At age 14, Helen wasn't bothered by the fact she was born via surrogacy.
"My mum is still my mum. My dad is still my dad," she told UK researchers conducting a study on the mental health and well-being of children born through egg donation, sperm donation and surrogacy. Helen is not her real name.
"I was talking to someone at school and they said they were an accident," 14-year-old Simon (also not his real name) told the researchers. "I know I was not an accident, I was really wanted, and it makes me feel special."
Parents worried their children may experience difficulties as a result of learning they were conceived by assisted reproduction can stop fretting - the kids are just fine, according to the study published this week after two decades in the making.
"When we began this study more than 20 years ago, there was concern the absence of a biological link between the child and the parents could have a damaging effect on their relationship and on the well-being of the child," said lead author Susan Golombok, professor emerita of family research and former director of the Centre for Family Research at the University of Cambridge in the UK.
However, at age 20, children born via egg or sperm donation and surrogacy were psychologically well-adjusted, the study found, especially if parents told the children about their birth history before age seven.
"What this research means is that having children in different or new ways doesn't actually interfere with how families function. Really wanting children seems to trump everything - that's what really matters," Golombok said.
Clinical psychologist Mary Riddle, an associate professor of psychology at Pennsylvania State University called the study "important, in that it represents research conducted over a long period of time."
However, Riddle, who was not involved in the study, said the results aren't completely applicable to the United States because surrogacy can be practised differently in the UK in several ways.
Called "tummy mummies" by some of the children, surrogates in the UK may become part of the family, participating in the upbringing of the child they helped bring into the world, according to Golombok's 2020 book, We Are Family: The Modern Transformation of Parents and Children.
"In the UK, intended parents often know their surrogate prior to the surrogate pregnancy whereas in the US, commercial surrogates are often matched through agencies and don't have prior relationships with the families for whom they carry babies," Riddle said.
It's also more common in the UK to use "partial" surrogacy, in which surrogates are impregnated with the sperm of the intended father and are therefore the biological mother of the child, Riddle said.
"Here in the US, gestational surrogacy, where the surrogate mother has no genetic connection to the child she is carrying, is far more common and thought to be potentially less fraught with psychological and legal pitfalls," she added.
Telling a child early helps
The study, published Wednesday in the journal Developmental Psychology, followed 65 children - 22 born by surrogacy, 17 by egg donation and 26 by sperm donation - from infancy until age 20. Another 52 families who did not use any assistance were also followed. Researchers spoke to the families when the children were one, two, three, seven, 10 and 14.
Young adults who learned about their biological origins before age seven reported better relationships with their mothers, and their mothers had lower levels of anxiety and depression, the study found.
However, children born through surrogacy had some relationship issues around age seven, "which seemed to be related to their increased understanding of surrogacy at that age," Golombok said.
"We visited the families when the children were 10, and these difficulties had disappeared," she said. "Interestingly, the same phenomenon has been found among internationally adopted children. It may have to do with having to confront issues of identity at a younger age than other children."
Developmentally, children begin to notice and ask questions about pregnancy between the ages of three and four, said clinical psychologist Rebecca Berry, an adjunct faculty member in the department of child and adolescent psychiatry at New York University's Grossman School of Medicine.
"To satisfy their curiosity they'll begin to ask questions about babies and where they came from as a way of trying to understand why they are here," said Berry, who was not involved with the study.
Children as young as seven will already have a basic understanding of genetics, and can be surprised when they learn they aren't genetically connected to one or both parents, said Lauri Pasch, a psychology professor at the University of California San Francisco, who specialises in infertility and family building.
"Our current thinking is that it is best for parents to share the story of donor conception with their children at a very early age, so that if I were to ask their child when they are an adult when they learned that they were donor conceived, they would respond that they 'always knew,'" said Pasch, who was also not involved in the study, via email.
"This allows the child to grow up with the information, as opposed to learning it later in life, when it comes as a surprise or shock and can hurt their trust in their parents and their identity development," she added.
A few differences
When it came to maternal anxiety and depression, there were no differences between families formed by surrogacy and egg or sperm donation and families with children born without assisted conception. Nor were they any differences in the mothers' relationships with their partners at home, the study found.
However, mothers who had babies via donor eggs reported less positive family relationships than mothers who used sperm donation, likely due to insecurities about lack of a genetic connection to their children, Golombok said.
Young adults conceived by sperm donation reported poorer family communication than those conceived by egg donation, the study found. That's perhaps due to a greater reluctance on the part of fathers to disclose they are not a genetic parent, Golombok said.
Only 42 percent of parents who had conceived via sperm donor had revealed the child's birth history by the time their children were age 20, compared to 88 percent of egg donation parents and 100 percent of parents who used surrogacy.
When asked, many of the children said they weren't concerned about how they were conceived.
"A lot of the children said 'It's not a big deal. I've got more interesting things going on in my life,' while others said 'Actually it's something a bit special about me. I like talking about it,' Golombok said. "I think it's really nice to hear from the children themselves and I don't think any other study has done this."
Once told, a child needs to revisit the birth history from time to time, so parents should be sure any conversation is an ongoing one, Golombok said.
"There is this idea parents will tell the child and that is it. But you need to keep having these conversations to give the child a chance to ask questions in an age appropriate way as they grow older," she said.
"Many of the parents in our study use children's books that were specifically designed for this purpose," Golombok added. "Then they could bring the child's own story into the narrative."
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