Child welfare paramountcy: the donor conception paradox

Author: Damian Adams

Adams, Damian, 2021 Child welfare paramountcy: the donor conception paradox, Flinders University, College of Nursing and Health Sciences

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Donor conception is the use of a third person’s gametes to achieve a pregnancy for a couple or person who may otherwise be unable to have a child. The donor-conceived child’s welfare is to be treated as paramount in Australia under various pieces of legislation, regulation and international conventions. My significant original contribution to knowledge is that this thesis presents the firsts published systematic reviews on oocyte and sperm donation neonatal outcomes, as well as the first publication of the health outcomes of donor-conceived adults while assessing these outcomes through the child welfare paramountcy principle.

Study questions:

1) Are the health and welfare outcomes of donor-conceived people different from spontaneously conceived people?

2) Is the welfare of donor-conceived people being appropriately accommodated under the child welfare paramountcy principle?

What is known already:

People conceived with assisted reproductive technologies such as IVF have adverse perinatal outcomes, and there are concerns regarding their long-term health trajectories. Pregnancies implementing donor gametes/embryos are at an increased risk for hypertensive disorders of pregnancy, including preeclampsia which is also associated with adverse perinatal outcomes. Furthermore, donor conception frequently uses laboratory techniques, including freezing and embryo culture, which may adversely affect the gametes or embryos. The Developmental Origins of Health and Disease (DOHaD) phenomenon suggests that those born with adverse neonatal outcomes are more likely to suffer increased disease risks in adulthood.

Study design:

Three studies were conducted of donor-conceived people in comparison to those conceived spontaneously or through other technologies such as IVF:

1) A systematic review and meta-analysis of donor oocyte, sperm and embryo health outcomes.

2) A perinatal population-based study of donor sperm neonates.

3) A worldwide online health survey of donor-conceived adults.

Main results:

Donor sperm neonates were significantly more likely to be born of low birthweight (< 2500g) and with increased incidences of birth defects. Donor oocyte neonates were significantly more likely to born of low birthweight, very low birthweight (< 1500g), preterm delivery (< 37 weeks), preterm delivery with low birthweight, and of a lower mean gestational age.

Donor-conceived adults were significantly more likely to self-report being diagnosed with type 1 diabetes, thyroid disease, Hashimoto’s disease, acute bronchitis, environmental allergies, sleep apnoea, having ear tubes/grommets surgically implanted, attention deficit disorder, autism and depressive disorder. They also reported increased incidences of having identity formation problems, learning difficulties, panic attacks, recurrent nightmares, alcohol/drug dependency, eating disorders, and seeing a mental health professional. DASS-21 analysis revealed that donor-conceived adults were also significantly more stressed.


Donor-conceived people experienced a range of altered health outcomes neonatally as well as in adulthood. These outcomes are consistent with the DOHaD phenomenon and published studies. The welfare of donor-conceived people has not been treated as paramount as there has been no follow-up on their welfare. Some of these health outcomes are potentially modifiable by reducing the incidence of hypertensive disorders of pregnancy, particularly preeclampsia.

Keywords: donor-conceived, welfare, health, outcome, donor sperm, donor oocyte, ART, assisted reproductive technologies, ethics

Subject: Biotechnology thesis

Thesis type: Doctor of Philosophy
Completed: 2021
School: College of Nursing and Health Sciences
Supervisor: Professor Sheryl de Lacey