Abstract
<jats:p>The intersection of genetic inheritance, psychological well-being, and ethics in assisted reproductive technologies (ART) underscores the need for nuanced reproductive decision-making. While genetic ties remain important, emotional, social, and psychological aspects of parenthood are equally central. Transitioning from autologous ART to gamete donation is often a pivotal, emotionally complex step. This qualitative study explored how individuals and couples navigate this transition, applying shared decision-making (SDM) and the family systems illness (FSI) model to examine relational dynamics.</jats:p> <jats:p>Nine semi-structured interviews with Portuguese participants undergoing gamete donation were analyzed using grounded theory. Six themes emerged: (1) doctor–patient communication, (2) proactive information-seeking, (3) treatment burden, (4) support systems, (5) child wish, and (6) patient-centered care. Participants stressed empathetic communication, comprehensive information, and flexible pacing. Emotional and financial exhaustion often precipitated consideration of donation. Researching options provided coping, while stigma and guilt fostered isolation. Peer and partner support offered resilience, and redefining parenthood from genetic to relational terms was critical in adaptation.</jats:p> <jats:p>Integrating SDM, grounded theory, and the FSI model, this study offers a multilayered view of infertility and gamete donation decisions as systemic and developmental processes. Findings highlight the importance of communication, psychological support, and family belief systems in shaping adaptation. Clinical implications include strengthening decision-support tools, embedding psychological care in ART, and training clinicians in patient-centered communication. Broader policy should address stigma, ensure equitable access to care, and support relationally informed models of fertility treatment.</jats:p>