This paper presents the case for a change from the current practice of anonymity and secrecy in the use of donated gametes in medically assisted conception. It does so by describing history of the practice, various committees of enquiry over the years, their recommendations for consideration of the children created and the need for follow-up of the outcome; presenting the evidence from outcome studies both about child development and family relationships where secrecy is maintained about the child's origin and those where the practice is openly to acknowledge their origins. This is followed by an analysis of the experience and views of these children once they are adults. In discussion of the composite findings recurring themes emerge. From this it is concluded that offspring from donated gametes should not continue to be denied knowledge of their origins and antecedents. In the public debate, four schools of thought are identified. Possible practical scenarios to implement change are discussed. This paper argues that the fundamental issue regarding any of these remains-that priority in decision-making should be the lifelong well-being of the children being created.

This article gives the findings of an in-depth study of the outcome for parents and children after assisted conception, namely in vitro fertilization and donor insemination. The study is of 54 families bringing up 110 children, 74 of whom were the result of these two medical interventions. The findings presented in this article deal specifically with the psychological issues and ethical dilemmas experienced by the parents of these two groups. Specific areas regarding in vitro fertilization are use of the term 'test-tube baby'; religious and community attitudes to the use of assisted reproductive technology; and the effects of these attitudes on the families. The major issue of multiple births and their social outcomes is dealt with in the following article. The specific areas for donor insemination families are secrecy and reticence about the whole procedure; infertility as a continuing taboo subject; donor anonymity; and the resulting effect of donor anonymity on parenting children who do not have access to their full health and genetic family history. Reference is made to the findings of other relevant research. Practice and legal implications from the findings are presented.

No abstract

Patients' perception of family life after a multiple birth: euphoria or Pandora's box? The aim of this article is to explore the realities of parenting children from a multiple pregnancy as an aid to decision-making about the number of embryos transferred. Outcome research regarding parenting of children from twin, triplet and higher order births is described and, in particular, children of multiple births from assisted reproductive technology. Current understanding of interpersonal relationships in multiple birth families is also discussed. The evidence from these various sources is put in the framework of social risk factors as an aid to predicting outcomes and as an essential part of decision-making with the full participation of patients. The implications of such an approach is presented in relation to support for such families. Case studies are included of three triplet families. Reference is made to fetal reduction as an option.

No abstract