The stability of psychological adjustment among donor-conceived offspring in the U.S. National Longitudinal Lesbian Family Study from childhood to adulthood: differences by donor type

Comparing the psychological outcomes of donor and non-donor conceived people: A systematic review

BACKGROUND

Over 70 000 donor-conceived (DC) people have been born in the UK since 1991. Little is known about their long-term psychological outcomes and no systematic review has assessed these.

OBJECTIVES

To conduct a systematic review of the psychological experiences of DC people through childhood and adulthood (Prospero: CRD42021257863).

SEARCH STRATEGY

Searches of Cumulative Index to Nursing and Allied Health Literature (CINHAL), the Excerpta Medica database (Embase), MEDLINE® and PsycINFO, conducted on 4 January 2024.

SELECTION CRITERIA

Quantitative and qualitative studies were included if: there were five or more participants; they were peer reviewed; and any DC psychological outcomes were assessed. No limits on date, language or country were applied.

DATA COLLECTION AND ANALYSIS

Double screening, selection, data extraction and quality assessment were performed, using Joanna Briggs Institute (JBI) scoring.

MAIN RESULTS

Fifty studies (with 4666 DC participants), mostly from high-income anglophone countries, with heterogeneity of design, populations and outcome measures, were included. Of 19 comparative studies, 14 found no difference in outcomes between DC and non-DC people, ten found better outcomes (in health, well-being, self-esteem and emotional warmth) and six found worse outcomes (increased autism spectrum disorder and attention deficit hyperactivity disorder, addiction issues, mental illness, disruptive behaviour and identity problems). Qualitative data revealed common themes relating to identity formation, mistrust and concerns regarding genetic heritage. The evidence regarding adulthood outcomes was very limited.

CONCLUSIONS

The research on DC individuals presents a nuanced picture, with most studies suggesting comparable or improved outcomes in terms of well-being and relationships, but with a notable minority indicating higher rates of mental health and identity struggles. Qualitative findings underscore common negative experiences, whereas the early disclosure of DC status appears beneficial for psychological well-being.

Prosocial and externalizing behaviors in children raised by different-and same-gender parent families: new directions in parenting research

Introduction

Limited research focused on the association between parenting practices and children's prosocial and externalizing behaviors comparing same- and different-gender parent families. The present study considered 76 Italian families (73% same-gender and 27% different-gender parent families) with 8-year-old (SD = 2.17; 49% assigned female at birth) children born through assisted reproductive techniques, to explore parenting practices and children's prosocial and externalizing behaviors.

Method

We ran a Multiple-group-by-couple Structural Equation Model in which we estimated the predictive role of parenting on children's behaviors, controlling for age, gender, and family socioeconomic status using the Maximum Likelihood estimation.

Results

Results showed that both same- and different-gender parent families reported high levels of parental warmth and very low levels of hostility and rejection; regarding children's behaviors, both same- and different-gender parent families reported high levels of prosociality and low levels of externalizing behaviors. In addition, same-gender parents reported significantly higher levels of children's prosociality and parental warmth than different-gender parents. Regarding associations between parenting practices and behaviors, we found a positive association between positive parenting practices and increasing children's prosocial behaviors and decreasing children's externalizing behaviors, in both same- and different-gender families, controlling for family background characteristics.

Conclusion

The present study encourages future research to investigate how specific parenting practices can influence behavioral adjustment in children, focusing on same-gender parent families.

Assisted Reproduction for a Same-Sex Couple: Interdisciplinary Preclinical Active Learning Module Combining Case-Based Small Group Discussion and Patient Panel

OBJECTIVE

Physicians often feel they are not equipped to serve the lesbian, gay, bisexual, and queer (LGBTQ) community, but integrating education that incorporates LGBTQ content and perspective into an already-condensed medical school curriculum is challenging. We developed a preclinical active learning module on assisted reproductive technologies (ART) in LGBTQ care, integrating clinical and basic science content with patient perspective.

METHODS

We created a module that combined a case-based small group discussion with a patient panel. We developed a case for discussion in collaboration with a female cis-gender same-sex couple who conceived through ART. A patient panel with the same couple followed the discussion. All first-year medical students attended both parts of the module. Prior to participation, students learned reproductive endocrinology and genetics concepts through lectures. After the module, students voluntarily completed an anonymous survey to evaluate self-perceived changes in familiarity and confidence with LGBTQ patients and satisfaction with the module.

RESULTS

Of the 126 students who attended, 72 (57%) completed the survey. Of these, 69 (95.8%) felt the module gave them better perspectives on LGBTQ patient experiences, and 66 to 69 (92-96%) agreed the small group discussion achieved its learning objectives on LGBTQ health barriers and the application of ART. Students valued the patient panel (84.7%) and cited a better understanding of reproductive barriers for LGBTQ patients as its most valuable point.

CONCLUSION

A preclerkship module combining a case-based small group discussion and patient panel on ART delivered in the context of a real-life LGBTQ patient experience provided an opportunity for the students to integrate basic science and clinical science knowledge to reflect on the healthcare needs of this patient population. Creating the case in collaboration with the same-sex couple and having them present their own experience provided an authentic perspective to students on reproductive healthcare issues and how they impact members of the LGBTQ community.

Does being conceived by assisted reproductive technology influence adult quality of life?

Numerous studies have investigated the physical health and development of children and adolescents conceived with assisted reproductive technology (ART). Less is known about the quality of life of ART-conceived adults. This study explores the contributions of being conceived with ART and psychosocial cofactors present in young adulthood to the quality of life of adults aged 22-35 years. Young adults conceived through ART or natural conception (NC) completed questionnaires which included a standardized measure of quality of life (World Health Organization Quality of Life - Brief assessment (WHOQoL-BREF)) when aged 18-28 years (T1) and again when aged 22-35 years (T2). The WHOQoL-BREF has four domains: (i) Physical, (ii) Psychological, (iii) Social relationships and (iv) Environment. A total of 193 ART-conceived and 86 NC individuals completed both questionnaires. When accounting for other cofactors in multivariable analyses, being ART-conceived was strongly associated with higher scores (better quality of life) on the Social relationships, and Environment WHOQoL-BREF domains at T2. In addition, less psychological distress, a better relationship with parents, a better financial situation, and perceptions of being about the right weight at T1 were associated with higher scores on one or more of the WHOQoL-BREF domains at T2. In conclusion, being ART-conceived can confer advantages in quality of life in adulthood, independent of psychosocial cofactors.

Adolescent Development and the Parent-Adolescent Relationship in Diverse Family Forms Created by Assisted Reproduction

Assisted reproduction techniques (ARTs) are employed by single individuals and couples who are not otherwise able to conceive spontaneously. While the use of ARTs is increasing, research is lacking on the attempts made by adolescent offspring conceived via ARTs to integrate their ART conception into their identity and negotiate a connection with, and autonomy from, their parents. The present article reviews studies investigating adolescent development and the parent-adolescent relationship in diverse family forms created by ARTs (mainly heterosexual and lesbian parent families), and discusses the results in light of attachment, identity development, and emotional distance regulation theories. Overall, the results indicate that the psychological adjustment of adolescents conceived via ARTs is not undermined by the manner of their conception, and that they enjoy positive relationships with their parents with no difference from those enjoyed by spontaneously conceived adolescents. However, it remains unknown whether the development of a reproductive identity in adolescence is likely to influence adolescents' interest in searching for or contacting their donors, surrogates, and/or donor siblings. The results suggest the relevance of considering the parent-adolescent relationship, disclosure, and identity formation issues when planning psychological counseling and support interventions with ART parents and their adolescent offspring, and emphasize the need to further investigate these aspects in diverse ART families, including single-, gay-, bisexual-, and trans*-parent families.

Are donor-conceived people willing to use donors themselves? Insights from individuals conceived via donor-assisted reproduction

STUDY QUESTION

Are donor-conceived people (DCP) willing to utilize donor gametes themselves if unable to conceive spontaneously?

SUMMARY ANSWER

The majority of DCP would consider or are undecided about utilizing donor gametes and those who would consider the utilization are more likely to have been told about their donor-conceived origins at a young age by a family member and have overall positive experiences as a DCP.

WHAT IS KNOWN ALREADY

DCP view their donor conception as an important part of their self-identity and many desire contact with genetically related individuals. Additionally, many believe that sperm donation should only be practiced if identifying information on the donor is provided.

STUDY DESIGN, SIZE, DURATION

This was a cross-sectional study using a Web-based survey that was disseminated from 6 March to 15 August 2021. A total of 528 participants completed the questionnaire.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The researcher-created survey was sent to registered users of the Donor Sibling Registry (DSR) who were conceived via donor-assisted reproduction and were 18 years of age or older. The survey was optional and anonymous, and the main outcome measure was the willingness to use donated gametes if unable to spontaneously conceive.

MAIN RESULTS AND THE ROLE OF CHANCE

Of the 528 participants who completed the survey, 40.2% (212/528) have or would consider using donor gametes themselves if unable to conceive spontaneously and 24.6% (130/528) were undecided. Those who had used or were undecided about the utilization were significantly younger (26 years vs. 31 years, P < 0.001) and less likely to be married (32.7% vs. 47.3%, P < 0.001) than those who would not consider using donor gametes. They were also less likely to self-identify as female (78.9% vs. 86.6%, P = 0.03) but had no difference in sexual orientation (P = 0.13). Additionally, they were more likely to have known about their donor-conceived origins for more years (18 (0-50) vs. 11 (0-61), P = 0.004), be informed by a family member (75.5% vs. 65.6%, P = 0.001) and have overall positive feelings about being conceived using a donor (93.0% vs. 52.5%, P < 0.001).

LIMITATIONS, REASONS FOR CAUTION

A major limitation is that DSR participants may not be representative of all DCP. Additionally, analyzing the DCP who stated that they were undecided about using donor gametes into the 'would consider' group may be overestimating the openness to utilization in this group.

WIDER IMPLICATIONS OF THE FINDINGS

The findings from this study give new insight for health care workers to further counsel patients who are considering using third-party reproduction by providing reassurance that the majority of their future children would consider similar means, if needed, to achieve their family-building goals.

STUDY FUNDING/COMPETING INTEREST(S)

Funding for this study was received from the Department of Obstetrics and Gynecology Division of Reproductive Endocrinology and Infertility, University of Colorado. All authors declare that there are no conflicts of interest to disclose.

TRIAL REGISTRATION NUMBER

N/A.

The forgotten group of donor conceived persons

A forgotten group of donor-conceived persons is those who believe that gamete donation is morally wrong and should be prohibited. Although they share the two main arguments with the anti-anonymity group, i.e. the psychological harm as a consequence of lacking the necessary information for identity construction, and the violation of a fundamental human right, namely the right to be cared for by one’s genetic parents, their voices are largely ignored in the debate. The anti-donation group also has a large part of the ideology of the family in common with the anti-anonymity group. The paper concludes that the anti-donation position should be accepted as an equivalent position. Moreover, given the similarities between the two positions, people who accept the claims of the anti-anonymity donor-conceived persons should explain why the claims of the anti-donation group should not be honoured.

Assisted Conception Socialization Self-Efficacy Among Israeli Lesbian, Gay, and Heterosexual Parent Families and its Association with Child Externalizing Problems

This questionnaire-based study compared 36 Israeli lesbian mother families (n = 72 lesbian mothers) formed by donor insemination, 39 Israeli gay father families (n = 78 gay fathers) formed by gestational surrogacy, and 36 Israeli heterosexual parent families (n = 72 heterosexual parents) formed by assisted reproduction (without donated gametes), all with a target child aged 3-10 years. The families were examined for parents' assisted conception socialization self-efficacy, depression, negative and positive affect, life satisfaction, positivity, resilience, social support, and child externalizing problems. Multiple factors associated with child externalizing problems were also examined. Multilevel modeling analyses indicated that parents' assisted conception socialization self-efficacy did not differ between family groups; however, lesbian mothers and gay fathers reported fewer child externalizing problems and greater social support, relative to heterosexual parents. Also, lesbian mothers-but not gay fathers-reported lower levels of depression, greater life satisfaction, and more positivity than did heterosexual parents. Finally, irrespective of family type, greater assisted conception socialization self-efficacy was associated with fewer parent-reported child externalizing problems. Findings are interpreted in light of the cultural socialization framework and Israel's familistic and pronatalist environment. Implications for health professionals, educators, and policymakers working with diverse family forms are discussed.

Sociological Accounts of Donor Siblings' Experiences: Their Importance for Self-Identity and New Kinship Relations

A fundamental part of the adolescent self is formed through interaction with intimates, usually family members whose roles are reasonably well-defined. However, donor siblings-children who share a sperm donor-lack social scripts for interacting with one another, particularly when they are raised in different households. Moreover, they are often challenged to figure out their relationship to newly discovered genetic relatives. This article examines how donor-conceived teens and young adults navigate relationships with their half siblings and form intimate relationships. Drawing on Garfinkel's concept of indexing, or the use of familiar categories to make sense of new situations, these youth rely upon their personal knowledge of friends and family to figure out what kinds of relationship they can develop with donor siblings. Based on interviews with 62 youth aged 14-28, who had their own social media accounts and who had chosen to establish contact with their donor siblings, the articles discusses the three stages most donor siblings go through-"anticipation", "first contact", and "relationship building"-and the way those stages shape individual identity formation. In the course of the analysis, the article also explores whether interaction with donor siblings affected individual's sense of identity and whether feelings of closeness with donor siblings differ for youth raised as solo children versus those who have siblings with whom they share a household. For those who report feeling close, youth describe how intimacy is sustained and negotiated at a distance. Finally, as much as youth pick and choose intimates from their larger network, the article also argues that their collective identity as related-kin members remains.

Attitudes of sperm donors towards offspring, identity release and extended genetic screening

RESEARCH QUESTION

What is sperm donors' attitude towards offspring, anonymity and extended genetic screening?

DESIGN

An online questionnaire for sperm donors was administered at Cryos International in the USA and Denmark between 9 and 30 September 2020. A total of 233 donors (37 in the USA and 196 in Denmark) completed the questionnaire. This study is unique because it was performed in a setting that allows donors to choose to be either ID-release or non-ID-release donors.

RESULTS

Most donors had two motives to donate: helping childless people and/or financial compensation. ID-release donors differed significantly from non-ID-release donors in numerous aspects of the donation, including relationships with the offspring, information sharing with others and wanting information about offspring. In general, donors had a very positive attitude towards genetic testing and extended genetic screening.

CONCLUSIONS

Offering the possibility for donors to be either ID-release or non-ID-release allows more donors to be recruited than if only one option were available. The multiple differences between the two donor types suggests that these are groups with profoundly different attitudes towards donation. The general attitude of donors towards genetic testing and expanded genetic screening is very positive but further studies on the attitude of candidate donors are needed.