Advertisement

Psychological adjustment in disclosing and non-disclosing heterosexual-couple families following conception with oocytes or spermatozoa from identity-release donors

Open AccessPublished:June 20, 2022DOI:https://doi.org/10.1016/j.rbmo.2022.06.011

      Abstract

      Research question

      Is there a relationship between disclosure and psychological adjustment in heterosexual-couple families following oocyte donation and sperm donation when the child is 7 years old?

      Design

      This was a cross-sectional study of heterosexual couples with 7- to 8-year-old children conceived with identity-release oocyte donation (n = 83, response rate 56%) or sperm donation (n = 113, response rate 65%). Participants individually completed instruments for the assessment of parents’ emotional distress (HADS), parenting stress (SPSQ) and relationship quality (ENRICH), and their child's psychological adjustment (SDQ-Swe) and reported whether they had talked with their child about their donor conception.

      Results

      About half of parents had talked with their child about their donor conception (oocyte donation 61%, sperm donation 58%). Separate analyses for mothers and fathers showed no main effects of disclosure or type of donation on the outcomes, nor were there any interaction effects. Overall, mothers and fathers in oocyte donation and sperm donation families were found to be well adjusted, reporting within-normal range levels of anxiety, depression and parental stress, and a high relationship quality. The children were well adjusted, with low levels of emotional and behavioural problems.

      Conclusions

      Overall, the present results confirm previous research indicating that early disclosure of the donor conception to children is not associated with negative outcomes for parents or children. Heterosexual couples using oocyte or sperm donation should be informed that disclosure when the child is 7–8 years old is not detrimental to the psychological adjustment of families.

      Keywords

      Introduction

      The potential benefits and harms of disclosure to donor-conceived individuals is a contentiously debated issue hampered by inconclusive evidence. Parental disclosure of the donor conception is argued to be in the child's best interest, and starting disclosure from an early age is increasingly being recommended (
      Ethics Committee of the American Society for Reproductive Medicine
      Informing offspring of their conception by gamete or embryo donation: an Ethics Committee opinion.
      ; ;
      • Kirkman-Brown J.
      • Calhaz-Jorge C.
      • Dancet E.A.F.
      • Lundin K.
      • Martins M.
      • Tilleman K.
      • Thorn P.
      • Vermeulen N.
      • Frith L.
      • Donation E.W.G.o.R.
      Good practice recommendations for information provision for those involved in reproductive donation.
      ;

      The National Board of Health and Welfare. Barnets rätt att få kännedom om sitt ursprung efter en assisterad befruktning med donerade ägg eller spermier. 2004.https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/meddelandeblad/2004-1-1_200411.pdf (25 May 2022, date last accessed).

      ). However, the extent to which parents disclose the mode of conception to their donor-conceived child varies, and parents’ decision making on disclosure has been found to be influenced by multiple factors (
      • Indekeu A.
      • Dierickx K.
      • Schotsmans P.
      • Daniels K.R.
      • Rober P.
      • D'Hooghe T.
      Factors contributing to parental decision-making in disclosing donor conception: a systematic review.
      ).
      Heterosexual couples have been shown to be less likely to disclose their use of sperm donation to their children (
      • Beeson D.R.
      • Jennings P.K.
      • Kramer W.
      Offspring searching for their sperm donors: how family type shapes the process.
      ;
      • Freeman T.
      • Zadeh S.
      • Smith V.
      • Golombok S.
      Disclosure of sperm donation: a comparison between solo mother and two-parent families with identifiable donors.
      ) and to express concerns about the impact of disclosure (
      • Blake L.
      • Casey P.
      • Readings J.
      • Jadva V.
      • Golombok S.
      Daddy ran out of tadpoles': how parents tell their children that they are donor conceived, and what their 7-year-olds understand.
      ;
      • Readings J.
      • Blake L.
      • Casey P.
      • Jadva V.
      • Golombok S.
      Secrecy, disclosure and everything in-between: decisions of parents of children conceived by donor insemination, egg donation and surrogacy.
      ;
      • Widbom A.
      • Isaksson S.
      • Sydsjö G.
      • Skoog Svanberg A.
      • Lampic C.
      Positioning the donor in a new landscape-mothers' and fathers' experiences as their adult children obtained information about the identity-release sperm donor.
      ). In comparison, single women and same-sex female couples tend to be open with their children about their conception with donor spermatozoa as they need to explain the absence of a father in the family (
      • Appleby J.B.
      • Blake L.
      • Freeman T.
      Is disclosure in the best interests of children conceived by donation? In Richards, M., Pennings, G. and Appleby, J.B. (eds) Reproductive donation: Practice, policy and bioethics.
      ). In line with this, heterosexual-couple parents have expressed worry about the potential negative impact on the parent–child relationship, particularly concerning the relationship with the non-genetic father (
      • Golombok S.
      • Brewaeys A.
      • Giavazzi M.T.
      • Guerra D.
      • MacCallum F.
      • Rust J.
      The European study of assisted reproduction families: the transition to adolescence.
      ;
      • Scheib J.E.
      • Riordan M.
      • Rubin S.
      Choosing identity-release sperm donors: the parents' perspective 13-18 years later.
      ;
      • Widbom A.
      • Isaksson S.
      • Sydsjö G.
      • Skoog Svanberg A.
      • Lampic C.
      Positioning the donor in a new landscape-mothers' and fathers' experiences as their adult children obtained information about the identity-release sperm donor.
      ). In view of the apparent challenges for heterosexual donor-conceiving couples and the ongoing debate about the benefits and risks of disclosure, it is important to consider the consequences of these parents’ disclosure for family well-being and functioning.
      Previous research comparing disclosing and non-disclosing heterosexual-couple families on a large number of outcome measures indicates more similarities than differences in terms of psychological functioning and relationship quality when the donor-conceived child is between pre-school age and early adolescence (i.e. 4–14 years) (
      • Blake L.
      • Jadva V.
      • Golombok S.
      Parent psychological adjustment, donor conception and disclosure: a follow-up over 10 years.
      ;
      • Freeman T.
      • Golombok S.
      Donor insemination: a follow-up study of disclosure decisions, family relationships and child adjustment at adolescence.
      ;
      • Golombok S.
      • Brewaeys A.
      • Giavazzi M.T.
      • Guerra D.
      • MacCallum F.
      • Rust J.
      The European study of assisted reproduction families: the transition to adolescence.
      ;
      • Golombok S.
      • Readings J.
      • Blake L.
      • Casey P.
      • Mellish L.
      • Marks A.
      • Jadva V.
      Children Conceived by Gamete Donation: Psychological Adjustment and Mother-Child Relationships at Age 7.
      ;
      • Golombok S.
      • Blake L.
      • Casey P.
      • Roman G.
      • Jadva V.
      Children born through reproductive donation: a longitudinal study of psychological adjustment.
      ;
      • Ilioi E.
      • Blake L.
      • Jadva V.
      • Roman G.
      • Golombok S.
      The role of age of disclosure of biological origins in the psychological wellbeing of adolescents conceived by reproductive donation: a longitudinal study from age 1 to age 14.
      ;
      • Kovacs G.T.
      • Wise S.
      • Finch S.
      Keeping a child's donor sperm conception secret is not linked to family and child functioning during middle childhood: An Australian comparative study.
      ;
      • Lycett E.
      • Daniels K.
      • Curson R.
      • Golombok S.
      Offspring created as a result of donor insemination: a study of family relationships, child adjustment, and disclosure.
      ). However, several of these studies have shown significant group differences on certain outcome measures, most often indicating an association between disclosure and more positive adjustment.
      Concerning the parents’ psychological state, one study did not find any significant differences in mothers’ psychological distress between disclosing and non-disclosing sperm donation families (
      • Kovacs G.T.
      • Wise S.
      • Finch S.
      Keeping a child's donor sperm conception secret is not linked to family and child functioning during middle childhood: An Australian comparative study.
      ), while two studies showed a tendency towards disclosure having more positive outcomes for mothers (
      • Blake L.
      • Jadva V.
      • Golombok S.
      Parent psychological adjustment, donor conception and disclosure: a follow-up over 10 years.
      ;
      • Golombok S.
      • Blake L.
      • Casey P.
      • Roman G.
      • Jadva V.
      Children born through reproductive donation: a longitudinal study of psychological adjustment.
      ). Interestingly, disclosure had different effects on the parenting stress of sperm donation and oocyte donation fathers when the child was age 7 years, and on depression symptoms when the child was 10, with sperm donation fathers in disclosing families reporting higher levels and oocyte donation fathers reporting lower levels of psychological distress compared with non-disclosing families (
      • Blake L.
      • Jadva V.
      • Golombok S.
      Parent psychological adjustment, donor conception and disclosure: a follow-up over 10 years.
      ).
      In regard to parents’ satisfaction with the partner relationship, three studies of sperm donation families found no significant differences between disclosing and non-disclosing couples (
      • Freeman T.
      • Golombok S.
      Donor insemination: a follow-up study of disclosure decisions, family relationships and child adjustment at adolescence.
      ;
      • Kovacs G.T.
      • Wise S.
      • Finch S.
      Keeping a child's donor sperm conception secret is not linked to family and child functioning during middle childhood: An Australian comparative study.
      ;
      • Lycett E.
      • Daniels K.
      • Curson R.
      • Golombok S.
      Offspring created as a result of donor insemination: a study of family relationships, child adjustment, and disclosure.
      ). No study to date has investigated the impact of disclosure on couple relationships in oocyte donation families.
      Concerning the impact of disclosure on parent–child interaction and family functioning, the majority of the reported results indicate no statistically significant differences between disclosing and non-disclosing families. However, several studies report positive outcomes of disclosure on some outcome measures. For example, mothers in disclosing families were found to report less frequent and less severe disputes with their child (
      • Golombok S.
      • Brewaeys A.
      • Giavazzi M.T.
      • Guerra D.
      • MacCallum F.
      • Rust J.
      The European study of assisted reproduction families: the transition to adolescence.
      ;
      • Lycett E.
      • Daniels K.
      • Curson R.
      • Golombok S.
      Offspring created as a result of donor insemination: a study of family relationships, child adjustment, and disclosure.
      ), less strict discipline (
      • Golombok S.
      • Brewaeys A.
      • Giavazzi M.T.
      • Guerra D.
      • MacCallum F.
      • Rust J.
      The European study of assisted reproduction families: the transition to adolescence.
      ), their child being less of a strain and themselves feeling more competent as a mother (
      • Lycett E.
      • Daniels K.
      • Curson R.
      • Golombok S.
      Offspring created as a result of donor insemination: a study of family relationships, child adjustment, and disclosure.
      ), and lower levels of conflict with their sons (
      • Freeman T.
      • Golombok S.
      Donor insemination: a follow-up study of disclosure decisions, family relationships and child adjustment at adolescence.
      ), compared with mothers in non-disclosing families. Among fathers, the only significant result indicates that disclosure is associated with sperm donation fathers feeling more competent as a parent (
      • Lycett E.
      • Daniels K.
      • Curson R.
      • Golombok S.
      Offspring created as a result of donor insemination: a study of family relationships, child adjustment, and disclosure.
      ). In contrast, adolescents in disclosing sperm donation families reported less warm father–child relationships (
      • Freeman T.
      • Golombok S.
      Donor insemination: a follow-up study of disclosure decisions, family relationships and child adjustment at adolescence.
      ).
      In terms of the children's psychological adjustment, studies have compared disclosing and non-disclosing sperm donation families or combined families that have used different types of treatment, and samples are typically represented by few disclosing families. Most studies have found no statistically significant differences between disclosing and non-disclosing families regarding child adjustment (
      • Freeman T.
      • Golombok S.
      Donor insemination: a follow-up study of disclosure decisions, family relationships and child adjustment at adolescence.
      ;
      • Golombok S.
      • Brewaeys A.
      • Giavazzi M.T.
      • Guerra D.
      • MacCallum F.
      • Rust J.
      The European study of assisted reproduction families: the transition to adolescence.
      ;
      • Golombok S.
      • Blake L.
      • Casey P.
      • Roman G.
      • Jadva V.
      Children born through reproductive donation: a longitudinal study of psychological adjustment.
      ;
      • Ilioi E.
      • Blake L.
      • Jadva V.
      • Roman G.
      • Golombok S.
      The role of age of disclosure of biological origins in the psychological wellbeing of adolescents conceived by reproductive donation: a longitudinal study from age 1 to age 14.
      ;
      • Kovacs G.T.
      • Wise S.
      • Finch S.
      Keeping a child's donor sperm conception secret is not linked to family and child functioning during middle childhood: An Australian comparative study.
      ;
      • Lycett E.
      • Daniels K.
      • Curson R.
      • Golombok S.
      Offspring created as a result of donor insemination: a study of family relationships, child adjustment, and disclosure.
      ). However, one study found that mothers in disclosing families considered their children to have lower levels of conduct problems (
      • Lycett E.
      • Daniels K.
      • Curson R.
      • Golombok S.
      Offspring created as a result of donor insemination: a study of family relationships, child adjustment, and disclosure.
      ).
      In summary, the literature on the associations between disclosure and psychological adjustment among heterosexual-couple families is inconclusive. While most results show no statistically significant differences between disclosing and non-disclosing families, there is an indication that disclosure is associated with positive aspects of family functioning, and a few findings suggest that disclosure in sperm donation families may have more negative outcomes for fathers. However, the majority of studies concern only sperm donation or do not differentiate between donation types, relate to treatment with anonymous donors and predominantly include the mothers’ perspectives. Furthermore, several studies have been hampered by selection bias, small sample sizes, and high attrition in longitudinal studies.
      The aim of the present study was to investigate the relationship between disclosure and psychological adjustment in heterosexual-couple families following oocyte and sperm donation.

      Materials and methods

      The present study was performed within the context of the Swedish legislation on identity-release donation, which mandates that the donor-conceived child has the right to obtain identifying information about their donor when they are sufficiently mature (i.e. around the age of 18 years; see the Genetic Integrity Act SFS 2006:351 as described in
      • Stoll J.
      Swedish donor offspring and their legal right to information.
      ). All recipients undergo a psychosocial evaluation with a counsellor and a physician to ensure that they understand the practical, psychosocial and legal aspects of the treatment and intend to share information about the donor conception with the resulting child. Initially, the legislation on identity-release donation applied only to heterosexual couples using donor insemination (1985) but this was later extended to include other recipient groups and types of donor conception: IVF treatment with donor oocytes and spermatozoa for heterosexual couples (2003), sperm donation for same-sex female couples (2005) and single women (2016), as well as embryo donation for heterosexual and same-sex female couples and single women (2019).

      Participants

      The present study is part of the prospective longitudinal Swedish Study on Gamete Donation (SSGD), where donors and recipients of donated gametes were recruited between 2005 and 2008 from all seven university hospitals providing gamete donation in Sweden. Eligibility criteria were being able to read Swedish and undergoing at least one round of treatment. A total of 309 (72%) recipients of donor oocytes and 255 (81%) heterosexual recipients of donor sperm were included in the SSGD.
      The present study concerns a cohort from the fourth wave of data collection of the SSGD, when parents were approached in the year following the child's seventh birthday. Inclusion criteria were being part of a heterosexual couple and having given birth to a child following treatment with donor spermatozoa or oocytes. Couples who had conceived with gametes from a donor they knew were excluded. Questionnaires were distributed via mail together with a cover letter informing them of the purpose of the study, and a pre-stamped return envelope. Non-responders were sent two reminders, and responders received a gift voucher (approximately €10).
      The study included a total of 196 participants: 83 parents following oocyte donation (response rate 56%), and 113 parents following sperm donation (response rate 65%). The 196 participants represented a total of 110 couples, where 86 couples were represented by both parents, and 24 couples were represented by one parent. The large majority of participants were living with the co-parent of the donor-conceived child. Participants’ demographics have previously been reported (
      • Lampic C.
      • Skoog Svanberg A.
      • Sorjonen K.
      • Sydsjö G.
      Understanding parents’ intention to disclose the donor conception to their child by application of the theory of planned behaviour.
      ) and are presented in Table 1. Responders and non-responders at the fourth wave were compared with regard to disclosure intentions and behaviour assessment when the children were 1–4 years of age (
      • Isaksson S.
      • Sydsjö G.
      • Skoog Svanberg A.
      • Lampic C.
      Disclosure behaviour and intentions among 111 couples following treatment with oocytes or sperm from identity-release donors: follow-up at offspring age 1–4 years.
      ), and no significant group differences were found (data not shown).
      Table 1Characteristics of the participating parents following oocyte or sperm donation
      ParameterOocyte recipientsSperm recipients
      Women (n = 43)Men (n = 40)Women (n = 61)Men (n = 52)
      Age, mean (SD)43 (3.5)45 (4.6)41 (3.8)45 (5.2)
      Education
      Highest accomplished level.
      ,
      Missing data for one female oocyte recipient.
      Elementary2 (5)1 (3)1 (2)3 (6)
      Upper secondary13 (31)18 (45)23 (38)31 (60)
      University27 (64)21 (53)37 (61)18 (35)
      Main occupation
      Full-time work25 (58)38 (95)32 (52)49 (94)
      Part-time work15 (35)2 (5)23 (38)2 (4)
      Unemployed1 (2)0 (0)1 (2)0 (0)
      Studying1 (2)0 (0)3 (5)0 (0)
      Other1 (2)0 (0)2 (3)1 (2)
      Same partner
      Living with the same partner at the time of the study (child age 7 years) as at the donation treatment (i.e. a co-parent of the donor-conceived child).
      Yes40 (93)36 (90)53 (87)44 (85)
      No3 (7)4 (10)8 (13)8 (15)
      Data are reported as n (%) unless otherwise indicated.
      Participants’ demographics have previously been reported (
      • Lampic C.
      • Skoog Svanberg A.
      • Sorjonen K.
      • Sydsjö G.
      Understanding parents’ intention to disclose the donor conception to their child by application of the theory of planned behaviour.
      ).
      a Highest accomplished level.
      b Missing data for one female oocyte recipient.
      c Living with the same partner at the time of the study (child age 7 years) as at the donation treatment(i.e. a co-parent of the donor-conceived child).

      Measures

      Participants individually completed a questionnaire including sociodemographic characteristics, as well as validated instruments covering aspects of the parents’ relationship quality and the psychological adjustment of the parents and their children.

      Parents’ psychological state

      This was assessed using the Hospital Anxiety and Depression Scale (HADS) (
      • Zigmond A.S.
      • Snaith R.P.
      The Hospital Anxiety and Depression Scale.
      ) with two subscales assessing symptoms of depression and anxiety, respectively. Subscale scores range from 0 to 21, with higher scores indicating more severe symptoms. A subscale score of ≥8 was defined as indicating anxiety disorder and depression, respectively (
      • Bjelland I.
      • Dahl A.A.
      • Haug T.T.
      • Neckelmann D.
      The validity of the Hospital Anxiety and Depression Scale: An updated literature review.
      ). The HADS is a reliable and valid instrument for assessing symptom severity of depression and anxiety and has demonstrated good internal consistency and concurrent validity (
      • Bjelland I.
      • Dahl A.A.
      • Haug T.T.
      • Neckelmann D.
      The validity of the Hospital Anxiety and Depression Scale: An updated literature review.
      ). In the present study, internal consistency was good for both depression (α = 0.77) and anxiety (α = 0.81).

      Parents’ relationship satisfaction

      This was assessed using the ENRICH (Evaluating and Nurturing Relationship Issues, Communication, Happiness) marital inventory (
      • Fournier D.G.
      • Olson D.H.
      • Druckman J.M.
      Assessing marital and premarital relationships: The PREPARE-ENRICH inventories.
      ;
      • Fowers B.J.
      • Olson D.H.
      ENRICH marital inventory: A discriminant validity and cross-validation assessment [Empirical Study].
      ) including 10 subscales: Personality issues, Communication, Conflict resolution, Financial management, Leisure activities, Sexual relationship, Children and parenting, Family and friends, Egalitarian roles, and Conception of life. Each subscale yields a score ranging from 10 to 50, adding up to a total score varying between 100 and 500, with higher scores representing greater relationship satisfaction.
      ENRICH is a reliable and valid instrument for assessing marital satisfaction and has demonstrated acceptable to excellent internal consistency (α = 0.69–0.97) and test–retest reliability (0.65–0.94) (
      • Fournier D.G.
      • Olson D.H.
      • Druckman J.M.
      Assessing marital and premarital relationships: The PREPARE-ENRICH inventories.
      ). The Swedish version of the inventory has demonstrated acceptable reliability and validity (
      • Wadsby M.
      Evaluation of the Swedish version of the ENRICH Marital Inventory [Empirical Study].
      ). In the present study, internal consistency for the total score was excellent (α = 0.94).

      Stress associated with parenting

      This aspect was assessed using the Swedish Parenthood Stress Questionnaire (SPSQ) (
      • Östberg M.
      • Hagekull B.
      • Wettergren S.
      A measure of parental stress in mothers with small children: dimensionality, stability and validity.
      ), which is the Swedish version of the Parenting Stress Index, Form 6, Parent Domain (
      • Loyd B.H.
      • Abidin R.R.
      Revision of the parenting stress index.
      ). The SPSQ includes five subscales: Incompetence, Role restrictions, Social isolation, Spouse relationship problems and Health problems. A total score is computed as the mean of the five subscales, ranging from 1 to 5, with higher scores indicating more stress (
      • Östberg M.
      • Hagekull B.
      • Wettergren S.
      A measure of parental stress in mothers with small children: dimensionality, stability and validity.
      ). The SPSQ is a reliable and valid instrument and has demonstrated good internal consistency (α = 0.89) and test–retest reliability (0.89) (
      • Östberg M.
      • Hagekull B.
      A Structural Modeling Approach to the Understanding of Parenting Stress.
      ), as well as concurrent, construct, predictive and discriminant validity (
      • Östberg M.
      Parental stress, psychosocial problems and responsiveness in help-seeking parents with small (2–45 months old) children.
      ;
      • Östberg M.
      • Hagekull B.
      • Wettergren S.
      A measure of parental stress in mothers with small children: dimensionality, stability and validity.
      ;
      • Östberg M.
      • Hagekull B.
      • Hagelin E.
      Stability and prediction of parenting stress.
      ). In the present study, internal consistency for the total score was good (α = 0.72).

      Child's psychological adjustment

      This was assessed using the Swedish version of the Strengths and Difficulties Questionnaire (SDQ-Swe) (
      • Goodman R.
      The Strengths and Difficulties Questionnaire: A Research Note.
      ;
      • Smedje H.
      • Broman J.E.
      • Hetta J.
      • von Knorring A.L.
      Psychometric properties of a Swedish version of the “Strengths and Difficulties Questionnaire.
      ). It includes the subscales Emotional symptoms, Conduct problems, Hyperactivity/inattention, Peer relationship problems and Prosocial behaviour. A Total Difficulties score is computed as the sum of four of the subscales (omitting Prosocial behaviour), yielding a total score ranging from 0 to 40, with higher scores indicating greater difficulties. A score of ≥14 was defined as indicating a borderline or abnormal range of psychological problems (
      • Malmberg M.
      • Rydell A.-M.
      • Smedje H.
      Validity of the Swedish version of the Strengths and Difficulties Questionnaire (SDQ-Swe).
      ;
      • Smedje H.
      • Broman J.E.
      • Hetta J.
      • von Knorring A.L.
      Psychometric properties of a Swedish version of the “Strengths and Difficulties Questionnaire.
      ). The SDQ-Swe is a reliable and valid instrument for assessing emotional and behavioural problems among children aged 4–16 and has demonstrated an acceptable to good internal consistency (α = 0.84 and 0.76) (
      • Malmberg M.
      • Rydell A.-M.
      • Smedje H.
      Validity of the Swedish version of the Strengths and Difficulties Questionnaire (SDQ-Swe).
      ;
      • Smedje H.
      • Broman J.E.
      • Hetta J.
      • von Knorring A.L.
      Psychometric properties of a Swedish version of the “Strengths and Difficulties Questionnaire.
      ). In the present study, internal consistency was good (α = 0.80).

      Parents’ disclosure intention/behaviour

      Disclosure at the child's age of 7–8 years was assessed by asking parents if they had started talking with their child about being conceived with oocyte/sperm donation. Five response alternatives were provided and participants were categorized into ‘Disclosers’ (Yes, I have started talking about it) or ‘Non-disclosers’ (No, I intend to do it later on; No, I intend to do it if/when the child raises the question; No, I am uncertain/hesitant; No, I will not tell the child about the donor conception).

      Statistical analysis

      A factorial analysis of variance (ANOVA) was conducted to compare the means of the outcome measures (ENRICH, HADS, SPSQ, SDQ-Swe) by the main effects of disclosure status (disclosing versus non-disclosing) and family type (sperm donation versus oocyte donation), as well as the interaction effect of disclosure status and family type, for mothers and fathers, separately. All analyses were performed using IBM SPSS, version 25 (IBM, USA). A P-value <0.05 was considered statistically significant.

      Ethical approval

      The Regional Ethical Review Board in Linköping, Sweden approved the study (M29/05, 2005-02-23; M29/05/1-06, 2006-02-14; 2013/299-31, 2013-08-07).

      Results

      More than half of the participants following oocyte donation (61%, n = 50/82) and sperm donation (58%, n = 64/110) reported that they had talked with their child about their donor conception (data were missing for four participants). In terms of the outcome measures, a majority of the participants’ scores were within the normal range on symptoms of anxiety (mothers 83%, fathers 89%) and depression (mothers 93%, fathers 92%). Similarly, most parents’ assessments of their child's psychological adjustment were below the cut-off indicating emotional and behavioural problems (mothers 95%, fathers 91%).
      Participants’ scores on the HADS, ENRICH, SPSQ and SDQ-Swe were entered into a factorial ANOVA and are presented in Table 2. Separate analyses for mothers and fathers showed no main effect of disclosure or type of donation, i.e. there were no statistically significant differences between disclosers and non-disclosers and between families following oocyte and sperm donation with regard to parents’ and children's psychological adjustment and parents’ relationship quality. In addition, there were no statistically significant interaction effects of disclosure status and donation type.
      Table 2Mothers’ and fathers’ psychological adjustment and relationship quality, and child's psychological adjustment in disclosing compared with non-disclosing families
      Outcome measure and donation typeDisclosingNon-disclosingDisclosureDonation type
      nMeanSDnMeanSDF
      The F-value (analysis of variance) is for the main effect of the factor, i.e. disclosure/non-disclosure, and donation type (oocyte donation/sperm donation).
      P-valueF
      The F-value (analysis of variance) is for the main effect of the factor, i.e. disclosure/non-disclosure, and donation type (oocyte donation/sperm donation).
      P-value
      Mothers
      Parenting stress (SPSQ)
      SPSQ (Swedish Parenthood Stress Questionnaire): scale from 1 to 5. Higher scores indicate higher stress.
      2.830.0960.6740.414
      Sperm donation3520.300.48232.190.39
      Oocyte donation272.280.50132.050.46
      Anxiety (HADS-A)
      HADS-A; HADS-D (Hospital Anxiety and Depression Scale): scale from 0 to21. Scores ≥8 indicate anxiety disorders (A) and depression (D).
      0.6630.4181.950.166
      Sperm donation355.373.81244.922.84
      Oocyte donation284.502.90143.794.12
      Depression (HADS-D)
      HADS-A; HADS-D (Hospital Anxiety and Depression Scale): scale from 0 to21. Scores ≥8 indicate anxiety disorders (A) and depression (D).
      1.030.3140.0160.899
      Sperm donation352.771.94243.082.62
      Oocyte donation283.573.38142.142.32
      Relationship quality (ENRICH)
      ENRICH (Evaluating and Nurturing Relationship Issues, Communication, Happiness): scale from 100 to 500. Highers score indicate greater relationship satisfaction.
      0.0150.9020.2280.634
      Sperm donation3339452.32340351.1
      Oocyte donation2540347.51339569.0
      Child adjustment (SDQ-Swe)
      SDQ-Swe (Strengths and Difficulties Questionnaire, Swedish version): scale from 0 to 40. Scores of 14–16 are borderline, and scores ≥17 indicate psychological disorder.
      0.4040.5270.1830.670
      Sperm donation356.574.88245.334.43
      Oocyte donation286.434.60146.366.16
      Fathers
      Parenting stress (SPSQ)
      SPSQ (Swedish Parenthood Stress Questionnaire): scale from 1 to 5. Higher scores indicate higher stress.
      1.670.1990.6860.410
      Sperm donation272.250.47222.060.42
      Oocyte donation222.270.43182.200.54
      Anxiety (HADS-A)
      HADS-A; HADS-D (Hospital Anxiety and Depression Scale): scale from 0 to21. Scores ≥8 indicate anxiety disorders (A) and depression (D).
      2.500.1180.9920.322
      Sperm donation293.692.78222.592.30
      Oocyte donation214.333.32173.294.22
      Depression (HADS-D)
      HADS-A; HADS-D (Hospital Anxiety and Depression Scale): scale from 0 to21. Scores ≥8 indicate anxiety disorders (A) and depression (D).
      0.3670.5460.0040.948
      Sperm donation293.623.75222.502.48
      Oocyte donation212.862.56173.183.01
      Relationship quality (ENRICH)
      ENRICH (Evaluating and Nurturing Relationship Issues, Communication, Happiness): scale from 100 to 500. Highers score indicate greater relationship satisfaction.
      0.0530.8181.320.254
      Sperm donation2339548.42141644.3
      Oocyte donation1940138.91738557.5
      Child adjustment (SDQ-Swe)
      SDQ-Swe (Strengths and Difficulties Questionnaire, Swedish version): scale from 0 to 40. Scores of 14–16 are borderline, and scores ≥17 indicate psychological disorder.
      0.0030.9571.220.272
      Sperm donation295.344.69225.183.19
      Oocyte donation226.274.92186.334.65
      a The F-value (analysis of variance) is for the main effect of the factor, i.e. disclosure/non-disclosure, and donation type (oocyte donation/sperm donation).
      b SPSQ (Swedish Parenthood Stress Questionnaire): scale from 1 to 5. Higher scores indicate higher stress.
      c,d HADS-A; HADS-D (Hospital Anxiety and Depression Scale): scale from 0 to21. Scores ≥8 indicate anxiety disorders (A) and depression (D).
      e ENRICH (Evaluating and Nurturing Relationship Issues, Communication, Happiness): scale from 100 to 500. Highers score indicate greater relationship satisfaction.
      f SDQ-Swe (Strengths and Difficulties Questionnaire, Swedish version): scale from 0 to 40. Scores of 14–16 are borderline, and scores ≥17 indicate psychological disorder.

      Discussion

      The present study examined the relationship between disclosure and psychological outcomes in heterosexual-couple families with 7-year-old children following identity-release gamete donation. Overall, mothers and fathers in oocyte donation and sperm donation families were found to be well adjusted, reporting within-normal range levels of anxiety, depression and parental stress, and a high relationship quality. The children were well adjusted, with low levels of emotional and behavioural problems. Disclosing families did not differ from non-disclosing families in terms of the parents’ relationship quality or the psychological adjustment among mothers, fathers or children. This indicates that early disclosure has neither detrimental nor beneficial consequences for the psychological well-being of families when the children are young.
      The present results showing no significant group differences between disclosing and non-disclosing families are in line with the overall picture from previous findings showing no significant effect of disclosure on the well-being and functioning of sperm donation families (
      • Blake L.
      • Jadva V.
      • Golombok S.
      Parent psychological adjustment, donor conception and disclosure: a follow-up over 10 years.
      ;
      • Freeman T.
      • Golombok S.
      Donor insemination: a follow-up study of disclosure decisions, family relationships and child adjustment at adolescence.
      ;
      • Golombok S.
      • Brewaeys A.
      • Giavazzi M.T.
      • Guerra D.
      • MacCallum F.
      • Rust J.
      The European study of assisted reproduction families: the transition to adolescence.
      ;
      • Golombok S.
      • Readings J.
      • Blake L.
      • Casey P.
      • Mellish L.
      • Marks A.
      • Jadva V.
      Children Conceived by Gamete Donation: Psychological Adjustment and Mother-Child Relationships at Age 7.
      ;
      • Golombok S.
      • Blake L.
      • Casey P.
      • Roman G.
      • Jadva V.
      Children born through reproductive donation: a longitudinal study of psychological adjustment.
      ;
      • Ilioi E.
      • Blake L.
      • Jadva V.
      • Roman G.
      • Golombok S.
      The role of age of disclosure of biological origins in the psychological wellbeing of adolescents conceived by reproductive donation: a longitudinal study from age 1 to age 14.
      ;
      • Kovacs G.T.
      • Wise S.
      • Finch S.
      Keeping a child's donor sperm conception secret is not linked to family and child functioning during middle childhood: An Australian comparative study.
      ;
      • Lycett E.
      • Daniels K.
      • Curson R.
      • Golombok S.
      Offspring created as a result of donor insemination: a study of family relationships, child adjustment, and disclosure.
      ). The current findings also add to the scarce research on disclosure in oocyte donation families, and confirm previous results that there are no significant differences between disclosing and non-disclosing families in terms of parents’ psychological state (
      • Blake L.
      • Jadva V.
      • Golombok S.
      Parent psychological adjustment, donor conception and disclosure: a follow-up over 10 years.
      ), parent–child relationships and child adjustment (
      • Golombok S.
      • Readings J.
      • Blake L.
      • Casey P.
      • Mellish L.
      • Marks A.
      • Jadva V.
      Children Conceived by Gamete Donation: Psychological Adjustment and Mother-Child Relationships at Age 7.
      ;
      • Golombok S.
      • Blake L.
      • Casey P.
      • Roman G.
      • Jadva V.
      Children born through reproductive donation: a longitudinal study of psychological adjustment.
      ;
      • Ilioi E.
      • Blake L.
      • Jadva V.
      • Roman G.
      • Golombok S.
      The role of age of disclosure of biological origins in the psychological wellbeing of adolescents conceived by reproductive donation: a longitudinal study from age 1 to age 14.
      ); in addition, they contribute new knowledge indicating that disclosure is not related to the relationship satisfaction oocyte donation couples.
      While previously reported results indicate more similarities than differences between disclosing and non-disclosing families, several studies have shown significant group differences in certain outcomes, most often indicating an association between disclosure and more positive adjustment. One possible explanation for why the present study did not show any group differences in parents’ psychological well-being is that non-disclosing parents in the present study differed from those in some previous studies regarding their stance on future disclosure. It is known from a previous wave of the SSGD (when the children were 1–4 years old) that almost all parents intended to talk with their child about the donor conception during their upbringing (
      • Isaksson S.
      • Sydsjö G.
      • Skoog Svanberg A.
      • Lampic C.
      Disclosure behaviour and intentions among 111 couples following treatment with oocytes or sperm from identity-release donors: follow-up at offspring age 1–4 years.
      ). Thus, it is conceivable that the parents in the present study who had not yet disclosed felt confident about their decision to delay disclosure until the child was older, reflected by a psychological well-being similar to that of disclosing parents.
      In contrast, non-disclosing parents in other studies may have had more conflicted views of disclosure. Many of the previous studies comparing disclosing and non-disclosing families are based on couples who underwent donor conception more than 20 years ago, which may have impacted both on their disclosure decisions and on their psychological adjustment to (non)disclosure. Studies from Sweden and Finland have shown higher disclosure rates among heterosexual couples who were treated in the past two decades than during earlier periods (
      • Gottlieb C.
      • Lalos O.
      • Lindblad F.
      Disclosure of donor insemination to the child: the impact of Swedish legislation on couples' attitudes.
      ;
      • Isaksson S.
      • Sydsjö G.
      • Skoog Svanberg A.
      • Lampic C.
      Disclosure behaviour and intentions among 111 couples following treatment with oocytes or sperm from identity-release donors: follow-up at offspring age 1–4 years.
      ;
      • Sälevaara M.
      • Suikkari A.M.
      • Söderström-Anttila V.
      Attitudes and disclosure decisions of Finnish parents with children conceived using donor sperm.
      ;
      • Söderström-Anttila V.
      • Sälevaara M.
      • Suikkari A.M.
      Increasing openness in oocyte donation families regarding disclosure over 15 years.
      ). This coincides with the introduction of Swedish guidelines (

      The National Board of Health and Welfare. Barnets rätt att få kännedom om sitt ursprung efter en assisterad befruktning med donerade ägg eller spermier. 2004.https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/meddelandeblad/2004-1-1_200411.pdf (25 May 2022, date last accessed).

      ) instructing clinicians to encourage their patients to share information of the donor conception with their children from an early age.
      In addition, Swedish studies have reported support for disclosure and openness to the donor-conceived child regarding their genetic origin in the general population (
      • Svanberg A.S.
      • Lampic C.
      • Bergh T.
      • Lundkvist O.
      Public opinion regarding oocyte donation in Sweden.
      ) and among child healthcare professionals (
      • Armuand G.
      • Sydsjö G.
      • Skoog Svanberg A.
      • Lampic C.
      Attitudes towards embryo donation among healthcare professionals working in child healthcare: a survey study.
      ;
      • Armuand G.
      • Skoog Svanberg A.
      • Lampic C.
      • Elenis E.
      • Sydsjö G.
      Attitudes among paediatric healthcare professionals in Sweden towards sperm donation to single women: a survey study.
      ), which may also reflect a change of societal attitudes towards greater openness about donor conception. As disclosure takes place in a social context, disclosure can be perceived as threatening if societal attitudes are unsupportive towards new family forms (
      • Macmillan C.
      Openness in donor conception families.
      ). Consequently, the present results may reflect that those parents who had not yet disclosed the donor conception to their child were not driven by threat.
      Based on the present results, early disclosure has neither harmful nor beneficial consequences for the psychological well-being of heterosexual-couple families with donor-conceived children between 7 and 8 years of age. In addition, most participants were within the normal ranges on the psychological outcome measures, which is in line with previous research showing that families from gamete donation overall function well (
      • Golombok S.
      We are family: The modern transformation of parents and children.
      ). The lack of evidence for non-disclosure being harmful to the child has been used as an argument against the notion that disclosure is in the child's best interest (
      • Pennings G.
      Disclosure of donor conception, age of disclosure and the well-being of donor offspring.
      ). While it is true that non-disclosure has not been associated with negative outcomes in families with relatively young children, this must be weighed against the potential negative consequences of delayed or accidental disclosure.
      Delayed disclosure has been found to be challenging for parents (
      • Hargreaves K.
      • Daniels K.
      Parents dilemmas in sharing donor insemination conception stories with their children.
      ) and was found to be associated with significantly less positive family functioning and psychological well-being in families with 14-year-old donor-conceived children (
      • Ilioi E.
      • Blake L.
      • Jadva V.
      • Roman G.
      • Golombok S.
      The role of age of disclosure of biological origins in the psychological wellbeing of adolescents conceived by reproductive donation: a longitudinal study from age 1 to age 14.
      ). In line with this, a recent study found that donor-conceived individuals whose parents had told them about their donor conception in adolescence or young adulthood reported significantly more negative emotions associated with disclosure and lower satisfaction with the timing of disclosure compared with those who had known about their conception from an early age (
      • Lampic C.
      • Skoog Svanberg A.
      • Gudmundsson J.
      • Leandersson P.
      • Solensten N.G.
      • Thurin-Kjellberg A.
      • Wånggren K.
      • Sydsjö G.
      National survey of donor-conceived individuals who requested information about their sperm donor-experiences from 17 years of identity releases in Sweden.
      ).
      Delaying disclosure may also lead to individuals finding out about their donor conception accidentally, which can have detrimental effects on their well-being (
      • Jadva V.
      • Freeman T.
      • Kramer W.
      • Golombok S.
      The experiences of adolescents and adults conceived by sperm donation: comparisons by age of disclosure and family type.
      ;
      • Turner A.J.
      • Coyle A.
      The identity experiences of adults conceived by donor insemination and the implications for counselling and therapy.
      ). Considering the risks of accidental disclosure, increasing with the popularity of direct-to-consumer DNA tests (
      • Crawshaw M.
      Direct-to-consumer DNA testing: the fallout for individuals and their families unexpectedly learning of their donor conception origins.
      ;
      • Harper J.C.
      • Kennett D.
      • Reisel D.
      The end of donor anonymity: how genetic testing is likely to drive anonymous gamete donation out of business.
      ), parents should be informed that disclosing the nature of conception to offspring early on does not appear to be detrimental to the psychological wellbeing of either parents or their children.
      The present results should be interpreted taking into account the methodological strengths and limitations of the study. The SSGD includes a population-based sample with high initial response rates, which reduces the risk of selection bias. In the present study, it should be taken into consideration that the response rate for oocyte donation couples and sperm donation couples was 56% and 65%, respectively, which limits the external validity. However, the prospective design of the SSGD allowed for an investigation of attrition bias, showing no significant differences between responders and non-responders in terms of disclosure intentions and behaviour assessed when the child was aged 1–4 years. Thus, it is unlikely that a drop-out of participants would have caused any systematic error, for example from a higher drop-out rate among participants who were less positive to disclosure. However, it is possible that completing repeated surveys as part of the SSGD made parents increasingly aware about disclosure issues.
      While it is a strength that all outcomes were assessed using validated instruments, the parents’ disclosure status was based on a study-specific item related to whether they had started to talk with their child about being conceived with oocyte/sperm donation. Previous research indicates that parents disclose in ‘layers’ (
      • Readings J.
      • Blake L.
      • Casey P.
      • Jadva V.
      • Golombok S.
      Secrecy, disclosure and everything in-between: decisions of parents of children conceived by donor insemination, egg donation and surrogacy.
      ), for example informing their child about the treatment but not about the donor gametes. Thus, it is possible that some participants were categorized as ‘disclosers’ despite not having informed their child about the specifics of having used gametes from a donor. Finally, the small sample sizes of the investigated subgroups (disclosing and non-disclosing mothers and fathers) limit the generalizability of the present findings.

      Conclusions

      The present results are in line with previous research indicating that the early disclosure of the donor conception to children is not associated with negative outcomes for the well-being of the parents or children. Therefore, heterosexual couples using oocyte or sperm donation should be informed that disclosure when the child is 7–8 years old is not detrimental to the psychological adjustment of families. In view of the increasing popularity of direct-to-consumer DNA testing, it is important that parents with donor-conceived children are made aware of the potential risks of delayed or accidental disclosure.

      Acknowledgements

      The authors wish to thank all the participants who took part in the study.

      References

        • Appleby J.B.
        • Blake L.
        • Freeman T.
        Is disclosure in the best interests of children conceived by donation? In Richards, M., Pennings, G. and Appleby, J.B. (eds) Reproductive donation: Practice, policy and bioethics.
        Cambridge University Press, New York, NY. 2012; : 231-249https://doi.org/10.1017/CBO9781139026390.013
        • Armuand G.
        • Skoog Svanberg A.
        • Lampic C.
        • Elenis E.
        • Sydsjö G.
        Attitudes among paediatric healthcare professionals in Sweden towards sperm donation to single women: a survey study.
        Fertil. Res. Pract. 2020; 6: 9https://doi.org/10.1186/s40738-020-00078-z
        • Armuand G.
        • Sydsjö G.
        • Skoog Svanberg A.
        • Lampic C.
        Attitudes towards embryo donation among healthcare professionals working in child healthcare: a survey study.
        BMC Pediatr. 2019; 19: 209https://doi.org/10.1186/s12887-019-1578-4
        • Beeson D.R.
        • Jennings P.K.
        • Kramer W.
        Offspring searching for their sperm donors: how family type shapes the process.
        Human Reproduction. 2011; 26: 2415-2424https://doi.org/10.1093/humrep/der202
        • Bjelland I.
        • Dahl A.A.
        • Haug T.T.
        • Neckelmann D.
        The validity of the Hospital Anxiety and Depression Scale: An updated literature review.
        Journal of Psychosomatic Research. 2002; 52: 69-77https://doi.org/10.1016/S0022-3999(01)00296-3
        • Blake L.
        • Casey P.
        • Readings J.
        • Jadva V.
        • Golombok S.
        Daddy ran out of tadpoles': how parents tell their children that they are donor conceived, and what their 7-year-olds understand.
        Human Reproduction. 2010; 25: 2527-2534https://doi.org/10.1093/humrep/deq208
        • Blake L.
        • Jadva V.
        • Golombok S.
        Parent psychological adjustment, donor conception and disclosure: a follow-up over 10 years.
        Human Reproduction. 2014; 29: 2487-2496https://doi.org/10.1093/humrep/deu231
        • Crawshaw M.
        Direct-to-consumer DNA testing: the fallout for individuals and their families unexpectedly learning of their donor conception origins.
        Hum. Fertil. (Camb.). 2018; 21: 225-228https://doi.org/10.1080/14647273.2017.1339127
        • Ethics Committee of the American Society for Reproductive Medicine
        Informing offspring of their conception by gamete or embryo donation: an Ethics Committee opinion.
        Fertil. Steril. 2018; 109: 601-605https://doi.org/10.1016/j.fertnstert.2018.01.001
        • Fournier D.G.
        • Olson D.H.
        • Druckman J.M.
        Assessing marital and premarital relationships: The PREPARE-ENRICH inventories.
        Marriage and family assessment. 1983; 54: 229-250
        • Fowers B.J.
        • Olson D.H.
        ENRICH marital inventory: A discriminant validity and cross-validation assessment [Empirical Study].
        Journal of Marital and Family Therapy. 1989; 15: 65-79https://doi.org/10.1111/j.1752-0606.1989.tb00777.x
        • Freeman T.
        • Golombok S.
        Donor insemination: a follow-up study of disclosure decisions, family relationships and child adjustment at adolescence.
        Reproductive Biomedicine Online. 2012; 25: 193-203https://doi.org/10.1016/j.rbmo.2012.03.009
        • Freeman T.
        • Zadeh S.
        • Smith V.
        • Golombok S.
        Disclosure of sperm donation: a comparison between solo mother and two-parent families with identifiable donors.
        Reproductive Biomedicine Online. 2016; 33: 592-600https://doi.org/10.1016/j.rbmo.2016.08.004
        • Golombok S.
        We are family: The modern transformation of parents and children.
        1 ed. Scribe Publications, 2020
        • Golombok S.
        • Blake L.
        • Casey P.
        • Roman G.
        • Jadva V.
        Children born through reproductive donation: a longitudinal study of psychological adjustment.
        Journal of Child Psychology and Psychiatry. 2013; 54: 653-660https://doi.org/10.1111/jcpp.12015
        • Golombok S.
        • Brewaeys A.
        • Giavazzi M.T.
        • Guerra D.
        • MacCallum F.
        • Rust J.
        The European study of assisted reproduction families: the transition to adolescence.
        Human Reproduction. 2002; 17: 830-840https://doi.org/10.1093/humrep/17.3.830
        • Golombok S.
        • Readings J.
        • Blake L.
        • Casey P.
        • Mellish L.
        • Marks A.
        • Jadva V.
        Children Conceived by Gamete Donation: Psychological Adjustment and Mother-Child Relationships at Age 7.
        Journal of Family Psychology. 2011; 25: 230-239https://doi.org/10.1037/a0022769
        • Goodman R.
        The Strengths and Difficulties Questionnaire: A Research Note.
        Journal of child psychology and psychiatry. 1997; 38: 581-586https://doi.org/10.1111/j.1469-7610.1997.tb01545.x
        • Gottlieb C.
        • Lalos O.
        • Lindblad F.
        Disclosure of donor insemination to the child: the impact of Swedish legislation on couples' attitudes.
        Hum. Reprod. 2000; 15: 2052-2056
        • Hargreaves K.
        • Daniels K.
        Parents dilemmas in sharing donor insemination conception stories with their children.
        Children & Society. 2007; 21: 420-431
        • Harper J.C.
        • Kennett D.
        • Reisel D.
        The end of donor anonymity: how genetic testing is likely to drive anonymous gamete donation out of business.
        Hum. Reprod. 2016; 31: 1135-1140https://doi.org/10.1093/humrep/dew065
      1. Human Fertility and Embryology Authority.Code of Practice.London, 2019.https://portal.hfea.gov.uk/knowledge-base/read-the-code-of-practice/

        • Ilioi E.
        • Blake L.
        • Jadva V.
        • Roman G.
        • Golombok S.
        The role of age of disclosure of biological origins in the psychological wellbeing of adolescents conceived by reproductive donation: a longitudinal study from age 1 to age 14.
        Journal of Child Psychology and Psychiatry. 2017; 58: 315-324https://doi.org/10.1111/jcpp.12667
        • Indekeu A.
        • Dierickx K.
        • Schotsmans P.
        • Daniels K.R.
        • Rober P.
        • D'Hooghe T.
        Factors contributing to parental decision-making in disclosing donor conception: a systematic review.
        Hum. Reprod. Update. 2013; 19: 714-733https://doi.org/10.1093/humupd/dmt018
        • Isaksson S.
        • Sydsjö G.
        • Skoog Svanberg A.
        • Lampic C.
        Disclosure behaviour and intentions among 111 couples following treatment with oocytes or sperm from identity-release donors: follow-up at offspring age 1–4 years.
        Human reproduction (Oxford). 2012; 27: 2998-3007https://doi.org/10.1093/humrep/des285
        • Jadva V.
        • Freeman T.
        • Kramer W.
        • Golombok S.
        The experiences of adolescents and adults conceived by sperm donation: comparisons by age of disclosure and family type.
        Hum. Reprod. 2009; 24: 1909-1919https://doi.org/10.1093/humrep/dep110
        • Kirkman-Brown J.
        • Calhaz-Jorge C.
        • Dancet E.A.F.
        • Lundin K.
        • Martins M.
        • Tilleman K.
        • Thorn P.
        • Vermeulen N.
        • Frith L.
        • Donation E.W.G.o.R.
        Good practice recommendations for information provision for those involved in reproductive donation.
        Hum. Reprod. Open. 2022; 2022: hoac001https://doi.org/10.1093/hropen/hoac001
        • Kovacs G.T.
        • Wise S.
        • Finch S.
        Keeping a child's donor sperm conception secret is not linked to family and child functioning during middle childhood: An Australian comparative study.
        Australian & New Zealand journal of obstetrics & gynaecology. 2015; 55: 390-396https://doi.org/10.1111/ajo.12349
        • Lampic C.
        • Skoog Svanberg A.
        • Gudmundsson J.
        • Leandersson P.
        • Solensten N.G.
        • Thurin-Kjellberg A.
        • Wånggren K.
        • Sydsjö G.
        National survey of donor-conceived individuals who requested information about their sperm donor-experiences from 17 years of identity releases in Sweden.
        Hum. Reprod. 2022; 37: 510-521https://doi.org/10.1093/humrep/deab275
        • Lampic C.
        • Skoog Svanberg A.
        • Sorjonen K.
        • Sydsjö G.
        Understanding parents’ intention to disclose the donor conception to their child by application of the theory of planned behaviour.
        Human reproduction (Oxford). 2021; 36: 395-404https://doi.org/10.1093/humrep/deaa299
        • Loyd B.H.
        • Abidin R.R.
        Revision of the parenting stress index.
        Journal of Pediatric Psychology. 1985; 10: 169-177https://doi.org/10.1093/jpepsy/10.2.169
        • Lycett E.
        • Daniels K.
        • Curson R.
        • Golombok S.
        Offspring created as a result of donor insemination: a study of family relationships, child adjustment, and disclosure.
        Fertility and Sterility. 2004; 82: 172-179https://doi.org/10.1016/j.fertnstert.2003.11.039
        • Macmillan C.
        Openness in donor conception families.
        BioSocieties. 2022; https://doi.org/10.1057/s41292-021-00265-1
        • Malmberg M.
        • Rydell A.-M.
        • Smedje H.
        Validity of the Swedish version of the Strengths and Difficulties Questionnaire (SDQ-Swe).
        Nordic Journal of Psychiatry. 2003; 57: 357-363https://doi.org/10.1080/08039480310002697
        • Pennings G.
        Disclosure of donor conception, age of disclosure and the well-being of donor offspring.
        Human reproduction (Oxford). 2017; 32: 969-973https://doi.org/10.1093/humrep/dex056
        • Readings J.
        • Blake L.
        • Casey P.
        • Jadva V.
        • Golombok S.
        Secrecy, disclosure and everything in-between: decisions of parents of children conceived by donor insemination, egg donation and surrogacy.
        Reproductive Biomedicine Online. 2011; 22: 485-495https://doi.org/10.1016/j.rbmo.2011.01.014
        • Scheib J.E.
        • Riordan M.
        • Rubin S.
        Choosing identity-release sperm donors: the parents' perspective 13-18 years later.
        Hum. Reprod. 2003; 18: 1115-1127
        • Smedje H.
        • Broman J.E.
        • Hetta J.
        • von Knorring A.L.
        Psychometric properties of a Swedish version of the “Strengths and Difficulties Questionnaire.
        European child & adolescent psychiatry. 1999; 8: 63-70https://doi.org/10.1007/s007870050086
        • Stoll J.
        Swedish donor offspring and their legal right to information.
        Uppsala universitet, Uppsala2008: 2008
        • Svanberg A.S.
        • Lampic C.
        • Bergh T.
        • Lundkvist O.
        Public opinion regarding oocyte donation in Sweden.
        Hum. Reprod. 2003; 18: 1107-1114
        • Sälevaara M.
        • Suikkari A.M.
        • Söderström-Anttila V.
        Attitudes and disclosure decisions of Finnish parents with children conceived using donor sperm.
        Hum. Reprod. 2013; 28: 2746-2754https://doi.org/10.1093/humrep/det313
        • Söderström-Anttila V.
        • Sälevaara M.
        • Suikkari A.M.
        Increasing openness in oocyte donation families regarding disclosure over 15 years.
        Hum. Reprod. 2010; 25: 2535-2542https://doi.org/10.1093/humrep/deq194
      2. The National Board of Health and Welfare. Barnets rätt att få kännedom om sitt ursprung efter en assisterad befruktning med donerade ägg eller spermier. 2004.https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/meddelandeblad/2004-1-1_200411.pdf (25 May 2022, date last accessed).

        • Turner A.J.
        • Coyle A.
        The identity experiences of adults conceived by donor insemination and the implications for counselling and therapy.
        Human reproduction (Oxford). 2000; 15: 2041-2051https://doi.org/10.1093/humrep/15.9.2041
        • Wadsby M.
        Evaluation of the Swedish version of the ENRICH Marital Inventory [Empirical Study].
        Nordic Journal of Psychiatry. 1998; 52: 379-387https://doi.org/10.1080/08039489850139409
        • Widbom A.
        • Isaksson S.
        • Sydsjö G.
        • Skoog Svanberg A.
        • Lampic C.
        Positioning the donor in a new landscape-mothers' and fathers' experiences as their adult children obtained information about the identity-release sperm donor.
        Hum. Reprod. 2021; 36: 2181-2188https://doi.org/10.1093/humrep/deab146
        • Zigmond A.S.
        • Snaith R.P.
        The Hospital Anxiety and Depression Scale.
        Acta psychiatrica Scandinavica. 1983; 67: 361-370https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
        • Östberg M.
        Parental stress, psychosocial problems and responsiveness in help-seeking parents with small (2–45 months old) children.
        Acta Pædiatrica. 1998; 87: 69-76https://doi.org/10.1111/j.1651-2227.1998.tb01389.x
        • Östberg M.
        • Hagekull B.
        A Structural Modeling Approach to the Understanding of Parenting Stress.
        J. Clin. Child. Psychol. 2000; 29: 615-625https://doi.org/10.1207/S15374424JCCP2904_13
        • Östberg M.
        • Hagekull B.
        • Hagelin E.
        Stability and prediction of parenting stress.
        Infant and Child Development. 2007; 16: 207-223https://doi.org/10.1002/icd.516
        • Östberg M.
        • Hagekull B.
        • Wettergren S.
        A measure of parental stress in mothers with small children: dimensionality, stability and validity.
        Scandinavian Journal of Psychology. 1997; 38: 199-208https://doi.org/10.1111/1467-9450.00028

      Biography

      Andreas Widbom is a clinical psychologist working within the field of reproductive medicine. The main area of his research relates to the psychosocial aspects of treatments with donated sperm and oocytes.
      Key Message
      Disclosure of the donor conception to young children does not appear to be associated with negative outcomes for parents or children. Heterosexual couples using oocyte or sperm donation should be informed that disclosure when the child is 7–8 years old is not detrimental to the psychological adjustment of families.