Attachment in families created through assisted reproductive techniques: results from the first study using the Strange Situation Procedure in same-sex and different-sex parent families

After completing this article, readers should be able to: 1. Describe the outcomes of assisted reproductive technologies (ART) for singleton, twin, and other multiple births. 2. Describe the role of fertility in adverse outcomes seen with ART births. 3. Review the association of birth defects with ART. 4. Delineate the association of disease of genomic imprinting with ART. 5. Describe the relationship between ART and the subsequent incidence of neurodevelopmental sequelae. In the 1977 ruling “Carey v. Population Services International,” the United States Supreme Court ruled that the decision to bear children is constitutionally protected. (1) Significant interest already had been shown in the development and improvements of in vitro fertilization (IVF) for infertile couples. The first human pregnancy and human birth using IVF were reported by Steptoe and Edwards in the United Kingdom. (2) Their work resulted in the first baby born via reproductive technologies, Louise Brown, born on July 25, 1978, at Oldham General Hospital in Oldham, United Kingdom. (3) She was born via a planned cesarean section, and her birthweight was 2.61 kg. The first successful viable IVF in the United States was performed by Jones and Seager-Jones in 1981 in Norfolk, Virginia. (4) Assisted reproductive technologies (ART) have seen a recent surge in popularity. The Centers for Disease Control and Prevention (CDC) reported that 122,872 cycles of ART were initiated in 2003, resulting in the delivery of 48,756 neonates, (5) accounting for approximately 1% of all neonates delivered in the United States. The percentage is higher in many countries, including Denmark, where it is estimated that 5% of all deliveries are with the assistance of ART. (6) Couples pursue ART for myriad reasons, including tubal transport factors, ovulatory dysfunction, uterine factors, endometriosis, male- and female-specific factors, and when a cause of infertility is unknown. (5) It would be very …

Parenting in new family forms

Attachment status and mother–preschooler parasympathetic response to the strange situation procedure

When Darine El-Chaar began her residency in obstetrics and gynecology at the University of Ottawa five years ago, she grew curious about the potential health repercussions of assisted reproductive technologies (ART), the catchall term for procedures used to help couples artificially conceive a child. ART involves surgically removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, and returning them to the womb.1 Women undergoing ART take “fertility drugs” such as clomiphene citrate and gonadotropins to stimulate the production of many eggs rather than the single egg that would normally grow during their monthly menstrual cycle.2 El-Chaar wondered about the influence that ART procedures, as well as the underlying infertility itself, might have on the health of children conceived. She is one of many researchers working to answer the fundamental question of whether introducing fertility drugs and manipulating eggs and sperm in a laboratory setting—in essence, altering the primal environment—sets the stage for adverse health effects in children. Artist’s rendering of intracytoplasmic sperm injection, in which a single sperm is inserted into an egg. Although some research indicates such a risk exists, there haven’t been enough large-scale studies to ascertain if the potential effects are severe enough over the long term to deter couples from seeking infertility treatments. Meanwhile, some findings are pointing the way toward possible refinements to improve health outcomes for ART babies.

Study question How does fertility treatment access, usage, and outcomes differ between family types in the UK? Summary answer IVF is increasingly used by single patients and female same-sex couples, with higher birth rates than opposite-sex couples. However, inequalities remain in state funding rates. What is known already The “Family formations in fertility treatment 2018” report was published by the Human Fertilisation and Embryology Authority (HFEA) in September 2020. This found differences in IVF use, birth rates, and rates of state-funded treatment between different family types. It was found that opposite-sex couples obtained treatment funding at higher rates than other family types. Additionally, recent documentation published by the UK government shows a variation in funding criteria for female same-sex couples across England. This report builds on the work of the previous HFEA publication, continuing to explore possible new data trends and disparities with regards to family type. Study design, size, duration This report used data from the UK national register held by the HFEA, where all licensed clinics in the UK are required to submit treatment data. All cycles recorded on the UK national register were analysed retrospectively from 2012-2022 (N = 901,866) with regards to family types, categorised into: opposite-sex couple, same-sex couple, and single patient. Participants/materials, setting, methods Power BI was used to perform descriptive statistical analysis, and to visualise the data. Statistics on IVF and Donor Insemination (DI) use, age at first treatment, births per embryo transferred, egg freezing and thawing, proportion of state-funded treatment, and surrogacy intended parents were produced. SQL Server Management Studio was used to perform data linkage on the UK national register to produce outputs pertaining to reciprocal IVF estimates and surrogacy. Main results and the role of chance The proportion of treatments among female same-sex couples and single patients doubled from 2012-2022, from 4% to 7% (n = 2,433 to n = 5,557), and 4% to 9% (n = 2,491 to n = 7,523), respectively. Female same-sex couples are now having IVF more than DI, with IVF accounting for 39% of their treatment cycles in 2012, rising to 58% in 2022. This in part relates to a rise in reciprocal IVF. We estimate that around 1 in 6 female same-sex couple IVF cycles (n = 497) were reciprocal IVF in 2022. Female same-sex couples and single patients had the highest birth rates per embryo transferred at 43% and 40% respectively, compared to 35% among opposite-sex couples for patients aged 18-34 in 2018-2022. Furthermore, single patients started IVF later than other family types at 36.3 in 2022, compared to 33.9 for female same-sex couples and 35.0 for opposite-sex couples. IVF funding was least common for single patients and female same-sex couples, aged 18-39, at 18% and 16% state-funded respectively, compared to 52% among opposite-sex couples in 2022. In 2022, opposite-sex couples made up at least 39% of surrogacy cycles. Other family types made up the other 61%, with the majority likely to be male same-sex couples. Limitations, reasons for caution Family type comparisons are limited by the data held on the UK national register. Classification of family types are based on sex assigned at birth and linked partner details; information on sexual orientation and gender identity are not available on the HFEA register. Wider implications of the findings Main findings from this study highlight inequality in state funding use by family types. This should be considered by funding commissioners reviewing funding eligibility criteria to consider where there may be adverse impacts on access to treatment among particular patients or families. Trial registration number No

This study is the first to explore the relation between children's attachment classifications, assessed by Mary Ainsworth's Strange Situation Procedure (SSP), and mothers' acceptance-rejection behaviors from the lens of Interpersonal Acceptance-Rejection Theory (IPARTheory). As a pilot study, the sample consisted of 23 Egyptian mother-child dyads. The mean age of children in the SSP was 18.6 months (SD=3.10). Mothers' acceptance-rejection behaviors were explored through the Parental Acceptance-Rejection/Control Questionnaire (PARQ/Control). The pilot study's findings revealed that maternal acceptance-rejection behaviors significantly differed across children's attachment classifications. The findings also shed light on gender differences in parenting, as mothers tended to show a higher level of hostility/aggression, undifferentiated rejection, and control with their daughters more than sons. This study is an important stepping-stone for attachment research in the Arab world. It highlights several cultural aspects to be taken into account for future research using the SSP in Egypt or any other Arab country.

Cross-border reproductive care: an Ethics Committee opinion.

Compared with singletons, what is the parent mental health, parent-child and couple relationship satisfaction, and child adjustment of 6- to 12-year-old assisted reproduction technology (ART) twins and their families? There are no differences between 6- and 12-year-old ART twin and singleton families in parent mental health or family relationships; however, twins had significantly fewer behavior and attention problems than singletons in middle childhood. When ART twins are younger than 5 years old, parents have more mental health difficulties and poorer parent-child relationship quality, and no differences have been found in ART twin and singletons' psychosocial adjustment. However, studies have only examined the implications of ART twin status in families with infant and toddler aged children. A cross-sectional study of 300 6-12-year-old ART children (n = 124 twins and n = 176 singletons) from 206 families at a reproductive endocrinology clinic in the USA. Patients from one clinic with a child born between 1998 and 2004 were invited to participate in an online survey (82% recruitment rate). Participants provided information on each 6- to 12-year-old ART child in the family, and responded to questions on parent mental health, family relationships and child adjustment. There were no differences in parent mental health or family relationships in families with 6- to 12-year-old ART twins versus singletons. However, twins (M = 2.40, SE = 0.35) had significantly fewer behavior problems than singletons (M = 3.47, SE = 0.36; F(1, 201) = 4.54, b = 1.08, P < 0.05). Twins (M = 1.86, SD = 0.23) also had fewer attention problems than singletons (M = 2.64, SD = 0.23; F(1, 156) = 5.75, b = 0.78, P < 0.05). Results also suggest that full-term twins had significantly fewer attention problems (M = 1.37, SE = 0.33; F(1, 222) = 2.65, P = 0.05) than premature twins (M = 2.32, SE = 0.32, b = 0.95, P < 0.05), full-term singletons (M = 2.25, SE = 0.21, b = 0.88, P < 0.05) and premature singletons (M = 2.84, SE = 0.49, b = 1.47, P = 0.01). There were no significant differences between the other groups. Although the response rate is high (82%) and family demographics are representative of US ART patients, patients are from one US clinic. Responses also are from one family member and may be subject to social desirability biases. Additionally, our data did not include identification of monozygotic and dizygotic twins. Studies on infant and toddler ART twins suggest these families have parents with more mental health difficulties and lower parent-child relationship quality than singleton families. This study indicates the negative effects of twin status may have ameliorated by middle childhood, and twins may even have more optimum psychosocial adjustment than singletons in this developmental period. This research is based on a collaborative research effort supported by University of Minnesota Agriculture Experiment Station Project Number MN-52-107, a University of Minnesota Grant-in-Aid of Research, Artistry and Scholarship grant, a University of Minnesota College of Education and Human Development Research Development Investment Grant and the M. Janice Hogan Fellowship. The authors of this article have no commercial or corporate interests to declare.

Understanding the relationship between attachment and mental health has an important role in informing management of perinatal mental disorders and for infant mental health. It has been suggested that experiences of attachment are transmitted from one generation to the next. Maternal sensitivity has been proposed as a mediator, although findings have not been as strong as hypothesised. A meta-analysis suggested that this intergenerational transmission of attachment may vary across populations with lower concordance between parent and infant attachment classifications in clinical compared to community samples. However, no previous study has examined major depression and adult attachment in pregnancy as predictors of infant-parent attachment classification at 12 months postpartum. Data were obtained on 52 first-time mothers recruited in early pregnancy, which included 22 women who met diagnostic criteria for current major depression using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. The Adult Attachment Interview was also administered before 20 weeks of pregnancy. A history of early trauma was measured using the Childhood Trauma Questionnaire and maternal sensitivity was measured at 6 months postpartum using the observational measure of the Emotional Availability Scales. Infant-parent attachment was measured using the Strange Situation Procedure at 12 months. Overall, we found no significant association between the Adult Attachment Interview and the Strange Situation Procedure classifications. However, a combination of maternal non-autonomous attachment on the Adult Attachment Interview and major depression was a significant predictor of insecure attachment on the Strange Situation Procedure. We did not find that maternal sensitivity mediated parental and infant attachment security in this sample. While previous meta-analyses identified lower concordance in clinical samples, our findings suggest women with major depression and non-autonomous attachment have a greater concordance with insecure attachment on the Strange Situation Procedure. These findings can guide future research and suggest a focus on depression in pregnancy may be important for subsequent infant attachment.

Predictors of school engagement among same-sex and heterosexual adoptive parents of Kindergarteners

Wild west. Brave new world. Playing God. Each of these phrases has become a symbolic and common way to describe the increasing use of assisted reproduction to build families. Technology has taken family building from the bedroom to the laboratory; from heterosexual married couples to same-sex couples and even single individuals; from a private act to an oftentimes public transaction; from an intimate relationship between two people to a medical procedure, involving three, four, or five participants, with sperm donation, egg donation, embryo donation, and surrogacy gaining in popularity from year to year. Such rapid and extreme change in family formation has evolved in just over three decades. Merely thirty-one years ago, in 1978, the era of assisted reproductive technology (ART) was ushered in with the birth of Louise Brown, the “first test tube baby.” Since that time society has, in fits and starts, struggled to adapt to and accommodate new family structures and these new ways of creating families. The law, in particular, continues to react slowly and inconsistently to the challenges raised by assisted reproduction. In her book, Test tube families: why the fertility market needs legal regulation, legal scholar Naomi Cahn examines the key legal issues in reproductive technology, focusing not only on the technologies themselves but also on the range of participants. With ART resulting in nearly a quarter of a million births annually worldwide, it comes as no surprise that 29 countries have detailed, national regulations for ART (1). What is surprising, however, is that in the United States, where in 2006, 54,656 infants were born as a result of ART (2), no comprehensive federal regulatory scheme exists, and at best, only piecemeal state regulation has been enacted. Cahn discusses how the politics of reproductive technology have served as an impediment to the development of policy in ART. She suggests that ART is here to stay, and rather than focusing on a redefinition of the legal meaning of family, public policy should instead focus on three key areas: market, parentage, and disclosure. Her suggestion is that the law need not become involved in the “easy” cases, in which private arrangements and agreements and autonomous decision making might be effective, but should focus more on “legal default” positions to address those situations in which private agreements and arrangements fail or are inadequate. Additionally, she recommends a multitiered regulatory scheme with authority allocated between the federal and state governments as well as the professional societies. Cahn, a lawyer and family law professor as well as a self-proclaimed “player in the fertility game,” is well situated to consider and make recommendations for regulation of the fertility industry, and she does so cogently, sensitively, and logically in Test tube families. Through a feminist lens and with the common threads of markets, relationships, and identity woven throughout the 12 chapters, Cahn considers not only the broad social implications of ART but also the more specific perspectives of all the stakeholders in ART — from the fertility specialists to the children conceived and all the donors, recipients (married, single, gay, and lesbian), and surrogates in between. Throughout the book she strives to balance what at times might be conflicting perspectives, in an attempt to identify some regulatory points of consensus. She also tackles the difficult issue of access to ART based on race, socioeconomic status, and gender, identifying three critical barriers to reproduction: medical infertility, cultural infertility, and structural infertility. Cahn argues that the latter two are perpetuated by anachronistic and inflexible laws and the reality that “[m]oney buys choices in infertility treatment.” Given the sweeping scope of her discussion, the appeal of Test tube families is quite broad; it would appeal to consumers of ART and academics in family law, health law, the social sciences, and medicine as well as practitioners and policy makers. The recommendations Cahn puts forth in the final part of the book, relating back to her three core themes of market regulation, parentage determinations, and identity issues for children of ART, will resonate with a range of readers. While some of her recommendations, particularly those related to identity disclosure of donors, reflect some personal bias rather than an empirical foundation, each provides a valuable and necessary launching pad for further discussion. Test tube families makes an important contribution to the discourse about new ways of making families and the technology that facilitates family formation. Cahn lays out salient considerations for regulation of a still burgeoning field, which take into account the fluidity of technology, politics, and cultural attitudes. She clearly states the case for “why the fertility market needs regulation.”

Parent-school relationships and young adopted children’s psychological adjustment in lesbian-, gay-, and heterosexual-parent families

Recent legal cases before the Supreme Court of the United States were challenging federal definitions of marriage created by the Defense of Marriage Act and California's voter approved Proposition 8 which limited marriage to different-sex couples only. Social science literature regarding child well-being was being used within these cases, and the American Sociological Association sought to provide a concise evaluation of the literature through an amicus curiae brief. The authors were tasked in the assistance of this legal brief by reviewing literature regarding the well-being of children raised within same-sex parent families. This article includes our assessment of the literature, focusing on those studies, reviews and books published within the past decade. We conclude that there is a clear consensus in the social science literature indicating that American children living within same-sex parent households fare just, as well as those children residing within different-sex parent households over a wide array of well-being measures: academic performance, cognitive development, social development, psychological health, early sexual activity, and substance abuse. Our assessment of the literature is based on credible and methodologically sound studies that compare well-being outcomes of children residing within same-sex and different-sex parent families. Differences that exist in child well-being are largely due to socioeconomic circumstances and family stability. We discuss challenges and opportunities for new research on the well-being of children in same-sex parent families.

Associations are reported among classifications of Adult Attachment Interviews (AAIs) obtained from expectant parents and subsequent classifications of their infants in the Strange Situation Procedure (SSP). Mothers' AAIs predicted infant-mother SSPs (chi 2 = 41.87, N = 96, df = 9, p < or = .0001), and fathers' AAIs predicted infant-father SSPs (chi 2 = 18.94, N = 90, df = 6, p < or = .005). Associations between parents' AAIs and infant-parent SSPs were lessened by the failure to predict the insecure-resistant pattern with mother and the absence of this pattern with father. Counter to expectation, infant-father SSPs were associated with infant-mother SSPs (chi 2 = 3.78, N = 90, df = 1, p < or = .05), which could not be accounted for in terms of an overlap between parental AAIs. A secondary analysis of the data suggested that this dependency effect of SSPs may be explained by the influence of maternal AAIs upon child-father SSPs. Results are discussed in terms of intergenerational and relationship-specific influences upon attachment during infancy, the possible influence of infant temperament, and the relative influence of mother and father upon the child's evolving representations of attachments within the family.

Research on family structure and child well-being rarely includes children in same-sex parent families, a notable omission since 28 % of female–female couple households contain children. Using the 2010–2013 pooled current population survey (CPS), we examined children’s economic well-being by family structure. These data were ideal for this study because they included a sizeable number of children in same-sex cohabiting mother families and the CPS measured both official and supplemental poverty, incorporating the cohabiting partner. Using the official poverty measure, children in same-sex cohabiting mother families were more likely to be poor than their counterparts in either different-sex cohabiting or married parent families. Using the supplemental poverty measure, children in same-sex mother families were no more likely to be poor than children in all other types of different-sex two-parent families.