1. Couple satisfaction twelve years after conception via medical assistance Jennifer Connor, PhD a, Martha A. Rueter, PhD b, Lauri Pasch c, Ascan F. Koerner, PhD d, Mark Damario e a Community Psychology, Counseling, and Family Therapy, St. Cloud State University, b Family Social Science, University of Minnesota, c University of California, San Francisco, d Communication Studies, University of Minnesota, e Obstetrics, Gynecology and Women’s Health, University of Minnesota Author’s Name Couple satisfaction twelve years after conception via medical assistance Jennifer Connor, PhD a, Martha A. Rueter, PhD b, Lauri Pasch c, Ascan F. Koerner, PhD d, Mark Damario e a Community Psychology, Counseling, and Family Therapy, St. Cloud State University, b Family Social Science, University of Minnesota, c University of California, San Francisco, d Communication Studies, University of Minnesota, e Obstetrics, Gynecology and Women’s Health, University of Minnesota Author’s Name Background Results Method Conclusions Relationship quality among couples during and following infertility treatment is an important consideration given that the couple hopes to raise children together. Some have suggested that the increased stress couples endure during infertility treatment can negatively affect the couple’s relationship (Andrews, Abbey, & Halman, 1991; Gamiero, Moura-Ramos, Canavarro, Santos, & Dattilio, 2009). Others propose that couples who make it through treatment are more resilient than the average couple (Drosdzol & Skrzypulec, 2009; Repokari et al., 2007; Sydsjö, Wadsby, Kjellberg, & Sydsjö, 2002; Sydsjö, Wadsby, Sydsjö, & Selling, 2008). At the time of treatment, heterosexual couples with diagnosed male infertility report lower couple satisfaction than fertile couples (Drosdzol & Skrzypulec, 2009) and anticipate lower relationship quality if they choose to utilize donor sperm versus donor eggs (Eisenberg Smith, Millstein, Walsh, Breyer, & Katz 2011). European studies undertaken after the birth of a child report similar couple satisfaction across infertile couples who conceived using donor insemination (DI), donor egg (DE), and in-vitro fertilization (IVF; Blake, Casey, Javda, & Golombok, 2012; Golombok, 1995; Murray, MacCallum, & Golombok 2006; Owen & Golombok, 2009). However, no studies of U.S. couples have examined couple satisfaction following conception using donor gametes. Relationship quality among couples during and following infertility treatment is an important consideration given that the couple hopes to raise children together. Some have suggested that the increased stress couples endure during infertility treatment can negatively affect the couple’s relationship (Andrews, Abbey, & Halman, 1991; Gamiero, Moura-Ramos, Canavarro, Santos, & Dattilio, 2009). Others propose that couples who make it through treatment are more resilient than the average couple (Drosdzol & Skrzypulec, 2009; Repokari et al., 2007; Sydsjö, Wadsby, Kjellberg, & Sydsjö, 2002; Sydsjö, Wadsby, Sydsjö, & Selling, 2008). At the time of treatment, heterosexual couples with diagnosed male infertility report lower couple satisfaction than fertile couples (Drosdzol & Skrzypulec, 2009) and anticipate lower relationship quality if they choose to utilize donor sperm versus donor eggs (Eisenberg Smith, Millstein, Walsh, Breyer, & Katz 2011). European studies undertaken after the birth of a child report similar couple satisfaction across infertile couples who conceived using donor insemination (DI), donor egg (DE), and in-vitro fertilization (IVF; Blake, Casey, Javda, & Golombok, 2012; Golombok, 1995; Murray, MacCallum, & Golombok 2006; Owen & Golombok, 2009). However, no studies of U.S. couples have examined couple satisfaction following conception using donor gametes. Participants Study participants were recruited from a Midwestern U.S. university reproductive endocrinology clinic. Eligible participants had at least one child conceived using IVF, ICSI, or IUI, born between 1998 and 2004 (M = 8.48 years, SD = 2.03, Min = 6.1, Max = 12.9). Of the eligible participants, 86% were located, and n = 209 (82% response rate) agreed to study participation. The present study excluded couples who were single, divorced, separated, or widowed, producing a final sample of n = 194. Participants were mostly heterosexual (96.4% heterosexual, 3.6% same-sex female relationship) and mostly White (94.5%) with annual household incomes ranging from less than $10,000 to greater than $200,000 (median = $90- 99,000). Procedures Using university IRB approved procedures, letters were sent to eligible clinic patients introducing the study and asking a parent to complete an online survey. The online survey included a consent form and demographic and marital satisfaction questionnaires. Letters were addressed to the parent identified by the clinic as the patient, who was in all cases female; survey respondents were mostly female (98%). As compensation for their time, participants received a $25 gift certificate. Measures Couple Satisfaction. Measured using the Huston Marital Opinion Questionnaire (Huston & Vangelisti, 1991). This measure consists of 11 semantic differential-type items that being with “I would describe my relationships as…” and end with two opposing options scaled from 1 to 7. Responses were reverse coded as necessary so that higher responses denoted greater couple satisfaction. Responses were summed and averaged (α =.96). Child Donor Status. Donor status was coded as 1 for participants with at least one child conceived using donor egg, and/or donor sperm and 0 for the participants whose children were conceived using the parents’ gametes. Participants Study participants were recruited from a Midwestern U.S. university reproductive endocrinology clinic. Eligible participants had at least one child conceived using IVF, ICSI, or IUI, born between 1998 and 2004 (M = 8.48 years, SD = 2.03, Min = 6.1, Max = 12.9). Of the eligible participants, 86% were located, and n = 209 (82% response rate) agreed to study participation. The present study excluded couples who were single, divorced, separated, or widowed, producing a final sample of n = 194. Participants were mostly heterosexual (96.4% heterosexual, 3.6% same-sex female relationship) and mostly White (94.5%) with annual household incomes ranging from less than $10,000 to greater than $200,000 (median = $90- 99,000). Procedures Using university IRB approved procedures, letters were sent to eligible clinic patients introducing the study and asking a parent to complete an online survey. The online survey included a consent form and demographic and marital satisfaction questionnaires. Letters were addressed to the parent identified by the clinic as the patient, who was in all cases female; survey respondents were mostly female (98%). As compensation for their time, participants received a $25 gift certificate. Measures Couple Satisfaction. Measured using the Huston Marital Opinion Questionnaire (Huston & Vangelisti, 1991). This measure consists of 11 semantic differential-type items that being with “I would describe my relationships as…” and end with two opposing options scaled from 1 to 7. Responses were reverse coded as necessary so that higher responses denoted greater couple satisfaction. Responses were summed and averaged (α =.96). Child Donor Status. Donor status was coded as 1 for participants with at least one child conceived using donor egg, and/or donor sperm and 0 for the participants whose children were conceived using the parents’ gametes. Few demographic differences were found across donor and nondonor groups, with one exception (see Table 1). At the birth of their oldest ART child, respondents who used donor gametes were significantly older than nondonor respondents (M nondonor = 33.78 years, M donor = 37.02 years, t = 3.76, p <.00). 94% of couples remained together. T-test comparisons across groups showed a statistically significant difference in couple satisfaction (t = 2.21, p =.04). General linear modeling showed that, after inclusion of study covariates (see Table 1), couple satisfaction was not significantly different across couples. The covariate respondent’s emotional disposition was significantly associated with couple satisfaction. F (1, 193)= 40.32, p = <.00, indicating respondents reporting high levels of depressive or anxiety symptoms tended to feel less satisfied with their partner. Mean couple satisfaction by those who used donor egg and donor sperm (see Table 2) showed egg donor respondents reported couple satisfaction levels similar to those of nondonors, but sperm donor respondents, F (1, 181) = 6.96, p =.01, particularly heterosexual sperm donor respondents, F (1, 173) = 5.60, p =.02, reported significantly lower satisfaction than nondonors. These findings account for the effect of all covariates, of which significant associations occurred only for emotional disposition (Nondonor vs. sperm donor: F (1, 181) = 31.35, p <.00, nondonor vs. heterosexual sperm donor: F (1, 181) = 27.57, p <.00). Few demographic differences were found across donor and nondonor groups, with one exception (see Table 1). At the birth of their oldest ART child, respondents who used donor gametes were significantly older than nondonor respondents (M nondonor = 33.78 years, M donor = 37.02 years, t = 3.76, p <.00). 94% of couples remained together. T-test comparisons across groups showed a statistically significant difference in couple satisfaction (t = 2.21, p =.04). General linear modeling showed that, after inclusion of study covariates (see Table 1), couple satisfaction was not significantly different across couples. The covariate respondent’s emotional disposition was significantly associated with couple satisfaction. F (1, 193)= 40.32, p = <.00, indicating respondents reporting high levels of depressive or anxiety symptoms tended to feel less satisfied with their partner. Mean couple satisfaction by those who used donor egg and donor sperm (see Table 2) showed egg donor respondents reported couple satisfaction levels similar to those of nondonors, but sperm donor respondents, F (1, 181) = 6.96, p =.01, particularly heterosexual sperm donor respondents, F (1, 173) = 5.60, p =.02, reported significantly lower satisfaction than nondonors. These findings account for the effect of all covariates, of which significant associations occurred only for emotional disposition (Nondonor vs. sperm donor: F (1, 181) = 31.35, p <.00, nondonor vs. heterosexual sperm donor: F (1, 181) = 27.57, p <.00). Findings show the majority of couples remain together and report high rates of relationship satisfaction. However, women in heterosexual couples who used donor sperm are less satisfied with their couple relationship than women who used their husband’s sperm, even after accounting for the possible biasing effect of emotional state. Future research should investigate specific strains in these relationships. Findings show the majority of couples remain together and report high rates of relationship satisfaction. However, women in heterosexual couples who used donor sperm are less satisfied with their couple relationship than women who used their husband’s sperm, even after accounting for the possible biasing effect of emotional state. Future research should investigate specific strains in these relationships. Objective This paper explores couple relationships six to twelve years after successful conception, comparing those who used IVF with own gametes, IVF with donor egg, and IVF or IUI with donor sperm insemination. Full Sample (n = 194) Nondonor (n = 163) Donor (n = 30) M(SE)RangeM(SE)RangeM(SE)Range Emotional Disposition 5.80 (.36)0 - 365.73 (.39)0 - 266.17 (1.03)0 - 22 Age at Birth34.22 (.27)25 - 4433.78 (.27)25 - 4237.02 (.82)27 - 44 Education4.90 (.08)2 - 74.92 (.09)2 - 74.77 (.21)2 - 6 Household Income 9.96 (.17)1 -1310.09 (.18)3 -139.23 (.53)1 -13 Full SampleNondonorAll DonorsEgg DonorAll Sperm DonorsSame-Sex Sperm Donor Heterosexual Sperm Donor N194163301218711 Couple Satisfaction Mean (SE)5.76 (.08)5.85 (.09) ab 5.37 (.22)5.88 (.25)5.03 (.31) a 5.34 (.51)4.83 (.40) ab Range2.35 – 7.00 3.20 – 7.003.80 – 7.003.20 – 7.003.40 – 6.853.20 – 7.00 Table 1. Descriptive Statistics for Study Covariates of Respondents Table 2. Statistics for Couple Satisfaction for the Full Sample and Donor and Nondonor Subgroups a Couple Satisfaction comparison across nondonor and sperm donor couples: F 1, 181) = 6.96, p =.01. b Couple Satisfaction comparison across nondonor and heterosexual sperm donor couples: F(1, 173) = 5.60, p =.02.