Egg donation families similar to IVF families
A longitudinal study of families created using egg donation: Family functioning at age 5. (Imrie, 2023)
Imrie, S., Lysons, J., Foley, S., Jadva, V., Shaw, K., Grimmel, J., & Golombok, S. E. (2023). A longitudinal study of families created using egg donation: Family functioning at age 5. Journal of Family Psychology, 37(8), 1253–1265. https://doi.org/10.1037/fam0001145
Geographic Region: United Kingdom
Research Question: How do heterosexual couples who used identity-release egg donation to have children differ from couples who conceived using in vitro fertilization with their own gametes in terms of parental psychological well-being, parent-child relationship quality, and children’s psychological adjustment at age 5? What parental factors predict higher levels of behavioral and emotional problems in children in these two family types?
Design: This paper includes data from Phase 2 of the United Kingdom Longitudinal Study of Assisted Reproduction Families conducted under the leadership of Susan Golombok at the Centre for Family Research, University of Cambridge. Researchers compared 72 heterosexual-couple families with children conceived through identity-release egg donation to 50 families who used IVF with their own gametes. Data collection occurred between April 2018 and December 2019, when children were approximately 5 years old. Families had participated in Phase 1 of the study when their children were approximately 1 year old. Parents completed semistructured interviews to assess their representations of the parent-child relationship using the Parent Development Interview, which captures parental affect, reflective functioning, and representations of the child. Parents and their children (aged 5) also participated in structured play tasks (Etch-a-Sketch for mothers and children; Co-Construction Task for fathers and children) that were videotaped and later coded using the Emotional Availability Scales, a measure of parent-child interaction quality grounded in attachment theory. Parents completed questionnaire booklets assessing parenting stress using the Parenting Stress Index, couple relationship quality using the Golombok Rust Inventory of Marital State, and perceived social support using the Multidimensional Scale of Perceived Social Support. Parents were also interviewed about their criticism of their child using a standardized coding scheme. Teachers completed the Strengths and Difficulties Questionnaire to assess children’s behavioral and emotional adjustment. A child psychiatrist, blind to family type, conducted ratings based on maternal interview data to assess the presence and severity of child psychiatric disorder. Statistical analysis used multivariate analysis of variance to compare groups on psychological and relationship measures, with demographic covariates (maternal and paternal education) included when they differed significantly between groups. Latent change score models were used to examine intraindividual change over time in parental measures from Phase 1 (age 1) to Phase 2 (age 5), which allowed researchers to examine how change in parental stress, reflective functioning, social support, and couple relationship quality predicted children’s adjustment at age 5. Moderation analyses tested whether family type (egg donation vs. IVF) changed the strength of these associations. The sample size provided power to detect medium-sized effects.
Sample: 122 mothers (mean age 45 years), 96 fathers (mean age 47 years), and 122 children (56 female, 66 male; mean age 5.6 years). The egg donation group consisted of 72 families, of which 63 had used identity-release donors and 9 had used known donors. The IVF comparison group consisted of 50 families who conceived using the parents’ own gametes. The overall participation rate was 85%. Teachers also participated (66% participation rate). 81% of families participated at both Phases 1 and 2; 79% of fathers participated at Phase 2. The sample predominantly identified as White British (96% of mothers; 90% of fathers). Mothers were significantly older in egg donation families (mean age 48 years) than in IVF families (mean age 42 years), and fathers in egg donation families were also older (mean age 48 years versus 44 years in IVF families). Fewer children in egg donation families had siblings compared to IVF families. Families did not differ significantly on working status, education level, perceived financial difficulties, or prior psychiatric contact. The article does not provide a detailed breakdown of disclosure status, but the researchers note that most parents intended to disclose by age 5.
Key Findings
Editor’s Note: All families in this study—both egg donation and IVF—had parents and children functioning in the healthy, normal range. No parent or child measures reached clinically concerning levels. While this study identified statistical differences between egg donation and IVF families, these differences were modest and should be understood within the context that both groups were functioning well.
Child Development Outcomes
Both egg donation and IVF children were developing well at age 5. Children’s behavioral and emotional scores (measured using the Strengths and Difficulties Questionnaire from teachers and parents and a psychiatric interview) fell within the normal healthy range in both groups.
Teachers reported slightly more behavior problems (like acting out or hyperactivity) and emotional difficulties (like anxiety or trouble with friendships) in egg donation children compared to IVF children. However, the differences were small to moderate in size and both groups scored in the normal range.
When a child psychiatrist reviewed mothers’ descriptions of their children, about 11% of all children across both groups had a diagnosable emotional or behavioral problem. There was no difference between egg donation and IVF families. This rate is typical for this age group in the general population.
What Parental Factors Were Associated With Variation in Child Outcomes
Across both egg donation and IVF families, researchers tracked changes in parental stress (Parenting Stress Index), social support (Multidimensional Scale of Perceived Social Support), and reflective functioning (ability to understand and reflect on the child’s feelings, coded from parent interviews) from age 1 to age 5. Within the normal range of functioning, certain parental characteristics were associated with children having slightly more behavior problems: mothers with lower social support at age 1, whose stress increased significantly between ages 1 and 5, and who expressed more criticism of their child. These factors together explained about 40% of the variation in child behavior. This association does not prove causation; the direction of influence cannot be determined.
Children with slightly more emotional difficulties were associated with parents whose couple relationship quality (Golombok Rust Inventory of Marital State) was lower at age 1 and whose reflective functioning did not improve over time.
In egg donation families specifically, increases in parenting stress over time showed a stronger association with children’s behavior problems than in IVF families. This does not mean stress caused problems; rather, the two measures were more closely linked in egg donation families. Whether stress affects children’s behavior, children’s behavior increases parental stress, or both happen together cannot be determined from this data.
Parental Well-Being and Self-Perceptions
Egg donation parents reported higher parenting stress on the Parenting Stress Index compared to IVF parents. However, both groups scored well below the clinical cutoff (71 and 62 vs. clinical concern at 85+), meaning neither group was in the stressed range.
Egg donation mothers reported lower social support and less satisfaction with their partnership compared to IVF mothers. Both groups scored in the moderate-to-high support range, not the low support range.
When interviewed about their feelings and representations of their child (Parent Development Interview), egg donation mothers and fathers reported feeling more anger, less confidence, and less competence compared to IVF parents. Egg donation fathers also expressed more criticism of their children. These parents’ absolute scores remained in the range reflecting good parenting.
Parent-Child Interaction in Real Time
When researchers watched parents and children in structured play tasks (Etch-a-Sketch for mothers and children; Co-Construction Task for fathers and children) and coded their interactions using the Emotional Availability Scales, they found that both egg donation and IVF families showed warm, responsive, emotionally healthy interactions. There were essentially no meaningful differences between groups. Both scored in the upper range of quality.
Egg donation fathers provided slightly less guidance and scaffolding during the play task compared to IVF fathers, though this difference was modest and did not reach clinical concern.
There is a notable contrast between how egg donation parents reported feeling in interviews and questionnaires (stressed, less confident, angry) and what researchers observed when watching them with their children (warm, responsive, engaged). This disconnect suggests that egg donation parents’ internal anxiety and stress did not substantially interfere with their actual parenting behavior.
Limitations: The sample was limited to predominantly White British, highly educated families, and intending to disclose, restricting generalizability to other sociocultural contexts and populations. All families were heterosexual, cisgender, and two-parent, preventing generalization to families using egg donation in other family structures. There was a smaller sample size for fathers, which limited the ability to examine father effects on child adjustment. The comparison to IVF families, while controlling for fertility treatment, still frames genetic relatedness as the baseline, potentially pathologizing egg donation rather than treating it as a neutral alternative family formation. The study relies on parental representations of the child rather than direct reports from the child. The study does not adequately disentangle whether elevated parenting stress, lower social support, and poorer couple relationship quality reflect the experience of being an egg donation parent or other factors, such as parental age (egg donation parents were, on average, 5 years older).
Applications: Within all families, multiple factors (e.g., parental stress, social support, couple relationship quality, and parental reflective functioning) are associated with variation in child behavior. This is true across family types, not specific to egg donation. General attention to family well-being benefits children, regardless of how they were conceived. Future research could examine whether the parental stress and lower confidence reported by egg donation parents in this study reflects egg donation itself, the context of identity-release disclosure, parental age, or other factors.
Funding Source: The Wellcome Trust (Grant 208013/Z/17/Z).
Lead Author: Susan Imrie is a developmental psychologist and researcher at the Centre for Family Research at the University of Cambridge, where she studies family functioning in new family forms, including families created through assisted reproduction and families with trans parents. No personal connection to donor conception was disclosed.
Regulatory Context:
The Human Fertilisation and Embryology Authority (HFEA) is the independent regulatory body overseeing fertility treatment and embryo research in the UK. In 2005, UK law changed from permitting anonymous egg and sperm donation to requiring identity-release donation, ending donor anonymity. This means that donor-conceived people born on or after April 1, 2005, have the legal right to request identifying information about their donor at age 18 and information about any donor siblings who have also registered interest in contact. Those conceived before 2005 do not have the same legal right to identifying information; donors were guaranteed anonymity at the time of donation. However, a voluntary Donor Conceived Register (DCR) allows pre-2005 donors and donor-conceived people to voluntarily register and potentially match.
Same-sex female couples gained access to fertility treatment in 2006. Access is available to different-sex couples, same-sex couples, and single individuals. Embryo donation is legal.
All fertility treatment must be provided by licensed fertility clinics authorized by the HFEA.
Legal parentage is typically determined by birth (for the birth mother) and consent/intention (for partners).
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