The ASRM also recommends setting a limit of 25 births per donor within a population of 800,000, in order to lower the risk of accidental incestuous relations. In many other countries, there are laws putting caps on the number of births per single donor within populations of a certain size, but the U.S. doesn’t have any such law.
The ASRM advises, additionally, that physicians offer anyone involved in a sperm donation psychological counseling before proceeding, and it specifies that “programs that choose to participate in intra-familial arrangements should be prepared to spend additional time counseling participants and ensuring that they have made free, informed decisions.” These consultations, per the ASRM, should happen before the donation process begins, should not be rushed, and should include the parents-to-be, the donor, and any surrogates, as well as each of their partners and children. The committee even specifically advises that these consultations focus on “how participants will cope with the unique aspects of the proposed arrangement and on the consequences for the prospective child,” and reminds practitioners that “the involvement of professionals representing multiple disciplines, including physicians, nurses, and counselors, should be anticipated for a thorough assessment.”
The presence of an expert can get people to have crucial conversations they wouldn’t otherwise have. Andrea Braverman, a clinical professor of obstetrics and gynecology as well as psychiatry and human behavior at Thomas Jefferson University, often counsels couples before (and sometimes after) the sperm donation process. For non-anonymous donations, she meets with the donor and their partner, the recipient and their partner, and then the whole group together to talk about “expectation of roles” and “how this information is going to be handled: Is it going to be shared or not shared, with the child? With the extended family? With the world? And when?” She says even a one-hour, one-time session can make a difference.
Braverman also asks everyone to talk through the possibility that over time, the relationship between the donor and recipient could change. But telling someone that at the time, especially in a known-donor situation, “I’m sure they would say, ‘Ah, we’re fine. What are you making us go see that person for?’” she says. Plus, some people already feel sad or ashamed to have to go this route in the first place, and counseling can make them feel like they’re being scrutinized or judged. “I think that’s, quite frankly, why a lot of practices and a lot of physicians don’t require it. Because they get that pushback,” Braverman says.
It’s not uncommon for counselors to refer patients to lawyers, though there are disagreements about whether this is prudent. “Many say that if it's a familial-donation circumstance, they love each other and they don't need the extra expense of a separate lawyer,” says Susan Crockin, the Georgetown professor. Crockin, however, has argued that a lawyer could help families account for possible future scenarios, especially ones they might not want to consider. “The lawyer’s job is to be the advocate of their client, asking them, ‘Are you sure? Do you want this to be a forever limitless donation, or do you want the option of saying, I've changed my mind and I need my sperm back because I happen to be infertile now, or, I want my new wife, who wasn’t in the picture before, [to have a say]'?”