A controlled study of the psycho-social development of children conceived following insemination with donor semen

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.

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.

Children of the new reproductive technologies: social and genetic parenthood

OBJECTIVE

To review empirical studies on families created by new reproductive technologies (NRT) in which only one parent has a genetic link to the child.

METHODOLOGY

Literature search was conducted among computerized databases. Inclusion criteria were that studies should focus on childrearing or parenting, as well as on the psychological adjustment of children in: heterosexual families formed through artificial insemination with donated semen (AID), single-mother AID families, oocyte-donation families, planned lesbian-mother families, planned gay-father families, and partial surrogacy families.

RESULTS

Compared to natural-conception parents, parents in these NRT families have better relationships with their children, and their children are functioning well.

CONCLUSION

Although several studies show that parents in NRT families are more emotionally involved in their parenting than are parents in naturally conceived families, no empirical evidence was found that the psychological adjustment of children in NRT families differs from that of their counterparts in natural-conception families. PRACTICAL IMPLICATION: The results inform counselors and infertile couples that concerns regarding the use of NRT in relation to negative consequences for the parent-child relationship or the psychological adjustment of the child are till now unfounded.

Practitioner review: outcomes for parents and children following non-traditional conception: what do clinicians need to know?

BACKGROUND

The birth of the first 'test-tube' baby in 1978 has led to the creation of family types that would not otherwise have existed.

METHODS

This paper examines research on the psychological outcomes for parents and children in assisted reproduction families with particular attention to the issues and concerns that have been raised by creating families in this way.

RESULTS

Parents of children conceived by assisted reproduction appear to have good relationships with their children, even in families where one parent lacks a genetic link with the child. With respect to the children themselves, there is no evidence of cognitive impairment in singleton children born at full term as a result of assisted reproduction procedures, although the findings regarding the cognitive development of intracytoplasmic sperm injection (ICSI) children are currently unclear. In relation to socioemotional development, assisted reproduction children appear to be functioning well.

CONCLUSIONS

Few studies have included children at adolescence or beyond, and little is known about the consequences of conception by assisted reproduction from the perspective of the individuals concerned. In addition, there are some types of assisted reproduction family, such as families created through a surrogacy arrangement or through embryo donation, about whom little is known at all. Although existing knowledge about the impact of assisted reproduction for parenting and child development does not give undue cause for concern, there remain a number of unanswered questions in relation to children born in this way.

Families from assisted conception: ethical and psychological issues

This article gives the findings of an in-depth study of the outcome for parents and children after assisted conception, namely in vitro fertilization and donor insemination. The study is of 54 families bringing up 110 children, 74 of whom were the result of these two medical interventions. The findings presented in this article deal specifically with the psychological issues and ethical dilemmas experienced by the parents of these two groups. Specific areas regarding in vitro fertilization are use of the term 'test-tube baby'; religious and community attitudes to the use of assisted reproductive technology; and the effects of these attitudes on the families. The major issue of multiple births and their social outcomes is dealt with in the following article. The specific areas for donor insemination families are secrecy and reticence about the whole procedure; infertility as a continuing taboo subject; donor anonymity; and the resulting effect of donor anonymity on parenting children who do not have access to their full health and genetic family history. Reference is made to the findings of other relevant research. Practice and legal implications from the findings are presented.

Gamete donation and anonymity: should offspring from donated gametes continue to be denied knowledge of their origins and antecedents?

This paper presents the case for a change from the current practice of anonymity and secrecy in the use of donated gametes in medically assisted conception. It does so by describing history of the practice, various committees of enquiry over the years, their recommendations for consideration of the children created and the need for follow-up of the outcome; presenting the evidence from outcome studies both about child development and family relationships where secrecy is maintained about the child's origin and those where the practice is openly to acknowledge their origins. This is followed by an analysis of the experience and views of these children once they are adults. In discussion of the composite findings recurring themes emerge. From this it is concluded that offspring from donated gametes should not continue to be denied knowledge of their origins and antecedents. In the public debate, four schools of thought are identified. Possible practical scenarios to implement change are discussed. This paper argues that the fundamental issue regarding any of these remains-that priority in decision-making should be the lifelong well-being of the children being created.

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Since the 70 years approximately 50 000 children have been born in the Federal Republic of Germany after artificial insemination by donor. The most studies of substantial collectives describe an inconspicious mental and emotional development of the children. However, due to examinations of Special cases, negative effects on the development of the children are expected as a result of the behaviour of social fathers to keep the insemination secret and to turn away from them. In a follow-up study six years after the treatment of insemination 22 successful couples of parents of originally 57 couples (before insemination) could be reexamined. They rated their children by a detailed interview, as well as by a variant of the repertory grid technique, which permits an estimation of object relations. Under an idiographic aspect, the use of the repertory grid technique made it possible to learn the individual meaning of the children to the respective couple. As a group examination it allowed generalizable Statements to judge the children in relation to the self-image of the parents. The major part of the parents judged their children as "close" to their seif and their self-ideal. Any indication of retreat by social fathers could not be given.

Parenthood motives in IVF-mothers

This is an exploratory study to answer two questions: (1) does in-vitro fertilization (IVF)-mothers' motivation for parenthood differ from the naturally conceiving mothers' motivation for parenthood? and (2) are IVF-mothers' parenthood motives correlated with their adjustment to parenthood (in the same way as they are for naturally conceiving mothers)? The study sample consisted of 31 mothers with a 24-30 month old, single-born child conceived by homologous IVF and a comparison group of 31 mothers with a naturally conceived child. Self-rating questionnaires were used. Overall, the parenthood motivation pattern was quite similar for IVF-mothers and mothers by natural conception. However, 'identity', 'motherhood' and 'social control' were significantly more important motives for IVF-mothers than for the naturally conceiving mothers. The two former motives remained more important for IVF-mothers when findings were adjusted for the influence of the mothers' age and educational level. Possible explanations for these findings refer to the infertility history. Overall, few correlations between parenthood motives and the adjustment to parenthood were significant, both for the IVF-mothers and for the mothers by natural conception. Further (hypothesis-testing) research is needed to support these findings.

The European study of assisted reproduction families: a comparison of family functioning and child development between Eastern and Western Europe

Developments in reproductive technology over the past 20 years have given infertile couples new opportunities to have children. Although assisted reproduction does not appear to lead to negative consequences with respect to parent-child relationships or the socioemotional development of the child, the outcome for children and their parents may well differ according to the social and cultural environment. The aim of the present study was to compare family functioning and the social and emotional development of children in families created as a result of assisted reproductive techniques in Western Europe with assisted reproduction families in an Eastern European country (Bulgaria) where there is a history of specific pronatalist interventions. The findings indicate greater difficulties in parental adjustment and child behavior in assisted conception families in Eastern Europe. In addition, Eastern European parents were more uncertain than Western European parents about whether they would tell the child, and Eastern European parents were much more secretive with respect to telling others. Thus the outcomes of assisted reproduction for family functioning and child development appear to be independent, to some extent at least, on the social context in which these techniques are carried out.

Assisted reproduction: a reassuring picture

Many couples seek solutions to problems of infertility by using assisted reproduction techniques. Despite very different beginnings, children conceived after donor insemination, ovum donation, in-vitro fertilisation or gamete intrafallopian transfer show no adverse long term effects, either physically or psychosocially.

Donor insemination, the impact on family and child development

The practice of donor insemination (DI) has undergone major changes in the past 20 years. Attention was paid to the long-term psychological effects, the pleas for openness became stronger over the years and the use of anonymous donors became subject to public debate in several countries. The present article reviews what empirical research there is into DI families and their children. Over the years follow up studies have appeared sporadically and in spite of the varying quality of the research methods, preliminary findings have emerged. Research into the confidentiality issue in DI couples revealed that 47-92% of the DI parents intended to keep the donor origin secret from their children. DI couples just starting treatment more often intended to tell their children the DI origin than those who already had children. It is, however, too early to tell whether the public pleas for more openness did affect attitudes of the DI patients themselves. Research into the psychological well-being of DI parents and children failed to reveal major psychological problems. DI parents appeared to be well adjusted and to have stable marital relationships. DI children did not show significantly more emotional disturbances than controls. The quality of the parent-child relationship was better in the DI group than in the controls of naturally conceived parents.

New reproductive technology and the family: the parent-child relationship following in vitro fertilization

Parent-child relationships and the parents' psychosocial functioning were assessed in families with a 24-30-month-old, single born child conceived by homologous in vitro fertilization (IVF) and in a control group of families with a naturally conceived child. The investigation included behavioural observations of mother-child interactions in the home, and self-rated questionnaires. No significant multivariate group effects were found for indicators of the parent-child relationship, nor for the parents' psychosocial functioning. However, in the case of IVF the employment status of the mother was associated with her behaviour towards her child: employed IVF-mothers showed less respect for their child's autonomy compared with both nonemployed IVF-mothers and employed control mothers.

Families created through ovum donation: a preliminary investigation of obstetrical outcome and psychosocial adjustment

PURPOSE

This study attempted to obtain preliminary follow-up information regarding obstetrical outcomes and the psychosocial well-being of families created through the ovum donation. There is presently very little known about this population with respect to obstetrical care, health status of offspring, family and marital relationships of recipient couples, or how couples feel about having chosen ovum donation as a family-building option.

RESULTS

Fifty-nine couples were initially surveyed and, ultimately, extensive information was obtained for 30 husbands, 31 wives, and 51 offspring. There was a very high percentage of cesarean section deliveries (81.6%), and although a few children experienced health problems at birth, they are all now in good health and developmental milestones are within normal limits. Information was also obtained about breast-feeding experiences, choice of donor (known [sister] or anonymous), reasons for choosing ovum donation over other parenting options, and the impact of this choice on marital and family relationships. Demographic data were also obtained.

CONCLUSIONS

For many infertile couples, the long struggle to become parents culminated in a successful birth, and the experience of pregnancy seemed to meet a need to be both biological and psychosocial parents. In general, subjects were extremely cooperative with the investigation and they indicated a desire to learn as much as possible about the psychosocial status of families created through ovum donation. As the assisted reproductive technologies move rapidly into the 21st century, it now seems imperative that health and mental health professionals gain more knowledge about the impact of third party reproduction and the psychosocial adjustment and well-being of families created by this medical technology.