Dr Vasanti Jadva Prof Susan Golombok and Dr Lucy Blake Centre for Family Research

1. Children conceived by gamete donation: psychological wellbeing, family functioning and children’s understanding of their birth. Dr Vasanti Jadva Prof Susan Golombok and Dr Lucy Blake Centre for Family Research University of Cambridge

2. UK Legislation • 1st April 2005- Donor anonymity removed • All UK donors are now Identity-Release • Donor conceived offspring can receive non-identifying information at age 16 (or earlier with parental consent) • Donor conceived offspring can receive identifying information at age 18 • Children in our study born before change in legislation

3. Recruitment • 50 Egg donation families and 51 sperm donation families recruited through 9 UK fertility clinics. • 80 non-ART families recruited through maternity wards • All 51 DI children conceived using anonymous sperm • 36 ED children conceived using anonymous donation- remainder through known donation by a family member or friend

4. Longitudinal study • Child aged 1, 2, 3, 7 and 10 years. • Participants visited at home • In-depth semi-structured interviews • Questionnaires assessing psychological health • At Age 7 and 10 years • Videotaped Parent-child interaction • Interviewed the children • Teachers completed questionnaires on child psychological adjustment

5. Results: Age 1 • Psychological health and marital quality • - no difference between groups • Mothers parenting • - Gamete donation mothers scored higher on warmth to child and involvement with child • Fathers parenting • - Gamete donation fathers scored higher on involvement with child • Infant temperament • - No difference between groups

6. Results: Age 2 • Psychological health and marital quality • - Gamete donation mothers viewed their child as more vulnerable • Mothers parenting • - Higher levels of joy/pleasure amongst gamete donation mothers than non-ART (ED higher than DI) • - Higher levels of over-protectiveness by DI mothers than ED mothers • Fathers parenting • - No differences • Child’s socio-emotional and cognitive development • - No differences

7. Results: Age 3 • Psychological health and marital quality • - No differences • Mothers parenting • - Higher levels of warmth and mother-child interaction amongst assisted conception group • Child’s psychological adjustment • - No differences

8. AGE 7 : Methods • Quality of parenting (from interview) • MATERNAL POSTIVITY • Warmth • Interaction • Sensitivity of child’s needs • Mother-child video-taped Observation • MOTHER-CHILD MUTUALITY • Dyadic cooperation • Dyadic reciprocity • Child’s responsiveness to mother • Mother’s-responsiveness to child • Child’s psychological adjustment • Interviews with mother rated by a clinical child psychologisy blind to family type • Questionnaires (SDQ) completed by mother and child's teacher • MATERNAL NEGATIVITY • Aggression • Criticism • Level of battle • Frequency of battle

9. AGE 7 : Findings • QUALITY OF PARENTING • Gamete donation children unaware of their conception scored lower on mother-child mutuality and maternal positivity compared to non-ART group. • Gamete donation children who were aware of their conception scored lower on mother-child mutuality compared to non-ART group. • Child’s psychological adjustment • No differences between non-ART children and children who had been informed and children who had not been informed.

10. Disclosure ED families DI families

11. Disclosure: Changes over time AGE 1 Planned not to tell (10 DI & 5 ED)

12. Disclosure: Changes over time AGE 1 Planned to tell (17 DI & 20 ED)

13. Disclosure: Changes over time AGE 1 Uncertain (9 DI & 7 ED)

14. Parents agreement about telling ‘I would be more likely to talk to [child], maybe not now but in a couple of years time, and talk it through with him but I don’t think ]husband] wants to do that, he doesn’t want him to know anything, but I don’t know, I’d have to ask [husband], I think we have a lot of talking to do about it.’ Mother of child conceived using egg donation

15. Partial disclosure ‘well we’ve told him that he’s an IVF baby but we weren’t telling him what the problem was…we’ll only tell him if the time arose to tell him’ “The only thing people have asked, because before we went down this line we had IVF, a lot of people said to me ‘so how did you get pregnant in the end then?' and I said ‘oh yeah it was IVF’, you know, or "fertility treatment" and that's all we say”

16. What do children know about donor conception “She [Mum] had the eggs put into her and then my dad’s sperm mixed it up and, and then I got created, and then she said like, about all the particles and stuff that like, run about and make stuff..” 10 year old child conceived using egg donation ““My dad couldn’t really make the seed so had a seed from a special man who gave one up” 10 year old child conceived using sperm donation

17. What do children know about donor conception “I slept in my tummy instead of her tummy? I got put in a freezer? She gave Mum something, what was it?” (ED, answer demonstrates little understanding)

18. How children feel about being donor conceived “I’m fine… I don’t feel any differently, I’m just carrying on with my life. I don’t really think about it much, because there’s much more like, special on my mind, like cooler things. So I don’t really care about it much.” 10 year old child conceived using sperm donation “I’m alright, just happy I’ve got my mum and my dad really’ 10 year old child conceived using egg donation

19. Children's feelings when first told • “Just a little bit shocked really. Yeah I just didn’t realise that it was like that. I thought it was just the normal way of people getting made…” • Child conceived using egg donation • “I was quite happy. It felt a bit strange. Like weird, or maybe I didn’t understand” • Child conceived using donor insemination

20. Children's feelings when first told • “I can’t remember the first time they said it, but I felt a bit strange, different, a bit, for a while …I felt a bit different, and just a bit weird for a while, but then I soon forgot about it and I just carried on.” • “I didn’t really feel anything.” (Child conceived by egg donation)

21. Children's feelings about telling friends Most children said they did not discuss their conception with others. “That’s the only secret that I haven’t told any of my friends because I don’t really want anyone to know.” 10 year old child conceived using sperm donation “Well at school I’ve been showing off but…um, most of my friends, definitely [best friend], yeah and most of my friends at school, about three or four friends.” 10 year old child born using egg donation

22. Children's feelings towards the donor “I’m very grateful for him, and I’m very thankful for him, and it’s weird that we can’t ever meet him, because I thought we could be like friends…be like my mum and dad’s friends”. 10 year old child conceived using sperm donation “I don’t really think about him, all I do is look at a picture of me and say that man, the man who helped must…the same colour of hair, or the same colour eyes, so I don’t really think about it much” 10 year old child conceived using sperm donation

23. Children's feelings towards the donor “I think I really want to meet him one day because he, I wouldn’t be here if he didn’t, you know, so, I’m quite thankful.” 10 year old child conceived using sperm donation Examples of descriptions of the donor as kind or nice are: “She was quite nice” An example of a neutral response is: “I don’t even know what he’s like or anything.” (DI, neutral)

24. Non-disclosing families: Age 10 • Non-disclosing families: • Plan not to tell • Uncertain • Plan to tell

25. Reasons for non-disclosure “Well he’s their father … I just don’t see any…he’s on the birth certificate, he’s the one that was there rubbing my back when I was throwing up, holding my hand when I had them, I mean, I just don’t, don’t see the point “ (No need to tell) “Just the fact that it might upset him, who knows what his reaction would be, but he is a worrier, and I think just the whole concept of it might make him feel insecure. So I think that might be an issue. What it would do to him” (Protect child)

26. We don’t think/talk about it “I think we’ve moved on, it’s like, nine years later, and we just don’t think about it so much now.” “We’re just a normal family, like any other. We don’t talk about it really” “ It doesn’t even enter our heads, it…you know, we’re so much of a family and you know, it’s not an issue”

27. Families who are uncertain: change over time “When we first did this, he didn’t want them to know. But that was before we had them, and I think before you have children, you’re, you look at life, you’re blinkered, you look at life in black and white. When you have kids, I know it sounds stupid, your vision goes that way, you see things differently”

28. Families who are uncertain: Timing “… because it’s almost like he’s too old to be told now. But I am worried that if I don’t tell him and he finds out, he’ll hate me” “I wish Id told him, not so much told him, but I wish he’s always known sort of thing” “When I saw you last time I was kind of thinking that when the sex education thing came up at school that might be my opportunity, well that’s been and gone and I didn’t take up the opportunity. [Child] being the way he is, I don’t want to give him an identity crisis so I feel less likely to tell him now than when I saw you two years ago”

29. Parents who plan to tell • “And we thought about it again recently, thinking we must do that and I know what it will be, sort of, I find November and December quite dreadful, and it kind of goes, its Halloween and then it will be 7 or so weeks to Christmas and that will shoot by and I bet that will go by and we won’t think about doing it…” • “I’m hoping to do it this summer when we’ve got time together, when we get back from holiday we’ve got time before I go back to work. So I’m here if he wants to ask any questions or he wants extra cuddles or anything”

30. Parents who plan to tell Privacy/control: “…because what I don’t want her to do is run and tell her friends you see, and she’s much more chatty and you know what girls are like, they’re much more likely to pass things on and then I’m embarrassed about it, it’s a funny feeling isn’t it, embarrassed or uncomfortable or whatever, so it…what I want to do, I want her to know but I don’t want her to pass the information on” Dread: “I was always really confident about telling him when he was younger, but I’m dreading telling him, just because I don’t know how, the kind of words I would have to use”

31. Summary • Overall, no negative consequences for families created using gamete donation. • Children are able to show some understanding of their birth by age 10 and most feel positive or indifferent about their birth. • Important to follow up the families as the child enters adolescence. • Limitations of the research need to be considered

32. Publications • Golombok S, Blake L, Casey P, Roman G, Jadva V. (2013). Children born through reproductive donation: a longitudinal study of psychological adjustment. J Child Psychol Psychiatry, 23. doi: 10.1111/jcpp.12015. • Blake L, Casey P, Jadva V, Golombok S. (2012). Marital stability and quality in families created by assisted reproduction techniques: a follow-up study. Reprod Biomed Online. 25(7), 678-832012 Sep 17. doi: 10.1016/j.rbmo.2012.09.006. • Golombok, S., Readings, J., Blake, L., Casey, P., Mellish, L., Marks, A and Jadva, V. (2011) Children Conceived by Gamete Donation: Psychological Adjustment and Mother-child Relationships at Age 7. Journal of Family Psychology. Vol 25(2), Apr 2011, 230-239. • Readings, J., Blake, L., Casey, P., Jadva, V and Golombok, S. (2011) Disclosure and Everything In-between: Decisions of Parents of Children Conceived by Donor Insemination, Egg Donation and Surrogacy. Reproductive BioMedicine Online. 22, (5), 485-495. • Blake, L., Casey, P., Readings, J., Jadva, V. and Golombok, S. (2010) 'Daddy ran out of tadpoles': how parents tell their children that they are donor conceived, and what their 7-year-olds understand. Human Reproduction 25(10):2527-34. • Golombok, S., Lycett, E., MacCallum, F., Jadva, V., Murray, C., Rust, J., Abdalla, H., Jenkins, J. and Margara, R. (2004) Parenting infants conceived by gamete donation. Journal of Family Psychology 18, 443-52.

33. 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.