Three decades of research suggests donor conception couples maintain health relationship dynamics, with one exception
Couple's interpersonal dynamics and relationship quality in donor-conceived families: a systematic review. (Fusco, 2025)
Fusco, C., De Carli, P., Fusoni, F., & Santona, A. (2025). Couple's interpersonal dynamics and relationship quality in donor-conceived families: a systematic review. Reproductive BioMedicine Online, doi: 10.1016/j.rbmo.2025.105105
Geographic Region: United Kingdom (17 studies), United States (9), Sweden (7), Australia (4), New Zealand (3), Norway (1), Italy (1), Netherlands (1), plus three multi-country European studies.
Research Question: How do interpersonal dynamics and relationship quality function within couples who use gamete donation (sperm, egg, embryo, or double donation) to conceive children?
Design: This systematic review followed PRISMA guidelines and employed a narrative synthesis approach. The researchers conducted a systematic search of four major databases (PUBMED, PsycINFO, Web of Science, and Scopus) in July 2023 without date restrictions to ensure comprehensive coverage of the literature. Due to substantial heterogeneity in study designs, populations, and methodological approaches across the included research, the authors used thematic narrative synthesis to analyze and integrate findings. The analysis organized studies into four key thematic areas: relationship quality dimensions (including satisfaction, dyadic adjustment, and attachment processes), relationship stability and duration, sexuality and intimacy within couples, and partners' agreement and decision-making processes regarding disclosure of donor conception.
Sample: The review included 46 peer-reviewed studies published between 1991 and 2023 that examined couples who used assisted reproductive technologies with donated gametes. Studies were required to clearly differentiate between donor and non-donor ART treatments, spontaneous pregnancies, and other paths to parenthood, with participants having at least one donor-conceived child not exceeding 18 years of age. Most research focused on heterosexual couples (35 studies), with only three studies specifically examining lesbian couples, though additional research compared lesbian and heterosexual families. The majority of studies examined sperm donation families (40 studies) compared to egg donation families (14 studies), with only one study including embryo donation participants. Children's ages across studies ranged from 12 weeks to 18 years, with most studies focusing on children under 10 years of age. Information about donor anonymity was available for 32 studies, including 13 studies with anonymous donors, 9 with identity-release donors, and 10 with mixed donation methods.
Key Findings
Twenty of the included studies suggest generally high levels of relationship satisfaction and no significant differences between families with children conceived through ART and those with children conceived spontaneously.
Fourteen studies explored the link between couples’ relationship quality and the disclosure process or agreement rates regarding the disclosure of donor conception. Disclosure of donor conception itself did not appear to directly affect relationship quality. Partners' agreement and decision-making processes regarding disclosure did emerge as key factors linked to relationship dynamics. Couples with partial agreement on disclosure showed more relationship stress than those in full agreement.
Sixteen studies provided insights on relationship stability, revealing that, at the moment of the study, nearly all gamete-recipient partners were still together with the person with whom they sought the treatment. Separation and divorce rates varied from 1.8% to 23% across the studies, generally similar to or lower than general population rates.
Intimacy and sexuality were investigated by seven studies. Overall, a donor-conceived child's birth did not negatively affect partners' interpersonal dynamics. Some couples reported that donor conception brought them closer together. Sexual satisfaction remained stable in lesbian couples but showed some decline in frequency, similar to patterns seen in all new parent populations.
Limitation: Limited representation from non-Western countries. Heterogeneity in methodologies, sample sizes, and outcome measures. Exclusion of grey literature and non-English publications.
Applications: For parents, early and ongoing communication about donor conception topics may benefit relationship dynamics. Mental health professionals can support couple communication and consensus on key decisions related to donor conception.
Funding Source: No specific funding source mentioned
Lead Author: Chiara Fusco is a clinical psychologist and PhD candidate in Psychology, Linguistics, and Cognitive Neuroscience at the University of Milan-Bicocca, Italy. Her research focuses on psychological functioning and interpersonal processes in different- and same-gender couples, with particular attention to family functioning in families formed through donor and non-donor Assisted Reproductive Technologies. No specific personal connection to donor conception was identified.
Regulatory Context: The studies were conducted across countries with varying regulatory frameworks for donor conception.
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