The Donor’s Responsibilities

This chapter considers the nature and extent of a gamete donor’s responsibility for their genetic offspring. The author argues that even if gamete donation is the kind of activity that triggers parental responsibility, gamete donors do not typically ever incur actual parental responsibility. Instead, they incur prospective parental responsibility, which is typically transferred to intended parents before the child comes into existence. The author argues that while prospective parental responsibility can be responsibly transferred, potential donors are generally obligated to be open donors so as not to implicate themselves in the morally problematic practice of conceiving children with anonymously donated gametes.

Conceiving People

Each year, tens of thousands of children are conceived with donated sperm or eggs, aka donated gametes. By some estimates, there are over 1 million donor-conceived people in the United States and, of course, many more the world over. Some know they are donor-conceived. Some don’t. Some know the identity of their donors. Others never will. Conceiving People: Identity, Genetics and Gamete Donation argues that people who plan to create a child with donated gametes should choose a donor whose identity will be made available to the resulting child. This is not because having genetic knowledge is fundamentally important. Rather, it is because donor-conceived people are likely to develop a significant interest in having genetic knowledge and parents must help satisfy their children’s significant interests. In other words: because a donor-conceived person is likely to care about having genetic knowledge, their parents should care too. Questions about what the donor-conceived should know about their genetic progenitors are hugely significant for literally millions of people, including donor-conceived people, their parents, and donors. But the practice of gamete donation also provides a vivid occasion for thinking about questions that matter to everyone. What value, if any, is there in knowing who your genetic progenitors are? To what extent are our identities bound up with knowing where we come from? What obligations do parents have to their children? And what makes someone a parent—the person responsible for lovingly raising a child—in the first place?

Policy and Practice

In this chapter, the author argues that even though creating children with anonymously donated gametes is (usually) morally wrong, people should be legally allowed to do it. This is partly because the failure to use an open donor is on a par with other permissible parental failures. But it is also because legally prohibiting anonymous gamete donation without simultaneously working to disrupt the bionormative schema of society will have negative expressive effects. This last point leads to a longer answer to the question of whether anonymous gamete donation should be prohibited: if legal prohibition should be pursued, it should only happen in the context of combating the bionormativity of society so as to minimize the expressive effects of simply outlawing anonymous gamete donation.

Parents’ psychological adjustment after gamete donation: a systematic review

The age factor plays a key role to the successful rates of ARTs protocols. The practical answer to this problem would be the acceptance of an egg, donated by a younger woman, who wants to undergo ovary stimulation, thus offering her cell to a female recipient. This review aims to investigate the psychological adjustment of parents who have used gamete donation, as well as its effect on the psychological adjustment of children in case of disclosing the children’s donor origin. The PubMed and Google Scholar databases were searched for peer reviewed papers, focusing on parents’ psychological adjustment after gamete donation. Key search inclusion criteria included all papers published in English (between 2005 and 2019) relating to investigate the psychological adjustment of parents after gamete donation, as well as its effect on the psychological adjustment of children in case of disclosing the children’s donor origin. These families are possibly expected to be affected by the circumstances of the birth, especially in case of gamete donation or surrogacy, in terms of parents’ thoughts, feelings and behavior towards the child.

P–478 Quality of life assessment in women undergoing assisted reproduction. A study of FertiQol and HADS

Study question The present study aims to explore infertility-related psychosocial outcomes, including fertility quality of life (QoL), as well as anxiety and depression levels, in women diagnosed with infertility. Summary answer Differences on fertility-related QoL appeared when comparing treatment types (gamete donation vs own gamete). Furthermore, statistically significant associations were found between QoL and anxious-depressive symptomatology. What is known already Those who wish to have children and do not achieve their objective just like other peers can see their goals and expectations with pessimism, generating concern and a series of negative emotions. Several psychological implications of infertility have been described, such as increased levels of stress, anxiety, depression, decreased self-esteem, mood and hope, or poor relationship adjustment. The emotional impact of infertility in people’s life cycle can be so strong that reducing it only to biological aspects would lead to a dangerous situation of neglect. For this reason, QoL assessment in ART becomes an important need. Study design, size, duration FertiQol stands as the most widely used tool to assess infertility-related QoL, overcoming the limitations of other instruments that only target specific medical conditions. The present is a multi-site cross-sectional study over patients with infertility (n = 104), aiming to explore their fertility-QoL, as well as their anxiety and depression levels, which are symptoms that have been previously associated.Questionnaire administration, and sociodemographic and medical data gathering took place between January 2019 and December 2020. Participants/materials, setting, methods Participants were 104 female patients (M.age= 39.8) undergoing or expecting a fertility treatment. The FertiQol Spanish version was administered through mobile app, and its paper version distributed at medical/psychological appointments. QoL was self-reported through FertiQol, assessing the influence of infertility problems in various areas (e.g. impact on self-esteem, emotions, general health, family, partners, social relationships, work, life projects...). Additionally, HADS (Hospital Anxiety and Depression Scale) was provided as a measurement of anxiety and depression levels. Main results and the role of chance Regarding treatments, 50.6% of participants were currently undergoing gamete donation while 44.3% were undergoing treatments that involved using their own gametes. After comparing QoL between these treatment types, results showed that patients who underwent egg donation, compared to those who used their own eggs, reported statistically significantly lower scores of QoL in the Social Subscale (p = .03), but not in the other psychological outcomes. Also, statistically significant negative correlations were found between HADS and all core FertiQol subscales (p< .05). Results are consistent with previous studies showing similar associations between fertility QoL and anxiety and depression, as well as with increased psychological negative implications of gamete donation. The majority of participants reported non-pathological scores of anxiety and depression when considering the cut off value of 8 for HADS, thus suggesting the presence of a relatively healthy sample. The number of treatments that patients had previously taken and the years of infertility were not associated with any of the psychological variables. Limitations, reasons for caution Some limitations to consider are presence of co-morbid diagnosis, differences in medication, or patient’s cultural backgrounds.Also, conclusions should be interpreted cautiously since the design doesn’t allow causal inferences. Further investigations should consider a continuous assessment to explore changes in psychological well-being at different points of intervention, specially with gamete donation. Wider implications of the findings: The great advantage we’ve seen so far when using FertiQol is the possibility to identify more accurately the true impact on other aspects of patient’s well-being besides the emotional area.ART professionals, including psychologists and counselors,will have more information within a small amount of time about QoL when using this tool. Trial registration number 1503-BCN–019-DG

P–477 The child’s right to know vs. the parents’ right not to tell: the attitudes of couples undergoing fertility treatments towards identity-release gamete donation

Study question Do couples undergoing assisted reproduction treatments (ART) have a different perception of anonymous vs identity-release gamete donation than a population interested in the subject? Summary answer Compared with a population interested in the subject, more couples undergoing ART believed the child shouldn’t be given information that would identify the gamete-donor. What is known already Recent research has investigated the psychological well-being of parents and children born through gamete donation, focusing on the possibility of having the donor’s identity revealed. Gamete donors have traditionally been anonymous to recipients and offspring; however, there is a global trend towards programs using donors that are identifiable to the resulting offspring at maturity. While some countries only allow the use of identity-release egg donation, others only allow anonymous-donation, and in some countries both types of donation are practiced. However, the attitudes concerning anonymous vs identity-release gamete donation, in a country where only anonymous donation is allowed, are still unknown. Study design, size, duration This cross-sectional study was performed from 01/Sep/2020 to 15/Dec/2020. For that, surveys through online-platforms were conducted, including either patients undergoing ART, (ART-group, n = 358) or those interested in the subject, who accessed the website of a university-affiliated IVF-center (interested-group, n = 122). Participants in the ART-group were invited via e-mail, with a cover-letter outlining the survey and a link to access it and participants in the interested-group accessed the questionnaire via website. Participants/materials, setting, methods The survey collected information on demographic characteristics and the participant’s attitudes towards anonymity of gamete donors. The questions were: (i) In the case of children conceived through ART, do you believe that revealing the method of conception may affect the relationship between children and their parents? (ii) Once the method of conception is revealed, do you believe that the child has the right to know the gamete donor? (iii) If yes, when? Main results and the role of chance Most of the participants answered that the relationship between children and parents wouldn’t be affected by the child’s knowledge of the origin of their conception, regardless of the group (83.6% vs 82.7%, for ART-group and interested-group, respectively, p = 0.868). Most participants in the ART-group answered that the sperm donor identity shouldn’t be revealed to the child, while only half of the interested-group stated the same (65.4% vs 50.8%, p = 0.044). The same result was observed when participants were asked if the oocyte donor should be identifiable (64.8% vs 50.8%, p = 0.050). When asked when the donor’s identity should be revealed to the child, no significant differences were noted in the responses among the groups (p = 0.868). Most of the participants who believe that the child has the right of learning the donor’s identity, stated that “the donor’s identity should be revealed if the child questions its biological origin” (67.2% vs 67.5%, for ART-group and interested-group, respectively). “Since birth” was the second most common response, (21.0% vs 19.7%, for ART-group and interested-group, respectively), while “when the child turns 18 years-old” (9.2% vs 11.2%, for ART-group and interested-group, respectively), and “sometime during teenage years” (2.5% vs 2.4%, for ART-group and interested-group, respectively) were less common answers. Limitations, reasons for caution Lack of adequate opportunities to conduct face to face interview and lack of knowledge of the real state of the website participants, concerning infertility or being involved in ART. The retrospective nature of the study and the small sample size may also be reasons for caution, Wider implications of the findings: It has been discussed that, whether or not children or parents are harmed by knowing their biological origins, donor offspring have the right to know. However, when facing the situation, couples undergoing ART would argue that in case of gamete donation, there are reasons for not telling the child. Trial registration number Not applicable