Couples experiencing infertility may be oered treatment with gamete donation where other methods of treatment have failed or are inappropriate. This paper examines a range of concerns related to gamete donation. The paper does not attempt to present a comprehensive and critical review of the literature but concentrates on selecting from the literature, in addition to clinical material, issues which have been identiยฎed as contributing to an understanding of patients' experience of treatment with donated gametes. The concerns include feelings and attitudes towards the donor, the role the donor plays in the couple's relationship, feelings about not being the genetic parent and whether to disclose the donation to the potential child and others. These concerns form a basis for counselling couples about the implications of gamete donation for themselves and any children born as a result. The diculties faced by some people are illustrated by consideration of a single case where the experience of donation linked up with unique aspects of that individual. Therapeutic counselling oers couples faced with such diculties the opportunity to explore in a more extensive way the underlying dynamics of their concerns, enabling them to think about and make sense of their experience.