Mothers who disclose before age 7 were significantly less anxious and depressed
A longitudinal study of families formed through third-party assisted reproduction: Mother–child relationships and child adjustment from infancy to adulthood. (Golombok, 2023)
Golombok, S., Jones, C., Hall, P., Foley, S., Imrie, S., & Jadva, V. (2023). A longitudinal study of families formed through third-party assisted reproduction: Mother–child relationships and child adjustment from infancy to adulthood.Developmental Psychology, 59(6), 1059–1073. https://doi.org/10.1037/dev0001526
Geographic Region: United Kingdom
Research Question: Do young adults born through egg donation, sperm donation, or surrogacy show greater psychological problems or poorer relationships with their mothers than young adults born through unassisted conception, and does the age at which children were told about their biological origins predict the quality of those relationships and their psychological wellbeing at age 20?
Editor’s Note: Because Golombok’s research is often quoted in donor conception spaces and this paper is a major one from the body of research, I spent a little more time explaining the design and sample.
Design: Seventh phase of a prospective longitudinal cohort study that followed the same families from infancy (ages 1 and 2) through early childhood (age 3), middle childhood (age 7), later childhood (age 10), adolescence (age 14), and early adulthood (age 20). The study design allowed researchers to examine how family functioning and child adjustment changed over nearly two decades. Data collection for Phase 7 took place online due to COVID-19 restrictions. Mothers completed standardized questionnaires and were interviewed using an adapted semi-structured interview assessing the quality of the mother-child relationship. Young adults completed separate questionnaires.
Maternal wellbeing was measured using the Trait Anxiety Inventory (TAI), the Edinburgh Depression Scale (EDS), and the Golombok Rust Inventory of Marital State (GRIMS).
Family relationship quality was assessed using a structured interview coded by trained researchers, the Parental Acceptance Rejection Questionnaire (PARQ), the Index of Family Relationships (IFR), and the communication subscale of the Family Assessment Measure (FAM).
Young adult psychological adjustment was measured using the Strengths and Difficulties Questionnaire (SDQ) - completed by both mothers and young adults, the Flourishing Scale, and a psychiatrist’s blind ratings of psychiatric disorder severity from interview transcripts.
Sample: Phase 7 included 117 mothers (average age 56) and their 20-year-old children (61 female, 56 male). The sample included 22 surrogacy families, 17 egg donation families, 26 sperm donation families, and 52 unassisted conception families (comparison group). All families had two heterosexual parents at the start of the study. Donor type varied: almost all sperm donation families used anonymous donors, as did most egg donation families (the study began before identity-release donation was common in the UK). Surrogacy families all knew their surrogates.
Of the 117 mothers eligible to participate, 91 (78%) completed questionnaires. Fewer than half of the mothers held a university degree (41%), and only 4% (n=5) identified as belonging to an ethnic minority group.
For the young adults, only those who were aware of their method of conception, plus those born through unassisted conception, were eligible to participate (n=98). Of these, 76 young adults (78%) took part in interviews (15 surrogacy, 11 egg donation, 9 sperm donation, 41 unassisted conception). Most self-identified as White British (91%); 9% identified as from an ethnic minority background.
The Phase 7 sample represents 83% of families who participated in Phase 6 (age 14). Families who dropped out between Phases 6 and 7 were marginally less likely to have disclosed their child’s conception origins by age 14.
Key Findings
Mothers in egg donation, sperm donation, and surrogacy families were doing just as well emotionally as mothers in families where conception happened without medical assistance. Researchers found no differences between the four groups in anxiety, depression, or relationship quality with their partners.
Mothers across all four family types were parenting in similar ways, showing similar levels of warmth and closeness with their 20-year-old children, and similar levels of conflict.
Mothers in all groups felt similarly accepted and close to their adult children, and reported similar levels of openness and ease of communication within their families. The 20-year-olds themselves reported similar perceptions of how accepted they felt by their mothers, how close their family relationships were, and how freely they could communicate within their families, regardless of how they were conceived.
The 20-year-olds in all four groups showed similar levels of psychological wellbeing and were doing well overall. Both mothers’ assessments and the young adults’ own reports placed the group’s average wellbeing scores comfortably within the normal range, comparable to national norms for young people of the same age. An independent child psychiatrist who reviewed interview transcripts (without knowing which family type was which) found no meaningful differences between groups in the severity of psychological difficulties.
Egg donation mothers reported their family relationships as somewhat less positive than sperm donation mothers did. This difference was statistically significant, and it replicates a finding from the same families when the children were 14. The researchers suggest this may reflect the additional emotional weight that some mothers carry when they have no genetic connection to their child, a challenge that appears more pronounced for mothers than for fathers in this context.
Twenty-year-olds conceived by sperm donation reported that communication within their families felt less open than those conceived by egg donation reported. The researchers link this to the historically higher rates of secrecy around sperm donation compared to egg donation. Fathers who used donor sperm have tended to be less willing to disclose, and less comfortable talking about it even after disclosing, than mothers who used donor eggs.
Editor’s Note: Small samples for these subgroups (egg donation families vs sperm donation families) mean the study may not have had enough statistical power to reliably detect true differences, and the findings about differences between egg donation families and sperm donation families should be treated as preliminary rather than definitive.
Of the 65 donor conception and surrogacy families in the study, 37 had told their child about their origins before age 7 and 11 had told their child after age 7. Seventeen families (almost all of them sperm donation families) had still not told their child by the time they turned 20.
Mothers who told their child before age 7 were significantly less anxious and less depressed at the age-20 follow-up than mothers who waited until after age 7. The size of these differences was meaningful, suggesting a genuine gap in wellbeing.
Mothers who told their child before age 7 also showed significantly less conflict and negativity in their parenting at age 20 than mothers who disclosed later. This was a large difference and is one of the most notable findings in the study.
Several other measures of family health, including how accepted children felt by their mothers, overall family closeness, and how openly families communicated, showed the same pattern, with families who disclosed earlier faring better. These differences did not reach statistical significance.
The 20-year-olds who had been told about their origins before age 7 tended to report better wellbeing, more positive family communication, and greater life satisfaction than those told later, though again, these differences did not reach statistical significance on their own.
Editor’s Note: The study was only large enough to reliably detect large differences in the disclosure comparisons, meaning moderate but meaningful effects may have gone undetected.
Limitations: The overall sample size was small, which limited statistical power, particularly for comparisons between the smaller subgroups (egg donation, sperm donation, surrogacy families) and between disclosing and non-disclosing families. Families who dropped out of the study in the preschool years often did so because they were concerned about participation affecting their decision to keep their child’s origins secret, meaning the sample is biased toward disclosing or more open families. The sample is homogeneous in race, ethnicity, and family structure. Seventeen families (26% of assisted reproduction families, almost entirely sperm donation families) had not disclosed their child’s conception origins by age 20. These families could not participate in the young adult data collection on ethical grounds, but their exclusion means the study captures almost nothing about the experiences of young adults who remain unaware of their donor conception origins. Disclosure timing is described as before or after age 7, but disclosure is not a single event. The nature of disclosure conversations, if/how families continued to discuss origins over time, and children’s individual reactions are not captured. The study began before widespread use of DNA ancestry testing, a contextual change that may affect both disclosure practices and outcomes in future cohorts.
Applications: This study provides reassuring evidence, drawn from 20 years of follow-up, that children born through donor conception and surrogacy are not at greater risk for psychological problems or difficulties in family relationships simply because of the method of their conception. The consistent finding that earlier disclosure is associated with better outcomes for family relationships and maternal wellbeing adds to a growing evidence base supporting disclosure in early childhood, ideally before age 7.
Funding Source: Wellcome Trust Collaborative Award (Grant 208013/Z/17/Z)
Lead Author: Susan Golombok is Professor of Family Research and Director of the Centre for Family Research at the University of Cambridge, and a Professorial Fellow at Newnham College, Cambridge. She was a member of the Nuffield Council on Bioethics Working Party on Donor Conception (2012-2013).
Regulatory Context
The Human Fertilisation and Embryology Authority (HFEA) is the independent regulatory body overseeing fertility treatment and research involving human embryos in the UK.
In 2005, the UK changed its laws on gamete donation from anonymous to identifiable: all donors who donated from April 1, 2005, onward must be willing to be identified to donor-conceived offspring who request their information at age 18. However, the families in this longitudinal study were recruited around 1999-2000, when their children were infants, meaning virtually all donor conception in this sample predated the 2005 law change, and most donors were anonymous.
Donor-conceived people conceived on or after April 1, 2005, can access identifying information about their donor, and can also request information about the identity of donor siblings who have expressed interest in contact, at age 18.
Those conceived before the 2005 law change do not have the same legal right to identifying information. A voluntary register, the Donor Conceived Register (DCR), allows pre-2005 donors and donor-conceived people to register and potentially match, but participation is not mandatory.
The UK does not legally require parents to disclose donor conception to their children. Disclosure is encouraged but remains a personal decision.
Commercial gamete donation (payment beyond expenses) is prohibited in the UK; donation must be altruistic, with donors receiving compensation for expenses and inconvenience only.
All licensed treatment must be carried out at HFEA-approved clinics. Informal or private arrangements for donor insemination are not regulated in the same way.
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