# Psychological impact of donor conceptions on all involved



## Me Myself and I (Dec 30, 2012)

Following the feelings and emotions thread I thought I would post this. It's very long but worthwhile reading.

Psychosocial considerations
Psychosocial considerations in the case of donor insemina- tion are essential to evaluate the interests of the different stakeholders: donors, parents and offspring. From a theo- retical perspective, donors may envy, be neutral, or be over- whelmed by having many offspring, and possible contact with donor offspring. Parents, at best (most probably), will be neutral, but more likely may well feel offended by donors seeking contact with them or their donor offspring, al- though exceptions with positive experiences exist, espe- cially in single mother and lesbian relationships. Offspring may be neutral, be curious or be longing to know their donor and to contact them. It is important to remember that, in addi- tion to the primary mentioned stakeholders, any relatives of stakeholders may also be affected by donor-related experi- ences. Such considerations include the experiences, opin- ions, feelings and expectations of each party, the interactions that the stakeholders may have with each other, and the social context within which this takes place.
Prima facie it seems useful to make a distinction between systems with guaranteed anonymous donors and donors whose identity may be released to the offspring (for an overview see Janssens et al., 2011). In anonymous systems, the expecta- tion is that donors, offspring and 'donor siblings, will nor- mally never have contact, suggesting that the contact argument counts differently in each system. It is doubtful, however, whether it is wise to preserve the distinction between anonymous and open-identity systems in view of the modern developments in information and communication systems (the Internet) and in DNA-technology and matching techniques (Sawyer, 2010). In the long run, parents in anony- mous systems may not be able to keep secret their chosen method of conception, and donors may find their privacy
breached by donor offspring using increasingly sophisti- cated methods to trace them. When one also takes into account the mobility of people that results from improved access to travel, it seems reasonable not to take into account regional or even national quota. An anonymous donor will usually experience fewer consequences of his donation, because the offspring (and parents) do not know him, so cannot easily seek contact, as long as the anonymity is preserved. In view of that, the only psychological arguments to be con- sidered for anonymous donors would relate to the idea the donor has in his mind when doing his donation (i.e. what he considers acceptable and reasonable as offspring number - offspring that would never know him). Seen from this per- spective, any quota on offspring might be permitted to be less stringent for anonymous donors than for non-anonymous donors. The latter would be likely to experience much more from their donation, so may be expected to request more strin- gent quota. By treating the issue only from the perspective of non-anonymous donation, we suppose we will end up with the more stringent figures, which only will overtly be more safe for anonymous donors if they were traced, as de- scribed in our genetics discussions above. Moreover, half- siblings from either anonymous or non-anonymous donations are nowadays already as likely to trace each other if they wish, using molecular genetic methodologies. This led us to make no distinction between anonymous and open identity systems in our psychosocial considerations.
Striving to make recommendations on donor quota, argu- mentation based on psychosocial evidence brings a chal- lenge, as the different stakeholders in donor insemination can have widely differing opinions, feelings and expectations. Even within groups of stakeholders, the opinions, feelings and ex- pectations can differ widely (Kirkman, 2003). In addition, there is as yet only a limited body of psychosocial research avail- able, using a limited range of methodologies and drawing on small numbers with a potential for bias that will not be un- derstood more fully until greater numbers are conducted (for a review see Blyth et al., 2012). Much existing research is quali- tative research and hence does not seek to evaluate the dif- ferent perspectives of the stakeholders but instead to increase understanding of the range of views (Mason, 2002). No studies were found with a sole focus of gauging views on donor quota.
With that in mind, a growing body of psychosocial re- search indicates the potential complexity of managing new relationships and contacts following the 'matching' of ge- netically related parties, be that between donors and off- spring, 'donor siblings', or parents whose children were conceived using the same donors (Blyth, 2012a; Freeman et al., 2009; Hertz and Mattes, 2011; Hertz et al., 2013; Jadva et al., 2010, 2011; Kirkman et al., 2014; Kramer and Cahn, 2013; Scheib and Ruby, 2009).
In a study concerning 63 German donors, 19% considered the national limit of 15 offspring per donor appropriate, 11% considered it too high and 27% too low (43% had no opinon), (Thorn et al., 200. A recent survey among 21 sperm donors registered with a UK-based DNA-based voluntary contact reg- istry showed that most sperm donors (13) imposed no limit on the maximum number of offspring conceived with their gametes and one would accept 'more than 20', whereas four would feel comfortable with five to 10 offspring and one fewer than five (van den Akker et al., 2015). These figures suggest that many donors consider rather high limits acceptable, but taken into account should be the fact that these data are from men that are interested in the outcome of their donation, which may lead to higher limits. Also, in a study among Danish sperm donors, 71% of the respondents said the offspring number did not matter; it might even be higher than 100 (Bay et al., 2014). A survey among 47 donors in the Netherlands reports that donors on average choose for 20 offspring per donor, whereas almost one-half accepted the 25 offspring allowed according to the professional Dutch directive (Winter et al., 2012). Rather contrasting with these figures are the results of a recent paper reporting on the attitude of Swedish gamete donors, showing that one-half of the sperm donors think that the offspring from a single donor should not exceed the number of 10, whereas 13% thought it should be limited to 15 (Sydsjö et al., 2014). Only some 12% of the donors in this study considered more than 30 or an unlimited number of offspring per donor acceptable. One study actually re- ported a donor having concerns about managing large numbers of offspring (vaguely specified as something like 14-27), should they appear (Crawshaw et al., 2007). An internal survey of UK DonorLink Registrants Panel's views about donor limits in 2012 (surveying offspring and donors), (Crawshaw, personal communication) and a German survey on parental attitudes (Thorn, personal communication) indicated that, according to a small majority of the respondents, the number should not exceed 10 offspring or families per donor. Donor off- spring in the UK DonorLink survey were inclined to favour lower limits than were donors and in addition more likely to believe that any limits should include the donors' own children. The former was not found in the survey of van den Akker et al. (2015), in which 62% of the donor offspring said to find 'no limits' on the number of siblings acceptable (63 responding donor offspring), so a majority, and a figure comparable to that of the donors. A survey among UK parents, patients, donors, offspring and the general public found that, al- though the number of families helped by one donor should go no higher than the UK limit of 10 (the UK guidelines count in families not offspring), a number which could potentially lead to about 20 offspring per donor (http://www.hfea .gov.uk/5605.html). Where surveys were conducted in coun- tries with national donor quota in place such as the Germany, UK, Denmark and the Netherlands, it should be noted that this may have influenced responses, with figures tending towards the status quo, as a hard-to-prevent effect of the well- known psychological anchoring and framing effects (Kahneman, 2011).
A survey on donor insemination recipients registered at the American Donor Sibling Registry (DSR) showed that 75% of 621 respondents preferred offspring limits between 1 and 10, with 43.2% indicating exactly 10 offspring per donor, whereas a small proportion (5.0%) of respondents thought that as many as 25 is acceptable. In addition, 78% of 1562 respondents in- dicated that donors should be restricted in donating at more than one semen bank, heterosexual-couples and single women being more in favour of this than respondents from lesbian relationships (Sawyer et al., 2013).
Systematic studies on the opinion of offspring on donor quota could not be found, although in some articles it has been reported that offspring (Allan, 2012; Blyth, 2012a, 2012b; Cushing, 2010; Kirkman, 2003, 2004; Rodino et al., 2010), and on occasion donors (Crawshaw et al., 2007) mention general concerns about accidental consanguineous relationships. Many
professionals in the field, however, find the extent to which such expressions of concern from self-selecting respondents (who may be those with the strongest desires and convic- tions) should influence the debate is difficult to determine. As with any developing field of research the use of data to assist discussion of setting donor quota is limited by the dearth of controlled studies with which to augment the growing un- derstandings offered by qualitative studies with limited se- lection criteria.
Given the limited research evidence base and that the focus of much psychosocial research is on the complexity and am- biguity of human reactions, interpretations benefit from also drawing on the practice experiences of psychosocial profes- sionals and the theoretical frameworks that are widely used to understand child development and family systems (Featherstone, 2009). Of potential significance is the family size norm in a given culture at a certain moment and the number of offspring with whom a donor may seem likely to manage an ongoing relationship, or the number of 'donor sib- lings' relationships that appear manageable, if desired. In situ- ations in which donor-siblings have met, no differences have been reported in the experiences among donor offspring in terms of whether they were in small or big groups (Jadva et al., 2010); elsewhere, however, higher numbers have produced challenges that need to be managed as well as rewarded (Blyth et al., 2012; Hertz and Mattes, 2011).

/links


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## Me Myself and I (Dec 30, 2012)

Part two is a lot shorter!

. The nature of any re- lationships resulting from 'matching', whether they are in- timate and long-lasting, and whether they will form a burden or be a pleasure for those involved is currently little under- stood. The likelihood is that there will be a range of experi- ences, related in part by the motivation behind searching. It should also be borne in mind that the effect and implica- tions can spread to each party's existing kinship and social networks too (Beeson et al., 2013).
Overall, this might be taken to suggest that high off- spring numbers might well, but should not necessarily, be del- eterious. To be on the safe side, however, the psychosocial point of view led to the conclusion that no more than 10 fami- lies per donor is reasonable, noting our recommendation that the numbers be discussed with donors, prospective parents, children, regulators and the public, in the context of 'fami- lies'. It is of course worth recognizing here that, in any system, the donors themselves should have a say and determine a lower maximum number of families to be created from their gametes than allowed according to the accepted donor quotum. We think that this is reasonable and in line with Western culture, because a donor gives something with great potential con- sequences, possibly also for himself (in cases where he would be identified). Also, as semen banks are (naturally) in need of having donors, it is not unwise to accommodate to rea- sonable wishes of donors.

http://www.rbmojournal.com/article/S1472-6483(15)00065-6/pdf

/links


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## nevertoolate (Jul 15, 2015)

Thanks. Would it be an idea to put the general overall points on there for people


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## Godiva (Nov 19, 2015)

Basically the article does not say very much really, apart from the fact that with growing access to information through internet and genetic testing, it is probably hard to keep donor conceived offspring in the dark about their origins, and even anonymous donors might in the future be able to be traced without too much difficulty. Then the article goes on to discuss limits to the number of offspring per donor, only saying what is the case now in a number of countries, and what people involved (mainly the donors though) think of this number.

I do think the number thing is an interesting concept, and I think few people are aware that the choice of spermbank can influence the number of "donor siblings" (I mainly talk about sperm donors because egg donors are less likely to have huge numbers of offspring around). The UK's HFEA system is quite a strict regulatory system: due to the fact that there is a central registration, a donor can not donate at multiple clinics and conceive a multiple of the "national maximum number of families". In Holland there is a similar system. In Belgium (where spermbanks only offer anonymous donors) there is no central mechanism, so even with a maximum number of families imposed by the law, there is no real way to check whether the donor has not donated to other banks too (and every clinic tends to have it's own bank). A donor could thus for example help conceive 6 families in Antwerp, 6 in Brussels and 6 in Ghent. The same goes for the big Danish banks: nothing stops a donor from donating at different banks. Each bank sticks to the different national limits of offspring/families per country, but there is no absolute maximum per donor. This means a donor could help 25 families in Holland, 15 in Germany, 6 in Belgium, 10 in the UK, 15 in France,... add these numbers up and you already have 70-ish families (possibly with more than 1 child each) in just 5 European countries! In some countries there is also an uncontrolled circuit, where parents-to-be and donors meet through internet and make private arrangements for home inseminations, which could add to the number of children one donor has.
This thought process why I ended up seeking treatment in a UK clinic with help of a UK spermbank, preferring not to use a Danish bank.


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## nevertoolate (Jul 15, 2015)

Do you think there is a big chance of the sperm donor donating multiple times with different clinics.I know it is possible but is it really likely


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## Godiva (Nov 19, 2015)

I do not know. I think it does happen, but probably not on a large scale. The chances are smaller with the big Danish banks, as a donor can go back there so often to donate, it is hard to imagine somebody going to 2 banks. In the Belgian setting however I am less sure: a donor might move, might live in one place and work in another making access to both banks easy,... And judging by some of the "adds" I have read by people offering to be a sperm donor for home insemination: there are some crazy people out there   (and of course also many people who just want to help, but sometimes do not think of the reason they might have a maximum number of donations they can do).


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## Godiva (Nov 19, 2015)

As info from uk clinics is registered with hfea i do not think a donor could go to different clinics for more than 10 families. I  am getting treatment in London as the hfea donor registry system seems a good thing, and because of the limited number of familied per donor.


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## Me Myself and I (Dec 30, 2012)

Godiva said:


> As info from uk clinics is registered with hfea i do not think a donor could go to different clinics for more than 10 families. I am getting treatment in London as the hfea donor registry system seems a good thing, and because of the limited number of familied per donor.


I know that the banks that import to uk also fulfill all of the hfea regs. So if a donor has met his ten family quota in uk he will be listed as unavailable. Even if the woman had treatment in another country!


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## Godiva (Nov 19, 2015)

HFEA logs treatments in the UK, not outside of the UK. This means that if a UK citizen had treatment outside the UK, it is not logged with the HFEA. This is also valid for UK spermbanks: if they export sperm abroad, this is not logged with the HFEA. A person conceived with UK sperm abroad, can not access donor information through the HFEA. 
I am pretty sure the international banks work in the same way: a "family" is registered in the country where the treatment takes place, not where they live or originate from. Of course there are different "safety standards", but in fact they all boil down to the same thing. Getting treatment abroad does not mean you are running huge risks, even though the sperm does not have an official "HFEA approval". In fact: if anonymous sperm is used, it is per definition not "HFEA approved", but just as safe.
The crucial words are that the family quota is per country. This means that the donor can still be used in other countries.


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## K jade (Aug 11, 2013)

thanks for posting. 
just wandering how do people come to terms with knowing that their potential child or child may have lots and lots of half sibs out there?
we are using xytex as that is what our NHS clinic is alifiiated with
so there may be quite a few children as a result  
luckily only 10 in the UK, but USA


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## Me Myself and I (Dec 30, 2012)

K jade said:


> thanks for posting.
> just wandering how do people come to terms with knowing that their potential child or child may have lots and lots of half sibs out there?
> we are using xytex as that is what our NHS clinic is alifiiated with
> so there may be quite a few children as a result
> luckily only 10 in the UK, but USA


I initially used xytex, but decided there seemed like there would be fewer siblings if used a donor via cryos! No real logic lol.

I used a donor with proven pregnancy but I hated knowing this meant there was no doubt my lo has siblings somewhere!

My only saving grace is that my donor doesn't meet the id release requirements for uk, so hopefully this reduces UK number of siblings.

I did look to see if anyone had registered on the siblings registry but they have not as yet!

The draw if finding siblings concerns me as lo will be an only child so looking for them maybe appealing?


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## solomum (Apr 17, 2012)

Godiva is correct that sibling limits are only respected within a specific country - so Xytex UK compliant donors can be used by ten families within the UK and then multiple times all over the world, the only restriction being each country's national limit (and some countries don't have national limits e.g. in the US).  Scandanavian and US banks are likely to have very large sibling groups (80 plus).

As a note: apart from errors (which have happened) UK donors will not be able to donate multiple times or go over the ten family limit. HOWEVER, some UK sperm donors are also active as private sperm donors, and thus also have multiple offspring in the unregulated sector (I went to a talk once where a donor spoke about doing just this). 

And Jade, in answer to your question, how do people come to terms with all these siblings...
Some people ignore it,
and others embrace it and treat the whole thing like a great big extended family.
Xytex is an interesting bank as it now has it's own internal registry for voluntary half-sibling/donor matching
you could sign up to it.
You can also look on the donor sibling registry www.donorsiblingregistry.com to see if your donor is already listed and you already have half siblings
(I've met my children's donor half siblings and it's been very positive)

/links


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## its the hope that hurts (Mar 19, 2014)

How easy do you think it will be for children of egg donors, to find their d-sibs or genetic mothers?  If anonymous and abroad, but say have a rare trait?  DCN before reckoned that in 18 years time, it would be easy to register you dna on the donor sib registry and find any sibs (who want to be found)  or a donor.


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## Me Myself and I (Dec 30, 2012)

its the hope that hurts said:


> How easy do you think it will be for children of egg donors, to find their d-sibs or genetic mothers? If anonymous and abroad, but say have a rare trait? DCN before reckoned that in 18 years time, it would be easy to register you dna on the donor sib registry and find any sibs (who want to be found) or a donor.


The speed that dna market has progressed its technology is already available so by the time our los are eighteen I would imagine it being a case of if they want to trace via dna rather than is it possible to trace via dna.


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