Egg donation beyond the standard model: fertility practitioners’ clinical reasoning in single, combined and shared treatment options in Sweden

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.