BACKGROUND In recent years, changes in attitudes towards (non-)disclosure of donor conception to offspring and/or others have been observed. Studies have started to identify possible factors that contribute to these changes that are relevant for clinics, counsellors and policy-makers in their approach to the disclosure process. The aim of this systematic review was to integrate the existing knowledge on factors that influence the disclosure decision-making process of donor conception to offspring and/or others in heterosexual couples, and to discuss future trends and concerns. METHODS A bibliographic search of English, French, German and Dutch language publications of five computerized databases was undertaken from January 1980 to March 2012. A Cochrane Database systematic review approach was applied. RESULTS A total of 43 studies met the inclusion criteria, and these represented 36 study populations. The review shows that the parents' disclosure decision-making process is influenced by a myriad of intrapersonal, interpersonal, social and family life cycle features. These influences were not necessarily independent but rather were interwoven and overlapping. Theoretical frameworks have not yet been used to explain how the different factors influenced disclosure. Methodological limitations of the original publications (lack of information, several factors included in one study, descriptive character of studies) and this review (multiple factors that may interact) which hindered integration of the findings are outlined. CONCLUSIONS Intrapersonal, interpersonal, social and family life cycle factors influence the parents' disclosure decision-making process. The review has demonstrated the need for the development of a theoretical model to enable integration of the identified influencing factors. Further research is needed on the role of stigma, confrontation efficacy, extended family, donor siblings' characteristics, cross-border treatment, culture, gender and socio-educational factors.

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This study examines transitions and consistencies in the views of donor sperm recipients on ‘parenthood’ and ‘family’ over time. A longitudinal qualitative study was carried out with 19 donor sperm recipients. Interviews took place during pregnancy, at birth and 1.5–2 years after birth and were analysed using a grounded theory approach. Participants intending to disclose the donor conception to their offspring (13/19) exhibited a transition from feeling anxious prior to birth to feeling more confident during the toddler stage about their parenthood. Previous anxieties about the lack of biological ties decreased as emerging social ties became more significant. Following birth, these participants (13/19) felt acknowledged by others as parents, which elicited feelings of normalization. Being able to engage in parenting and develop parental relations enhanced their confidence in their parental position. This confidence empowered donor sperm recipients to tackle future challenges and made them more convinced about their disclosure intention. Participants intending not to disclose the donor conception (6/19) reported viewing their parenthood as no different from parenthood experienced by naturally conceiving parents, no transitions were observed and insecurity about physical traits that could reveal the donor conception remained. These findings have implications for counselling throughout specific stages in parenthood.

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Little is known about recipients' views of their sperm donor. This study aimed to examine the possible transitions or consistencies in donor sperm recipients' (DSRs') view on the sperm donor over time. A longitudinal qualitative study of 19 Belgian heterosexual DSRs was undertaken. Interviews took place with both partners of the couple during pregnancy, at birth and 1.5-2 years after birth, and were analysed using a grounded theory approach. Recipients who intended to disclose exhibited a transition in their awareness of the donor from being of minimal importance to one who was increasingly seen as part of their family narrative. This was partly triggered by the offspring's life, remarks about resemblance and the socio-cultural context. The perceived position of the donor changed for most recipients from a threatening rival to a 'distractor'. This change was supported by the emerging father-child bond and the confidence that stemmed from it. These observations were applicable to those recipients who intended to disclose their donor conception; for those recipients who intended not to disclose, little or no transition was observed. This study describes and analyses the transitions and consistencies in recipients' views of the donor over different stages of the family life-cycle (pregnancy, birth, toddler stage) and could help the fertility clinics tailor their counselling to the specific stages of parenthood.