Journal of Reproductive and Infant Psychology

ISSN: 0264-6838 (Print) 1469-672X (Online) Journal homepage: http://www.tandfonline.com/loi/cjri20

Disclosing their type of conception to offspring

conceived by gamete or embryo donation in Spain

Giuliana Baccino, Paloma Salvadores & Eleuterio R. Hernández

To cite this article: Giuliana Baccino, Paloma Salvadores & Eleuterio R. Hernández (2014)
Disclosing their type of conception to offspring conceived by gamete or embryo donation in Spain,
Journal of Reproductive and Infant Psychology, 32:1, 83-95, DOI: 10.1080/02646838.2013.853171

To link to this article: https://doi.org/10.1080/02646838.2013.853171

Published online: 26 Nov 2013.

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Journal of Reproductive and Infant Psychology, 2014
Vol. 32, No. 1, 83–95, http://dx.doi.org/10.1080/02646838.2013.853171

Disclosing their type of conception to offspring conceived by

gamete or embryo donation in Spain
Giuliana Baccinoa*, Paloma Salvadoresb and Eleuterio R. Hernándeza
a
FivMadrid, Centre for Reproductive Medicine, Madrid, Spain; bDepartamento de
enfermería, obstetricia y ginecología, pediatría y psiquiatría, Universidad Rey Juan Carlos,
Alcorcón, Madrid, Spain
(Received 28 June 2013; accepted 5 October 2013)

Objective: To explore the intention of Spanish patients who were undergoing a

reproductive donation treatment to disclose their offspring’s origins.
Background: In Spain, the law establishes the anonymity of the donation
process and prohibits revealing the donor’s identity to the offspring or the par-
ents. Method: The design was a prospective observational study in a private
institution. The participants were Spanish family units (heterosexual couples,
homosexual couples and single women) undergoing a reproductive donation
treatment in FivMadrid, Madrid, Spain. One hundred and thirty family units
accepted and returned the complete questionnaire specially designed for this
study. Results: Of the participants, 61% intend to disclose their offspring’s ori-
gins; 85% of those who want to reveal will do so during childhood (between 3
and 8 years of age); 95% think it is a good decision to undergo a gamete dona-
tion treatment; 95% feel the future child is theirs; 64% of the participants are
concerned about the physical characteristics of the donors; 63% consider
psychological counselling to be important during treatment, and 55% during
pregnancy and after delivery. In all these results there were no significant
differences (P < 0.05) between traditional families (heterosexual couples) and
non-traditional families (lesbian couples and single women). Conclusions: Even
though Spanish legislation does not allow families and donors to know each
other, our results are consistent with others presented in different European
countries where legislations are different and the offspring and the families are
permitted to meet their donors. Many of the Spanish parents studied plan to
take a responsible and coherent decision about disclosing their origins to their
children, choosing an honest and open relationship.
Keywords: gamete donation treatment; embryo donation treatment;
reproductive donation; disclosure

Introduction
Disclosing their origins to the offspring of reproductive donation is one of the most
controversial issues in reproduction (Cowden, 2012; Owen & Golombok, 2009;
Turkmendag, Dingwall, & Murphy, 2008). The parents’ attitude toward telling the
child about the treatment as well as the effect of this knowledge is a thorny factor
for consideration by medical doctors, psychologists, lawyers and ethicists. Parental

*Corresponding author. Email: giuliana.baccino@fivmadrid.es

© 2013 Society for Reproductive and Infant Psychology

84 G. Baccino et al.

disclosure is always an autonomous, voluntary and independent decision, even in

those countries that grant offspring the right to access information about the donor.
Historically, support for non-disclosure has prevailed (Braude, Johnson, &
Aiken, 1990; Daniels & Golden, 2004; Daniels & Taylor, 1993; Frith, 2001;
Snowden & Mitchell, 1981; The Ethics Committee of the ASRM, 2004), although
nowadays there is growing evidence of the harmfulness of not revealing their
origins to the child and the importance of disclosure (Coughlin & Golish, 2002;
Cowden, 2012; Daniels, Grace, & Gillett, 2011; Lycett, Daniels, Curson, &
Golombok, 2004; McWhinnie, 1995; Turner & Coyle, 2000). Regarding the
importance of disclosure, some countries, like Switzerland, New Zealand, or the
state of Victoria in Australia, have enacted laws or policies to enable children to
gain access to information grounded on the child’s right to know the nature of their
conception. If parents do not disclose, they run the risk of becoming distanced from
the child, who usually discovers the truth eventually (Turner & Coyle, 2000). Also,
if for any reason a child discovers their genetic origins once they are adult, there
could be psychological damage resulting from the accidental and late discovery of
the circumstances of their conception (Turner & Coyle, 2000).
The intention to disclose and the effect of disclosure on the child have been the
focus of many studies. (Blake, Casey, Readings, Jadva, & Golombok, 2010;
Daniels, 2009; Isaksson et al., 2011; Laruelle, Place, Demeestere, Englert, & Delba-
ere, 2011; MacDougall, Becker, Scheib, & Nachtigall, 2007; Soderstrom-Antilla,
Salevaara, & Suikkari, 2010). In the large majority of these studies, the legislation
of the countries where they were written allowed offspring and their parents to
have access to information on the identity of the donor. However, the situation in
Spain is different. In this country, assisted reproductive legislation allows every
treatment but surrogacy, sex selection in the absence of a genetically transmitted
disease, or reproductive cloning; any woman over 18 who is considered legally
competent is considered eligible, independent of her sexual orientation or marital
status. However, Spanish law protects the anonymity of all medical donors,
meaning that children will never be able to identify their donors and, in fact, there
is no national donor registry.
The Spanish fertility clinics report that 50% of their activities are gamete dona-
tion treatments (Navarro, 2011), but little is known about the intention. the parents
to disclose his/her origins to their child. Thus although we know openness is
important for the well-being of the family and the child, we also know that, if the
parents do not wish, they are not obliged to disclose the information.
The present study is part of a broader study in FivMadrid regarding the parents’
attitude toward revealing the donation treatment to their family and child.
The primary purpose of the first phase of this study was to explore the intention
to disclose their origin to the offspring on the part of Spanish patients undergoing
gamete donation and embryo donation treatments. We examined this by determin-
ing whether there were differences between traditional (heterosexual couples) and
non-traditional (lesbian couples and single women) in their intention to disclose.
We also wanted to consider a differences between those families who wished to tell
only the child, and those who wanted to disclose the origin to other family mem-
bers and friends as well as the child. The last consideration was to explore any dif-
ferences between traditional and non-traditional families regarding their attitude
toward psychological counselling during and after treatment.
 Journal of Reproductive and Infant Psychology 85

Materials and methods

Participants and procedures
During October 2010–October 2011, a prospective, descriptive and non-randomised
epidemiological study of couples undergoing reproductive donation treatments was
performed in FivMadrid (a private institution for reproductive medicine and gynae-
cology), Spain. One hundred and seventy-two patients were invited to participate,
and those who accepted completed a questionnaire. Although our clinic has a large
number of foreign patients, and the difference in reproductive legislation between
their countries and Spain influenced their decision to undertake donation treatment
in Spain, all the participants in our study are Spanish. A total of 330 donation
cycles were performed in FivMadrid during October 2010–October 2011. Each par-
ticipant in our study received one or more donation cycles.
Patients were categorised into three types of family units: heterosexual couples,
lesbian couples and single women. Each family unit completed only one
questionnaire.
Of the 172 patients invited to participate, 141 returned completed question-
naires; 11 of these were discarded because they were incomplete (more than half of
the questionnaire was unanswered), and 130 were considered valid.
This research was based on the guidelines of the Spanish Committee on
Assisted Reproductive Techniques and the Helsinki Declaration (1975) for research
on human beings; and it was also approved by the Ethical Committee of
FivMadrid.

Survey questions
The semi-structured questionnaire with closed and open questions was specially
designed for this investigation taking into consideration the questionnaires used in
similar studies. (Blake et al., 2010; Soderstrom-Antilla et al., 2010).
The questionnaire contains 15 closed questions and one open question. This
open question refers to parents’ motivations to disclose or not the child’s origin, if
they have already decided. For this question, participants were encouraged to give
details on their motives.
The 16 questions composing the questionnaire covered self-report of the partici-
pant’s characteristics (age, sex, education level, type of family unit, who completes
the questionnaire, type of donation treatment); intention to disclose to the offspring
(if they had decided; why they had taken that decision; if so, at what age did they
intend to disclose); if they intended to advise the hospital where the child would be
born and tell other people (family and friends); if they thought that undergoing this
kind of treatment was a good decision; if they felt that the future child was theirs;
if they were concerned about the physical characteristics of the donors; and what
their attitude to psychological counselling during treatment and after (pregnancy
and post-delivery).
The questionnaire was handed out by the medical doctor during the first
appointment initiating treatment with the request that it be returned before the
blood pregnancy test, six weeks later. This was to allow them sufficient time to
discuss the questions with their partner (if they had one) and think over their own
attitude toward disclosing, when doing so would be best for the child and how they
personally felt toward their fertility treatment to obtain a child.
86 G. Baccino et al.

Treatments
Intrauterine insemination (IUI) with sperm donation
Fourteen family units received donor intrauterine insemination (DI) treatment. Six
patients underwent this treatment because of their male partner’s infertility, and
eight were members of a lesbian couple.
The standard IUI procedure was followed as previously described (Gómez-
Palomares et al., 2008).

Intracytoplasmatic sperm injection (ICSI) using sperm, oocyte or embryo donation

A total of 102 patients underwent an ICSI cycle. Twenty-two received their own
oocytes and donor sperm (12 lesbians and 10 single women), while 80 received
donated oocytes and semen from their partner. ICSI was routinely performed in all
fertilisation procedures, as described elsewhere (Palermo, Joris, Devroey, & Van
Steirtegham, 1992). The ovarian stimulation for patients and donors was performed
following the description for ovarian stimulation (Acevedo, Gómez-Palomares, Ricc-
iarelli, & Hernández, 2006; Hernández, Gómez, & Ricciarelli, 2009; Manzanares,
Gómez-Palomares, Ricciarelli, & Hernández, 2010). Fourteen patients in this study
underwent an embryo-donation treatment; eight were members of a heterosexual
couple and six were single women. The Spanish legislation determines that embryo
donation must be done with embryos from other couples who, for different personal
reasons, have decided not to keep the embryo and have chosen to donate it for
reproductive purposes.
There are two types of embryo donation in Spain: one of frozen embryos previ-
ously donated to the centre by other couples; another is a ‘fresh’ embryo-donation
cycle (donor oocytes and sperm microinjected by an ICSI procedure as described
above).

Statistical analysis
Quantitative analysis was performed with SPSS 11.0 (SPSS Inc., USA). For
descriptive statistics, we used means ± SD. Student’s t-test, Fisher’s exact test, and
the χ2-test were used where appropriate. P-value < 0.05 was considered significant.
The Pearson coefficient was calculated to determine correlations. The answers to
the open question were categorised, grouped and analysed. Investigator triangula-
tion was performed to gather and interpret data.

Results
Demographic results
Data from a total of 130 ‘family units’ were analysed; 94 (72%) were heterosexual
couples, 20 (15%) lesbian couples and 16 (12%) single women. These percentages
are representative of the population undergoing fertility treatments in Spain (Navar-
ro, 2011). The mean age of women who were part of a heterosexual couple was 40
years (SD 4.8), with 41 years for the men (SD 5.5). In lesbian couples the mean of
age of the future biological mother was 36 years (SD 2.9) and 39 (SD 3.9) for the
co-mother. The mean of age of the future single mothers was 39 (SD 4.0; see
Table 1).
 Journal of Reproductive and Infant Psychology 87

Table 1. Mean age per type of family.

Type of family Patient Mean age (SD)
Traditional families (N = 93 + 1 no response) Mother 40 (4.8)
Father 41 (5.5)
Homosexual families (N = 20) Mother 36 (2.9)
Co-mother 39 (3.9)
Single mother families (N = 16) Mother 39 (4.0)

In the three types of family units our results reveal that, independently of the
type of family and treatment, the questionnaire was usually completed by the
mother (gestational or biological). In the heterosexual couples, 65% of the question-
naires were completed by the mother alone (independently of the type of treat-
ment), 33% by both parents jointly, and in 4% of the families, by the father alone.
In lesbian couples 50% of the questionnaires were completed by the biological
mother alone, 38% by the mother and co-mother jointly, and 13% were only com-
pleted by the co-mother.
Regarding differences of view about disclosing or not disclosing, only 5 women
(all future mothers in heterosexual couples) of the 130 respondents answered that
their partner did not agree with their opinion about disclosure. These five women
answered that they had not decided if they would disclose to the offspring.

Educational level
Two-thirds of our total sample had continued their education after completing sec-
ondary school; 18% had a post-graduate university degree, 30% a university
degree, 19% had gone to a professional school, 26% had completed secondary edu-
cation, and 7% elementary education.
In heterosexual couples 14% had post-graduate degrees, 36% a university
degree, 17% had gone to professional school, 26% secondary education and 7%
elementary school. However, among lesbian couples 38% had a post-graduate uni-
versity degree, 13% a university degree, 38% a secondary school certificate, and
none had only an elementary level or a degree from a training school.
The educational level of the future single mother families was: 29% post-uni-
versity graduate; 14% university graduate; 43% secondary school; and 14% had
only completed elementary school.

Type of donation treatment per family, related to intention to disclose

In the three family types analysed, 62% were undergoing oocyte donation, 27%
semen donation and 11% embryo donation (Figure 1).
Our results show that 61% of our participants intend to disclose their origin to
the child, while 17% intend to not disclose and 22% had not yet decided at the
time of completing the questionnaire (Figure 2).
We evaluated these results by family type, and found that in heterosexual cou-
ples 48% wanted to tell, 18% did not, and 34% still had not decided; in lesbian
couples, 100% wanted to tell; and among single mothers, 89% had decided to tell
and 11% did not know if they would tell their offspring his/her origins.
88 G. Baccino et al.

Figure 1. Type of treatment.

Figure 2. Intention to disclose to the offspring.

In the analysis by family type (Table 2), 6 heterosexual couples underwent

donor IUI (2 intended to disclose to the child), 80 egg donation with the partner’s
semen (39 intended to disclose), and 8 embryo donation (4 intended to disclose).
There were no significant differences between intention to disclose and type of
treatment in these families.
Among homosexual couples, 12 underwent IVF with donor semen and 8 donor
IUI. All of them intended to disclose.
In single women, 10 underwent IVF with donor semen (9 intended to disclose)
and 6 embryo donation (5 intended to disclose). There were no significant differ-
ences between intention to disclose and type of treatment in these families.
We also compared embryo donation between heterosexual couples and single
women, but there were no significant differences related to the intention to disclose
in either type of family undergoing the same treatment.
We found significant differences (P < 0.05) between donor IUI in heterosexual
couples and homosexual couples in terms of intention to disclose. All homosexual
couples intended to disclose while only two of the heterosexual couples intended to
disclose this treatment to the child.
We found significant differences (P < 0.005) between family units in terms of
decision-making. Non-traditional families (lesbian couples and single women)
 Journal of Reproductive and Infant Psychology 89

Table 2. Number and type of treatments per family unit, related with intention to disclose.
Type of treatment
Type of IVF + semen Egg donation + Embryo
family unit donor Donor IUI partner’s semen donation
Heterosexual 0 6 80 8
couples
Intention to 2 intend to 39 intend to disclose 4 intend to
disclose disclose disclose
1 no 13 no 3 no
3 not decided 28 not decided 1 not decided
Homosexual 12 8 0 0
couples
Intention to All intend to All intend to
disclose disclose disclose
Single women 10 0 0 6
Intention to 9 intend to 5 intend to
disclose disclose disclose
1 not decided 1 not decided

decided almost immediately to tell their offspring; among heterosexual couples,

only 48% had decided to do so when filling in the questionnaire.

Age of disclosure
The majority of participants (85%) chose childhood (from 3 to 8 years of age) as
the best time for disclosure, while 7% chose adolescence and 8% chose adulthood
(Figure 3).

Motivation for disclosing or not

Disclosure
We asked the participants to describe their motives for disclosing or not disclosing
to their offspring their conception origins. We divided the answers into four catego-
ries; the first two categories received the majority of the answers.

Figure 3. Age of disclosure.

90 G. Baccino et al.

The first category could be called the ‘child’s right’ and it grouped all the
answers oriented toward one’s right to know the truth about their lives, origins and
the importance of a healthy parent–child relationship without lies (‘Because it is
part of my child’s life’; ‘Because the child has the right to know where he or she
came from’; ‘Everyone has the right to know their origins and the truth about their
history’; ‘It is my child’s right’).
The second category could be called ‘Honesty above all’, and grouped the
answers related to the importance of sincerity and honesty in the parent–child rela-
tionship (‘We should be as honest as we can with our children’; ‘This is a serious
topic, we must be honest’; ‘It is the truth and it shouldn’t be hidden’).
The third category is called ‘Fear of being discovered at the wrong time’, and
grouped those answers related to the future parents’ fear that their child could be
told about their origins by someone else or in a special situation (‘Fear of finding it
out in adulthood’; ‘I prefer to tell my child myself, not for someone else to tell
him/her’; ‘We should be the ones to tell him/her’). The fourth category, ‘Fear of
diseases’, grouped those parents who want to tell their offspring about their origins
because they think it is better to tell before anything could happen, in particular, a
disease (‘I must tell him, just in case in the future he has any illnesses’; ‘I should
tell him, we don’t know if a genetic disease may appear’).
Participants in this study received the same social and media input about dona-
tion treatment and disclosure as the rest of the general population in Spain. They
did not have any extra suggestions on the topic of disclosure. These answers were
not a result of the psychological consultation, because these consultations were
optional, and only five participants took advantage of them before or during
treatment.

Non-disclosure
While 17% of the participants decided not to disclose, only 3 described their
motives: ‘Because of moral convictions on both our parts’; ‘I will not reveal it’;
‘Because some children can tell others’, which we took to mean that the child
might tell someone he should not.

Intention to disclose to others

We found a relationship (P < 0.005) between those parents who would tell their
child and also tell others (66% would tell others, 32% would not, and 2% did not
answer). Almost all of the future parents who would tell family and friends about
the donation would also tell the offspring (Figure 4).
Regarding the intention to reveal the treatment in the hospital where they would
be giving birth, 64% would tell the medical staff, 31% would not tell, and 3% did
not answer.

Decision-making about the donation

Our results reveal that 94% of the participants thought it had been a good decision
to undergo a donation treatment, 3% were not very sure, and 3% did not answer
(Figure 5). It should be noted that when they answered the questionnaire all partici-
pants were receiving the treatment.
 Journal of Reproductive and Infant Psychology 91

Figure 4. Intention to disclose to others (family and friends).

Figure 5. Was it a good decision to undergo a gamete donation treatment?

Do they feel it is their own child?

Almost all of the participants feel the child is theirs (95%). However, 1% were not
entirely sure, 1% had not decided, and 1% did not answer (Figure 6).

Donor’s physical characteristics

We questioned patients regarding their concern with the donor’s physical character-
istics: 28% were very concerned, 36% somewhat concerned, 18% only slightly con-
cerned, 14% not concerned, and 4% did not answer. There were no significant
differences (P > 0.05) between the types of families (traditional and non-traditional)
in this response.

Psychological counselling during and after treatment

Our results reveal that 64% of our participants (traditional and non-traditional
families) consider psychological counselling necessary during the treatment and
55% also thought it necessary after treatment. There were no significant differences
(P > 0.05) between family types.
92 G. Baccino et al.

Figure 6. Do they feel the future child is theirs?

Discussion
Some research regarding disclosing their origins to the offspring born after a gam-
ete donation treatment has been done respectively, when the treatment is done and
the child born (Blake et al., 2010; Daniels, 2009; Soderstrom-Antilla et al., 2010);
in our study, as in other studies (Isaksson et al., 2011), we were interested in learn-
ing the future parents’ feelings before they had a child.
Study participation was high in a context in which disclosure to the offspring is
delicate and controversial; additionally, Spanish legislation establishes an anonymity
requirement in the donation process. In other European countries the legislation
allows, once the offspring is of age, the identity of the donor to be learnt and an
evential meeting with him/her (Berkel, Candido & Pijffers, 2007; Cowden, 2012;
Daniels, 2009; Laruelle et al., 2011; Soderstrom-Antilla et al., 2010). However,
when all gamete donation is anonymous by law, the consequent prohibition on
learning the donor’s identity means the child will never be able to satisfy his/her
curiosity about the donor. As confirmed by recent research, offspring are curious
and sometimes want to meet the donor (Beeson, Jennings, & Kramer, 2011; Jadva,
Freeman, Kramer, & Golombok, 2010). This curiosity may vary depending on the
type of family and the age of disclosure. This situation may make Spanish parents
aware of the importance of the timing of disclosure and, when they decide to do it,
of being sure to tell their children that they will never be able to meet the donor.
This should be discussed with the patients. The legal emphasis on the anonymity
of the donation process is something that will also have to be explained to the
child, and this issue should be addressed during psychological consultations prior
to starting a reproductive donation treatment and consultation should be available
before, during and after treatment.
In Spain, as in other countries, the offspring and their parents can have general
information about the physical characteristics of the donor(s) such as eye colour,
hair colour, blood group, etc.; nevertheless, according to law, they will never meet
their donor.
Our results are consistent with those presented in different European countries,
with 61% intending to disclose their pregnancy’s origin to their children (Berkel
et al., 2007; Daniels, 2009; Laruelle et al., 2011; Soderstrom-Antilla et al., 2010).
Parents choose to tell the children in order to be honest and establish an honest and
open relationship.
 Journal of Reproductive and Infant Psychology 93

Of the 22 family units who decided not to reveal his/her genetic origins to the
child, only 3 gave any explanation. With so few explanations, it is not possible to
say much, but interesting approaches for future research would possibly be deter-
mining whether and to what extent, if any, the parents’ moral and or religious con-
victions affect their attitude; this information might help to resolve the future
parents possible fears and fantasies regarding the possibility of the child revealing
their ‘secret’ or even rejecting the parents.
It would also be interesting to explore whether Spanish patients would prefer to
know more about their donors than they now know; for example, the donor’s
identity.
Of all participants who wanted to disclose their origin to their child (61%),
85% intend to do so during childhood (3–8 years of age). This will allow the child
to grow up with the knowledge as a part of their life, while revealing it during
adolescence or at adulthood may cause conflicts in the individual and in the
relationship with his/her parents because they have kept this secret from them.
Regarding disclosure to others, research describes different criteria considered
by parents in relation to their decision to tell their child and/or others. Sometimes,
they will disclose to family or friends, but not to the child (MacCullum &
Gombok, 2007; Murray & Golombok, 2003). Our study shows a different result;
there was a correlation (P < 0.005) between those parents who intended to disclose
to the child and those who would also tell others. Almost all of the family units
who wanted to disclose to others would also disclose to their child. It is important
to note that our results are in future parents, and the results presented by MacCal-
lum and Golombok and by Murray and Golombok were in families who already
had their children.
Regarding the decision-making about the donation, our results reveal that almost
all of our participants thought it had been a good decision to undergo a gamete dona-
tion treatment. The same happened when we asked the participants if they felt their
future child would be theirs. Almost all of them felt the child to be their own. Taking
into account that at the time of answering the questionnaire they were all beginning
or receiving the treatment, we insist on the importance of offering a psychological
consultation before starting a gamete donation or embryo donation treatment.
In relation to donor physical characteristics, traditional and non-traditional fami-
lies give high importance to this issue. This information gives us the idea that
because they know that although neither themselves nor their offspring will ever be
able to meet the donor, having information about the donor’s physical appearance
can give them some sense of what this unknown donor is like.
In conclusion, and in the Spanish legal context prohibiting donor identification
in reproductive donation treatments, the majority of our participants, heterosexual
couples, lesbian couples and single women, intend to disclose the origin of their
conception to their child. These results may provide some insights to practitioners
in countries where donor identity is not mandated on the parents’ high motivation
to disclose genetic origins in order to have no secrets between them and their future
offspring.

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