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Manuscript Number: RBMS-D-17-00008

Title: Bioethical dilemmas in gamete donor regulation and recipients'

disclosure intentions: results from a nationwide multi-centre study in
France

Article Type: Original Article

Section/Category: Ethics

Keywords: gamete donation, anonymity, assisted reproduction,disclosure,

France

Corresponding Author: Professor Nikos Kalampalikis, PhD

Corresponding Author's Institution: University Lyon 2

First Author: Nikos Kalampalikis, PhD

Order of Authors: Nikos Kalampalikis, PhD; Marjolaine Doumergue, PhD;

Sophie Zadeh, PhD; French Federation of CECOS

Abstract: Although there is no common European legislative framework on

assisted reproduction, the existing literature suggests that recipients
of both anonymous and identifiable donor gametes do not share information
about donor conception with their children. Despite public and
parliamentary debate in 2011, the French context is characterised by a
stable legal framework (anonymous and non-remunerated donation). However,
there is a lack of evidence concerning recipients' views. 929
heterosexual couple members undergoing a donor conception procedure were
administered a questionnaire during their visit to one of 20 national
fertility centres. They were invited to report their attitudes towards
the French legal framework, their perceptions of the anonymous donor, and
their intentions to disclose the donor conception. The vast majority of
respondents (94%) approved the current legal framework. Participants'
perceptions of the donor were characterised by ambivalence. The majority
(71%) indicated that they intended to disclose to their children. Given
that this is the first, largest, nationwide study of French recipients of
donor sperm, the findings are an important contribution to the research
evidence currently available about disclosure in the increasingly
uncommon context of donor anonymity in Europe. This study raises
questions about the complexity of bioethical dilemmas in this setting.

Suggested Reviewers:

Opposed Reviewers:
Cover Letter

Dear Editors,

I would like to submit our paper entitled ‘Bioethical dilemmas in gamete donor
regulation and recipients’ disclosure intentions: results from a nationwide multi-centre
study in France’ for consideration for publication in Reproductive Biomedicine Online.

The material contained in the manuscript has not been published, has not been
submitted, and is not being submitted elsewhere for publication.

The authors’ roles in the study were as follows: N.K., M.D. planned and designed the
study. The French Federation of CECOS was the research partner of the study. M.D., S.Z.,
N.K. analyzed the data. N.K., M.D., S.Z. were primarily responsible for writing the paper.
All authors were involved in drafting and revising the manuscript. All authors have
agreed to the submission of the manuscript.

As detailed in the acknowledgements section of the manuscript, staff members of the

centers from the French Federation of Cecos made an important contribution to
recruitment of participants and data collection (Alsace : Isabelle Koscinski ; Besançon :
Jean-Luc Bresson ; Bordeaux : Aline Papaxanthos ; Caen : Éthel Szerman ; Clermont-
Ferrand : Laurent Janny ; Dijon : Jean-Claude Jimenez ; Grenoble : Sylviane Hennebicq ;
Lille : Pascale Saint-Pol ; Lyon : Jean François Guérin ; Marseille CHU : Jackie Saias ;
Marseille IMR : Roger Roulier ; Montpellier : Samir Hamamah ; Nancy : Bernard Foliguet
; Nantes : Paul Barrière ; Nice : Patrick Fenichel ; Paris Cochin : Jean-Marie Kunstmann ;
Paris Tenon : Jacqueline Mandelbaum ; Paris Jean Verdier : Florence Eustache ; Reims :
Marie-Claude Melin ; Rennes : Dominique Le Lannou ; Rouen : Nathalie Rives ; Toulouse
: Louis Bujan ; Tours : Claire Barthélémy).

Thank you for your consideration. I look forward to hearing from you in due course.

Yours sincerely,

Nikos Kalampalikis
*Manuscript

1 Running title: Bioethical dilemmas in gamete donor regulation and disclosure

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 1 Title: Bioethical dilemmas in gamete donor regulation and recipients’ disclosure
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2 2 intentions: results from a nationwide multi-centre study in France
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9 5 Authors: N. Kalampalikis, Ph.D,* M. Doumergue, Ph.D, S. Zadeh, Ph.D, French Federation
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11 6 of CECOS.
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16 8 * Corresponding author. Postal address: Laboratoire GRePS (EA 4163), Institut de
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18 9 Psychologie, Université Lyon 2, 5 avenue P. Mendès-France, 69 656 Bron (France). Email
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20 10 address: nikos.kalampalikis@univ-lyon2.fr
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27 12 Study funding: This study was supported by a Biomedicine Agency Research Grant and
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29 13 by a Rhône-Alpes Council Grant to Nikos Kalampalikis.
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32 14 Conflicts of interest: There are no conflicts of interest to disclose.
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 1 Abstract
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2 2 Although there is no common European legislative framework on assisted reproduction,
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3 the existing literature suggests that recipients of both anonymous and identifiable donor
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7 4 gametes do not share information about donor conception with their children. Despite
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9 5 public and parliamentary debate in 2011, the French context is characterised by a stable
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11 6 legal framework (anonymous and non-remunerated donation). However, there is a lack
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14 7 of evidence concerning recipients' views. 929 heterosexual couple members undergoing
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16 8 a donor conception procedure were administered a questionnaire during their visit to
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18 9 one of 20 national fertility centres. They were invited to report their attitudes towards
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20 10 the French legal framework, their perceptions of the anonymous donor, and their
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23 11 intentions to disclose the donor conception. The vast majority of respondents (94%)
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25 12 approved the current legal framework. Participants' perceptions of the donor were
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27 13 characterised by ambivalence. The majority (71%) indicated that they intended to
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14 disclose to their children. Given that this is the first, largest, nationwide study of French
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32 15 recipients of donor sperm, the findings are an important contribution to the research
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34 16 evidence currently available about disclosure in the increasingly uncommon context of
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36 17 donor anonymity in Europe. This study raises questions about the complexity of
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39 18 bioethical dilemmas in this setting.
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 1 Bioethical dilemmas in gamete donor regulation and recipients’ disclosure
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2 2 intentions: results from a nationwide multi-centre study in France
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9 5 Introduction
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11 6 Over the last 40 years, the legal landscape of gamete donation has changed significantly,
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13 7 such that in several countries, identifiable donation is now mandatory. Such legal
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8 changes have been accompanied by much public and political debate about children’s
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18 9 right to know about their ‘genetic origins’ (Turkmendag et al., 2008). However, in the
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20 10 European Union, despite the fact that many common legislative and regulatory
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22 11 frameworks exist, there is no common law for this bioethical dilemma. As such, a
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25 12 plurality of polarised policies on gamete donation can be identified. In some countries,
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27 13 such as Italy, all forms of assisted reproduction are illegal, while in others, such as Spain,
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29 14 it is possible to access fertility treatment using donor gametes irrespective of marital
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31 15 status or sexual orientation. Moreover, the practice of assisted reproduction is
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34 16 differentially organised, such that in some countries, fertility treatment is subsumed
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36 17 under public healthcare, while in others, it remains largely private. Concerning donor
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38 18 anonymity, equally diverse laws can be identified; while in Belgium, Sweden, Germany,
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19 Austria, the UK, the Netherlands, and Finland, donor identifiability is mandatory, in
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43 20 Spain and France, donation remains anonymous. In France in particular, until 2015, a
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45 21 condition of donation was that the donor must also be a parent prior to his or her
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47 22 donation.
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50 23 Despite the common transition towards donor identifiability, both in countries within
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52 24 the European Union, and beyond, the only existing piece of legislation that mandates
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54 25 state-led disclosure of donor conception, via the birth certificate, is the Children and
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26 Family Relationships Act (2015), which has recently come into effect in Ireland. Yet in
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59 27 light of such legislative changes, much research has focussed on the question of the
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 1 relationship between the anonymity or identifiability of the donor and patterns of
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2 2 parents’ disclosure. Some studies have found higher rates of disclosure or intentions to
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3 disclose amongst prospective (Greenfeld et al., 1998; Brewaeys et al., 2005; Godman et
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7 4 al., 2006; Crawshaw, 2008; Isaksson et al., 2011) and actual (Scheib et al., 2003; Lalos et
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9 5 al., 2007) parents who received gametes from identifiable sperm or egg donors.
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11 6 However, other research has not substantiated this (Baetens et al., 2000; Greenfeld &
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14 7 Klock, 2004). Studies of parents’ disclosure practices following the introduction of
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16 8 identifiable donation in Sweden found both no evidence (Gottlieb et al., 2000) and
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18 9 substantial evidence (Isaksson et al., 2012) that parents using identifiable donors were
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20 10 more likely to disclose. In the UK, no significant increase in the rate of disclosure has
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23 11 been shown following legislative changes towards donor identifiability in 2005
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25 12 (Freeman et al., 2016). A review of the factors that might contribute to parental
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27 13 disclosure decision-making in the studies carried out over the last 30 years concluded
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14 that the impact of legislation on parents’ disclosure decisions is therefore unclear
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32 15 (Indekeu et al., 2013).
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34 16 Parents have cited both the anonymous and identifiable status of the sperm donor as a
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36 17 reason not to inform offspring about their donor conception. Amongst parents who have
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39 18 used identifiable donors, the prospect of disclosure has been described as arousing the
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41 19 fear that offspring could form an attachment to the donor; amongst those who have used
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43 20 anonymous donors, it has been argued that disclosure is unnecessary or may even be
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21 frustrating for offspring, who remain unable to access identifying information (Daniels
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48 22 et al., 1995; Lycett et al., 2005; Golombok et al., 2006; Lalos et al., 2007; Sälevaara et al.,
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50 23 2013). In qualitative studies, parents’ representations of sperm donors have been
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52 24 shown to be characterised by ambivalences and tensions (Kirkman, 2004; Zadeh et al.,
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55 25 2016), such that the donor may be depersonalised at the same time as he is regarded as
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 1 This large-scale, multi-centre study is the first to examine disclosure intentions and
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2 2 perceptions of the donor amongst heterosexual couples seeking fertility treatment with
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3 donor sperm in France. The French national context is unique insofar as the legislative
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7 4 changes observed in other countries are not similarly found in this setting. Since 1973,
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9 5 French fertility centres have been organised in a national network embedded within
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11 6 public healthcare provision (the French Federation of CECOS - FFC), and regulated by
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14 7 the French bioethics law. Despite a comprehensive legal review in 2011, and social and
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16 8 political challenges to donor anonymity (CCNE, 2005; Théry, 2010; Clayes & Viallatte,
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18 9 2008; Leonetti, 2011), as well as citizen forums organised for this purpose (Graf, 2009),
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20 10 the laws regarding donor anonymity and non-remuneration of donation, as well as the
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23 11 limits on access to treatment to heterosexual couples, remain intact. The information
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25 12 provided to prospective parents about donors is limited, and generally includes basic
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27 13 phenotypical information only. Given this context, unparalleled in other parts of Europe,
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14 this systematic study sought to elicit the views of heterosexual couples regarding the
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32 15 legal framework of anonymity, the anonymous donor, and their disclosure intentions.
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36 17 Material and Method
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38 18 Sample characteristics
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41 19 Potential participants were invited to partake in the study during their visit to one of 20
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43 20 certified fertility centres (of a total of 23 in France) for a medical or counselling
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45 21 appointment during two six month periods: April – September 2008, and September
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22 2011 – February 2012. Potential participants were informed that completion of the
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50 23 questionnaire was not mandatory, and would not impact upon their subsequent
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52 24 treatment. As reported in Table I, 929 participants, 51% of a total of 1808 couples who
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54 25 presented for treatment during this time, consented to take part, 470 (51%) of whom
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57 26 were female, and 459 (49%) of whom were male. Across both time-periods, the average
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59 27 age of participants was 32.1 years (S.D.=8.13), with women on average 30.7 years
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 1 (S.D.=6.93), and men on average 33.5 years (S.D.=9.00). The majority of participants
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2 2 (n=714, 77%) were at the preconception stage, of a period between 10 and 24 months;
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3 the remainder (N=215, 23%) were already parents, returning to the clinic to conceive a
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7 4 second or third child. The socio-demographic profile of participants was similar to the
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9 5 general population of French recipients of donor gametes, as identified by Hennebicq et
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11 6 al. (2010).
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16 8 Questionnaire and analysis
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18 9 Pilot interviews were conducted with 13 individuals who were currently accessing
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20 10 fertility treatment with donated gametes in France. Along with the existing literature,
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11 interviewees’ responses informed the items included in the questionnaire. Each
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25 12 participant was asked to complete an anonymous questionnaire in the presence of a
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27 13 researcher or a professional. The questionnaire asked participants to indicate closed
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29 14 responses to the following: (i) preference for anonymous or identifiable donation; (ii)
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32 15 preference for non-remunerated or remunerated donation; (iii) perceptions of the
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34 16 donor; (iv) disclosure to others (excluding physicians); (v) disclosure intentions to
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36 17 offspring; (vi) reasons for disclosure or non-disclosure; (vii) anticipated timing of
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38 18 disclosure (where applicable). For each question, participants could select more than
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41 19 one answer; unless otherwise specified, they were asked to indicate each response on a
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43 20 four-point Likert scale (ranging from 1= ‘strongly disagree’ to 4= ‘strongly agree’).
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45 21 Questionnaires were analysed using descriptive statistics to identify frequencies. For
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22 clarification, agreement rates (the number of participants who ‘agreed’ or ‘strongly
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50 23 agreed’ with specific items) are reported below.
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53 24 We controlled the effect of gender (women vs. men) on one hand, and time of
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55 25 participation (2008 and 2011-2012) on the other, on the dependent variables through
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57 26 analyses of variance (ANOVA) and χ -tests (with the measures of the size of the effect:
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 1 respectively η2 and Cramer’s V with .01<η <.05 and 0.10 <Cramer’s V<0.50 considered
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2 2 as indicating a low to moderate effect size).
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5 3 The study was approved by the ethical committee of the FFC, and all ethical precautions
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7 4 were taken in order to respect participants’ autonomy and confidentiality.
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12 6 Results
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15 7 Preferences concerning regulation about donation
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18 8 Participants’ responses to questions concerning their attitudes about the legislation on
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20 9 gamete donation are reported in Table II. Almost all respondents (n= 861, 94%)
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10 indicated that they agreed or strongly agreed with the existing legal principles in this
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25 11 national context: anonymity and non-remuneration of donation. Several (n= 330, 37%)
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27 12 also agreed or strongly agreed that anonymity and remuneration of donation was
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29 13 acceptable. A minority (n= 109, 12%) agreed or strongly agreed with donation being
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32 14 identifiable and non-remunerated. Fewer (n= 45, 5%) agreed or strongly agreed with
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34 15 identifiable and remunerated donation. No differences were found between women and
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36 16 men. Respondents in 2012 agreed significantly more than those of 2008 with the idea
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17 that the donation should be anonymous and remunerated (M =1.87 (SD=1.012) vs
2008

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41 18 M =2.30 (SD=.973); F=42.42; p=.001; η =.046: moderate effect) and with the idea that
2012
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43 19 the donation should be identifiable and remunerated (M =1.23 (SD=.252) vs M =1.36
2008 2012

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45 20 (SD=.630); F=9.85; p=.002; η =.011: small effect).
2

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50 22 Perceptions of the donor
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52 23 Participants’ responses to questions concerning their perception of the donor are
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54 24 detailed in Table III. The majority (n= 755, 83%) of participants agreed or strongly
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25 agreed with the statement that the donor is ‘a generous and unselfish man’, and more
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59 26 than half (n= 476, 52%) agreed or strongly agreed with the statement that the donor is
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 1 ‘a hero who is helping without expecting something back’, suggesting that the donor is
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2 2 personalised by intending parents through his donation only. However, other
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3 statements that would suggest more concrete forms of personalisation of the donor (as
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7 4 ‘someone we are thinking about very frequently’, and ‘to some extent, someone who
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9 5 belongs to the family’) were not met with such agreement. More than half (n= 549, 60%)
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11 6 of participants agreed or strongly agreed that the donor is ‘just someone who gave
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14 7 spermatozoa’, and 504 participants (55%) agreed or strongly agreed that the donor is
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16 8 ‘not a particular person’, seemingly indicating reification or depersonalisation of the
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18 9 donor amongst more than half of the respondents. However, fewer respondents (n= 275,
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20 10 30%) agreed or strongly agreed with the statement that the donor is ‘nobody, just a
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23 11 sperm straw’.
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25 12 Regarding terminology used to describe the donor, the majority (n= 752, 83%) of
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27 13 participants agreed or strongly agreed with the denomination ‘gamete donor’ only. Very
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14 few (n=86, 9%) agreed or strongly agreed with the term ‘natural father’, and fewer still
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32 15 agreed or strongly agreed with ‘real father’ (n=56, 6%) and ‘real father’ (n=33, 4%).
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34 16 Some differences were established between women and men and participants at
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36 17 different time points regarding their perceptions of the donor (see Table III). For
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39 18 example, women were more likely than men to agree with the statement that the donor
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41 19 is a generous and unselfish man (M =3.19 (SD=.818) vs M =3.02 (SD=.880); F=9.19;
wom. men

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43 20 p=.003; η =.013), and to refer to him as a gamete donor (M =3.26 (SD=.861) vs
2
wom.

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21 M =3.04 (SD=.972); F=12.47; p=.001; η =.014). However, the effect size for all
men
2

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48 22 significant differences was small.
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50 23
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52 24 Disclosure to others
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54 25 677 respondents (73%) had told their family about their use of gamete donation, and
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57 26 568 (62%) had discussed the topic at least once with their friends (Table IV). Among
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59 27 those who disclosed to others their pursuit of donor conception, 177 participants (19%)
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 1 reported having regretted it afterwards. In particular, women (24%) were more likely
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2 2 than men (14%) to indicate regret at having shared such information with others (χ2 (1,
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3 n= 911)=14.64; p=.001 ; Cramer’s V=0.127), but again, the effect size for this significant
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7 4 difference was small.
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12 6 Disclosure to children
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14 7 696 participants (75%) indicated that they had decided to tell their prospective child
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8 about the fertility problems they had experienced (see Table IV). 657 participants (71%)
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19 9 indicated that they had decided to disclose to their offspring that they received donated
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21 10 gametes in order to conceive, while 133 participants (14%) were in favour of no
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23 11 disclosure at all.
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26 12 Regarding the timing of disclosure, a little more than half of participants (n= 500, 54%)
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28 13 were uncertain about when to share information about donor conception with their
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30 14 child. The majority (n= 668, 72%) of respondents indicated that they favoured that the
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15 decision regarding when to tell reflected the best moment for them. 269 participants
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35 16 (35%) indicated that they anticipated that the timing of disclosure would be that
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37 17 defined by psychologists as the most appropriate. More than half (n= 534, 58%)
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39 18 indicated that ‘the best moment to have a conception-related discussion with the child is
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42 19 when he/she would be asking about where babies come from’, and in 20011-2012, 243
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44 20 participants (53%) agreed with the idea that disclosure should take place at ‘the earliest
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46 21 possible’ moment.
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48 22 Those responding in 2011-2012 were more likely than those responding in 2008 to
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51 23 state that they had decided to tell their child about the use of fertility treatment (χ2 (1,
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53 24 n= 929)=8.38; p=.004 ; Cramer’s V=0.095) and the donor (χ2 (1, n= 929)=15.60; p=.001;
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55 25 Cramer’s V=0.130). They also were less uncertain as regards when doing so (χ2 (1, n=
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26 929)=14.61; p=.001; Cramer’s V=0.125). Effect sizes for these differences were again
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2 2 Discussion
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4 3 The findings of this study provide information on attitudes towards existing regulation,
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4 perceptions of the donor, and disclosure intentions among 929 heterosexual couple
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9 5 members undergoing the process of donor conception in France between two six month
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11 6 periods: April – September 2008, and September 2011 – February 2012. Findings
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13 7 indicate that the vast majority of respondents approved the current legal framework for
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16 8 sperm donation in France. The political and public controversy concerning whether or
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18 9 not donor-conceived offspring should have a legal right to access identifying information
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20 10 about the donor, which occurred during the study period, was not mirrored in the
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11 responses of intending parents. Moreover, findings seem to suggest that those seeking
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25 12 fertility treatment after this time were more likely to favour remuneration for donation
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27 13 than were those seeking treatment in 2008. One interpretation of this finding might be
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29 14 that those pursuing treatment with donor gametes were fearful that such controversy
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32 15 would result in fewer donations across the country, and that they believed that
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34 16 remuneration might counteract this shortage. Taken together, and similar to research in
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36 17 other contexts (Zadeh, Imrie & Braverman, 2016), such findings attest to the fact that
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38 18 intending parents’ ideas about the appropriate legislation concerning gamete donation
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41 19 are partially shaped by the legal and societal contexts in which they begin their path to
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43 20 parenthood.
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45 21
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47 22 In terms of perceptions of the donor, participants were found to simultaneously
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50 23 personalise and depersonalise him, as a generous person who nevertheless was
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52 24 considered to be irrelevant to intending parents’ everyday lives and family experiences.
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54 25 These findings therefore corroborate those of previous studies (Kirkman, 2004; Grace et
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26 al., 2008), in which ambivalence about the donor amongst heterosexual couples has also
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59 27 been identified. However, given that such research has also shown that feelings about
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 1 the donor are likely to change over time, and especially post-birth (Kirkman, 2004;
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2 2 Grace et al., 2008; Burr, 2009; Indekeu et al., 2014), the findings of this study raise
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3 questions about whether or not those who access fertility treatment using gamete
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7 4 donation in France will remain similarly ambivalent about the donor once they have
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9 5 children. Further, large-scale research on those who are already parents of donor-
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11 6 conceived children in France think and feel about the donor is now needed.
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14 7 The findings also indicate that the majority of prospective parents report an intention to
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16 8 disclose to their children the use of sperm donation. For most of the participants in this
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18 9 study, the fact that the offspring would be unable to access identifying information
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20 10 about the donor did not appear to be a major obstacle to the decision to inform them
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23 11 about their donor conception (see also Jouannet et al., 2010). As in the existing literature
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25 12 on families who have used either identifiable or anonymous donation, findings illustrate
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27 13 that the legal status of the donor does not appear to consistently affect disclosure
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14 intentions in France, as in other parts of Europe (Indekeu et al., 2013). In fact, the results
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32 15 of this study would seem to suggest that intending parents in France, who are most
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34 16 accepting of regulation that ensures donor anonymity, and who appear comfortable to
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36 17 personalise the donor in relation to his donation only, may feel able to share with their
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39 18 children information about the donation precisely because of the limited information
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41 19 they have. This coexistence of donor anonymity and intention to disclose echoes
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43 20 previous data from contexts in which identifiable donation is mandated, which has
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21 similarly shown that attitudes towards information sharing to offspring, and attitudes
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48 22 concerning children’s access to the donor’s identity, are distinct (Brewaeys et al., 2005;
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50 23 Isaksson et al., 2011). Particularly in the French context, it seems that donor anonymity
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52 24 does not have the causal effect of inhibiting disclosure among intending parents.
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55 25 Although the data here presented would seem to support the idea that intending parents
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57 26 in France may disclose to their children because of the existing legal framework, this
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59 27 interpretation of the results must be made cautiously. In previous research on parents of
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 1 donor-conceived children in the UK, intentions to tell children about their conception
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2 2 were not found to correlate with actual disclosure rates (Golombok et al., 2002;
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3 Readings et al., 2011). It is therefore possible that although the prospective parents in
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7 4 this study reported intending to disclose, such decisions were not realised once they
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9 5 became parents. Moreover, given the institutional context in which participants were
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11 6 recruited, it may be the case that the findings are indicative of socially desirable
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14 7 responses, rather than prospective parents’ actual disclosure intentions and/or future
15
16 8 actions. Further research, using longitudinal designs, must therefore be conducted on
17
18 9 this issue.
19
20 10 Beyond the legislative framework, it is additionally possible that other contextual
21
22
23 11 factors impacted upon prospective parents’ disclosure intentions. In the context of
24
25 12 French fertility centres, a change driven by FFC health professionals and professional
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27 13 counselling staff – from secrecy prevalence towards greater parental openness – has
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14 been effective since the early 1990s (Brunet & Kunstmann, 2012). However, although it
31
32 15 may be the case that prospective parents’ disclosure decisions are partially shaped by
33
34 16 such professional advice, it is noteworthy that the majority of participants emphasised
35
36 17 that the timing of disclosure would be decided in accordance with their own wishes,
37
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39 18 rather than those of the professionals with whom they were in contact.
40
41 19 Despite the difficulties in interpreting the motivations behind prospective parents’
42
43 20 disclosure patterns, the present study offers a unique insight into a population not often
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21 researched in the existing literature on gamete donation. Given that this is the first,
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48 22 largest, nationwide study of French recipients of donor sperm, the findings are an
49
50 23 important contribution to the research evidence currently available about disclosure in
51
52 24 the increasingly uncommon context of donor anonymity in Europe. This study raises
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55 25 questions about the complexity of bioethical dilemmas in the area of assisted
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57 26 reproduction as they relate to political, professional and public spheres. Further
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59 27 research, which explores the information sharing strategies of recipients of donor
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 1 gametes in France, and their perceptions of the donor following the birth of the child, is
1
2 2 now recommended.
3
4
5
3
6
7 4
8
9 5 References
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11 6 Baetens P, Devroey P, Camus M, Van Steirteghem AC, Ponjaert-Kristoffersen I.
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14 7 Counselling couples and donors for oocyte donation: the decision to use either
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16 8 known or anonymous donors. Hum Reprod 2000;15:476-484.
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18 9 Brewaeys A, de Bruyn JK, Louwe LA, Helmerhorst FM. Anonymous or identity-registered
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20 10 sperm donors? A study of Dutch recipients’ choices. Hum Reprod 2005;20:820–824.
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23 11 Brunet L, Kunstmann J-M. Gamete donation in France: the future of the anonymity
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25 12 doctrine. Med Health Care and Philos 2013;1:69-81.
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27 13 Burr J. Fear, fascination and the sperm donor as ‘abjection’ in interviews with
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14 heterosexual recipients of donor insemination. Sociol Health Ill 2009;31:705–718.
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32 15 CCNE. Accès aux origines, anonymat et secret de la filiation. Avis n 90. Paris: CCNE, 2005.
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34 16 Claeys A, Vialatte J-S. Rapport d’information. La loi bioéthique de demain, 107. Paris:
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36 17 OPECST, 2008.
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39 18 Crawshaw M. Prospective parents' intentions regarding disclosure following the
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41 19 removal of donor anonymity. Hum Fertil 2008;11:95-100.
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43 20 Daniels KR, Lewis GM, Gillett W. Telling donor insemination offspring about their conception: the
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45 21 nature of couples' decision-making. Soc Sci Med 1995;40:1213-20.
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47 22 Freeman T, Zadeh S, Smith V, Golombok S. Disclosure of sperm donation: a comparison
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50 23 between solo mother and two-parent families with identifiable donors. RBM Online
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52 24 2016;33:592-600.
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54 25 Godman KM, Sanders K, Rosenberg M, Burton P. Potential sperm donors’, recipients’ and
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 1 Golombok S, Lycett E, MacCallum F, Jadva V, Murray C, Rust J, Abdalla H, Jenkins J,
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2 2 Margara R. Parenting infants conceived by gamete donation. J Fam Psychol
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3 2004;18:443–452.
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7 4 Golombok S, Murray C, Jadva V, Lycett E, MacCallum F, Rust J. Non-genetic and non-
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9 5 gestational parenthood: consequences for parent–child relationships and the
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11 6 psychological well-being of mothers, fathers and children at age 3. Hum Reprod
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14 7 2006;21:1918-1924.
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16 8 Gottlieb C, Lalos O, Lindblad F. Disclosure of donor insemination to the child: the impact
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18 9 of Swedish legislation on couples' attitudes. Hum Reprod 2000;15:2052-2056.
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20 10 Grace V, Daniels K, Gillett W. The donor, the father and the imaginary construction of
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23 11 family: Parent’s constructions in the use of donor insemination. Soc Sci Med
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25 12 2008;66:301–314.
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27 13 Graf, A. Etats généraux de la bioéthique. Paris: French Health Ministry, 2009.
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14 Greenfeld DA, Greenfeld DG, Mazure CM, Keefe DL, Olive DL. Do attitudes towards
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32 15 disclosure in donor oocyte recipients predict the use of anonymous versus direct
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34 16 donation? Fertil Steril 1998;70:1009-1014.
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36 17 Greenfeld DA, Klock SC. Disclosure decisions among known and anonymous oocyte
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39 18 donation recipients. Fertil Steril 2004;81:1565-1571.
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41 19 Hennebicq S, Julliard J-C, Le Lannou D. Données descriptives de l’activité d’AMP avec
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43 20 don de spermatozoïdes au sein des Cecos de 1973 à 2006 en France. Andrologie
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21 2010; 1: 3–10.
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48 22 Indekeu A, Dierickx K, Schotsmans P, Daniels K, Rober P, D’Hooghe T. Factors
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50 23 contributing to parental decision-making in disclosing donor conception: a
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52 24 systematic review. Hum Reprod Update 2013;6:714-733.
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55 25 Indekeu A, D’Hooghe T, Daniels KR, Dierickx K, Rober P. When ‘sperm’becomes ‘donor’:
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2 2 G, Lampic C. Two decades after legislation on identifiable donors in Sweden: are
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3 recipient couples ready to be open about using gamete donation? Hum Reprod
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7 4 2011;26:853–860.
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9 5 Isaksson S, Sydsjo G, Skoog Svanberg A, Lampic C. Disclosure behaviour and intentions
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11 6 among 111 couples following treatment with oocytes or sperm from identifiable
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14 7 donors: follow-up at offspring age 1–4 years. Hum Reprod 2012;27:2998-3007.
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16 8 Jouannet P, Kunstmann JM, Juillard JC, Bresson JL. La majorité des couples procréant par
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18 9 don de sperme envisagent d’informer l’enfant de son mode de conception, mais la
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20 10 plupart souhaitent le maintien de l’anonymat du donneur. Androl 2010; 20:29-36.
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23 11 Kirkman M. Saviours and satyrs: ambivalence in narrative meanings of sperm provision.
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25 12 Cult Health Sex 2004;6:319–336.
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27 13 Lalos A, Gottlieb C, Lalos O. Legislated right for donor-insemination children to know
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14 their genetic origins: a study of parental thinking. Hum Reprod 2007;22:1759-1768.
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32 15 Leonetti J. Rapport fait au nom de la commission spéciale chargée d’examiner le projet de
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34 16 loi relatif à la bioéthique n 3011. Paris: Assemblée Nationale, 2011.
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36 17 Lycett E, Daniels K, Curson R, Golombok S. School-aged children of donor insemination:
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39 18 a study of parent’s disclosure patterns. Human Reprod 2005;20:810–819.
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41 19 Readings J, Blake L, Casey P, Jadva V, Golombok S. Secrecy, disclosure and everything in-
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43 20 between: decisions of parents of children conceived by donor insemination, egg
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21 donation and surrogacy. Reprod Biomed Online 2011;22:485-495.
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48 22 Sälevaara M, Suikkari A, Söderström-Anttila V. Attitudes and disclosure decisions of
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50 23 Finnish parents with children conceived using donor sperm. Hum Reprod ;10 :2746-
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57 26 perspective 13-18 years later. Hum Reprod 2003;18:1115-1127.
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 1 Turkmendag I, Dingwall R., Murphy T. The removal of donor anonymity in the UK: the
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2 2 silencing of claims by would-be parents. Int J Law Policy Family 2008;22:283–310.
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3 Zadeh S, Freeman T, Golombok S. Absence or presence? Complexities in the donor
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7 4 narratives of single mothers using sperm donation. Hum Reprod 2016;31:117-124.
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11 6 future donor information provision in clinically-assisted reproduction. In S.
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14 7 Golombok, at al. (Eds.) Regulating Reproductive Donation. CUP, 2016: 311-333.
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Tables

Total 2008 2011-2012

Total
Women Men Women Men Women Men
N= (%) 929 (100) 470 (51) 459 (49) 236 (50) 234 (50) 234 (51) 225 (49)
32.1 30.7 33.5 30.8 34.07 30.67 32.81
Age [Mean (SD)]
(8.13) (6.93) (9.00) (6.80) (8.28) (7.09) (9.67)

Parents of at least a
215 (23) 108 (23) 107 (23) 58 (25) 55 (24) 50 (21) 52 (23)
DI child; N= (%)
Table I. Characteristics of the sample (Frequencies, Means, Standard Deviation (SD)

1
 2011-
Total Women Men F p* η2 2008 F p* η2
2012
% of agreement (3+4) N=(%)
N=(%) N=(%) N=(%) N=(%)
Which kind of donation do you prefer?
Anonymous and non-remunerated 861 (94) 440 (95) 421 (93) / NS / 438 (95) 423 (93) / NS /
Anonymous and remunerated 330 (37) 176 (40) 154 (35) / NS / 122 (28) 208 (47) 42.42 .001 .046
Identifiable and non-remunerated 109 (12) 51 (12) 58 (13) / NS / 52 (12) 57 (13) NS /
Identifiable and remunerated 45 (5) 22 (5) 23 (5) / NS / 13 (3) 32 (7) 9.85 .002 .011
* ANOVAs calculated on original data (four-point scale)
Table II. Preferences concerning regulation about donation (Agreement rates)
2011-
% of agreement (3+4) Total Women Men F p* η2 2008 F p* η2
2012
N=(%)
N=(%) N=(%) N=(%) N=(%)
To you, the donor is…
A generous and unselfish man 755 (83) 396 (86) 359 (79) 9.19 .003 .013 372 (79) 383 (84) / NS /
A hero who is helping without expecting something back 476 (52) 244 (53) 232 (51) / NS / 224 (48) 252 (55) 7.30 .001 .013
Someone we are thinking about very frequently 107 (12) 53 (12) 54 (12) / NS / 58 (12) 49 (11) / NS /
To some extent, someone who belongs to the family 90 (10) 31 (7) 59 (13) .001 .013 53 (11) 37 (8) / NS /
Just someone who gave spermatozoa 549 (60) 290 (63) 259 (57) / NS / 271 (58) 278 (61) / NS /
No matter who, it’s not a particular person 504 (55) 235 (52) 269 (59) / NS / 261 (56) 243 (53) / NS /
Nobody, it is just a sperm straw 275 (30) 154 (34) 121 (27) / NS / 147 (31) 128 (28) / NS /
How to name the donor?
Gamete donor 752 (83) 402 (86) 350 (76) 12.47 .001 .014 379 (81) 373 (81) / NS /
Natural father 86 (9) 35 (7) 51 (11) 10.07 .002 .011 51 (11) 35 (8) / NS /
Father 56 (6) 22 (5) 34 (7) 10.91 .001 .012 26 (6) 30 (7) / NS /
Real father 33 (4) 13 (3) 20 (4) 13.93 .001 .015 19 (5) 14 (3) / NS /
* ANOVAs calculated on original data (four-point scale)
Table III. What is the donor like? (Agreement rates)
2
 χ2 2011- χ2
Total Women Men 2008
p Cramer’s V 2012 p Cramer’s V
N=(%) N=(%) N=(%) N=(%)
Y/N answers; % of agreement N=(%)
I discussed my donor conception process with…
my family 677 (73) 355 (76) 322 (70) / NS / 331 (70) 346 (75) / NS /
my friends 568 (62) 304 (65) 264 (56) / NS / 264 (56) 304 (66) / NS /
I have told someone about the donor conception process,
177 (19) 113 (24) 64 (14) 14.64 .001 .127 92 (20) 85 (19) / NS /
and I have been regretting it
Within our couple, we decided to…
tell the child about the fertility problems we faced 696(75) 357 (76) 339(74) / NS / 333 (71) 363 (79) 8.38 .004 .095
tell the child about his/her donor conception 657 (71) 333 (71) 324(71) / NS / 305 (65) 352 (77) 15.60 .001 .130
not tell the child 133 (14) 70 (15) 63 (14) / NS / 90 (19) 43 (9) 18.00 .001 .139
If you want to tell your child, when will you do it?
when it seems to us to be the best moment 668 (72) 331 (70) 337 (73) / NS / 327 (70) 341 (74) / NS /
we don’t know exactly yet 500 (54) 258 (55) 242 (53) / NS / 282 (60 218(48) 14.61 .001 .125
when psychologists consider is the best moment 269 (35) 127 (27) 142 (31) / NS / 106 (23) 163 (36) 18.96 .001 .143
the earliest possible, since his/her birth / 136 (58) 108 (48) / NS / 243 (53) / / / /
when the child will start to ask where babies come from 534 (58) 269 (57) 265 (58) / NS / 251 (53) 283 (62) / NS /
Table IV. Disclosure to the child and to social circle (Agreement rates)
3
*Author photo
Click here to download high resolution image
*Author Biography (100 words max.)

Nikos Kalampalikis is Professor of social psychology at the University of Lyon 2, France. His actual work on
social representations deals with symbolic practices of kinship and gift in medical procreation.
Ethical Approval Documentation

Ethical approval documentation

All stages of the study (design, population, methodological tools, analysis, results) were
approuved by the ethical committee of the French Federation of Cecos.