Elsevier

Developmental Review

Volume 22, Issue 4, December 2002, Pages 644-673
Developmental Review

Parenting and psychosocial development of IVF children: Review of the research literature

https://doi.org/10.1016/S0273-2297(02)00501-4Get rights and content

Abstract

When in vitro fertilization is performed, the transition to parenthood takes place in a special way. Many hypotheses have been formulated about the possible (mainly negative) effects that this method of conception may have on the parent–child relationship and the child’s psychosocial development. Since the early 1990s, various studies have been carried out to investigate these assumptions. Overall, few significant differences have been found in the parent–child relationship and psychosocial development of children in IVF families and non-IVF families. Some of the studies have even determined that IVF parents experienced the relationship with the child more positively. A limited number of results indicate a more negative view of parenting in IVF families, especially in terms of allowing for autonomy and feelings of child vulnerability. In one particular study, indications were found for an increased incidence of behavioral and emotional problems in IVF children. Potential explanations for these findings (including methodological issues) and suggestions for future research are discussed.

Introduction

Since the birth of Louise Brown in 1978, thousands of children have been born all over the world as the result of ‘test tube’ fertilization (in vitro fertilization or IVF). The development of new, increasingly refined techniques is making it possible for more and more infertile couples to have a biological child of their own in this way.

In the case of assisted reproduction, the transition to parenthood has a particular character. Many couples must wait a long time and undergo lengthy procedures before they finally get their much-desired baby. Children are conceived technically, outside the sexual relationship of their parents. Moreover, pregnancies obtained by IVF present a risk of medical complication: compared with the general population, there is an increased risk of multiple birth, miscarriage, prematurity, and low birth weight (cf. Van Balen (1998) for a review).

It has been suggested, both from theory and clinical experience, that using IVF to achieve parenthood can profoundly influence—mainly in a negative way—both the attitudes and expectations of parents towards their child, and, consequently, the nature of the ensuing parent–child relationship (for reviews, cf. Colpin, 1994, Colpin, 1996 and Van Balen (1998)). Most couples undergoing IVF have been faced with an infertility problem. Those who have not worked through their conflicts and feelings towards infertility may expect their child to be a cure for the psychological wounds it has caused. The child may become a persistent reminder of the parents’ infertility and may act as a ‘narcissistic injury’ (Mushin, Spensley, & Barreda-Hanson, 1985). Golombok (1992) suggests that the alienation of the father from the process of conception may put strain on the relationship with the child. According to Mushin et al. (1985), society may perceive these children as ‘abnormal’ or different, which can lead to a self-fulfilling prophecy. Furthermore, it has been suggested that, because of the long periods of waiting and investment in the child, parents may develop unreasonably high expectations (Hammer-Burns, 1987, Hammer-Burns, 1999). This may result in difficulties around the issues of separation and differentiation, primarily in the form of parental overprotection and infantilization of the child. Experience with problematic pregnancies has shown that any stressful situation preceding or following the birth of a child, which creates unusual concern for the health and well-being of the infant, may retard mother–child bonding (Pullan-Watkins, 1987). Anxious mothers may be more protective and less able to allow optimal attachment and autonomy to develop. As a result, the child may be more at risk for social and emotional difficulties.

For the past 10 years, studies have been carried out in which parenting and psychosocial development of young IVF children is investigated, in comparison with parenting and development of naturally conceived children. This paper provides a theory-based overview of this research literature, chiefly derived from a systematic analysis of the Medline and psycINFO (former psycLIT) databases from 1985 till July 2001. In the 1990s two reviews have been published, one in 1995 (McMahon, Ungerer, Beaurepaire, Tennant, & Saunders, 1995) and one in 1998 (Van Balen, 1998), the last one focusing on the broader (including physical, cognitive and motor) development of IVF children. Most of the studies in this rapidly growing research domain, cited in the present review, had not been published in 1995. In the absence of a substantial body of empirical research, McMahon et al. (1995) also included anecdotal and clinical writings. The only study that can be considered as an authority in this domain (cf. infra, reflections on the design and methods of the study) to be discussed in this paper is the UK-part of the study by Golombok, Cook, Bish, and Murray (1995). A considerable proportion of the studies in this paper had not been published in 1996 (when Van Balen’s paper was submitted); only five of the 15 studies discussed in this review were included in the review by Van Balen (Colpin, Demyttenaere, & Vandemeulebroecke, 1995; Golombok et al., 1995; Raoul-Duval, Bertrand-Servais, & Frydman, 1993; Van Balen, 1996; Weaver, Clifford, Gordon, Hay, & Robinson, 1993). Moreover since the later 1990s the methodological quality of studies has improved, researchers are beginning to study older children and some follow up studies have been published.

An initial section describes the studies on the parent–child relationship. It is assumed that parenting does not occur in a vacuum, but within a broader context (Belsky, 1984; Bronfenbrenner, 1979; Lerner, Castellino, Terry, Villarruel, & McKinney, 1995). In a second section, in connection with the Belsky model on the determinants of parenting, a number of factors from the family context will be discussed, specifically the parents’ personal functioning, marital relationship, and social support. The third section describes the results in relation to the psychosocial development of the children. Based on the review, research design and methodology issues will be discussed and suggestions will be made for further research.

In Table 1, a number of methodological characteristics of the studies have been summarized.

Section snippets

Findings on the parent–child relationship

In the parent–child relationship two parties can be distinguished: the parents and the child. Successively findings on the parents’ contribution and the child’s contribution in the parent–child relationship will be presented. Finally findings of two studies having investigated the overall quality of the parent–child relationship will be presented.

Personal functioning

In various studies, the personal functioning of IVF parents has been compared with that of the parents of naturally conceived children. In the study by Weaver et al. (1993), no significant differences were found between these two groups. The same applies for the studies by Colpin et al., 1995, Colpin et al., 1999. In the latter study of the twins, however, an interaction effect was found once again between the method of conception and the presence of older children in the family for the

Findings on the psychosocial development of the children

Studies of children’s psychosocial development following IVF have investigated child attachment (the findings of which have been discussed in the section on the parent–child relationship), the incidence of child behavioral and emotional problems and child characteristics.

Reflections on the design and methods of the studies

In interpreting the empirical results described above, it is worthwhile to bear a number of conceptual and methodological questions in mind.

Conclusion

At the end of the 1980s and the beginning of the 1990s, the risks of infertility and IVF for the parent–child relationship and development of the child were thrust into the spotlight by both theoretical and practical sources. In this connection, a limited number of studies have been set up in which parenting and the child’s development in these families is compared with that of naturally conceived children. This research has generally not confirmed the negative image that is encountered in

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