Anonymous or identity-registered sperm donors? A study of Dutch recipients' choices.

BACKGROUND: The aim of the present study was to gain insight into parents' own donor preferences within a system offering the choice between an anonymous and identity-registered donor. A comparison was made between recipients choosing for an anonymous donor (AD choosers) and those choosing for an identifiable donor (ID choosers) with regard to their sexual orientation, demographic characteristics, disclosure issues and infertility distress. METHODS: Data from 105 couples (61% heterosexual, 39% lesbian) were registered on a standardized form during implication counselling sessions previous to treatment. RESULTS: Sixty-three per cent of the heterosexual couples and 98% of the lesbian couples had chosen an ID donor. Major differences between ID and AD choosers were identified. Among the ID choosers secrecy towards the child was no option, whereas 83% of the AD choosers did not intend to inform their child. Compared with heterosexual ID choosers, AD choosers were more distressed about their infertility and had a lower educational level. CONCLUSION: Legislation imposing ID donors appears to be acceptable for the majority of this study population. For a vulnerable group of heterosexual couples, who remained secretive about the use of a donor, adaptation to the new system is not self-evident.

Health-related quality of life in relation to gender and age in couples planning IVF treatment.

BACKGROUND: Specific subgroups of people planning IVF might be at risk of having more psychological or health-related problems. Identification of subgroups at risk may better enable allocation of appropriate counselling. METHODS: A group of 425 men and 447 women planning to undergo IVF treatment filled out a questionnaire. Four domains of health-related quality of life were measured, namely perceived emotional, physical, cognitive and social functioning. RESULTS: Young men and women (aged 21-30 years) planning IVF had more short-term social and emotional problems than people of the same age group in the general population. No substantial differences were found in cognitive and physical functioning for all age groups of men nor women planning IVF compared with the general population. A high level of irrational parenthood cognitions substantially accounted for a less optimal score on all the different domains of quality of life. These cognitions ('needing a child in order to live a happy life') were especially prevalent among younger women. CONCLUSIONS: Patients with high levels of irrational parenthood cognitions are at risk of a less optimal quality of life. A short cognitive counselling therapy is advised for patients with high levels of these cognitions.

Why do children want to know more about the donor? The experience of youngsters raised in lesbian families.

In this study, we focus on the donor origin of youngster who are raised in lesbian donor insemination (DI) families. The aim was to explore why some of these DI children like to know more about the donor while others do not, these data were gathered by means of a semi-structured interview. Secondly, we investigated, by means of several questionnaires, whether psychological variables such as global self-esteem, emotional and behavioral adjustment and children's perception of the quality of the parent-child relationship were in some way linked to whether or not they wanted to know more about the donor. In our study the majority of the children who preferred to have no information about the donor expressed their loyalty towards the social mother. For the majority of the children who opted for donor information, curiosity was the most salient motive. No differences were found with regard to the psychological variables between the two groups considered. In conclusion, the wish to know more about the donor or the absence of such a need is not reflected in the child's well-being and is not linked to the quality of the parent-child interaction.

The European study of assisted reproduction families: the transition to adolescence.

BACKGROUND: Findings are presented of the second phase of a European longitudinal study of families created by assisted reproduction. The present investigation reports on data obtained during the child's transition to adolescence. METHODS: A total of 102 IVF families, 94 donor insemination (DI) families, 102 adoptive families, and 102 families with a naturally conceived child were compared on standardized interview and questionnaire measures of parenting and children's psychological well-being. RESULTS: The assisted reproduction families were similar to the adoptive and natural conception families for many of the measures of the quality of parent-child relationships. To the extent that differences were found between the assisted reproduction families and the other family types, these reflected mainly more positive functioning among the assisted reproduction families, with the possible exception of the overinvolvement with their children of a small proportion of assisted reproduction mothers and fathers. The assisted reproduction children were functioning well and did not differ from the adoptive or naturally conceived children on any of the measures of psychological adjustment. However, only 8.6% had been told about their genetic origins. CONCLUSIONS: IVF and DI families with an early adolescent child appear to be functioning well.

What does it mean for youngsters to grow up in a lesbian family created by means of donor insemination?

In many countries fertility services still refuse to inseminate lesbian couples because they believe the child's welfare would be at stake. One of their concerns is that these children will be stigmatized because of their non-traditional family structure. In this follow-up study, we interviewed children from lesbian donor insemination (DI) families about how they present their 'non-traditional' family to people in their immediate social environment. We also explored whether or not children were teased or harassed about their lesbian family and whether or not coping with a non-traditional family constellation was reflected in their psychological well-being. According to this study, almost all children from lesbian DI families share the fact that they live in a two-mother unit spontaneously with close friends who react positively. Others are only informed about the non-traditional family structure when they ask questions about it. From the children's answers, we can conclude that for some peers it is hard to understand that someone can have two mothers without having a father somewhere. Compared with children from heterosexual families, these DI children are not more likely to be teased but they are more prone to family-related teasing incidents. However, introducing their non-traditional family into their peer group does not seem to interfere with their psychological well-being. Nonetheless, teachers indicate that children from lesbian families experience more attention problems compared with children from heterosexual households.

Lesbian couples requesting donor insemination: an update of the knowledge with regard to lesbian mother families.

Although a variety of ways exist of becoming a lesbian mother, an increasing number of lesbian couples have began to visit fertility centres requesting donor insemination (DI). The practice of inseminating lesbian couples remains a controversial issue within the reproductive medicine world. Lesbian mothers offer their children a familial context, which differs on a number of important characteristics from the traditional heterosexual family. In lesbian families, a father has been absent right from the start, and the child is raised by two mothers. The present article reviews whether there is any theoretical and/or empirical evidence for the most common assumptions with regard to lesbian motherhood. It also reports on a number of studies in which the practice of counselling lesbian couples is discussed. Although many important research questions have yet to be addressed, none of the investigations carried out so far could identify an adverse effect of lesbian motherhood on child development. Counselling lesbian couples for DI should aim to provide information about the practical aspects of the treatment. The requests of lesbian couples, however, differ substantially from those of single mothers and heterosexual couples. Counsellors should respect these differences and focus upon the specific living conditions of lesbian families.

An attempt to reconstruct children's donor concept: a comparison between children's and lesbian parents' attitudes towards donor anonymity.

BACKGROUND: This study investigated the donor concept of children who were born by means of donor insemination (DI), and their lesbian parents. METHODS: A total of 41 children aged between 7 and 17 years, and 45 parents, took part in the follow-up study. In-depth topic interviews were used to reconstruct how DI children and their mothers perceived the donor. Data were collected about the birth story, about children's conversations with their mothers concerning donor characteristics and about children's and parents' attitudes towards the status of the donor. RESULTS: 54% of these children preferred donor anonymity at this point in their life, whereas 46% wanted to know more about the donor. The majority of the latter group would have liked to know the donor's identity, with boys outnumbering girls. The remaining children of this group were content with non-identifying information. Children wanted to know more about the donors whereas the majority of the mothers preferred the donor to remain anonymous. CONCLUSIONS: Our results suggest that among DI children in general and among members of the same family, unit opinions differ on the status of the donor. A flexible system offering different types of donors seems to be necessary in order to meet the needs of each family.

Review: parent-child relationships and child development in donor insemination families.

The present article reviews the empirical research regarding the parent-child relationships and the development of children in donor insemination (DI) families. Over the years, follow-up studies have appeared sporadically and, despite the varying quality of the research methods, preliminary findings have emerged. Heterosexual DI parents were psychologically well adjusted and had stable marital relationships. DI parents showed a similar or higher quality of parent-child interaction and a greater emotional involvement with their children compared with naturally conceived families. The majority of studies which investigated several aspects of child development found that, overall, DI children were doing well. Findings with regard to emotional/behavioural development, however, were divergent in that some studies identified an increase of such problems while others did not. A steadily growing group within the DI population is lesbian mother families. More recently, follow-up studies have been carried out among DI children who were raised from birth by two mothers. Despite many concerns about the well-being of these children, no adverse effects of this alternative family structure on child development could be identified. As the DI children in all investigations were still young, our knowledge about the long-term effects of DI remains incomplete.

Donor insemination: Dutch parents' opinions about confidentiality and donor anonymity and the emotional adjustment of their children.

Results from a comparative study investigating 38 donor insemination (DI) Dutch families with 4-8 year old children are presented. The aims of this study were to investigate parents' opinions on the issues of confidentiality and donor anonymity, to assess the emotional development of the children, and to examine in DI families the association between secrecy with regard to the use of a donor and the emotional adjustment of the children. The DI families were compared to families with a child conceived by in-vitro fertilization (IVF) and to families with a naturally conceived child. Secrecy appeared to be associated with DI and not with IVF: 74% of the DI parents intended not to inform the child about the way in which she/he was conceived, whereas none of the IVF parents intended to keep the secret. Only one set of DI parents and two sets of IVF parents had actually told the child. As to donor anonymity, a spread of opinions appeared among DI parents; 57% preferred an anonymous donor, 31% would have liked non-identifying information about the donor, 9% preferred the donor's identity to be registered and 3% remained unsure. Parents' major concern was to know more about the medical/genetic background of the donor. Mothers and fathers in the DI families differed in their opinions concerning the issues of confidentiality and donor anonymity: fathers, more often than mothers, were secretive with regard to the use of a donor and husbands, more often than their wives, were in favour of donor anonymity. With regard to the emotional development of the children, more emotional/behavioural problems were revealed among DI children than among children who were naturally conceived. No association was found between secrecy and the emotional/behavioural adjustment of the children.

Donor insemination: child development and family functioning in lesbian mother families.

Findings are presented of a comparative study investigating the family relationships and the emotional and gender development of children raised in lesbian mother families. A total of 30 lesbian mother families with 4-8 year old children created as a result of donor insemination (DI) were compared with 38 heterosexual families with a DI child and with 30 heterosexual families who had a naturally conceived child. A variety of assessment measures, including a standardized interview and questionnaires from the parents and psychological testing of the child were used to collect the data. The quality of the couples' relationships and the quality of the mother-child interaction did not differ between lesbian mother families and either of the heterosexual family groups. The quality of the interaction between the social mother and the child in lesbian families was superior to that between the father and the child in both groups of heterosexual families. Childrens' own perception of their parents was similar in all family types; the social mother in lesbian families was regarded by the child to be as much a 'parent' as the father in both types of heterosexual families. With regard to their emotional/behavioural development, boys and girls raised in lesbian mother families were well adjusted and their gender role development did not differ from that of children raised in heterosexual families. These results indicate that child and family development in lesbian mother families is similar to that of heterosexual families.

Lesbian motherhood: the impact on child development and family functioning.

The wide variety of lesbian families who became visible during the past 20 years gave rise to important practical and theoretical questions. Up to now society has treated lesbian mothers differently with regard to a number of child-issues. In the past, divorcing lesbian mothers were often denied child custody because of their sexual orientation and the majority of fertility centers still refuse lesbian couples in their donor insemination programs. The present article reviews whether there is any theoretical and empirical evidence for the most widespread assumptions on which such decisions have been based. A number of psychological theories, such as psychoanalytic theory, social and cognitive learning theory and attachment theory are discussed with regard to the two most salient features of lesbian families; the absence of a father and the homosexual orientation of the mother. Meanwhile, there is a growing body of empirical research investigating a variety of aspects of child development, such as gender development, emotional/behavioral adjustment and social competence. Most of these studies involved children of divorced lesbian mothers who spent their early years in a heterosexual household. More recently, however, studies were sporadically carried out among children who were raised from birth in a lesbian relationship. As early childhood experiences are believed to have an important impact on future development, the study of these newly created families provides a challenge for existing psychological theories. Although many important research questions have yet to be addressed, the results of all reviewed studies were unanimous; none of the investigations could identify an adverse effect of lesbian motherhood on child development.

The European study of assisted reproduction families: family functioning and child development.

Findings are presented of a European study (conducted in the UK, Italy, Spain and The Netherlands) of family relationships and the social and emotional development of children in families created as a result of the two most widely used reproductive technologies, in-vitro fertilization (IVF) and donor insemination (DI), in comparison with control groups of families with naturally conceived child and adoptive families. Mothers of children conceived by assisted reproduction expressed greater warmth towards their child, were more emotionally involved with their child, interacted more with their child and reported less stress associated with parenting than mothers who conceived their child naturally. Similarly, assisted reproduction fathers were found to interact more with their child and to contribute more to parenting than fathers with a naturally conceived child. With respect to the children themselves, no group differences were found for either the presence of psychological disorder or for children's perceptions of the quality of family relationships. The findings relating to the quality of parenting and the socio-emotional development of the children were similar in each of the four countries studied.

Donor insemination, the impact on family and child development.

The practice of donor insemination (DI) has undergone major changes in the past 20 years. Attention was paid to the long-term psychological effects, the pleas for openness became stronger over the years and the use of anonymous donors became subject to public debate in several countries. The present article reviews what empirical research there is into DI families and their children. Over the years follow up studies have appeared sporadically and in spite of the varying quality of the research methods, preliminary findings have emerged. Research into the confidentiality issue in DI couples revealed that 47-92% of the DI parents intended to keep the donor origin secret from their children. DI couples just starting treatment more often intended to tell their children the DI origin than those who already had children. It is, however, too early to tell whether the public pleas for more openness did affect attitudes of the DI patients themselves. Research into the psychological well-being of DI parents and children failed to reveal major psychological problems. DI parents appeared to be well adjusted and to have stable marital relationships. DI children did not show significantly more emotional disturbances than controls. The quality of the parent-child relationship was better in the DI group than in the controls of naturally conceived parents.

Difficulties in the differential diagnosis of vaginismus, dyspareunia and mixed sexual pain disorder.

This retrospective study was undertaken to investigate predictors of vaginismus, dyspareunia and mixed sexual pain disorder in respect of symptom profile and treatment history variables of female patients and their partners. The study sample consisted of 147 female patients attending a university hospital outpatient clinic for Psychosomatic Gynecology and Sexology. All patients met the DSM-III-R criteria of the diagnoses of vaginismus (n = 50), dyspareunia (n = 46), or of both diagnoses (n = 51). No univariate differences were found between members of the three groups or between their partners. It was not possible to make a multivariate prediction of group membership.

Lesbian mothers who conceived after donor insemination: a follow-up study.

This study investigated the development of family relationships in lesbian families who conceived after donor insemination (DI). The main characteristics of this unknown family structure were analysed. An anonymous donor was used to conceive, the family unit consisted of two mothers and a father was non-existent, and both women had a homosexual orientation. A total of 50 lesbian couples who conceived after DI with children aged between 1 and 2 years participated in this study, using a standardized interview created for this study. After the birth of their child, 56% of the lesbian mothers (n = 100) would have wanted the identity of the donor to be registered, while 10% would have done so at the time of the insemination. Opinions differed in 12 of the 50 couples: the biological mother was in favour of identity registration while the social mother was not. Both women considered themselves a parent of the child with equally shared responsibilities. Mothers were open about the special features of their family structure with children and within their immediate social network. Only 30% disclosed their lesbian identity in a broader social environment. The features of these newly created families may influence the psychological development of the children and therefore make long-term follow-up studies indispensable.

Children from anonymous donors: an inquiry into homosexual and heterosexual parents' attitudes.

This study compared two groups of homosexual and heterosexual parents with respect to their attitudes towards the donor-origin of their children. All couples had applied at the Fertility Clinic for artificial insemination with anonymous donor sperm (AID). Both groups had used anonymous donors in order to conceive. However, the sexual orientation of the parents and the presence or absence of a social father was different in the two groups. By comparing such different families it was hoped to obtain insight into those factors which influence parents' attitudes concerning donor insemination. Twenty-five lesbian and 25 heterosexual parents were interviewed. The open-ended questionnaires solicited information on the following issues: attitudes towards secrecy/disclosure of the use of a donor, views on anonymity/identity registration of the donor, parents' cognitive and emotional representation of the donor. Response rates differed between the groups: all homosexual parents consented to the interview and 44% of the heterosexual parents did so. Parents' attitudes depended on several variables. The different family structures were related to different motivations for AID treatment. For heterosexual couples, the use of a donor offered them the opportunity to become a 'normal family'. For homosexual couples, creating a two-mother family unit meant going one step further in 'being different'. Attitudes towards the use of a donor were consequently different: heterosexual couples chose secrecy and donor anonymity. Homosexual parents intended to inform their children. Of these homosexual parents, 40% would prefer the identity of the donor to be registered. This evolution towards removal of the anonymity seemed to be encouraged by the openness surrounding the use of a donor itself. In both groups it remained difficult to reduce the donor to an anonymous sperm cell, fantasies and questions about the donor continued to exist over the years.

Counselling and selection of homosexual couples in fertility treatment.

Artificial insemination with anonymous donor sperm (AID) is a widespread practice for heterosexual couples in which the male partner appears to be infertile. The Centre for Reproductive Medicine of the Brussels University teaching hospital has been one of the first to extend this form of therapy to lesbian couples. In the course of the past 7 years, 27 lesbian couples have come to the centre with a request for AID. The question of whether children can be brought up within such a frame of reference cannot be dissociated from the question of attitudes towards homosexuality as such. Such attitudes still solicit a whole range of controversial reactions. This paper will deal with the most important findings from investigations thus far carried out on the issue of homosexual parenthood. It also sets out the selection criteria used in the evaluation of applicants. A profile of the homosexual couples selected will be presented, with particular attention to their social status, their psychosexual development and their motivation towards parenthood.