Assisted reproduction kids grow up just fine, according to a study following the impact of third party-assisted reproduction on parenting and child adjustment all the way from infancy to adult life. The study, led by the Centre for Family Research at the University of Cambridge, reported "no difference in psychological wellbeing or quality of family relationships" at age 20 between children born by assisted reproduction and those born naturally.
These results are the latest phase of a long-term follow-up study that previously reported assessments at child ages 1, 2, 3, 7, 10, and 14, and its findings on outcomes overall are consistent with those, the team said.
Donor-conceived children now account for 1 in 170 births, with the number of children born from sperm donation more than tripled since 2006, according to a recent report by the Human Fertilisation and Embryology Authority (HFEA).
Best to Tell Children Before They Start School
Their study, published in Developmental Psychology, is also the first to investigate prospectively the effect of the age at which children were told about their conception. "Findings suggest that telling children about their biological origins early – before they start school – can be advantageous for family relationships and healthy adjustment," the researchers said.
The researchers followed 65 UK families with children born by assisted reproduction – 22 by surrogacy, 17 by egg donation, and 26 by sperm donation – and compared them with 52 families with children born by unassisted conception over the same period. All the families had two heterosexual parents at the outset.
There were no differences between families formed by egg donation, sperm donation, surrogacy, or unassisted conception in maternal anxiety or depression, the quality of parental or family relationships, positive or negative parenting, mothers' acceptance of their adult children, or the openness of family communications. Nor were there any differences in the young adults' psychological adjustment, perceptions of maternal acceptance, or quality of family relationships.
"The absence of a biological connection between children and parents in assisted reproduction families does not interfere with the development of positive relationships between them, or [with] psychological adjustment in adulthood," the authors said.
Really Wanting Children 'Trumps Everything'
These results overturn previous widely held assumptions, which were partly based on studies of stepchildren and adopted children.
Lead researcher Susan Golombok, professor emerita of family research at Cambridge, said: "Today, there are so many more families created by assisted reproduction that it just seems quite ordinary. But 20 years ago, when we started this study, attitudes were very different. It was thought that having a genetic link was very important and without one, relationships wouldn’t work well.
"What this research means is that having children in different or new ways doesn't actually interfere with how families function. Really wanting children seems to trump everything – that's what really matters.
"Despite people's concerns, families with children born through third-party assisted reproduction – whether that be an egg donor, sperm donor, or a surrogate – are doing well right up to adulthood."
The authors further explained: "It seems that the absence of biological relatedness is not in itself detrimental to positive family relationships for children who are raised by their non-biological parents from the start. Instead, in such families, it appears that the absence of a biological link matters less for children than the quality of family relationships."
The only exceptions were that, within the gamete donation families, egg donation mothers, but not the adult children themselves, reported less positive family relationships than sperm donation mothers, whereas young adults conceived by sperm donation reported poorer family communication than those conceived by egg donation.
These results replicated findings from the adolescent phase of the study, and was attributed by the authors to "the absence of a genetic link between mothers and their children presenting greater difficulties for mother-child relationships than the absence of a genetic link between fathers and their children".
Maternal Insecurities and Paternal Secrecy
Perceptions of poorer family functioning among mothers of genetically unrelated adult children possibly reflected their insecurities as mothers, they said, while the poorer family communications reported by sperm donor children was in line with their previous findings of "parents' greater secrecy about sperm donation than egg donation. This is sometimes driven by the greater reluctance of fathers than mothers to disclose to their child that they are not their genetic parent, and their greater reluctance to talk about it once they have disclosed".
Children had been told about the nature of their conception by age 7 in 37 families, and when older in 11 families, while 17 sets of parents had not disclosed this information to the child by age 20 – 15 of which were children from donor insemination. Only 42% of sperm donor parents had disclosed the method of contraception to the child by the time they reached age 20, compared with 88% of egg donation parents and 100% of surrogate parents.
Early Disclosure Benefits Both Children and Parents
Mothers who had told their children about their biological origins in the preschool years had more positive relationships with them at age 20, and showed lower levels of anxiety and depression. Those who had disclosed their child's conception method by age 7 had slightly more positive scores on measures of quality of family relationships, parental acceptance (mother's feelings towards young adult), and family communication. For example, only 7% of mothers who had disclosed by age 7 reported problems in family relationships, compared with 22% of those who disclosed after age 7.
Findings for the young people themselves mirrored this – those who had been told about their origins before age 7 had slightly more positive scores for parental acceptance (young adult's perceptions of mother’s feelings towards them), communication (the extent to which they felt listened to, knew what was happening in their family, and received honest answers to questions), and psychological wellbeing. Whereas 12.5% of those told before age 7 reported problems on the family relationships questionnaire, 50% of those told after age 7 did so.
"There does seem to be a positive effect of being open with children when they're young – before they go to school – about their conception. It's something that's been shown by studies of adoptive families too," said Prof Golombok. "The assisted reproduction families were functioning well, but where we did see differences, these were slightly more positive for families who had disclosed."
The authors noted: "Parents of children born through third-party assisted reproduction who are open with their children about their biological origins at an early age no longer need to worry about their child's reaction to disclosure, or about keeping this information secret. Thus, telling children about their origins when they are young may be beneficial to both children and parents."
Later Life Discovery Potentially 'Emotionally Damaging'
The HFEA concurred with the study's findings, and warned that: "Finding out suddenly in later life can be emotionally damaging to donor-conceived people and their families". Its current consultation on possible regulatory changes to assisted reproduction laws notes that the effects of direct-to-consumer DNA testing and matching services have "revolutionised" people's ability to find their genetic relatives. This, combined with the availability of identifiable personal information on the internet, particularly social media, has allowed many donors and donor-conceived people to be identified to each other, whether directly or by inference.
At present, children conceived from 2005 can request donor information from the HFEA when they reach age 18. This does not reflect "the current professional advice that children benefit from learning from a young age that they have been conceived using donor gametes", the HFEA said.
It proposed that while parents "should continue to decide when or if to tell their child about their donor-conceived status", and fertility clinics should continue to "encourage" disclosure, they should also "be required by law to inform donors and recipients of the potential for donor identity to be discovered through DNA testing websites".
Asked to comment by Medscape News UK, Clare Ettinghausen, director of strategy and corporate affairs at the HFEA said: "Parents will choose whether to tell their children about their donor conception. The expert advice is to be open with donor conceived individuals from an early age."
Information on how to get support on decision-making and information sharing can be found on the HFEA website.
"Our Code of Practice also clearly sets out that when people seek treatment using donated eggs, sperm, or embryos, they must be given information about the importance of telling any resulting child, at an early age, of their donor-conceived origins, and suitable methods of telling the child this."
The research was funded by a Wellcome Trust Collaborative Award. The authors declared no conflicts of interest.