Deciding genetic fatherhood: sperm-choice decision-making among gay fathers via gestational surrogacy

This qualitative study examined how gay fathers who formed families through cross-border gestational surrogacy described decision-making about whose sperm to use, and how they made genetic asymmetry relationally workable within couple dynamics, family narratives, and a legally uncertain context. Eighty Italian gay fathers (40 families) completed individual semi-structured interviews at home. Transcripts were analyzed using reflexive thematic analysis and four interconnected themes were generated. Fathers framed sperm choice as an interpersonal and moral task rather than a purely biomedical step. They described (1) fairness as a relationship technology used to manage unavoidable genetic asymmetry and prevent resentment; (2) ‘defensive genetics’, whereby anticipated stigma, resemblance talk, and legal insecurity made genetics a pragmatic kinship resource; (3) delegation to clinical, probabilistic, or randomising procedures to reduce blame and relational threat, sometimes leaving delayed grief; and (4) identity and lineage work linking sperm choice to continuity, repair, vulnerability, and future disclosure planning. Interpreted through the sensitising lens of ambiguous loss and minority stress theories, sperm choice emerged as a decision-specific psychosocial process with implications for couple equality, perceived legal security, and children’s origin narratives. Fertility and mental health professionals should address sperm choice as both a medical and relational decision, support non-hierarchical language, and facilitate early disclosure planning.