‘I’m the only mum she knows’: parents’ understanding of, and feelings about, identity-release egg donation

Abstract

STUDY QUESTION How do parents understand and feel about identity-release egg donation? SUMMARY ANSWER Almost one-third of mothers and fathers did not understand the identifiable nature of their egg donation; mothers expressed complex and sometimes difficult feelings about the prospect of future donor–child contact. WHAT IS KNOWN ALREADY Identity-release egg donation has been the only treatment option available to patients wishing to pursue this route to parenthood in the UK since 2005. However, little is known about how well parents understand this legislation, and how they feel about potential donor–child contact. STUDY DESIGN, SIZE, DURATION This qualitative interview study included 61 mothers and 51 fathers whose 5-year-old children were conceived via identity-release egg donation. Interviews were conducted between April 2018 and December 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS Data are reported from phase two of a longitudinal study of families created using open-identity egg donation. In-depth, semi-structured interviews were conducted with mothers and fathers. The interviews contained a section on what parents understood about the identifiable nature of the donor. These data were analysed using qualitative content analysis. Mothers who understood the identifiable nature of their egg donation (n = 44) were then asked about their thoughts and feelings regarding the prospect of future donor–child contact. Mothers’ narratives were analysed using thematic analysis. MAIN RESULTS AND THE ROLE OF CHANCE Almost one-third of parents (28% of mothers, n = 17; 31% of fathers, n = 16) did not understand the identifiable nature of their egg donation. Mothers’ and fathers’ misunderstandings about identity-release egg donation fell into two categories: (i) Unclear about identity-release and (ii) Belief that the donor is anonymous. Reflexive thematic analysis revealed that egg donation mothers’ feelings about identity-release donation could be understood via three organizing themes: (i) identity-release as a threat, (ii) acceptance: it is what it is and (iii) embracing identity-release. The findings indicated that egg donation mothers utilized various strategies to manage their feelings about identity-release egg donation in day-to-day life, and each theme was associated with at least one coping strategy. LIMITATIONS, REASONS FOR CAUTION Participants were predominantly from White, middle-class backgrounds. Further research with a more diverse sample is needed to improve generalizability. WIDER IMPLICATIONS OF THE FINDINGS These findings indicate that parents would benefit from more comprehensive provision of information, both at time of treatment and following conception, to ensure they have fully understood the nature of the donation. Parents may also benefit from follow-up care to help manage any complex or difficult feelings about donor–child contact. STUDY FUNDING/COMPETING INTEREST(s) This research was supported by a Wellcome Trust Collaborative Award [208013/Z/17/Z]. The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.

A longitudinal study of families created using egg donation: Family functioning at age 5.

“…At Phase 1 of the study, mothers and infants in egg donation families had shown less optimal interaction quality (Imrie, Jadva, Fishel, & Golombok, 2019), a difference that may be explained by some mothers in egg donation families finding it challenging to adjust to nongenetic parenthood, perhaps because of a lack of physical resemblance with their child. In the present phase of the study, some mothers reported that knowing what the donor looked like might interfere their relationship with their child (Lysons et al, 2022, 2023). However, no differences were identified between family types on the observational measure of interaction quality.…”

“…Identity-release donation is not without its challenges. The prospect of the child learning the donor's identity in the future and potentially being able to contact them may be threatening for some parents and offer less clear boundaries between the two families (Lysons et al, 2022(Lysons et al, , 2023. The process of deciding whether and how to disclose the child's donor conception to them may also pose different challenges in identity-release families, as disclosure may have a different meaning to parents, given that the child may discover the donor's identity in the future (Isaksson et al, 2016) which may add greater complexity to these decisions (Freeman et al, 2016).…”

A longitudinal study of families formed through third-party assisted reproduction: Mother–child relationships and child adjustment from infancy to adulthood.

“…It is perhaps not surprising that the egg donation mothers, who lacked a genetic connection to their children, obtained higher scores on this measure than the sperm donation mothers, who did not. In the recent study of mothers of children born using an identifiable egg donor, some mothers reported anxiety during pregnancy about whether they would bond with their baby (Imrie et al, 2020), and when the children reached age five, some perceived their child's ability to access the donor's identity as a direct threat to their relationship with their child, and to their identity as their child's mother (Lysons et al, 2022). Egg donation mothers' ratings of less positive family relationships are notable given the absence of separated or divorced egg donation mothers in the present phase of the study, perhaps reflecting a tendency for mothers who do not have a genetic tie to their children to remain with their children's father even when experiencing an unsatisfactory marriage.…”

“…A recent study of families created using identifiable egg donors by the present research team, found that many mothers were concerned during pregnancy that they would not bond with their baby, and although most felt that the baby was their own by age 1, some still struggled with the idea that their child was not genetically related to them (Imrie et al, 2020). When followed up at age 5, some mothers reported feeling threatened by the prospect of their child discovering the identity of the egg donor, and possibly forming a relationship with her (Lysons et al, 2022). These reactions are perhaps unsurprising given the high level of social significance that is placed upon genetic connections (Freeman, 2014; Groll, 2021).…”

Single fathers’ experiences of using egg donation and surrogacy to start a family

“…Secondly, this suggests that, at the point of choosing a donor, intended parents need to be provided with comprehensive, accessible information, by agencies and clinics, to help all parents make informed decisions, and to assist parents to better understand the implications of different types of gamete donation. Research by Lysons et al (2022) revealed that parents of 5-year-old children who used identifiable donation sometimes did not show a full understanding of the type of egg donation they had used. The present research further emphasizes the importance of enabling parents to be fully informed in their decisions when using donated gametes.…”