Moving beyond a 'just say no' approach to informal donor conception

The UK's fertility regulator (the Human Fertilisation and Embryology Authority (HFEA)) strongly advises against home insemination with donor sperm. While well-intended, this 'just say no' approach is not working and informal donations, outside of medical institutions, are increasing. It is time for a more nuanced conversation about, and response to, non-clinical routes to donor conception. This must start by engaging with the experiences of parents, donors and others impacted by informal donor conception in order to ensure that all donors and families formed through donor conception are recognised and supported.

Informal donor conception has a long history in LGBTQ+ communities. This is linked to the historical (in the UK) and continued (in some other jurisdictions) exclusion of same-sex couples, as well as single women, from clinical forms of assisted conception. What is more recent is the growth in online platforms which are used to facilitate informal donor conception. These include specialist websites and apps, such as Pride Angel, Modamily and Just a Baby, as well as social media platforms which have been adopted for this purpose (typically Facebook groups). These platforms enable would-be sperm donors, and those seeking donor sperm, to find and contact one another directly and arrange the donation themselves, typically 'bypassing' a clinic and arranging donation and conception at home or a hotel.

In the first phase of the Wellcome-funded Digital Donor Conception study, we analysed the online public-facing content of leading fertility clinics and UK regulators. Where discussed, these institutions strongly discourage DIY donor conception methods. The HFEA website, for example, states, 'It's always safer to have treatment with donor sperm at a licensed clinic before listing the legal and health risks associated with DIY methods. In addition, several leading UK fertility clinic websites explain why 'online' or 'private' donation is a 'bad idea' – both for donors and intended parents. Such messages are often particularly targeted at same-sex couples and solo mothers.

However, this 'just say no' approach is failing on its own terms. Growing numbers of donors and intended parents, most often same-sex couples, are pursuing informal and online routes to donor conception. In 2022, Pride Angel, one of several introduction websites, had nearly 5000 UK sperm donors and 25,000 UK-based would-be recipients registered (personal communication with Pride Angel Director). In comparison, HFEA statistics show that there have been approximately 400 new UK-based sperm donors registering with UK clinics each year since 2012. Of course, we do not know how many members have donated or conceived following registration on matching websites or groups. However, Francesca Taylor from Leeds School of Social Sciences at Leeds Beckett University, and colleagues' recent estimates, suggest that informal donor conception is a reproductive practice of considerable significance in the UK and globally.

The Digital Donor Conception study aims to move the discussion of informal donor conception beyond 'just say no' and, in doing so, to improve support and recognition for those donors, parents (and their children and families) who do take this route. The first step to achieve this must be to engage with the experiences of parents and donors through informal donor conception. By listening to their experiences we can better understand how decisions to pursue informal donor conception are situated, enacted and experienced in the context of their reproductive biographies, personal relationships and engagement with medical institutions.

For some, this will include barriers to clinical fertility treatment, for example racialised inequalities in relation to access and outcomes in fertility treatment (see BioNews 1089), a 'postcode lottery' in relation for same-sex couples seeking NHS funding and the high costs of private fertility treatment (see BioNews 1224). However, a deficit approach is insufficient. We must also recognise that, for some, informal donor conception will bring real benefits, for example, the ability for donors and recipients to get to know one another prior to donation, or the possibility of conceiving in the comfort and intimacy of a home or hotel. Informal donor conception can also be understood as part of queer or alternative community and family-building practices.

Moving beyond 'just say no' would involve developing policy and practice which responds to the social reality that informal donor conception is happening and works to support parents and donors, their families, and crucially the donor-conceived people born through informal donor conception, in ways which promote positive experiences and outcomes. It could involve, for example, enabling informal (as well as clinical) donors' details to be recorded on central registers and/or as part of birth registration process (see BioNews 1235) so that donor conceived people conceived via informal routes have a route to access information about their donor. It could also mean legislative change so that parents and donors through informal donor conception can secure legal parenthood (or legal non-parenthood) in ways comparable to clinic parents and donors, where that is what all parties intend.

Early findings from our interviews with parents through informal donor conception suggest that current UK laws, which mean that (in some cases of informal donor conception) sperm donors will be recognised as the legal parent of a child born can encourage anonymity and secrecy, even when parents are morally committed to talking about donor conception with their children. In addition, if we could move beyond simply telling people not to use informal donor conception, we might open up a conversation about how we can prevent and/or police some of the more harmful behaviours, for example coercive requests for 'natural insemination' (sex) or deception by donors about the numbers of children they have helped to conceive (see BioNews 1180), that have been reported by users of informal donor conception platforms.

My conversations with fertility professionals suggest that, while many have concerns about contemporary informal donor conception, there is an appetite to move the public conversation beyond an exclusive focus on risk. Some professionals I spoke to had friends who had conceived with a donor outside of a clinic. Another commented that they would likely try this route if they needed a donor themselves. This suggests that moving beyond 'just say no' by improving support for those who choose informal donor conception and not simply advising against it, will be possible. To do this, our starting point must be to listen to the experiences of donors and families formed through informal donor conception, including, crucially, the donor conceived people born through such arrangements.

Researchers on the Digital Donor Conception study are currently looking for (intended) parents or donors with experience of informal donor conception to take part in interviews. All interviews are anonymised and all participants receive a £20 voucher in recognition of their contribution. For more information about how you or someone you know can support our research, please see our website or contact Leah directly.