Colouring the different phases in gamete and embryo donation

Gamete and embryo donation, although technically fairly straightforward, are psychologically, emotionally and socially complex, having significant impact on parents and donor offspring. The activity follows a pathway that can be distinguished in multiple phases, each characterized by specific choices and dilemmas for which no standard solutions are available (Figure 1). The expectations, beliefs and considerations of parents and offspring, in combination with past and present experience, are crucial for the choices made in each phase. Choices that, often, cannot be reversed once they are made. This underlines the importance of providing good information for participants and all others involved: professionals, policy makers and governments. For the latter, having balanced information is of additional importance as they make the regulations that determine the freedom of choice. Gamete and embryo donation are relatively new, having been used on a wide scale for just 30 and 15 years, respectively. Only now are significant numbers of children from the first gamete and embryo donation period approaching adolescence or adulthood. Moreover, the significant use of donors whose identity can be revealed to donor children stems only from the last decade. So there is still much to be learned about the later phases of gamete and embryo donation, and even more concerning the use of open-identity donors. Accordingly, the development of donor parents and offspring through different stages is followed in the scientific literature. Research groups based around Golombok (UK) and the Scheib (CA, USA), as well as others, have presented useful information in this context. In the present issue of HR, another relevant piece of knowledge is added, concerning the contacts of donor parents plus their children with donor (half)siblings and, to a lesser extent, donors (Freeman et al., 2009). In addition, a second study by MacCallum (2009) is presented, which compares embryo donation parents with adoption parents. This highlights the importance of the gestational link in conceiving children. The findings presented, as usual, will probably affect our views on gamete and embryo donation issues and may be also influence our views on adoption and surrogacy. In an extensive study, Freeman et al. (2009) describe the motives, impact and experiences of parents searching for and contacting donor siblings and the donors of their donor children. The research data were gathered by means of questionnaires filled in by 791 parents registered in the Donor Sibling Registry set up in the USA. This registry, with more than 22 000 registrants at the end of 2008, is presently by far the largest of various worldwide family and donormatching services on the internet (www.donorsiblingregistry.com/; some other registries: www.ukdonorlink.org.uk, www.groups.yahoo. com/group/BCdonorconception, www.voluntaryregister.health.wa. gov.au/, www.cibg.nl/burgers/donorgegevenskunstmatigebevruchting/ and www.donorkind.nl/), all with the aim of facilitating contact of donor conceived children and their parents with each other, and/or with donors. The study of Freeman et al. neatly complements that of a smaller Californian study (14 respondents with only one heterosexual couple) published a little earlier (Scheib and Ruby, 2008). What are the results? Almost all responding parents declare that they and their donor children were very positive about the contacts they made with the families of children from the same donor. The experience of meeting with these families and their donor children was felt to be so positive that in many cases the other families were referred to as friends, and donor siblings were referred to as being members of one big family (all together suitably described as ‘extended families’). The experience with contacts appeared not to differ between single mothers, lesbian or heterosexual couples. Also the contacts with donors were definitely rated as positive (Freeman et al., 2009). These latter contacts occurred much less frequently (21) than donor sibling contacts (291) and were not investigated by Scheib and Ruby (2008). Overall, these findings suggest that knowledge of donor sibling families is a good thing, and that disclosure of the donor identity makes sense, and need not be a problem. They also suggest that for many parents and children, having only information about donors is not satisfactory—real encounters are the ultimate desire. Unexpectedly these findings might also lead us to question the importance of a common family history for the creation of a ‘family feeling’. After all, none of the donor families calling their donor sibling relatives shared anything but genes. Nonetheless, many said they felt intuitively bonded. The findings presented by MacCallum (2009) show that a common family life is crucial for a feeling of being ‘one of us’. The ultimate factor for parents and children in this respect proves to be the gestational link and the rearing of the child by the parents from the outset. MacCallum, by means of standardized semi-structured interviews, compared the attitudes of parents having children by means of embryo donation with those having children via adoption. The original aspect of MacCallum’s approach is that two groups of parents were compared, both