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Embryo donation raises unique challenges for donors, recipients, and the resultant child, yet little is known about the outcomes for those involved. This review summarizes research on the motivations for donating and receiving embryos from others and the experiences that follow, including the outcomes for parenting and child adjustment. Research has shown that given the varied ways in which embryo donation is practiced, understanding the outcomes within different legislative and cultural contexts is vital. The lack of information on outcomes means that counselors and psychologists have little empirical evidence to guide them. Gaps in existing knowledge are identified as well as areas for future research.

STUDY QUESTION Does shared biological motherhood, in which a woman gives birth to the genetic child of her female partner, result in more positive mother–child relationships than donor insemination, in which only one mother is biologically related to the child? SUMMARY ANSWER Mothers in both family types showed high levels of bonding with their children and viewed their relationship with their child positively. WHAT IS KNOWN ALREADY There is some evidence of feelings of inequality regarding their relationship with their child between biological and non-biological mothers in lesbian mother families formed by donor insemination, with a qualitative longitudinal study showing a tendency for children to form stronger bonds with their biological than their non-biological mother. STUDY DESIGN, SIZE, DURATION Thirty lesbian mother families created through shared biological motherhood were compared with 30 lesbian mother families formed by donor-IVF. All families had two mothers who both participated in the study, and the children were aged from infancy up to 8 years old. Data collection took place over 20 months beginning in December 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS Each mother in the family was interviewed separately using the Parent Development Interview (PDI), a reliable and valid measure of the nature of the parent’s emotional bond with their child. The interviews were transcribed verbatim and coded separately by one of two trained researchers who were unaware of the child’s family type. The interview produces 13 variables that relate to the parent’s representations of themselves as a parent, 5 variables that relate to the parent’s representations of the child, and a global variable that assesses the extent to which the parent can reflect on the child and their relationship. MAIN RESULTS AND THE ROLE OF CHANCE Families formed through shared biological parenthood did not differ from families created by donor-IVF in terms of the quality of mothers’ relationships with their children as assessed by the PDI. Neither were differences identified between birth mothers and non-birth mothers across the entire sample, or between gestational and genetic mothers within the families formed by shared biological parenthood. Multivariate analyses were conducted to minimize the role of chance. LIMITATIONS, REASONS FOR CAUTION Ideally, larger samples of families and a narrower age range of children would have been studied, but this was not possible as we were reliant on the small number of families formed through shared biological motherhood in the UK when the study began. To maintain the anonymity of the families, it was not possible to request information from the clinic that may have shed light on differences between those who responded to the request to participate and those who did not. WIDER IMPLICATIONS OF THE FINDINGS The findings show that shared biological motherhood is a positive option for lesbian couples who wish to have a more equal biological relationship to their children. One type of biological connection does not appear to have a greater influence on the quality of parent–child relationships than the other. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the Economic and Social Research Council (ESRC) grant ES/S001611/1. KA is Director, and NM is Medical Director, of the London Women’s Clinic. The remaining authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.

Recent decades have seen a global trend towards delaying parenthood, referred to as the ‘postponement transition’. Whilst there is plentiful research regarding obstetric and paediatric outcomes related to delayed parenthood, relatively little is known about the psychosocial outcomes associated with advanced parental age during early and middle childhood. This mini-review examines the current literature regarding the psychosocial functioning of families headed by older parents. First, we give an overview of the literature that examines the psychological wellbeing of older first-time parents. We then review the literature regarding the quality of the parent–child relationship in older parent families. Finally, we discuss the psychosocial adjustment and cognitive development of children of older parents. We conclude with suggestions for future research avenues.

Peer reviewed: True, This article extends existing sociological scholarship on doing and displaying family by developing the concept of documenting families. We suggest that documenting is conceptually rich insofar as it showcases the relationship, and tensions, between institutional practices and individual experiences of family display. Drawing on our research with men who became parents without partners, we argue that the process of documenting family is made especially evident in studies of what Finch originally referred to as ‘non-conventional’ family relationships. We explain that documenting sheds light not only on the official and unofficial means through which families are recognised on paper, but also on family practices as work – in this case paper-work – that involves negotiation between different social actors who are generally unequal in terms of their authority and agency to impose situational meaning.

The 7th phase of this longitudinal study, conducted in the United Kingdom, aimed to establish whether children born through third-party assisted reproduction experienced psychological problems, or difficulties in their relationship with their mothers, in early adulthood. The impact of disclosure of their biological origins, and of the quality of the mother-child relationship from age 3 onward, were also examined. Sixty-five assisted reproduction families, including 22 surrogacy families, 17 egg donation families, and 26 sperm donation families, were compared with 52 unassisted conception families when the children were aged 20. Less than half of the mothers had completed tertiary education and less than 5% were from ethnic minority backgrounds. Standardized interviews and questionnaires were administered to mothers and young adults. There were no differences between the assisted reproduction and unassisted conception families in mothers’ or young adults’ psychological wellbeing, or in the quality of family relationships. However, within the gamete donation families, egg donation mothers reported less positive family relationships than sperm donation mothers, and 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 7 had less negative relationships with their mothers, and their mothers showed lower levels of anxiety and depression. The associations between parenting and child adjustment did not differ between the assisted and unassisted reproduction families from age 3 to age 20. 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.

Background Lesbian, gay and bisexual (LGB) young people’s increased risk of self-harm, suicidal attempts and suicide compared with heterosexual youth is well established. The current study sought to examine whether these findings also apply to the trans (T) population and which factors act as additional risk or protective factors. Methods In a national cross-sectional survey, 3713 LGBT adolescents, aged 11–19 years, reported on their own history of self-harm, suicidal ideation and suicide attempts, as well as their experiences of school and homophobic, biphobic and transphobic bullying. Logistic regressions tested the association between risk and protective factors on self-harm, suicidal ideation and suicide attempts. Results A high proportion of the sample reported self-harm (65.3%), suicidal ideation (73.8%) and suicide attempts (25.7%). Demographic risk factors included identifying as female, non-binary or trans and being from a low-income background. Bullying and online bullying were associated with an increased risk for each outcome, and positive school experience was associated with a reduced risk for each outcome. Conclusions Consistent with minority stress theory, the study found high rates of mental health problems within LGBT youth. Interventions focused on improving young people’s experiences in schools appear useful targets to help improve mental health outcomes.

15-20% of women suffer from prenatal and postnatal clinical mental health disorders in low-income nations. There is however limited information on mothers’ mental health and associated factors such as prenatal bonding from developing nations. 70 women facing urban poverty in India were recruited during pregnancy and 49 were followed up 4-5 months post-birth. Data were collected on participants’ prenatal and postnatal anxiety, depression, stress, and prenatal bonding. Psychological health of women did not significantly improve or deteriorate from pregnancy to post-birth. Over 30% of the women experienced moderate to severe anxiety, depression, and stress. Greater prenatal bonding was related to better psychological health during pregnancy. The present study highlights the importance of building an emotional connection with the fetus during pregnancy, especially for women facing urban poverty. The results provide empirical information to both clinicians and educators regarding maternal well-being in developing nations.

A growing number of adolescents are using a number of different identities to describe their gender. Schools have been noted for their uninclusive environments and high levels of discrimination for LGBTQ+ individuals, yet research has neglected the school experiences of UK gender-diverse adolescents. This article explores the school experiences and navigation strategies of gender-diverse adolescents in the UK, examining the experiences of binary-trans, non-binary and gender-questioning adolescents separately. The data presented in this article come from a large survey of LGBTQ+ young people’s social experiences; a subsample of 74 adolescents’ (25 binary-trans, 25 non-binary, and 24 gender-questioning) open-ended responses were selected for qualitative thematic analysis. Findings highlight that gender-diverse adolescents experience discrimination within the school environment from the curriculum, space, peers and teachers, and a number of strategies, including disclosure negotiation, cognitive restructuring and proactive protection, are used to navigate this environment. Findings shed light on the school experiences of gender-diverse adolescents, and suggest that the British school system is fundamentally unsuitable for non-binary and gender-questioning identities.

STUDY QUESTION How do the demographic characteristics, motivations, experiences and expectations of unregulated sperm donors (men donating sperm online through a connection website) compare to sperm donors in the regulated sector (men donating through a registered UK sperm bank)? SUMMARY ANSWER Online donors were more likely to be older, married and have children of their own than sperm bank donors, were more varied in their preferences and expectations of sperm donation, and had more concerns about being a sperm donor. WHAT IS KNOWN ALREADY While studies have examined motivations and experiences of both regulated sperm bank, and unregulated online sperm donors, no study has directly compared these two groups of donors. STUDY DESIGN, SIZE, DURATION An email was sent to the 576 men who were registered sperm donors at the London Sperm Bank, the UK’s largest sperm bank regulated by the Human Fertilisation and Embryology Authority (HFEA), who had commenced donation between January 2010 and December 2016, and had consented to be contacted for research. The online survey, which contained multiple choice and open-ended questions, was completed by 168 men over a 7-week period. The responses were compared to those of sperm donors registered on Pride Angel, a large UK-based connection website for donors and recipients of sperm: our research team had already collected these data. In total, 5299 sperm donors were on Pride Angel at time of data capture and 400 men had completed a similar survey. The responses of 70 actual online sperm donors (i.e. those whose sperm had been used to conceive at least one child) were used for comparison with the sperm bank donors. PARTICIPANTS/MATERIALS, SETTING, METHODS The survey obtained data on the sperm donors’ demographic characteristics, motivations, experiences and expectations of sperm donation. Data from sperm bank donors were compared to online donors to examine differences between the two groups. The study compared online and clinic donors who had all been accepted as sperm donors: online donors who had been ‘vetted’ by recipients and sperm bank donors who had passed the rigorous screening criteria set by the clinic. MAIN RESULTS AND THE ROLE OF CHANCE A response rate of 29% was obtained from the sperm bank donors. Online donors were significantly older than sperm bank donors (mean ± SD: 38.7 ± 8.4 versus 32.9 ± 6.8 years, respectively) and were more likely to have their own children (p LIMITATIONS, REASONS FOR CAUTION Findings may not be representative of all sperm donors as only one online connection site and one HFEA registered sperm bank were used for recruitment. WIDER IMPLICATIONS OF THE FINDINGS Despite concern regarding shortages of sperm donors in licensed clinics and unease regarding the growing popularity of unregulated connection websites, this is the first study to directly compare online and sperm bank donors. It highlights the importance of considering ways to incorporate unregulated online sperm donors into the regulated sector. With many online donors well aware of the legal risks they undertake when donating in the unregulated online market, this would both increase the number of sperm donors available at clinics but also provide legal protection and support for donors. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by the Wellcome Trust Grants 104 385/Z/14/Z and 097857/Z/11/Z. The authors have no conflicts of interest.

Is parental age associated with parents' psychological health, couple relationship satisfaction and child adjustment in egg donation families, and how do parents think and feel about their age in relation to parenting?Seventy-two families with a child born after IVF egg donation were included. Mothers were aged between 32 and 51 years and fathers between 31 and 61 years when the target child was born. When the child was aged 5 years, parents were interviewed and asked to complete questionnaire assessments of parenting stress, anxiety, depression, marital quality and child adjustment.Older parents experienced more parenting stress and poorer couple relationship quality than younger parents. No differences were found for child adjustment. Qualitative content analysis of the interviews revealed themes related to 'health and mortality', 'giving and receiving support', 'treatment and age', 'positive aspects of older parenting' and 'other'.This exploratory study found that older parents experienced greater parental stress and poorer relationship quality. Some parents had concerns about their older age, specifically in relation to their health and mortality. It would be important to follow up these families as the child grows older to understand the child's thoughts and feelings about having older parents. Furthermore, findings should be replicated in a larger sample of families formed through egg donation, which includes more younger mothers who have used egg donation.

The present study aimed to explore UK intending parent’s reasons for cross-border and domestic surrogacy, their preparations for the birth and the practical and legal challenges faced after the birth. An online survey was completed by 203 participants, of which 132 had a child had born through surrogacy, 33 were in the process of surrogacy and 38 were planning a surrogacy arrangement. The most common reason for pursuing surrogacy in the UK was wanting a relationship with the surrogate (43%, 17) and for the USA it was having a better legal framework (97%, 60). Parents returning to the UK from countries other than USA experienced greater delay and difficulties in obtaining the necessary documents for their return. This study highlights the disparities in parents’ experiences of undergoing surrogacy in different countries, the frustrations some face in obtaining legal parenthood and the feelings of stress and anxiety this may cause. Whilst this is the first study comparing the experiences of people from the UK having surrogacy in different countries, the representativeness of the sample is unknown. The findings are important in identifying future directions for research, including assessing the impact of these early decisions and experiences for later parental wellbeing and children’s welfare.

Findings are presented from the second phase of a UK longitudinal study of 33 gay father, 35 lesbian mother, and 43 heterosexual parent families when their adopted children reached early adolescence. Participants predominantly lived in urban/suburban areas and were mostly white and well‐educated. Standardized interviews, observations, and questionnaires of parental mental health, parent–child relationships, and adolescent adjustment were administered to parents, children, and teachers between 2016 and 2018. There were few differences between family types. However, adjustment problems had increased in all family types, with better parenting quality and parental mental health associated with fewer adjustment problems. The findings contribute to adoption policy and practice, and to theoretical understanding of the role of parental gender in child development. [ABSTRACT FROM AUTHOR]

Third-party reproduction refers to assisted reproductive treatments involving the use of donor gametes or surrogacy. Children born through surrogacy or gamete donation may form strong familial relationships with other children raised in separate families with whom they share a genetic or gestational connection, using terms such as brother, sister, or half-brother, half-sister to describe these sibling-like relationships. Some families who have used surrogacy to conceive their child continue to see the surrogate after the birth and maintain close relationships as the child grows up. The children in these families therefore also grow up knowing each other and can form close relationships to one another. The chapter will draw from interview data carried out with 36 children of surrogates. They were aged 12–25 years and differed in terms of whether they had contact with the children their mothers had given birth to. In addition some surrogates had used their own egg for the pregnancy (traditional surrogacy) which meant their children were genetically related to the surrogacy born child. The chapter will explore how surrogates’ own children defined these relationships and how these relationships developed over-time. It will compare these findings to studies of individuals born through sperm donation who seek out others conceived using the same donor. The chapter will thus highlight the individual variation in the significance of these genetic or gestational connections. It will also discuss the limitations of our understanding of these new relationships as well as the limitations of the terminology used for defining these new connections.

The number of families being created through fertility treatment with donor eggs is increasing yearly. Women who conceive in this way share a gestational, but not genetic, relationship with their child, yet there is limited understanding of how mothers experience the mother-child relationship during its formative period, infancy. This study explored heterosexual mothers’ thoughts and feelings about the mother-infant relationship in families created through egg donation. Qualitative interviews were conducted with a sample of 85 women who had conceived following egg donation treatment at UK fertility clinics. Mothers had at least one infant (6-18 months) and were living with the child’s father. Interview data were analysed according to the principles of thematic analysis. The results showed that egg donation mothers used a range of strategies across the transition to parenthood which enabled them to establish their identity as the child’s mother and facilitated the process of helping them feel that the baby was their own. This process was individual to each woman, with the absent genetic connection varying in significance between mothers. The strategies employed enabled most mothers to adjust successfully to parenthood and manage any ambivalence and uncertainties associated with non-genetic parenthood. Most mothers felt secure and confident in their position as the child’s mother by the end of the first year., his research was supported by a Wellcome Trust Senior Investigator Award [097857/Z/11/Z] and a CHESS-ESRC studentship

Findings are presented from the second phase of an investigation of the attachment security of children in adoptive gay father families. Children (10-14 years) in 30 gay father families, 29 lesbian mother families and 38 heterosexual parent families were interviewed using the Friends and Family Interview (FFI). Children in gay father families showed significantly higher levels of secure-autonomous attachment than children in heterosexual parent families, significantly lower levels of preoccupied attachment than children in either lesbian mother or heterosexual parent families, and significantly lower levels of disorganised attachment than children in heterosexual parent families. For children in gay father families, stepwise multiple regression revealed that neither hyperactivity nor emotional symptoms at Phase 1 were predictive of disorganisation at Phase 2. However, when entered alone, Phase 1 emotional symptoms predicted Phase 2 disorganisation. The results indicate that adopted children in gay father families are at least as likely to be securely attached as children in lesbian mother or heterosexual parent families.

The objective of this study was to examine the motivations, experiences and future expectations of identity-release egg donors in the UK following the removal of donor anonymity and the increase in financial compensation for egg donation. This exploratory, in-depth qualitative study comprised semi-structured interviews with 11 women who had attended an egg donation screening appointment at a UK clinic during a four-month period in 2014. Interviews were conducted two to six weeks after the woman had donated or had withdrawn/been rejected from the donation process. Participants' primary motivation for donating was to help infertile women have their 'own child', and the recent increase in financial compensation did not seem to play a significant role in their decision. All were happy to be identifiable and contacted by children born as a result of their donation. However, some were hesitant about providing non-identifying information about themselves for these offspring and wished for further information about the recipient(s) of their eggs and the outcome of their donation. Whilst this study was limited due to the small sample size, it is the first study of UK egg donors following the rise in donor compensation and suggests that other strategies may be more effective in increasing donor numbers.

STUDY QUESTION: What are the demographic characteristics, motivations, preferences and experiences of heterosexual, gay and bisexual sperm donors on a connection website (i.e. a website that facilitates direct contact between donors and recipients of gametes)? SUMMARY ANSWER: This demographically diverse group of men was donating for altruistic reasons and perceived the website as providing greater choice over donation arrangements: approximately one third favoured anonymous donation, most of whom were heterosexual, whilst gay and bisexual donors were more likely to be in contact with children conceived with their sperm. WHAT IS KNOWN ALREADY: Despite substantially more sperm donors being registered on connection websites than with clinics, there has been very little research on this population. Current understanding of the impact of sexual orientation on donors' attitudes is also limited. STUDY DESIGN, SIZE, DURATION: An online survey was conducted over 7 weeks with 383 men registered as sperm donors with Pride Angel, a large UK-based connection website for donors and recipients of sperm. PARTICIPANTS/MATERIALS, SETTING, METHODS: The survey obtained data on participants' demographic characteristics and their motivations, preferences and experiences regarding online sperm donation, including attitudes towards contact with offspring. Differences according to participants' sexual orientation were examined. MAIN RESULTS AND THE ROLE OF CHANCE: Most participants (80.4%, 308) were heterosexual, 10.5% (40) were gay and 9.1% (35) were bisexual; ages ranged from 18 to 69 years (median = 36, mean = 37.3, SD = 9.7). A greater proportion of gay and bisexual men desired open-identity donation (P < 0.005) and contact with offspring (P

This study interviewed adolescents conceived using sperm donation to examine their experiences of contacting and meeting 'same-donor offspring' (i.e. donor-conceived offspring raised in different families who share the same donor), their motivations for this contact, and how they make meaning of these relationships. This in-depth qualitative study involved semi-structured interviews with 23 young people aged 12-19 years (mean = 14 years). Interviewees were motivated by curiosity about their biological relations and by wanting to extend their family. Contact with same-donor offspring was described as being either normal/neutral or as a unique experience that was integrated into their identity. This study highlights the importance of contact between same donor offspring, particularly during adolescence, a developmental stage associated with identity formation. The findings have important policy implications as they suggest that donor-conceived individuals may benefit from contact with others conceived using the same donor prior to the age of 18 years.

STUDY QUESTION What are the psychological health, relationship quality and perceived social support outcomes of heterosexual couples who have conceived an infant through identity-release egg donation? SUMMARY ANSWER Parents’ scores on all measures were within the normal range. Egg donation mothers had poorer perceived social support, and egg donation fathers had less optimal psychological health than a comparison group of IVF parents, although these differences were associated with the older age of egg donation parents, rather than being an effect of family type. WHAT IS KNOWN ALREADY There is limited understanding of the psychological health and couple relationship quality of egg donation parents, and no empirical data on parents’ social support, during the first year of parenthood. No studies have included families who have used an identity-release egg donor. The study offers the first examination of the psychological well-being of identity-release egg donation parents. STUDY DESIGN, SIZE, DURATION This study included 57 families created through identity-release egg donation, and a comparison group of 56 families who had used IVF with their own gametes, recruited through UK fertility clinics. Families were visited at home between October 2013 and June 2015. The sample forms part of a larger study examining family functioning in families created following fertility treatment. PARTICIPANTS/MATERIALS, SETTING, METHOD All families were heterosexual two-parent families with an infant aged 6–18 months. Mothers and fathers were administered standardised questionnaires assessing psychological health (Edinburgh Postnatal Depression Scale, Trait Anxiety Inventory and Parenting Stress Index-short form), couple relationship quality (Golombok Rust Inventory of Marital State) and perceived social support (Multidimensional Scale of Perceived Social Support). MAIN RESULTS AND THE ROLE OF CHANCE Scores from the egg donation and IVF parents were within the normal range on all measures. Significant differences were found between the groups indicating less optimal social support in egg donation mothers compared to IVF mothers, and poorer psychological health in egg donation fathers compared to IVF fathers. These differences appeared to be related to the older age of egg donation parents or to twin parenthood, rather than to egg donation per se. No differences were found between the groups in the parents’ relationship quality. LIMITATIONS, REASONS FOR CAUTION It is possible that families who were managing the transition to parenthood less well may have been less likely to participate in research. Fewer IVF than egg donation fathers participated in the study, so the statistical power was lower for comparisons between fathers. WIDER IMPLICATIONS OF THE FINDINGS The findings are of relevance to UK clinics offering identity-release egg donation. That scores of egg donation parents on measures of psychological well-being were more similar than different to those of IVF parents should prove reassuring to individuals considering this treatment type. As less optimal outcomes were found for egg donation parents on several measures, and these were associated with parental age rather than conception type, it is recommended that clinics discuss with older patients how they may establish a social support network and signpost patients to appropriate post-natal support. STUDY FUNDING, COMPETING INTERESTS This research was supported by a Wellcome Trust Senior Investigator Award [097857/Z/11/Z] and a CHESS-ESRC studentship. The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A

Increasing numbers of children are being born through egg donation and thus do not share a genetic relationship with their mother. Parent–infant relationship quality was examined in 85 egg donation families and a comparison group of 65 in vitro fertilization families (infant M = 11 months). Standardized interview and observational measures were used to assess mother–infant and father–infant relationship quality at the representational and behavioral levels. Few differences were found between family types in parents’ representations of the parent–infant relationship. Differences were found between family types in the observational assessment of mother–infant relationship quality, indicating less optimal interactions in egg donation families. Findings suggest that egg donation families function well in infancy overall, but there may be subtle yet meaningful differences in mother–infant interaction quality.

This is the first study to examine characteristics, motivations and experiences of Indian egg donors. In-depth interviews were conducted with 25 egg donors who had donated during the previous 8 months at a fertility clinic in Mumbai. The semi-structured interviews were conducted in Hindi and English. In addition to demographic information, data were collected on donors’ motivations for donating, with whom they had discussed donation, and feelings towards the recipients. The response rate was 66%. All participants were literate and had attended school. Twenty (80%) egg donors had children and five (20%) did not. The most common motivation (19, 76%) for donating was financial need. Egg donors had discussed their donation with their husband or with close family/friends, with almost all mentioning that wider society would disapprove. The majority (20, 80%) had no information about the recipients and 11 (44%) preferred not to. The findings highlight the similarities and differences between egg donors from India and those from other countries and that egg donors are of a more varied demographic background than surrogates in India. Given that India has been a popular destination for fertility treatment, the findings have important implications for regulation and practice within India and internationally.

The psychological impact of surrogacy on Indian surrogates has not previously been examined. This chapter explores how factors associated with surrogacy within the Indian context may contribute to surrogates’ psychological well-being. We discuss the significance of whether the surrogate sees or meets the newborn(s) and intended parent(s), the secrecy and social stigma associated with surrogacy, the availability of social support from family and other surrogates, and the role of financial compensation. We end by evaluating the relevance of these findings to the new policy inclined towards ‘altruistic’ surrogacy being introduced in India. This research has strong implications for policy by highlighting the features of surrogacy that may affect the well-being of those involved.

An increasing number of children are being born with the use of assisted reproduction techniques such as donor insemination, egg donation and surrogacy. There have been concerns that the use of these third-party reproduction techniques may have a negative effect on the quality of the relationship between the mother and father. Marital stability and quality was examined in a UK sample of donor insemination, egg donation and surrogacy families and families in which children were naturally conceived. Interview and questionnaire assessments of marital stability and quality were collected from mothers and fathers over five time points, when the children in the families were aged 1, 2, 3, 7 and 10. Of those families who participated when children were 10 years old, a minority of couples in each family type had divorced/separated and few differences emerged between the different family types in terms of mothers’ or fathers’ marital quality. Despite concerns, couples in families created by donor insemination, egg donation and surrogacy were found to be functioning well. An increasing number of children are being born with the use of assisted reproduction techniques such as donor insemination, egg donation and surrogacy. There have been concerns that the use of these third-party reproduction techniques may have a negative effect on the quality of the relationship between the mother and father. Marital stability and quality was examined in a UK sample of donor insemination, egg donation, and surrogacy families and families in which children were naturally conceived. Interview and questionnaire assessments of marital stability and quality were collected from mothers and fathers over five time points, when the children in the families were aged 1, 2, 3, 7 and 10. Of those families who participated when children were 10 years old, a minority of couples in each family type had divorced/separated and few differences emerged between the different family types in terms of mothers’ or fathers’ marital quality. Despite concerns, couples in families created by donor insemination, egg donation and surrogacy were found to be functioning well.

Whilst studies have examined the experiences of women who use clinic donors, to date there has been limited research investigating women’s motivations and experiences of searching for a sperm donor online. A total of 429 women looking for a sperm donor on Pride Angel (a website that facilitates contact between donors and recipients) completed an online survey. Fifty-eight percent (249) saw advantages of obtaining donated sperm online with the most common advantage reported as being able to connect with and meet the donor (n = 50 (24%)). A third (n = 157 (37%)) of the participants gave disadvantages, the most common reported was encountering ‘dishonest donors’ (n = 63 (40%)). Most recipients (n = 181 (61%)) wanted the donor to be ‘just a donor’ (i.e. to provide sperm and have no further contact). Whilst it was important for recipients to know the identity of the donor, some did not see this as important for the child and thus the level of information that parents have about the donor, and that which the child has, can differ. Finding a donor online blurs the distinction between categories of ‘anonymous’, ‘known’ and ‘identity release’ donations. Whilst the survey had a large sample size, the representativeness of the sample is not known.

This study examined the psychological well- being of fathers and father-child relationships in families with a 7-year-old child conceived by donor insemination. Twenty-four donor insemination families and comparison groups of 25 egg donation and 32 unassisted-conception families were assessed using a standardized interview and questionnaires administered to the father, and father-child dyads participated in an observational assessment of father-child interaction. On the basis of perspectives from Parental Investment Theory and stress- related models, it was expected that donor insemination fathers would show raised levels of psychological problems and a poorer quality of parenting and have more conflictual relationships with their children than genetically related fathers in egg donation and unassisted- conception families. These hypotheses were not supported by the findings. Instead, it seems that commitment to parenthood may be more important than genetic relatedness for positive father-child relationships.Key Words: family interaction, father-child relations, fatherhood, fertility/family planning/infertility, parenting styles.Fathers are generally viewed as integral to positive family functioning, with children of highly involved fathers found to perform better at school and to have higher levels of psychological adjustment, social competence, and empathy than children whose fathers are less involved (Fagan & Iglesias, 1999; Flouri & Buchanan, 2002; Lamb, 2010; Parke, 2002). Research on the mechanisms through which fathering influences child development has shown that fathers influence their children in ways similar to mothers, with sensitive yet authoritative parenting found to be positively associated with children's socioemotional and cognitive development (Bronte-Tinkew, Moore, & Carrano, 2006; Lamb, 2012; Lamb & Lewis, 2010; Marsiglio, Day, & Lamb, 2000). Fathers in families created by donor insemination differ from fathers in unassisted-conception families in that they lack a genetic link with their children, raising concerns that this may interfere with the development of a positive relationship between them. It has been suggested that, in comparison to biological fathers in unassisted-conception families, donor insemination fathers may be more distant from and less warm toward their children (Baran & Pannor, 1993; Burns, 1987; Warnock, 1984) and may lack a sense of entitlement in their role as fathers (Cordray, 1999; Turner & Cole, 2000) in a way similar to stepfathers, who tend to disengage themselves from disciplinarian roles (Amato & Sobolewski, 2004; Hetherington & Stanley-Hagan, 2002). With almost 500 children currently being born each year in the United Kingdom through donor insemination (Human Fertilization and Embryology Authority, 2010), and an estimated 30,000 to 60,000 children born each year through donor insemination in the United States (Evan, 2009), it is important that these concerns are addressed.Evolutionary psychologists have framed these concerns in terms of Parental Investment Theory (Fox & Bruce, 2001), which explains differential parental investment in offspring in terms of reproductive survival such that parents will be more inclined to allocate important resources (e.g., time, caregiving, financial aid) to offspring with whom they share a genetic connection (Daly & Wilson, 1996, 1998; Hamilton, Cheng, & Powell, 2007). This view is based in part on the finding that stepfathers offer less direct care, engagement, financial aid, and playtime to their stepchildren than do biological fathers (Anderson, Kaplan, Lam, & Lancaster, 1999; Hofferth, 2003; Zvoch, 1999). Thus, from an evolutionary psychology perspective, donor insemination fathers may similarly be expected to show less positive relationships with their children in comparison to genetically related fathers.It has also been suggested that the stress associated with the experience of infertility and its treatment may have an adverse impact on parents' psychological well-being and may interfere with adjustment to parenthood when a long-awaited child eventually arrives (Burns, 1990; Daniels, 2005). …

Donor conception and parent–child relationships were explored from the child's perspective. At ages 7 and 10, interview data were obtained from children in 31 donor insemination, 28 egg donation and 51 natural conception families. Children were also administered the MacArthur Story Stem Battery and a family map. Children in all family types reported close and affectionate relationships with their parents, irrespective of the lack of a genetic link between the parent and the child. Of those children who were aware of their donor conception at age 10, most demonstrated an understanding of, and had positive feelings about their donor conception.

Background: Parenting and children’s adjustment were examined in 30 surrogacy families, 31 egg donation families, 35 donor insemination families, and 53 natural conception families. Methods: Parenting was assessed at age 3 by a standardized interview designed to assess quality of parenting and by questionnaire measures of anxiety, depression, and marital quality. Children’s adjustment was assessed at ages 3, 7, and 10 using the Strengths and Difficulties Questionnaire (SDQ). Results: Although children born through reproductive donation obtained SDQ scores within the normal range, surrogacy children showed higher levels of adjustment difficulties at age 7 than children conceived by gamete donation. Mothers who had kept their child’s origins secret showed elevated levels of distress. However, maternal distress had a more negative impact on children who were aware of their origins. Conclusions: The absence of a gestational connection to the mother may be more problematic for children than the absence of a genetic link. Keywords: Surrogacy, egg donation, psychological adjustment, parenting.

background: This study aimed to prospectively examine families created using surrogacy over a 10-year period in the UK with respect to intending parents’ and children’s relationship with the surrogate mother, parents’ decisions over disclosure and children’s understanding of the nature of their conception. methods: Semi-structured interviews were administered by trained researchers to intending mothers, intending fathers and children on four occasions over a 10-year period. Forty-two families (19 with a genetic surrogate mother) participated when the child was 1-year old and by age 10 years, 33 families remained in the study. Data were collected on the frequency of contact with the surrogate mother, relationship with the surrogate, disclosure of surrogacy to the child and the child’s understanding of their surrogacy birth. results: Frequency of contact between surrogacy families and their surrogate mother decreased over time, particularly for families whose surrogate was a previously unknown genetic carrier (P , 0.001) (i.e. where they had met through a third party and the surrogate mother’s egg was used to conceive the child). Most families reported harmonious relationships with their surrogate mother. At age 10 years, 19 (90%) children who had been informed of the nature of their conception had a good understanding of this and 13 of the 14 children who were in contact with their surrogate reported that they liked her. conclusions: Surrogacy families maintained good relationships with the surrogate mother over time. Children felt positive about their surrogate mother and their surrogacy birth. The sample size of this study was small and further, larger investigations are needed before firm conclusions can be drawn.

BACKGROUND For the past 10 years, we have been carrying out a longitudinal investigation of egg donation families in the UK; a subsample of recipients in these families had a child by egg donation from a sister or sister-in-law. In response to the current debate over the practice of intra-family donation, together with the general lack of available data on the consequences of donation between family members, we examined recipients’ experiences of donation between sisters and sisters-in-law. METHODS We analysed data from a subsample of recipient mothers who were taking part in a larger investigation of gamete donation families. Mothers were visited at home and interviewed when their child was aged 1, 3, 7 and 10 years. Data from nine recipient mothers whose egg donor was either their sister or sister-in-law were examined to assess the nature of mothers’, fathers’ and the child's relationship with the donor, and whether mothers had disclosed the nature of their child's conception to others, including the child. RESULTS The majority of recipient mothers reported positive relationships between the donor and members of their family (themselves, their partner and their children). Most mothers were happy with the donor's level of involvement with the child and reported that they and the donor maintained their social roles within the family, i.e. as mother and aunt, respectively. By age 10, two children had been told that they had been conceived using egg donation, both of whom had been told the identity of the donor. CONCLUSIONS Although the sample was small, this study provides the first longitudinal data on the experiences of families created using donated gametes from a family member. Intra-family donation between sisters or sisters-in-law can be a positive experience for recipients during the first 10 years following the child's birth. Studies that are specifically designed to look at donation between family members are needed to better evaluate the practice.

This study examined families where children lack a genetic and/or gestational link with their parents. A total of 101 families (36 donor insemination families, 32 egg donation families and 33 surrogacy families) were interviewed when the child was aged 7 years. Despite a shift in professional attitudes towards openness, about half of the children conceived by egg donation and nearly three-quarters of those conceived by donor insemination remained unaware that the person they know as their mother or father is not, in fact, their genetic parent. By contrast, almost all the surrogacy parents had told their child how they were born. A majority of parents who planned never to tell their child about their conception had told at least one other person. However, qualitative data indicated that to categorize families as ‘secret’ or ‘open’ is inadequate. In fact many parents engage in ‘layers’ of disclosure about their child’s conception, both with their child and with family and friends.

Each year, an increasing number of children are born through surrogacy and thus lack a genetic and/or gestational link with their mother. This study examined the impact of surrogacy on mother-child relationships and children's psychological adjustment. Assessments of maternal positivity, maternal negativity, mother-child interaction, and child adjustment were administered to 32 surrogacy, 32 egg donation, and 54 natural conception families with a 7-year-old child. No differences were found for maternal negativity, maternal positivity, or child adjustment, although the surrogacy and egg donation families showed less positive mother-child interaction than the natural conception families. The findings suggest that both surrogacy and egg donation families function well in the early school years.

background: This study examined the motivations and experiences of anonymous donors who decide to make themselves open to contact with their donor offspring. methods: Online questionnaires were completed by 63 sperm donors and 11 oocyte donors recruited via the Donor Sibling Registry (http://www.donorsiblingregistry.com/), a US-based international registry that facilitates contact between donor-conceived offspring and their donors. results: Donors’ main reasons for donating were financial payment and wanting to help others. Sperm donors had donated between 1 and 950 times (median ¼ 100) and oocyte donors had donated between 1 and 5 times (median ¼ 2). The majority of sperm donors and more than one-third of oocyte donors expressed concerns about having donated. These concerns were mainly about the well-being of any children conceived using their gametes and not being able to make contact with them. Most sperm and oocyte donors felt that it was important to know how many offspring had been born using their donation, and 51% of sperm donors and 46% of oocyte donors wanted identifying information. All of the donors who had contact with their donor offspring reported positive experiences and the majority continued to have regular contact. conclusions: Although the sample may not be representative of all anonymous donors, this study highlights the importance of donors having access to information about their donor offspring and the positive consequences that may arise when contact is made.

BACKGROUND: The present study explored the process of disclosure in gamete donation families in the UK. METHODS: Interviews were conducted with 23 mothers and 15 fathers who had told their 7-year-old child about the nature of their conception. Twelve children were interviewed about what they understood and how they felt about their donor conception (DC). RESULTS: The majority of families had disclosed by the age of four and mothers were found to be the main disclosers. Although some parents expressed concerns about the disclosure, the majority did not experience difficulties. No child responded to disclosure in a negative way. Seven-year-old children showed little understanding of their DC, despite parents starting the process of disclosure before the age of four. CONCLUSIONS: In spite of mothers' concerns about disclosing DC to their children, children responded to disclosure in a neutral way and most parents did not find disclosure to be problematic.

This study investigates a new phenomenon whereby individuals conceived by donor insemination are searching for and contacting their donor and/or ‘donor siblings’ (i.e. donor offspring conceived by the same donor who are their genetic half siblings). On-line questionnaires were completed by members of the Donor Sibling Registry (DSR), a US-based registry that facilitates contact between donor conception families who share the same donor. Of the 165 donor offspring who completed the survey, 15% were searching for their donor siblings, 13% were searching for their donor, and 64% were searching for both. Differences were found according to family type and age of disclosure. Fewer offspring from heterosexual couple families had told their father about their search when compared with offspring from lesbian couple families who had told their co-parent. Offspring who had found out about their conception after age 18 were more likely to be searching for medical reasons, whereas those who had found out before age 18 tended to be searching out of curiosity. Some offspring had discovered large numbers of half siblings (maximum = 13). The majority of offspring who had found their donor relations reported positive experiences and remained in regular contact with them., We are grateful to The Nuffield Foundation, UK, for funding this research.

Girls and boys differ in their preferences for toys such as dolls and trucks. These sex differences are present in infants, are seen in non-human primates, and relate, in part, to prenatal androgen exposure. This evidence of inborn influences on sex-typed toy preferences has led to suggestions that object features, such as the color or the shape of toys, may be of intrinsically different interest to males and females. We used a preferential looking task to examine preferences for different toys, colors, and shapes in 120 infants, ages 12, 18, or 24 months. Girls looked at dolls significantly more than boys did and boys looked at cars significantly more than girls did, irrespective of color, particularly when brightness was controlled. These outcomes did not vary with age. There were no significant sex differences in infants' preferences for different colors or shapes. Instead, both girls and boys preferred reddish colors over blue and rounded over angular shapes. These findings augment prior evidence of sex-typed toy preferences in infants, but suggest that color and shape do not determine these sex differences. In fact, the direction of influence could be the opposite. Girls may learn to prefer pink, for instance, because the toys that they enjoy playing with are often colored pink. Regarding within sex differences, as opposed to differences between boys and girls, both boys and girls preferred dolls to cars at age 12-months. The preference of young boys for dolls over cars suggests that older boys' avoidance of dolls may be acquired. Similarly, the sex similarities in infants' preferences for colors and shapes suggest that any subsequent sex differences in these preferences may arise from socialization or cognitive gender development rather than inborn factors.

Background This study investigates the new phenomenon of parents of donor offspring searching for and contacting their child's 'donor siblings' (i.e. donor offspring conceived by the same donor) and donor. Methods Online questionnaires were completed by 791 parents (39% lone-mother, 35% lesbian-couple, 21% heterosexual-couple, 5% non-specified) recruited via the Donor Sibling Registry; a US-based international registry that facilitates contact between donor conception families who share the same donor. Data were collected on parents' reasons for searching for their child's donor siblings and/or donor, the outcome of these searches and parents' and their child's experiences of any resulting contact. Results Parents' principal motivation for searching for their child's donor siblings was curiosity and for their donor, enhancing their child's sense of identity. Some parents had discovered large numbers of donor siblings (maximum = 55). Most parents reported positive experiences of contacting and meeting their child's donor siblings and donor. Conclusions This study highlights that having access to information about a child's donor origins is important for some parents and has potentially positive consequences. These findings have wider implications because the removal of donor anonymity in the UK and elsewhere means that increasing numbers of donor offspring are likely to seek contact with their donor relations in the future.

Objective To study the processes by which donor-conceived children incorporate donor conception into their subjective sense of identity. Design Cross-sectional. Setting Family homes. Patient(s) Nineteen donor-conceived adolescents. Intervention(s) Administration of an interview and questionnaire. Main Outcome Measure(s) The mother-child relationship was assessed through the Friends and Family Interview, a semistructured interview designed to assess adolescents' security of attachment in terms of secure-autonomous, insecure-dismissive, insecure-preoccupied, and insecure-disorganized attachment patterns. The Donor Conception Identity Questionnaire assessed adolescents' thoughts and feelings about donor conception, yielding two factors: [1] curiosity about donor conception and [2] avoidance of donor conception. Result(s) Statistically significant associations were found between the Curiosity scale and the secure-autonomous and insecure-dismissing attachment ratings. Adolescents with secure-autonomous attachment patterns were more interested in exploring donor conception whereas those with insecure-dismissing patterns were less likely to express curiosity. Insecure-disorganized attachment ratings were statistically significantly correlated with the Avoidance scale, indicating higher levels of negative feelings about donor conception. Conclusion(s) The results of this study of the influence of parent-child relationships on thoughts and feelings about donor conception in adolescence suggest that the valence of the parent-child relationship influences adolescents' appraisal of their donor conception within the context of their growing sense of identity.

Background: Findings are presented of the second phase of a longitudinal study of families created through surrogacy. Methods: At the time of the child’s 2nd birthday, 37 surrogacy families were compared with 48 egg donation families and 68 natural conception families on standardised interview and questionnaire measures of the psychological well-being of the parents, parent–child relationships and the psychological functioning of the child. Results: The surrogacy mothers showed more positive parent–child relationships, and the surrogacy fathers reported lower levels of parenting stress, than their natural conception counterparts. The surrogacy children did not differ from the natural conception children with respect to socio-emotional or cognitive development. Conclusions: Surrogacy does not appear to impact negatively on parenting or child development in families with 2-year-old children. Keywords: Surrogacy, egg donation, parent–child relationships, child development.

Findings are presented of a study of families created through surrogacy arrangements. Forty-two surrogacy families were compared with 51 egg-donation families and 80 natural-conception families on standardized interview and questionnaire measures of the psychological well-being of the parents, the quality of parent-child relationships, and infant temperament. The differences that were identified between the surrogacy families and the other family types indicated greater psychological well-being and adaptation to parenthood by mothers and fathers of children born through surrogacy arrangements than by the natural-conception parents.

BACKGROUND: This study examined the motivations, experiences and psychological consequences of surrogacy for surrogate mothers. METHODS: Thirty-four women who had given birth to a surrogate child approximately 1 year previously were interviewed by trained researchers, and the data rated using standardized coding criteria. Information was obtained on: (i) reasons for the woman’s decision to become a surrogate mother; (ii) her retrospective view of the relationship with the commissioning couple before the pregnancy, during the pregnancy, and after the birth; (iii) her experiences during and after relinquishing the child; and (iv) how others reacted to her decision to become a surrogate mother. RESULTS: It was found that surrogate mothers do not generally experience major problems in their relationship with the commissioning couple, in handing over the baby, or from the reactions of those around them. The emotional problems experienced by some surrogate mothers in the weeks following the birth appeared to lessen over time. CONCLUSIONS: Surrogate mothers do not appear to experience psychological problems as a result of the surrogacy arrangement.

BACKGROUND: Findings are presented of a study of families with a child created through a surrogacy arrangement. This paper focuses on the commissioning couples’ reports of their experiences. METHODS: A total of 42 couples with a 1-year-old child born through surrogacy were assessed using a standardized semi-structured interview. Data were obtained on motivations for surrogacy, details about the surrogate mother, experience of surrogacy during pregnancy and after birth and disclosure of the surrogacy to friends and family. RESULTS: Couples had considered surrogacy only after a long period of infertility or when it was the only option available. Couples retrospectively recalled their levels of anxiety throughout the pregnancy as low, and relationships between the couple and the surrogate mother were found to be generally good. This was the case regardless of whether or not the couple had known the surrogate mother prior to the arrangement. After the birth of the child, positive relations continued with the large majority of couples maintaining some level of contact with the surrogate mother. All couples had told family and friends about the surrogacy and were planning to tell the child. CONCLUSIONS: Commissioning couples generally perceived the surrogacy arrangement as a positive experience.

What is the relationship between parent psychological adjustment, type of gamete donation (donor insemination, egg donation) and parents' disclosure of their use of donated gametes to their children.Disclosure of donor origins to the child was not always associated with optimal levels of psychological adjustment, especially for fathers in donor insemination families.Cross-sectional analyses have found mothers and fathers who conceived a child using donated sperm or eggs to be psychologically well-adjusted, with few differences emerging between parents in gamete donation families and parents in families in which parents conceived naturally. The relationship between mothers' and fathers' psychological well-being, type of gamete donation (donor insemination, egg donation) and parents' disclosure decisions has not yet been examined.In this follow-up study, data were obtained from mothers and fathers in donor insemination and egg donation families at 5 time points; when the children in the families were aged 1, 2, 3, 7 and 10. In the first phase of the study, 50 donor insemination families and 51 egg donation families with a 1-year-old child participated. By age 10, the study included 34 families with a child conceived by donor insemination and 30 families with a child conceived by egg donation, representing 68 and 58% of the original sample, respectively.Families were recruited through nine fertility clinics in the UK. Standardized questionnaires assessing depression, stress and anxiety were administered to mothers and fathers in donor insemination and egg donation families.Mothers and fathers in both donor insemination and egg donation families were found to be psychologically well-adjusted; for the vast majority of parents' levels of depression, anxiety and parenting stress were found to be within the normal range at all 5 time points. Disclosure of the child's donor origins to the child was not always associated with optimal levels of parental psychological adjustment. For example, disclosure was associated with lower levels of psychological well-being for certain groups in particular (such as fathers in donor insemination families), at certain times (when children are in middle childhood and have a more sophisticated understanding of their donor origins).Owing to small sample sizes, the value of this study lies not in its generalizability, but in its potential to point future research in new directions.Donor insemination and egg donation families are a heterogeneous group, and future research should endeavour to obtain data from fathers as well as mothers. Support and guidance in terms of disclosure and family functioning might be most beneficial for parents (and especially fathers) in donor insemination families, particularly as the child grows older. The more that is known about the process of disclosure over time, from the perspective of the different members of the family, the better supported parents and their children can be.The project described was supported by grant number RO1HD051621 from the National Institute of Child Health and Human Development. The content is solely the responsibility of the authors and does not represent the official views of the National Institute of Child Health and Human Development or the National Institutes of Health. The authors have no conflict of interest to declare.