Counselling in Gametedonation

Non- anonymity and disclosure in gamete donation has been studied for years in
recipients of Gamete Donation (GD). Comparative studies between parents who did
and did not disclose GD show that parents who disclosed GD for their (non
adolescent) children had a more positive parent-child relationship, less
conflicts between them and their children, and better relationships between
parents than in families where parents choose for secrecy. Nevertheless,
families which kept GD secret, were functioning within the range of normal
family life (Lalos et al., 2007; Paul & Berger, 2007).
According to Nagy, there is an essential loyalty between parents and children:
he departs from the position that such an essential or *vertical* tie of
loyalty with the biological origin is indissoluble and important for trust and
self- esteem and though not always visible, it is always present (Böszörményi-
Nagy, 1973). Therefore, biological origin is very important to be acknowledged
and accepted (Böszörményi-Nagy, 1973, 1986; McGee et al., 2001).
Concealing important issues for a child by parents, or introducing another
reality to avoid harm, may confuse children and disturb their psychological
development (Dolto, 1971, 1984). Non disclosure of donor conception creates
family tension because the secret is always present in the mind of the keepers
and causes a troublesome burden with subsequent detrimental impact on the child
(Daniels, 2009; McGee et al., 2001). For gamete donor offspring who discovered
GD by coincidence and who are told later in life it is difficult to trust their
parents, they have feelings of confusion, distress and anger, and feel a lack
of genetic continuity (Daniels et al., 2007; Javda et al., 2009; Kirkman et
al., 2007; Paul and Berger, 2007).
Past practice of anonymity and secrecy gradually changed in the direction of
identified donors and disclosure, because of decreasing stigma of infertility,
growing importance of children*s rights, increasing call of donor offspring for
an end to secrecy, and legal changes (Akker, 2006; Daniels, 2006; McWhinnie,
2001). Apart from late disclosure and disclosure by accident, there is no
evidence that disclosure is harmful for donor offspring (McWhinnie, 2001;
Turner and Coyle, 2000). Disclosure appears to be important because of the need
of trust and honesty within the family and acknowledgment of genetic
continuity, attributes which are highly psychologically and socially valued
(Turner and Coyle, 2001). Adult donor gamete offspring who have always known
their origin feel good with a donor, feel loved by their family and have good
relationships with their parents (Daniels et al., 2001, 2007; Paul and Berger,
2007; Scheib et al., 2005). Therefore, current tendency in literature is that
parents using GD should tell their child of their true origin as early as a
child can understand reproduction in general (Daniels, 2009; Javda et al.,
2009; McGee et al., 2001; Landau, 2010). In practice single mothers and
lesbian-couple families are more likely to disclose gamete donation and
disclose from a younger age than heterosexual parents (Akker, 2006; Javda,
2009).
Since a few decades more (intended) parents opt for known gametes to have the
possibility to respect the right of their child to know its origin (Akker 2006;
Javda, 2009). Because of consensus about non anonymity and disclosure GD,
several countries changed their laws. These countries don*t allow anonymity
anymore and regulate provision of identifying information of donors to
offspring (Daniels, 2007; Janssens, 2006; Wet Donorgegevens Kunstmatige
Bevruchting Staatsblad, 2002).

Aim of research
The overall aim of this research is to contribute to a more adequate and
congruent professional counselling of (intended) parents in the process of
decision making on (non) disclosure of GD with their child.
The specific aims are:
1. to explore the current counselling practices with regard to GD and to know
on which (implicit) assumptions, cognitions and evidence these practices are
based. 2. to get insight in when and how parents need assistance in the
disclosing process about when and how to disclose GD to donor offspring.

Data will be collected by individual, semi structured in-depth interviews and
focus groups.

Collection of data will take place in three groups of respondents:
- parents who told their child about the gamete donation
- parents who did not tell their child about the gamete donation
- professionals (doctors, nurses and non-medical social workers/ psychologists)
involved in the counselling process of parents who use(d) gamete donation

Parents will be interviewed on individual basis.
Professionals will be interviewed first on individual basis, and later in focus
groups.

Parents will be contacted by files of patients of several Centres for
Reproductive Health in The Netherlands.

Professionals will be recruited from Dutch Centres of artificial reproduction.
Interviews will be held by topic lists, which will be based on literature and
professional experiences of the research team. The focus groups will be held by
topic lists and results of the interviews.

All interviews will be audio recorded and transcribed ad verbatim.

The effort for participants is a visit to the researcher for the interview.
When desired the researcher will interview a participant in his own place.
Participants will be interviewed on individual basis. The interviews are semi
structured depth-interviews that will be held by topic lists. Next to it,
focusgroups will be held with professionals, also by topiclists en based on
results of interviews.

Psychological inconvenience is not expected, though is realized an interview
could effect someone. In the patient information letter participants can read
what the research is about, but when their experience about the effect will be
different after the interview and they need support, a professional counsellor
is available. Participation is on fully voluntarily basis. Participants are not
denied any treatment when they don't participate.
By participation respondents get attention for their (specific) situation
(namely it was possible to get a family by using GD), they can give their
opinion upon their situation and with their experiece they can contribute to
increase professional counselling in case of GD. This can outweigh the
emotional inconvenience participation could give. The possibilily of
professional counselling that is offered seems to be justified and sufficient.
Because respondents are asked to participate by asking fertility centres,
where respondents have been treated, to cooperate can give them the
acknowledgement that this clinics are interested in their situation and
experiences.

Psychological inconvenience for professionals is not expected.