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The long-standing ethical and policy debate about whether gamete donors should remain anonymous or be identifiable has been conducted with very limited empirical evidence about the implications of open-identity donation for those involved. While there is a growing consensus that the use of identifiable donors is preferable to the secrecy that has traditionally surrounded gamete donation, there is uncertainty around the consequences of policy decisions to remove donor anonymity, particularly regarding potential outcomes should donor offspring wish to meet their donor or other families created using their donor’s gametes. Open-identity donation is now available and is sometimes mandatory in several countries around the world, although it will be some years before the social effects of this regulatory change are realized. In the UK, for example, the entitlement of individuals conceived using donated gametes from 1 April 2005 onwards to receive identifying information about their donor at age 18 will not come into effect until 2023.
There are various types of identifiable donors. Clinics may use ‘identity-release’ donors whose identifying information is accessible once the child conceived with their gametes reaches a specified age; information may or may not be available to parents before this time. Alternatively, in instances where children have been conceived using anonymously donated gametes, the donor may choose to revoke their anonymity and make their identity known at a later stage. Lastly, the donor’s identity may be known from the time of the child’s conception, as is the case when prospective parents ask friends or relatives to donate their gametes, a practice that appears to be on the increase since the removal of donor anonymity. This chapter is primarily concerned with the first two types of open-identity donation, that is identity-release donation and formerly anonymous donation, and will focus on donations that occur within the context of the clinic (for a discussion of intra-familial donation, see Vayena and Golombok, Chapter 10).
From its beginnings, surrogacy has been dogged by controversy. Even the terminology has been met with controversy (English et al., 1991). In the United Kingdom arrangements where the surrogate is also the genetic mother of the child have been defined as ‘partial’, ‘straight’ or ‘genetic’ surrogacy, and arrangements where the surrogate is not genetically related to the child have been called ‘full’, ‘host’ or ‘gestational’ surrogacy.
In the United States surrogacy originally described an arrangement in which intended parents attempted conception through the use of a woman’s egg, and that woman underwent inseminations with the intended father’s sperm. In this case the surrogate was providing both the genetics and the gestation. As in vitro fertilization emerged as a viable treatment option, another surrogacy option emerged wherein a couple or individual worked with a woman who would carry a genetically unrelated embryo that was transferred to her. In this scenario the surrogate contributes only the gestation. In 2006 1 per cent of all fresh ART cycles in the United States involved a gestational surrogate (for a total of 1,042 cycles); additional cycles were performed involving donor eggs (CDC, 2006). In the UK the number of surrogate births, although rising, is harder to estimate due to a number of more informal home-insemination arrangements. In this case IVF is not required and so the surrogate birth goes unregistered as such.
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