Assisted reproduction children grow up just fine

Results from the seventh phase of the University of Cambridge 20-year-long research into donor conceived children have been released.

This Cambridge study examined:

1. The long-term effects of different types of third-party assisted reproduction on parenting and child adjustment. They specifically looked at whether donor conceived children experienced psychological problems, or difficulties in their relationship with their mothers, in early adulthood, and
2. The effect on the quality of the mother–child relationship of the age at which children were told that they were donor conceived.

The research participants:

The donor conceived children in the survey are now young adults, aged 20. Previous assessments took place at age one, two, three, seven, ten and 14.

65 mothers participated in the 2023 study (column A), but not all of their children took part: 19 had to be excluded, 17 of these because they had not been informed about their conception (26%) and 11 elected not to participate (Column B).

This compares to the original number of 143 families that joined the survey in 2003. 55% of them have dropped out over the intervening years. This compares to 35% drop out rate for the Unassisted Conception comparator group.

Focusing solely on the 65 assisted reproduction families that are still participating, 37 (57%) sets of parents had told their child about the nature of their conception by age 7, 11 sets of parents had told their child after age 7, and 17 sets of parents had not disclosed by age 20 (26%). There was a significant difference between family types in whether parents had told their children about their conception by age 20. All the surrogacy parents, 88% of the egg donation parents, but only 42% of the sperm donation parents had done so.

Standardized interviews and questionnaires were administered to mothers and young adults.

The Cambridge findings:

Directly from the report:

• “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.
• “Egg donation mothers reported less positive family relationships than sperm donation mothers.
• “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 seven had less negative relationships with their mothers, and their mothers showed lower levels of anxiety and depression.
• “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.”

Reading this Cambridge study we were left with the following thoughts:

• The modest sample size of course has limitations, which the survey acknowledges.
• There’s most probably a natural positive bias to this research as the families that have continued to participate across the 20 years are likely to be the most engaged and therefore the most positive.
• The survey concludes that the wellbeing and quality of parent relationships of Donor Conceived People (“DCP”) is not significantly different to ‘non-assisted’ offspring – but actually the survey only includes DCP that have been told their origin story. The paper states: “Most of the families who did not remain in the study from the start dropped out in the preschool years due to their concern that participation might jeopardize their decision to keep their child's origins secret.” And in this round young people who hadn’t been told had to be excluded to keep the secret. In total 76% (see 4) below) of the original families are no longer included, most of whom have not told their children. It brought home to us the difficulties of finding out how donor conceived children that don’t know their conception story actually do feel.
• In this age of genetic testing we were initially surprised that the % of parents not telling was so high. But on reflection this does make sense. This survey commenced in 2003 when there was very little research available and no platform to hear DCP voices. And parents that decided not to tell when their child was little then faced the difficult decision of when to tell – you can see why they put it off, some indefinitely. Had these children been born in the last 5 years we expect these numbers would be vastly different.
• We feel it’s important to mention that many DCP do face emotional challenges related to their conception, as set out in our Voices of Donor Conceived People blog. This included people that were told at a young age and those that found out later in life. For example, of the 51 responders to our survey, 13 made references to feeling ‘alone’, and half called for more therapy, counselling or psychological help. But we are conscious our survey isn’t reflective of all DCP – we must acknowledge that many that are totally comfortable with their donor conception might well not think about it often, don’t follow related hashtags or people on social media and hence won’t be aware of surveys or discussions on the subject.
• It’s interesting that the study mentions a previous expectation of poorer wellbeing, according to the report: “The findings overturn previous widely held assumptions that children born by third-party assisted reproduction are at a disadvantage when it comes to wellbeing and family relationships because they lack a biological connection to their parents.”

This study commenced a long time ago. Reading the Cambridge study you’ll see that it references research into relationships between stepparents and children as a relevant comparator. We feel that in most cases the relationship a recipient parent has with their child is so different to that of a stepparent that this is irrelevant. From the report: “. . . empirical studies of stepfamilies which have found stepfathers to be less warm and less involved in disciplining their children than fathers of genetically related children, and stepchildren to show raised levels of emotional and behavioral problems, especially those in stepmother families . . . However, they also reported that stepparents did not view their stepchildren as their own children, and in families with both step and biological children, parents were found to be less affectionate toward, and supportive of, their step than their biological children.”

The report also references adoptive family relationships, setting out that there’s little difference in psychological problems between adopted and non-adopted children. In our view this comparison has its own disadvantages e.g. the age and prior experience of the adopted child clearly impacts future parental relationships.

We think that any study commenced today would not draw parallels between the parental relationships of step and adopted children to those of donor conceived children.

Telling and telling early

The Cambridge finding on telling resonates with us: “Young adults who learned about their biological origins before age seven had less negative relationships with their mothers, and their mothers showed lower levels of anxiety and depression”. Our Donor Conceived friends are unanimous, telling and telling early is important.

Susan Golombok, Professor Emerita of Family Research and former Director of the Centre for Family Research, University of Cambridge, who led the research summed it up: “The assisted reproduction families were functioning well, but where we did see differences, these were slightly more positive for families who had disclosed”.

According to the paper, most of the parents who had disclosed did so by age four and found that the child took the news well.

From the article: “. . . in the final stage of this 20-year study, mothers who had disclosed their child’s origins by seven years old obtained slightly more positive scores on questionnaire 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 seven reported problems in family relationships, compared with 22% of those who disclosed after age seven.

The young adults who had been told about their origins before seven obtained slightly more positive scores on questionnaire measures of parental acceptance (young adult’s perception of mother’s feelings towards them), communication (the extent to which they feel listened to, know what’s happening in their family and receive honest answers to questions), and psychological wellbeing. They were also less likely to report problems on the family relationships questionnaire; whereas 50% of young adults told after age 7 reported such problems, this was true of only 12.5% of those told before age 7.

Reflecting on their feelings about their biological origins, the young adults were generally unconcerned. As one young adult born through surrogacy put it, “It doesn’t faze me really, people are born in all different ways and if I was born a little bit differently - that’s OK, I understand.”

Another young adult born through sperm donation said, “My dad’s my dad, my mum’s my mum, I've never really thought about how anything’s different so, it's hard to put, I don’t really care.”

Some young adults actively embraced the method of their conception as it made them feel special, “I think it was amazing, I think the whole thing is absolutely incredible. Erm…I don’t have anything negative to say about it at all.”

Conclusion

This study highlighted for us the challenge of getting the views of all donor conceived people when you can’t get the views of those that haven’t been told. In our own research we’ve realised it is difficult to find donor conceived people that are so comfortable with their conception that it just isn’t front of mind so they aren’t engaging on social media for example. And lastly, we thoroughly appreciate the difficulties of studying the psychological wellbeing and the quality of parental relationships of those young people that haven’t been told about their donor conception.

We definitely agree with the finding: “It’s better to tell them early about biological origins.” This is consistent with everything we’ve read and indeed said . . . see our blog on 5 reasons to tell your child they are donor conceived.

And of course we advocate using our Magic of You books to help with telling. The books include default, age-appropriate, words (all of which you can edit), to help with the telling.

By Clare McDougall, Sensitive Matters

Photo credit Ben Wicks, Unsplash