Mothers experience complex emotions when daughters pursue donor sperm treatment in China
A qualitative study of the emotional and decision-making experiences of mothers whose daughter undergoes assisted reproductive technology with donor sperm. (Wei, 2025)
Wei, Q., Yang, X., Hong, X., He, Y., Fan, Z., & Wang, Z. (2025). A qualitative study of the emotional and decision-making experiences of mothers whose daughter undergoes assisted reproductive technology with donor sperm. International Journal of Women’s Health, 17, 1971-1984. https://doi.org/10.2147/IJWH.S528398
Geographic Region: China (Zhejiang Province)
Research Question: What are the emotional experiences, decision-making dilemmas, and social support needs of Chinese mothers whose daughters have used donor sperm in assisted reproduction treatment due to male partner azoospermia?
Design: Qualitative study employed a descriptive phenomenological approach guided by Colaizzi’s seven-step analysis method. Data were collected between January and March 2025 through face-to-face, semi-structured interviews, each lasting 30 to 45 minutes, conducted at a tertiary reproductive medicine center. Interviews explored how mothers learned of their son-in-law’s azoospermia, their thoughts on sperm donation, their emotional responses, the support they provided, and their concerns about privacy and treatment outcomes.
Sample: 12 mothers (ages 45-63 years) whose daughters were undergoing first-time donor sperm assisted reproduction treatment. Mothers ranged in educational level from primary school to master’s degree, with occupations including retired professionals, clerks, medical staff, laborers, and farmers. Most mothers were married (10/12), with two divorced. Residence varied from countryside to city locations. Most mothers (9/12) had only one daughter, while three had additional children. Daughters ranged in age from 23-38 years and received either artificial insemination with donor sperm (10/12) or in vitro fertilization with donor sperm (2/12).
Key Findings
Mothers expressed disbelief and anger upon learning of their son-in-law’s infertility, with some questioning whether he knew beforehand and concealed the condition. One mother stated, “How is it possible! He is so tall and fit, how can he have no sperm? Isn’t this harming my daughter?”
Some mothers demonstrated deep care and rational thinking, advising daughters to consider the son-in-law’s positive qualities and the uncertainties of divorce. One mother advised, “I advise my daughter to calm down and think carefully about the good qualities of the son-in-law...while IVF can be painful, it is short-lived and finding a new partner can bring more uncertainty.”
Several mothers expressed satisfaction that donor sperm would allow children to avoid perceived negative physical or genetic traits from the son-in-law. One stated, “I was always worried that my son-in-law’s baldness and dry skin condition would be passed on to his children. The fact that using donor sperm will allow their children to avoid these health problems gives me peace of mind.”
Mothers worried about physical side effects, success rates, financial burdens, and their daughters’ ability to cope with the treatment process, particularly for older daughters with diminished ovarian function.
Mothers expressed significant concern about information disclosure in small communities, potential discrimination against grandchildren, impacts on family business reputation, and even property inheritance rights. One mother worried, “We live in a small town, everyone knows each other, once everyone knows, it will definitely be talked about.”
Mothers feared the son-in-law might not accept or bond with a non-biological child, that financial stress could cause marital tension, and that differing views on child-rearing could affect marriage stability.
Mothers worried about custody and child support issues in case of divorce, differential treatment by paternal grandparents, and children discovering their origins through physical dissimilarity or medical needs.
Mothers attended appointments to learn treatment details and provide encouragement, helped with cooking and daily care, and offered financial assistance to prevent treatment abandonment due to cost concerns.
Mothers actively protected daughters’ privacy by requesting confidentiality from healthcare providers, advised daughters on disposing of medical records, requested involvement in donor selection to obtain “good sperm from a well-educated, healthy and good-looking donor,” and sought information about future genetic testing services.
Mothers provided regular emotional check-ins, shared success stories to reduce feelings of isolation, offered encouragement about daughters’ bravery and strength, and practiced relaxation exercises together to reduce treatment-related stress.
Limitations: The majority of treatments were artificial insemination with donor sperm rather than in vitro fertilization, which involves more complex procedures that may differently impact maternal psychological experiences and decision-making. The study examined only maternal perspectives rather than broader family dynamics. Interviews were conducted during active treatment, capturing emotions and concerns at a specific time point rather than tracking how maternal experiences evolve throughout and after the treatment process. The study does not examine how maternal involvement was negotiated or whether daughters actually desired this level of maternal participation in their treatment decisions.
Application: Providers could assess family structures and involvement levels when working with people pursuing donor sperm treatment, offer family counseling services that address intergenerational dynamics and decision-making patterns, develop psychoeducational materials targeted that address common concerns about treatment safety, privacy, and family relationships, and help patients develop communication strategies for setting boundaries with involved family members while maintaining supportive relationships.
Funding Source: Zhejiang Province Traditional Chinese Medicine Science and Technology Plan Project (Grant No. 2024ZF100, 2024KY112)
Lead Author: Qun Wei is an associate chief nurse in the Nursing Department at Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, with over ten years of experience in reproductive health nursing. No personal connection to donor conception was disclosed.
Regulatory Context
China’s National Health Commission oversees all assisted reproductive technology services, which must be approved and licensed.
Only non-commercial altruistic donation is permitted, with payment beyond basic compensation strictly prohibited. Donations occur exclusively in government-authorized medical institutions.
Donation is mandatory anonymous by law. Donor-conceived individuals have no legal right to access identifying information about their donor.
The number of offspring per donor is legally limited, though specific caps vary by province, commonly ranging from 5-10 families. Clinics maintain careful records to avoid consanguinity risks.
Access to assisted reproductive technology services, including donor conception, is primarily available to heterosexual legally married couples, with single women, LGBTQ+ individuals, and unmarried couples historically barred from accessing donor gametes.
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