Donor Conception is not a fertility treatment

On November 2nd a new and important event took place in London.  Entitled, From Secrecy and Anonymity to Facebook and DNA Testing, this workshop for professionals working in and around the donor conception industry and put on by the Donor Conception Network, was an attempt to help those in positions of influence to get to grips with what 21st Century donor conception practice needs to look like.

Marilyn Crawshaw set the scene by looking at research that addresses three fundamental background questions –

  • What helps people to decide whether DC is right for them?
  • How can we be sure that ‘telling’ children early is the best thing to do?
  • What do people say helps them or hinders them in their contact with clinics about donor conception?

I am going to assume that anyone reading this blog is quite clear that telling a child from early years is best for both child and family in the vast majority of cases so lets look at Questions 1 and 3.

Crawshaw explained that the most effective and supportive way of helping people make the decision about whether DC is right for them is a psycho-educational approach that is ideally adopted by all clinic staff, rather than just the counsellor. This way of working first takes into account everything that the would-be parents bring with them – their personal histories, their relationship (if a couple), their culture etc. and then supports their decision  confidence by giving high quality information in a way in which it is possible for those particular individuals to hear it.  The importance of the decision should be underlined by helping the potential parents to think about who else needs to know and building strategies for talking with the child and others.  Marilyn identified that concerns from the would-be parents could usually be divided into those that are child-centred and those that come from the here-and-now adult.  Examples of the former are anxieties around both medical or emotional hazards for a donor conceived child and the latter are demonstrated in worries about bonding and whether they could love a non-genetically connected child.  All staff in contact with parents should ideally be aware of the need for a balance of both types of concerns and be prepared to give good information or point the contemplating couple to people or places where their anxieties can be addressed rather than brushing them off with bland reassurance that everything will be fine.  Here-and-now adult concerns can also influence how people visualise the donor.  Someone who wants to see a donor egg as ‘a clump of cells’ rather than a vital component of life that comes from a living person is giving a message that this is the only way she can get her head round the idea of using a donor at the moment.  As this way of seeing is obscuring a more child-centred approach, staff need to have the skills to gently challenge this vision and help the person concerned (probably a would-be mother) to be able to accept the reality of egg donation so that she and her partner can move forward in a way that will help sustain healthy relationships in their future family…or decide not to go ahead.

Crawshaw’s presentation was rich and dense and contained so much more than I can possibly bring you here.  I hope it may become more widely available but in the meantime these are the points that Marilyn has extracted from research and experience as being the most helpful for clinics to bring to the attention of clients and support them with.

  • Present DC as bringing additional aspects in family life that need preparation
  • Be alert to the ‘here and now’ adults AND the ‘parents-to-be’
  • Make clear that counsellors are there for patients not as gatekeepers
  • Acknowledge that ambivalences and uncertainties are normal and can ebb and flow over the years to come but rarely disappear all together
  • Normalise that people may need time to come to decisions and that sometimes (for couples) one partner has to wait for the other
  • Aim for patient-led rather than clinic-led donor selection but provide help and support to the process
  • Display DCN books and DVDs and copies of their free material

Even before genealogist Debbie Kennett’s presentation on the revolution that DNA testing is bringing to the DC community and the hugely complicated situations that can arise from the information about genetic relatedness that becomes available, it is possible to extract from Marilyn Crawshaw’s talk the seeds of a new way of helping people create families using third party conception. I will return to this shortly.

Becky, a donor conceived adult in her fifties and a member of a well-known group of DC siblings, spoke movingly of the tumult that occurred in her life when at 37 she was told of her DC beginnings by her mother.  But to my mind her most valuable contributions were in challenging the language used by many around ‘telling’ and in her explanation of how complicated and emotionally draining the appearance of so many recent new half-siblings is to manage.  These are often older people who have been given DNA testing kits for big birthdays as a ‘fun’ present only to have secrets opened up that have sent shock waves through extended families.  Becky explained that the DNA companies had difficulty interpreting the connectedness between so many apparent half-siblings often appearing to be only months apart in age and that these new people often appear as ‘grandparents’ in the list of genetic relatives that is available for her to see.  She knows just who they are, but the recipients of the ‘fun’ present usually think that there must be some fault with the DNA testing process.  Is it her (and her already known half-siblings) responsibility to reach out to these people or should they leave them to make enquiries that will lead to donor conception becoming known about or give up and declare the whole DNA testing process a farce?  An ethical dilemma that is debated hotly in Becky’s half-sibling community, but also undoubtedly a reason to continue limiting the number of families created from each donor and in the importance of openness about donor conception.  Which leads to Becky’s significant observation that ‘telling’ is not good enough.  Although ‘telling’ is now advocated as a process rather than a one-off event, Becky believes that ‘openness’ is a preferred term as it implies an internal process within an individual or couple as well as the external act of sharing information with a child and others.  What is required for donor conception to be managed in a healthy way in all families is for openness to become a state of mind for parents.  For this to become possible I am quite clear that a new way of providing donor conception services to would-be parents is needed.

The first principle that needs to be put in place is that donor conception is not a fertility treatment. Using DC does not make a person more fertile.  It circumvents the fertility problem and replaces missing or sub-par gametes with eggs, sperm or embryos from someone else.  It is a different way of founding a family.  This difference I believe is at the heart of Crawshaw’s guidance to fertility clinics to ‘Present DC as bringing additional aspects in family life that need preparation’.   The fact that DC is different to all other treatments to help people have a child leads I believe to a radical idea that services for people requiring donor conception should be separated from those treating people using their own gametes.  This service, probably based in the same building because medical services are needed, would start from the premise that they are helping to build families rather than simply helping in the creation of a baby.  Building families, rather than a narrow focus on making babies, inevitably leads to a longer view, taking into account the needs of the child as they grow and move from infancy to school years, becoming teenagers and then adults possibly thinking about a family of their own.  One of the reasons that Becky’s mother told her at 37 was because Becky had recently had a daughter  and the new grandmother didn’t want the secret to be perpetuated down the generations.

A new type of service would be based more on an adoption rather than a medical model, understanding that decisions made before donated gametes are used for conception (for instance, to go abroad for anonymous donation but actually all decisions) will have an impact that will last longer than a lifetime.  DNA testing to find donors is likely to become available world-wide within ten years or so but donors promised anonymity may not want to be found, with all the pain and sadness that implies, and communication may be difficult because of different cultures and languages.  A new service would understand that  parents-to-be need time and opportunities to really get their heads round what they are undertaking and be prepared for the responsibilities that come with making a family with the help of a third/fourth party.  DC Network’s Preparation for DC Parenthood workshops do just that but at present can only reach a tiny number of people undertaking donor conception.  Part of this process would be helping potential parents to gain insight into their own motivations for wanting a child and recognising that if blood lines and the child being a ‘mini-me’ are really important for them, then donor conception is probably not the right way for them to create a family.  And most of all a new service would, in a matter of fact and gentle way, encourage would-be parents to accept the donor as a real man or woman (a biological parent) who may, at some point, sooner or later, have a place – close in or more remote – in their family.  It goes without saying that this new service would have openness at its heart and as a result many more parents would feel confident and comfortable with this path to family creation. As a consequence of the new open climate DC would become, like IVF, just another way for modern families to come into being.

I wonder which of the current clinics will have the foresight and the courage to break out of their mould and develop the service that is required for donor conception to become more mainstream.  Perhaps that place doesn’t exist yet but I throw down the challenge to existing clinics that have been leaders in the recruitment of identifiable donors and understanding that good donor information is important in developing the confidence of potential parents rather then seeing it as a route to ‘designer babies’.  DNA testing has quite rightly had the term ‘revolution’ attached to it  Who will step up to be the first revolutionary provider of a new donor conception service in the UK?

 

 

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About oliviasview

Co-founder and now Practice Consultant at Donor Conception Network. Mother to two donor conceived adults and a son conceived without help in my first marriage.
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14 Responses to Donor Conception is not a fertility treatment

  1. JoJo says:

    Olivia, I think it would be more appropriate if, in your second to last paragraph, you changed the wording to reflect the strict scientific truth. The “donor” (to the parents) is not just a man or a woman….he/ she is child’s biological parent, nothing more or less.(pares- to bring forth). This simple fact should never ever be avoided. It has been avoided up to now and it’s wrong. This reality needs to be faced head on.

    Everything that goes with being a child’s biological parent MATTERS. The biological parent is the giver of 50% of the child’s genetic make up and medical and historic heritage, looks, mannerisms, interests and so much more.This gets to the heart in an honest way of what exactly is going on. Prospective parents should be encouraged to explore the reality that while for them, the arrival of a child created by means of third party reproduction is a means of making a family, for that child it means loss. Loss of and separation from half of their genetic family.

    • oliviasview says:

      Thank you for taking time to comment JoJo. I agree that the ‘donor’ is of course a biological parent and have added this fact in parentheses. As things stand at the moment I think those assisting would-be parents by donor conception need to be very gentle with their clients who are at a very vulnerable time in their lives. This does not mean hiding the true facts, but it does mean taking things at the pace of their client who probably said at the beginning of their infertility journey that they would never use a donor. This is why I advocate a modified adoption style model of preparation for parenthood by donor conception so that this time can be taken. And parenting this way is definitely not for everyone.
      I know that for you the fact of discovering your donor conception and your parents’ long deception has been and is continuing to be massively important in your life and has caused searing but both negative and positive emotions. I also know that it is not like this for everyone – even many of those who discover this fact as adults. Significant loss and trauma are true for you and some others and we should all listen and take note, but it is not everyone’s experience.

      • JoJo says:

        I’d like to make it quite clear that my response has nothing whatsoever to do with the circumstances of my discovery Olivia and I don’t think this is an appropriate forum for you to raise them to be honest. I don’t believe you’d discuss commissioning parents’ back stories so publicly in order to try to formulate a point. To be frank, I found your attitude pretty patronising. My response has to do with my own intellectually reasoned judgement about the realities of third party reproduction. It is to do with both the terminology surrounding donor conception being represented honestly and the need for the realities and impacts of the act of donor conception to be made clear without any sugar coating to make it more palatable to those considering it. Surely if people are in a vulnerable position the truth about the reality of what they might consider doing SHOULD always be told?

        • oliviasview says:

          Dear JoJo
          I was rather taken aback by your strong response. First of all I want to apologise for patronising you in any way. This was absolutely not my intention but looking back I can see how it could be taken that way. I think what puzzles me is that you seem to be wanting to separate your ‘intellectually reasoned judgement’ from your feelings by refuting that the position you have come to about what donor conception means for the people created has anything to do with your own personal situation. As I understand it, all rational thought is influenced by our own feelings and personal experiences. Academic findings are given higher status in society and academics often resort to very dry language to try and remove emotional bias, but personal experience is usually what reaches peoples’ hearts and minds and results in change (viz Jo Rose’s challenge to the law resulting in the ending of anonymity for donors). With regard to donor conception, the research is pretty sparse but does reveal a spectrum of feelings about finding out or being told late about origins. Yours and others strong feelings about it are valid and important, but they do not represent the feelings of everyone.

          I am sorry also that you think I referred to your personal situation because you are a donor conceived adult and that I would not have done the same had the writer of a comment been a recipient parent. I think that if I had known the backstory of the writer, as I know something of yours, and the comment they had made seemed to reflect that story, I would have referred to it in just the same way, whilst being very careful not to write anything that could reveal their identity. I apologise if you feel I breached a trust between us in any way.

          The reason we advocate gentleness with recipient parents is that if they are introduced too soon to the real genetic relationship between the child they hope to have and the ‘donor’ they may take fright and seek a sperm donor on the internet or go abroad for egg donation to a country where donors are anonymous. DNA testing is likely of course to catch up with them in the future but do not underestimate the capacity of people who are frightened to put their hands over their ears and shout La,La La if you try and force what feels like unpalatable information down their throat before they are ready to hear it. This is why DCN strongly advocates a proper preparation period so that the truth can be revealed at a time when would-be parents are able to take it on and understand the responsibilities it brings. And of course our aim is that every person conceived with the help of a third party should be able to choose to have easy access to their genetic relatives if that is what they want. We won’t know for a long time after 2023 (when the first cohort of people conceived with identifiable donors become 18) how many people will actually choose to exercise this right, but similar to people who have been adopted, it is likely to be a percentage rather than the total number of eligible donor conceived people who will apply for information.

          It is my great wish that you and I should be able to keep up a good connection and I hope this response will help rather than hinder this.

          • JoJo says:

            I was steaming for several hours it is true. Thank you for your apology. And thank you for at least including the term “biological parent” in your blog. That’s a very important change and shows a willingness to listen.

            Your initial response read to me as if you were attributing my views in their entirety to the fact that my parents had not told any of us about our origins and that simply is not the case. When I was pregnant with my eldest daughter, one of the ladies in our NCT group actually ran a fertility clinic. We talked about it then – and I worked out in my mind that third party reproduction was the premediated decision to separate third party conceived child from half of its biological family – and that I did not agree with it ( tho I can’t remember what form of words I came up with in my mind to describe it). This is what I meant by intellectual. At the time I (wrongly) held my tongue for the sake of group peace. But my attitudes and beliefs predate the discovery that I was the product of this industry (and that my parents had lied to me about my origins) by nearly two and a half decades.

            It was factual then and remains factual now that donor conceived people are deliberately separated from half of their genetic family, one of their biological parents from lifelong access to medical heritage, from access to people who could well be very like them. That is FACT. Those are facts. Beyond that, of course emotions come in to play for each one of us, you included, but also… moral judgement… Is this an OK thing to do, am I making too much of a fuss about this… or do I believe that morally and ethically this is wrong? That’s an emotional AND an intellectual process.

            You know judges, in court, before sending out the jury, remind them to make their decisions solely based on the facts.

            You say “we advocate gentleness with recipient parents is that if they are introduced too soon to the real genetic relationship between the child they hope to have and the ‘donor’ they may take fright and seek a sperm donor on the internet or go abroad for egg donation to a country where donors are anonymous”.

            I would like to turn this argument on its head and ask you a rhetorical question. What if, by your “gentle” approach, you are actually normalising the belief that third party reproduction is acceptable and increasing its general usage – that it’s acceptable to create children with the intent of separating them from half of their biological heritage with everything that this means? What if your practices are making the industry as a whole MORE popular more prevalent, more widespread? What if that in turn encourages more people to go undercover and use third party reproduction informally and anonymously? What if you are increasing the number of third party created children by your actions?

            Whichever way you look at it…. that’s still condoning a practice by your actions which continues to separate people pre conception from their genetic parents and wider families.

            Finally, I’d like to say that…. just because lots of people have different opinions to me, doesn’t mean that they are right. I know I always come back to this one, but once upon a time the majority had no problem at all with the enslavement and trafficking of millions of Africans. Those who spoke out against it were shouted down in the most derisory of terms. But the in the end, the minority view prevailed and I don’t think anyone would now condone what happened. I believe this to be the case with attitudes towards third party reproduction.

            Ironically, my social father said I should always stand up for what I believe in, regardless of whether or not I was in the minority. My biological father, as it turns out, was a powerful public orator and writer who stood up for his beliefs from a very young age. Like them… I wish to speak for my people.

            .

            • oliviasview says:

              Who knows, JoJo, you may well prove to be right, but I suspect I will be dead long before then. In the meantime I’d just like to take you up on a couple of points. You say,
              “It was factual then and remains factual now that donor conceived people are deliberately separated from half of their genetic family, one of their biological parents from lifelong access to medical heritage, from access to people who could well be very like them. That is FACT. Those are facts. Beyond that, of course emotions come in to play for each one of us, you included, but also… moral judgement… Is this an OK thing to do, am I making too much of a fuss about this… or do I believe that morally and ethically this is wrong? That’s an emotional AND an intellectual process.”

              Maybe for you outcome is all, but for me intention has great meaning and of course no-one has ever set out to deliberately separate people from their genetic family. It was far from the minds of people in my era (30+ years ago now) and it certainly isn’t even in modern times with only identifiable donors having been allowed in the UK since 2005. From 2023 DC people conceived from 2005 onwards WILL be able to find their donor/bio dad or mum or whatever they choose to call them. On the question of moral or ethical rights or wrongs, I am what I refer to as an ethical pragmatist. The justification for this stance goes something like this…the longing for children, to create a family, is for some people the strongest natural impulse in the world. This is unlikely to go away. If people find they cannot conceive without help, many will do everything and anything necessary to fulfil their dream. If high quality, regulated and affordable services are not available they will seek unofficial means or go abroad, neither of which is in the best interests of their children. Better that high quality services are available that as far as possible put the interests and needs of the children/people first. Of course services could always be better, and I will continue to advocate for this as long as I live; the UK should be following Victoria in Australia in backdating rights for donor conceived people and then putting in place high quality intermediary services to help donors and offspring connect. Donor conception is not going away any time soon.
              It follows from what I have said that yes, being gentle with recipients about the genetic link between donor and child, is intended and does normalise the practice of donor conception. I don’t think this necessarily is likely to lead to more people using unregulated services and going abroad if the spread of the normalisation has connected to it, understandings about the ‘truth’ of the scientific link and the practice of openness, as defined by Becky, the DC adult who spoke at our workshop. People who seek unregulated services tend not to believe in either.

              And yes, by my actions I am condoning the use of third party conception/family building -under the right circumstances. This is something I know we cannot reconcile, but I hope I am doing it with my eyes open and with as much integrity as I can muster.

  2. Liz says:

    “The first principle that needs to be put in place is that donor conception is not a fertility treatment. Using DC does not make a person more fertile. It circumvents the fertility problem and replaces missing or sub-par gametes with eggs, sperm or embryos from someone else. It is a different way of founding a family. This difference I believe is at the heart of Crawshaw’s guidance to fertility clinics to ‘Present DC as bringing additional aspects in family life that need preparation’. The fact that DC is different to all other treatments to help people have a child leads I believe to a radical idea that services for people requiring donor conception should be separated from those treating people using their own gametes. This service, probably based in the same building because medical services are needed,”

    This sounds like a interesting workshop! A couple of thoughts:

    If the clinic for donor IVF is not located in the same medical building, there is a obvious cost and specialist problem. For donor IVF the clinic needs a the specialist doctor, a embryologist, nurses, the excellent lab, clean room, storage materials, and lab & medical equipment.

    The second thought has to do with the historical meaning of the word “fertility.” Not to get all Oxford English Dictionary, but it seems to me this post is not being precise with the definition. One’s uterus must be fertile for implantation to be successful. I suppose everybody could agree to call uterine implantation, gestation and pregnancy something that is NOT “fertility.” But that’s not the historical definition of fecund or fertile, and you’d have to get a lot of people to agree to change the definition of implantation, chemicals, miscarriages, and pregnancy. Some uteruses are very fertile. Some are more sensitive and tend to reject more embryos. Some uteruses implant embryos that others do not. Some uteruses miscarry frequently, and are referred to as less fertile. Some uteruses are unable to implant any embryos, no matter the quality of the embryo.

    We tend to call productive soil fertile. We don’t call seeds fertile. If a field is fertile, it’s because it’s growing stuff. Seeds are planted in fertile soil and grow. If the soil isn’t fertile, nothing grows. Likewise, embryos aren’t fertile until their successful relationship with the uterus environment and implantation. If Implantation is not successful, the uterus is not fertile.

    Medical treatments are sometimes needed to grow a tri-linear thick lining ready superior for implantation. Endometrium is critical to fertility. That is why I think of endometrium prep and implantation transfers as important steps in IVF fertility treatments.

    Just my take on these definitions. Maybe a new word is needed?

    • oliviasview says:

      Hi Liz, I think many women would be very pleased with your rather pedantic insistence that the context of my use of the word ‘fertile’ was not entirely correct. At least one part of them could be considered to be working OK, even if they were still not able to get pregnant/maintain a pregnancy. There are so many instances in the assisted/donor conception world where we could do with new words.
      And yes, it was a fascinating workshop that DC Network will definitely be repeating.

  3. gsmwc02 says:

    I think it’s also important to record cases where DC is used to identify all of the cases of infertility so numbers aren’t skewed in any way. This will help identify how big of a problem infertility is and allow a focus to be on treatments that address infertility.

    Interesting stuff Olivia.

    • oliviasview says:

      Thanks for your comment. In the UK our regulator, the Human Fertilisation and Embryology Authority records all treatments for infertility and donor conception for those not able to conceive with their own eggs or sperm.

      • Jim says:

        As much use as that is when Facebook is abused by prospective parents. The HFEA is somewhat redundant when people do what they want anyway, do you not think? The industry has essentially because deregulated because of this

  4. Mar says:

    Hello,

    Firsly, excuse my English made to pieces by Google translator and my improvable knowledge. I’ve been reading this blog for a long time but I had not written before.

    In this post it is sentenced: the donors are the biological parents. The word donor would be a euphemism to make the transit to “social parents” more passable.

    I read an article by Irène Théry, sociologist director of studies in EHESS, who says very interesting things and always justifying the prohibition of anonymity in France (I hope it would be also banned in Spain, where I write from). It says things like that the most democratic countries are banning anonymity (UK among them, of course) based on a change in the conception of filiation through the distinction between the respective statuses of donor of engender and parents by filiation. In this way, instead of being implicitly considered by two rivals for a single position (the “biological parent” the “psychological parent”), donors and parents are assumed as individuals who play different and complementary roles. But among countries that have banned anonymity there is an exception in this conception: in Germany the prohibition is based on a right to origins traditionally understood as a right of the child to the “primacy of biological filiation”.

    It surprises me a lot, because this blog seems more German than English.

    Following the article… “In the current debates on ART, two classes of parents are very often opposed: a “biological” parent and a “social” parent. This is to indicate that the filiation is not a replica of the procreation, as shown by the adoptive filiation. However, this opposition is inadequate insofar as every father is social. The main contribution of the contemporary anthropology of kinship is to have questioned the idea of the biological parent. Always and everywhere, engender is a social act, not a natural act: it is already always inscribed in a kinship system that gives it its meaning. The mere physical complementarity between male and female would not be enough to create a sociability of a human kind by itself, and this is what has led Maurice Gaudelier to say that “nowhere is it enough a man and a woman to have a child”.

    Article: http://revistas.ucm.es/index.php/RASO/article/view/RASO0909110021A

    However, if a DC person feels that his donor is his parent, I find it very respectable. Nobody has to tell anyone what their family is. But sentence that donors are biological parents and take it as a scientific fact it is at least questionable. If we talk about parents, this is a matter of kinship and
    the science that studies kinship is Anthropology, not Genetics or Biology. We should be careful too when we talk about “reality”, because as we are social beings our reality is a social construction, an ideological discourse. Luckily, changeable.

    • oliviasview says:

      Thank you for your comment Mar. I am interested that you are writing from Spain, as of course your country supplies a large proportion of the fertility services in Europe but sadly without feeling the need to end donor anonymity.
      I am afraid I do not find it easy to understand some of your points. I think this is a language problem in two ways – partly because of the translation from original to English and partly because some of the content is from academic sources. Academics are not known for their ability to write in a way that ordinary people can understand. I am not an academic, simply a parent, a co-founder of DC Network and someone who has trained as a counsellor in the past. But I will try to answer some of the points I think you are making –
      I think it has to be accepted as scientific fact that donors are biologically and genetically related to the children they help to create. In this very narrowly defined sense they are parents. In a more everyday sense, the people who are raising a child are ‘doing’ the parenting and are, therefore, parents. Personally I see no rivalry or opposition between these two definitions. I wonder if you have seen the blog by former egg donor Marilyn Drake on ‘Parent as a Noun and a Verb’ https://www.donorsiblingregistry.com/blog/?p=835.
      The anthropological term ‘kinship’ is sometimes interpreted in a very broad way – anyone you name as family becomes a family member. The problem is that different discourses will define terms/language/words in very different ways. My sense is that each discipline has it’s own richness to add to the mix and personally I wouldn’t get too hung up on any of them. People are certainly entitled to name their own reality, and some DC people do consider their donor to be a parent, in both biological and social senses. Some DC people (and also many who are not DC) would support biological/genetic determinism. I would not support this but neither do I believe that anthropological thinking holds the key either. As I understand it, academic disciplines are increasingly working together as they realise how little value there is in blinkered silos that do not take into account what other discourses have to say. I think it is perfectly possible to make the statement that donors are undoubtedly biological parents AND that donors and (social/psychological/everyday) parents play different and complementary roles. So supporting both so-called German and UK positions. Maybe the problem is with academics who have no experience of donor conception families or donor conceived people trying to fit the enormous spectrum of feelings and experiences into definitions that fit within their own narrow discipline.
      You may enjoy reading the contributions to the Comments on this blog by donor conceived adult JoJo.

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