What are the different types of donor arrangements and which one is right for me?

Understanding the different donor arrangements will empower you and your family to choose the right one for your fertility journey. 

When using third-party reproduction (TPR), a treatment that involves someone other than the intended parents, there are different types of gamete (sperm or egg) donor arrangements to consider. These arrangements include Directed (also referred to as Known), Non-Disclosed (formerly referred to as Anonymous*), Semi-Open, and Open. It’s important to consider the impact the various types of arrangements will have on your life, the life of your child, and also your donor’s life. Ultimately the donor arrangement chosen will depend on what is available to you from your provider and what is best for you and your future child. 

It’s important to understand the meanings and differences of various TPR terminology. Feel free to reference the Glossary at the bottom for clarity. 

CHOOSING A DIRECTED DONOR 

A Directed Donor, also commonly referred to as a Known Donor, can be someone you already know personally or someone to whom you are introduced for the specific reason of gamete donation through a mutual acquaintance or social media site. 

Working with a Directed Donor can have some clear benefits. Fertility clinics vary in their approach to these arrangements, and at ORM, as with all donor and gestational surrogacy arrangements, we require specific legal documents to be written and signed as well as a psychological review with our in-house team.   

What are the Potential Benefits of a Directed Donor (Known Donor) Arrangement?

You know more about the donor and their background. 

two gay men intended parents with donor-conceived child through a non-disclosed donor arrangement

When using a Directed Donor, you likely know much more about this person than what you can glean from reading a donor’s profile and viewing a selected number of photos. When the person who is contributing DNA to your future child is someone you already know personally, you may feel more confident that you have a more thorough and accurate understanding of their background, personality traits, and personal and family medical history.   

A Directed Donor will be less expensive. 

Directed Donors are typically not paid for donating which significantly reduces the cost for intended parents. Even though the donor’s direct medical and legal expenses of the donation would still need to be covered by the intended parents, using a known donor may still be significantly less expensive than using an anonymous donor. 

The experience can bring a bond and provide support.

Going through fertility treatment can be stressful and emotional, and utilizing a donor can add another layer to that. When the donor knows and cares about the intended parents, the donor and recipients can be mutually supportive of one another. Going through a fertility treatment cycle together can potentially strengthen the bond between the two parties and lead to an even closer relationship both during the journey and beyond. 

The donor may provide a genetic connection.

donor with a genetic connection in a directed donor or known donor arrangement

Using a known/directed donor that is a family member of the recipient not using their own gametes allows that recipient to maintain a familial genetic connection to the resulting child. For example, a sister may offer to donate her eggs to her brother and his same-sex partner, with the plan that gametes from her brother’s partner be used to fertilize her eggs and create embryos. This provides the opportunity for each of the men to have his family’s genetics represented in the resulting child. Maintaining a familial genetic connection can be important for some recipients, and this can be positive for many families. 

The donor may have a relationship with the conceived child.

Directed donor arrangements may not only provide the donor-conceived child with more information about their origins and history but may also provide more opportunities for the child to have any additional questions answered. Though most donor-conceived children have a healthy relationship and strong bond with their parents, it’s still very common and natural for a donor-conceived child to be curious about their genetic heritage. In directed donor arrangements, the donor often has an ongoing relationship with the donor-conceived child, or at least is more available for contact throughout their life. 

What are the Potential Drawbacks of a Directed Donor (Known Donor) Arrangement?

Challenges in Relationship Dynamics

In a directed donor arrangement, there is a potential for difficult emotions to arise that can exacerbate any existing relationship challenges between the donor and one or both of the recipients or create new ones. For instance, in a sibling-to-sibling donation, new and unexpected feelings of jealousy, competitiveness, or insecurity can arise. If such dynamics already exist in the relationship, they may be intensified. 

Conflicts Arising as a Result of Differences in Parenting Styles

Despite legal contracts clearly detailing the rights, roles, and responsibilities (and limitations thereof) of the donor and the recipients, directed donors may find themselves experiencing a more complicated emotional investment in how the resulting child is raised than he or she expected. For instance, it may be more difficult for the donor if the recipients make parenting decisions that fall significantly out of alignment with the donor’s values or parenting philosophy.  On the other side of the coin, recipients may also find themselves more sensitive to unsolicited opinions or suggestions from a family member who is the child’s gamete donor than they otherwise would if this person was not the child’s gamete donor. 

Increased Risk of Legal Disputes

Within directed donor arrangements, there is an increased risk of legal disputes between the recipient and the donor. As with conflicts related to parenting styles, even though contracts are negotiated and signed before the donation, there can still be legal challenges that arise between a directed donor and intended parent(s).  

A Directed Donor May Experience Increased Responsibility and Guilt

A directed donor may feel obligated to agree to the donation out of a sense of pressure to help with the situation, especially if the request is coming from a relative or close friend. It’s also possible that even though the donor may have wanted to donate to help their loved one grow their family, after learning more about what is involved or the potential risks, they may no longer feel comfortable proceeding. Alternatively, the donor’s circumstances may have changed and there may be new stressors or challenges in the donor’s life that make it less realistic or practical to continue with plans to donate. In these cases, the donor may find it extremely difficult, if not impossible, to decline a request to donate or to retract a previous agreement to donate. Donating under these circumstances can lead to resentment or animosity. 

Because a directed donor is typically someone the recipients know personally, the donor may feel personally responsible for the success or failure of the cycle, and the donor may feel guilty if the fertility treatments are unsuccessful. Cycles that don’t result in pregnancies are obviously extremely difficult emotionally for recipients, but they can also be painful for their donor, especially if the donor is someone that cares for their family. 

 These additional layers of emotional complexity during a fertility journey may cause damage to the intended parent(s)’ and donor’s relationship. It is important to recognize that while a directed donor arrangement can bring everyone closer together, it can also drive people apart.  

Potential Ethical or Medical Incompatibilities

Some family donor pairs present ethical complexities or are problematic from a medical point of view. For example, when a sister agrees to donate her eggs to her brother and his partner, even when the plan is that gametes from the brother’s male partner will be utilized to fertilize the eggs, there may remain a social perception that the situation is somehow incestuous. While the plan’s logistics and propriety may be amply clear to the adults involved, the resulting child may struggle with misunderstanding and misperception among his or her peers, especially during childhood, if he or she tries to explain to others that his or her aunt is the egg donor. In the past, the potential appearance of incest was considered ethical grounds for discouraging such arrangements. However, such arrangements have increasingly been looked at more favorably, as the potential advantages of allowing for a familial genetic connection to one’s future child have been recognized. Still, the “appearance of an incestuous relationship” and the potential implications for the resulting child should be considered. 

Ethical issues can arise when a “power differential” exists in the relationship between the recipient and the directed donor, particularly if the recipient’s position in the relationship is considered, relative to the donor, to hold more “power” or authority.  This would be the case, for example, if the prospective donor is a daughter being asked to consider donating to her mother and stepfather or is an employee being asked to consider donating to a current or former supervisor. In these cases, the prospective donor may feel unduly pressured to agree to donate. The Ethics Committee of the American Society for Reproductive Medicine discourages directed donor arrangements when such power differentials exist between the parties and the donor is in the relative position of less power or authority.

CHOOSING A NON-DISCLOSED DONOR

Formerly referred to as an “Anonymous Donor”

At ORM Fertility, we no longer use the term “anonymous” when referring to non-disclosed donor arrangements, as it implies something that cannot at all be guaranteed these days given the proliferation of consumer DNA testing kits such as Ancestry.com and “23 & Me.”  We use the term “non-disclosed” instead (meaning that the identities of the two parties will not be disclosed to each other by the agency or clinic) to describe these donor arrangements. In a non-disclosed (anonymous) donor arrangement neither the donor nor the intended parents are given any identifying or contact information about each other by the agency or clinic.

Within non-disclosed donor arrangements, the parties can enter into one of several different agreements regarding potential contact with one another, now or in the future.  It is important to recognize, however, that such legal agreements cannot be extended to apply to the resulting children who were not conceived at the time the legal agreements were made and, therefore, cannot be bound by them

 “Anonymous/No-contact” arrangements were once regarded as the most ideal for all parties involved. However, the extent to which anonymity can be guaranteed has changed dramatically over time as information sharing technology has evolved, and mental health professionals have increasingly recognized the potential downside of completely anonymous arrangements and the absolute lack of contact options, neither of which can really be guaranteed anyway. Still, some recipients may perceive there to be certain benefits in pursuing a non-disclosed donor arrangement or a donor arrangement with a “no contact” agreement between the parties.

What are the Potential Benefits of a Non-Disclosed Donor Arrangement? 

Potential for Less Shame for the Recipients

Although there are mass movements to remove the stigma around infertility, there remains a great deal of shame and guilt for many intended parents experiencing infertility. With non-disclosed donor arrangements, recipients have more ability to choose whether, when, and to whom to share the fact that they used a donor to grow their family. 

A note on this: Most experts believe donor-conceived children should be told they were conceived using a donor. Previously, it was more acceptable that donor-conception to be kept a secret from children, it is now much more widely agreed that being honest with children is best. This is especially true with modern DNA testing kits readily and inexpensively available to consumers as well as website and social media resources designed to help genetically linked individuals find and connect, such as the Donor Sibling Registry. Research has shown that when donor conception has been kept a secret and children discover the truth on their own, later on in life, it is likely to cause considerable emotional distress and lead to feelings of anger, betrayal, and distrust in their relationship with their parents. In contrast, there is a considerable body of research demonstrating the psychological benefits of openness with donor-conceived children about their donor conception from a relatively early age, including not only positive psychological adjustment and self-esteem in the child, but stronger, healthier, and more positive parent-child relationships in middle childhood and adolescence. 

What are the Potential Drawbacks of using a Non-Disclosed Donor?

A non-disclosed donor can be costly. 

In comparison to directed donor arrangements, Non-Disclosed Donors can be more expensive. When a donor is contracted through a fertility clinic’s in-house program or a donor agency database, the donor’s fee paid for by the recipients can be thousands of dollars and typically averages about $10,000. At ORM, utilizing a donor from our donor program includes a fee of $7,500 – 10,000 for the donor. 

Future Communication May be Unavailable Leaving Unanswered Questions

All children grow up having questions about who they are and where they come from. When donor-conceived children are curious about their genetic origins, the questions can be difficult to answer in the case of a non-disclosed or “no contact” arrangement. If the donor-conceived child has additional questions and no access to the donor to have these questions answered, the child may struggle with a healthy sense of identity. In some cases, it’s not even answers to specific additional questions that are desired—a donor-conceived child may feel that it would give them a more complete sense of their origins and identity to be able to exchange communication with their donor, by email, phone, social media, virtually through Skype or FaceTime, or in-person even just once, to hear how the donor talks, laughs or expresses themself.  It’s been found that the vast majority of donor-conceived children are not interested in seeing their donor as a new parental figure, rather their motive is rooted in wanting to know more about themself and where they come from. The fear some parents have is that the donor will replace them in any way is nearly always unfounded. 

Even when arrangements are made for potential future contact in non-disclosed donor arrangements, such as through the Donor Sibling Registry, there is the risk that over the years, the donor may lose track of their registration or may not respond to contact initiated through the registry if it’s many years after the time of the donation. For recipients who are interested in potential future contact options for their donor-conceived children in the future, we recommend considering asking to set up a facilitated meeting around the time of the donation. At ORM, if the recipients request this and the donor is open to this, a virtual meeting can be arranged with an ORM coordinator participating to help facilitate. In our experience, when a donor has the chance to meet the recipients, they tend to be more comfortable with the prospect of being available for future contact if or when it’s needed by the recipients or potentially the donor-conceived child (typically once the child has reached adulthood). If meeting the donor is not an option that recipients are comfortable with, sending a personal note to ORM to be passed on to the donor that shares some non-identifying information about the recipients (hobbies, occupations, pets, etc), thanking the donor for donating, and explaining their reasons for hoping their future child might be able to access contact with the donor in the future if this feels important to their child’s sense of identity and understanding of their genetic origins. We believe that this kind of personalized communication not only helps donors feel more comfortable making themselves available for future contact but also perhaps increases their personal investment in helping promote the resulting child’s best interests.

On the other side of the situation, donors sometimes wonder about the family they helped create and without the ability to contact, those curiosities will never be resolved. Recipients also can come to want to know more about the donor that helped them realize their dreams, however, with non-disclosed donor arrangements, future contact may not be possible or easily accessed. 

Limitations to Family Medical Information

Although recipients receive a comprehensive and complete personal and family medical health history of their donor, that information only reflects what is true (or known) at the time the donor completed their profile. If a donor-conceived child later develops a condition, recipients may want to reach out to the donor and ask for any new medical developments in their family. With non-disclosed donor arrangements, recipients may have to rely on their fertility clinic or agency to reach out for up-to-date medical and health information, and these contact attempts, particularly years after a donation are not always successful. It’s also possible that a donor-conceived child can develop a health issue that the donor should be informed of so that they are aware of implications for their own existing or future children.

No Longer Fully Anonymous 

Although in a non-disclosed donor arrangement, no identifying or contact information is shared by the clinic or agency, these donor arrangements are getting increasingly less anonymous. With modern genetic technology, it’s often fairly simple for a donor-conceived child to find their donor by using a consumer DNA test kit. Even if the donor themselves never uses a DNA testing kit, if a genetic relative of the donor does, the relative may show up in the child’s results as someone that he or she is related to, ultimately leading to the child learning the identity of the donor. By the same token, it’s fairly simple for an individual to have their DNA tested and learn if they are genetically related to their family. There have already been many cases in which a donor-conceived person who hadn’t been told they were donor-conceived, used a DNA test kit to learn more about their ancestry and geographic origins and unexpectedly learned that they were not in fact genetically related to one or both parents. Also, a donor-conceived child can use the Donor Sibling Registry to potentially find not only their donor but their “genetic siblings” as well (children conceived by other parents who received gametes from the same donor).

Semi-open and open donor arrangements may mitigate some of these problems.

CHOOSING A SEMI-OPEN DONOR

non disclosed donor meeting virtually with donation recipients More personal information or communication is exchanged in a semi-open donor arrangement, but typically not enough to permit communication directly between the donor and the intended parent(s). Rather, communication happens through an intermediary, such as the fertility clinic, lawyer, or donor database, that relays messages between both parties. While first names may be shared, or the two parties may even meet one another (either in person, by phone, or through videoconference in a meeting facilitated by an agency or clinic staff member), no identifying information such as last names or contact information is exchanged. Many prospective parents appreciate the opportunity to have direct interaction with their future child’s donor so that when they do share with the child the information about their donor conception, they have more direct and first-hand information about what the donor was like. 

Sometimes in a semi-open donor arrangement, prospective parents and the donor agree to be accessible for potential future contact in a way that does not require exchanging identifying or contact information. Though some agencies or clinics may agree to serve as the intermediary for future contact, typically it is recommended that recipients and donors in a semi-open arrangement, plan to have any future contact occur through a registry designed specifically to facilitate contact between people who share a genetic link, such as the Donor Sibling Registry 

Such arrangements can support a recipient or donor’s wish for some degree of privacy while still allowing more information regarding their genetic origins to be accessible to donor-conceived children.  

At ORM, non-disclosed (previously termed “anonymous”) donor arrangements can either be “no-contact” or with some contact options, the latter being “semi-open.” Many, though not all, of ORM’s non-disclosed donor arrangements, are in fact also semi-open arrangements. 

What are the Potential Benefits of a Semi-Open Donor Arrangement? 

Future Contact Possible 

Semi-open donor arrangements may allow a donor-conceived child to have direct contact with their donor. For instance, in an “identity release” agreement, which is common in sperm donation arrangements, sperm donors agree to allow the sperm bank or donation program to release their full name and date of birth to the donor-conceived child once the child turns 18.  The information is not provided automatically to the child. Rather, the donor-conceived child must contact the clinic to request this information. Some states, including the State of Washington, have enacted laws such that all gamete donations are, by default, “identity release arrangements” in that when the resulting donor-conceived child turns 18, they have the legal right to contact the egg or embryo donation program or sperm bank and receive the gamete donor(s)’ full name(s) and date(s) of birth unless the gamete donor has “opted out” of granting permission for their identifying information to be released to the resulting donor-conceived child.  Gamete donors in the State of Washington must submit their decision to “opt-out” in writing and submit it to the egg or embryo donation program or sperm bank. Typically these contracts require the donor-conceived child to be at least 18 years old before initiating contact and there is not necessarily an expectation that contact will continue, though it could if the donor and the donor-conceived child mutually agreed to do so. 

Gives Donors the right to know about what happens to their gametes.

In a semi-open donor arrangement, the donor may receive information on whether the pregnancy was successful or how many children resulted from their donation. Through an intermediary, the donor might receive a newborn photo from the parents. In most of these situations, communication ceases after birth.  

Can transition to an Open Donor Arrangement 

If both the donor and the intended parents decide they would like to continue communication, they can propose to the clinic or agency they’re working with to transition their arrangement into an open arrangement. 

CHOOSING AN OPEN DONOR

At least at this point, open donor arrangements are among the least common of donor arrangements. With an open donor, also known as an identified donor, recipients and donors have contact information for one another, allowing for direct communication to take place between one another.

Also, more identifying details may be shared in comparison to semi-open and non-disclosed donor arrangements. In addition to contact information, These details may include full name, occupation, location. Each open donor arrangement is unique and can vary widely between meeting occasionally to having an ongoing relationship between the donor and the donor-conceived child and their parents.  

GLOSSARY

Third-party assisted reproduction comes with its own collection of jargon. Understanding these terms is important and will aid in your empowerment to make the best decision for you and your family. Below are commonly used terms accompanied with a short definition. 


Intended-Parents or Recipient(s): This is the individual or couple who plan to raise the child. The use of the word “intended” is because fertility treatment does not always result in a live birth.
 


Donor: This is the individual (or individuals) donating their gametes  sperm or eggs) or their embryo(s).


Gametes: A reproductive cell and either a sperm or an egg.


Donor-Conceived Child: A donor-conceived child, is conceived via the donation of sperm (sperm donation) or ova (egg donation), or both (either from two separate donors or from a couple). 


Gestational Carrier (Surrogate): A woman who carries an embryo that was formed from the egg of another woman. The gestational carrier usually has a contractual obligation to return the infant to its intended parents. 


Directed Donor: Commonly referred to as a Known Donor, a Directed Donor is a person known personally by the intended parents who donates sperm, eggs, or embryos. Known donors can be friends, relatives, or even acquaintances. 


Non-Disclosed Donor Arrangement (Formerly referred to as an Anonymous Donor Arrangement): Non-Disclosed Donor Arrangements are when neither the donor nor the intended parents are given any identifying information about each other by the clinic or agency at all. Some non-disclosed donor arrangements are set up with the expectation that there will be no contact between the two parties (although this cannot be guaranteed given the wide availability of relatively inexpensive consumer DNA testing).  

Other non-disclosed donor agreements include an arrangement allowing potential contact between the two parties without the clinic or agency releasing identifying or personal contact information, these may fall into the subcategory of semi-open donor arrangements. The contact could involve a face-to-face meeting between the two parties early on in the process (in-person or virtual) or could involve an arrangement for potential email contact through an intermediary, such as a fertility clinic, donor agency, attorney, or registry. 

Although contact information isn’t revealed, recipients can still search through our database or other donor databases to review and consider different donor profiles. Donor profiles typically provide a variety of details such as current photos, baby photos, hair color, eye color, height, weight, educational background, family history, career, hobbies, personality, and more. 


Semi-Open Donor Arrangement: This arrangement involves sharing some information between the intended parent and donor, however, the details are limited. The donor and intended parent still don’t have each other’s personal contact information, and typically the donor agency, fertility clinic, or a lawyer acts as an intermediary. Details shared may include general information about the outcome, for example, if a pregnancy resulted from the donation, a letter, or even a photo of the newborn. 

Semi-open arrangements may or may not involve ongoing or future communication, depending on the preferences and comfort each of the two parties has concerning ongoing or future contact.  


Open Donor Arrangement: This arrangement typically set up between donor and intended parent is one where personal contact information is shared for direct communication with one another. The donor and recipients may also decide to meet each other either virtually or in-person before or after the birth of the baby. This arrangement is very personalized to the situation and does not guarantee ongoing contact. t is not uncommon for there to be more frequent contact early on in the arrangement and then for the frequency to organically decline over time.

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