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This interview-based study, conducted in Sweden, advances feminist and queer scholarly debates on the logics of choice and care in medically assisted reproduction. It focuses on conception with donor eggs as a reproductive method, where the medical scenarios entail that decision-making in clinical practice and family-making intertwine. In addition, it examines experiences of both receiving and donating eggs or gametes across the life span. Drawing on Annemarie Mol’s critique of choice logics and autonomous decision-making in care practices, we argue for the value of centring patienthood within feminist scholarship on egg donation. Our analysis demonstrates that the positive sense of patienthood reported by egg donors in public clinics—who repeatedly emphasised that they were well cared for—was contingent upon their utility to the clinic. Turning to recipient narratives, we show how becoming a consumer of fertility care involved a shift in responsibility for the practice. Our findings reveal a paradox: when interviewees travelled outside Sweden to access donor gametes, the consumer logic that expanded their choices simultaneously diminished their position as patients. This, we suggest, exemplifies Mol’s argument that choice does not necessarily equate to better care.

The use of donor eggs, sperm and embryos in medically assisted reproduction (MAR) provide new possibilities for reproductive assistance and family-making. In clinical practice, it also brings to light questions of responsibility and ethical conduct. Despite this, fertility practitioners' reasoning in clinical decision-making remains surprisingly understudied. Drawing on Annemarie Mol's work on ontologies in medical practice (2002), we examine how fertility practitioners' clinical reasoning varies across different types of reproductive assistance involving donor eggs. Following Sweden's legal change on double gamete donation (2019), and drawing on data from focus group discussions with practitioners from public and private fertility clinics across Sweden our findings show that practitioners structured their clinical reasoning along pre-defined conceptualisations of the appropriate donor candidate and distinguished between social and medical indications for treatment. We contend that a standard model of egg donation, based on single donations for heterosexual couples, can be identified in health care decision-making. While double donation can fit this model, surplus embryo and partner donation (ROPA) challenge it, causing confusion and disruption in donor and recipient assessment processes. In this model, fertility and infertility is understood as inherent bodily conditions rather than shared or socially influenced situations. Consequently, the obstetric risks of donor-egg pregnancies are justified only on the ground of medical reasons. Our study contributes knowledge on how egg donation, as a medical procedure with certain health risks, can be practiced and conceptualized differently across the same clinical domain while also arguing for an analysis of inequity as embedded in practices. In our case, practitioners' dependency on conceptual and procedural conventions in donor and recipient assessments had an implicit reliance on heterosexual and nuclear understandings of conception and family, ultimately limiting the availability of treatment methods. These findings underscore the importance of attending to fertility practitioners' clinical reasoning in order to better understand issues of patient access and provider accountability.

This article analyses shifts and continuities in Swedish regulation of information sharing in identity-release donor conception. At a time when families include both solo and same-sex parenting, I draw on a practice-oriented method to compare legal and pre-legislative documents from the early 1980s with those of the late 2010s as developed in a Swedish national context. Following the turn to openness in donor conception, I discuss the practical implications of framing access to information from the hospitals' so-called 'special medical record' as a children's right, when information is in fact only available after 'maturity' is reached. Furthermore, I show how a significant change in the understanding of child–parent relationships in donor-conceived families is articulated in the 2019 legislation. If early policy documents portrayed donor-conceived children as potentially problematic for not 'knowing their origin', I argue that now it is parents in donor-conceived families who are constructed as potentially problematic. Drawing on critical kinship theory, I conclude that Swedish policy-making on information sharing in donor conception relies on a symbolic rather than material understanding of genetic relatedness that fails to acknowledge how different family forms might have different needs. Based on these findings, I suggest that policymakers take into account the implications a changing view on family life and genetics have for children and parents following donor conception.