Psychosocial outcomes of children born via embryo donation
Authors: Salari Salomeh , Lee Seungho , Mangels Joshua , Flyckt Rebecca , Madeira Jody , Gordon John , Keenan Jeffrey , Lee Miryoung , Lin Paul , Pennings Guido , Sweet Craig , Klock Susan , Lindheim Steven R 
Published: February 2024

Abstract

STUDY QUESTION
What are parents’ perceptions of their relationships with and the psychosocial adjustments of their children who are born via embryo donation?

SUMMARY ANSWER
Families created through embryo donation have well-adjusted parent–child relationships and reassuring child psychosocial outcomes.

WHAT IS KNOWN ALREADY
Embryo donation is an effective and growing form of third-party reproduction, but there is limited research in this field. Prior studies suggest that families created through gamete donation function well regarding parent–child relationship quality and child behavioral and socioemotional adjustment.

STUDY DESIGN, SIZE, DURATION
This is a cross-sectional survey study with 187 total participants.

PARTICIPANTS/MATERIALS, SETTING, METHODS
Parents of children born via embryo donation were recruited nationally by contacting all embryo donation programs registered with the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) as well as medically directed embryo donation or ‘embryo adoption’ centers. Participants completed three online Qualtrics questionnaires. The first was a survey including 33 questions on demographics, the procurement process, and self-reported obstetric outcomes. Participants also completed two standardized measures assessing children’s behavior and parents’ adjustment to parenthood: the Strengths and Difficulties Questionnaire (SDQ) and the Parental Acceptance-Rejection Questionnaire (PARQ). Scoring of the SDQ and PARQ was totaled and compared to standardized values (SDQ) or previously published results on other forms of gamete donation (PARQ), such as oocyte donation and sperm donation.

MAIN RESULTS AND THE ROLE OF CHANCE
On the SDQ (n = 46), the average total difficulties scores by age were: 8.2 ± 0.98 for ages 2–4, 7.6 ± 0.93 for ages 5–10, and 3.5 ± 0.77 for ages 11–17; this is compared to the normal reported range of 0–13, which indicates that clinically significant psychosocial problems are unlikely. Across all ages and individual categories (emotional symptoms, conduct problem, hyperactivity, peer problem, prosocial), scores on the SDQ were within the normal ranges. The average PARQ score (n = 70) for all respondents was 27.5 ± 1.18 (range: 24–96), suggesting perceived parental acceptance.

LIMITATIONS, REASONS FOR CAUTION
Because this study was cross-sectional, it could not capture familial relationships over time. This survey-based study design allows for potential selection bias (parents of well-adjusted children may be more likely to participate). Additionally, the overall sample size is relatively small; however, it remains one of the largest published to date. Another significant limitation to this study is the lack of generalizability: most participants were recruited from private, faith-based, embryo donation programs who are demographically similar.

WIDER IMPLICATIONS OF THE FINDINGS
Though embryo donation is an established form of third-party reproduction, it is significantly less robustly studied compared to other forms of gamete donation (oocyte or sperm donation). This study provides a larger data set with a more expanded age range of children compared to the limited number of previously published studies. Furthermore, these findings indicate a high parental disclosure rate with respect to the use of embryo donation which contrasts previous findings.

STUDY FUNDING/COMPETING INTEREST(S)
No external funding source was utilized for the completion of this study. No conflicts are disclosed.

TRIAL REGISTRATION NUMBER
N/A.