Western Iranian infertility patients accept donor egg treatment but resist disclosure
Sociocultural determinants of attitudes toward oocyte donation among infertility patients in western Iran. (Esmaeilivand, 2026)
Esmaeilivand, M., Jahanbakhsh, S., Rezaeian, S., & Khatony, A. (2026). Sociocultural determinants of attitudes toward oocyte donation among infertility patients in western Iran. Scientific Reports, 16, 10679. https://doi.org/10.1038/s41598-026-45147-3
Geographic Region: Western Iran (Kermanshah province)
Research Question: What are the attitudes of infertility patients in western Iran toward oocyte (egg) donation, and which sociodemographic characteristics predict those attitudes?
Study Design: Cross-sectional survey conducted between October 2023 and January 2024. Participants were recruited through consecutive sampling, meaning every eligible patient who came to the clinic during the study period was approached and invited to participate. Only one partner per couple was included, so all responses reflect individual rather than joint views. Attitudes toward egg donation were measured using a validated 52-item questionnaire developed specifically for use in the Iranian context. The questionnaire covers 12 domains including decision-making, donor and recipient characteristics, anonymity, disclosure, legal issues, and the parent-child relationship.
Sample: 171 infertility patients - 117 women (68%) and 54 men (32%) - attending a public infertility clinic in western Iran. The majority had more than a high school diploma (84%), and most had primary infertility (61%) rather than secondary infertility (39%). The most common infertility causes were female-factor (41%), both partners (34%), and male-factor (26%). About 36% of participants had previously used at least one assisted reproductive technology (ART) procedure, and 36% reported they had considered or actually used egg donation.
Key Findings
Participants showed generally positive attitudes toward egg donation overall, with a mean total score well above the midpoint, suggesting overall acceptance of egg donation as a treatment option. There was no significant difference between men and women in overall attitude scores.
Participants strongly favored anonymity between donors and recipients and between children and donors, with clear preferences for secrecy toward extended family and the broader community. Higher male educational level was significantly associated with stronger preference for donor-recipient anonymity.
Support for disclosing the use of egg donation to the future child was low, reflecting cultural concerns about lineage (nasab), social judgment, and family reputation. Female educational level showed a modest positive association with disclosure-related attitudes, possibly reflecting women’s greater engagement with emotional and relational dimensions of family communication.
Despite favoring secrecy, participants reported highly positive attitudes about the parent-child relationship and sense of belonging, indicating confidence that strong emotional bonds are possible regardless of genetic connection.
Age, infertility type, infertility cause, and prior ART experience were not significantly associated with any attitude domain.
Limitations: No a priori power calculation was reported. The study is correlational, so no causal claims can be made. Self-report questionnaires may produce socially desirable responses, especially on sensitive topics like secrecy and disclosure. Religious and social norms in Iran may have led participants to underreport stigmatized attitudes.
Applications: In Iran’s legally anonymous system, donor-conceived people currently have no pathway to access donor information. The strong cultural preference for non-disclosure documented in this study means many donor-conceived people in this context are likely unaware of their origins. Advocates should understand the sociocultural context shaping non-disclosure in Iran even when they may not agree with it. Counselors working in or with populations from Muslim-majority countries should recognize that secrecy preferences reflect broader social pressures (concerns about lineage, marital stability, and community judgment) rather than simply individual psychological avoidance. At the same time, counselors have a professional obligation to help clients consider the long-term implications of non-disclosure for their children, including the possibility of inadvertent discovery through DNA testing.
Funding: Student Research Committee of Kermanshah University of Medical Sciences (Grant No. 4020594).
Lead Author: Masoumeh Esmaeilivand is a physician-researcher affiliated with the Clinical Research Development Center at Motazedi Hospital and the Department of Obstetrics and Gynecology at Kermanshah University of Medical Sciences in Kermanshah, Iran, where her research focuses on reproductive health, fertility, and assisted reproductive technologies. No personal connection to donor conception was disclosed.
Regulatory Context
Iran is governed by Islamic jurisprudence (Sharia law), primarily Shi’a interpretations issued by religious scholars (fatwas). Unlike many Sunni-majority countries, Iran has developed a relatively permissive framework for some forms of assisted reproduction under specific conditions.
Egg donation is legally and religiously permitted under Shi’a jurisprudence in Iran. The 2003 Act concerning Embryo Donation to Infertile Couples provides a legal framework, primarily for embryo donation, but egg donation has been accepted through religious rulings. Sperm donation remains more religiously contested.
Donor anonymity is mandated under Iranian law. Fertility centers are required to keep donor and recipient identities confidential. There is no legal mechanism for donor-conceived individuals to access identifying information about their egg donors.
Non-commercial donation is required; payment for gametes beyond basic expense reimbursement is prohibited, though the enforcement of this is not comprehensively documented.
Access to ART, including egg donation, is primarily available to legally married heterosexual couples. Single individuals and LGBTQ+ people are not legally entitled to access donor-assisted reproduction in Iran.
There is no centralized national registry tracking donation outcomes or offspring numbers per donor, which limits the monitoring of consanguinity risks and donor usage patterns.
Cultural and social enforcement of secrecy is strong. Families are not legally required to disclose donor conception to their children, and there is a pervasive norm of keeping ART use private, including from extended family members and the donor-conceived child.
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