The relationship between solo parents and fertility clinics

In 2018, I decided to conceive a child as a solo mother through sperm donation. My GP recommended a clinic but initially, I couldn't find any information about solo pathways on their website. I eventually discovered 'single women' mentioned on a page about intra-partner egg sharing for lesbian couples.

I soon discovered that many fertility clinics conflated solo patients with same-sex couples due to the necessity of donor gametes; this meant that the language used and advice offered wasn't always fitting. My clinic was extremely supportive about my conception pathway and through them I had two children, but I did feel that as a solo woman I was anomalous, and the processes and resources weren't necessarily designed for my circumstances.

Over the next few years, as an academic in the medical humanities researching donor conception and a volunteer with the Donor Conception Network, I frequently heard similar stories to mine:

'There is definitely scope for more bespoke support for solo mums. There seems to be a general presumption that only couples undergo fertility treatment. Support is vital as we are going through this all on our own and don't have a partner to discuss things with', said Emma James, a solo mother by choice via sperm donation.

While donor conception has been around for a long time, it was really in the 1980s that solo parenthood by choice started to gain traction and become visible in public discourse, and this was partly due to the establishment of the organisation Single Mothers by Choice in 1981 by Jane Mattes – a solo mother through gamete donation. Since 1981, solo parenthood through gamete donation has increased exponentially.

In 1993, the Donor Conception Network was established in the UK by five donor-assisted families with the focus of bringing together people with direct experience of donor conception. In the short period between 1980 and today, we can see the establishment of organisations which centralise lived experience. Experiences such as those of Emma and myself made me question what else can be done to help bridge the gap between community spaces and clinical environments.

• How can medical practitioners be invited to engage with patient communities?
• How can we collectively enable a more generative exchange of experiences between patients and clinics?
• How can clinics incorporate the experience of donor-assisted families into the designing of webpages, resources, processes, and policy?

Complicating this issue is the saturation of anti-donation narratives involving solo parents in popular culture, bioethics, and media. Many solo parents are exposed to clinical practices that do not fully represent their specific conception pathway and are additionally exposed to external narratives that can be combative, which can lead to feelings of alienation. Taking control of the solo parenting narrative and championing positivity and inclusivity is important.

Fortunately, in the UK, fertility clinics are very conscious of inclusivity and strive for equal, fair, and bespoke treatment for all patients. However, more can be done to help clinics understand the nuanced and specific issues facing solo parents when they enter an environment traditionally aimed at couples and co-parents.

The construction of the booklet Independent Family Planning: Choosing Solo Parenthood through Gamete or Embryo Donation. A guide for fertility healthcare professionals (2023), funded by the Wellcome Trust, is an attempt to share solo parents' experiences with the fertility industry and invite clinics to learn more and compliment their inclusive practice.

Fittingly, the grant award was for 'translation' activities and this is what the Independent Family Planning booklet intends: to translate patient experience to healthcare professionals. The contents were written by a group of solo mothers with expertise in medicine, life-coaching, reproduction, and bioethics, and it has been peer reviewed by industry professionals.

Everyone involved, including our digital designer and illustrator, are solo mothers through donor conception. Consulting on the project was Dr Thanos Papathanasiou, CEO and medical director of Bourn Hall (the world's first IVF clinic), and the Donor Conception Network.

The booklet explores a range of questions:

• Why is solo parenthood a chosen or preferred reproduction pathway?
• What common false assumptions are made about solo parents?
• What research has been published on solo-parent families?
• How best can clinics communicate with solo parents? What language should be employed (single/solo, mother/parent, donor/bioparent)?
• What fears and concerns may the patient feel when pursuing solo parenthood?
• What information does a patient need to know about donor selection?
• What support exists for solo parents?

Even if clinics are already centralising lived experience in their practices, the booklet may prove useful for patients as it includes a list of support groups including Single Parent's Rights UK and Gingerbread (a charity providing advice and practical support for single parent families), and a list of recommended reading, including memoir and academic articles.

Although I am using the lens of solo parenthood (specifically for women in this case using sperm, double donation, or embryo donation) to explore these issues, the suggestions here are transferable to other patient groups. Ultimately, we need to think about how medicine can engage (or continue to engage) patient communities and how patient communities can offer their experiences to the medical community.

It is said that it takes a village to raise a child. Sometimes it can take a village to make one. This village comprises of doctors, nurses, sonographers, embryologists, laboratory technicians, administrative staff and wider groups, including donors, sperm banks, charities, support networks, friends and family, and community groups. Finding ways to bring these voices together will strengthen the complex architecture that is assisted reproduction.

The tighter this village can be, the better for everyone.