How parents whose children have been conceived with donor gametes make their disclosure decision: contexts, influences, and couple dynamics.
OBJECTIVE
To describe parents' disclosure decision-making process.


METHODS
In-depth ethnographic interviews.


METHODS
Participants were recruited from 11 medical infertility practices and 1 sperm bank in Northern California.


METHODS
One hundred forty-one married couples who had conceived a child using donor gametes (62 with donor sperm, 79 with donor oocytes).


METHODS
Husbands and wives were interviewed together and separately.


METHODS
Thematic analysis of interview transcripts.


RESULTS
Ninety-five percent of couples came to a united disclosure decision, some "intuitively," but most after discussions influenced by the couples' local sociopolitical environment, professional opinion, counseling, religious and cultural background, family relationships, and individual personal, psychological, and ethical beliefs. Couples who were not initially in agreement ultimately came to a decision after one partner deferred to the wishes or opinions of the other. Deferral could reflect the result of a prior agreement, one partner's recognition of the other's experiential or emotional expertise, or direct persuasion. In disclosing couples, men frequently deferred to their wives, whereas, in nondisclosing couples, women always deferred to their husbands.


CONCLUSIONS
Although the majority of couples were in initial agreement about disclosure, for many the disclosure decision was a complex, negotiated process reflecting a wide range of influences and contexts.
Shehab
Dena
D
Institute for Health and Aging, University of California, San Francisco, California 94118, USA.
Duff
Julia
J
Pasch
Lauri A
LA
Mac Dougall
Kirstin
K
Scheib
Joanna E
JE
Nachtigall
Robert D
RD
D000328:Adult; D002140:California; D002648:Child; D003376:Counseling; D003469:Culture; D003657:Decision Making / Q000941:ethics; D005195:Family Relations; D005260:Female; D006801:Humans; D007316:Insemination, Artificial, Heterologous / Q000941:ethics; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D017008:Negotiating; D018587:Oocyte Donation / Q000941:ethics; D012959:Socioeconomic Factors; D014019:Tissue Donors / Q000941:ethics; D014342:Truth Disclosure / Q000941:ethics