Psychosocial aspects of infertility and the impact of assisted reproductive techniques - a comprehensive review.

The decision to engage to ART is made by adult individuals, logically without the direct participation or prior consent of the children conceived through these techniques. Nevertheless, these children are directly affected by this choice, as their conception and birth are shaped by this context. When these techniques were introduced, questions were raised about their impact on the children born, both physically and psychologically. While concerns regarding physical development quickly proved unfounded, questions regarding psychological development persisted ( Peterson et al., 2006a ; b ). Thus, it becomes important to reflect on the impact ART has on these children, from their emotional and psychological development to their understanding of their own identity and origin. Table 3 presents a concise overview of the literature’s findings regarding how ART impacts the psychosocial well-being of the children born. Psychosocial Impact of Assisted Reproductive Techniques (ART) on the Children Born and their Development Analyzing the literature, no significant differences were found in scores of behavioral problems or temperament, both in reports from parents and teachers, being similar in families who engaged to ART and those who conceived spontaneously ( Carneiro et al ., 2024 ; Gibson et al ., 2002 ; Jadva & Imrie, 2023 ; Brennan D. Peterson et al ., 2006). These children show equal interest in school activities and good relationships with peers ( Peterson et al., 2006a ; b ). Furthermore, they are equally confident and exhibit equal levels of verbal aggression. One difference noted, although not consistent throughout the literature, is that children born after ART are less physically aggressive ( Peterson et al., 2006a ; b ). Thus, the attitudes described in previous chapters of greater parental protection in ART parents do not seem to have an adverse impact on the child’s adjustment and development and may even reflect greater attention and sensitivity towards the child, related to this unique path to conception ( Gibson et al ., 2002 ). The transition to adolescence is a critical period for identity and autonomy development, marked by increased biological and genetic awareness. This stage poses unique challenges for individuals conceived through ART, especially those involving gamete or embryo donation or gestational surrogacy. Understanding how these children perceive their conception method during adolescence is crucial. Most adolescents show indifference toward their mode of conception, regardless of the type of ART used ( Zadeh et al ., 2018 ). Analyzing the long-term impact, studies have also been conducted with young adults conceived through ART. Most of them are neutral or unconcerned regarding their mode of conception, with a significant percentage of these individuals (40%) feeling unique due to this particularity in their history ( Jadva & Imrie, 2023 ). Although they report that the method of conception is rarely discussed with others, when it is brought up, it does not cause discomfort or problems for these young adults, indicating that they are well-adjusted and comfortable discussing this matter ( Jadva & Imrie, 2023 ). Regarding heterologous treatments, children conceived this way show typical emotional and behavioral development, with no significant differences compared to naturally conceived peers in terms of their emotional state, symptoms of hyperactivity or attention deficit, and the quality of relationships they establish with friends and family ( Zweifel, 2015 ). Studies indicate that even during adolescence, these children exhibit similar psychosocial development levels and do not report heightened anxiety or issues related to their conception or birth ( Zadeh et al ., 2018 ). It is understandable that whether they know their origin, especially if conceived through gamete donation, may impact how these children perceive identity and particular developmental issues. Thus, it has been suggested that disclosure and the possibility of discovering more information about the donor and/or establishing contact with them can be an empowering experience and a way for children and young people to feel more in control of these challenges. These children may have varying levels of interest in knowing more about their donor or gestational carrier, with some showing a strong desire for information or even contact ( Zadeh et al ., 2018 ; Zweifel, 2015 ). This desire is generally greater in families without a socially recognized father, such as single mothers or same-sex couples. Overall, those who establish contact with donors or gestational carriers report positive experiences, with no negative impact on family relationships observed ( Zadeh et al ., 2018 ; Zweifel, 2015 ). The family configuration in which a child is raised, often resulting from ART, can impact their development, warranting separate analysis. Research indicates that children from various family structures exhibit similar levels of psychological and cognitive development, regardless of parental sexual orientation or family size ( Brandão & Ceschin, 2023 ; Carneiro et al ., 2024 ). Heterosexual couples usually engage to ART due to infertility, while same-sex couples or single individuals have different motivations. Most studies find no differences in children’s psychological development across family types, but some note lower adjustment problems in children of same-sex couples compared to those with heterosexual parents ( Carneiro et al ., 2024 ). Heterosexual families using donor gametes may experience more adjustment difficulties, possibly due to greater reservation about discussing conception methods ( Carneiro et al ., 2024 ). This confidentiality and taboo surrounding infertility and gamete donation may influence the behavioral and emotional adjustment of children in this group. However, there are studies where these differences were not observed. Regarding families with transgender individuals who used ART, they have only recently gained visibility, with no data analyzing them or their children’s development ( Carneiro et al ., 2024 ). A limitation of the findings presented is that they reflect the experiences of individuals who agreed to participate in the studies, meaning these data may tend to represent only well-functioning families who feel comfortable participating and underrepresent families experiencing greater difficulties ( Zadeh et al ., 2018 ; Zweifel, 2015 ). Regarding posthumous reproduction, the effects on the children are not fully known and the literature is sparse ( Polyakov & Rozen, 2023 ). Children born through PAR face unique challenges, largely because one of their parents is not present from the time they are born. Not having that parent, can be highly damaging emotionally and psychologically for a child as they grow; especially if one learns later in life. The long-term psychological consequences of this are unknown ( Bahadur, 2004 ). Within the fertility industry, some experts contend that today there is unduly emphasis on fulfilling potential parents’ wishes and less of a focus upon what may or will be in the interests of these children born as a result ( Bahadur, 2004 ).

For prospective parents, conception, pregnancy, childbirth, and the transition to parenthood represent a profoundly significant period ( Crespo & Bestard, 2017 ). In most cases, pregnancy occurs naturally and as planned; however, for about one-third of individuals, this is not the case, and they must come to terms with the possibility of not being able to fulfill this dream ( Gameiro et al ., 2014 ). According to World Health Organization (WHO), infertility is defined as the inability to achieve pregnancy after 12 or more months of regular, unprotected heterosexual intercourse. The American Society for Reproductive Medicine (ASRM) has recently expanded this definition to include the inability to conceive for social reasons, such as being a single parent or part of a same-sex couple. According to WHO, approximately 17.5% of the global population is affected by it, with minor fluctuation across different geographic regions and socioeconomic strata, indicating it as a universal issue ( WHO, 2023 ). About half of the couples facing fertility problems are estimated to need Assisted Reproduc tive Technology (ART) treatments ( Mahany & Smith, 2017 ). These treatments are also inevitable for single people, same-sex couples and couples with a transgender partner without usable gametes. This has led to an increasing use of ART over the last few decades. Since the birth of the first child conceived via in vitro fertilization in 1978 ( Kamel, 2013 ), millions of children have been born using these techniques, making it pertinent to evaluate their impact. The medicalization of infertility has sometimes led to an underestimation of its emotional aspects and psychological implications, even though there is significant focus on treatment and scientific research ( Cousineau & Domar, 2007 ). Thus, while initial studies in this area concentrated on improving birth rates, more recent research has shifted towards assessing the psychosocial aspects, as infertility and treatment failures are associated with adverse effects on mental health, such as worse life satisfaction, poor self-esteem, and significant distress ( Hammarberg et al ., 2008 ; Johansson et al ., 2010 ). Even when treatments are successful and result in pregnancy, barriers like difficult access, which leads to long waiting times, and generally associated high costs, which can lead to financial difficulties, as well as the pressure to which couples are subjected, also affect their well-being and family relationship ( Cousineau & Domar, 2007 ; Silva & Barros, 2012 ). It is also important to mention heterologous treatments, those involving gamete donation, and the specific psychosocial aspects of such treatments, which have unique characteristics and thus merit analysis. Included in this group of treatments is the ROPA method (Reception of Oocytes from Partner), which is aimed at female couples wishing to have biological children. In this method, one woman provides the eggs, while the other undergoes gestation. This has become an increasingly popular option among female couples desiring a shared biological parenting experience. However, like other ART techniques, the ROPA method also raises ethical, legal, and emotional concerns that deserve careful consideration. Moreover, within this group of treatments involving donated gametes, in addition to single women and female couples, there are also heterosexual couples for whom the necessity of engaging to donor genetic material generates very specific feelings and attitudes ( Crespo & Bestard, 2017 ). Surrogacy represents a special case of ART where a woman agrees to gestate and give birth to a baby for another person or couple. This arrangement can be chosen for various reasons, such as conception difficulties, health issues preventing the intended mother from gestating, or in cases of single men, transgender men or male couples. It is a complex issue that raises a multitude of ethical, legal, and social questions, concerning the consent of the gestational carrier, the rights and responsibilities of the intended parents, and the emotional and physical well-being of all involved parties, especially the child to be born and the children already born of the gestational carrier. Another specific technique that presents unique challenges and concerns is posthumous-assisted reproduction (PAR), a form of ART that includes the use of sperm, eggs, or embryos that have been cryopreserved before or immediately following the death of an individual ( Lawson et al ., 2016 ). It is an important topic to address due to its profound implications for both surviving partners and the children born from such procedures. The use of reproductive material after one partner’s death introduces unique emotional and ethical challenges. This review aims to assess the psychological and social impact after engaging to ART techniques on the recipients and born children, as well as on their parental relationship. Gaining a deeper understanding of these aspects will be beneficial for a more tailored and individualized approach by healthcare professionals dealing with infertile couples or women searching these techniques, ultimately leading to improved medical care ( Crespo & Bestard, 2017 ).

The methodology for this narrative review is outlined in Figure 1 , and it involves bibliographic research conducted in medical and scientific databases such as PubMed, Scopus, Scielo, and the Google Scholar search engine. This review includes articles published between 1993 and 2023 that have experimental or observational designs, conducted on humans, about the psychosocial impact of infertility and ART. The research strategy was developed and executed between September 2023 and February 2024. The search was designed using the following keywords: “reproductive techniques, assisted,” “in vitro fertilization,” “pregnancy,” “parenting,” “psychology,” “psychological adaptation,” “infant behavior,” and “parent–child relations.” Various types of studies were included. Figure 1 Flowchart of article search and validation mode. Flowchart of article search and validation mode. Articles were selected based on specific criteria, namely, if the samples were statistically relevant and if the psychological and social impact of the techniques was evaluated, not just the clinical impact. Studies were excluded if the full article was not available online. Only studies available in English and Portuguese were considered.

There are some medical conditions that predispose infertility and may be the reason for engaging to ART. Thus, it is relevant to analyze these cases and their psychosocial impact. The ones selected were polycystic ovary syndrome (PCOS), endometriosis, and premature ovarian insufficiency, for their high prevalence, strong association with infertility, and extensive study. PCOS is one of the most common endocrine disorders in women of childbearing age and a significant public health problem. This condition can cause a variety of longterm health problems, impacting the physical and mental well-being of women, and is a major cause of infertility. The literature suggests a high prevalence of symptoms and psychiatric pathology, such as depression, anxiety, bipolar disorder, obsessive-compulsive disorder, and somatization, recently being associated with a higher risk of suicide attempts compared to the rest of the population ( Brutocao et al ., 2018 ; Hsu et al ., 2024 ). Endometriosis is also a frequent gynecological pathology associated with infertility, affecting about 10% of women of reproductive age. Like PCOS, it has been associated with depressive and anxious symptoms and a lower quality-of-life, with intense pelvic pain, as well as concerns regarding sexual dysfunction and infertility, seeming to underlie this depressed mood ( La Rosa et al ., 2020 ; Laganà et al ., 2017 ; Roomaney & Mitchell, 2022 ). Similarly to the cases presented previously, patients with premature ovarian insufficiency experience the loss of reproductive function, in addition to the physical symptoms of the disease, and both factors can impact their quality-of-life ( van Zwol-Janssens et al ., 2024 ). Once again, the literature points to a reduction in quality-of-life indicators, with an increased risk of depression and anxiety ( van Zwol-Janssens et al ., 2024 ; Xi et al ., 2023 ). Although ART is widely used globally, it is not universally accepted. For instance, devout Catholics and adherents of other religious groups often oppose to the use of assisted methods that involve fertilization outside the context of intercourse, such as IVF and IUI ( Radkowska-Walkowicz, 2018 ). These ethical and religious considerations raise doubts for some couples, especially when it is necessary to engage to gamete or embryo donation. While ART has gained widespread acceptance, the same cannot be said when it comes to gamete or embryo donation. This raises concerns and uncertainties for some couples who may be considering these options ( Crespo & Bestard, 2017 ). For some people, it is important that the child born is genetically related to them, as physical similarities tend to promote the relational aspect of kinship, strengthen moral bonds, and constitute an important part of a person’s identity ( Kantsa et al ., 2015 ). Opting for heterologous treatments is not always easy, nor is it the one considered at the beginning of the process, except in cases of single women or same-sex couples, in which this is the only option ( Crespo & Bestard, 2017 ). Studies reveal that in heterosexual couples seeking treatment for infertility, engaging to heterologous treatments occurs for three main reasons: failure of previous treatments, advanced age, and/or a medical history of some pathology, namely genetic, which prevents or contraindicates the use of their own gametes ( Crespo & Bestard, 2017 ). This need to engage to donor gametes proves to be a challenge for some couples, especially because it is an alternative that most of them did not anticipate, and it is a confrontation with the reality of not being able to conceive naturally, which often affects individuals’ self-esteem, as they feel less capable, besides increasing the stress and anxiety associated with this situation ( Crespo & Bestard, 2017 ). Additionally, individuals express fear of their peers’ reaction and anxiety when anticipating the moment they will tell the child that they were the result of gamete donation ( Crespo & Bestard, 2017 ). Literature shows that these concerns are accentuated when individuals choose embryo donation. This situation poses unique challenges as it implies that none of the genetic material comes from the future parents of the child. This lack of biological connection may raise some questions and insecurities, such as concerns about the child’s sense of identity, fears of not bonding as strongly with the child, and worries about potential social stigma. Yet, studies regarding its social impact are scarce and mostly theoretical, not actually expressing opinions or feelings of individuals going through this process. Still, raised concerns revolve around this absence of genetic connection between the child and the parents and the complex family structures that this method can originate, including donors, receiving parents, children from both parties, and other family members. In this sense, questions also arise about the interaction between the two families (if such relationship exists) and how the children from both parties will react when learning about the existence of biological siblings in another family ( Jadva & Imrie, 2023 ; Samorinha et al ., 2020 ). Recent literature highlights the potential psychosocial and health impacts on gamete donors, especially given the increasing likelihood that donors can be identifiable despite intentions for anonymity. Careful psychological screening and psychoeducation of donors are warranted. ASRM and ESHRE guidelines emphasize the need for comprehensive psychosocial assessments to address the emotional impacts on donors and ensure their well-being throughout the donation process. Similarly, it is crucial to conduct psychological screening and implications counseling for gestational carriers, their partners, and recipient parents. This practice, endorsed by ASRM and ESHRE, significantly impacts the emotional well-being of all parties involved in a surrogacy arrangement, helping to navigate the complex emotional and psychological dynamics inherent in these processes ( Freeman, 2015 ). Another case that should be analyzed for its specificities is shared motherhood in female couples and the use of the ROPA method. This is an ART for female couples in which one provides the oocyte and the other receives the embryo and carries it during pregnancy ( Bodri et al ., 2018 ). This type of treatment is not legal in all countries, but by the end of 2021, it could be used without restrictions in 13 European countries ( Brandão, 2022 ). Other options for these couples include artificial insemination or IVF with donor sperm, where both women are legally mothers, but from a biological point of view, these are monoparental methods, as only one of them undergoes all procedures. Thus, the ROPA method presents itself as a biparental method, as it allows both women to have an active role in the conception of the newborn ( Brandão et al ., 2023 ). The reasons behind the choice of this method include not only allowing the couple to share biological motherhood but also clinical and obstetric reasons, such as ovulatory or uterine dysfunction in one of the women, or in cases of transgender individuals who underwent gender affirming surgery after fertility preservation ( Eyler et al ., 2014 ). Studies on this method, despite its increasing use, are limited and often rely on expert opinions or perspectives of women yet to undergo treatment, leading to sparse and unclear findings ( Brandão & Ceschin, 2023 ; Brandão et al ., 2022 ). Theoretically, this method may enhance the mother-child bond by allowing both partners to assume maternal roles, potentially strengthening the couple’s relationship ( Roth, 2017 ; Voultsos et al ., 2019 ). Moreover, this method allows the burden of ART to be shared by both parents, which does not happen in cases of heterosexual couples, where the woman is generally subjected to more procedures and more invasive ones ( Roth, 2017 ). With the ROPA methos, the couple shares this burden at the physical, mental, and emotional levels, with none of the women having to take on the role of a mere spectator ( Brandão & Ceschin, 2023 ). Both partners are actively involved, mitigating feelings of exclusion or jealousy often reported in monoparental treatments among female couples ( Pelka, 2009 ). Another situation that must be considered is the use of surrogacy. This involves a woman carrying a child for another individual or couple, with no intention of parenting the child herself, utilizing either donor gametes or those of the prospective parent ( Shenfield et al ., 2005 ). The main indication for engaging to this technique is the congenital or acquired absence of a functional uterus; however, it is also employed in instances of maternal medical conditions that may pose risks during pregnancy and in the biological impossibility of conceiving or bearing a child, which applies to male couples, single men, or transgender individuals ( Blake et al ., 2017 ; Brinsden, 2003 ). Surrogacy raises various ethical questions and is not legal in some European countries ( Brunet et al ., 2012 ). Regarding the psychological impact on future parents and their marital relationship, no significant differences were detected between these and those engaging to other forms of ART ( Söderström-Anttila et al ., 2016 ). Instances have been documented where parents have rejected children post-gestation, such as the case of baby Gammy. His parents left him with the gestational carrier after birth due to his Down syndrome condition, opting to only take his healthy twin sister to Australia, their country of residence ( Schover, 2014 ). This case draws attention to situations in which the fetus presents some disability or malformation, and future parents may not accept the child and even blame the gestational carrier, creating a complex problem. Thus, these peculiarities must be ensured in the surrogacy agreement, so that parents cannot abandon the child with the gestational carrier. Fortunately, these cases are rare, and the risk of parents not accepting children after gestation in Western countries is currently low ( Brinsden, 2003 ). Couples who, after a process of examinations and counseling, remain committed to this complex and time-consuming process, are generally very motivated to become parents. Nonetheless, the importance of pre-treatment counseling and monitoring during pregnancy is emphasized ( Söderström-Anttila et al ., 2016 ). It is relevant to address the existence or not of compensation for the gestational carrier and how this compensation occurs. Surrogacy can be designated as commercial or altruistic, depending on whether the gestational carrier receives monetary compensation for the pregnancy, with legislation differing in different countries ( Schenker & Cain, 1999 ). In commercial surrogacy, the gestational carrier is usually recruited through an agency (common in the United States), reimbursed for medical expenses, and paid for her gestational services ( Schenker & Cain, 1999 ). This, being considered a business, ends up being associated with greater pressure exerted on agencies, if that was the case, and on the gestational carrier herself to deliver a “valid end product” that is, a healthy newborn, to their “clients,” the future parents ( Sydsjö et al ., 2019 ). Moreover, poverty, illiteracy, and lack of economic development in their country can lead to disadvantaged women becoming gestational carriers for the financial reward, increasing the possibility of exploitation by the cross-border reproductive care industry and by future parents ( Sydsjö et al ., 2019 ). On the other hand, in altruistic surrogacy, the gestational carrier is found through friends, family, acquaintances, or advertising and may be reimbursed for health expenses directly related to pregnancy and for lost wages due to this ( Schenker & Cain, 1999 ). In these cases, as the gestational carriers are often close to the family, they will probably have contact with the child after birth and during their upbringing, which can have a significant psychological impact on these women ( Schenker & Cain, 1999 ). Gestational carriers are compensated for however far along in the treatment/ pregnancy process they go; and there is pressure on any gestational carrier (compensated or altruistic) to carry a fetus to term ( Schenker & Cain, 1999 ; Sydsjö et al ., 2019 ). Since surrogacy is illegal in much of the Western countries, infertile couples seek commercial surrogacy agreements elsewhere, such as Russia, Ukraine, and India, where these treatments are available ( Brandão & Garrido, 2022 ; Söderström-Anttila et al ., 2016 ). It was estimated that more than 25,000 children were born through gestational carriers in India, more than half of which are Westerners ( Söderström-Anttila et al ., 2016 ). Cross-border surrogacy is an activity that raises ethical and legal issues, putting both parents and the gestational carrier at risk and may leave the child vulnerable in various aspects (Söderström- Anttila et al ., 2016). However, perhaps contrary to what would be expected, the literature reports high satisfaction levels of future parents when engaging to treatments outside their country, stating that they feel more in control of the treatment, being able to be actively involved in decisions regarding the protocol, donors, time, as well as establishing a closer relationship with the clinician ( Jackson et al ., 2017 ). This may reflect a disparity between the opinion of healthcare professionals, who tend to believe that the parents’ focus is clinical success and treatment costs, while they often value personal connections more. Regarding legal problems, most parents are unconcerned about the possibility of lack of legal parenthood, valuing only the child’s health and well-being and the fact that they can be together ( Jackson et al ., 2017 ). However, these legal issues and having to go through a bureaucratic process to ensure legal parenthood in their country of origin may raise psychosocial problems, both during pregnancy and during the child’s entire childhood. Many studies report positive and fulfilling relationships between gestational carriers and the intended parents. These relationships are often characterized by clear communication, mutual respect, and emotional support. Additionally, research indicates that most gestational carriers do not experience negative psychological outcomes; they often express satisfaction with their role and a sense of fulfillment from helping others achieve parenthood ( Greenfeld, 2015 ; Söderström-Anttila et al ., 2016 ). Studies also indicate low levels of parental stress, with both heterosexual and homosexual couples being open about engaging to surrogacy, even in countries where it is not legally permitted ( Sydsjö et al ., 2019 ). Generally, individuals are not confronted with hostility or questioned when they mention engaging to surrogacy, receiving support from family, friends, healthcare professionals, and the child’s school environment ( Jackson et al ., 2017 ). However, some heterosexual couples choose not to disclose their child’s surrogacy conception due to fear of stigma, particularly in countries where surrogacy is prohibited ( Jackson et al ., 2017 ). On the other hand, homosexual couples tend to be more open about their child’s conception method ( Jackson et al ., 2017 ). Despite no significant differences being noted between heterosexual and homosexual couples regarding the time needed to ensure legal custody of the child and their nationality, some same-sex couples describe negative experiences with individuals they had to contact during this process ( Brandão & Garrido, 2022 ). The literature on PAR is limited, but existing studies indicate that the implications for the well-being of all parties involved can be profound. The field of fertility preservation (FP) has evolved significantly in recent years, offering new possibilities for individuals with life-threatening illnesses, providing patients with a chance to experience genetic parenthood posthumously ( Polyakov & Rozen, 2023 ). There are two groups of people involved in this process that should be analyzed separately: the individual with the life-threatening illness and the partner, who will be the single living parent of the child. While both are clearly important, the third critical stakeholder is the child born through a method of conception that guarantees that they will have an entire life with no relationship with one of their genetic parents. For individuals facing the uncertainty of a poor prognosis, PAR can offer solace and a sense of legacy in the knowledge that should their partner conceive using their genetic material, together they will create new life ( Jones et al ., 2023 ). It grants their imagination of parenthood and their role in the lives of generations beyond even after the loss. For the surviving partners, this may provide some consolation with a biological part of their deceased loved one being carried forward in the world ( Polyakov & Rozen, 2023 ). On the other hand, this can also cause discomfort and conflicting thoughts, since he or she might feel obligated to try again which may not always be in their best interests or wish ( Polyakov & Rozen, 2023 ). The practice of posthumous reproduction is governed by diverse legal and regulatory frameworks worldwide, which greatly influence its feasibility and ethical considerations ( Lawrence et al ., 2022 ).

The detailed analysis of various situations related to ART reveals an emotional and social complexity that marks the lives of individuals seeking these treatments. From the decision to engage to ART to the psychosocial implications of the different options available, each stage of this process show unique challenges and complex ethical questions. It is not clear that the emotional impact of these techniques is significant, affecting not only the direct beneficiaries but also their interpersonal relationships, especially the marital relationship with the person with whom they share this parenting experience. Anxiety and depression can emerge as natural responses to the challenges faced during treatment, especially in cases where expectations are not met. Additionally, factors such as age, reproductive history, and the availability of emotional support play a crucial role in individuals’ adaptation to these challenging circumstances. There are also particular situations, such as the use of heterologous treatments, including the ROPA method, and surrogacy, which present additional layers of emotional and ethical complexity, with their own challenges. Moreover, disparities in health systems and laws of different countries highlight the importance of the social context in the accessibility and impact of ART. The availability of resources, governmental regulation, and cultural norms vary widely, significantly influencing the experience of individuals engaging to ART. The legal uncertainty and emotional challenges faced by individuals wishing to become parents through surrogacy highlight the urgent need for a more comprehensive and ethical approach in regulating these techniques. It is essential to ensure that all parties involved are protected and that the rights and interests of future parents, pregnant women, and children are duly considered. The impact of ART on the parenting relationship was also analyzed, concluding that it is complex and multifaceted. Although studies suggest that the use of these techniques does not have direct negative effects on parenting or the relationship established between parents and children, there are important nuances to consider. The anxiety and depression experienced by future parents during the infertility process and ART treatments can influence the transition to parenthood. Moreover, parents’ concerns about when and how to reveal to their children that they were conceived through ART also affect family dynamics and the trust relationship between parents and children, especially in cases where donor gametes were necessary. The decision to reveal or not reveal the conception’s origin to the children and the timing of such revelation have significant implications on children’s psychological and emotional development, as well as on family dynamics. While disclosure may generate anxiety in parents, studies suggest that honesty and openness can strengthen family bonds and reduce conflict. However, there are still gaps in the literature on the psychosocial impact of ART on the parenting relationship, especially in diverse cultural and social contexts. It is crucial to continue investigating this issue to create policies and practices that effectively support parents and promote the well-being of families conceived through ART. At last, regarding the impact of ART on the development of children conceived through these methods, research over recent decades has extensively explored this issue, suggesting that in most cases, children born via ART do not show significant differences compared to naturally conceived ones in terms of psychological adjustment, academic performance, social interactions, and personal identity. Specific factors such as disclosure of conception origin and access to donor information may affect the emotional and psychological development of ART-conceived children, but overall, they demonstrate resilience to these challenges. Furthermore, family configuration—whether heterosexual, homosexual, or single-parent—does not seem to significantly impact the development of ART-conceived children. These findings suggest that the quality of the family environment and parental emotional support are more crucial factors than the method of conception itself. However, it’s important to acknowledge the limitations of existing research, particularly regarding the representativeness of the studied samples. Many studies rely on families who agree to participate, potentially resulting in a biased sample of well-functioning families. Additionally, a significant portion of the research is correlational in nature, which limits the ability to draw causal inferences. Correlational studies can identify associations between variables, but they do not establish cause-and-effect relationships. This is a critical limitation, as many studies cannot conclusively determine whether observed psychological outcomes are directly caused by ART procedures or are influenced by other underlying factors, such as pre-existing mental health conditions, socio-economic status, or stress related to infertility itself. Furthermore, the generalizability of findings can be limited due to varying cultural, legal, and healthcare contexts across different studies. Therefore, further research is needed to fully understand the impact of ART techniques on child development. Nevertheless, current evidence suggests that ART-conceived children generally have the potential to thrive as much as naturally conceived children. Thus, it’s crucial to continue supporting these families and ensure they have access to resources and services that promote their emotional and psychological well-being over time, ensuring that all children, regardless of their method of conception, have the opportunity to reach their full potential and lead happy and healthy lives. More than a thousand articles have been published on the emotional well-being of fertility patients and their children in recent years. The inclusion of so many different areas of focus also makes difficult to detail each aspect of the different psychosocial dynamics involved, but one of the authors’ ambitions was, precisely, to try to combine in the same work a general vision and that sought to list the most impactful situations in the point of view of the psychosocial well-being of the various protagonists of medically assisted procreation treatments. In summary, this review underscores the need for a holistic and compassionate approach to infertility treatment and the provision of ART services. Recognizing and addressing the emotional, ethical, and social challenges faced by beneficiaries of these treatments and the resulting children is essential to ensuring adequate support and a more positive and satisfactory treatment journey. Parenthood extends beyond biological conception and is shaped by a variety of factors, including emotional experiences, cultural contexts, and family dynamics. By better understanding the impact of ART techniques on parenthood, we can provide the necessary support for all families to thrive and grow with love and mutual respect.