Adolescent-parent relationships similar across donation and IVF families

Psychological well-being and family functioning following identity-release gamete donation or standard IVF: follow-up of parents with adolescent children (Paulin, 2024)

Paulin, J., Widbom, A., Sydsjö, G., Skoog Svanberg, A., & Lampic, C. (2024). Psychological well-being and family functioning following identity-release gamete donation or standard IVF: follow-up of parents with adolescent children. Human Fertility, 27(1). https://doi.org/10.1080/14647273.2024.2375098

Research Question: Do heterosexual-couple parents with adolescent children following identity-release oocyte donation, sperm donation, or standard IVF differ in psychological distress, family functioning, and parent-child relationships?

Design: Fifth wave of data collection (14-18 years after treatment) of a prospective longitudinal study (Swedish Study on Gamete Donation). Parents completed surveys with Hospital Anxiety and Depression Scale (HADS), General Functioning Scale (GF6+), and parent-child relationship measures.

Sample: 205 heterosexual-couple parents of children ages 13-17 years old (73 oocyte donation, 67 sperm donation, 65 IVF/no donor). Most parents still living with co-parent. Most donation parents used identity-release donors. 84.9% of oocyte donation families had disclosed. 94% of sperm donation families had disclosed.

Key Findings:

• No significant differences between donation and IVF parents in psychological distress, family functioning, or parent-child relationships.

• Majority reported normal range anxiety, depression, and family functioning.

• High levels of parent-child closeness reported across all groups.

• Sperm donation mothers showed higher rates of anxiety compared to oocyte donation mothers. The authors suggested this finding may be related to "bystander stress", where sperm donation mothers might experience anxiety about anticipated challenges for the family due to their child's interest in the identity-release sperm donor, particularly regarding potential impacts on father-child relationships. They noted that recent findings showed children's interest in their sperm donor could be challenging for families, especially fathers. In contrast, they explained that egg donation mothers experience and process non-genetic parenthood differently, often feeling reinforced by the gestational bond with the child.

Limitations: Only includes heterosexual couples. Parent-child relationship assessed only from parent perspective. Mothers who hadn't disclosed by the previous follow-up (when children were 7-8 years old) were more likely to drop out of the study, suggesting these rates might be higher than in the general population of donor conception families.

Applications:

• Having a genetic link is not necessary to be a good parent or have a healthy family. Using donor eggs or sperm with identity-release does not harm family relationships over the long term. Parents should expect and prepare for conversations about donors as children grow up.

• Identity-release donation programs can work well for families long-term. Open-identity systems do not negatively impact family relationships or parent wellbeing. Ongoing counseling and support services should be available to donor conception families.

Lead Author: Johan Paulin is a researcher in the Department of Psychology at Umeå University in Sweden.

Regulatory Context:

• Sweden was one of the first countries to implement identity-release donation, passing legislation in 1984 that went into effect in 1985.

• Only altruistic gamete donation is allowed. Donors can receive compensation for expenses and inconvenience, but not payment for the gametes themselves.

• Both sperm and egg donation are permitted. Embryo donation became legal in 2019.

• Same-sex female couples have had access to donor insemination since 2005 and IVF since 2016. Single women gained access in 2016.

• Donation is only allowed at authorized fertility clinics. Private arrangements are not legal.

• All prospective donors and recipients must undergo counseling and medical/psychological screening.

• Donors must be 18 years or older.

• Anonymous donation is prohibited. All donors must agree to be identifiable to offspring.

• Donor-conceived individuals have the legal right to obtain identifying information about their donor when they reach "sufficient maturity," typically interpreted as age 18, though no specific age is mandated by law.

• Parents are encouraged, but not legally required, to tell children about their donor conception. However, the information is recorded in medical records that the child can access as an adult.

• There are restrictions on how many children/families can be created from one donor's gametes, but the exact number can vary between clinics.

• A central register of all donor treatments is maintained by the National Board of Health and Welfare.

• Donors do not have any legal or financial obligations to offspring. They are not considered the legal parents.