COUNSELLING

Counselling faces a minefield of hazards in donor conception today

The wide availability of ancestry-tracing DNA services means donor anonymity can be no longer guaranteed.

Published 15 February 2021

Discovering you have dozens of half-siblings or being rejected by your sperm-donor-conceived child are among the many hazards of third-party reproduction today. The role of counselling and information in helping parents, donors and children navigate this minefield was comprehensively explored in this January Campus meeting.

It was clear that clinics today face increasing challenges in how they support donor-conceived families simply because anonymity can no longer be guaranteed, a consequence of the growth in ancestry-tracing DNA services. As a result, even more research is needed into the provision and benefits of psychological help.

For clinics to identify suitable donors, psychological evaluation is as important as clinical screening. Although regulations differ between countries on who should carry out assessments (some allow nurses or any clinic worker), Giuliana Baccino, co-ordinator SIG Psychology & Counselling, was insistent that the task should be performed by psychologists or counsellors. The aim, she said, should be to ensure that donors fully comprehend what they’re undertaking, from the emotional to economic and legal implications in the country where the donation is carried out (or where the gametes are used). Reasons listed by Baccino which might rule an individual out as a donor include not telling close family about their intentions or being motivated by money. If the evaluation triggers doubts, then Baccino’s advice was to ask the donor ‘to take a break and come back’.

The desire of would-be parents for a genetic child – and how to manage this expectation – was a recurring theme throughout the Campus meeting. For fertility patients to adjust psychologically, the consensus from speakers was that clinics should make them aware from the outset of the possibility their own gametes won’t be used. Astrid Indekeu from Dutch DNA databank Fiom described this process of acceptance as a ‘complex transition to non-biological parenthood’ which is not to be rushed and should be supported by appropriate counselling throughout to allay parent’s fears, even that their donor-conceived child might reject them.

What about the psychological effects of donor-conception on children, especially if they eventually search for their biological relatives? In general, the reassuring evidence from longitudinal studies to date suggests no differences in emotional or behavioural problems or self-esteem among teenagers compared with those naturally conceived.(1)

Moreover, the earlier they’re told (before age seven) the better the relationship with a parent according to findings presented by Vasanti Jadva from the Centre for Family Research at the University of Cambridge, and the less chance of them finding out by accident, especially from a genealogy website such as 23andMe or AncestryDNA.

However, can learning of their origins at a young age protect donor-conceived people from the psychological consequences of contact with donor siblings or their biological parent(s)? Despite most countries imposing a maximum pregnancy quota per donor, these were originally just guidelines and the number of donor sibling groups are expanding as more donor-conceived people turn to DNA databases to discover their biological families.

Mariana Martins – a past co-ordinator of the SIG Psychology & Counselling – said evidence was scarce on the consequences of contact and on donor-conceived people in general, which, she said, highlighted the need for a central European registry. What is known is that nearly two-thirds (64%) of registered donor-conceived children search for both their donors and same-donor offspring, largely out of curiosity. She said this has significant implications for counselling and psychotherapy services – for example, the unrealistic expectation that donor-conceived children might start a relationship with a biological parent or half-sibling. Other issues listed by Martins include donor-conceived people having to deal with unwanted questioning from peers and being prepared ‘to meet many same-donor offspring at once (or none)’.

A presentation from Maaike Janssen from the Netherlands provided compelling insights into life as a donor-conceived person and how this redefines the whole notion of family. Conceived via sperm donation 31 years ago, Janssen was told of this fact at the age of six, and later informed that eight children were conceived from gametes provided by her biological father. This information proved incorrect: she has (to date) made contact with 80 half-siblings and expects to find more.
On one hand, she said she is lucky to have found her biological father, who was able to fulfil her need to know her genetic heritage. Yet Janssen was adamant that she only wants a child who is genetically related to her and her husband, and warned of the perils of parents imposing ‘missing pieces on their child’ out of a wish to have a family.

Looking for relatives in genealogy databases has been described as ‘harmful and wrong’ but geneticist Joyce Harper pointed out they are here to stay despite being a ‘timebomb’.(2) Although this genie cannot be put back in the bottle, the take-home message from this Campus was that fertility professionals should ensure that children are protected as much as possible and are at the heart of guidelines, registries and clinical practice.

1 Psychological adjustment in adolescents conceived by assisted reproduction techniques: a systematic review.
Ilioi EC, Golombok S. Hum Reprod Update 2015; 21: 84-96. doi:10.1093/humupd/dmu051
2 Pennings G. Looking for genetic relatives in genetic databases is harmful and wrong. BioNews 2019 May;
https://www.bionews.org.uk/page_143010

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