Assisted reproduction and family functioning

An estimated one in seven couples experience infertility, and an ever increasing proportion of these couples turn to assisted reproductive technologies as a solution to their childlessness. Many new and often complex family relationships have emerged as a result. It is now possible for a child to have five parents – an egg donor, a sperm donor, a surrogate mother who hosts the pregnancy and the two social parents whom the child knows as mum and dad.

Despite the obvious advantages to parents who have waited for so long to conceive a child, several questions have been raised about potential psychological difficulties for children born as a result of these new reproductive techniques. A major concern relates to the child’s lack of a genetic and/or gestational link with one or both parents, and the impact on parent–child relationships: will parents feel or behave less positively towards a non-genetic or non-gestational child?

Another concern is that the majority of children conceived by egg or sperm donation remain unaware that the person they know as their father or mother is not, in fact, their genetic or gestational parent. Is secrecy about their origins detrimental to children, placing them at risk for psychological problems in the future?

New family forms

A team from the Centre for Family Research led by Professor Susan Golombok, comprising Polly Casey, Lucy Blake, Jennifer Readings and Dr Vasanti Jadva, has been conducting a longitudinal study of parent–child relationships and the psychological well-being of parents and children in families created by assisted reproductive technologies. Donor insemination families (where the child lacks a genetic link with the father), egg donation families (where the child lacks a genetic link with the mother) and surrogacy families (where the child lacks a gestational link with the mother and sometimes a genetic link as well) are being compared with families with a naturally conceived child.

The study, funded by the US National Institutes of Health (NIH), began when the children were one year old, with the most recent phase conducted at age seven. Assessments of family relationships and child development were made alongside children’s growing understanding of the meaning of reproductive origin: genetic or gestational.

The results so far show that the assisted reproduction families appear to be functioning well: the parents have positive relationships with their children and the children themselves are well adjusted. Assisted reproduction mothers displayed a slight tendency to be more emotionally over-involved with their children than mothers of naturally conceived children. This refers to the extent to which mothers are over-concerned or inhibiting towards their children. Furthermore, mothers of egg donation and surrogacy children were found to be more sensitive to the needs and anxieties of their children, all of which may reflect a more involved parenting style.

Secrecy versus disclosure?

Family therapists and researchers in the area of adoption have argued that secrecy may damage communication between family members, creating a divide between those who know the secret (the parents) and those who do not (the child). As a result, legislation in the UK has recently changed to allow donor-conceived children to obtain identifying information about their donor on reaching age 18. However, little is known about children who are aware of their donor conception, largely because so few have been told about their genetic origins.

At the beginning of this study, approximately half of the gamete donation parents and all of the surrogacy parents intended to be open with their child about the nature of the conception. But, by the time the children were aged seven years, the majority of egg donation and donor insemination parents had not yet told their child about their donor conception.

Rising nines

The project enters its next phase as the children reach nine years of age, and the team hopes to continue to follow up the families for as long as possible. Longitudinal studies such as this are essential, and yet to date there are few in this research area. Over time, more parents may tell their child about the nature of their birth, allowing the impact of secrecy or disclosure to be investigated in more detail. Also, as the children get older, they will develop an increasingly more sophisticated understanding of the circumstances of their birth, and it will become ever more important to monitor parent–child relationships and the well-being of all involved.

For more information, please contact the author, Polly Casey (pc371@cam.ac.uk), at the Centre for Family Research in the Faculty of Social and Political Sciences. These findings were reported at the Annual Conference of the European Society for Human Reproduction and Embryology in Barcelona in 2008, winning the Fertility Society of Australia Exchange prize for best presentation.