Background: Despite significant advances in reproductive technology, using DONOR assisted reproductive technology is a double-edged sword that has numerous challenges. One of the most challenging issues for COUPLES is whether or not to disclose this information to DONOR offspring. This study, therefore, explored infertile COUPLES’ decision to disclose DONOR conception to their future child. Materials and Methods: This qualitative study was conducted using content analysis approach in 2012 in the Milad Infertility Centre, Mashhad, Iran. Data were collected through semi-structured interviews with 32 infertile persons including nine COUPLES and 14 women who were selected by purposive sampling. Data were analysed by conventional qualitative content analysis adopted by Graneheim and Lundman using MAXQDA 2010 software. Results: Two categories were emerged: ‘ not to disclose information to the child’ and ‘ to disclose information to the child’ . The first category consisted of three subcategories: 1. child support from probable harms; 2. to maintain healthy family relationships; and 3. lack of a compelling reason to disclose this information. The second category embraced four subcategories: 1. awareness of the others; 2. emergence of new living conditions; 3. appreciation for the DONOR; and 4. honesty among family members. The main reason for not disclosing information was to protect the child from probable harm. Conclusion: Although protecting children from possible harms was a major reason for infertile COUPLES' secrecy, keeping this secret would not be always easy. Therefore, increasing public awareness about the donation process in order to change the beliefs of community and eliminate the infertile COUPLES’ concerns would help them to overcome this problem. Additionally, long-term psychological counselling during and after the donation process is highly recommended.

Background: Despite the fact that many infertile COUPLES have to decide about whether or not to choose DONOR conception, there is no predictive scale for evaluating the process of decision-making on DONOR conception and its determinants in such COUPLES. The present study was conducted to develop a decision-making questionnaire for selecting DONOR conception and assess its psychometric properties in Iranian infertile COUPLES. Materials and Methods: This cross-sectional validation study was conducted based on the method developed by DeVellis (2012) in four steps at Milad Infertility Clinic, Mashhad, Iran. The dimensions of the concept of decisionmaking were determined in the first step based on the qualitative results obtained from 38 semi-structured in-depth interviews. Items that were appropriate for the questionnaire were developed in the second step using the qualitative data and a review of the literature. In the third step, the research team reviewed and eliminated some of the items. The fourth step evaluated the face, content and construct validity of the questionnaire through exploratory factor analysis on a sample of 220 infertile COUPLES using convenience sampling and investigated its initial and final reliability. Results: Based on the results of the qualitative study, a pool of 170 items was developed, 101 of which were eliminated after revision due to ambiguity, repetition or their poor face and content validity and initial reliability. The questionnaire was evaluated for its construct validity with 69 items. After the exploratory factor analysis, the decisionmaking DONOR conception questionnaire (DMDCQ) having 51 items and seven factors, was finalized. All the factors had Cronbach’ s alpha values of 0. 75-0. 87 and intra-class correlation coefficients (ICC) greater than 0. 7. Conclusion: This study led to development of a valid and reliable scale for examining infertile COUPLES’ decisionmaking about whether or not to use DONOR conception as well as the determinants of this decision.