Most donor-conceived people have good psychological health

Abstract

The use of donor gametes to conceive is increasing in many high-income countries. One reason for this is that the average age of women at first birth has increased in the last few decades and is now around 30 years in many countries (oe.cd/fdb). This in turn increases the risk of age-related infertility and the need for donor eggs. There is also now more acceptance of non-traditional families, such as same sex and single parent families (Hammarberg et al., J Reprod & Infant Psych, 2015; 33, 466–477).

The lack of genetic links between one or both parents and the child has created debate about the psychological implications for people born as a result of gamete donation. The review by Talbot et al. in this issue of BJOG is a timely contribution to this debate. In this paper, the authors report findings from a review of 50 studies published in the last three decades comparing the psychological outcomes of donor and non-donor-conceived people. The review reveals that, in this body of research, the tools used to assess psychological functioning, the ages of study participants and the methods of recruitment vary greatly between studies, making it difficult to interpret the findings. However, in broad terms, most studies suggest that the psychological well-being of donor-conceived people is comparable or better than that of their non-donor-conceived counterparts, with a notable minority indicating higher rates of mental health and identity struggles. The findings are reassuring and useful in clinical practice when discussing the implications of using donor gametes with people who contemplate this.

Two aspects of gamete donation likely influence the long-term psychological well-being of donor-conceived people. First, the age when they are told about the way they were conceived. While the advice in the past was to keep the use of donor sperm secret, openness and early disclosure to the child about their origins are now recommended and supported by the findings of Talbot et al.'s review. And second, whether they are able to trace their donor. The context of gamete donation differs between jurisdictions with some banning and others mandating anonymous donation. In jurisdictions where anonymous donations are banned, the child has the right to know who the donor is once they reach a certain age. The ability to know one's genetic origins is important for adult development and identity. As such, knowing who the donor is may positively influence the psychological adjustment of donor-conceived people. Conversely, when donations are anonymous, the inability to know who their donor is may have adverse psychological consequences for those who want to know their genetic origins.

As stated by Susan Golombok (Child Development Perspectives; 15, 103–109), one of the most prominent researchers of the psychological aspects of gamete donation, love and truth is what really matter for the psychological health of donor-conceived children. Based on her longitudinal studies, Golombok concludes that biological relatedness is less important than positive parent–child relationships for the well-being of donor-conceived children, and that telling children about their origins in their preschool years is associated with better adolescent well-being and family relationships.

TC and KH drafted the manuscript and approved the final version.

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No conflicts to declare.

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