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.
DESIGN: In-depth ethnographic interviews.
SETTING: Participants were recruited from 11 medical infertility practices and 1 sperm bank in Northern California. PATIENT(S): One hundred forty-one married couples who had conceived a child using donor gametes (62 with donor sperm, 79 with donor oocytes). INTERVENTION(S): Husbands and wives were interviewed together and separately. MAIN OUTCOME MEASURE(S): Thematic analysis of interview transcripts. RESULT(S): 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. CONCLUSION(S): 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.