Study reveals how medical practitioners’ conceptual frameworks restrict access to donor treatments
Egg donation beyond the standard model: Fertility practitioners’ clinical reasoning in single, combined and shared treatment options in Sweden. (Lindgren, 2025)
Lindgren, M., Bodin, M., Elenis, E., & Dahl, U. (2025). Egg donation beyond the standard model: Fertility practitioners’ clinical reasoning in single, combined and shared treatment options in Sweden. Social Science & Medicine, 384, 118506. https://doi.org/10.1016/j.socscimed.2025.118506
Geographic Region: Sweden
Research Question: How does fertility practitioners’ clinical reasoning vary across different types of reproductive assistance involving donor eggs?
Note: In 2019, donated eggs became an option for lesbian couples and single women for the first time, and the use of donor eggs in combination with donor sperm was made legal.
Design: This qualitative study used focus group discussions during 2022-2023.
Sample: 19 fertility practitioners from four different fertility clinics (three public, one private) across Sweden. The participants represented various roles within fertility treatment teams who were directly involved in egg donation decision-making: physicians, embryologists, mental health providers, and midwives/nurses.
Key Findings
Fertility practitioners structured their clinical reasoning around a “standard model” of egg donation based on single donations for heterosexual couples, which limited access to newer donation options despite legal changes permitting them.
While double donation (donor egg and donor sperm) could fit within existing clinical frameworks, surplus embryo donation and partner donation (ROPA/reciprocal IVF) challenged established protocols, causing confusion and disruption in assessment processes.
Practitioners distinguished between “social” and “medical” reasons for treatment, with medical indications being seen as more legitimate justifications for taking on the health risks of donor egg pregnancies.
The standard treatment model treated fertility as an inherent bodily condition rather than a shared or socially influenced situation, reinforcing heterosexual and nuclear understandings of conception and family.
Practitioners’ clinical reasoning relied heavily on step-wise assessment procedures that worked well for single donations but created barriers when applied to newer, more complex donation scenarios.
Fertility practitioners emphasized altruistic motivations as crucial for “appropriate” egg donors, with significant focus on evaluating donors’ psychological readiness and “right reasons” for donating. Partner donation (ROPA/reciprocal IVF) was particularly problematic for practitioners because it blurred the established line between donors and recipients, challenging existing assessment protocols that relied on clear role separation.
When embryos had been created and stored for a lesbian couple, practitioners would not allow them to switch carriers for a second pregnancy, despite the couple’s preference and intent to parent together.
The private clinic showed more flexibility in adapting protocols for lesbian couples, while public clinics maintained stricter adherence to traditional assessment frameworks.
In discussing surplus embryo donation, practitioners expressed skepticism about both recipient interest (”who would want that kind of embryo?”) and donor understanding of long-term implications.
Limitations: The study is limited to fertility practitioners’ accounts of their decision-making rather than observations of actual clinical practice, potentially missing disconnects between what practitioners say versus what they do. The focus group methodology may have encouraged consensus views rather than surfacing dissenting opinions, particularly as the authors noted that “most discussions tended to lean towards a consensus model.” The study does not include the perspectives of patients seeking these treatments, leaving out crucial information about how clinical decisions impact recipient experiences and family formation.
Applications: Clinics should reexamine their assessment protocols to ensure they accommodate diverse family structures and reproductive intentions rather than relying on frameworks developed for heterosexual families. Standard work procedures need updating to integrate new legal options like partner donation and embryo donation rather than trying to fit these into existing models. Counselors working with donors and recipients should be aware of how clinical assessment protocols may impose normative assumptions about appropriate motivations and family structures, potentially creating unnecessary psychological burdens on clients.
Funding Source: Financial support was received from the research school WOMHER, Centre for Gender Research, and Familjeplaneringsfonden at Uppsala University.
Lead Author: Matilda Lindgren is a researcher at the Centre for Gender Research and Centre for Women’s Mental Health during the Reproductive Lifespan at Uppsala University in Sweden, specializing in reproductive technologies and family formation policies. No personal link to donor conception was disclosed.
Regulatory Context
Sweden was one of the first countries to implement identity-release donation, passing legislation in 1984 that went into effect in 1985. Donor-conceived individuals have the legal right to obtain identifying information about their donor when they reach “sufficient maturity,” typically interpreted as age 18, though no specific age is mandated by law. Donor information is recorded in medical records that the child can access as an adult.
Only altruistic gamete donation is allowed. Donors can receive compensation for expenses and inconvenience, but not payment for the gametes themselves. Donors must be 18 years or older.
Legislation allowed donor insemination through the public healthcare system for heterosexual couples in 1985, and IVF treatment with donor eggs or sperm were also permitted to heterosexual couples in 2003. Sperm donation treatment became accessible to lesbian couples in 2005. In 2016, legislation was passed to allow access to assisted reproductive treatments, including procedures with donor eggs and donor sperm, for single women and lesbian couples. A separate change occurred in 2019, allowing both private and public clinics to perform treatments with donated eggs, and a double donation (using both a donated egg and donated sperm) became legal.
In Sweden, a donor can contribute to a maximum of six families. A central register of all donor treatments is maintained by the National Board of Health and Welfare. This register helps to connect donor-conceived individuals, donors, and their relatives.
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