Oocyte donation disclosure decisions: a longitudinal follow-up at middle childhood

Abstract

Few studies have captured oocyte donation (OD) parents' decision processes about intended and actual disclosure over time. Likewise, OD children's perceptions about their family composition during middle childhood is underexplored. To address these gaps, a longitudinally followed cohort of OD recipient families was invited to participate in a qualitative, follow-up study. With an 86% response rate after 12 years, families were comprised of oocyte recipient mothers (n = 6) and biological fathers (n = 6) representing 12 donor-oocyte conceived children (M = 10.33 years). Of the 12 children, two that were aware and two that were unaware of their conceptual origins completed conversational interviews. Only one family in the initial cohort disclosed OD to their children by the 12-year follow-up, despite 43% of parents intending to disclose and another 43% undecided about disclosure during pregnancy. Four parental disclosure patterns emerged at 12 years: Wanting to Disclose, Conflicted about Disclosure, Not Planning to Disclose, and Having Disclosed. Children that were unaware of their conceptual origins displayed no knowledge of their method of conception. There is a need for family-centric interventions to assist Wanting to Disclose parents in their disclosure process and Conflicted about Disclosure parents in their decision-making process post-OD treatment.

Understanding parents’ intention to disclose the donor conception to their child by application of the theory of planned behaviour

“…Among these parents, the greater confidence they had in their ability to talk with the child about his/her genetic origin, the less they were inclined to initiate sharing this information during the coming year. This is a somewhat surprising finding as previous research has shown that parents frequently report uncertainty about how to talk with their child as a major obstacle for disclosure ( Readings et al , 2011 ; Applegarth et al , 2016 ; Hershberger et al , 2019 ). The present results indicate that some parents had made a deliberate decision to postpone disclosure until their child was older, which might be considered to be in contrast to the message from the fertility clinics that parents should start sharing information about the donor conception with the child from an early age ( The National Board of Health and Welfare, 2004 ).…”

“…The present results indicate that some parents had made a deliberate decision to postpone disclosure until their child was older, which might be considered to be in contrast to the message from the fertility clinics that parents should start sharing information about the donor conception with the child from an early age ( The National Board of Health and Welfare, 2004 ). However, the perception that the child is too young and needs to reach sufficient maturity to understand donor conception is a commonly reported reason to postpone disclosure ( Indekeu et al , 2013 ; Hershberger et al , 2019 ). This finding may also be related to parents’ desire to protect the family from potential stigmatization by limiting information about the donor conception to a small circle, e.g.…”

“…However, to postpone disclosure until certain conditions are fulfilled, referred to as the ‘right-time’ strategy ( Mac Dougall et al , 2007 ), has been found to be risky as the envisioned optimal time-point for disclosure may never appear ( Applegarth et al , 2016 ) and sharing this information may become more difficult the longer parents wait ( Daniels et al , 2011 ). Longitudinal studies also indicate that parents’ intentions to disclose are only borne out in practice to a limited degree ( Readings et al , 2011 ; Hershberger et al , 2019 ). Finally, while the TPB-DQ assessed parents’ intention to talk about the donor conception with their child during the upcoming year, this finding may also reflect the relation between perceived behavioural control and disclosure intentions of parents who are reluctant to ever disclose this information to their child.…”

“…However, it should be noted that the TPB has been criticized for investigating behaviour too much on a cognitive, rational level and not considering emotion as part of behaviour ( Ajzen, 2011 ). In the context of donor conception, this may include fear of stigmatization ( Indekeu et al , 2013 ) and unresolved grief related to infertility ( Hahn and Craft-Rosenberg, 2002 ; Hershberger et al , 2019 ). Additional factors not addressed in the present study, such as cultural and relational aspects as well as the child’s developmental stage and maturity, may also influence parents’ disclosure intentions.…”

“…Regarding perceived behavioural control, previous studies have reported a range of parents’ perceptions of control over disclosure and their ability to talk with offspring about the donor conception ( Shehab et al , 2008 ; Isaksson et al , 2012 , 2016 ). Among parents who want to disclose, uncertainty about how to talk with their child has been reported to hinder disclosure ( Readings et al , 2011 ; Applegarth et al , 2016 ; Hershberger et al , 2019 ), which suggests a relation between parents’ perceived confidence in this regard and their disclosure behaviour. Other factors with potential influence on disclosure concern gender, infertility status and the importance placed on the biogenetic link between parent and child.…”