Reimagining how fertility clinics prepare parents for donor conception
“Why do I need to meet with a mental health professional?”: A Class Format as a Novel Approach to Delivering Gamete Recipient Education. (Alsup, 2026)
Alsup S, Conant J, Woodward J. “Why do I need to meet with a mental health professional?”: A Class Format as a Novel Approach to Delivering Gamete Recipient Education. F&S Reports. 2026. https://doi.org/10.1016/j.xfre.2026.07.002
Geographic Region: United States
Research Question: Is a class-based psychoeducational consultation model for gamete recipients feasible and acceptable as an alternative to individual consultation in a private multi-site fertility clinic?
Editor’s Note: The 2024 ASRM guidance strongly recommends psychoeducational consultation for gamete recipients with a qualified licensed mental health professional trained in third-party reproduction, and specifies eleven content areas that should be addressed (e.g., disclosure, long-term family implications, the needs of donor-conceived persons, grief and loss, donor screening limitations, anonymity challenges from DNA testing, donor-sibling relationships, future medical information implications). Beyond that, ASRM specifies no format, no session length, and no minimum number of sessions for recipients of nondirected donations. Individual clinics have operationalized this recommendation as a condition for treatment access, and many require a written sign-off from the mental health professional confirming that the consultation was completed and that no concerns were identified that warranted further evaluation. It is well documented that some patients, in particular LGBTQ+ and solo parents, experience the mandatory individual consultations as gatekeeping, discriminatory, or anxiety-provoking.
Design: Process evaluation of a class-based model for gamete recipient psychoeducation at a private multi-site fertility clinic. The class format was offered alongside the standard individual consultation, and patients were given the choice between the two. Group classes were delivered virtually via encrypted video platform, used slides to structure didactic content, and were tailored by family type (e.g., same-sex female couples, solo parents, cisgender heterosexual couples using donor sperm or eggs). Class sessions ran 90 minutes at a cost of $150, compared to 75-minute individual sessions at $495. Following each session, the mental health provider emailed an after-visit summary and tailored resources; individual follow-up was offered when clinical concerns arose. Process evaluation data were collected via patient survey over a one-year period (approximately 2025). Survey items assessed uptake (whether patients chose class or individual format), reasons for their choice, and perceived helpfulness of the class. No validated outcome measures were used, and no follow-up data were collected.
Sample: 196 patients at Spring Fertility locations in Portland, OR, and San Francisco, CA. Patients represented same-sex female couples, solo parents, and cisgender heterosexual couples.
Key Findings
75% of eligible patients chose the class format over an individual consultation.
81% of class participants rated the session as moderately to extremely helpful.
The top three reasons patients chose the class were: (1) reduced financial cost, (2) interest in community-building and meeting others on a similar path, and (3) perceptions of greater inclusivity.
The class format is not appropriate for all patients. Individual consultation may be more appropriate for those using a directed (known) donor, needing decisional support, or presenting with complex mental health or treatment needs.
Privacy and confidentiality cannot be fully guaranteed in a group setting.
Large class sizes (more than ~10 participants) limit individualized observation and meaningful dialogue.
Some patients prefer the personalization of individual consultations.
Not all mental health professionals have group facilitation training or experience.
Limitations: There is no control group, no randomization, no validated measures, no curriculum assessment, and no follow-up on whether patients retained information or changed parenting practices. No data are reported on patients who chose the individual session or declined both options. Ongoing formal research is underway to assess the impact of the class model on patient knowledge, confidence, and perceived inclusivity, but results are not yet available. The cost comparison is specific to Spring Fertility’s fee structure and may not generalize across settings.
Applications: The class format could offer a practical and potentially more affirming model for delivering ASRM-required consultations.
Funding Source: All three authors work in fertility clinic or academic medical center settings. Two authors are employed by Spring Fertility.
Lead Author: Shelby Alsup is a clinical psychologist at Spring Fertility in Portland, Oregon.
Regulatory Context
The United States has no comprehensive federal legislation governing donor conception, with regulation primarily occurring at state level, creating a patchwork of laws across the country. The Food and Drug Administration (FDA) provides minimal federal oversight, mainly focused on screening requirements for disease prevention.
There are no federally mandated limits on the number of children conceived from a single donor. The American Society for Reproductive Medicine (ASRM) recommends limiting donors to 25 live births per population area of 850,000, but this is voluntary and not enforced. Colorado became the first state to establish a statutory limit in 2022, capping donor use at 25 families per donor, regardless of location, effective January 2025.
No centralized national registry exists to track donor-conceived births OR donors, making it difficult to enforce any limits in practice.
Commercial donation is permitted throughout most of the United States. Donors can be compensated for their gametes.
Access to donor conception is generally open to a wide range of individuals regardless of marital status, sexual orientation, or gender identity. Most major medical organizations support the position that fertility treatments should be available to any individual who is fit to parent.
The U.S. does not have national laws prohibiting anonymous donations, but this practice is gradually changing. Colorado’s 2022 “Donor-Conceived Persons Protection Act” (effective January 2025) bans anonymous donation and gives donor-conceived individuals the right to access their donor’s identity upon reaching age 18. In January 2024, the Uniform Law Commission amended the Uniform Parentage Act to require disclosure of donor identifying information to adult donor-conceived persons upon request, though states must adopt this amendment for it to become law in their jurisdictions.
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