Child development and parent-child relationships in assisted reproduction families

The recent presentation of our interim findings for our study of assisted reproduction families, at the ESHRE annual meeting in Barcelona in July, has generated a large amount of national and international press attention, suggesting a growing interest in the outcomes for children born through assisted reproduction technologies. Gamete donation and surrogacy are very topical at the moment, particularly in the UK, with the recent legislative change to remove donor anonymity, and the as yet unresolved controversy over whether or not to legislate to force parents who have children via egg or sperm donation to register the fact on the birth certificate. Furthermore, on an international level, European countries still differ considerably in their policy approaches to donor conception and surrogacy.

In our presentation, given by Polly Casey, we reported on findings gathered from interviews and questionnaires with parents and children in different types of assisted conception family and a control group of natural conception families. We found that there were surprisingly few differences between egg donation, donor insemination (DI) , surrogacy and natural conception families in terms of family relationships and parent and child psychological wellbeing. The small differences we did find appeared to reflect slight over-involvement and higher levels of sensitivity of egg donation and surrogacy mothers towards their children. We suggested that this may reflect a slightly more involved parenting style by mothers by assisted conception, for whom parenthood has been long-awaited.

Although the study has to a large extent been reported fairly and accurately by the media, I think it is important to emphasise that we presented only interim results (a total of 80 families) as the research is ongoing, and it must therefore be admitted that when all analyses are complete different conclusions may be reached. In addition, it is worth emphasising that it is a longitudinal study, begun at age nine months, and that we intend to follow the families as their children grow older. Some people interviewed in relation to our study, such as Diane Allen from the Toronto-based Infertility Network, have expressed concern that it may be too soon to draw positive conclusions for donor conception and surrogacy children, who at seven years old are not yet old enough to fully understand the implications of the genetic or gestational link missing with their parent. We entirely appreciate these concerns, and would not claim that our results show anything more than good family functioning at age seven. It is for future stages of this project to tell us about the outcomes for children as they get older. For those children who have been told about their conception, it is reasonable to suppose that as they grow older, and in particular in their teenage years, the information they were told as a young child may come to have a different significance to them than it does currently.

In addition, at the time of interview, only 39 per cent of egg donation parents, 29 per cent of donor insemination parents, and 89 per cent of surrogacy parents had been told about their donor conception, and many parents planned to tell their children at a future date. It will be particularly interesting to see the outcomes for those children who are told later on. A co-author of our paper, Dr Vasanti Jadva, presented a second study at the ESHRE meeting, relating to age of telling amongst donor conception children, conducted through online interviews with members of the Donor Siblings Registry. She reported that children who were told at an early age express less shock and anger than those told after the age of 18. Whilst some press articles represented these findings as 'All children should be told before the age of four', neither of these two studies argue either for telling or not telling. In our study, some small differences were found between assisted conception children who had been told and those who had not on the 'emotional difficulties' subscale of the Strengths and Difficulties Questionnaire, as completed by teachers. However it is far too early to say that these findings support telling all children of their donor conception.

It is very pleasing for us that our study has generated so much interest, but from a broader perspective that the psychology section of the ESHRE meeting was so very well attended, suggesting that perhaps the psychological aspects of infertility and fertility treatment are being taken more seriously now than they have been in the past. It is, we believe, very important that all developments in assisted reproduction are accompanied by studies of the wellbeing of the parents and children involved.