Families and family ties in Western society have been primarily through direct blood lines unless specific legal contracts have designated parenthood through adoption or guardianship acts. This has not been the case for a number of family constructions in other societies such as Maori and in some Pacific Island nations. In these cultures, family is defined in a much wider sense and relates to an extended whakapapa (genealogy) in which family is blood linked but wider than a nuclear family. For example, the Maori extended family rather than a two parent family has responsibility for children and for each other. So it is not unusual for children to be parented by grandparents, aunties and uncles and cousins without any formalised contractual arrangement. Stranger adoption is not a normal practice.

In traditional practice in Samoa for example, it is the eldest child who looks after the next child and so on. So parenting in the recognised European sense with attachment to a primary adult caretaker is not the norm. Relations between parents and children are formal and reserved. While holding these adults in special affection, the relationship tends to be respectful rather than individualistic and personal (Meleisea & Schoeffel; 1998). For first generation New Zealanders with pressure by children to be more European and often without the extended family solidarity of the village-life, aspects of parenting are in change. The cultural differences in the conception of family and parenting need to be kept in mind in the following discussion which may relate more to a Western notion of family than to more traditional cultures.

Until 1978 when the first in vitro fertilised (IVF) birth took place, the main options for infertile couples to create a family of their own was adoption. There had been some examples of donor insemination in a fairly ad hoc way for about 100 years, but the development of clinics specialising in this practice also started around the 1970’s. This

may have been coincidental, but at about this time, the social climate in New Zealand changed to encourage birth mothers to keep their children. Thus adoption became a less feasible option (Adair & Rogan, 1998).

In vitro fertilisation is a technique used to replace embryo in a womb at the four cell stage of development and may be used for female and male factor infertility. Indications for use in male factor infertility are when there is a low sperm count or when sperm are not motile. The process of IVF is somewhat emotionally and physiologically traumatic for women and the success rate is relatively low (15-19% per replacement). When the gametes are from both partners there are no differences in relationship between children and their parents but as the techniques have improved they have been widened to use donor sperm, donor egg and donor embryo. In these cases the genetic relationship between children and their parents differs according to what is donated.

There have been various State and National changes to law to account for this position. For example in New Zealand in 1987 the Status of Children Amendment Act legitimised the relationship between a child and the parenting couple. The Act requires the social parents to register themselves as parents of the child. Thus the husband/partner of the woman who gives birth to a child is registered as the father. This Act provides protection for a donor and legitimises the relationship with social parents. What it has also accomplished is to ‘hide’ the relationship of the child to her/his non-biological parent and has thus identified a fundamental shift in the definition of family from a biological link to a marital one (Macklin, 1991).

There are a number of issues which arise from this shift which have to do with changing beliefs and attitudes and which affect the relationships between participants who have genetic and social relationships because of involvement in assisted human reproduction.

The first is the fundamental concern expressed when clinics began to assist conception through IVF. This was, that the techniques would in some way harm the resulting children and that the emotional investment in conception, frequently after years of unsuccessfully trying to have children, would affect the ways in which these adults parented. A number of studies have reported on this. The medical outcomes have always been documented with the most recent Australasian statistics from the National Perinatal Statistics Unit for 1979 to 1994 showing that congenital abnormalities occurred in 2.9% of singleton births and 1.9% of IVF multiple births; i.e. 2.6% of all IVF births (Lancaster, P., Shafir, E., Hurst, T. & Huang (1997, p.57). The impetus for a longitudinal study of the wider implications for children came from Mushin, Spensley & Barreda-Hansen in 1985. Two studies in 1990 reported that for multiple births from IVF, there were only minor problems for sleep in the infants (Bertrand- Servais & Frydman) and no difference in the degree of morbidity in mothers (Munro, Ironside & Smith). One further study by Weaver, Clifford, Gordon, Hay & Robinson (1991) comparing IVF parents and a group of non-IVF parents indicated that the parents who conceived by IVF scored higher on an adjustment scale than the contrast group. There was discussion in this paper and by Mushin et al previously, that successful IVF parents have a higher than average level of coping ability and stress tolerance.

A longitudinal study by Adair (1994) with first born children in 22 families who conceived by IVF, 26 families who conceived by donor insemination and 51 families who conceived by natural conception, showed very little difference in the parenting of these three sets of parents when their child was 18 months old. While the scores on parental stress were low compared to population norms, the IVF group reported higher stress from their marital relationship when their infant was 10 months old than either of the other groups. At the same time they recorded lower stress from the infant’s ability to adapt. The cognitive and psychomotor levels of development as assessed by the Bayley Scales of Infant Development were not significantly different,with the means for all groups in the above average range at 18 months.

In 1995 the first of a series of papers from a large study in the United Kingdom was reported by Golombok, Cook, Bish and Murray. This study included 41 families with a child conceived by IVF, 45 families with a child conceived by donor insemination, 55 families with a child adopted at birth and a control group of 43 families with a child by natural conception. There were significant differences in the ages of the children, the ages of the mothers and the social class of the groups, each of which may have influenced the results. Golombok et al reported that the families with assisted conception were functioning extremely well which may not be surprising considering the commitment given to parenting by these groups. However, it needs to be noted that all of the children in this study were generally functioning well when compared with available population norms. The authors note the higher non-inclusion rate among the parents who conceived with donor insemination and that none of the parents had told their child about their conception.

A subsequent study reported in 1996 (Golombok, Braeways, Cook, Giavazzi, Guerra, Mantovani, Hall, Crosignani & Dexeus) again found no evidence for the presence of psychological disorder in the children or for children’s perceptions of family relationships, which were positive. Again in this sample, not one of the parents who had conceived by donor insemination had told their child any details of this.

It is this factor which is contentious in the use of assisted conception technology - whether or not to tell children about the presence of donated gametes. In New Zealand although the Status of Children Amendment Act (1987) allows the relationship of the father to legally be hidden, clinics do not now bank semen from anonymous donors and couples are encouraged to be open about the involvement of a donor. Proposed new legislation under parliamentary debate (Assisted Human Reproduction Bill) will give children conceived with donor gametes the right at age 18 to identifying donor information. Victoria on the 1st January 1998 proclaimed the Infertility treatment Act 1995 which allows donor conceived offspring, access to a donor’s identity, when they are over the age of 18. No donor consent is required to obtain this information.

Egg and embryo donation used in IVF are relatively new technologies and there is not a lot of evidence about these processes. What is known, is that infertile women are less likely than sperm recipients to want to keep anonymity and more likely to want donor contact with subsequent children (Bolton-reading, Golombok, Bish & Rush, 1991). One concern for parents of donor sperm conceived children is whether or not having knowledge of a donor will in some way affect the familial relationships, particularly between a child and their father. A second concern is when and how to tell children this story.

It seems that a belief that children ‘ought’ to know about their donor conception does not necessarily correlate with actually telling them, nor does being open with other adults correlate with telling their own children. There is a small number of couples who have used personal known donors; that is the donors were either friends or family members. In a study of families with personal donors, 37% of the parents were intending not to disclose this information to their children and had in fact told only selected members of their own adult family (Adair and Purdie, 1996). For example only sisters were told and not their parents, or the wife’s side of the family but not the husband’s even when the donor was one of his brothers.

The issues for both recipients and donors were similar and were around contact between the recipient couple and the donor couple. Each couple were concerned to put boundaries around their relationship in order to preserve the original relationship rather than any donor relationship. For example, recipients wanted the donor to remain as ‘uncle’ or ‘grandfather’ rather than as donor and donors were concerned that the recipients did not feel ‘under observation’ as parents during their contact times. Conversely, recipient couples did feel concern that they might be judged as parents by the donor.

There is an expanding number of opportunities for using donated gametes. Originally the use of donor sperm was for male infertility but with the process of IVF available, donor sperm has been used for sub-fertility. For female infertility donor egg and donor embryo have been available for the past eight years in New Zealand and since the end of 1997, medically assisted surrogacy has been available to individually approved couples; so far only to women on compassionate grounds such as a congenital absence of the uterus. In the two cases cleared for process, the surrogate has no biological relationship to any conceived and carried child. However, in other countries, donor contracts using any of the above gametes can be used in a surrogate arrangement. Indeed in the United States of America, one clinic is offering "embryos for adoption".

Using donated gametes raises a number of issues for families:

• the effect on identity development for adolescents

• the effect of holding secrets within families

• the effect of changing perceptions of family relationships when knowledge is disclosed

• the effect on intra-familial relationships

• the effect on inter-familial relationships.

For example, there is certainly a large amount of evidence in developmental literature that (at least in the western world) one of the major tasks in the teenage years is concerned with finding a sense of self identity (Kroger,1989; Marcia, 1980). This develops in part out of the information ‘given’ to children in their early years of growing up in families and by the construction of information, as teenagers actively test out those around them.

Identities are forged by a combination of the past, present and the future and it is here that parents of children who have a conception using donor gametes have a special set of variables to contend with. As knowing oneself depends to some extent on knowing where one comes from, there may be different stresses and tasks to accomplish. It is always tempting to look to adoption as a comparison, but the situation has important differences. With assisted reproductive technology (ART) there is no ‘giving away’ of a child and donors have been encouraged to view gametes as ‘body parts’ by the donors, rather than as a prospective living child. The second difference is that semen and/or eggs have been produced specifically for recipient parents.

However, there are similarities for the child especially in the middle and late teenage years. The similarities are around the need for information about genetic background. For those teenagers who have a knowledge of the involvement of a donor in their conception, the interest in who they are seems to begin from about 13 years of age. Some want information about the donor at this stage and some want to meet him whether or not that is possible. There is not enough information to make definitive statements about this, but it appears that boys may be less likely to want to meet a donor than girls and that older more than younger teenagers want information. As well, it appears that acceptance of having no information or possible contact is dealt with differently. It would take an indepth study to determine which characteristics lead to acceptance and which do not, and at this point no such study has been undertaken.

Children who have been told about their involvement of a donor have asked questions subsequently, for example:

"Why didn’t they chose the smartest person with blond hair?" (girl aged 15)

"At first I was disappointed they didn’t get anyone with blond hair. I didn’t think about it much. Dad was my father and that was that!" (girl aged 15)

"Mum and Dad said I was DI-ed in another country, so I asked if I was half Australian. I asked a few questions about the donor and why Dad couldn’t have kids". I really appreciated when I found out what they went through to have me".(girl aged 13)

"Why did you do this? Do you still care for me as much?" (girl of 11)

"Are you allowed to meet the donor" (girl of 9)

"Will I ever find out who is the donor?" (boy of 11)

"Does this happen to a lot of people?" (boy of 10)

In the ongoing study with donor conceived offspring (n=29) those who took the opportunity to give suggestions to parents and people running programmes, all said "Tell them when they are young". This came from children aged 9-22 years old. Three young teenagers said, "Don’t be afraid. It’s quite normal". This contrasts with experiences reported in a compilation of letters from donor conceived offspring published by the Donor Conception Support Group in NSW, which showed that finding out about the involvement of a donor as an adult can have traumatic effects. The effect of being told later, was also reported in the present study by a boy and a girl who were told aged 14 and 12 (a sister and brother). The boy said he was upset and angry when he was told because it had been kept a secret and said that a better way would be to have told him when he was much younger. he talked about it with friends because he wanted "to get it out and not keep it kept inside me". His sister said she was "surprised, unsure about things, scared and cried because my brother was crying". She said she wanted to know what the situation was because;

"If Dad wasn’t my real Dad, then Nana wasn’t my real Nana and Poppa wasn’t my real Poppa".

This comment highlights the importance of semantics. The use of ‘real father’ or even ‘biological father’ to describe the donor is in my opinion, a mistake. Donors are not fathers by law and by choice. They do not parent a child and do not wish to do so. Using this terminology has a critical impact as well children perceive the relationship.

Indeed, for the brother and sister cited above, their whole perception of ‘family’ had to be renegotiated. In fact, both children, like all of the others in the study, just wanted to know what the donor is like and what he looks like. None of them wanted to replace their Dad who had brought them up.

One of the most contentious outcomes of involvement in a donor programme is the future relationship is between any recipient family and a donor. With donors contracting to be anonymous, and recipient families having no access to identifying information the possibility of any relationship at all has previously not been possible. However, with more understanding of the needs of children, especially adolescents, and the experiences of adoptees and relinquishing mothers, attitudes to information and contact are changing. Prospective parents have challenged clinics in New Zealand to provide donors who are willing to provide identifying information and/or to be identifiable. A recent study (Adair, 1998) has shown that even donors who had been in donor programmes as long ago as 1976 had agreed to be anonymous merely because the clinic had required that but would have been willing to provide identifying information from the beginning. This study will be used to illustrate some of the issues.

The 39 men in this study ranged in age between 34 and 66 (xage = 46 years) and had donated between 8 and 22 years ago(xage = 35 years). At the time of donation, 80% were married or in a partnership (n=31), 11% single and 13% were separated or divorced. A requirement of inclusion in the study was that the programme had guaranteed anonymity, however for 46% of these donors, information had been recorded that made them potentially identifiable

Thirty donors had told their wife/partner about their involvement in a donor programme (77%), half (n=21) had told friends and about a third had told parents (n=13) and siblings (n=12). There were mixed reactions to giving this information, which illustrates firstly that donors were selective in who they told and secondly that reactions were not always as they expected.

"When I was overseas I sat my sister-in-law down (my brother was away) and told her I had donor offspring. She was quite angry about it. "So you have placed this extra strain on us so if we produce a girl we have to vet her future partners. How do we do this? At what stage?" She thought I had been irresponsible (not my wife who had suggested it) and was quite vociferous about the way I had put upon them to check up on the relationships of her children even though they live in another country. My other two brothers were mildly amused and thought I had done ‘a noble thing’. The youngest was quite brassed off because they have since had a daughter. They were annoyed because as they said "We now have to deal with your problem because you had to bloody go off and have donor children".

Nearly three quarters of the donors have been given information about the number of children born from their donations and over half knew the gender of these children. This information had been given following requests from the donors. It had been assumed that male donors had little interest in the results of their donations, and there was no evidence of any interest in subsequent children. But this study has shown that not to be correct.

There was a high level of interest which appeared to increase as the donor conceived children got older, often in parallel with the donor’s own children.

Although all except one donor would agree to become part of any process to help children find out about themselves as their donor, and would, or have agreed to contact between themselves and their donor conceived offspring, there are a number of issues related to this change in status. There is an understanding that practises and attitudes have changed and in the future, it is likely that decisions will have to made about providing future identifying information and possible contact with children.

"I was an anonymous donor but tagged possible change in the future. I was happy to have contact with recipient families or any approaches from children. If I personally was adopted or born as the result of a donation I’d want to know about my biological parents - I’d be upset psychologically, if I couldn’t have that information. So I’d be happy to give just what they wanted" ^{Donor 38}

Thirty seven (95%) would agree to contact with a donor conceived child.

Although all except one of the donors would agree to contact with children.. Donors believed that the request should be initiated by the child themselves, wanted the contact to be facilitated by an independent person such as a member of clinic staff (n=13) and were agreeable to meeting parents first if this would help to work out the process. One concern expressed by nearly half of the donors (n=18) is that the recipient parents are not threatened in any way by children wanting to know more about and/or meet the donor. Donors were very clear that the children were the children of the recipient families although they did feel a responsibility to assist children in their need for any information.

This donor was one of four donors who said they would want to be notified if anything happened to the parents which would leave children without guardians, as they felt some responsibility towards the well-being of these children. Conversely although two thirds of these donors (n=25, 64%) are very interested in meeting the donor conceived offspring but alongside this was an issue for four of them about how acceptable they would be to the children. There was also some uncertainty (n=12) about their own emotional reaction when they did actually meet their donor offspring.

A further issue for donors was the welfare of the children. many of the donors were from care-related professions such as teachers, welfare officers, police, justice dept, and had seen the effect of neglect and abuse. As well, one of the contributing factors towards the decision to be a donor was the pleasure from their own children and those of their friends and family. They felt that they were partly responsible for this/those donor conceived children being born and would like assurance that this has worked out well for the children and for the families.

All except one of the donors believed that donor conceived offspring should be told about the involvement of a donor. This donor was against having any contact with his donor conceived offspring and did not believe that there was anything to be gained from contact.

It was around the issue of openness with children that a contradiction was observed. Although almost all of the donors were willing to be identified to donor conceived offspring and were willing to meet them, only 37% (n=12) had told their own children. Those who had told their children had done so when they were 5-13 years old. Others (n=8) intended to tell their children, but had not done so because they believed they were at present, too young to be told.

Two contrasting comments illustrate these differences:

Although all except one of the donors believed that children conceived by donor insemination should be told about this and that 75% (n=29) were willing for their children to meet donor offspring, only two donors had told their children that they had half siblings. Several commented that perhaps they should tell their children now that their donor offspring are in, or approaching adolescence and may be seeking information and /or contact. Given that one of the concerns for donors was donor offspring arriving ‘on the doorstep’ or making romantic attachments with their own children, this is somewhat surprising.

Sixteen (41%) of donor’s present partners had issues around the donor involvement.

the major issue was that contact with donor conceived offspring would in some way conflict with the time and attention available for their own children. Other concerns were the risk of romantic attachment between the children, experience of infertility for partners of a second relationship, the lack of participation in the decision for second partners and whether the children were developing well and were happy. There was no significant difference in the number of concerns held by women who were the wives/partners a the time of donation and those who are new partners (Chi-square = .488, df =1, p>.05). No significant difference was found in the number of women who had concerns about their husband/partner’s involvement as a donor, between those donors who had and had not told their own children (Chi-square = .488, df =1, p>.05.).

The introduction of donor gametes into conception began with the advice from medical practitioners that it was in the interests of the adults concerned to ignore the process and keep it a secret. A concern existed that a non-genetic relationship between parents and children might in some way negatively affect parenting and in past this advice came from the reluctance in semen donation programmes to ‘publicly’ acknowledged the presence of a male factor infertility problem. However, from the beginning there was concern reported by therapists and researchers (e.g. Daniels & Taylor, 1993; Papp, 1993)that the effect of keeping secrets in families in itself may elicit negative outcomes affecting parent and child relationships.

Measures:
Parents
Parents' marital and psychological state (mother and father)
Beck Depression Inventory
Trait Anxiety Inventory
Parenting Stress Inventory (Short form)
Quality of Parenting Interview
Mothers' interview about openness (egg donation only)
Children
Rutter "A" scale (Child's psychiatric state) Data from mother.
Pictorial Scale of Perceived Competence and Social Acceptance for young Children

A recent study to examine this inter-relationship (Golombok, Murray, Brinsden & Abdalla, in press) has shown that for families with children aged between 4 - 8 years, from families with a sperm donor or egg donor conception, families with adopted children and families conceiving naturally, there were few significant differences. However, when there was no genetic relationship with the mother, the emotional well-being of the parents was higher which may reflect a high commitment to parenting by this group as this is the most invasive treatment process. One further difference was that children conceived by donor sperm reported a higher perception of competence than children in either of the other three groups. This may reflect the genetic pool from which the donors are selected.

Golombok et al note the difference between the attitude of social policy makers who favour openness with children about their conception and parents in Europe who prefer secrecy. In New Zealand the percentage of parents telling their children in the study reported by Rumball and Adair (under review) was 30%. Considering that recipients in both the Golombok et al and Rumball and Adair studies showed high number of parents who had told someone about the use of donor gametes, the potential for damaging the intra-familial relationships through disclosure by someone other than a parent is a real possibility.

References

Adair, V.A. (1994). Parenting after assisted conception by in vitro fertilisation, GIFT or donor insemination. Unpublished dissertation for the degree of Doctor of Philosophy, The University of Auckland, New Zealand.

Adair, V.A., Ellis, J., & Irwin, R. Established semen donors: Changing the contract? Paper presented at the Fertility Society of Australia Conference, October 29-31st, 1998, Hobart, Australia.

Adair, V.A. & Purdie, A. (1996). Donor insemination programmes with personal donors: Issues of secrecy. Human Reproduction, 11, 150-176.

Adair, V.A. & Rogan, C. Infertility and parenting; The story so far. In V.A. Adair & R.S. Dixon (Eds.). Families in Aotearoa New Zealand. New Zealand:Addison, Wesley Longman.

Bolton-Reading, V., Golombok, S., Bish, A., & Rush, J.(1991). A comparative study of attitudes towards donor insemination and egg donation recipients, potential donors and the public. Journal of Psychosomatic Obstetrics and Gynaecology, 12, 1-12.

Daniels, K., & Taylor, (1993). Secrecy and openness in donor insemination. Politics and Life Sciences, 12, 155-170.

Donor Conception Support Group (1997). Let the offspring speak. P.O. Box 53, Georges Hall, 2198, NSW, Australia.

Durna, E.M., Bebe, J., Steigrad, S.J., Leader, L.R., & Garrett, D.G. (1997). Donor insemination:attitudes of parents towards disclosure. Medical Journal of Australia, Vol 167, 256-259.

Golombok, S., Braeways, A., Cook, R., Giavazzi, M., Guerra, D., Mantovani, A., van Hall, E., Crosignani, P., & Dexeus, S. (1996). The European study of assisted reproduction families: Family functioning and child development. Human Reproduction, Vol. 11, No. 10, 2324 - 2331.

Golombok, S., Cook, R., Bish, A., & Murray, C. (1995). Families created by the new reproductive technologies: Quality of parenting and social and emotional development of the children. Child Development, 66, 285-298.

Golombok, S., Murray, C., Brinsden, P., & Abdalla, H. (in press). Social versus biological parenting: Family functioning and the socio-emotional development of children conceived by egg of sperm donation. Human Reproduction.

Kroger, J. (1989). Identity in adolescence:the balance between self and other. London: Routledge.

Lancaster, P., Shafir, E., Hurst, T. & Huang (1997). Assisted conception series, number 2, Assisted conception Australia and New Zealand 1994 and 1995. Sydney, Australia: Australian Institute of health and welfare, National Perinatal Statistics Unit.

Macklin, R. (1991). Artificial means of reproduction and our understanding of the family. Hastings Centre Report, January - February, pp5-11.

Marcia, J. (1980). Identity in adolescence. In Handbook of adolescent psychology, Adelson, J. (Ed.), pp. 159-187. New York: Wiley

Meleisea, M., & Schoefel, P. (1998). Samoan families in New Zealand: the cultural context of change. In V.A. Adair & R.S. Dixon (Eds.). Families in Aotearoa New Zealand. New Zealand:Addison, Wesley Longman.

Mushin, D., Barreda-Hanson, M.C. & Spensley, J.C. (1986). IVF children:early psychosocial development. Journal of In Vitro fertilisation and Embryo technology, 3, 247-252.

Papp, P (1993). the worm in the bud: Secrets between parents and children. In E. Imber-Black (Ed.), Secrets in families and family therapy (pp. 66-85. New York: Norton.

Rumball, A., & Adair, V.A. (1998). Telling the story: Parents’ scripts for donor conceived offspring. Manuscript submitted for review.

Weaver, S.M., Clifford, E., Gordon, A.G., Hay, D.M. & Robinson, J. (1991). A follow-up study of ‘successful’ IVF/GIFT couples: Social-emotional well-being and adjustment to parenthood. Paper presented at the 7th World Congress on IVF and assisted procreations. Paris.