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Fertility counselling services have had to respond to significant developments in fertility treatments in recent years, prompting increasingly complex personal and professional ethical challenges. This Commentary focuses on those rising from donor conception and/or surrogacy. The profile of those seeking such treatments has changed to include growing numbers of same sex couples, single people, people who are transitioning or have done, people seeking posthumous use of gametes, and people using cross-border services. Alongside, awareness has grown of life-span implications, the impact of commercial DNA testing, and the need for 'later-life' support. Responses vary internationally and the time for debate is overdue. Who should provide fertility counselling and how? Should specialist qualifications, training, continuing professional development, and regulation be required? Should counsellors play a role in assessing suitability to parents? What aspects of different contractual arrangements and conflicts of interest need attention? Has the time come for counselling to be mandatory as part of pre-treatment pathways? What should be the relationship between fertility counsellors and multi-disciplinary clinic teams? How might fertility counsellors be represented nationally and internationally? What should be their relationship to 'later life' professional support? What place should professional knowledge hold in the evidence base?

Increasing numbers of donor-conceived individuals (and/or parents) are seeking individuals genetically related through donor conception. One route is through 'direct-to-consumer' (DTC) DNA testing, prompting calls for fertility services to alert donors and prospective parents to the increasing unsustainability of anonymity and secrecy. The complexity of interpreting DNA results in this context has also been discussed, including their lack of absolute certainty, as has the need for professional and peer support. This commentary highlights a different 'threat', from individuals learning of their donor-conception origins through the use of such tests by themselves or relatives for such purposes as genealogy or health checks. It illustrates the personal complexities faced by three older women and their families on learning not only of their genetic relationship to each other but also to 15 more donor-related siblings. DTC DNA services are a growing feature of modern life. This commentary raises ethical questions about their responsibilities towards those inadvertently learning of donor conception origins and the responsibilities of fertility services to inform prospective parents and donors of this new phenomenon. Considerations of how and when parents should tell their children of their donor-conception origins here instead become how and when children should inform their parents.

This article considers the disclosure, sharing and exchange of information on being donor conceived within families, drawing on data from a study undertaken with donor-conceived adults registered with UK Donor Link (a voluntary DNA-linking register). This paper considers the narratives of how respondents found out they were donor-conceived and what events triggered disclosure of this information. This paper then goes on to examine the role secrecy played in their family life and uses the concept of 'display' to explore how secrecy affected their relationships with their immediate and extended family. Secrets are notoriously 'leaky' and we found complex patterns of knowing and uncertainty about whom in the family knew that the person was donor-conceived. We argue that what is kept secret and from whom provides insights into the multifaceted web of social relationships that can be created by donor-conception, and how knowledge can be managed and controlled in attempts to display and maintain family narratives of biogenetic connection., (© 2017 Foundation for the Sociology of Health & Illness.)

This paper considers the experiences of adults conceived following sperm donation, who were registered with a voluntary DNA linking register and considers: how awareness of being donor-conceived affected their identity and family relationships; and the process of searching for their donor and donor-conceived siblings. The views and experiences of donor-conceived adults has, until recently, been a relatively neglected research area. This study is the first, to our knowledge, to consider the experiences of donor-conceived adults using a DNA-based register. This paper presents qualitative data from a questionnaire-based study with 65 adults conceived following sperm donation. It examines how ideas of relatedness, kinship and identity are enacted and how narrative certainties are challenged by opening up new conceptions of what it means to be ‘related’. No single story of being donor-conceived emerged - with competing narratives about the effects and implications for respondents’ kinship relationships and sense of identity. The knowledge of being donor-conceived could be both a powerful disrupter and a consolidator of existing family relationships. This study sheds light on how identity and kinship relationships are negotiated and managed by donor-conceived adults, both with their existing family and donor ‘relations’, and how these can change over the life-course. [ABSTRACT FROM AUTHOR]

This paper reports on a study of the views and experiences of 21 sperm donors and five egg donors registered with UK DonorLink (UKDL), a voluntary DNA-based contact register established to facilitate contact between adults who wish to identify and locate others to whom they are genetically related following donor conception. Specifically, the paper examines donors’ reasons for searching for, or making information about themselves available to donor-conceived offspring. Their expectations of registration with UKDL, experiences of being registered and finally, the experiences of those who had contacted donor-conceived offspring and other genetic relatives are investigated. While most respondents reported largely positive experiences of registration, the study found significant issues relating to concerns about donation, DNA testing, possible linking with offspring and expectations of any relationship that might be established with offspring that have implications for support, mediation and counselling. Research that puts the experiences, perceptions and interests of gamete donors as the central focus of study is a relatively recent phenomenon. This study contributes to this debate and highlights directions for future research in this area. [ABSTRACT FROM PUBLISHER]

Biomedicine, bioethics and the law dominate policy and practice in controversial methods of creating families through assisted reproductive technologies including cross-border reproductive care and surrogacy. This commentary discusses the ascendancy of' the right-to-parent' lobby in global free markets where individualism, neo-liberal and neo-feminist perspectives, consumerism and porous state borders thrive and legislative frameworks only regulate risky practices well after they are established. It argues the need for social work to be a critical voice in ethical debates, a key contributor to national and international social policy and practice, and a leader in global child welfare matters. [ABSTRACT FROM AUTHOR]

Using donor conception treatment for family building brings challenges as well as rewards. As social model approaches to managing genetic difference within families gradually replace earlier medical models, parents are encouraged to be open with their children about their origins amidst greater social acceptance. Little is known about effective interventions to help prospective parents prepare for such family life. A survey was sent to participants in 16 Preparation for Parenthood workshops run in England by Donor Conception Network, a peer support organisation, between 2008 and 2010. The 79 respondents (32.4% response) included heterosexual couples, lesbian couples and single women considering sperm, egg or double donation. In 86% couples, both partners responded. The use of a range of techniques, a family lifespan approach, facilitators with personal as well as professional experience, medical and psychosocial specialists, and access to peer support were well received. Results suggest the value of attending cognitive and affective processes, acknowledging the impact of stigma and discussing how the donor's biography/presence can be conjoined with that of the new family. Findings suggest workshop approaches to donor conception parenthood preparation can be useful for prospective lesbian/single women/heterosexual-headed families considering donor conception. Such interventions have not previously been reported. [ABSTRACT FROM AUTHOR]

Objective: To gather respondent feedback about whether workshops for heterosexual couples, lesbian couples and single women considering donor conception treatment (i) aided decision-making and (ii) improved intentions and confidence about openness with offspring. Background: Research indicates donor offspring consider that risk to their well-being is heightened if not made aware of their origins from infancy. However, some parents do not disclose this information, especially heterosexual couples. Preparation for Parenthood workshops were run by Donor Conception Network, a UK support group, using parent facilitators. Methods: A survey was sent simultaneously to those who attended 16 workshops over two years (2008–2010) (n = 246), with each partner in couples invited to respond separately. Results were considered descriptively as follows: all respondents; those in heterosexual and lesbian couples by intended donation type; single women. Open comments provided tentative understanding of quantitative results. Results: Response rate: 32.4% (n = 79); both partners responded in 86% couples. Workshops were rated as predominantly helpful by all groups for deciding whether to proceed. There were similar improvements in feeling comfortable with the idea of becoming donor conception parents, surety about openness with children and knowing when and how to start the process. Openness with social networks appeared more challenging to achieve. Levels of congruent couple responses increased post-workshop, starting from low levels on some aspects. Couples considering egg donation showed the widest variation in responses. Conclusions: Workshops appear helpful in aiding decision-making and in preparing for openness with any offspring across family types and whether considering sperm, egg or double donation. [ABSTRACT FROM AUTHOR]

This study considered professional input into collecting personalized donor information for later release to donor offspring. Existing studies report the importance of such information for identity completion, to satisfy curiosity, and to allay anxiety about genetic inheritance. The study used a three-pronged approach: a literature search of professional practices in this and related fields; key informant telephone interviews with donor-conceived adults, sperm and egg donors, and professionals and a postal survey of UK clinics' practices and views. The literature revealed only one previous study, which suggested gendered approaches to pen portraits were used in commercial donor banks. Key informants agreed on the importance of information for offspring well-being and the need for support services in its compilation and on release. Donors reported inadequate professional assistance to date. The postal survey of clinics revealed variable practices in the process of acquiring and storing later life information and variable success in achieving its completion. Respondents identified factors that hinder completion (donor anxiety, lack of guidance, shortage of staff time) and factors that help (donor belief in the importance of later life information, staff belief, dedicated staff time). Further research, including intervention studies, is needed into the processes and skills involved in collecting later life information. [ABSTRACT FROM AUTHOR]

This paper outlines a 22 year campaign to introduce openness into the arena of donor conception in the UK. It identifies key aspects of the development of an advocacy based approach to such work and argues that social work values and principles can prove key to identifying structural inequalities which are not necessarily based in socio-economic disadvantage. Donor conceived people may find themselves in families which enjoy material privilege hut whose exposure to a legislative framework and dominant professional cultures within the treatment centres encourages secrecy around genetic origins. Social workers' experience of adoption and family work leads them to recognise the danger of such secrets within families. Turning such social is- sues into policy changes requires vision, strategic long term advocacy and partnership with those directly affected. [ABSTRACT FROM AUTHOR]