The psychosocial impact of being a sperm donor recipient

A mixed-methods systematic review of the attitudes, experiences, motivations and disclosure decisions among recipients of donor sperm. (Nash, 2026)

Nash, E., Kahn, L., Jaspal, R. K., Saso, S., Jones, B., Parikh, J., Nicopoullos, J., Faris, R., Bora, S., Thum, M. Y., & Bracewell-Milnes, T. (2026). A mixed-methods systematic review of the attitudes, experiences, motivations and disclosure decisions among recipients of donor sperm. Reproductive BioMedicine Online. Pre-Print https://doi.org/10.1016/j.rbmo.2026.105533

Geographic Region: This review draws from studies conducted in multiple countries: UK (n=7), USA (n=7), Belgium (n=5), Australia/New Zealand (n=7), Sweden (n=4), France (n=3), Spain (n=2), and Canada (n=1). Individual studies were also conducted in the Netherlands, Italy, Switzerland, Czech Republic, Slovenia, Finland, and Korea.

Research Question:

• Primary: What is the psychosocial impact of being a sperm donor recipient, across heterosexual couples, same-sex female couples, and single women?

• Secondary: What motivates recipients to seek cross-border reproductive care (CBRC) for donor sperm access, and what are their experiences doing so?

Design: Systematic review that followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was prospectively registered in the PROSPERO database (CRD42024527213). The research team searched PubMed and PsycINFO, with no restrictions on publication date, identifying studies published between 1991 and 2024. There were no language restrictions on the initial search, though studies not available in English were ultimately excluded. Articles were assessed for quality using the Mixed Methods Appraisal Tool (MMAT, 2018) and JBI checklists for qualitative research.

Sample: 35 articles encompassed a combined total sample ranging from 4 participants (smallest study) to 1,700 participants (largest study). All included participants were actual recipients of donor sperm—people who had already undergone, were undergoing, or had children via donor sperm—distinguishing this review from studies of potential or prospective recipients. Participants represented three recipient groups: heterosexual couples, same-sex female couples, and single women. Some studies focused on one group exclusively; others included multiple recipient types. Most study participants were Caucasian, middle-class, highly educated, and in a relationship, reflecting well-documented selection biases in donor conception research. Eighteen studies used questionnaires and sixteen used semi-structured interviews; one study combined both methods. Six of the 35 studies specifically examined recipients who had pursued cross-border reproductive care (CBRC) to access donor sperm.

The authors frame this review as an examination of psychosocial impact, with the goal of helping providers and policymakers improve psychosocial “outcomes” for sperm donor recipients. The articles included in the review largely document how recipients think, make decisions, and navigate social contexts. It is not the same as measuring what happens to people as a result of using donor sperm. This distinction matters because many of the processes described are not problems to be solved; they are simply the diversity of human experience. They may describe normal variation rather than deficits requiring intervention. Readers should also note that the included studies span 1991 to 2024. Social attitudes, legal frameworks, and clinical practices have changed enormously across this period, and the review does not consistently account for this when drawing conclusions. Finally, I found myself thinking about what is missing. Many of the psychosocial processes described in the review (e.g., how recipients represent the donor, how families navigate disclosure, how counseling needs evolve) are not specific to sperm donation. They occur across egg and embryo donation, within the same family structures, and in the same clinical, legal, and social contexts. By restricting inclusion to sperm donation studies, the review produces a thinner evidence base than necessary.

Key Findings

• Motivations to Use Donor Sperm - Heterosexual couples were motivated by male infertility, avoiding genetic disease transmission, maintaining relationships, enabling male partners to experience fatherhood, and achieving social normalcy; they preferred donor insemination over adoption for control over genetics and the ability to experience pregnancy. Same-sex female couples sought pregnancy experience for one partner and avoidance of legal complications with known donors. Single women were typically motivated by approaching the end of reproductive years without a partner.

• Disclosure Patterns - Heterosexual couples were least likely to disclose, while same-sex female couples and single women disclosed at significantly higher rates. Reasons for disclosure: honesty, respecting children’s rights to genetic origins, preventing accidental discovery via genetic testing, and reducing stigma. Reasons against: protecting non-biological parents, fear of harm to children, concern about children telling others, worry about donor relationships. Disclosure increased over time across all groups and evolved as children developed and bonds with non-biological parents strengthened. Couples usually agreed on disclosure approach; disagreement caused stress and typically resulted in non-disclosure. Those who disclosed were satisfied; non-disclosure sometimes caused guilt.

• Preference for Anonymous vs. Identity-Release Donors - Preference for open-identity donors increased significantly over the years covered in the study.

• Counseling - Counseling provision was inconsistent and inequitably distributed. Counseling was identified as important both before, during, and after treatment and during disclosure. Opinions on mandatory counseling are divided: some (especially heterosexual couples) supported it; others (especially same-sex couples) objected. Content included disclosure decisions, legal implications, and donor selection, though advice was sometimes inconsistent.

• Cross-Border Reproductive Care (CBRC) - Six studies specifically examined recipients who traveled outside their home country to access donor sperm.

  • The most popular European destinations were Spain, Czech Republic, Denmark, and Belgium, while common non-European destinations included the United States, India, Thailand, and South Africa. Destination choice was influenced by geographic proximity, availability of donors matching recipients’ desired phenotypic characteristics, legal frameworks, and cost.

  • The most common motivations for CBRC were legal and access-related: prohibitive legislation in home countries restricting access to donor sperm for specific groups (particularly single women and same-sex couples), donor shortages, desire for anonymous donors when home countries prohibited anonymous donation (or conversely, desire for identity-release donors when home countries only permitted anonymous donation), and shorter waiting times. Other motivations included lower cost, perceived lack of prejudice toward single women or same-sex couples in destination countries, and privacy from home communities. Legal restrictions were the predominant driver for recipients from Italy, Germany, France, and Norway, while difficulties accessing treatment, namely long wait times and donor shortages, were most often cited by UK recipients.

  • The most significant challenge was access to follow-up care at home. Having a supportive home physician was identified as the single most important factor in treatment experience, with some recipients able to access supportive treatment (prescriptions, cycle monitoring) at home while others could not. Support levels varied dramatically by home country: Germany, France, and Switzerland provided high levels of home physician support, while the Netherlands, UK, and Sweden provided low levels. Other challenges included financial strain from travel costs and inability to access insurance reimbursement, difficulty gathering reliable information about clinics and legal requirements, justifying absence from work without disclosing fertility treatment, and legal vulnerabilities, particularly for same-sex couples around parental rights. Notably, French patients seeking treatment in Belgium reported frustratingly long waiting times, reproducing the very problem they had traveled to solve and highlighting that CBRC does not always resolve the access issues that motivated it.

• Several themes appeared in the review, but I felt they lacked sufficient consistency and sample size to support reliable conclusions.

  • Donor selection criteria and characteristics: Studies reported that health was the most important factor, followed by physical characteristics, and preferences were highly individual and context-dependent.

  • Clinical and procedural preferences: The evidence is insufficient to make recommendations.

  • Terminology and donor representation: How recipients describe the donor varied widely.

  • Quality of life and relationship outcomes: Most findings came from studies conducted in the 1990s with small samples; one recent study (2024) found no significant differences between sperm donor recipient parents and IVF parents in anxiety, depression, or family functioning

  • Treatment experience: Recipients generally reported positive experiences with healthcare professionals, but these findings were not specific to sperm donation and may reflect general fertility clinic satisfaction.

  • Effect of legislation on behavior: Findings were inconsistent about whether legislation (particularly laws prohibiting anonymous donation) affected recipient behavior around donor choice and disclosure.

Limitations: Only English-language studies were included, which excludes important research conducted in other languages and limits the global perspective. Studies used varied methodologies, limiting direct comparisons and the strength of conclusions. There is significant variation in care settings (private vs. public funding), which may affect findings. Although quality appraisal was conducted, the review synthesizes a 4-participant study alongside a 1,700-participant survey with roughly equal interpretive weight.

Applications: Laws, practices, and attitudes have changed profoundly over time. Reviews should be restricted by time period, stratify findings by era, or explicitly flag when older research may no longer reflect current experience.

Funding Source: None declared.

Lead Author: Emma Nash is a Specialist Trainee (ST6) in Obstetrics and Gynaecology in North West London, currently based at St Mary’s Hospital, and has completed a Clinical Fellowship at the Fertility Centre at Chelsea and Westminster Hospital; she is a member of the Royal College of Obstetrics and Gynaecology. No personal link to donor conception was disclosed.

Regulatory Context: Varies globally

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