Findings from this study suggest that intra-family egg donation where the donor is either the recipient mother's sister or sister-in-law does not have a negative impact on the relationship between the adults concerned, a finding similar to other studies of intra-generational donation between family members (Lessor, 1993
; Weil et al., 1994
). Social rather than genetic connections were of greater importance in determining the nature of the adult's relationship to the child, with each adult maintaining their social role in the family, i.e. the recipient of the egg as the mother of the child, and the donor as the aunt.
By age 10, only two of the families that remained in the study had told their child that they were born using a donated egg from their aunt. In contrast, most mothers had told other family members about the egg donation, which may increase the chances of disclosure from somebody else. In addition, in situations where the donor and her family are in close contact with the recipient family, the child may notice a resemblance between themselves and the donor, or between themselves and the donor's children or the donor's children may notice a resemblance between themselves and the donor-conceived child. Resemblance between the child and the donor's children should be less of a concern for families where the donor is a sister, as similarities in appearance between cousins, or between the donor and the child, can be explained by the sharing of genetic material. However, this may be more problematic in cases where there is no perceived genetic relationship between the donor and the child, i.e. in cases where the donor is a sister-in-law of one of the parents. Similarly, this may also be problematic for couples whose donor is a close friend and who decide to keep the donor’s identity a secret.
Another feature of disclosure within this sample was that of ‘partial disclosure’ where parents had told others that they had used IVF, but not disclosed the use of a donor egg, or where they had mentioned the use of egg donation, but not disclosed that the donor is a family member. Partial disclosure has also been found among parents of children conceived using gamete donation and surrogacy in our larger sample (Readings et al., 2011
), and may lead to the potentially problematic scenario where parents feel that they have been open and honest with the child, but where the child does not know the full story. The two mothers in the current study who had told the child the identity of the donor did not report any difficulties in telling the child and felt comfortable with their decision to tell. It is possible that children conceived using the gametes of family members may react more positively to the information that they are donor-conceived because of the fact that they already know the donor. Their feelings may also depend on the quality of their relationship to the donor, that is, they may respond more favourably if the donor is someone they get on particularly well with rather than someone they dislike. That our study began over 10 years ago is noteworthy. Participants in our study conceived their child at a time in the UK when donor anonymity was still in place. While some of the clinics encouraged couples seeking treatment to be open with their child about the donation, this was not the case for all clinics. It is possible that current patients seeking gamete donation from a family member may have different counselling experiences compared with those seeking treatment in the past, which may have an impact on parents’ decision to tell the child about their conception.
Some clinics now offer ‘pooling schemes’ where a relative of the recipient donates into a pool and in return the recipient receives gametes from an unknown donor. Such systems may offer an alternative to recipients and donors who may not be comfortable with direct donation within the family, and would also be an option in situations where direct donation would be consanguineous, for example, when a brother wishes to help his sister. One UK clinic which operates a ‘pooling scheme’ reported that around half of sisters donated to the pool and the other half donated directly to their sister (HFEA, 2010
It is also worth noting the ethnic composition of the sample. Almost half the mothers belonged to an ethnic minority group (Asian, Black or mixed race), suggesting that intra-family donation may be more common among some cultures. In the Belgium study by Laruelle et al. (2010)
, it was also reported that 60% of couples who were of African origin had donors who were relatives, mostly sisters or cousins. In the UK, there is a shortage of donors from ethnic minority groups. Intra-family donation may be the only viable route for ethnic minority couples to access donor gametes.
A particular advantage of this study was its longitudinal design, enabling recipient mothers to be followed up until the child approached adolescence. In most cases, good relationships were maintained between the recipient mother and donor, and the quality of these relationships remained stable over time. Mothers were happy with the donor's involvement with their child and did not appear threatened by this. In the few instances where mothers reported dissatisfaction in their or their partner's relationship with the donor, this was not serious and did not appear to affect the relationship between the child and the donor. Thus, our overall findings suggest that recipient mothers have positive experiences of donation from a sister or sister-in-law.
This study has a number of limitations. Our investigation was not designed to look specifically at intra-family donation. While more general questions about known donation were included in the study, we did not ask questions specific to donation from a family member—for example, we did not ask if recipient mothers would have preferred to have used an anonymous donor instead of a related donor.
A second limitation of this study was its small sample size of nine families diminishing to five families by the 10 year follow-up. Some families were lost to follow up, which may suggest that certain types of families, for example, those who were particularly secretive or who were experiencing problems in their relationship with the donor, were less likely to participate. However, the study did not reveal a clear pattern between those families who dropped out and those who remained and the participation rates for this sample of recipient mothers who had intra-family donation were similar to those of the remaining recipient mothers in our larger investigation, most of whom who had used an anonymous donor (56 versus 60%, respectively).
It should be emphasized that the donors themselves were not interviewed and therefore no conclusions can be drawn about their feelings and experiences. For example, we cannot comment on the extent to which donors felt under pressure to donate to a family member or how they feel about their relationship with the child. The fact that in some families, requests for a related donor to donate her eggs was made by the mother or the father does raise some concern about whether these women were free to make an autonomous decision to donate.
While this study sheds some light on the experiences of recipients of egg donation from a sister or a sister-in-law, and shows that such donations can work out well for recipient mothers, future studies with larger samples are needed to replicate and extend these findings. There is a need for investigations that are specifically designed to study intra-family gamete donation and which include different forms of donation—that is, inter-generational and intra-generational donation.