways DTCGT can affect sharing information about donor conception. Support is needed for those affected by these changes.

The motives and experiences of donor-conceived persons requesting the identity of their sperm donors

Research questionWhat are the motives and experiences of donor-conceived persons (DCP) who search for and receive information about their identity-release sperm donor? DesignA qualitative interview study with 29 individuals (21 women, seven men, one non-binary) who were consecutively recruited after having requested information about their sperm donor at five Swedish University hospitals. All participants were conceived after donor insemination to heterosexual couples within an identity-release donation programme. Individual semi-structured interviews were conducted face-to-face or via telephone between September 2016 and November 2019, and transcribed audio recordings were analysed using reflexive thematic analysis. ResultsThe motives and experiences of DCP were described in two themes. The theme ‘donor information can fill different needs’ describes that varying motives, thoughts and feelings are related to searching for and obtaining donor information. Motives ranged from curiosity and a desire for agency over one's conception to hopes of finding a new father. The theme ‘navigating donor information in a relational context’ describes the process of obtaining donor information as interpersonal, highlighting that the DCP needs to balance the interests of different stakeholders, and that obtaining donor information can challenge the relationship quality with the father. ConclusionsObtaining the donor's identity has the potential to affect the understanding of DCP of themselves, and to influence relationships within their family in unexpected and challenging ways. Therefore, adequate resources should be allocated to support the growing number of families after identity-release donation.

A Sense of Connectedness in Reproductive Donation. Contrasting Policy With Donor and Donor Kin Lived Experience

This article asks how well new developments in family life are reflected in law and policy, with a particular focus on donor conception. There has been an unprecedented ‘opening up’ of family life in recent decades; this increased diversity is, at least in part, linked to developments in reproductive technologies, including gamete donation. In family lives touched by donation, genetic relations with ‘donor connections’ take genetic connectedness beyond traditional notions of kinship. There is not yet an established social script for how to understand what constitutes meaningful connectedness in reproductive donation. Focussing on the UK context specifically, where assisted conception is highly regulated, this article examines on the one hand, how UK law and policy portray meaningful connectedness in the context of donation, and, on the other hand, how well this fits with connectedness as experienced within egg and sperm donor communities. Drawing on original data from UK law and policy analysis, and empirical interview data with egg and sperm donors and their kin, our analysis shows important disparities between law and policy, and the empirical evidence, suggesting a need for an overhaul of UK donor conception law and policy.

“Tango for Two”: Women’s Interviews in Clinical Reproductive Practice

This article attempts to combine data obtained through interviews by a psychologist of female donors participating in an assisted reproductive technology program and interpret them through narrative analysis and communicative situation analysis. The article describes the structure of an oocyte-donor which has never been done before with reference to Russian-language material. An ethical platform for the study is openness to a new type of scientific knowledge that results from the interpretation of the informants’ answers who try to comprehend their motives to donate. The narrative analysis of 21 transcripts helps determine the roles of the interviewer and the informant at each stage and their contribution to the discussion-testing communicative situation. The interview includes several stages, such as “a window to the past”, at which the autobiographical narrative is recorded as comprehensively as possible; a description of the donor’s current state which focuses on strategies for solving problem situations; the interview ends with a series of thought experiments that allow the psychologist to assess the emotional stability of the potential donor and make a forecast regarding the prospects for long-term cooperation with the reproductive medicine clinic. The paper outlines the cases of participants’ cooperation and mismatches in building a credible and value-consistent autobiographical narrative that includes the donation experience. The authors seek to fit this experience into a broader value context, including a compensatory one related to the urgent problems of potential donors. Women’s answers help specify the concept of donor ‘multi-motivation’. The ambiguity of public opinion regarding donation as a reproductive medicine phenomenon is expressed in the fact that the availability of information for those who are aware of the issue co-exists with donors’ persistent reluctance to display their activity outside the inner circle. Research perspectives include the need to consider the narrative contribution of each participant in the situation of reproduction, i. e. physicians, donors, and recipient parents, and its further use in practice.

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

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

Donors: Curious connections in donor conception. By PetraNordqvist and LeahGilman, Bingley, United Kingdom: Emerald Publishing Limited. 2022. pp. 344. £23.00 (pbk); £23.00 (ebk). ISBN: 978‐1‐80043‐567‐4 (pbk)

Sociology of Health & IllnessEarly View BOOK REVIEW Donors: Curious connections in donor conception. By Petra Nordqvist and Leah Gilman, Bingley, United Kingdom: Emerald Publishing Limited. 2022. pp. 344. £23.00 (pbk); £23.00 (ebk). ISBN: 978-1-80043-567-4 (pbk) Rhonda M. Shaw, Corresponding Author Rhonda M. Shaw [email protected] Te Herenga Waka–Victoria University of Wellington, Wellington, New ZealandSearch for more papers by this author Rhonda M. Shaw, Corresponding Author Rhonda M. Shaw [email protected] Te Herenga Waka–Victoria University of Wellington, Wellington, New ZealandSearch for more papers by this author First published: 11 May 2023 https://doi.org/10.1111/1467-9566.13653Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Donors: Curious Connections in Donor Conception, Petra Nordquist and Leah Gilman

Donor-assisted conception is generally not a priority concern in the field of social work. Although often hidden in plain sight, the grief of people with unwanted childlessness and the identity issues of people conceived with the use of donated semen, eggs or embryos may seem very insignificant in the face of structural violences such as climate change, poverty, homelessness and political oppression, where many social workers are engaged in helping those affected. Yet, it was nearly a quarter of a century ago that the BJSW published an article arguing for the continuing contribution of social work to this field (Blyth, 1999) and highlighting the values and principles underlying social work which have relevance to it. At that time, gamete donors in the UK were still legally allowed to remain anonymous, but the British Association of Social Work through its Project Group on Assisted Reproduction (Progar) was campaigning vigorously (and ultimately successfully) for that to change. Social workers had concerns about the destructive impact of secrecy in families and the Human Rights aspect of the discrimination against donor-conceived people in being prevented from obtaining information about their origins.

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...

‘Once you open that Pandora's box, you cannot close it’: a qualitative study on family relationships following insemination fraud

Research questionInsemination fraud occurs when the spermatozoa intended for insemination have been intentionally swapped for another person's without the knowledge of the intended family. In what ways is this experienced by recipient parents and their offspring? DesignThis was a qualitative study involving semi-structured interviews with 15 participants (seven parents and eight donor-conceived individuals) affected by insemination fraud involving the same doctor in Canada. ResultsThis study documents how insemination fraud is experienced by recipient parents and (their) offspring at the personal and relational levels. At the personal level, insemination fraud can induce a sense of agency loss for the recipient parents and a (temporary) sense of identity realignment for the offspring. At the relational level, it can lead to a reshuffling of genetic ties through the new genetic mapping it involves. This reshuffling can, in turn, disrupt kinship ties, leaving a deep imprint that some families struggle to overcome. Experiences differ depending on whether or not the progenitor is known, and when he is known, on whether it is another donor or the doctor himself. ConclusionsGiven the significant challenges that insemination fraud poses to the families who experience it, it is important that this practice be subjected to the medical, legal and social scrutiny it deserves.

Zero or 18

Zero or 18

'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.

Make our wellbeing a priority: donor-conceived adults call for ongoing support and conversation about their donor conception

The experiences of donor-conceived adults have received relatively little research attention despite the increasing trend of gamete conception. In this qualitative study, ten donor-conceived adults: eight women and two men, were interviewed to explore their experience of being donor-conceived. The participants did not automatically have the right to access identifying information of their donors upon turning eighteen as they were born prior to the introduction of the 2004 Human Assisted Reproductive Technology (HART) Act in New Zealand. The overarching theme identified was a need for parents, donors, and the fertility industry to prioritise their longer-term wellbeing. To this effect, participants wanted recognition of the importance of their donor conception history for their identity, and called for early disclosure to be reinforced through open, ongoing conversations with their parents. They highlighted the need for support to process the implications of donor conception, and to search for and link with their donors. Study findings underscore the value of legislation and practices which enable disclosure in the context of ongoing openness and provide access to support for donor-conceived individuals.

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.

Sperm donor attitudes and experiences with direct-to-consumer genetic testing

To identify factors influencing sperm donor willingness to participate in direct-to-consumer genetic testing, comfort with sharing genetically identifiable data in commercial genetic testing databases, and likelihood to donate sperm again. Cross-sectional online anonymous survey. Multicenter, 2 large American sperm banks from July 1, 2020 to July10, 2021. Sperm donors from 1980 to2020. None. Associations between donor demographic characteristics, donation history, and attitudes toward direct-to-consumer genetic testing. A total of 396 donors completed the survey. Most donations (61.5%) occurred from 2010 to 2020, and 34.3% were nonidentified donations. Nonidentified donors were less comfortable with their genetic data being shared than open-identity donors (25.4% vs. 43.8%) and were less likely than open-identity donors to donate sperm again (43.3% vs. 72.1%). Donors who donated after the inception of direct-to-consumer genetic testing in 2007 were less likely to participate in commercial genetic testing than those who donated before 2007 (25.8% vs. 37.1%). Most donors (87.4%) have disclosed their donation(s) to current partners, but fewer have disclosed them to their families (56.6%) or children (30.5%). Of the donors who had been contacted by donor-conceived persons, 79.5% were identified via direct-to-consumer genetic testing. Overall, 61.1% of donors would donate again regardless of direct-to-consumer genetic testing. Direct-to-consumer genetic testing is playing a dynamic role in sperm donor identification, but donors seem willing to donate again. Implication counseling regarding future linkage and contact from donor-conceived persons needs to be standardized for potential donors before donation.

Experiences and attitudes of Danish men who were sperm donors more than 10 years ago; a qualitative interview study.

More knowledge about the long-term impact of sperm donation is essential as the donor's attitude towards donation may change over time. Personal and social developments may prompt a rethinking of previous actions and decisions, or even regret. Thus, the aim of this study was to explore the experiences and attitudes of men who were sperm donors more than 10 years ago. From May to September 2021, semi-structured, qualitative interviews were conducted with 23 former donors (> 10 years since last donation) from Cryos International sperm bank. Two participants were non-anonymous donors and 21 were anonymous. The interviews were conducted by phone or via video (mean 24 minutes). All interviews were recorded, transcribed verbatim and rendered anonymous. Data were analyzed using thematic analysis. The analysis showed that most men had been donors for monetary and altruistic purposes, and now considered sperm donation as a closed chapter that was 'unproblematic and in the past'. Most men valued anonymity and emphasized the non-relatedness between donor and donor conceived offspring. Knowledge about recipients and donor offspring was seen as 'damaging' as it could create unwanted feelings of relatedness and responsibility towards them. All men acknowledged donor conceived persons' potential interests in knowing about their genetic heritage in order to understand appearance and personal traits, but also emphasized the donors' rights to anonymity. Potential breach of anonymity was generally considered 'highly problematic' as it was expected to disturb their families and force a relationship on them. This study reports on former donors who might not have volunteered for research due to lack of interest or protection of privacy. The majority of men valued anonymity and clearly demarcated a line between sperm donation and fatherhood, which was enforced by not knowing about the donor offspring or recipients.

Donor Conception, Genetic Knowledge, and Bionormativity: A Book Review of Daniel Groll's Conceiving People.

Donor Conception, Genetic Knowledge, and Bionormativity: A Book Review of Daniel Groll's Conceiving People.

The Role of Buffers in Establishing a Balance of Homeostasis and Maintaining Health

Homeostasis is the body’s ability to self-regulate biological processes. There are several buffer systems in the body that operate cooperatively to maintain health. A buffer system consists of two components, one that acts on its counterpart. In acid-base homeostasis, almost all physiological processes in the body occur as a result of a buffer that allows a solution to tolerate pH changes. Buffers can be used beyond the concept of hydrogen ion donors or acceptors. A body consists of numerous components and their counterparts, such as excitatory and inhibitory neurotransmitters, entropy and potential energy, and anabolic and catabolic metabolic processes. As for values, they can be material and non-material; behaviours can be permitted or prohibited. Buffers play an important role in maintaining balance, but their capacity needs to be improved in order to handle stress more effectively. It is appropriate to evaluate buffering systems by analogy to acid-base buffers, and the results can be interpreted in terms of maintaining balance. A well-coordinated and compatible system helps maintain a balance between matter and its counterpart, enabling the immune system to function effectively and maintain homeostasis.

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.

The influence of avoidant attachment and perceived support on disclosure about involvement in donor-assisted conception to family and friends.

Do the attachment-related dimensions Anxiety and Avoidance and perceived partner and social support in recipients and donors influence disclosure to others about their involvement in donor-assisted conception (DAC)? A higher global score on attachment Avoidance was associated with greater non-disclosure about involvement in DAC by participants to relationship-specific others. Within the context of DAC, the topic of disclosure has been investigated in terms of the 'if', 'when', and the 'how' to disclose about circumstances of conception. Less focus, however, has been directed to investigating psychological theoretical frameworks that influence disclosure decisions to others, i.e. to whom information is disclosed and to what extent details are transparently revealed about the donor programme. The study was of a cross-sectional design and utilized a sample of 301 participants who were, or had been, involved in DAC, and were recruited across states of Australia. An online self-report questionnaire was completed between June 2014 and June 2017. English speaking participants consisting of 209 female recipients and 92 donors (36 sperm; 48 egg; 8 embryo donors). Of the recipients, 104 had successfully conceived children via donated gametes (68 sperm, 23 eggs, 6 embryos, and 7 recipients where both gametes were donated from 2 donors to create the embryo). Participants anonymously completed an online questionnaire consisting of five sections: Demographics, Donor Conception and Disclosure Practices, the Experiences in Close Relationships-Relationships Structure, the Quality of Relationship Inventory, and the Multidimensional Scale of Perceived Social Support. Pearson correlations, independent samples t-tests, Chi-square, and ANOVA were used to explore the association between attachment Anxiety and Avoidance scores and disclosure about involvement in a DAC programme to significant others (i.e. parents, siblings, in-laws, and friends). Compared to published community cohort data, participants reported lower global scores on attachment Anxiety and Avoidance and high levels of romantic partner and social network support, suggestive of secure relationships in the overall study sample. A higher score on attachment Avoidance was associated with less disclosure to significant others in their social network (i.e. parents, siblings, in-laws, and close friends), even in the presence of strong partner support (partial r = -0.248, P = 0.005). Higher scores on attachment Avoidance were inversely associated with level of perceived partner and social network support (all P < 0.05). Irrespective of attachment scores, more than 90% of all participants agreed that a child born of DAC should be told about mode of conception. This study utilized a cross-sectional design precluding causal inferences between dimensions of insecure attachment and disclosure practices. Participants were required to self-report on the quality of their relationships with the potential for social desirability respondent bias. The study's self-selecting sample may limit generalization to participants who were dis-inclined to participate. Specifically, respondents who have an Avoidant attachment style, may have elected not to participate in the study. Given the increased use of biotechnology and digital facial recognition enabling self-discovery of the donor and the donor's extended family, non-disclosure about involvement in DAC may have consequences. An 'Avoidant' attachment style is important to assess as a potential risk factor for non-disclosure about involvement in DAC across different relational contexts (e.g. close family members and friends). Fertility counsellors should consider introducing a measure of attachment screening as a pre-emptive psychoeducational strategy during donor implications counselling. This information could be used to offer patients insight into concerns they have about DAC disclosures to key important relationships, providing a target of clinical intervention. No external funds were sought for this work. None of the authors have any competing interests to declare. N/A.