Social pressures and partner support drive parents' disclosure of donor conception

Using the theory of planned behavior to predict parents' disclosure of donor conception to their children: A longitudinal study (Paulin, 2024)

Paulin, J., Sorjonen, K., Sydsjö, G., & Lampic, C. (2024). Using the theory of planned behavior to predict parents' disclosure of donor conception to their children: A longitudinal study. Human Reproduction, 39(6), 1247-1255. https://doi.org/10.1093/humrep/deae070

Geographic Region: Sweden

Research Question: Can the theory of planned behavior help predict heterosexual parents' disclosure of donor conception to their children?

Research Methods: Part of the Swedish Study on Gamete Donation, a larger longitudinal study following couples from treatment start (2005-2008) through five waves of data collection. Participants completed questionnaires when children were 7-8 years old (T4) and 13-17 years old (T5) to measure attitudes and intentions to disclose.

Sample Size and Description: 130 heterosexual-couple parents (68 oocyte donation, 62 sperm donation) who conceived children through identity-release gamete donation. Most of the respondents were female. 40 parents had not disclosed at T4.

Analysis Methods: Survival analysis with Cox regressions

Key Findings:

• By the time the children were teenagers, most parents (90%) had told their children about their donor conception.

• Parents who felt strongly about following what society and others thought was right (especially their partner's opinion) were more likely to tell their children about their donor conception.

• Having a partner who supported being open about the donor conception was one of the strongest factors in whether parents went ahead with telling their children.

• Some things that might seem important didn't end up making much difference. For parents who believed telling their child was the right thing to do, or felt confident about how to have the conversation, these feelings alone didn't predict whether they actually told their children. Parents who said they planned to tell their children within the next year when first asked didn't necessarily follow through with their intentions.

Limitations: Small sample size, particularly for non-disclosing parents at T4. Risk of systematic dropout over time. Limited generalizability (heterosexual couples only, identity-release donors only). Higher dropout among divorced/separated mothers and non-disclosing mothers.

Applications:

• Healthcare professionals and counselors should focus more on helping couples develop open communication about donor conception from the very beginning of their treatment journey.

• Rather than just providing instructions on how to tell children, professionals should help couples discuss their feelings, concerns, and expectations about disclosure with each other.

• Parents might benefit from connecting with other families who have gone through similar experiences, as social support appears to play a significant role in disclosure decisions.

Funding Source: Swedish Research Council

Lead Author: Johan Paulin is a postdoctoral researcher Umeå University studying the psychosocial well-being of families who have conceived using donated egg or sperm.

Regulatory Context:

• Sweden was one of the first countries to implement identity-release donation, passing legislation in 1984 that went into effect in 1985. Donor-conceived individuals have the legal right to obtain identifying information about their donor when they reach “sufficient maturity,” typically interpreted as age 18, though no specific age is mandated by law. Donor information is recorded in medical records that the child can access as an adult.

• Only altruistic gamete donation is allowed. Donors can receive compensation for expenses and inconvenience, but not payment for the gametes themselves. Donors must be 18 years or older.

• Legislation allowed donor insemination through the public healthcare system for heterosexual couples in 1985, and IVF treatment with donor eggs or sperm were also permitted to heterosexual couples in 2003. Sperm donation treatment became accessible to lesbian couples in 2005. In 2016, legislation was passed to allow access to assisted reproductive treatments, including procedures with donor eggs and donor sperm, for single women and lesbian couples. A separate change occurred in 2019, allowing both private and public clinics to perform treatments with donated eggs, and a double donation (using both a donated egg and donated sperm) became legal.

• In Sweden, a donor can contribute to a maximum of six families. A central register of all donor treatments is maintained by the National Board of Health and Welfare. This register helps to connect donor-conceived individuals, donors, and their relatives.