Two studies to be published tomorrow (Thursday 27 January) in Europe's leading reproductive medicine journal, Human Reproduction provide a generally optimistic picture about attitudes towards the increasing trend in society to be more open about the use of sperm donors. However, they indicate that not all parents are comfortable with the new openness, there are still many unknowns about attitudes and further research and public education will be needed.
It became compulsory last June in the Netherlands for all sperm donors to be identified. The Fertility Center at Leiden University Hospital has run a double-track system since 1994 allowing couples to choose either an anonymous or an identifiable donor whose details would be available to children when they are 16. This has enabled researchers led by Dr Anne Brewaeys of the university's medical center to compare the reasons for the different choices and provide some insight into the potential impact of the new legislation.
In the UK from April this year all children conceived via donors will be entitled to have identifying information when they are 18. In a study led by Dr Emma Lycett of the Family and Child Psychology Research Centre of London's City University, researchers compared the emotions and experiences of parents who favoured openness with their children with those who were not keen on disclosure.
The Netherlands Study
The Dutch study involved 105 couples seeking a sperm donor for their first child. Sixty-one percent were heterosexuals and 39% were lesbian couples. All received counselling before treatment (which did not include upfront advice about the choice of donor) and data were collected on reasons for their choice. Sixty-three per cent of heterosexual couples and all but one of the lesbian couples chose identifiable donors.
"Motives for choosing an identifiable donor were the same for heterosexual and lesbian couples," said Dr Brewaeys. "The majority pointed to the right of the child to know its genetic origins. Although most parents did not want to be involved with the donor they decided it was not for them to block the child's access to donor information. Access to the donor's medical records was an important factor and some couples were also influenced by the fact that the majority of DI children in the future would have access to information because of the forthcoming legislation."
Dr Brewaeys said that for the lesbian couples, the absence of a male infertile partner spared them the stigma of infertility and their children would be informed early in their lives about their origins.
Among heterosexual couples, those opting for anonymous donors had a different profile from those wanting an identifiable donor. They were more likely to have a low socioeconomic status, difficulties coping with male infertility and an attitude of secrecy to the child. Only 12% had considered adoption. By contrast, among those opting for identifiable donors, the majority were better educated and better off financially, the men dealt better with their fertility problems and secrecy towards the child was not an option. About half had previously considered adoption or a known donor.
"The associations between donor choices, education level and infertility distress were intriguing," said Dr Brewaeys. "We believe these are strongly influenced by the sociocultural environment, with those choosing anonymity living more often in a context where other family values prevail. Male infertility and non genetic parenthood remains more of a taboo whereas childlessness is less accepted. Such values may have influenced the high levels of distress about infertility seen in most of the men and the wish not to tell the children about their genetic origins. However, the design of our study does not allow for firm conclusions: we need more sophisticated measures to disentangle the complex relationships that play a part."
She said that the findings, while they could not be generalised to the whole population, suggested that lesbian couples and more privileged heterosexual parents should fare well under the new laws, but couples wanting anonymous donation appeared more vulnerable. "It's essential that we make available pre-treatment counselling focused on individual motives and attitudes and that we continue the counselling after the birth. We also need to develop education campaigns to prevent further stigmatisation of male infertility, as increased tolerance may influence parents' openness. We also need large-scale follow-up studies investigating DI parents' and children's choices and concerns."
The UK study
UK researchers interviewed 46 families from a London clinic who had a 4 to 8-year old child conceived through DI. They found that 39% were inclined to openness and 61% were not. Thirteen per cent had already told their child, 26% intended to in the future, 43% had decided against telling their child and 17% were still uncertain.
They divided the parents into two groups – disclosers being those who had told their child or intended to and non-disclosers being those who were definitely not telling their child or were uncertain.
The two most important reasons the disclosers gave for telling their child were that they favoured openness to avoid accidental discovery and because they wanted to be honest. Almost half also said they believed the child had a right to know their genetic origins. The reaction of the children who had already been told (six couples whose children were aged between 3 and 5) was generally one either of curiosity or disinterest.
The two main reasons for the non-disclosers not to tell their child were that the parents felt there was no reason to tell, or to protect one or more family members, including the feelings of the child itself. Nearly 30% also felt that openness might affect the relationship between the father and child. Some feared the child might reject them with some fathers being concerned they would be rejected in favour of the biological father.
The researchers found that families with two or more siblings were less inclined to be open, possibly because a decision had been made when the first child was born and the climate was less inclined toward openness, and the parents wanted to remain consistent even if their own views had changed. Couples who had been together longer may also have made their decision long before the birth of the child when attitudes were more inclined to secrecy.
Dr Lycett said that although the sample of parents could not be considered representative of DI parents as a whole, the findings suggested a marked proportion of parents recognised the importance of sharing DI information with their child.
"It will be interesting to know what proportion of those parents who intend to tell the child actually follow through," said Dr Lycett. "An earlier European study of parents in this age group found that fewer than 10% had told their child by the time they reached early adolescence, which shows that intention is not necessarily followed by practice. However, in our most recent study of DI children born since the new millennium 46% of parents said that they intended to disclose the donor conception to the child, suggesting a change in attitudes to openness in recent years."
She said the findings will have practical implications for clinics in the provision of counselling before and after a child's birth, particularly for parents who were unsure about how and when to tell children and the impact and reactions they may face.
"The new legislation could mean a greater proportion of parents will be encouraged to be open, as has been the case in Sweden since anonymity was barred, but it remains to be seen how the new laws will affect parental attitudes towards disclosure in the future."