Children conceived by gamete donation: psychological adjustment and mother-child relationships at age 7

A longitudinal study of families created using egg donation: Family functioning at age 5

Findings are reported from Phase 2 of a longitudinal study of family functioning in heterosexual-couple families with 5 year olds conceived using identity-release egg donation. Seventy-two egg donation families were compared to 50 in vitro fertilization (IVF) families (ethnicity: 93% White British) using standardized observational, interview, and questionnaire measures. There were no differences between family types in the quality of mother-child or father-child interaction, apart from lower structuring by fathers in egg donation families. Egg donation mothers and fathers reported higher levels of parenting stress and lower levels of confidence and competence than their IVF counterparts. Egg donation mothers reported lower social support and couple relationship quality, greater anger toward their child, and perceived their child as more angry and less happy, compared to IVF mothers. Egg donation fathers showed greater criticism and anger toward their child, less joy in parenting, and were less satisfied with the support they received, than IVF fathers. Children in egg donation families showed higher levels of externalizing problems than IVF children as rated by mothers, fathers, and teachers, whereas they were rated as having higher levels of internalizing problems by teachers only. Externalizing problems were predicted by mothers' lower initial social support, steeper increases in parenting stress and greater concurrent criticism, whereas internalizing problems were associated with poorer initial couple relationship quality as rated by mothers. Both were predicted by fewer gains in reflective functioning. There was a moderation effect such that parenting stress was a stronger predictor of externalizing problems for egg donation than IVF families. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Discovering your presumed father is not your biological father: Psychiatric ramifications of independently uncovered non-paternity events resulting from direct-to-consumer DNA testing

Direct-to-consumer DNA tests provide information on ancestry and family relations. Their increased use in recent years has led many to discover that their presumed father is not their biological father, a non-paternity event (NPE). We aimed to explore and quantify the psychiatric effects of discovering one's father's identity was misattributed. We distributed questionnaires in a private online community of individuals who learned they were NPEs. Questionnaires included clinical scales assessing depressive, anxiety, and panic symptomatology as well as background and personal details regarding participants' NPE discovery and demography. A total of 731 people participated. Results demonstrated increased levels of depression, anxiety, and panic symptoms relative to controls. Multiple factors influenced such effects, including demographics, background information, family members' reactions, and personal reactions. We identified a worsening relationship or attitude toward the mother as a risk factor for worse mental health. The ability to openly discuss the discovery and acceptance of it were identified as protective factors. This is the first paper to explore the psychiatric sequelae of discovering misattributed paternity in a large cohort. This unique psychosocial stressor is likely to become more common as direct-to-consumer DNA tests gain popularity, requiring the attention of mental health professionals.

Development of the Tool to Empower Parental Telling and Talking (TELL Tool): A digital decision aid intervention about children's origins from donated gametes or embryos

Objective

This study aimed to create and develop a well-designed, theoretically driven, evidence-based, digital, decision Tool to Empower Parental Telling and Talking (TELL Tool) prototype.

Methods

This developmental study used an inclusive, systematic, and iterative process to formulate a prototype TELL Tool: the first digital decision aid for parents who have children 1 to 16 years of age and used donated gametes or embryos to establish their families. Recommendations from the International Patient Decision Aids Standards Collaboration and from experts in decision aid development, digital health interventions, design thinking, and instructional design guided the process.

Results

The extensive developmental process incorporated researchers, clinicians, parents, children, and other stakeholders, including donor-conceived adults. We determined the scope and target audience of the decision aid and formed a steering group. During design work, we used the decision-making process model as the guiding framework for selecting content. Parents' views and decisional needs were incorporated into the prototype through empirical research and review, appraisal, and synthesis of the literature. Clinicians' perspectives and insights were also incorporated. We used the experiential learning theory to guide the delivery of the content through a digital distribution plan. Following creation of initial content, including storyboards and scripts, an early prototype was redrafted and redesigned based on feedback from the steering group. A final TELL Tool prototype was then developed for alpha testing.

Conclusions

Detailing our early developmental processes provides transparency that can benefit the donor-conceived community as well as clinicians and researchers, especially those designing digital decision aids. Future research to evaluate the efficacy of the TELL Tool is planned.

Embryo donation: motivations, experiences, parenting, and child adjustment

Embryo donation raises unique challenges for donors, recipients, and the resultant child, yet little is known about the outcomes for those involved. This review summarizes research on the motivations for donating and receiving embryos from others and the experiences that follow, including the outcomes for parenting and child adjustment. Research has shown that given the varied ways in which embryo donation is practiced, understanding the outcomes within different legislative and cultural contexts is vital. The lack of information on outcomes means that counselors and psychologists have little empirical evidence to guide them. Gaps in existing knowledge are identified as well as areas for future research.

The impact of the method of genetic identity disclosure on the donor conceived adult

Aim: 106 donor conceived people (DCP) responded to an anonymous survey study that examined the impact of the method of genetic identity disclosure and age at the time of the disclosure on their emotional wellbeing, familial relations, and perceptions of donor conception practices.Methods: Participants were asked to select the way in which they were informed they are DCP and the age group at which this occurred, and then were asked to select strongly agree, agree, neither agree or disagree, disagree, or strongly disagree in response to 26 statements that examined their perceptions of the topics listed above. Responses were grouped based on the age of genetic identity disclosure and the method of genetic identity disclosure, then numerically compared by assigning each type of response a number. Statistical analysis using repeatedmeasures ANOVA was performed to identify differences among these factors.Results: This analysis revealed that most participants 18 ≥ years and most participants who discovered their genetic identity through means other than through their parent(s) had worse emotional wellbeing and familial relations. However, most participants among all categories had a negative perception of donor conception practices.Conclusion: Continued work is needed to understand and support the growing DCP population.

Openness in donor conception families

Dempsey, Nordqvist and Kelly’s recent publication in BioSocieties highlights the complexity of disclosure in donor conception, which is legally, ethically, and morally challenging. However, contemporary society means that donor-conceived people’s awareness of their conception history can no longer be controlled by their parents. Late, accidental, and non-parent disclosure is becoming more prevalent and can be distressing. Research has consistently found that openness in donor conception families from an early age is optimal, and that disclosure positively impacts rather than threatens family relationships. Despite this, disclosure can be difficult for parents, particularly if they perceive an unsupportive social context. Both donor conception and adoption literature has found more positive outcomes among disclosing families compared to non-disclosing families and interestingly, parents who have chosen to disclose have not reported regret. This response briefly discussed these important considerations and also notes some instances of inaccurate reporting and misleading information in their article.

Parent-child relationship quality and child psychological adjustment in families created using egg donation: children's perspectives at age 5 years

STUDY QUESTION

What are children's perspectives of the quality of their relationships with their parents and their own psychological well-being in families created using egg donation?

SUMMARY ANSWER

Children's scores indicated good parent-child relationship quality and high levels of psychological well-being, with children in families created using egg donation rating their relationships with their mothers as higher in warmth/enjoyment than children in a comparison group of families created using IVF.

WHAT IS KNOWN ALREADY

Little is known about how children in families created through egg donation view their family relationships and their own psychological well-being. Research with 7-and-10-year-olds in anonymous egg donation families has indicated good parent-child relationship quality from children's perspectives, but studies have not involved younger children or those conceived following identity-release egg donation.

STUDY DESIGN, SIZE, DURATION

This study included 50 children who had been born through egg donation and a comparison group of 43 children conceived through IVF with the parents' own gametes. Data were collected between April 2018 and December 2019. The sample forms part of a larger longitudinal study examining family functioning in families created through fertility treatment.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Children were aged 5 years old and had been born into families with different-sex couple parents. All families were visited at home. Children were administered the Berkeley Puppet Interview, a standardized assessment of parent-child relationship quality and psychological well-being.

MAIN RESULTS AND THE ROLE OF CHANCE

Children in egg donation families rated their relationships with their mothers as higher in warmth and enjoyment than did children in IVF families. No differences were found between the two family types in children's ratings of the father-child relationship, or in children's ratings of their own psychological well-being.

LIMITATIONS, REASONS FOR CAUTION

It is possible that children who did not consent to take part in the research had less positive perceptions of their family and themselves than children who participated.

WIDER IMPLICATIONS OF THE FINDINGS

The findings are relevant to UK clinics offering identity-release egg donation, to parents who have used egg donation to create their family and to individuals and couples considering their fertility treatment options. That children in egg donation families were more similar than different to children in IVF families in their self-concept and perception of their family relationships should prove reassuring.

STUDY FUNDING/COMPETING INTEREST(S)

This research was supported by a Wellcome Trust Collaborative Award [208013/Z/17]. The authors have no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

N/A.

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.

Self-reported mental health status of donor sperm-conceived adults

While donor-conceived children have similar mental health outcomes compared to spontaneously conceived children, there is an inconsistency between studies investigating mental health outcomes of donor-conceived people in adulthood. This study is an online health survey that was completed by 272 donor sperm-conceived adults and 877 spontaneously conceived adults from around the world. Donor sperm-conceived adults had increased diagnoses of attention deficit disorder (P = 0.004), and autism (P = 0.044) in comparison to those conceived spontaneously. Donor sperm-conceived adults self-reported increased incidences of seeing a mental health professional (P < 0.001), identity formation problems (P < 0.001), learning difficulties (P < 0.001), panic attacks (P = 0.038), recurrent nightmares (sperm P = 0.038), and alcohol/drug dependency (P = 0.037). DASS-21 analysis revealed that donor sperm-conceived adults were also more stressed than those conceived spontaneously (P = 0.013). Both donor sperm and spontaneously conceived cohorts were matched for sex, age, height, alcohol consumption, smoking, exercise, own fertility, and maternal smoking. The increase in adverse mental health outcomes is consistent with some studies of donor-conceived adult mental health outcomes. These results are also consistent with the Developmental Origins of Health and Disease (DOHaD) phenomenon that has linked adverse perinatal outcomes, which have been observed in donor-conceived neonates, to increased risk of chronic disease, including mental health. Further work is required to reconcile our observations in adults to contrary observations reported in donor-conceived children.

'Genes versus children': if the goal is parenthood, are we using the optimal approach?

First medical contact for couples trying for a child will usually emphasise the array of assistance available to ‘help them have their own child’, usually with options involving ART, after diagnosis. For many poorer prognosis couples, this means repetitive unsuccessful cycles of invasive and stressful treatment. What is sometimes lost at this stage is a reflection on the likelihood of success of different options, which may lead patients to focus on hoping for their own ‘genetic’ progeny, but failing to consider the alternative and potentially more successful other options, including donation and adoption, for achieving parenthood of a child. Factors not only such as female age but also advanced requirements such as preimplantation genetic testing or even mitochondrial replacement therapies all have reduced chances of success but further tend to reinforce the importance of a genetic link. The financial, physical and psychosocial burden associated with cumulative failure also lead to a higher probability of dropout and consequently an even higher probability of remaining in involuntary childlessness. We advocate formulation of a detailed roadmap for discussion of parenthood, with reference explanation to genetics and epigenetics, which gives due consideration to the psychological effects from the beginning to end of the treatment process, alongside a balanced consideration of the likelihood of treatment success and discussion of other options. Only when we provide patients with the service of a clear and transparent discussion of these matters, we will really realise the true potential of our field, which may then be better considered as assisted families.

The psychological wellbeing of ART children: what have we learned from 40 years of research?

Our understanding of what makes a family has changed dramatically in recent decades due to advances in reproductive technologies accompanied by changing social attitudes. But what has the impact been on children? This article presents a summary of research on parent-child relationships and the psychological adjustment of children in families created by assisted reproduction. The findings show that families with lesbian mothers, gay fathers, and single mothers by choice, and families created by donor conception and surrogacy, are just as likely to flourish as traditional families, and sometimes more so, although the children from these families will sometimes face prejudiced attitudes from others. It is concluded that the quality of family relationships and the wider social environment matter more for children's psychological wellbeing than the number, gender, sexual orientation, or biological relatedness of their parents.

Adult offspring of lesbian parents: How do they relate to their sperm donors?

OBJECTIVE

To study how adult offspring in planned lesbian-parent families relate to their unknown or known donors.

DESIGN

Qualitative analyses of the sixth wave of online surveys from a longitudinal study of adult offspring in planned lesbian families, enrolled at conception.

SETTING

Community-based United States national study.

PATIENT(S)

The 76 participants were 25-year-old donor insemination (DI) offspring whose lesbian parent(s) enrolled in a prospective longitudinal study when these offspring were conceived.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Offspring were asked about donor type, feelings about permanently unknown donor, satisfaction with and role of known donor, whether relationship with known donor was ongoing, and age of meeting open-identity donor.

RESULT(S)

This cohort (n = 76) of DI offspring with lesbian parents was among the first generation to reach adulthood. Thirty participants had permanently unknown donors and most participants felt comfortable about not knowing them. Sixteen participants had open-identity donors they had not met. Thirty had currently known donors-met in childhood (n = 22) or after open-identity donor disclosure (n = 8)-of whom two thirds had ongoing relationships with donors, half considered their donors as acquaintances, and nearly half had good feelings about their relationship, although a minority expressed conflicted feelings.

CONCLUSION(S)

This study of adult DI offspring from planned lesbian families shows that those who knew their donors mainly felt positively about these relationships. Qualitative analyses offered insight into offspring-donor relationships, whose numbers are increasing due to historical and demographic trends.

"Making the child mine": Mothers' thoughts and feelings about the mother-infant relationship in egg donation families

The number of families being created through fertility treatment with donor eggs is increasing yearly. Women who conceive in this way share a gestational but not genetic relationship with their child, yet there is limited understanding of how mothers experience the mother-child relationship during its formative period, infancy. This study explored heterosexual mothers' thoughts and feelings about the mother-infant relationship in families created through egg donation. Qualitative interviews were conducted with a sample of 85 women who had conceived following egg donation treatment at U.K. fertility clinics. Mothers had at least 1 infant (6-18 months) and were living with the child's father. Interview data were analyzed according to the principles of thematic analysis. The results showed that egg donation mothers used a range of strategies across the transition to parenthood that enabled them to establish their identity as the child's mother and facilitated the process of helping them feel that the baby was their own. This process was individual to each woman, with the absent genetic connection varying in significance between mothers. The strategies employed enabled most mothers to adjust successfully to parenthood and manage any ambivalence and uncertainties associated with nongenetic parenthood. Most mothers felt secure and confident in their position as the child's mother by the end of the first year. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The living experience of losing genetic continuity: Concealment tendency in Chinese recipients of donor-assisted conception

This study explored how Chinese women with donor-assisted conception experienced loss of genetic continuity and managed donor-assisted conception-related information. Through Interpretative Phenomenological Analysis, a thematic framework on women's beliefs, motivation, and behaviors in information management was constructed. Contrary to the Western trend toward disclosure, it was found that Chinese women strongly preferred to conceal, in order to protect their family members, the parent-child relationship, and family stability. Participants' strong preference was also indicated in specific behaviors that ensure information concealment. The findings of this study may contribute toward the development of culturally sensitive clinical guidelines for counseling practice that supports infertile couples' decision-making.

'Is blood thicker than water?' Donor conceived offspring's subjective experiences of the donor: a systematic narrative review

The aim of this study was to provide a systematic narrative review of the published research articles on donor conceived offspring's subjective experiences of their donor. A systematic search of electronic databases (PsycINFO and PubMed) provided 29 published quantitative and qualitative studies matching the inclusion criteria. The analysis of the studies outcomes led to the identification of four main themes: (i) views/representations of the donor; (ii) desire to contact the donor (in terms of desire to meet the donor, reasons for wanting to contact the donor, type and frequency of contact); (iii) reactions to discovering the donor's identity and contacting the donor; (iv) identity issues. The findings revealed that genetic ties do matter to donor conceived people, especially during adolescence or adulthood. Many donor conceived people were interested in contacting the donor and all of them needed to make meaning of the role of the donor, as well as to integrate it into their family life and self-concept. Besides curiosity and medical reasons, many people reported wanting to contact the donor to see what he/she looked like, and to have access to their own ancestry and genetic history.

Families Created by Egg Donation: Parent-Child Relationship Quality in Infancy

Increasing numbers of children are being born through egg donation and thus do not share a genetic relationship with their mother. Parent–infant relationship quality was examined in 85 egg donation families and a comparison group of 65 in vitro fertilization families (infant M = 11 months). Standardized interview and observational measures were used to assess mother–infant and father–infant relationship quality at the representational and behavioral levels. Few differences were found between family types in parents’ representations of the parent–infant relationship. Differences were found between family types in the observational assessment of mother–infant relationship quality, indicating less optimal interactions in egg donation families. Findings suggest that egg donation families function well in infancy overall, but there may be subtle yet meaningful differences in mother–infant interaction quality.

The mental health of mothers and fathers during pregnancy and early parenthood after successful oocyte donation treatment: A nested case-control study

INTRODUCTION

The aim of this study was to compare the mental health problems between parents after oocyte donation treatment, after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) with own gametes and after naturally conceiving (NC).

MATERIAL AND METHODS

This is a prospective, longitudinal questionnaire study. The study group consisted of 26 oocyte donation mothers and their matched IVF/ICSI (n = 52) and NC (n = 52) controls. Matching was performed according to mother's age, parity, type of pregnancy, and number of returned questionnaires. The parents filled-in the General Health Questionnaire (GHQ-36) at gestational weeks 18-20 (T1), and at 2 months (T2) and 12 months (T3) after the childbirth.

RESULTS

Full response rate (T1-T3) for oocyte donation mothers was 76.9% and for oocyte donation fathers was 73.1%. At T1, no significant differences were found between groups in depression, anxiety, sleeping difficulties, or social dysfunction, but they differed at T2 and T3 in anxiety (T2, P = .02; T3, P = .01), in sleeping difficulties (T2, P = .02; T3, P = .04) and in social dysfunction (T2, P = .01; T3, P = .04). Oocyte donation mothers showed less anxiety than NC mothers (T2, T3), and fewer sleeping difficulties and less social dysfunction than IVF/ICSI (T2, T3) and NC mothers (T2). Mental health problems of oocyte donation fathers did not differ from those of IVF/ICSI and NC control fathers at T1-T3.

CONCLUSIONS

Oocyte donation mothers showed fewer mental health symptoms in early parenthood compared with IVF/ICSI and NC mothers. No differences were found among mothers during pregnancy and among fathers at any time point.

Narrative Identity in Third Party Reproduction: Normative Aspects and Ethical Challenges

In the last few decades, assisted reproduction has introduced new challenges to the way people conceive and build their families. While the numbers of donor-conceived (DC) individuals have increased worldwide, there are still many controversies concerning access to donor information. Is there a fundamental moral right to know one's genetic background? What does identity in DC families mean? Is there any relationship between identity formation and disclosure of genetic origins? These questions are addressed by analysing core regulatory discourse (ethical recommendations and codes of practice). This analysis shows that the notion of narrative identity is suitable for defining and answering these questions. This review analyses the meaning of resemblance in DC families and the way donors are selected following affinity-ties and discusses disclosure strategies and agreements. As a preliminary conclusion, it could be said that, in the field of third-party reproduction, knowing about the donor conception significantly contributes towards the development of a narrative identity and also serves as a moral basis for the child's right to know.

The attitudes of IVF patients treated in the Czech Republic towards informing children born after gamete donation

BACKGROUND

In recent decades gamete donation has received growing attention. Data from the Czech National Registry of Assisted Reproduction show that the number of cycles using donated oocytes has been increasing every year. According to Czech law, gamete donation is anonymous. Since 2011, some members of the Czech parliament have repeatedly made requests to revoke the anonymity but anonymity is one of the preconditions for such donation in this country. The aim of this study was to find out how the gamete recipients feel towards informing their child about the circumstances of their conception and their access to the identity of the donor.

METHODS

A total of 195 recipients (122 women undergoing treatment - 43 Czechs, 79 foreigners (Western Europe and the USA) and 73 male partners - 28 Czechs, 45 foreigners) participated in this survey. The data were obtained by anonymous questionnaire.

RESULTS

A significant difference between the attitude of the future Czech and foreign parents regarding disclosing the mode of conception was found (P = 0.003). The vast majority of Czechs were against disclosure. The foreign recipients were somewhat more divided. Regarding the donor's identity, there was no difference in atttitude between the groups. Recipients rarely consider that the knowledge of the donor's identity will be important for their child. The recipients overall, were convinced that the psychological aspects of parenting are far more important to the child than genetics, and see no reasons for disclosing the donor´s identity.

CONCLUSION

While the the foreign recipients were less adamant about non-disclosure, the overall finding was in accord with the current Czech law on anonymity and not in agreement with the proposed abolition. The recipient's attitudes towards disclosing were also culturally determined. The fact that some countries have revised their rules towards open idendity is not a rationale for such change in the Czech Republic.

A longitudinal study of families formed through reproductive donation: Parent-adolescent relationships and adolescent adjustment at age 14

The aim of the 6th phase of this longitudinal study was to establish whether children born through assisted reproduction involving reproductive donation were at risk for psychological problems following the transition to adolescence at age 14 and, if so, to examine the nature of these problems and the mechanisms involved. Eighty-seven families formed through reproductive donation, including 32 donor insemination families, 27 egg donation families, and 28 surrogacy families, were compared with 54 natural conception families. Standardized interviews, questionnaires, and observational assessments of the quality of parent-adolescent relationships and adolescent adjustment were administered to mothers, adolescents, and teachers. The mothers in surrogacy families showed less negative parenting and reported greater acceptance of their adolescent children and fewer problems in family relationships as a whole compared with gamete donation mothers. In addition, less positive relationships were found between mothers and adolescents in egg donation families than in donor insemination families as rated by both mothers and adolescents. There were no differences between family types for the adolescents themselves in terms of adjustment problems, psychological well-being, and self-esteem. Longitudinal analyses showed no differences between family types in negative parenting from age 7 to age 14, and a weaker association between negative parenting and adjustment difficulties for gamete donation than natural conception and surrogacy families. The findings suggest that the absence of a genetic link between mothers and their children is associated with less positive mother-adolescent relationships whereas the absence of a gestational link does not have an adverse effect.

Disclosure of sperm donation: a comparison between solo mother and two-parent families with identifiable donors

Disclosure of donor conception to children was compared between solo mother and two-parent families with children aged 4–8 years conceived since the removal of donor anonymity in the UK. Semi-structured interviews were conducted with 31 heterosexual solo mothers and 47 heterosexual mothers with partners to investigate their decisions and experiences about identifiable donation and disclosure to their children. No significant difference was found in the proportion of mothers in each family type who had told their children about their donor conception (solo mothers 54.8%; partnered mothers 36.2%). Of those who had not told, a significantly higher proportion of solo mothers than partnered mothers intended to disclose (P < 0.05). Partnered mothers were more likely than solo mothers to feel neutral, ambivalent or negative about having used an identifiable donor (P < 0.05), and were less likely to consider children's knowledge of their genetic origins as extremely important (P < 0.05). These findings are relevant to provision of counselling services as it cannot be assumed that parents will tell their children about their origins or their entitlement to request the identity of their donor at the age of 18 years. Further qualitative research would increase understanding of solo mothers' attitudes towards disclosure.

Single mothers by choice: Mother-child relationships and children's psychological adjustment

Fifty-one solo mother families were compared with 52 two-parent families all with a 4-9-year-old child conceived by donor insemination. Standardized interview, observational and questionnaire measures of maternal wellbeing, mother-child relationships and child adjustment were administered to mothers, children and teachers. There were no differences in parenting quality between family types apart from lower mother-child conflict in solo mother families. Neither were there differences in child adjustment. Perceived financial difficulties, child's gender, and parenting stress were associated with children's adjustment problems in both family types. The findings suggest that solo motherhood, in itself, does not result in psychological problems for children. (PsycINFO Database Record

Keeping a child's donor sperm conception secret is not linked to family and child functioning during middle childhood: An Australian comparative study

BACKGROUND AND AIM

Controversy exists as to whether children conceived using donor sperm should be told about their origins and the possible deleterious effects of secrecy.

MATERIALS AND METHODS

The Follow-Up of Children Conceived through Donor Insemination research compares 'family functioning' and 'child well-being' in 62 families where donor-conceived children aged between 5 and 13 years had been 'told' (N = 29) and 'not told' (N = 33) of their genetic heritage. Couples were treated through the Prince Henry's Institute of Medical Research Reproductive Medicine Clinic. Standardised measures of family functioning and child well-being collected from mothers were modelled to estimate mean differences according to knowledge of conception.

RESULTS

Mean differences between the two 'knowledge of conception' groups were generally very small and not statistically significant; adjustment for covariates did not make a substantive difference to the interpretation of group differences. Scores on family functioning and child well-being measures were within normal limits for both the 'told' and 'not told' groups.

CONCLUSION

Further research on parents' experiences would usefully inform discussion on the forms of education and support that would encourage parents to engage with the issues of disclosure and nondisclosure, and promote transparency as well as societal awareness, acceptance and understanding of this method of family formation.

Gamete donation, information sharing and the best interests of the child: an overview of the psychosocial evidence

This paper overviews key empirical findings from social science research regarding the impact of gamete donation on child wellbeing. In particular, the paper addresses current regulatory debates concerning information sharing and the best interests of the child by considering psychosocial aspects of telling--or not telling--children about their donor conception and the identity of their donor. The paper identifies three core sets of empirical, ethical and policy concerns underpinning these debates relating to (i) the psychosocial impact of gamete donation per se on child wellbeing, (ii) the psychosocial impact of parental disclosure decisions on child wellbeing, and (iii) the psychosocial implications of donor identification for donor-conceived offspring. The paper illustrates how these concerns are framed by ideas about the significance-or not-of 'genetic relatedness'; ideas which have come to the fore in contemporary discussions about the potential consequences of donor-conceived individuals gaining access to their donor's identity. By drawing together research findings that may be pertinent to the regulation of gamete donation and information sharing, a further aim of this paper is to explore the potential use and misuse of empirical 'evidence' in ethical and policy debates. Whilst this paper starts from the premise that psychosocial data has a vital role in grounding normative discussions, it seeks to contribute to this dialogue by highlighting both the value and limitations of social science research. In particular, the paper argues for a cautious approach to applying psychosocial evidence to ethical issues that is sensitive to the caveats and nuances of research findings and the changing cultural and regulatory context.

Parent psychological adjustment, donor conception and disclosure: a follow-up over 10 years

STUDY QUESTION

What is the relationship between parent psychological adjustment, type of gamete donation (donor insemination, egg donation) and parents' disclosure of their use of donated gametes to their children.

SUMMARY ANSWER

Disclosure of donor origins to the child was not always associated with optimal levels of psychological adjustment, especially for fathers in donor insemination families.

WHAT IS KNOWN ALREADY

Cross-sectional analyses have found mothers and fathers who conceived a child using donated sperm or eggs to be psychologically well-adjusted, with few differences emerging between parents in gamete donation families and parents in families in which parents conceived naturally. The relationship between mothers' and fathers' psychological well-being, type of gamete donation (donor insemination, egg donation) and parents' disclosure decisions has not yet been examined.

STUDY DESIGN, SIZE, DURATION

In this follow-up study, data were obtained from mothers and fathers in donor insemination and egg donation families at 5 time points; when the children in the families were aged 1, 2, 3, 7 and 10. In the first phase of the study, 50 donor insemination families and 51 egg donation families with a 1-year-old child participated. By age 10, the study included 34 families with a child conceived by donor insemination and 30 families with a child conceived by egg donation, representing 68 and 58% of the original sample, respectively.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Families were recruited through nine fertility clinics in the UK. Standardized questionnaires assessing depression, stress and anxiety were administered to mothers and fathers in donor insemination and egg donation families.

MAIN RESULTS AND THE ROLE OF CHANCE

Mothers and fathers in both donor insemination and egg donation families were found to be psychologically well-adjusted; for the vast majority of parents' levels of depression, anxiety and parenting stress were found to be within the normal range at all 5 time points. Disclosure of the child's donor origins to the child was not always associated with optimal levels of parental psychological adjustment. For example, disclosure was associated with lower levels of psychological well-being for certain groups in particular (such as fathers in donor insemination families), at certain times (when children are in middle childhood and have a more sophisticated understanding of their donor origins).

LIMITATIONS, REASONS FOR CAUTION

Owing to small sample sizes, the value of this study lies not in its generalizability, but in its potential to point future research in new directions.

WIDER IMPLICATIONS OF THE FINDINGS

Donor insemination and egg donation families are a heterogeneous group, and future research should endeavour to obtain data from fathers as well as mothers. Support and guidance in terms of disclosure and family functioning might be most beneficial for parents (and especially fathers) in donor insemination families, particularly as the child grows older. The more that is known about the process of disclosure over time, from the perspective of the different members of the family, the better supported parents and their children can be.

STUDY FUNDING COMPETING INTERESTS

The project described was supported by grant number RO1HD051621 from the National Institute of Child Health and Human Development. The content is solely the responsibility of the authors and does not represent the official views of the National Institute of Child Health and Human Development or the National Institutes of Health. The authors have no conflict of interest to declare.

Assisted reproduction for postmenopausal women

With increasing longevity, an ageing population and advances in assisted reproductive technologies (ART), a greater number of women are deciding to have a child and become a mother in their later years. With this social and demographic change, an important social and ethical debate has emerged over whether single and/or married postmenopausal women should have access to ARTs. The aim of this paper is to address this question and review critically the arguments that have been advanced to support or oppose the use of ART by older women. The arguments presented consider the consequences for the individual, the family and wider society. They cover the potential physical and emotional harm to the older woman, the possible impact on the welfare and wellbeing of the future child, and the impact on the norms, values, customs and traditions of society. After reviewing the evidence, and weighing the opposing arguments, this paper concludes that there is no moral justification for a restriction on the use of ART by postmenopausal women. Allowing access to ART for postmenopausal women is an extension of reproductive autonomy and procreative rights in an age where the promotion of agency, autonomy, individual choice and human rights is paramount.

Genre, parenté et techniques de reproduction assistée : bilan et perspectives après 30 ans de recherche

Ce numéro d’Enfances Familles Générations propose de se pencher sur les problématiques actuelles soulevées par les techniques de reproduction assistée (TRA) au regard des questions de parenté et de genre. Si, dans un monde globalisé, diverses possibilités reproductives sont désormais accessibles, celles-ci soulèvent de nombreuses questions socioanthropologiques du point de vue des rapports de pouvoir qu’elles engendrent, des pratiques et des régulations parfois très différentes dont elles font l’objet, ainsi que des significations individuelles et culturelles qui leur sont attribuées. Ces questions ont donné lieu à une littérature riche et abondante au cours des trente dernières années, en particulier dans le monde anglo-saxon. Cet article introductif est ainsi l’occasion de faire dialoguer davantage, en soulignant leurs apports respectifs, des travaux relevant de traditions différentes, en particulier dans les mondes francophones et anglophones. À partir de ce bilan des questionnements majeurs qu’a suscités l’étude des TRA dans les domaines du genre et de la parenté, nous soulignons les enjeux qui restent en suspens et qui mériteraient selon nous de faire l’objet de plus amples investigations. Le fil conducteur de notre propos, sur la base de la littérature disponible et des enquêtes menées jusqu’ici en sciences sociales, est d’insister sur la dimension du genre comme inextricable de l’expérience et de l’étude des techniques de reproduction assistée.

Adoptive gay father families: parent-child relationships and children's psychological adjustment

Findings are presented on a U.K. study of 41 gay father families, 40 lesbian mother families, and 49 heterosexual parent families with an adopted child aged 3-9 years. Standardized interview and observational and questionnaire measures of parental well-being, quality of parent-child relationships, child adjustment, and child sex-typed behavior were administered to parents, children, and teachers. The findings indicated more positive parental well-being and parenting in gay father families compared to heterosexual parent families. Child externalizing problems were greater among children in heterosexual families. Family process variables, particularly parenting stress, rather than family type were found to be predictive of child externalizing problems. The findings contribute to theoretical understanding of the role of parental gender and parental sexual orientation in child development.

Strengths and pitfalls of Canadian gamete and embryo donor registries: searching for beneficent solutions

For the gamete and embryo donation community, it is well recognized that the implementation of a gamete and embryo donor registry (GEDR) represents a good initiative to ensure the best possible health conditions for donor-conceived individuals. Be they national, institutional or independent, GEDR can play a major role in the transmission of health-related genetic and medical information. However, from a bioethical analysis standpoint, GEDR raise many questions regarding the extent of their beneficent nature. Based on the recent Canadian GEDR aborted attempt, this article will focus on bioethical issues and paradoxes that can impact the wellbeing of donor-conceived individuals, half-siblings, donors and parents. On one hand, the implementation of a GEDR can be ethically justified as a beneficent action towards lessening harm associated with the transmission of hereditary disease and increasing the effectiveness of preventive and therapeutic approaches. On the other hand, examined through the concept of nonpaternalistic beneficence, GEDR challenge us to recognize beneficiaries' free agency, as well as the importance to transmit reliable and pertinent information. Ultimately, beyond an individualistic application of the principle of beneficence, socioethics invite us to consider consistency with societal values as a prerequisite for achieving a common good. Because the issue of whether or not to protect the donor's anonymity occupies the forefront of the discussion surrounding gamete and embryo donation, there is less interest in other initiatives, which may be implemented to ensure the best possible medical and psychosocial conditions for donor-conceived individuals. In this article, we propose a bioethical analysis of the use of gamete and embryo donor registries (GEDR) from the angle of the principle of beneficence. More specifically, we will concentrate on the Canadian situation regarding GEDR. We will look at the strengths and pitfalls of this mechanism and suggest a solution to maximize the benefits of a GEDR. Many have suggested that such an initiative could have a beneficial impact on the wellbeing of donor-conceived individuals, half-siblings, donors and parents, by ensuring the constant flow of health-related medical and genetic information. As self-evident as the social acceptability of a GEDR may seem, we wish to show the limitations of the benefits that a registry is supposed to provide. We argue that a GEDR has to do more than simply transmit health-related information between parties. It also has to be based on pertinent and reliable data, be useful for health promotion and recognize beneficiaries' free agency. Ultimately, the implementation of a GEDR has to take into consideration wider social values.

Children born through reproductive donation: a longitudinal study of psychological adjustment

BACKGROUND

Parenting and children's adjustment were examined in 30 surrogacy families, 31 egg donation families, 35 donor insemination families, and 53 natural conception families.

METHODS

Parenting was assessed at age 3 by a standardized interview designed to assess quality of parenting and by questionnaire measures of anxiety, depression, and marital quality. Children's adjustment was assessed at ages 3, 7, and 10 using the Strengths and Difficulties Questionnaire (SDQ).

RESULTS

Although children born through reproductive donation obtained SDQ scores within the normal range, surrogacy children showed higher levels of adjustment difficulties at age 7 than children conceived by gamete donation. Mothers who had kept their child's origins secret showed elevated levels of distress. However, maternal distress had a more negative impact on children who were aware of their origins.

CONCLUSIONS

The absence of a gestational connection to the mother may be more problematic for children than the absence of a genetic link.

Social and ethical determinants of sexuality: 4. Sexuality and families

OBJECTIVES

To investigate the evolving relationship between sexuality and family formation. New family units exist today whose impact on society needs to be explored.

METHODS

For each main area researched (anthropology, biology, sociology, sexology, ethics) we identified articles dealing with family formation, sexuality and reproduction using PubMed, ScienceDirect, Google, religious websites and texts.

RESULTS

The three monotheistic religions and the cultures derived from these have considered sexuality as focused on reproduction. Presently, sexuality has acquired new dimensions, independent from reproduction, as contraception and IVF have separated procreation and sexuality. Thus, the very concept of family has been expanded and so-called 'unusual families' have proved not to be a danger per se for children born and raised within them.

CONCLUSIONS

Human sexuality has moved away from having a purely reproductive function, but remains a powerful bond keeping families together, irrespective of the gender identity and the biological links of their members. Even among traditional societies, different types of families exist and the situation has become more complex as technical developments have made parenthood possible for people who in the past were excluded from it.

Counselling on disclosure of gamete donation to donor offspring:a search for facts

BACKGROUND

High quality counseling of potential parents is needed in the process of disclosure to donor offspring, which is important for the child and for family relationships. We performed a search for facts to identify the role of counseling in couples undergoing gamete donation.

METHODS

We systematically searched Pubmed, EMBASE and Psychinfo. Studies were included if they reported on counseling in gamete donation.

RESULTS

A total of 20 studies were included. Twelve studies stated that counselling was offered. The reported studies reflected no consensus about when and how counselling in gamete donation should be offered and no theoretical background of the disclosure/ secrecy issue. About 50% of the parents expressed the need for guidance and support of a counsellor. Special concerns were the disclosure issue and the future contact with the donor. Parents did not receive the guidance and support they needed in the disclosure process after treatment.

CONCLUSION

Empirical knowledge on counselling is lacking. This review demonstrates the need to know more precisely at what moments couples should be counselled, and which specific information and guidelines couples need to receive to be more confident in the disclosure process to donor offspring.

Families created through surrogacy: mother-child relationships and children's psychological adjustment at age 7

Each year, an increasing number of children are born through surrogacy and thus lack a genetic and/or gestational link with their mother. This study examined the impact of surrogacy on mother-child relationships and children's psychological adjustment. Assessments of maternal positivity, maternal negativity, mother-child interaction, and child adjustment were administered to 32 surrogacy, 32 egg donation, and 54 natural conception families with a 7-year-old child. No differences were found for maternal negativity, maternal positivity, or child adjustment, although the surrogacy and egg donation families showed less positive mother-child interaction than the natural conception families. The findings suggest that both surrogacy and egg donation families function well in the early school years.