Human Fertility, 2014; 17(4): 269–277 © 2014 The British Fertility Society ISSN 1464-7273 print/ISSN 1742-8149 online DOI: 10.3109/14647273.2014.910872

ORIGINAL ARTICLE

When ‘sperm’ becomes ‘donor’: Transitions in parents’ views of the sperm donor ASTRID INDEKEU1, THOMAS D’HOOGHE2, KEN R. DANIELS3, KRIS DIERICKX1 & PETER ROBER4 1

Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium, 2Department of Obstetrics and Gynecology, Leuven University Fertility Centre, University Hospitals Leuven, Leuven, Belgium, 3School of Social and Political Sciences, University of Canterbury, Christchurch, New Zealand, and 4Institute for Family and Sexuality Studies, KU Leuven, Leuven, Belgium

Abstract Little is known about recipients’ views of their sperm donor. This study aimed to examine the possible transitions or consistencies in donor sperm recipients’ (DSRs’) view on the sperm donor over time. A longitudinal qualitative study of 19 Belgian heterosexual DSRs was undertaken. Interviews took place with both partners of the couple during pregnancy, at birth and 1.5–2 years after birth, and were analysed using a grounded theory approach. Recipients who intended to disclose exhibited a transition in their awareness of the donor from being of minimal importance to one who was increasingly seen as part of their family narrative. This was partly triggered by the offspring’s life, remarks about resemblance and the socio-cultural context. The perceived position of the donor changed for most recipients from a threatening rival to a ‘distractor’. This change was supported by the emerging father–child bond and the confidence that stemmed from it. These observations were applicable to those recipients who intended to disclose their donor conception; for those recipients who intended not to disclose, little or no transition was observed. This study describes and analyses the transitions and consistencies in recipients’ views of the donor over different stages of the family life-cycle (pregnancy, birth, toddler stage) and could help the fertility clinics tailor their counselling to the specific stages of parenthood.

Keywords: transition, donor conception, sperm donor, parents

Introduction

existence of the donor might be considered an example of a general research trend to neglect the donor as a stakeholder (Van den Broeck et al., 2013). To our knowledge, in over 30 years of research on donor sperm insemination, only four empirical studies (Kirkman, 2004; Grace & Daniels, 2007; Grace et al., 2008; Burr, 2009) have focussed on recipients’ perceptions and interpretations of sperm donors. Kirkman’s (2004), as Burr’s (2009), study reflected considerable ambivalence in recipients’ views of the donor, which Kirkman outlined as donors being simultaneously ‘saviours and satyrs’. Recipients’ constructions were strongly influenced by the perceived threat to the integrity of the parental position. By addressing the recipients’, donor’s and offspring’s perspectives, the study showed how for example, recipients’ view of the donors’ motivation to donate could diverge from the donors’ own perspective. Grace et al. (2008) focussed solely on recipients’ views of the donor. In their study, parents’ negation of the donor appeared to support the normative formation of the

Couples who rely on sperm donation to build their families owe the existence of their child to a third party. How do parents give meaning to the donor and how do they manage ‘the genitor and the pater’ (Grace, 2008) or ‘the origins and originators’ (Nordqvist, 2012)? The first referring to the genetic contributor while the latter to the social parent, in their family discourse. Little is known about how parents experience the existence of the donor, despite the fact that in the context of disclosing the donor conception to the offspring, recipients’ views of the donor might be important. The relevance of their view is seen in studies on couples’ donor choice – whether they opt for an identifiable or anonymous donor in relation to their disclosure decision (e.g. Klock & Greenfield, 2004; Brewaeys et al., 2005; Stuart-Smith et al., 2012), on the amount of donor information desired (Rodino et al., 2011) and how contact with the donor is experienced (Freeman et al., 2009; Blyth, 2012). This lack of knowledge on how recipients view the

Correspondence: Astrid Indekeu, Centre for Biomedical Ethics and Law, KU Leuven, Kapucijnenvoer 35, B-3000 Leuven, Belgium. Tel: ⫹ 32-16-3-36951. Fax: ⫹ 32-16-3-36952. E-mail: [email protected] (Received 15 July 2013; revised 19 December 2013; accepted 17 January 2014)

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family (being a man and a woman with offspring who are biological related to them) and was in turn supported by an instrumental and de-personalizing discourse of the donor. However a tension was observed within the parents’ perspectives whereby donors were negated and yet simultaneously treated as persons (e.g. reflecting interest in what he had passed on, and expressing gratitude towards him). Moreover parents generated a parallel point of view whereby genetic inheritance was seen to be simultaneously irrelevant (to how the family bonds and functions) and yet at the same time relevant in highly restricted domains, where medical issues arise that may be linked to the donor’s genes (Grace & Daniels, 2007). However, in these studies (Kirkman, 2004; Grace & Daniels, 2007; Grace et al., 2008; Burr, 2009) participants were interviewed at one point in time only. Recent research (Hargreaves, 2006; Hershberger et al., 2007; Blyth et al., 2010; Stuart-Smith et al., 2012) suggests that needs (e.g. donor information) and meanings of the concepts (e.g. ownership of donor information, the significance of the donor conception) relating to a third-party reproduction (TPR) are likely to change over time. Most studies on TPR have been one point in time explorations or retrospective in nature (Stuart-Smith et al., 2012; Indekeu et al., 2013). Such research designs tend to optimize the numbers of participants yet lose out on changes over time and rely on recall, which may not be accurate. There is a pressing need to conduct long-term prospective studies and to record the changes over time (Indekeu et al., 2013). This study aimed to provide insight into transitions or consistencies in recipients’ views on the sperm donor by focusing on three time periods, using a prospective, longitudinal, qualitative design.

Material and methods Socio-cultural-medical context Belgium provides a tax-financed comprehensive health care system with equal, free and easy access to highquality fertility treatment (Belgian Royal Decree, June 4th 2003, B.S. 16.07.2003). Belgian legislation retains a system of donor anonymity, albeit known donation with the mutual agreement of donor and recipient is legally allowed (Belgian Act of July 6th 2007, B.S. 17.07.2007). Clinics are legally responsible for ‘matching’ donor and recipient, meaning that gametes may be chosen to create the minimum of physical differences between donor and recipient. Registration of IVF treatments (including oocyte recipients) in the national register is mandatory. Data regarding non-IVF treatment (including insemination with donor sperm) is conducted on a voluntarily base. Prevalence of birth after treatment with donor sperm is estimated at 391/annum during the period 2007–2010 (BELRAP, 2009-2013). As estimations are based on voluntary registration, actual numbers are likely to be higher. There is no professional association

for infertility counsellors in Belgium and there are no ‘Guidelines for Good Practice in Infertility Counselling’. Each fertility clinic is free to determine its own counselling policy. In most clinics, counselling prior to the start of a TPR treatment is mandatory. No specific advice towards (non-)disclosing the donor conception to the offspring is given by the counsellor and there is no national consumer organization for (potential) TPR recipients. This socio-cultural-medical context might have implications for how families might perceive the donor. Participants Heterosexual couples who relied on sperm donation to achieve a pregnancy were recruited through the Leuven University Fertility Center (LUFC) and through advertisements in a women’s magazine (‘Libelle’). Participants were recruited irrespective of their disclosure stance. Couples were contacted by the first author (AI) after they had given consent to the midwife of LUFC to be contacted or after they had responded to the advertisement. Information about the study was given orally and in written form during home visits to address both partners at the same time so men would feel equally involved. No financial compensation was given for participation. This study was approved by the Commission for Medical Ethics of the University Hospital of Leuven. Informed consents were signed prior to participation. Interviews took place between July 2010 and September 2012. For information concerning the Belgian legal context on TPR, we refer to Indekeu et al. (2012). Out of 14 eligible couples who were approached through the LUFC, seven agreed to participate (one without her husband) and seven declined. Reasons for declining were ‘too sensitive to talk about’ (n ⫽ 6) and ‘want to enjoy the pregnancy without being reminded of the mode of conception’ (n ⫽ 2). Three additional couples participated after reading the advertisement. A total of 19 donor sperm recipient (DSR) parents (representing 10 DSR couples including 1 DSR woman who participated alone) were included in the study. Participants’ details are presented in Table I. The interviewer (AI) was introduced as a researcher with professional expertise in medical psychology and sexology in order to establish the researcher’s familiarity with the topic. Participants often mentioned spontaneously that this information helped them to discuss the topic. Data collection Data were collected through home interviews based on the belief that eligible candidates would invest more time and feel more at ease in discussing these topics at home. Interviews were scheduled during evening and weekend hours to maximize participation. Parents were seen (1) during the last trimester of pregnancy (T1); (2) three months after birth (T2) and (3) 1.5–2 years after birth (T3). Human Fertility

Recipients’ views of the sperm donor 271 Table I. Participants details. DSRs (n ⫽ 10)

Age Average age (range) of women Average age (range) of men Nationality* Belgian Other Children Pregnant from first DSR offspring Pregnant from second DSR offspring Other children present (from previous relationship) Anonymous donor Disclosure ** Intention to disclose Intention to not disclose

29 yr 10 mnths (26.1–33.5) 32 yr 11 mnths (28–39.2) 9 1 8 2 (Couple Nos. 2 and 9) 1 (Couple No. 11) 10 7 (Couple ID-No 1, 2, 4, 6, 7, 8 and 10) 3 (Couple Nos. 3, 5 and 9)

DSR ⫽ Donor Sperm Recipient. *All living in Belgium, no cross-border patients. **All couples remained same disclosure stance throughout T1, T2 and T3; except Couple 1 changed from intention not to disclose at T1, to disclose after T2.

At each interview time (T1, T2 and T3), both joint couple and individual interviews of each partner were conducted. Couple interviews made it possible to capture parents’ often ‘shared construction of reality’ (Hargreaves, 2006). During joint interviews, partners can jog each other’s memory, control each other’s honesty and support each other in discussing infertility from the male and the female perspective which helps to enhance reliability and validity of the data (Hargreaves, 2006). Interviewing couples was also useful in the recruitment process because men, typically, are reluctant to participate in research involving discussing the sensitive topic of male infertility (Hargreaves, 2006). On the other hand, each parent has individual experiences which contribute to ‘the shared construction of reality’. Individual interviews therefore took place the day after the couple interview. Couple interviews were videotaped whereas individual interviews were audiotaped. The individual interview was based on video excerpts from the couple’s interview: Video excerpts were selected by the researcher based on ‘verbal expressions needing clarification’, ‘clarification about facial expressions’ and ‘reaction to partner’s contribution’, and shown to the participant during the individual interview. The video excerpts served to support the participants’ memory. One couple declined to be videotaped because of concerns regarding anonymity. For this couple, audiotapes were used instead of videotapes. After each interview, observations were noted down in memos. A narrative in-depth interview style (Kvale & Brinkmann, 2008) was used asking couples to share their story. According to a narrative interview style, participants’ responses dictated the course of the interview yet an aide memoire existed containing broad topics to be discussed (Supplementary Appendix 1 to be found online at http:// informahealthcare.com/doi/abs/10.3109/14647273.2014. 910872). All interviews lasted 1.5–2 h and were carried out by the first author (AI). All DSRs, regardless of their disclosure stance, continued to participate over the three interviews. No individuals were lost to follow-up. © 2014 The British Fertility Society

Data analysis All 87 collected interviews (9 couple and 20 individual interviews at T1, T2 and T3) were transcribed verbatim. A grounded theory approach (GTA) according to Charmaz (2006) was used to analyse the data as GTA has proven to be useful to obtain the in-depth understanding of subjective experiences concerning health issues (Charmaz, 1990; Potter & Bhattacharya, 2008; Peddie et al., 2009). Such a qualitative approach results in a complex hierarchically structured list of interconnecting themes that reflects what is central in the experiences of the participants. As little consensus exists as to how longitudinal qualitative research analysis should be undertaken (Lewis, 2007), detailed information on how GTA analysis was applied is given in Supplementary Appendix 2 to be found online at http://informahealth care.com/doi/abs/10.3109/14647273.2014.910872. Codes and categories were initially identified by the first author (AI). In order to heighten the validity of the analysis, we then applied the method of investigator triangulation by working with internal team auditors (third and last author) and an external auditor (HVP) who discussed the coding, developed (sub) categories and observed patterns until agreement was reached. Analysis was undertaken with the help of software (QSR NVIVO 10.0) Results This paper is based on 87 interviews and what they revealed about DSR views on the sperm donor. Thirteen of the total of 19 participants exhibited transitions in their views over time. These 13 individuals intended to disclose the donor conception to the offspring (Table I). The remaining six participants (3 couples) exhibited little or no transition in their view on the sperm donor from T1 to T3. At each interview (T1, T2 and T3) the topic of the donor was discussed and their responses remained the same. These six DSR intended not to disclose the donor conception to the offspring. Since the two groups exhibited different patterns they

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will be discussed separately. Themes are clarified with quotations, and references are made to interviewees’ gender (M ⫽ male, F ⫽ female), couple number, interview wave (T1, T2 and T3) and individual (I) or couple (C) interview. Original quotations were translated and controlled for accuracy by a native English speaking person also fluent in Dutch and back translated by a third person. The use of ‘…’ refers to a pause participants made in their sentence.

Participants who intended to disclose We will discuss consecutively transitions in participants’ awareness of the donor and views on the position of the donor in relation to the partner and the parent–offspring relationship. Awareness of the donor. For the majority of the participants a progressive increase (throughout the interviews T1, T2, T3) in the awareness of the donor was observed. At T1 the topic of the donor was almost never raised and had to be introduced by the interviewer. There was an overall need to describe the donor in a depersonalized way (‘a syrup the clinic gave us’ [F6T1I]; ‘similar to a blood donor who has no face and no origin’ [M4T1C] – referring to the donor as ‘it’) while simultaneously realising that the donor is a person. This ambiguity was noticed in several statements: ‘Obviously it’s a person, but … I take what I need, the donor isn’t there nor is his semen’ [M1T1C]

After birth, some participants experienced the donor as ‘pervasive’ (‘leaking in’ [F1T2I]) while others referred to something that ‘comes and goes’ [F8T1I] against the background of an ‘ongoing story’ (‘Chapters that we could write, are written, we need to wait for the rest’[F6T2I]). It was quite common for participants at T2 to express discomfort when they described having thoughts about the donor as there seemed to be a need to justify thinking about the donor by emphasizing the normality of their thoughts (‘it is normal, it is normal’ [F9T2P2]). However by T3 they were naming the issue quite spontaneously and extensively and several references were made to ‘it’s part of our everyday life’ [F4T3I] or ‘It’s going to take place anyway.You can’t avoid that, it’s just the way it is’ [F7T3C]. Several reasons were mentioned that could explain the increase in awareness of the donor. At T1 and T2 some participants mentioned that thinking about the donor evoked the feeling that they did not acknowledge their partner as the father (‘The more I search for information, the more I confirm it’s not really his’ [F1T2I]), or was experienced as too frightening because many aspects were still unknown or a negative image of the donor would appear. This sometimes resulted in a desire to deny the existence of the donor:

‘Possibly, they had no good reasons for donating’, ‘to spread their genes’ or… ‘I basically blocked that and came up with ideas I could live with’ [F1T2C]

Becoming a parent was for some so overwhelming that after birth they stated having no energy left to wonder about other things such as the donor (‘we’re just Mom and Dad now’ [F8T2I]). Others stated that birth itself triggered the donor theme (‘Previously it was conceptual, easier not to think about it. Now he’s born it’s inevitable to think about it’ [M4T2I]) and some expressed gratitude to the donor. Within the couple, being able to relate physical traits of the offspring to a parent (genetic or non-genetic parent), seemed for some to lessen the need to think about the donor. Yet, resemblance remarks made by others (or the absence of them) were frequently mentioned as triggering thoughts about the donor. Moreover, when focusing on the donor’s genetic contribution participants sometimes ‘forget’ the contribution of the genetic parent. M: people say it’s such a beautiful baby and that makes me proud, though I know it’s …from the donor F: From me huh M: also you, sorry honey, yes that’s true! [M/F10T2C]

At T3, resemblance remarks were in general less often mentioned as evoking thoughts about the donor. Elements of the offspring’s life (e.g. doctor visit, school questionnaire about medical family history, realizing that the child might have questions about the donor that they do not have) were more often mentioned at T3 as prompting thoughts about the donor and sometimes it was just triggered by the physical development of the child itself. ‘You’ve sort of a picture of the donor that is very blank at the beginning. I feel like physically we could soon fill in that picture a bit, deducing from our son’s characteristics,…’.[F4T3I]

Participants also referred to the impact of more general reactions of others (family, friends and medical professionals) to the donor conception, especially when those who had been informed in the past about the donor conception never raised the topic anymore or seemed to have forgotten about it. This created for some the impression that the donor conception or the donor was not a salient issue (‘That’s the best sign that it, in itself perhaps, isn’t so important’ [F10T2C]). Depending on whether this was in line with participants’ own impressions, this was felt by some as de-stigmatizing while others felt their experiences and feelings were being denied. ‘Almost no one talks about it anymore. But it’s still there. For most it seems “that was your problem in the past, it’s completely Human Fertility

Recipients’ views of the sperm donor 273 out of the way, now you’re like everyone else.” That’s not how I see it. Not that there are any problems but we still need to tell and how will we deal with it...’ [F7T3C]

‘Once the insemination, the confrontation with the strange semen was over,. . it wasn’t male sperm anymore, it became genetic material a wonderful process …’ [M1T1C]

On the other hand, living in a socio-cultural context where the value given to genetics and semen was experienced as very high, seemed to hinder some participants in their attempt to keep the donor issue as trivial as possible:

‘The insemination could be the start of our child… often it remained another man’s sperm … now you’re pregnant, it’s less important, it’s all joy…nice there was a strange man who did this and a baby is coming’ [M7T1I]

‘“Society” makes it that important… with sperm, there is this whole thing about dynasty and kinships strapped to it…. culture makes some things more renowned than what they are. …but we live in that culture and we’re brought up with these ideas’ (M4T1I)

Participants who intended to disclose the donor conception to their offspring expected the donor to remain implicitly present throughout their family life. Disclosing the donor conception and subsequently not talking about the donor was experienced as incompatible. Simultaneously they were aware that vagueness on how to manage the role of a donor as their child’s genitor and the position of the non-genetic parent still existed. ‘… you’ve to give it a place, otherwise, you tell him and ignore the rest... make it sound bad. ….Then it’s equal to not telling…I understand my husband, that it might become too important for our son and he’ll have the idea “now I am less important”’ [F7T3I]

In summary, a transition was observed in their awareness of the donor: from being of minimal importance to one who was increasingly seen as part of their family narrative. This was partly triggered by elements of the offspring’s life, resemblance remarks and the sociocultural context. Perceived position of the donor. Changes were observed in the position of the donor in relation to the partner and the parent–offspring relationship. The donor as intruder in the partner relationship

At T1 participants often looked back to the early stages of treatment and described the donor as an intruder in the partner relationship (‘coming inside our atmosphere’ [M1T1C]) and frequently the metaphor of adultery was used when referring to the donor insemination (‘it’s still sperm of another man injected to your wife,...normally it’s seen as sacred’ [M7T1I]). This image disappeared by T2 and T3. Becoming pregnant, the beginning of their baby and their family seemed to trigger a change in some parents’ view about the donor as an intruder to a more positive one of someone who helped them build their family: © 2014 The British Fertility Society

One woman exhibited a reversed pattern where the experience of the donor insemination as adultery became more pressing at T2 and T3. During pregnancy she had expressed the need to block the donor in order to be able ‘to create my own world’ [F1T1], in which she carried her husband’s biological child. Once the baby was born it became more difficult to deny the donor. The donor as rival for the position of the father

Throughout the three interviews the image of the donor seemed to shift from ‘a rival’ (‘you can call it rivalry’ [M7T1I] -‘I’ll just be the second dad’ [M10T1I]) at T1 to a less threatening image as ‘distracter’; someone who just by existing might attract attention from the child and distract the offspring from the relationship with the father at T3. After birth the theme of rivalry was not raised as most fathers seemed to be focussed on building up a bond with their offspring. The intensity of the imagined threat to the father’s position prior to birth was noticeable in the adjectives participants used when they imagined the offspring having interest in the donor: ‘doomsday-scenarios’ [M7T1C], ‘worst nightmare’ [F6T1I], … At T3 several participants mentioned becoming ‘more moderate’ [M7T3I] and ‘more relaxed’ [F4T3I] about the donor. ‘It [feeling towards donor] has nothing to do to with a bond between the donor and my son, nor…of great interest, or… take an important role. Just that it would take “a” role… I make an extra effort to be the best parent as possible… suddenly someone comes into the picture. I don’t want anyone else entering my son’s perception I want to be the only one’ [M7T3C]

This feeling of threat to their position as father was also expressed in the lack of clarity in the naming of the donor (‘Not father cause that’s my position’ [M7T1C]). One couple pointed to socio-cultural influences (‘Through TV and media you hear often about the biological father… The link to the word father is laid’ [M1T3I]) enhancing the link between ‘donor’ and ‘biological father’, thereby blurring the boundaries between the biological ‘father’ and the non-genetic ‘father’. The actual experience of a father–child bond was mentioned by one couple as helpful in clarifying the donor’s and non-genetic fathers’ position. Participants were often not in favour of using the term ‘donor’ as it was expressed as an unfamiliar and meaningless word to the child.

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‘When you struggle with these dad-feelings, you link donor faster to ‘your real daddy’. Now, based on a bond it seems an idiocy to say that ... ‘real daddy’. I wouldn’t say I feel too much like ‘real daddy’. He’s a genetic donor.’ [M1T3C]

Despite the overall negative (rival, intruder) views on the donor, the need (‘it has to be’ [F1T1C]) of a positive view was expressed by some: ‘“Someone who isn’t empathic won’t spend time doing this”... in the end it’ll have been a decent person’ [F7T1C]

Besides their view on the donor, their own position in relation to the donor also seemed to change for some. Prior to birth, DSR men were in the position of ‘expecting father’, whereas at T3 some DSR men started to incorporate their actual position explicitly as father in the relation to the donor and placed their own needs and desires secondary to those of their offspring. Although it was portrayed as a difficulty that the donor might take up space in their offspring’s life, they would set these feelings aside as they felt, as a parent, responsible to help their offspring as best as possible. ‘“My son can search for his donor, no problem we’ll help wherever we can”… but I don’t need to be confronted with him for now. I don’t know how I’m going to evolve… ’[M1T3C]

Moreover, the confidence that arose from the emerging bond between the non-genetic parent and the offspring was mentioned as a possible impulse to experience the donor as less threatening: ‘… the confidence in the relationship between father and son has been built up, the more that has been done, the more the donor gets a friendly look’ [F4T3I]

In summary, the perceived position of the donor in relation to the partner relationship and the position of the non-genetic parent changed for most participants from a threatening rival to a distractor. This change was supported by the emerging father–offspring bond and the confidence that stemmed from it. Participants who intended not to disclose Participants who intended not to disclose the donor conception experienced the donor as a means to create their child. Becoming a parent was the most important part of the experience. Prior to birth, the donor existed in the context of their uncertainty about the donor’s contribution to physical appearance of their child (‘you know your partner’s looks, your own looks so you can imagine…now you’ll never know’ [F9T1C]). Yet, they indicated that the donor’s involvement and existence stopped being relevant at birth or when their wish for children was fulfilled (‘It’s like totally ours, conceived by us, although we

know it didn’t happen that way’ [M9T3C] – ‘– ‘We’ve received semen, that’s not connected to a person, it’s something technical’ [F3T2C] – ‘Since birth I haven’t thought about it’ [M3T3C]). These participants generally retained the same level of awareness of the donor over time. Resemblance remarks, offspring’s physical appearance and so on that were mentioned by the disclosing participants, made the donor invade non-disclosing participants’ lives as well, especially when the child had a physical trait that made him stand out from the family (e.g. very short height). Participants mentioned their wish, subsequently, to push these thoughts aside (‘When I feel I start thinking about it…I think ‘No, it’s no use’ [F3T1I]).

Discussion Participants in this study who intended to disclose the donor conception to the offspring exhibited an enhanced awareness of the sperm donor. At first, the donor was negated as described in previous studies (Kirkman, 2004; Grace et al., 2008; Stuart-Smith et al., 2012) and the metaphors of ‘adultery’ and ‘rivalry’ (Burr, 2009) were often used in relation to the donor, evoking feelings of threat and uncertainty about their position as partner and/or non-genetic parent (Indekeu et al., 2013). These feelings of uncertainty seemed to be further enhanced by features involved in the matching system (the donor is chosen by the clinic), uncertainty about resemblance between future offspring and parents and uncertainties about the development of family relationships (Indekeu et al., 2013). Negating the donor seemed to be a way of coping with these feelings (StuartSmith et al., 2012). These findings should also be seen in the socio-cultural context of TPR in Belgium, where donor anonymity is adhered to and there is no national consumer organization for (potential) TPR recipients. Moreover, the Belgian Federal Advisory Committee of Bio-ethics (2004) stated that ‘in Belgian society the opinion that the biological parent is the ‘real’ parent is still too prevalent. This is even more explicit in relation to the role of the man than the woman. (p41)’ A second common prejudice, noticed by the Committee and stemming from the developments in the field of genetics, is the idea that ‘a human is determined by its genes’ (p41). Living in a socio-cultural context that highly values genetics made it challenging to negate the genetic origin of the child – being partly the sperm donor, while the system of donor anonymity – separating donor and recipient – hindered the existence of the donor. After birth many of the uncertainties faded away and the donor was experienced as slowly invading daily family life through resemblance remarks (Becker et al., 2005; Grace et al., 2008; Nordqvist, 2010) and elements of the offspring’s life (e.g. inquiries about medical family history). The emerging attachment between the non-genetic parent and the offspring and the confidence that emerged from it in their choice of familybuilding and the parental position of the non-genetic Human Fertility

Recipients’ views of the sperm donor 275 parent (Indekeu et al., 2014), resulted in a more relaxed approach to the contribution of the donor such that he became more accepted and integrated in their family narrative. Nevertheless, an on-going careful negotiation was observed between acknowledging ‘the conceptual value of the donor’ (Nordqvist, 2012 p.304) for the offspring while safe-guarding parental authority of the non-genetic parent and acknowledging ‘the donor as a person’. Participants who intended not to disclose their donor conception to the offspring viewed the sperm donor as a means to their desired child (Grace et al., 2008) but one who played no further role in their family life after birth. These recipients generally retained the same level of awareness of the donor and stayed consistent in their statements about the donor’s position. The negation of the donor supported a normative (biological) formation of the family, similar to Grace et al. (2008). Yet, when the donor invaded their lives (e.g. in terms of resemblance remarks and the offspring’s physical appearance) he was subsequently pushed aside. Strength and limitations This is a unique qualitative study using a longitudinal design which has allowed transitions to be demonstrated in a reliable way. The absence of any drop-out from amongst the participants in such a time-consuming study can be seen as remarkable, especially for the participants who intended not to disclose. The use of a qualitative methodology made it possible to highlight views of the donor that would not have been possible in a quantitative design. Yet, the study-group was selfselected. The group of non-disclosing parents (three couples) was very limited and couples varied in terms of contextual factors (e.g. being aware of infertility from youth or recently, and the number of donor conceived children). Further data collection is therefore needed from non-disclosing parents. Moreover, non-disclosing parents experienced the donor as confined to the phase of conception. Subsequent attempts to investigate the experience of the donor during parenthood were hampered by the very aspect being examined; namely the non-relevance of the topic to them. Yet, in daily life they encountered reminders of their donor conception. Alternative ways of data collection or different interview set-ups should be considered in order to collect further rich data and enhance the understanding of non-disclosing parents. In qualitative longitudinal research, the relationship between the researchers and the researched affects both over time. Participants mentioned spontaneously that with time they became less occupied with ‘making a best impression’ (i.e. providing desirable answers) but felt more at ease in expressing anxieties and insecurities. A similar increasing openness was noticed with women as well as men; a growing confidence in their role as © 2014 The British Fertility Society

father might have supported this. The research interviews may have had a therapeutic value for some of the participants as they helped the couple to talk about the TPR which was often experienced as difficult without the help of a third person. This finding should be situated in the socio-cultural context of Belgium where most participants expressed a lack of possibilities of exchanging experiences with others. We are aware that data on possible differences between partners and interactions between the partners would provide a more complete account of the transition described. Since this would be an extensive undertaking it will be addressed in a separate paper. Research and clinical implications Further follow-up research is needed to examine how the offspring’s development (e.g. the development of physical and character traits) might impact on parents’ views of the donor. Little is known about how adolescent-adult donor offspring view their donor (Blyth et al., 2012) and the view of the offspring might collide or diverge with the parents’ view. Secondly, it is important to examine how donors view their position as a donor and whether it corresponds with the recipients’ views of him. Research on the experiences of donors has started to be undertaken and indicates that some semen donors continue to have thoughts and feelings that arise from their having been a donor. These include retaining an interest in those to whom they are genetically related regardless of any social contact (Crawshaw et al., 2007, Jadva et al., 2011, Daniels et al., 2012). As with the recipients’ views in this study, the meanings and experiences of donors associated with semen donation are dynamic – in other words they continue to develop and may change following donation in line with philosophical beliefs and personal and social experiences of the recipients (Daniels et al., 2005; Crawshaw et al., 2007). Research is needed which investigates the dynamic (divergence, parallelism or convergence) – between the recipients’ views of the donor and the views of the donors. Thirdly, public perceptions (e.g. Hudson et al., 2009) as well as the fertility clinics’ perception of the donor (e.g. Adrian, 2010) should be assessed as they contribute to recipients’ views of the donor. Informing and preparing recipients about possible transitions in recipients’ views of their donor might lessen insecurities and anxieties about the donor and might enable them to approach TPR and the disclosure question with more confidence. What this study shows, and Stuart-Smith et al. (2012) suggest, is that the process of giving birth can be transformative in how recipients view the donor. For those disclosing the donor conception, we observed a pattern from feeling anxious to relieved to confident in relation to the view of the sperm donor. Having a real baby as opposed to a desired baby gives rise to a marked shift in attitudes and a different perspective not only for

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oocyte recipient mothers (Stuart-Smith et al., 2012), but also DSRs. This has implications for pre-treatment counselling.

Acknowledgements We would like to acknowledge the men and women who generously shared their stories with us and without whom this research could not have been completed. The authors thank Veerle Gilissen and Katja Servaes; midwives at the Leuven University Fertility Centre (LUFC) for their assistance in patient recruitment. Furthermore, they acknowledge the advice and comments of Hanna van Parys (HVP), UGent, as external auditor of the data analysis. First author, A.I., acknowledges support from the Brocher Foundation for her stay at the Brocher Centre during which this paper was written. www.brocher.ch This research has been made possible with the support of a project grant (number G.0594.09) of the Research Foundation-Flanders (FWO).

Declaration of interest: The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.

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