Major gaps in psychosocial support for donor conception across 10 countries
Donor conception and psychosocial support provisions across jurisdictions – what’s out there? (Goedeke, 2026)
Goedeke, S., Indekeu, A., & Crawshaw, M. (2026). Donor conception and psychosocial support provisions across jurisdictions – what’s out there? Human Fertility, 29(1), 2595800. https://doi.org/10.1080/14647273.2025.2595800
Geographic Region: Australia, New Zealand, Canada, United States, Belgium, the Netherlands, United Kingdom, Germany, Ireland, and Sweden
Research Question: What psychosocial support and counseling services are currently available to donor-conceived people, parents, donors, and their families across ten jurisdictions, and how well do these services meet the growing complexity of donor conception at all life stages?
Design: Descriptive, cross-national mapping study using publicly available information and expert consultation. Data were collected in three areas: (1) the legislative and regulatory context of donor conception in each country, including identity-release provisions; (2) psychosocial support available before or during treatment; and (3) psychosocial support available after treatment or donation, including at the time of information release and donor-linking. Information was gathered through publicly available government and organizational documents, with verification from key researchers and representatives of professional counseling bodies in each country. Data were accurate at the time of publication (early 2026).
Sample: Ten jurisdictions: Australia, New Zealand, Canada, USA, Belgium, the Netherlands, UK, Germany, Ireland, and Sweden. Countries were selected based on two criteria: having a professional fertility counseling organization, and/or having published research on donor conception in English. The authors consulted with key informants from each country, including researchers, psychosocial practitioners, and members of fertility counseling organization boards.
Key Findings
Legislative Landscape
Legislation governing donor conception varies widely across the ten countries. While Belgium, Ireland, Germany, the Netherlands, New Zealand, Sweden, and the UK have national legislative frameworks, Australia and Canada regulate ART at the state/provincial level, and the USA has almost no federal legislation.
Sperm donation is permitted in all ten countries. Egg donation is prohibited in Germany. Gestational surrogacy using donor gametes is not permitted in Sweden and is not yet legally available in Ireland.
Seven of the ten countries (Australia, Germany, Ireland, the Netherlands, New Zealand, Sweden, and the UK) require identity-release donation, meaning DCP can access identifying information about their donor when they reach a certain age (typically 18). Anonymous donation remains an option in the USA (except for one state), most of Canada, and Belgium (though Belgium has committed to ending anonymity by 2027).
Donor-conceived people generally have the right to access identifying donor information at age 18 in identity-release jurisdictions, but parents have far more limited rights in most countries, and donors have even fewer rights to information about the children born from their donations.
Restrictions on the number of children or families that can be created from one donor are inconsistently applied. Ireland legally restricts one donor to four families; Belgium limits one donor to six women; Sweden recommends (but does not mandate) six families. The UK allows up to ten families; the US allows up to 25. No international limits exist, and enforcement across borders is largely impossible.
Record-keeping requirements vary significantly, with some countries specifying that records must be kept for 70 to 110 years, and others having no legal time limits. This inconsistency has implications for DCP’s future ability to access information about their origins.
None of the jurisdictions surveyed explicitly address donor conception that occurs outside the formal medical system (e.g., home insemination) or cross-border reproductive care, leaving many DCP without legal protections or access to support.
Pre-Conception Counseling
Mandatory pre-conception counseling exists in some form in Ireland (at least one implications counseling session required by law), Quebec/Canada (an information session required by law), Sweden (mandatory psychosocial assessment, though not implications counseling), and Australia and New Zealand (two counseling sessions required for clinic accreditation, making attendance effectively mandatory).
In Belgium and the UK, counseling must be offered, but attendance is not required. In Germany, the Netherlands, Canada (outside Quebec), and the USA, counseling is recommended by professional guidelines but not mandated.
Qualification requirements for fertility counselors also vary significantly. Australia, New Zealand, the UK, Ireland, and Canada have established professional associations with training and registration requirements. In the USA, the ASRM Mental Health Professional Group recommends certain qualifications but has no official accreditation, and anyone can join regardless of training. In the Netherlands, counselor qualifications are loosely defined.
Post-Conception and Long-Term Support
Post-treatment psychosocial support is rarely mandated in legislation. The Netherlands stands out as having the most developed post-conception support system, providing government-funded counseling to DCPs and donors on identity release and donor-linking. The Belgian Flemish Ancestry Centre (‘Het Afstammingscentrum’) offers free, government-funded support without session limits.
Some Australian states (Queensland, New South Wales, and South Australia) have recently introduced provisions for free counseling when DCP access the register. However, in Victoria, the Assisted Reproductive Treatment Authority (VARTA), which had provided free counseling and donor-linking services, was dissolved at the end of 2024.
In the UK, the HFEA previously offered time-limited free counseling when people requested donor information; this service was discontinued in September 2024 and replaced with online information pages only.
Peer support organizations exist in most countries and provide valuable community-based support. However, these organizations are largely run by volunteers with lived experience, are typically unfunded, and should be seen as complementary to (not a replacement for) professional support. This leaves DCP, parents, and donors without adequate support as they navigate disclosure, donor-linking, large sibling networks, and DNA testing discoveries across their lifetimes.
Limitations: Notably absent from the study are countries in the Global South, Asia, the Middle East, and Eastern Europe, including countries with significant ART industries, such as Spain (a major destination for reproductive tourism), Denmark (a major sperm-exporting country), India, and Thailand. Countries where anonymous donation remains the norm (e.g., China, South Africa, Iran, Italy, Brazil) are also not included, even though many DCPs globally were conceived in these contexts. The study does not examine whether the counseling that does exist is culturally appropriate, linguistically accessible, or relevant to families of color, Indigenous families, LGBTQ+ families, or families with lower socioeconomic resources. Legislative and practice provisions are under active review in several of the included countries. Publicly available data may not reflect the most recent changes, and individual clinic practices within jurisdictions may vary and were not captured.
Applications: The study highlights the need for post-conception counseling to be treated as a distinct and specialized practice area, separate from pre-conception fertility counseling. The study identifies direct-to-consumer DNA testing as a growing source of unexpected DC discoveries, early donor contact, and large sibling network identification. Very few jurisdictions have support systems designed for these situations. Clinicians, counselors, and DCP organizations should be prepared to support individuals who encounter these situations without warning. This mapping study identifies multiple important research gaps, including studies on the psychosocial needs of donors (particularly as DCP seek contact), the effectiveness of different counseling models for DC-linking, experiences of families using cross-border or informal donor conception, and the support needs of DCP from non-Western or non-disclosure contexts.
Funding Source: No funding source is identified
Lead Author: Sonja Goedeke is an Associate Professor in the Department of Psychology and Neuroscience at Auckland University of Technology (New Zealand), a registered clinical psychologist, and a specialist in the psychosocial and ethical implications of infertility treatment and donor conception; she is also Co-Chair of the ASPIRE Special Interest Group on Psychology and Counseling. No personal connection to donor conception was disclosed.
Regulatory Context: Varies by jurisdiction
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We also need to have culturally sensitive counselling catering to diverse immigrant and second generation communities who often live in a bicultural world. This is even harder to find.