Children's thoughts and feelings about their donor and security of attachment to their solo mothers in middle childhood

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.

The intergenerational transmission of attachment during middle childhood in lesbian, gay, and heterosexual parent families through assisted reproduction: The mediating role of reflective functioning

The present study examined the attachment patterns distribution of 60 lesbian mothers, 50 gay fathers, and 42 heterosexual parents through assisted reproduction and their 76 children, using the Adult Attachment Interview (AAI) and the Friends and Family Interview (FFI), respectively. The study also explored the intergenerational transmission of attachment through reflective functioning (AAI-RF). All families lived in Italy and children were aged 6-12 years (Myears = 8.11, SD = 2.17; 48.68% assigned female at birth). The AAI patterns distribution was similar across family types and did not significantly differ from international and national normative data. Similarly, children's FFI attachment patterns were evenly distributed between family types, and no significant differences emerged in comparison to international and national normative data referring to middle childhood samples. Mediational models revealed that, in all three family types, parents with greater AAI coherence of mind exhibited higher AAI-RF, which, in turn, was associated with increased FFI attachment security in children. Furthermore, parents' AAI coherence of mind directly influenced children's FFI attachment security. The results support and expand hypotheses regarding the intergenerational transmission of attachment in lesbian, gay, and heterosexual parent families through assisted reproduction, while offering unique indications to support these families during middle childhood.

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.

'I'm the only mum she knows': parents' understanding of, and feelings about, identity-release egg donation

STUDY QUESTION

How do parents understand and feel about identity-release egg donation?

SUMMARY ANSWER

Almost one-third of mothers and fathers did not understand the identifiable nature of their egg donation; mothers expressed complex and sometimes difficult feelings about the prospect of future donor–child contact.

WHAT IS KNOWN ALREADY

Identity-release egg donation has been the only treatment option available to patients wishing to pursue this route to parenthood in the UK since 2005. However, little is known about how well parents understand this legislation, and how they feel about potential donor–child contact.

STUDY DESIGN, SIZE, DURATION

This qualitative interview study included 61 mothers and 51 fathers whose 5-year-old children were conceived via identity-release egg donation. Interviews were conducted between April 2018 and December 2019.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Data are reported from phase two of a longitudinal study of families created using open-identity egg donation. In-depth, semi-structured interviews were conducted with mothers and fathers. The interviews contained a section on what parents understood about the identifiable nature of the donor. These data were analysed using qualitative content analysis. Mothers who understood the identifiable nature of their egg donation (n = 44) were then asked about their thoughts and feelings regarding the prospect of future donor–child contact. Mothers’ narratives were analysed using thematic analysis.

MAIN RESULTS AND THE ROLE OF CHANCE

Almost one-third of parents (28% of mothers, n = 17; 31% of fathers, n = 16) did not understand the identifiable nature of their egg donation. Mothers’ and fathers’ misunderstandings about identity-release egg donation fell into two categories: (i) Unclear about identity-release and (ii) Belief that the donor is anonymous. Reflexive thematic analysis revealed that egg donation mothers’ feelings about identity-release donation could be understood via three organizing themes: (i) identity-release as a threat, (ii) acceptance: it is what it is and (iii) embracing identity-release. The findings indicated that egg donation mothers utilized various strategies to manage their feelings about identity-release egg donation in day-to-day life, and each theme was associated with at least one coping strategy.

LIMITATIONS, REASONS FOR CAUTION

Participants were predominantly from White, middle-class backgrounds. Further research with a more diverse sample is needed to improve generalizability.

WIDER IMPLICATIONS OF THE FINDINGS

These findings indicate that parents would benefit from more comprehensive provision of information, both at time of treatment and following conception, to ensure they have fully understood the nature of the donation. Parents may also benefit from follow-up care to help manage any complex or difficult feelings about donor–child contact.

STUDY FUNDING/COMPETING INTEREST(s)

This research was supported by a Wellcome Trust Collaborative Award [208013/Z/17/Z]. 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.

Children's Exploration of Their Surrogacy Origins in Gay Two-Father Families: Longitudinal Associations With Child Attachment Security and Parental Scaffolding During Discussions About Conception

Evidence is lacking about the factors that are pivotal in enhancing the exploration of surrogacy origins in children of gay fathers during middle childhood. The present study examined the separate and combined influences of child attachment security and parental scaffolding (i.e., fathers' attempts to accept, encourage, and emotionally support their children's expression of thoughts and feelings) during discussions about conception on children's exploration of their surrogacy origins in 30 Italian children born to gay fathers through gestational surrogacy. Within each family, both father-child dyads (n = 60) participated in a 5-minute videotaped conversation regarding an aspect of the child's conception when children were mean aged 8.3 years (t1). At this time, children were also administered the Security Scale Questionnaire to evaluate their attachment security. Approximately 18 months later (t2; M age = 9.9 years), children were interviewed about their surrogacy origins. Linear mixed models (LMMs) for longitudinal data indicated that, with higher levels of parental scaffolding, only children who perceived greater attachment security reported greater exploration of their surrogacy origins. The findings are the first to underscore the importance of conversations about surrogacy within the context of parent-child attachment relationships, as well as the importance of fathers sensitively supporting their children as they explore their origins during middle childhood. In doing so, it is expected that fathers will likely facilitate their children's positive integration of their surrogacy conception into a coherent sense of identity during adolescence.

The perspectives of adolescents conceived using surrogacy, egg or sperm donation

STUDY QUESTION

What are the perspectives of adolescents conceived using surrogacy, egg or sperm donation regarding their conception and the third party involved?

SUMMARY ANSWER

The majority of adolescents described feeling indifferent about their conception, and yet simultaneously reported an interest in the third party involved, or were in contact with them.

WHAT IS KNOWN ALREADY

There is an assumption that children conceived through reproductive donation will feel negatively about their origins in adolescence. However, little is known about the views of adolescents who have been conceived through different types of reproductive donation.

STUDY DESIGN, SIZE, DURATION

Forty-four adolescents, all of whom had been told about their conception in childhood, participated in a semi-structured interview as part of the sixth phase of a longitudinal, multi-method, multi-informant study of assisted reproduction families in the UK.

PARTICIPANTS/MATERIALS, SETTING, METHODS

All adolescents were aged 14 years, had been conceived using surrogacy (n = 22), egg donation (n = 13) or sperm donation (n = 9) to heterosexual couples, and varied in terms of their information about, and contact with, the third party involved in their conception. Semi-structured interviews were conducted in participants' homes. Interviews were analysed qualitatively to determine adolescents' perceptions of their conception, and their thoughts and feelings about the surrogate or donor involved.

MAIN RESULTS AND THE ROLE OF CHANCE

Adolescents were found to feel positive (n = 7), indifferent (n = 32) or ambivalent (n = 5) about their conception. Amongst adolescents not in contact with the surrogate or donor, most were interested (n = 16) in the surrogate or donor, and others were ambivalent (n = 4), or not interested (n = 6) in them. Adolescents in contact with the surrogate or donor expressed positive (n = 14), ambivalent (n = 1) or negative (n = 1) feelings about them.

LIMITATIONS, REASONS FOR CAUTION

Of 56 adolescents invited to take part in the study, 47 consented to take part, giving a response rate of 84%. It was not possible to obtain information from adolescents who do not know about their conception.

WIDER IMPLICATIONS OF THE FINDINGS

The findings contradict the assumption that children conceived through reproductive donation will feel negatively about their origins in adolescence and suggest that it may be helpful to draw a distinction between adolescents' feelings about their conception in general, and their feelings about the surrogate or donor in particular.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by the Wellcome Trust [097857/Z/11/Z]. The authors have no conflicts of interest to declare.

Oocyte donation disclosure decisions: a longitudinal follow-up at middle childhood

Few studies have captured oocyte donation (OD) parents' decision processes about intended and actual disclosure over time. Likewise, OD children's perceptions about their family composition during middle childhood are underexplored. To address these gaps, a longitudinally followed cohort of OD recipient families was invited to participate in a qualitative, follow-up study. With an 86% response rate after 12 years, families were composed of oocyte recipient mothers (n = 6) and biological fathers (n = 6) representing 12 donor-oocyte conceived children (10.33 ± 1.23 years; mean ± SD). Of the 12 children, two that were aware and two that were unaware of their conceptual origins completed conversational interviews. Only one family in the initial cohort had disclosed OD to their children by the 12-year follow-up, despite 43% of parents intending to disclose and another 43% undecided about disclosure during pregnancy. Four parental disclosure patterns emerged at 12 years: (i) wanting to disclose; (ii) conflicted about disclosure; (iii) not planning to disclose; and (iv) having disclosed. Children that were unaware of their conceptual origins displayed no knowledge of their method of conception. There is a need for family-centric interventions to assist 'wanting to disclose' parents in their disclosure process and 'conflicted about disclosure' parents in their decision-making process post-OD treatment.