Non-anonymous Donation Research Articles

O-181 It takes more than genes to build a family

Abstract Sperm donation has been known to mankind possibly for a very long time, although first medical reports come from the late 18th century. Initially, most inseminations in married couples were homologous, involving the husband’s semen. The first publicized breakthrough that came in 1884 would today be considered unethical, as an anesthetized woman was subjected to an injection of semen from a handsome (as duly reported) student of medicine, without any consent of both her and her spouse. The veil of secrecy that covered heterologous insemination was finally lifted when Dr Mary Barton openly acknowledged the practice in her clinic and published the first manual on “artificial insemination.” It set the ethical standards for such procedures—including mutual anonymity of donors and recipients and maintaining absolute secrecy of the fact of donor insemination—for decades to come. The cost was of course the lost identity of the conceived children and the often reported emotional detachment of the fathers from their social, but not genetical, offspring. The grave consequences of the limited pool of donors were yet to be discovered with the advent of DNA testing. In the UK, Barton’s husband and another collaborator were confirmed to father at least 100 children each. In the Netherlands, the country was shaken by the case of Jan Karbaat who used the sperm of an anonymous donor—who probably should not have even passed psychological screening—to bring more than 200 babies to the world. Suddenly, lots of adults learnt of the existence of their never expected siblings. Concomitantly, more and more parents revealed the fact of donor conception to their children motivated by openness. The secrets could not be held any longer and Joanna Rose was the first British woman that won a court case in 2002 against her own country that was wilfully breaking her right to respect for private and family life guaranteed by European Convention on Human Rights. The proponents of open donation found support also in Convention on the Rights of the Child. More and more countries started enforcing either open or at least double-track donation from then on. However, even more legislations blissfully ignore these ethical developments and maintain complete anonymity of the donor insemination procedures. This is where my personal story begins, as a father of twins born in 2012 from in vitro fertilization thanks to the semen of an anonymous donor. At that time, Poland even did not have an actual law on fertility treatment. The ART centres adopted their own policies on anonymous donation and signed contracts with their patients on a case by case basis. The legal status in my country was further cemented with the long overdue adoption in 2015 of Act on Fertility Treatment that forbids non-anonymous donation and even excludes the prospective parents from the decision process on the choice of the donor. The burden of partially lost identity of my kids will be with me possibly my entire life. But I don’t want it to cast a shadow on our family relations. We have to deal with my non-genetic fatherhood one way or another. We maintain our family ties in full knowledge of the fact of the existence of some unnamed benefactor that made this possible. Maybe one day my children will find some unsuspected genetic relatives via increasingly popular public DNA banks if they choose so, thus sticking together parts of their identity. Only time will tell.

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

Five years of single embryo transfer with anonymous and non-anonymous oocyte donation

Single embryo transfer (SET) has been the main embryo transfer strategy in the oocyte donation programme at the authors' clinic since 2000. The primary aim of this study was to evaluate the effect of SET on the clinical outcome in an unselected group of oocyte recipients. A retrospective analysis of the outcome in 142 recipient cycles (116 from anonymous donors; 26 from known donors) was performed. The oocytes from each anonymous donor were shared between two recipients if at least 10 oocytes were obtained. The proportion of SET of all fresh transfers was 77.3%. The clinical pregnancy rate (CPR) was 43.2% and the delivery rate 31.1% per embryo transfer. The outcome was similar in recipients undergoing anonymous and non-anonymous donation. The delivery rates were similar after SET (30.4%) or double embryo transfer (DET) (33.3%), whereas the twin rate was 0% after SET and 40% after DET. The implantation rate was significantly better (P < 0.01) with good-quality embryos (54.7%) compared with non-optimal embryos (27.1%). Of 152 frozen–thawed embryo transfer cycles, 78.9% were SET. The CPR was 28.3% and the twin rate was 7.1%. In fresh oocyte donation cycles, elective SET can be recommended if the embryo quality is considered good, and always if there is a contraindication for twin pregnancy.

Don d’ovocytes : secrets et mensonges

Since 1994, oocyte donation in France must be organized anonymously, in compliance with the bioethics law. The donation is free and any publicity to enrol donors is forbidden. In this system, the recipients are encouraged to incite a donor to visit the recipient's fertility unit. These donors are called "symbolic" donors, since they allow the recipient to be entitred to receive oocytes from another anonymous donor. According to the law, this procedure can be performed both anonymously and non-anonymously. We wanted to study the implication of the anonymous system, focusing on the secret of the child's conception and on the relationship between the recipient family and the "symbolic" donor. We contacted all the patients (n=83) who had children with oocyte donation in our center between 1988 and 1998. These patients participated in an interview conducted with a standardized questionnaire. Fourteen (17.8%) of the couples were lost to follow-up and three declined to participate. Five recipient couples preferred a non-anonymous donation. In all, 70% of the couples had not yet told their child about the donation. They had mentioned the IVF but not the donation despite of the fact that 50% of symbolic donors came from the family of the recipients, 34% from their friends, or 6% from their professional environment; 10% were not related to the recipients. Long after the child's birth, 25% of the recipients had no contact with the symbolic donor but 41% had selected her as the child's godmother and 15% of symbolic donors were the first to be informed of the birth of the child. After the donation, a gift was offered to the "symbolic" donor by 57% of couples, 33% did not know how to thank them (retribution is forbidden by law) and 10% of couples mentioned that their donor refused any gift. Concerning the donor whose oocytes were used, 63% of recipients did not want to know anything about her. 20% would have liked to have medical information and 13% would like to have all kind of information about her. Only 2% of recipients would have liked to know her identity and 2% would have liked to meet her. In agreement with earlier reports in the literature, the majority (70%) of the parents did not inform their child about the oocyte donation even though the symbolic donor was in contact with the child (being his aunt or his godmother for example). The French system has created a double debt: one related to the real donor and another related to the symbolic donor. In the long run, the parents have found a way to humanize this technique: they have given a symbolic place of godmother to the volunteer donor.

Beneath the rhetoric: the role of rights in the practice of non-anonymous gamete donation.

The use of rights based arguments to justify claims that donor offspring should have access to information identifying their gamete donor has become increasingly widespread. In this paper, I do not intend to revisit the debate about the validity of such rights. Rather, the purpose is to examine the way such alleged rights have been implemented by those legislatures that have allowed access to identifying information. I will argue that serious inconsistencies exist between the claim that donor offspring have a right to know the identity of their gamete donor and the way such a right is currently met in practice. I hope to show that in systems where non-anonymous donation is practised, an understanding of the proclaimed right of donor offspring to know their genetic identity is one composed of two different rights--the right to know the circumstances of their conception and the right to information identifying the gamete donor--can provide important insights into this important area of public policy.

Gamete donation and anonymity: the ethical and legal debate.

The British government is currently considering whether to review the law on information provision for donor offspring. This paper therefore provides an overview of the current international legal situation relating to donor anonymity and a review of the key arguments and evidence on both sides of the debate. While the British government is considering all aspects of information giving, both identifying and non-identifying donor information, this paper will focus on the most contentious issue: the provision of information that would identify the donor. The current legal situation in the UK and internationally is examined, drawing attention to a possible international trend towards more information giving. The evolution of the present British system is outlined and it is asked whether some of the concerns and values that gave rise to the practice of anonymous donation are still relevant today. Looking at the concept of a child's right to know their biological identity it examines the possible basis of such a right and its potential conflict with the perceived interests of the child's parents. Finally, some of the practical obstacles to non-anonymous donation are evaluated. The paper concludes that a review of the British law is both timely and desirable.

Attitudes towards gamete donation among couples undergoing in vitro fertilization

The attitudes of 234 anonymous couples undergoing in vitro fertilization toward sperm and oocyte donation were explored by questionnaire. All the questionnaires were returned of which 222 (95%) were complete and analysed. A high proportion of couples found the use of donor sperm acceptable for therapeutic, diagnostic and treatment purposes (77%, 90% and 97% respectively) and 72%, 84% and 90% respectively were willing to donate oocytes for these purposes. Of potential oocyte donors 41% would agree to nonanonymous donation, 12% would wish to meet the recipient couple and although only 4% wanted to choose the recipient, a quarter of the couples would prefer a relative or friend as the recipient. Provision of nonidentifying information about the donor to the recipient couple was acceptable to almost 70% whereas 40% found giving the same information to the child acceptable.

Anonymous and non-anonymous oocyte donation preliminary results.

During the past year, we have developed an oocyte donation programme in 10 patients with complete absence of endogenous ovarian function (premature ovarian failure in seven cases, castration in two cases and Turner's syndrome in one case). In cases of anonymous donation, donors were volunteers devoid of any major genetical risk who were included in our IVF programme and who consented to donate one oocyte when at least seven oocytes were recovered, and two oocytes when at least 11 oocytes were recovered, to a recipient couple. As far as possible, morphological characteristics of both couples were paired. In cases of non-anonymous donation, donors were 'affective' donors, having at least one child. The resulting embryos after IVF of donated oocytes were either replaced directly in recipient women which required synchronization of the donor's and recipient's cycles, or cryopreserved and then thawed, usually at day 16 of recipient's artificial cycle, i.e. 2 days after introduction of the progestational compound. On the 10 patients entering this oocyte donation programme (20 cycles), 13 transfers were carried out resulting in four clinical pregnancies in three patients with premature ovarian failure and one with Turner's syndrome (20% pregnancy per cycle and 31% per transfer). Despite the small numbers, these good results prompted us to develop this protocol.