Searching for and making genetic connections: recommendations for practice from donor conceived adults in the UK.

RESEARCH QUESTION: What are the support needs of donor conceived individuals who are searching for or open to matching with genetic connections? DESIGN: A total of 88 donor conceived adults in the UK participated in an online survey open between January and August 2022. Participants were asked about their level of awareness of current resource provision, recommendations for resources to support the process of searching for genetic connections, and recommendations for resources to support with feelings about searching for or being found by genetic connections. RESULTS: Participants were found to have varying levels of awareness of the resources available to them, with 39% describing themselves as aware, 41% as partly aware and 20% as unaware. Their recommendations for practical and emotional resources also varied. The most recommended resources for practical support were DNA testing and changes to UK law. The most recommended resources for emotional support were counselling and peer and other support groups. CONCLUSIONS: The impact of legal and technological changes such as direct-to-consumer DNA testing and the legal transition to identifiable donation may be felt by donor conceived individuals irrespective of their year of birth. The wishes of donor conceived individuals for different support resources should be borne in mind by practitioners, regulatory bodies, and policy makers going forward.

Grappling with tradition: the experiences of cisgender, heterosexual mothers and fathers in elective co-parenting arrangements.

Elective co-parenting families, meaning two (or more parents) who are not in a romantic relationship having a child together, are becoming more common amongst cisgender, heterosexual parents. The study of elective co-parenting families offers researchers a unique opportunity to decouple co-parenting relationships from romantic relationships, but little research to date has explored their experiences. This study explored two research questions: why do individuals decide to enter into elective co-parenting arrangements? And how do they manage their co-parenting arrangement and their relationship with their co-parent? Interview data from 10 elective co-parents (5 mothers and 5 fathers) were analyzed according to the principles of reflexive thematic analysis. Sociological theorisations of family practices, family display and family thinking were utilized to make sense of the data. The results centred around two organizing themes ('Reproducing the traditional family' and 'Modernising the traditional family'), and participants experienced a tension between these two ideas. Participants aimed to manage their co-parenting relationship with shared values and friendship, but defining their relationship was complex and gendered parenting patterns were ubiquitous. Findings add nuance to theorisations of family life and demonstrate that traditional parenthood ideologies remain pervasive, as parents aim to imagine and pursue parenthood on their own terms.

The psychosocial outcomes of older parenthood in early to mid-childhood: a mini-review.

Recent decades have seen a global trend towards delaying parenthood, referred to as the 'postponement transition'. Whilst there is plentiful research regarding obstetric and paediatric outcomes related to delayed parenthood, relatively little is known about the psychosocial outcomes associated with advanced parental age during early and middle childhood. This mini-review examines the current literature regarding the psychosocial functioning of families headed by older parents. First, we give an overview of the literature that examines the psychological wellbeing of older first-time parents. We then review the literature regarding the quality of the parent-child relationship in older parent families. Finally, we discuss the psychosocial adjustment and cognitive development of children of older parents. We conclude with suggestions for future research avenues.

Relationships between mothers and children in families formed by shared biological motherhood.

STUDY QUESTION: Does shared biological motherhood, in which a woman gives birth to the genetic child of her female partner, result in more positive mother-child relationships than donor insemination, in which only one mother is biologically related to the child? SUMMARY ANSWER: Mothers in both family types showed high levels of bonding with their children and viewed their relationship with their child positively. WHAT IS KNOWN ALREADY: There is some evidence of feelings of inequality regarding their relationship with their child between biological and non-biological mothers in lesbian mother families formed by donor insemination, with a qualitative longitudinal study showing a tendency for children to form stronger bonds with their biological than their non-biological mother. STUDY DESIGN, SIZE, DURATION: Thirty lesbian mother families created through shared biological motherhood were compared with 30 lesbian mother families formed by donor-IVF. All families had two mothers who both participated in the study, and the children were aged from infancy up to 8 years old. Data collection took place over 20 months beginning in December 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS: Each mother in the family was interviewed separately using the Parent Development Interview (PDI), a reliable and valid measure of the nature of the parent's emotional bond with their child. The interviews were transcribed verbatim and coded separately by one of two trained researchers who were unaware of the child's family type. The interview produces 13 variables that relate to the parent's representations of themselves as a parent, 5 variables that relate to the parent's representations of the child, and a global variable that assesses the extent to which the parent can reflect on the child and their relationship. MAIN RESULTS AND THE ROLE OF CHANCE: Families formed through shared biological parenthood did not differ from families created by donor-IVF in terms of the quality of mothers' relationships with their children as assessed by the PDI. Neither were differences identified between birth mothers and non-birth mothers across the entire sample, or between gestational and genetic mothers within the families formed by shared biological parenthood. Multivariate analyses were conducted to minimize the role of chance. LIMITATIONS, REASONS FOR CAUTION: Ideally, larger samples of families and a narrower age range of children would have been studied, but this was not possible as we were reliant on the small number of families formed through shared biological motherhood in the UK when the study began. To maintain the anonymity of the families, it was not possible to request information from the clinic that may have shed light on differences between those who responded to the request to participate and those who did not. WIDER IMPLICATIONS OF THE FINDINGS: The findings show that shared biological motherhood is a positive option for lesbian couples who wish to have a more equal biological relationship to their children. One type of biological connection does not appear to have a greater influence on the quality of parent-child relationships than the other. STUDY FUNDING/COMPETING INTEREST(S): This study was funded by the Economic and Social Research Council (ESRC) grant ES/S001611/1. KA is Director, and NM is Medical Director, of the London Women's Clinic. The remaining authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER: N/A.

Families created via identity-release egg donation: disclosure and an exploration of donor threat in early childhood.

RESEARCH QUESTION: What are mothers' disclosure intentions and practices from infancy to early childhood, and is perceived donor threat associated with disclosure in identity-release egg donation families when the children are aged 5 years? DESIGN: This longitudinal study included 73 heterosexual-couple families with infants born following IVF-egg donation at phase one, and 61 families with 5-year-old children at phase two. At both phases, mothers were interviewed about their disclosure intentions and practices. At phase two, mothers were interviewed about their feelings about future donor-child contact. RESULTS: Most mothers (75.3%) intended to disclose their use of egg donation to their children at phase one; half had begun to do so when their children were aged 5. Most remaining mothers planned to tell, although a minority were uncertain or planned not to disclose. When the child was aged 5, four mothers had started telling them that they could access their donor's identifying information at age 18, and most (84%) intended to do so in the future. Most couples agreed on a disclosure strategy at phase two. Most mothers perceived at least some threat from future donor-child contact, but this was unrelated to their disclosure practices. CONCLUSIONS: Disclosure intentions in infancy are borne out in early childhood. Despite perceiving some threat from future donor-child contact, most mothers intended telling their child that they could access the donor's identifying information at age 18. Revisiting these families as the children grow older will be important to understand how the mothers' perceived donor threat may change over time, and how this is related to family processes.

An exploration of parental age in relation to parents' psychological health, child adjustment and experiences of being an older parent in families formed through egg donation.

RESEARCH QUESTION: Is parental age associated with parents' psychological health, couple relationship satisfaction and child adjustment in egg donation families, and how do parents think and feel about their age in relation to parenting? DESIGN: Seventy-two families with a child born after IVF egg donation were included. Mothers were aged between 32 and 51 years and fathers between 31 and 61 years when the target child was born. When the child was aged 5 years, parents were interviewed and asked to complete questionnaire assessments of parenting stress, anxiety, depression, marital quality and child adjustment. RESULTS: Older parents experienced more parenting stress and poorer couple relationship quality than younger parents. No differences were found for child adjustment. Qualitative content analysis of the interviews revealed themes related to 'health and mortality', 'giving and receiving support', 'treatment and age', 'positive aspects of older parenting' and 'other'. CONCLUSIONS: This exploratory study found that older parents experienced greater parental stress and poorer relationship quality. Some parents had concerns about their older age, specifically in relation to their health and mortality. It would be important to follow up these families as the child grows older to understand the child's thoughts and feelings about having older parents. Furthermore, findings should be replicated in a larger sample of families formed through egg donation, which includes more younger mothers who have used egg donation.

Adoptive Gay Father Families: A Longitudinal Study of Children's Adjustment at Early Adolescence.

Findings are presented from the second phase of a UK longitudinal study of 33 gay father, 35 lesbian mother, and 43 heterosexual parent families when their adopted children reached early adolescence. Participants predominantly lived in urban/suburban areas and were mostly white and well-educated. Standardized interviews, observations, and questionnaires of parental mental health, parent-child relationships, and adolescent adjustment were administered to parents, children, and teachers between 2016 and 2018. There were few differences between family types. However, adjustment problems had increased in all family types, with better parenting quality and parental mental health associated with fewer adjustment problems. The findings contribute to adoption policy and practice, and to theoretical understanding of the role of parental gender in child development.

Father-child attachment in adoptive gay father families.

The attachment security of children in 30 gay father families, 29 lesbian mother families and 38 heterosexual parent families was investigated using the Friends and Family Interview (FFI) at the second phase of a longitudinal study. Children in gay father families showed significantly higher levels of secure-autonomous attachment than children in heterosexual parent families, significantly lower levels of preoccupied attachment than children in either lesbian mother or heterosexual parent families, and significantly lower levels of disorganised attachment than children in heterosexual parent families. For children in gay father families, stepwise multiple regression revealed that neither hyperactivity nor emotional symptoms at Phase 1 were predictive of disorganisation at Phase 2. However, when entered alone, Phase 1 emotional symptoms predicted Phase 2 disorganisation. The results indicate that adopted children in gay father families are at least as likely to be securely attached as children in lesbian mother or heterosexual parent families.

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 role of age of disclosure of biological origins in the psychological wellbeing of adolescents conceived by reproductive donation: a longitudinal study from age 1 to age 14.

BACKGROUND: The question of whether children should be told of their biological origins is one of the most controversial issues regarding the birth of children through donated eggs, sperm, embryos or surrogacy. METHODS: In the sixth phase of this longitudinal study when the children were aged 14 years, family relationships and adolescent adjustment were examined in 87 families created through reproductive donation and 54 natural conception families. The quality of family relationships was assessed by standardised interview with mothers and by standardised questionnaires and an observational measure with mothers and adolescents. Adolescent adjustment was assessed using standardised questionnaires. Systematic information on whether and when parents had told children about their biological origins was obtained at earlier phases of the study. RESULTS: There were no overall differences between disclosing families and either nondisclosing or natural conception families. However, within the disclosing families, more positive family relationships and higher levels of adolescent wellbeing were found for adolescents who had been told about their biological origins before age 7. CONCLUSIONS: The earlier children born through reproductive donation are told about their biological origins, the more positive are the outcomes in terms of the quality of family relationships and psychological wellbeing at adolescence.

The long-term experiences of surrogates: relationships and contact with surrogacy families in genetic and gestational surrogacy arrangements.

This study examined the contact arrangements and relationships between surrogates and surrogacy families and whether these outcomes differed according to the type of surrogacy undertaken. Surrogates' motivations for carrying out multiple surrogacy arrangements were also examined, and surrogates' psychological health was assessed. Semi-structured interviews were administered to 34 women who had given birth to a child conceived through surrogacy approximately 7 years prior to interview. Some surrogates had carried out multiple surrogacy arrangements, and data were collected on the frequency, type of contact, and surrogate's feelings about the level of contact in each surrogacy arrangement, the surrogate's relationship with each child and parent, and her experience of, and motivation for, each surrogacy. Questionnaire measures of psychological health were administered. Surrogates had completed a total of 102 surrogacy arrangements and remained in contact with the majority of families, and reported positive relationships in most cases. Surrogates were happy with their level of contact in the majority of arrangements and most were viewed as positive experiences. Few differences were found according to surrogacy type. The primary motivation given for multiple surrogacy arrangements was to help couples have a sibling for an existing child. Most surrogates showed no psychological health problems at the time of data collection.

The Donor Conception Identity Questionnaire: associations with mental health and searching for and finding donor connections.

OBJECTIVE: To understand how the Donor Conception Identity Questionnaire (DCIQ) correlates with mental health and explore differences in the DCIQ between donor conceived people who were actively searching for donor connections to those who were not and those who had found their donor connections to those who had not. DESIGN: Cross-sectional survey. SETTING: Online survey conducted within United Kingdom. PATIENT(S): A total of 88 donor conceived adults ranging in age from 18 to 70 (mean, 34.27 years; median, 31 years). A total of 39 participants were actively searching for their donor connections, and 49 were not. INTERVENTION(S): Donor conception identity was measured using a questionnaire and scores were correlated with existing measures of mental health. MAIN OUTCOME MEASURE(S): Participants completed the DCIQ and measures of well-being, satisfaction with life, identity, pride, and stigma. RESULT(S): Factor analysis of items from the DCIQ identified four domains: concern and preoccupation; internalized stigma; pride and acceptance; and openness and understanding. The identified factors correlated with scales of psychological and social well-being. Active searchers scored higher than non-active searchers on "concern and preoccupation" and "internalized stigma". Donor conceived individuals who had found their donor connections scored lower on "internalized stigma" and higher on "openness and understanding" compared with those who had not found their donor connections. CONCLUSION(S): The findings of the present study show that scores on the DCIQ correlate with existing measures of psychological and social well-being. Furthermore, donor conceived individuals searching for their donor connections differ from those not actively searching on key domains of the DCIQ. Implications for future avenues of study and support for donor conceived people are discussed.

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.

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.

A longitudinal study of families formed through third-party assisted reproduction: Mother-child relationships and child adjustment from infancy to adulthood.

The seventh phase of this longitudinal study investigated whether children born through third-party assisted reproduction experienced psychological problems, or difficulties in their relationship with their mothers, in early adulthood. The impact of disclosure of their biological origins, and quality of mother-child relationships from age 3 onward, were also examined. Sixty-five assisted reproduction families, including 22 surrogacy families, 17 egg donation families, and 26 sperm donation families, were compared with 52 unassisted conception families when the children were aged 20. Less than half of the mothers had completed tertiary education and less than 5% were from ethnic minority backgrounds. Standardized interviews and questionnaires were administered to mothers and young adults. There were no differences between assisted reproduction and unassisted conception families in mothers' or young adults' psychological well-being, or the quality of family relationships. However, within the gamete donation families, egg donation mothers reported less positive family relationships than sperm donation mothers, and young adults conceived by sperm donation reported poorer family communication than those conceived by egg donation. Young adults who learned about their biological origins before age 7 had less negative relationships with their mothers, and their mothers showed lower levels of anxiety and depression. Associations between parenting and child adjustment did not differ between assisted and unassisted reproduction families from ages 3 to 20. The findings suggest that the absence of a biological connection between children and their parents in assisted reproduction families does not interfere with the development of positive mother-child relationships or psychological adjustment in adulthood. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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).

Solo Fathers and Mothers: An Exploration of Well-Being, Social Support and Social Approval.

Research has begun to explore the experiences of single mothers by choice who choose to start a family alone and do so using donated gametes. However, very little is known about the experiences of single fathers by choice, and even less is known about how their experiences might compare to mothers in the same position. This exploratory study of single mothers (n = 19) and fathers (n = 17) by choice examined mental health and social support among mothers who used sperm donation, and fathers who used egg donation and surrogacy, to become parents. Data relating to their reasoning for pursuing solo parenthood, mental health, and social support were analyzed quantitatively. To further explore fathers' experiences of being a solo parent, a thematic analysis was conducted exploring their descriptions of social responses to their family type. Regarding parental mental health, no statistically significant differences were found between mothers and fathers, and both groups of parents had sought out supportive networks, both before becoming a parent, and as a single parent. Fathers' responses indicated that they received both supportive and negative reactions, although they generally perceived the majority of interactions to be positive. However, frequent references made by members of the public, or by the media, to their family type being new or different served to reproduce social scripts about normative family types. The study findings, despite the small sample size, contribute to a new understanding of the well-being and experiences of both mothers and fathers who choose to start their family and parent alone.

Secrecy, disclosure and everything in-between: decisions of parents of children conceived by donor insemination, egg donation and surrogacy.

This study examined families where children lack a genetic and/or gestational link with their parents. A total of 101 families (36 donor insemination families, 32 egg donation families and 33 surrogacy families) were interviewed when the child was aged 7 years. Despite a shift in professional attitudes towards openness, about half of the children conceived by egg donation and nearly three-quarters of those conceived by donor insemination remained unaware that the person they know as their mother or father is not, in fact, their genetic parent. By contrast, almost all the surrogacy parents had told their child how they were born. A majority of parents who planned never to tell their child about their conception had told at least one other person. However, qualitative data indicated that to categorize families as 'secret' or 'open' is inadequate. In fact many parents engage in 'layers' of disclosure about their child's conception, both with their child and with family and friends.

Cross-border and domestic surrogacy in the UK context: an exploration of practical and legal decision-making.

This study aimed to explore UK intending parent's reasons for cross-border and domestic surrogacy, their preparations for the birth and the practical and legal challenges faced after the birth. An online survey was completed by 203 participants, of which 132 had a child born through surrogacy, 33 were in the process of surrogacy and 38 were planning a surrogacy arrangement. The most common reason for pursuing surrogacy in the UK was wanting a relationship with the surrogate (43%; n = 17) and for conducting surrogacy in the USA was because of a better legal framework (97%; n = 60). Parents returning to the UK from countries other than USA experienced greater delay and difficulties in obtaining the necessary documents for their return. This study highlights the disparities in parents' experiences of undergoing surrogacy in different countries, the frustrations some face in obtaining legal parenthood and the feelings of stress and anxiety this may cause. Whilst this is the first study comparing the experiences of people from the UK having surrogacy in different countries, the representativeness of the sample is unknown. The findings are important in identifying future directions for research, including assessing the impact of these early decisions and experiences for later parental wellbeing and children's welfare.

Experiences of offspring searching for and contacting their donor siblings and donor.

This study investigates a new phenomenon whereby individuals conceived by donor insemination are searching for and contacting their donor and/or 'donor siblings' (i.e. donor offspring conceived by the same donor who are their genetic half siblings). On-line questionnaires were completed by members of the Donor Sibling Registry (DSR), a US-based registry that facilitates contact between donor conception families who share the same donor. Of the 165 donor offspring who completed the survey, 15% were searching for their donor siblings, 13% were searching for their donor, and 64% were searching for both. Differences were found according to family type and age of disclosure. Fewer offspring from heterosexual couple families had told their father about their search when compared with offspring from lesbian couple families who had told their co-parent. Offspring who had found out about their conception after age 18 were more likely to be searching for medical reasons, whereas those who had found out before age 18 tended to be searching out of curiosity. Some offspring had discovered large numbers of half siblings (maximum=13). The majority of offspring who had found their donor relations reported positive experiences and remained in regular contact with them.