Disclosure decisions by pregnant, donor oocyte recipient women are formulated through a complex, multifactoral, and dynamic process. The two broad themes identified from the women’s disclosure experience were the overwhelming responsibility to the resulting child and the women’s attempts to gain control over disclosure about conception. The factors, as delineated above, represent aspects of the women’s experience which they perceive as important or influential to their disclosure decisions. Moreover, these factors provide unique insight into pregnant recipient women’s reasoning for or against disclosure.
A number of studies have examined factors which influence disclosure decisions. The findings from this study support the importance of donor oocyte recipient’s values and beliefs on disclosure decisions. Prior research has demonstrated that the right of the child to know is significant among disclosing parents (10
). Less evidence exists about the influence of specific social and cultural factors upon donor oocyte recipient women’s choice of disclosure; albeit, other investigators have demonstrated the importance of several sociocultural factors among other groups of individuals contemplating disclosure decisions (30
Recipient individuals selecting non-disclosure have reportedly placed more emphasis on protecting the child from stigma and voiced concern that there is no compelling reason to tell (18
). Only one woman who participated in this study indicated she was not planning to tell her child. Her reasoning focused upon protecting the child and others from relationship and identity discordance. Furthermore, she honored the request of her sister, the oocyte donor, for anonymity to the child to protect normative relationships.
Despite several reports that undecided parents voice more concern over how and when to tell the child (18
), the undecided women in this study did not express this concern as influencing their decision. Because the women were early in pregnancy, concerns about telling the child may not be as paramount as when the child is actually present in the woman’s everyday environment. However, it should be acknowledged that the women who were undecided about informing their child emphasized their contemplation over the protection of and benefits to the child, such as the acceptance of the child by other family members, as influencing their decision to inform their offspring. Also notable, several of the women opting for disclosure to the child asked the investigator for appropriate information on how and when it would be best to inform the child. Thus, it is plausible that both undecided and disclosing parents may need more information about how and when to tell the child.
Although maternal age was not examined as a unique entity, analysis of the data revealed several disclosure differences among the younger and older women in the study. Previous research investigating disclosure decisions among parents who used oocyte donation, IVF or ICSI to conceive children reported the age of the parent was not associated with whether the child had been told about their method of conception (16
). While theses studies conclude there is no difference in the patterns of disclosure based on a woman’s age, this study described differences in the woman’s reasoning
such that younger women fear non-acceptance and stigma because of their diagnosis of infertility and older women fear non-acceptance and stigma because of their mature status during childbearing. These are important distinctions. Understanding the difference in how younger and older women reason and perceive threats, not only to disclosing the means of conception, but to other elements interrelated within the donor oocyte experience, is essential when deducing how these factors affect their disclosure decisions. Additionally, the women greater than 39 years-of-age were more likely to tell obstetrical professionals about their use of donor oocytes.
The selection of a known or an anonymous donor was, in-part, contemplated in relationship to disclosure. For the women selecting an anonymous donor, disclosure decisions were made without the involvement of the oocyte donor. In the case of the recipient selecting her sister as the donor, the oocyte donor’s preference for disclosure was considered and honored by the recipient. This may reflect significant control of the disclosure decision by the known oocyte donor. While the oocyte donor’s preference for disclosing has been suggested as a factor in disclosure decisions (5
), the extent of control in this case by the donor is unknown and little research exists that could enhance understanding in this area. Most of the research has focused on disclosure patterns based on donor type selected (12
). The differing experiences of known and anonymous donor oocyte recipients and how choice of donor type impacts disclosure is unclear and warrants further investigation.
The results presented here should be interpreted with the understanding that all of the recipient women underwent a psychological counseling session for couples contemplating the use of donor oocytes at the recruiting infertility center. The center and the psychologists and other health care professionals are affiliated with the American Society for Reproductive Medicine, which supports disclosure to offspring (35
). The extent to which the psychological counseling session influenced the women’s disclosure decisions is unknown. While all of the women in this study reported the counseling session beneficial, several of the women openly questioned the disclosure recommendations made by mental health professionals. As one undecided woman stated, “I don’t know if psychologists are always right.”
Other limitations of the study were the self-selective nature in which the women chose to participate, and the small sample inherent in qualitative research. The results should be interpreted with caution as only one woman indicated she was not planning to inform her child. This, along with the small sample size may not have adequately captured other factors that influence disclosure decisions. Further research should include a larger, more diverse number of women, including men, who have also been significant in determining disclosure in other similar studies (17
). Also, the investigation did not capture disclosure decisions made by the women prior to pregnancy, nor did it address possible changes in the women’s disclosure patterns made as a direct result of the pregnancy or over time. A longitudinal study examining the influence of pregnancy on disclosure would be beneficial to both researchers and clinicians.
Nevertheless, the findings provide a detailed description of the disclosure experience of pregnant, donor oocyte recipient women and illustrate the factors which influenced their decision, from their perspective. Health care professionals can use the dense and factual account, generated from this phenomenological study, to increase understanding of women’s disclosure decisions. Specifically, clinicians can improve patient assessment, communication, and anticipate concerns through increased awareness of the importance and influence of the patient’s values and beliefs and social and cultural environment on disclosure decisions (36
Noteworthy was the withdrawal of one eligible oocyte recipient woman after initially agreeing to participate in the study. Her actions provide evidence of speculation by other investigators that oocyte recipient women who prefer non-disclosure are more likely not to participate in research examining their disclosure experience (17
). Although the percentage of women intending to inform the resulting child in this study (50%) is comparable to the 56% reported by Hahn and Craft-Rosenberg (18
) and the 52% by Greenfeld and colleagues in their sample of anonymous oocyte donation in the United States (14
), the actual percentage of women informing their child may be occurring less frequently than indicated.