Surrogacy families headed by gay men: relationships with surrogates and egg donors, fathers' decisions over disclosure and children's views on their surrogacy origins.

STUDY QUESTION: How do gay father families experience surrogacy in terms of their relationships with surrogates and egg donors, fathers' disclosure decisions and children's views on their surrogacy origins?

SUMMARY ANSWER: More families had a relationship with the surrogate than the egg donor, and almost all had started to disclose to their children, the majority of whom expressed limited interest in their surrogacy conception.

WHAT IS KNOWN ALREADY: Gay fathers tend to report greater contact with the surrogate than the egg donor and to disclose only the use of a surrogate (omitting discussion of the egg donor and the respective fathers' genetic relatedness). Children's views on their surrogacy conception to gay fathers are not known.

STUDY DESIGN, SIZE, DURATION: Thirty-one children and 80 fathers were interviewed as part of a larger in-depth investigation of 40 Italian gay father surrogacy families. Multiple strategies were used to recruit participants.

PARTICIPANTS/MATERIALS, SETTING, METHODS: Children were aged 6-12 years and had been born to gay fathers through gestational surrogacy. Semi-structured interviews were conducted in participants' homes with each family member, separately. Fathers' interviews were presented from the perspective of the father who identified as being most involved with the child on a day-to-day basis. Qualitative content analysis was performed and quotations illustrating the findings were reported. Where appropriate, comparisons were conducted using χ2 or Fisher's exact tests.

MAIN RESULTS AND THE ROLE OF CHANCE: A total of 31 children in 24 families were interviewed. Most families reported a harmonious relationship with the surrogate (n = 20, 57.1%) and a distant relationship with the donor (n = 10, 66.7%) (χ2(1) = 23.33, P < 0.001). Before the child was aged 4 years, almost all families (n = 34, 85%) had started to disclose their use of a surrogate, with 16 families (n = 16, 40%) also disclosing their use of a donated egg, and only 4 (10%) disclosing which father's sperm had been used. Of the 31 children interviewed, most (n = 17, 54.8%) showed a clear understanding of their conception. About 19 (61.3%) expressed limited interest in their conception, 11 (35.5%) felt positive and 1 child (3.2%) was unsure how he felt. Children differed in their feelings towards their surrogate and egg donor (Fisher's exact test, P = 0.002). Of the 31 children who were aware of the surrogate, the majority felt grateful towards her (n = 22, 71%), while of the 25 children who were also aware of the egg donation, 11 (44%) showed limited interest in their donor.

LIMITATIONS, REASONS FOR CAUTION: The sample's convenience nature and the gay father families' high income limited the representativeness of the findings. Further, some children belonged to the same family, and this could have biased the results, as these children may have had similar experiences.

WIDER IMPLICATIONS OF THE FINDINGS: Prior to this study, the voice of children conceived by gay fathers through surrogacy had not been heard. Future research on factors influencing children's desired contact with-or interest in-the surrogate and/or egg donor and their feelings when contact is not possible will be important in preparing families for such events.

STUDY FUNDING/COMPETING INTEREST(S): Support was obtained from a Sapienza Starting Grant for Research to the first author (grant number AR11715C77EB56B2). None of the authors has any conflict of interest.