A systematic review on the demographics, motivations, and experiences of single mothers by choice

Introduction

An increasing number of single women are actively choosing to become mothers without the involvement of a male partner in high-income countries, turning to donor insemination instead. While progress has been made in reducing inequalities in access to Assisted Reproductive Technologies (ART), disparities persist. Single women’s access to fertility treatment is still frequently contested, often due to concerns about child welfare.

Objective and rationale

The aim of this systematic review was to integrate and critically examine the current body of knowledge about the demographic characteristics, motivations and experiences of single mothers through ART with gamete donation, and to provide insight into the mother–child relationship.

Search methods

A comprehensive literature search of empirical research conducted in single women without a partner during at least 6 months prior to receiving assisted reproductive treatment with gamete donation was conducted across PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Scopus up to December 2024. English-language, peer-reviewed articles were screened for eligibility.

Outcomes

A total of 26 studies were analyzed, revealing consistent demographic patterns: single mothers by choice (SMC) are typically well-educated, financially independent women in their late 30s. Motherhood is often a long-standing personal goal, pursued independently due to the absence of a suitable partner and concerns about declining fertility. The decision is portrayed as both pragmatic and empowered, reflecting broader societal shifts in family formation. SMC benefit from considerable support within their social networks and when healthcare systems acknowledge their distinct circumstances and tailor support accordingly. Findings consistently report high levels of maternal well-being and satisfaction, strong mother–child bonds and positive child developmental outcomes. While some variation exists in attitudes toward donor identity, most mothers embrace openness. Limited data from non-European contexts constrains the generalizability of findings.

Wider implications

This review shows that although legal, ethical, and cultural frameworks significantly shape access and experiences, SMC tend to share similar profiles and motivations. These findings challenge traditional family structures as the evidence supports intentional single motherhood as a valid and successful family model and advocates for greater recognition of reproductive autonomy and family diversity.

Plain language summary

In recent years, a growing number of single women have actively chosen to become mothers without a partner, often through the use of donor insemination and assisted reproductive technologies (ART). Despite progress in gender equality, single women still face legal, social, and cultural barriers to accessing fertility treatment in many parts of the world. Concerns about child well-being are often cited to justify these restrictions.

This systematic review examined 26 studies to better understand the demographic characteristics, motivations, and family experiences of single mothers by choice (SMC) who conceive through ART. Findings, primarily from Western contexts, indicate that SMC are typically in their late 30s, financially secure, and well-educated. Many women viewed motherhood as a lifelong aspiration and chose to pursue it independently due to the absence of a suitable partner and concerns about age-related fertility decline. The review found consistently positive outcomes: high levels of maternal satisfaction and well-being, strong mother–child bonds and healthy child development. While perspectives on donor identity vary, most mothers favor open communication.

However, as the majority of studies were conducted in Europe, limiting the global applicability of the findings, there is a clear need for more research in diverse cultural contexts, particularly in regions with restrictive ART policies. Overall, the evidence challenges traditional family norms and supports the legitimacy of intentional single motherhood.

Introduction

“Single mothers by choice” (SMC) or “solo mothers” are a growing but not recent group of single women who have chosen to parent alone and have children through donor insemination. The Human Fertilization and Embriology Authority (HFEA) reported a significant increase in the number of single women undergoing fertility treatment with donor sperm, rising from 3,147 in 2019 to 5,084 in 2022 in the UK. Additionally, also in the UK, a major sperm bank reported that 54% of its clients were single women seeking to become pregnant with donor sperm [1]. In Spain, estimates from Fertility Clinics suggest that around 40% of women utilizing these treatments are single [2].

Growing evidence on the sociological profile of these women has revealed that these women are not infertile, and pursue motherhood within the context of a single-parent family project [3]. SMC often choose to become single mothers when they do not find a suitable partner to start a family while feeling that their fertility is declining [4]. The rise in maternal age at first birth is driven by a combination of social and economic factors, including extended education, the desire to invest in a professional career, unstable employment, housing challenges, shifts in social norms and individual values, changes in partnership trajectories, the opportunity costs of motherhood and work-family reconciliation difficulties [5].

The postponement of childbearing to relatively advanced ages is an increasingly generalized phenomenon in high income countries [6]. The overall rise in the mean age at first birth is known as “the postponement transition” and begun in economically affluent societies in the 1970s. The first countries to experience this phenomenon were those in Northern and Western Europe, Canada, and the US, followed by East Asia, Southern Europe, Central and Eastern Europe [7–9] and since 2000 s, by Latin American countries Argentina, Chile and Uruguay [10].

Research indicates that in countries with very low fertility rates due to delayed childbearing—such as Spain and Italy—one in four women is likely to remain permanently childless [11]. Assisted reproductive technologies (ART) are often regarded as a solution for individuals facing barriers to reproduction. While these barriers may be physiological, they can also arise from social circumstances—such as being single or in a same-sex relationship—positioning ART as a pathway to parenthood for those at risk of involuntary childlessness [8]. Despite significant progress in addressing inequalities in access to ART, notable disparities persist. These inequities are primarily attributed to two factors: (a) restrictive legislative frameworks in certain countries, and (b) ambiguities within existing regulations [12]. The variation in ART policies reflects broader cultural and religious differences in how societies view and accept “non-traditional” family structures, which in turn influences who is granted access to ART.

When ART became available as an independent clinical service in many countries in the 1980’s, it was generally offered without specific requirements for access and with few measures in place to ensure equal availability to all. When ART services became more established, many countries set forth conditions that either limited or ensured access to groups other than heterosexual married couples. As the number of countries with specific legislation or guidelines in place continued to expand, a general trend favoring expanded and protected access was noted, especially for individuals who were not in married, heterosexual relationships [13]. However, data from the International Federation of Fertility Societies (IFFS) Triennial Report of 2025 suggest a shifting trend, with an overall increase in the number of countries that now require individuals accessing ART services to be in a stable heterosexual relationship [14]. Between 2019 and 2024, the proportion of countries with this requirement rose significantly—from 38% to 52%—reflecting a global move toward more restrictive ART policies [14, 15]. Similarly, in countries without explicit legislation governing ART, access is frequently restricted to heterosexual couples in stable relationships [16]. These regulatory disparities not only limit reproductive autonomy for single women but also underscore enduring inequalities in ART access based on marital status and sexual orientation [3]. Accordingly, prior to the adoption of legislation granting access to ART with sperm donation for unmarried women and female couples in Norway (2020) and France (2021), single women from both countries regularly traveled to Sweden, Spain, Denmark and Belgium to receive treatment [17, 18]. Currently, many single women from countries which still have restrictive ART regulation, such as Germany, Italy or China seek access to ART in more inclusive settings [19–21].

The access of single women to ART is perceived as problematic out of concern for the welfare of the intended offspring. Some scholars argue that the best environment for a child is a married, heterosexual couple and are reluctant to facilitate any other arrangement [16, 22]. Additionally, there is often opposition in regard to SMC motivations for having a child, their ability to provide for it, and the strength of their support [23]. Therefore, in some settings, single women are denied standing equal to other groups of patients seeking ART treatment.

The aim of this systematic review was to draw an in-depth profile of SMC by integrating and critically examining the current body of knowledge about the demographic characteristics, motivations and experiences of single mothers through ART with gamete donation, and to provide insight into the mother–child relationship. To date there is no existing work in the literature that systematically collects all this information. This paper compiles evidence intended to prompt reflection on the development of inclusive reproductive policies, particularly in contexts where access to ART remains restricted.

Methods

Search strategy

The present systematic review was conducted according to the Preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement [24, 25], according to the 2009 guidelines and the updated 2020 PRISMA methodology [26]. The electronic databases searched were Cochrane Library, PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus, and ScienceDirect. The search was performed using the terms “ART,” “assisted reproduction,” “fertility treatment,” “single mother,” and “solo mother,” combined with the Boolean operators OR and AND: ((ART OR artificial assisted reproduction OR fertility treatment) AND (single mother OR solo mother))

Study selection

Inclusion criteria

Original studies written in English with no geographical restriction and with no time limit until December 2024 of empirical research conducted on single women without a partner during at least 6 months prior to receiving assisted reproductive treatment with gamete donation (sperm, oocytes). Studies which analyzed the demographic characteristics, attitudes, motivations and experiences of single mothers were included, as well as family relationships. All citations were collected and imported into Zotero Citation Manager.

Exclusion criteria

Reporting data of single mothers who had conceived naturally, or interviews of children of single mothers, studies that included ART in other family models, systematic reviews, opinion articles, debates and editorials, clinical cases or articles focused on technical or medical descriptions.

Study characteristics

Original empirical research studies (with quantitative, qualitative, or a mixed methodology) conducted in humans were included.

Screening and quality assessment

Researcher NZ performed the initial selection of original manuscripts by screening titles and abstracts and created a reference list of papers on the topics evaluated in this review. NZ and LP performed each stage of the study selection, deleted duplicate entries and reviewed studies as excluded or requiring further assessment. All data was extracted by NZ and cross-checked by LP. In case of discrepancies in the selected studies, we opted for reconciliation by team discussion.

This systematic review was registered in PROSPERO (International Prospective Register of Systematic Reviews), on May 22, 2025 with the registration number CRD42020178816.

The quality of the included studies was assessed using the Critical Appraisal Skills Programme (CASP) checklists [27]. For qualitative studies, the CASP Qualitative Checklist was used to evaluate methodological rigor, credibility, and relevance. For quantitative studies, the relevant CASP tools (e.g., the Cohort Study Checklist) were applied to assess validity, results, and applicability to the research question. Since CASP does not directly evaluate the integration of mixed-methods data, appraisal focused on assessing each component’s methodological quality independently. Where appropriate, the coherence between qualitative and quantitative findings was considered during the synthesis process. Each study was independently assessed by two reviewers. Disagreements were resolved through discussion or by consulting a third reviewer. Quality appraisal results were not used as inclusion criteria but were used to inform the interpretation of findings and assess the strength of the evidence.

Data abstraction

Demographic, methodological data and the results of each of the selected studies were independently extracted by two researchers (NZ and LP). Several structured data extraction tables were prepared to assess the homogeneity of the data, where all the relevant information from each of the studies was collected. The table collected the following variables: authors and year of publication, country of publication, study objectives, study design, data collection process and place of collection, type of data obtained, sample size and type of conception, average sample age, research design, data collection, recruitment, research aim, main results and quality (Table 1). Qualitative synthesis of peer-reviewed qualitative studies was carried out using Thomas and Harden [28] thematic synthesis.

Table 1.

Summary of the findings

Authors/year of publication, location of research	Sample size/type of conception	Age	Research design	Data collection	Recruitment	Research aim	Main results	Research quality casp
Farabet-Demarquette et al. 2024 [54] France	272 single women/76 in heterosexual relationship	Single women 36,5 ± 0,21 Married women 33,3 ± 0,48	Retrospective single center cohort study	Fertility center data (Medical and socio-demographic data and outcomes of MAR attempts)	Fertility Clinic/France	To assess and compare the profile of unmarried women and women in heterosexual couple applying for sperm donation. The secondary objective was to compare the MAR attempts and pregnancy outcomes of unmarried women and women in heterosexual couple.	Unmarried women were more likely to work in intermediate occupations, whereas women in heterosexual couple more often had employee status. Female age appears to play a major role in the likehood of pregnancy and live birth.	9/12 High
Freeman et al. (2016) [33] /UK	78 women (31 single and 47 with couple). ART with known donor	Single women 43,71 ± 3,36 years. Women with couple 38,83 ± 3,86 years	Cross-sectional observational study. Mixed methodology (quantitative and qualitative)	Semi-structured interviews recorded with audio (between 1 and 2.5 h)	Fertility Clinic/UK	Experience of heterosexual families and single mothers regarding the decision of disclosing the origins to children	No significant difference was found on donor conception disclosure based on family type. Of those who had not told, a significantly higher proportion of solo mothers than partnered mothers intended to disclose. Partnered mothers were more likely than solo mothers to feel neutral, ambivalent or negative about having used an identifiable donor, and were less likely to consider children’s knowledge of their genetic origins as extremely important	9/10 High
Frydenrejn et al. 2024 [40] Denmark	20 single women	36,6 years	Cross-sectional observational study. Qualitative methodology	Semi-structured interviews	Telephone or face-to-face.	To explore solo mothers’ needs in order to prepare them for childbirth and parenthood	The conventional antenatal packages offered by the healthcare system did not meet the solo mothers’ needs. Solo mothers may benefit from structured antenatal classes in small groups. Being with like-minded women was essential for preparing for childbirth and parenting.	9/10 High
García et al. (2020) [52] /Spain	281 single women. ART with sperm donor (n = 208) and oocytes freeze group (n = 70)	ART group 38.3 ± 4.0 years. Oocytes freeze group 37.9 ± 2.4 years	Cross-sectional observational study. Quantitative methodology.	Anonymous questionnaire (15 min). 18 questions combining multiple choice and closed answers	Fertility Clinic/Barcelona, Spain	To compare the motivations (desire to be a mother) and social aspects (family support) of single mothers by choice and women who have decided to freeze their oocytes and postpone motherhood.	The most common reason for not having fulfilled motherhood desire was lack of partner. Women undergoing IVF/IUI report a longer motherhood desire, > 10 years (71.3% vs. 54.3%), live closer to their families (75.5% vs. 56.5%), and perceive a stronger family support than women undergoing elective egg freezing (85.4% vs. 68.8%).	9/11 High
Goldberg and Scheib 2015 [47] US	50 donor insemination mothers (14 single, 36 female-partnered)	44.80 ± 8.33 years	Cross-sectional observational study. Qualitative methodology	Semi-structured telephone interviews	Sperm Bank of California (TSBC)	Exploration of why women in same-sex couples and single women seek contact with donor-linked families, as well as their experiences doing so	Themes for seeking contact were to obtain (i) support and (ii) information about children’s shared physical and psychological traits. Some wanted to increase their child’s family network, through adding a sibling, but more often as extended family. Data, from partnered parents especially, revealed the challenges of balancing the boundaries of family formed without the genetic link with the perceived benefits of exploring the child’s donor origins.	9/10 High
Golombok et al. (2016) [34]/UK	103 women (51 single and 52 with couple). ART with sperm donor	Single women 44,80 ± 3,90 years. Women with couple 39,21 ± 4,30 years	Longitudinal observational study. Mixed methodology (quantitative and qualitative)	Semi-structured questionnaires. Semi-structured interviews recorded with audio (1.5 h) Children´s observation recorded with video: 5–10 min	Fertility Clinic/London, UK	To compare the quality of parenthood and psychological adjustment of children in heterosexual families and single mothers by choice.	No differences in parenting quality between family types apart from lower mother– child conflict in solo mother families. Neither were there differences in child adjustment. Perceived financial difficulties, child’s gender, and parenting stress were associated with children’s adjustment problems in both family types. The findings suggest that solo motherhood, in itself, does not result in psychological problems for children.	9/10 High
Golombok et al. (2021) [35]/UK	44 single heterosexual mothers were compared with 37 partnered heterosexual mothers	Single women 48.59 ± 3.56 Women with partner 44.16 ± 3.56	Follow-up study Longitudinal observational study. Mixed methodology (quantitative and qualitative)	Standardized interviews that was audio recorded and standardized questionnaires	Telephone, letter or e-mail when the children were aged around 8–10 years	To assess maternal wellbeing, mother-child relationships and child adjustment	The presence of two parents—or of a male parent—is not essential for children to flourish. Family structure is less influential in children’s adjustment than the quality of family relationships.	9/10 High
Jacobsen and Dahl (2017) [50]/Norway	9 single women. ART with sperm donor	36 years	Cross-sectional observational study. Qualitative methodology	Systematized interviews between 35 and 67 min (average 49 min). Data collection through systematic text condensation, and cross-thematic analysis (Giorgi´s Phenomenological Analysis)	Social Networks (Closed Facebook Group)/Norway	To explore the experiences of single mothers during conception, pregnancy, childbirth and postpartum in Norway (where reproductive treatment in single mothers was prohibited by law at the time).	Women found that being open about their decision to conceive was essential, but required being upfront and selecting healthcare professionals carefully. Secondly, the women’s experiences of being seen or overlooked depended upon healthcare professionals’ personal opinions about their situation. Finally, the women experienced that their decision to be a solo mother challenged the societal idea of motherhood	8,5/10 High
Jacobsen et al. (2020) [51]/Norway	9 single women. ART with sperm donor	36 years	Cross-sectional observational study. Qualitative methodology	Qualitative interviews between 35 and 67 min (average 49 min). Data collection through systematic text condensation, and cross-thematic analysis	Social Networks (Closed Facebook Group)/Norway	To analyze the experiences of single mothers in childcare in their postnatal stage (where reproductive treatment in single mothers was prohibited by law at the time).	The decision to be a solo mother entailed responsibility and rendered solo mothers vulnerable. It was valuable, but sometimes surprising, to be met with care and interest, and finally, bending standard rules and regulation of the postnatal ward proved necessary to fit the needs of solo mothers.	8,5/10 High
Jadva et al. (2009) [67]/UK	291 single women. ART with anonymous donor (n = 170), ART with known donor (n = 14), adoption (n = 35) and other methods (n = 83)	42 ± 5,6 years	Cross-sectional observational study. Mixed methodology (quantitative and qualitative)	Two-part online questionnaire: a multi-response part and open answers part	Website” Choice Moms”/US, Canada, UK, Australia, Israel, Latvia, South Africa and Switzerland.	To assess the motivations and decisions to be a single mother. To explore the experiences of being single mother and raising a child without a father figure	Women often sought advice from others and made practical changes before becoming choice mothers. The most common method used to have a child was sperm donation with most opting for an anonymous donor. The majority felt that it was important for their child to have a male role model, and most ensured that their child had a male figure in their lives. Many choice mothers expressed some concern about their child of growing up without a father, although this did not necessarily mean that they wished to form a relationship in the future	7,5/10 Moderate
Kelly and Dempsey (2016) [48]/Australia	30 single women. ART with sperm donor (n = 23), ART with anonymous sperm and egg donor (n = 5), ART with embryo donor (n = 2)	Not mentioned	Longitudinal observational study. Qualitative methodology	Semi-structured interviews (1–2 h)	Social Networks (Closed Facebook Group) and online forum/4 Australian states	To analyze the sociodemographic characteristics of single mothers and their opinions regarding the genetic identity	Early contact with donors was extremely popular among single women and even when formal legislative mechanisms are available, informal linking remains common	8,5/10 High
Kelly (2019) [49]/Australia	30 single women. ART with sperm donor (n = 23), ART with anonymous sperm and egg donor (n = 5), ART with embryo donor (n = 2)	Not mentioned	Cross-sectional observational study. Qualitative methodology	Semi-structured interviews (1–2 h)	Social Networks (Closed Facebook Group) and online forum/4 Australian states	To explore the reasons of single mothers to look for the donor and their experiences to find them (how they have contacted)	All women embraced openness in their homes, speaking to their children from a young age about their conception story. Most of the women also sought information about their child(ren)’s donor, with many choosing to do so when their children were very young	9/10 High
Konge et al. 2023 [41] Denmark	20 single women	Not mentioned	explorative, qualitative study	Semi-structured interviews (1–2 h)	Telephone recruitment	To explore women’s experiences of and perspectives on creating a solo-mother family.	Women went through a process redefining themselves, because they considered the nuclear family as the ideal. They realised on a profound level that they were ‘on their own’. Generally, the woman’s biological family played a vital role, supporting her emotionally and in practical ways. The creation of a solo-mother family was often seen to take place with grandparents as co-parents. The women leaned to a less extent on close friends.	9/10 High
Landau et al. (2008) [43]/Israel	11 single women. ART with sperm and egg donor	45.88 years	Cross-sectional observational study. Qualitative methodology	Structured closed-response and multiple-choice questionnaires. Oral interviews (between 1 and 3 h)	Sperm donor bank. Telephone contactIsrael	To assess the sociodemographic characteristics of single women with both egg and sperm donation, child welfare, mother-to-child relationship, genetic identity and disclosure of the donor	Most women want their children to have identifying information about the genetic father at the age of 18. About two-thirds of the mothers had not yet disclosed the donor conception to their children but intended to do so in the future. A total of 77.4% of the mothers reported being concerned about the donor conception: for the psychosocial development of the child, fear of genetic disorders, fear of incest and lack of certainty of access to genetic information when needed	8,5/10 High
Landau and Weissemberg (2010) [44]/Israel	62 single women. ART with anonymous sperm donor	43 years	Cross-sectional observational study. Qualitative methodology	Structured closed-response and multiple-choice questionnaire. Oral interviews (between 1 and 3 h)	Sperm donor bank. Telephone contact/Israel	To discuss mothers’ views and concerns about knowing the identity of the donor and revealing the identity of the donor to the child	The impact of assisted reproduction on parenting and child development does not give undue cause for concern.	7,5/10 Moderate
Lindell Petterson et al. 2023 [36] /Sweden	207 solo women (study group) and 256 cohabiting women (comparison group)	35,6 years (Solo women were on average 3.6 years older)	Longitudinal observational study	Demographic questionnaire and the Multidimensional Scale of Perceived Social Support (MSPSS) assessing different sources of support.	6 Swedish public and private fertility clinics	To compare demographic characteristics, social network and perceived social support among solo women and cohabiting women awaiting fertility treatment	Solo women were on average 3.6 years older, had a higher level of education, a higher-income profession, and were more frequently working full time. Solo women perceived an equally high degree of social support from their families, significantly higher levels of support from friends and significantly lower support from a significant other compared to cohabiting women. Solo women expected their mother to be the most supportive person in future parenthood, while cohabiting women most often stated their cohabiting partner to fill that role.	8/10 Moderate
Murray and Golombok (2005a) [29] /UK	77 women (27 single and 50 with couple). ART with anonymous donor	Single women 38,30 ± 3,96 years. Women with couple 34,58 ± 4,26 years	Cross-sectional observational study. Mixed methodology (quantitative and qualitative)	Questionnaires with standardized items and audio-recorded interviews	4 Fertility Clinics (single mothers) and 6 Clinics (heterosexual couples)/UK	To compare motivations, experiences and mother-child relationships between single mothers and heterosexual couples	Solo mothers showed greater pleasure in their child and lower levels of anger accompanied by a perception of their child as less ‘clingy’. Fewer emotional and behavioural difficulties were shown by children of solo than married mothers.	8/10 Moderate
Murray and Golombok (2005b) [30]/UK	67 women (21 single and 46 with couple). ART with anonymous donor	Single women 39 years. Women with couple 36 years	Longitudinal observational study. Mixed methodology (quantitative and qualitative)	Questionnaires with standardized items and audio- recorded interviews	Sample collected in Phase I (Murray, 2005a)	To compare motivations, experiences and mother-child relationships between single mothers and heterosexual couples at time of child second birthday	Solo mothers showed lower levels of mother-child interaction and lower levels of sensitivity toward their infant than married mothers. Solo mothers appeared to be more open toward disclosing the donor conception to the child than were married mothers.	8,5/10 High
Psouni et al. 2022 [37]/Sweden	10 single women	27–42 years	Cross-sectional observational study. Qualitative study	Semi-structured interview (45 min)	Sample collected through social networks for solo parenting	To explore thoughts and feelings concerning experiences in pregnancy and early parenthood	Swedish SMC share positive experiences in health-services but also fear and worry. SMC have strong reasons to present themselves as strong, autonomous and competent. SMC express wish to be treated as other expectant parents but also differently and consider individual needs are blurred by supposed uniformity and social stereotypes.	9/10 High
Salomon et al. (2015) [42]/Denmark	311 women (184 single and 127 with couple). ART with anonymous donor	Single women 36.1 ± 3 years. Women with couple 32.6 ± 4,7 years	Cross-sectional observational study. Cohort, prospective, multicenter study. Quantitative and qualitative methodology	Semi-structured questionnaires and interviews	9 Public Fertility Clinics/Denmark	To compare the demographic characteristics, family background and attitudes between single mothers and heterosexual couples	Single women were 3.5 years older on average when initiating treatment compared with cohabiting women. No significant differences were found regarding sociodemographic characteristics, previous long-term relationships, previous pregnancies, or attitudes towards motherhood between single women and cohabiting women. The vast majority of single women wanted to achieve parenthood with a partner, 85.8% wished to have a partner in the future, and approximately half of them preferred for a partner to take parental responsibilities	8/10 Moderate
Scheib et al. (2003) [46]/US	45 women (17 single and 28 with partner). ART with anonymous donor	49,6 years	Cross-sectional observational study. Mixed methodology (quantitative and qualitative)	Structured questionnaires with 3 sections	1 Fertility Clinic. Phone contact and email/US	To analyze the experiences of different family types (heterosexual couples, homosexual couples and single women) who chose to know the identity of the donor (13–18 years post conception)	Almost no parents regretted using an open-identity donor. Almost all parents had told their child about his or her donor conception early on and reported a neutral to moderately positive impact. Finally, of those who had told, almost all expected their child to obtain the donor’s identity.	8,5/10 High
Schneider and Eichenberg 2022 [53]/Germany	131 single women	Not mentioned	Cross-sectional observational study.Quantitative study	Structured questionnaires	Online survey	To investigates the psychological factors of SMCs assessing attachment style, social support, and Big Five personality traits	Findings indicate similarities in characteristics between German-speaking SMC and internationally reported SMC. Independent-samples t-tests showed significant differences from the corresponding German norm sample in personality traits (conscientiousness, extraversion, and openness to experience), attachment style, and social support.	8,5/10 High
Volgsten and Schmidt (2021) [38]/Sweden/Denmark	54 single women. ART with sperm donor	35,1 ± 2,8 years	Cross-sectional observational study. Mixed methodology (quantitative and qualitative)	Questionnaire with 48 items	1 Public Fertility Clinic via mail/Sweden	To assess the demographic characteristics, family background and previous relationships in single mothers	The women had a mean age of 35.1 years and were well-educated. Most of them worked full-time, were permanently employed, and had a stable income. They had previously had long-term relationships, although these had not been right for having children. More women (61%) could consider embryo donation rather than adoption (50%) (p < 0.05). The motivations most commonly cited for choosing motherhood by MAR was that because of their age, having a child was more important than waiting for the right partner. Nevertheless, they still had hope to find a partner in the future.	7,5/10 Moderate
Volgsten et al. 2023 [39] Sweden/Denmark	16 single women	36.7 years	Cross-sectional observational study. Qualitative methodology	Semi-structured interviews	1 University Hospital Sweden	To explore Swedish single women’s experience of making the decision to choose motherhood through MAR	Qualitative content analysis was used to analyse the data. The data analyses resulted in three main categories: (i) longing and belonging; (ii) social exclusion and support; and (iii) evaluation and encounter. The overarching theme reflects the decision to become a single mother by choice: motherhood through MAR – an emotional and ambivalent decision to make on your own.	7,5/10 Moderate
Weissenberg et al. (2007) [45]/israel	62 single women. ART with sperm donor	42.96 ± 4.58 years	Cross-sectional observational study. Mixed methodology (quantitative and qualitative)	Closed-scale, multi-response structured questionnaire. Interviews (between 1 and 3 h)	Sperm donor bank/Israel	To analyze the demographic characteristics, child’s welfare and mother-child relationships of older single mothers	currently young children’s socio-emotional development seems to be within the normal range, the mean age of 43 years at first birth of the mothers, the fact that about one-fifth of them gave birth to twins, the health condition of some of the mothers and children, and the difficulties they encounter, may raise some concerns	7,5/10 Moderate
Zadeh et al. (2016) [32]/UK	46 single women. ART with anonymous sperm donor (n = 20) and ART with known sperm donor (n = 26)	44.17 ± 4 years	Cross-sectional observational study. Mixed methodology (quantitative and qualitative)	Qualitative interviews (90 min)	1 Fertility Clinic/UK	To evaluate the differences in preference for donor anonymity, the pre- and post-conception feeling and thinking about the donor. To analyze the experiences with their children, family and friends.	Marked diversity in single mothers’ representations of the donor. Most (n 1⁄4 27) mothers talked about the donor as symbolically significant to family life and were likely to describe the donor as (i) a gift-giver, (ii) a gene-giver and (iii) a potential partner. Others (n 1⁄4 16) talked about the donor as (i) unknown, (ii) part of a process and (iii) out of sight and out of mind. There were mothers with anonymous and identity-release donors in each group. Several mothers explained that their feelings about the donor had changed over time.	9/10 High

Abbreviations: MAR Medically assisted reproduction, M Media, IVF In vitro fertilization, IUI Intrauterine insemination, SMC Single mothers by choice

Results

Search strategy and study selection

The literature results included 1216 articles in the initial electronic search. After removing 17 duplicates, titles were reviewed and 1144 articles that were not related to the study topic were discarded. Once the abstracts were reviewed a selection of 50 articles remained. Of these, 24 were excluded because they did not meet the inclusion criteria and/or were not related to the objectives of the study, were opinion articles or reflection essays. No additional articles were identified through backward citation searching. The remaining 26 articles were included for revision. The literature-screening flowchart is shown in Fig. 1.

Fig. 1.

PRISMA flowchart for the selected studies.

Source: Page MJ, et al. BMJ 2021;372:n71. doi: 10.1136/bmj.n71.

Study characteristics

The characteristics of the 26 studies, as well as the data extracted from the articles included in this review are summarized in Table 1.

Overall, considerable variation was found regarding research questions, recruitment methodology and sample size. All aspects related to the studies, as well as the central issues that arose, are discussed in the synthesis of the findings.

Country of origin

Authors from 10 different countries have contributed to the scientific knowledge concerning the demographic characteristics, motivations, attitudes and experiences of SMC through ART, covering heterogeneous laws, regulations and guidelines on access to ART, although almost all permissive for single women, as well as topics related to anonymity and donor information.

Nearly a third of the studies (7/26) were from the UK [29–35]; 4/26 were from Sweden [36–39], 3/26 were from Denmark [40–42], 3/26 were from Israel [43–45] 2/26 were from the US [46, 47], 2/26 were from Australia [48, 49]; 2/26 from Norway [50, 51], 1/26 from Spain [52], 1/26 from Germany [53] and 1/26 from France [54].

Of the European countries whose articles were included in this review, the UK, Sweden, Denmark, Germany, Spain, and France allowed ART in single women by law at the time the studies took place, except Norway, which granted access in 2020. By the time the norwegian studies took place, ART was granted solely to heterosexual and lesbian married or cohabiting couples [15]. Consequently, single Norwegian women who wished to become pregnant traveled abroad for assisted fertilization. Although single women had no legal right to ART, they were entitled to full medical care and treatment during pregnancy [55].

The non-european countries, Israel and Australia, also have regulatory frameworks that granted single women access to ART at the time the studies took place. Meanwhile, the US has a policy of non-regulation, where problems are solved by voluntary jurisprudence or guidelines and not through pre-existing legislation [49, 56, 57].

Research design

Methodologies used to collect and evaluate the demographic characteristics, attitudes, motives and experiences included the use of socio-demographic data and structured or semi-structured questionnaires (n = 8) [31, 35–38, 46, 52–54], structured or semi-structured interviews (n = 9) [33, 39–41, 47–50], qualitative interviews (n = 2) [32, 35, 51] or a combination of questionnaires and interviews (n = 7) [29, 30, 34, 42–45]. Data is shown in Table 1.

1. Questionnaires: Some of the questionnaires were semi-structured without reports on reliability or validity. Only one of the studies listed the questions used and added them into supplementary material [52]. The type of questions used in the 10 studies included open or closed questions, while the answer categories featured multiple option, single answer and Likert type scale as response types.

2. Interviews: ranging from standardized to detailed formats, in all studies the interviews were conducted individually. On average the interviews lasted 1–1.5 h, the shortest interviews being 35 min [50] and the longest, 3 h [43, 44].

Sample collection

Public or private fertility clinics, hospitals, sperm banks or social media were found among the places used for sample collection. Twelve studies collected the sample through fertility clinics [29, 30, 32–34, 36, 38, 39, 42, 46, 52, 54], 4 from donor banks [43–45, 47] and 10 from websites, social networks or specific forums, like the Donor Siblings Registry [31, 35, 37, 40, 41, 48–51, 53].

Participants and sample size

1723 single women accessing ART with gamete donation were assessed. Sample sizes ranged from 10 to 281 participants, the mean sample size being 82 participants and the median, 46 participants. Some populations were used for more than one study covering motivations and experiences [29, 30, 34, 35, 38, 39, 48–51]. Therefore, the n = 1723 represents 21 study populations.

Synthesis of the findings

The results of the studies are summarized in Table 1 and later described based on demographic characteristics, motivations, experiences of single mothers, mother–child relationship and origin disclosure.

Demographic characteristics

Age

Seven studies described the age of single women at the time of first birth by sperm donation [32, 33, 35, 36, 39, 40, 42]. Women assessed were on average 35 years old, except for 3 studies which reported a higher age (43 and 45.8 years), likely due to the inclusion of participants who received both donor sperm and donor oocytes [43, 45], or because the data were drawn from a follow-up study conducted when the children were 8–10 years old [35].

In a study by Salomon et al. [42], carried out in Denmark, single women were on average 36.1 years old, 3.5 years older than cohabiting women having had children with sperm donation. Similarly, a more recent study by Peterson et al. [36] of 207 single women reported an average age of 35.6, 3.6 years older than the cohabiting women in the comparison group. The studies by Volgsten and Schmidt [38, 39] in Sweden, were based on the same sample of single women with a an average age of 35.1 years. Overall, single women using sperm donation tended to be in their mid-thirties, and slightly older than cohabiting women having children.

Socioeconomic characteristics

Nine articles reported data on these parameters [31, 36, 38–40, 42, 43, 45, 52]. Most women lived in European countries, had university education [36, 38–40, 43], had stable full-time jobs [43, 45] and a stable financial situation [45, 52].

Salomon et al. [42] found no differences in educational level or occupational social class among single Swedish women compared with cohabiting women recruited in public fertility clinics. However, Jadva et al. [31] and more recently, Lindell Petterson et al. [36], in a multicenter study of 291 and 207 single women, respectively, found that solo women had a higher level of education, a higher-income profession, and were more frequently working full time than cohabiting women. It is worth noticing that the latter studies included both fully subsidized and self-funded treatment. Overall, the evidence suggests that SMC are generally well-educated, financially stable, and professionally established, although findings vary depending on the treatment context (public vs. mixed funding).

Motivation

Motivations for choosing single motherhood through ART

Eight articles described the motivations that led single women to choose motherhood through ART [29–31, 38, 42, 50–52]. The decision to pursue motherhood as a single woman was shaped by several motivational themes, including a long-standing desire for children, a sense of timing and a redefinition of family norms, as shown in Table 2. A consistent finding across studies is that the primary motivation for single women to pursue motherhood is a strong and enduring desire to have children. Volgsten and Schmidt [38] found that single women often prioritized becoming mothers over other considerations, such as finding a partner or being in a stable relationship. Similarly, Jadva et al. [31] reported that 86% of participants had always wanted to be mothers and Jacobsen et al. [50] found the decision to become a solo mother primarily originated in a great desire to have children and that some women had never wanted a partner in the first place.

Table 2.

Motivations for choosing motherhood through ART

Motivations for choosing motherhood through ART
Had always wished to have children	60% of women had always had a “desire to become mothers between the ages of 20 and 40” “prioritized it over other issues such having a stable partner or having met the right partner” 66% single women, at the age of 20, had “wished to have a stable partner and to have 2–3 children”	(31) (38) (42)
Timing	“time was running out”	(29,30,38,42,52)
New family model	Decision for having a child was deliberate and wished to be considered equally suitable	(50,51)

ART Assisted reproduction techniques

In another study, Murray and Golombok [29] found that 70% of single women chose to become mothers because they felt that time was running out. Similarly, Volgsten and Schmidt [38] observed that most SMC were financially and socially stable and opted for assisted reproduction due to their advancing age, a reluctance to wait any longer, and the absence of a suitable partner. Nevertheless, many of these women still hoped to find a partner later in life.

Several studies identified reasons behind not having had children earlier, including the absence of a partner, unsuitable partners, partners who did not want children or poor timing despite being in a relationship [30, 31, 38, 42, 52]. In the study by Jadva et al. [31] 76% of women had previously been in stable relationships, but 64% indicated that they had not had children because either the relationship was not appropriate or the timing was not right. Both Jadva et al. [31] and Volgsten and Schmidt [38] also noted that most women expressed a desire to have a partner. However, 58% reported that although they wished to be in a relationship, becoming a mother was a higher priority. Salomon et al. [42] found that 66% of single women had envisioned, by age 20, a future that included a stable partner and two to three children. However, they had delayed motherhood. Jacobsen and Dahl [50, 51] explored the motivations of single women in Norway, before assisted reproduction was approved by law for this group, and consequently, single Norwegian women who wished to become pregnant had to travel abroad for assisted fertilization. The decision for having a child was “deliberate” and wished to be considered as suitable as the traditional family form.

Additionally, the majority of women reported having been single for one to four years before deciding to pursue single motherhood through assisted reproduction [38, 42, 52].

Experience of single mothers

A total of 16 articles reported data on the experiences of single women who chose to access maternity through ART [29–31, 36–38, 40, 42–45, 48–52]. The study identified several key domains of experience among SMC, ranging from social support to concerns about the donor, as shown in Table 3.

Table 3.

Experiences of single mothers by choice

Experiences of single mothers by choice
Perceived family support and friendship	single mothers received “a lot of support (51%) from their family and friends during the first few weeks of parenting”. However, only 61% of women were “able to redo their social lives on an occasional basis” and only 18% “had social life whenever they wanted to” Stronger family support compared to cohabiting women Higher level of social support from friends compared to cohabiting women, although the first person expected to be supportive in their life as mothers was their mother.	(31) (52) (36)
Perceived support in Health care	SMC appreciate not being treated differently “being with like-minded women” in antenatal care “Being open about the decision to conceive, being seen and made visible”.	(37,40) (40) (50)
Solo parenting experience	Same individual difficulties in raising their children as other type of mothers	(31)
Concerns about a father figure	efforts to counteract the negative effects of absence of father figure Concerns about child not having a “masculine figure”	(29) (31)
Concerns about the donor	58% women opted for an anonymous donor. Women who chose identifieble donors did so to give the child a clear origin identity, and some wanted to receive support from the donor. 50% of the women in the sample would have “preferred to know the identity of the donor”. 81% of women would have chosen “an identifiable donor” given the chance. In Australia, single mothers accessed information about the donor informally, as databases are not easily available Interviewed women felt strongly that openness and access to information were key to the positive health and wellbeing of their donor conceived children.	(31) (44) (38) (48) (49)

SMC Single Mothers by Choice

Family support and friendship

In terms of family support, Jadva et al. [31] found that 51% of SMC reported receiving strong support from family and friends during the early weeks of parenthood. However, social life was often limited—only 61% of women were able to occasionally resume social activities, and just 18% could do so freely whenever they wished. García et al. [52] observed that women who underwent IVF received significantly more emotional or financial support from their families (88.1%) compared to those who opted for oocyte cryopreservation (71.9%).

Similarly, Lindell Pettersson et al. [36] reported that solo mothers perceived high levels of social support from their families and significantly greater support from friends compared to cohabiting women. However, they reported significantly lower support from a significant other. While cohabiting women expected their partner to be the primary source of support in parenting, solo mothers most often identified their own mother as the key support figure. SMC also value not being treated differently from others. As the nuclear family model remains the prevailing social norm, many women prefer not to be constantly reminded that their family structure diverges from that norm.

Perceived support in healthcare

Three studies examined how SMC perceived support within healthcare systems [37, 40, 50]. In Norway, Jacobsen and Dahl [50] conducted their study prior to the legalization of assisted fertilization for single women; nevertheless, participants still had full access to prenatal, birth, and postnatal care through the Norwegian healthcare system. The findings revealed that women deemed transparency about their decision to conceive vital. SMC valued “being open about the decision to conceive” and “being seen and made visible”. Also, SMC tended to be selective about which healthcare professionals they approached. Their experiences of being either acknowledged or overlooked hinged on professionals’ personal convictions regarding their family situation. This group considered important that healthcare professionals were familiar with their history. Recognition included listening, being taken seriously and understanding their situation. The women considered it helpful when the fact that they were solo mothers became the topic of conversation and felt supported when staff was open to this. Additionally, SMC felt that their choice to parent solo challenged prevailing societal conceptions of motherhood.

In contrast, a study by Psouni et al. [37] in Sweden revealed that most participants received generally good treatment in maternal health-services. In general, positive contacts with midwifes and medical staff were reported, indicating positive attitudes and awareness. However, “equal treatment does not always equate to identical treatment” highlighting the nuanced ways in which social support is experienced by solo mothers. A discrepancy was found between what participants described as their own needs and what they perceived to be the other SMC needs. Most participants in this study considered other SMC to be vulnerable, fragile, and easily offended if they felt that they were being questioned or treated differently. However, none of the participants identified with this vulnerability, describing themselves instead as strong women.In fact, a more recent study carried out in Denmark [40] revealed the conventional antenatal packages offered by the Danish healthcare system did not meet the needs of SMC. The women called for content and information tailored to single parents and considered that being with like-minded women was essential for preparing for childbirth and parenting.

Solo parenting experience

Several studies have explored the experiences and perceptions of SMC [30, 31, 42, 45, 50, 51]. Jadva et al. [31] found that nearly half felt their parenting challenges were similar to those of partnered mothers, though many reported social criticism. Murray and Golombok [30] observed no significant differences in emotional warmth or parenting satisfaction between solo and partnered mothers. Jacobsen and colleagues [50, 51] emphasized that a firm decision to pursue motherhood was linked to better psychological well-being and solo mothers sought equal recognition without special treatment, though they valued postpartum support.

Regarding future partnerships, most women expressed a desire to eventually find a partner. Some hoped this would include shared parenting [42], while others focused more on companionship without explicitly mentioning co-parenting [45]. Overall, the wish for a partner was common, but expectations around shared responsibility varied.

Concerns about a father figure

Two studies explored concerns related to the absence of a male figure in the lives of children of SMC [30, 31]. A primary concern was the need for a male role model and how to distinguish between the roles of a partner, donor, and other male references. Jadva et al. [31] reported that 60% of women expressed concern about their child lacking a masculine figure, particularly mothers of boys who emphasized the importance of engaging in traditionally masculine activities. Nonetheless, 81% of respondents identified a male family member or friend who could serve as a role model. Similarly, Murray and Golombok [30] found that 92% of women indicated their child had regular contact with at least one male figure. The authors also noted that many mothers actively sought to mitigate potential negative effects associated with the absence of a father.

Attitudes and concerns towards the donor

SMC engaged with the idea of the sperm donor in varying ways, often shaped by views on genetic heritability. Some emphasized the donor’s role as a meaningful presence, while others downplayed genetic ties. Zadeh et al. [32] found that many mothers valued the donor’s motivations for donating. Post-birth, concerns typically focused on the donor’s health, the number of offspring conceived from the same donor, and future issues like accidental incest or identity disclosure [43].

Preferences around donor anonymity varied: while many women initially chose anonymous donors (e.g., 58% in Jadva et al. [31]), others expressed a strong interest in identity-release donors (81% in Volgsten and Schmidt [38], and 50% in Landau [44] would have preferred identifiable donors, if legal in their country). Some women sought this information to support the child’s identity development or emotional well-being.

In countries with limited access to donor data, women may search informally [48]. An Australian study [49] found that single mothers widely valued openness, often discussing conception with their children early and seeking donor information to support their child’s mental health. Many also pursued early contact with donors and advocated for equal access to information.

Mother–child relationship and child adjustment

Eight articles addressed mother–child relationship and child adjustment [29, 30, 33–35, 43, 45, 46]. In examining the longer-term outcomes of single motherhood by choice, research has consistently shown positive results. Detailed findings regarding the quality of mother–child relationships, the social and emotional adjustment of children, and their reactions to donor conception disclosure is provided in Table 4.

Table 4.

Mother–child relationship and child adjustment

Mother–child relationship and child adjustment
Positive mother–child relationships	maternity satisfaction, happiness and joy	(34,43,45)
Child adjustment	well adapted, both socially and emotionally no significant differences with children of women with partners	(34,43,45)
Child feelings about donor conception	Emotional response: 53%–68% of children had neutral or mixed feelings at disclosure Future intentions: 88.2% of mothers believed their children would seek out the donor through various means.	(33,46) (46)

Mother–child relationship

Four studies addressed the issue of mother–child relationships [34, 35, 43, 45]. Weissenberg et al. [45] found positive results regarding mother–child relationships, with a significant positive correlation between happiness with motherhood and child psychosocial adjustment. Also, on a scale of maternity satisfaction, Landau et al. [43] found all women marked the highest degree, although single mothers of twins found it more difficult to deal with conflicting situations than the rest of mothers.

On the other hand, at phase 1 of a longitudinal study by Golombok et al. [34], when the children were in their preschool or early school years, no significant differences in attitude, well-being or the emergence of problems were found. In fact, in their study, single women had higher values of joy and happiness and lower values of rage. In line with these results, findings of the second phase when children were aged around 8–10 years no differences were identified between the single mother families and the two-parent families in parenting when the children reached middle childhood. In addition, there were no differences between the single and partnered mothers in anxiety, depression, or stress associated with parenting [35].

Child adjustment

A total of five articles addressed child adjustment to their family situation showing consistent positive results [29, 30, 34, 35, 45]. In the study of Weissenberg et al. [45], women reported that their children were well adapted, both socially and emotionally. The results were supported by school scores, assessed using the “Child and Adolescent Functioning and Environment Schedule” scale, with 84% of children getting good results. Similarly, Murray and Golombok [29] found children of single mothers had lower values in difficulty and adjustment scales than those of married women.

These same authors found, in a follow-up at age 2 years, lower values of dependent behavior in children of single mothers compared to those of married mothers [30]. These children had better competency results and less psychological problems. On the other hand, no significant differences in child adjustment or psychological mismatches between single mothers and couples were detected in middle childhood (8–10 years) [34, 35].

Child feelings about donor conception

Two articles mentioned offspring feelings upon disclosure of donor-conceived origins [33, 46]. The authors found that between 53% [33] and 68% [46] of women reported neutral or mixed feelings in their children when being disclosed, without finding clear positive or negative feelings. 88.2% of the mothers in the study of Scheib et al. [46] thought offspring would go looking for the donor through different means.

Discussion

The aim of this systematic review was to integrate the current body of knowledge on the demographic information on SMC, and to provide insight into the motivations, attitudes and experiences of single mothers and the donor-conceived child.

A total of 26 studies were included in the review. The literature reviewed shows that there are striking similarities between SMC concerning demographic characteristics and motivations, while attitudes and experiences are more variable.

The limited geographic scope of the reviewed literature—largely concentrated in Western countries—may reflect greater legal access to ART for single women. In contrast, countries where ART access is legally restricted, are underrepresented in the empirical literature, despite growing academic interest in the legal and ethical dimensions of ART in these regions. However, it does represent the majority of single women who access ART since, globally, Europe has the highest number of treatments [15, 58].

All the articles included in this study had regulations allowing access of single women to ART at the time the study took place, except Norway. In 2000, Australia became one of the first countries to pass laws permitting single women to access assisted reproductive technologies, including sperm donation. Despite this progressive step, a survey at the time revealed that only 38% of the population supported single women having children through such methods [59]. Meanwhile, in the United Kingdom, a 2008 legal amendment removed the requirement for fertility clinics to consider a child’s need for a father, replacing it with the need for supportive parenting [60]. The revised legislation expanded access to single women, since under the previous law, most clinics limited treatment to couples conforming to traditional family structures, not without controversy. Denmark followed in 2006, Israel in 2010, Sweden in 2016, Norway in 2020 and France in 2021. In Germany, the Embryo Protection Act of 1990 did not explicitly prohibit assisted reproductive treatment for single women. Nevertheless, access had historically been limited in practice, given that professional guidelines limited ART primarily to married, mixed-sex couples, and, in exceptional cases, to consensual unions. Thus, single women were excluded from access to MAR [21]. However, the revised guideline introduced in 2018 removed these eligibility restrictions, no longer barring single women from accessing ART [61].

Kocourkova et al. [62] illustrate that country differences in ART usage are related to fertility postponement: the greater the extent of first-birth postponement, the higher the demand for ART treatments. Interestingly, the highest proportion of ART births was observed in countries where fertility is concentrated among women aged 25 to 34. This suggests that ART is most effectively used in populations with moderate—not extreme—delays in childbearing. Fertility postponement, in turn, has been strongly linked to women’s higher educational attainment [5]. Consistent with this broader pattern, our study found that single women using sperm donation tend to be in their mid-thirties, well-educated, financially stable, and professionally established—although these characteristics may vary depending on the treatment context (e.g., public vs. mixed funding).

The motivations driving single women to pursue motherhood through assisted reproductive technologies (ART) reflect a complex interplay of personal aspirations, relational circumstances and broader societal shifts. Across the reviewed studies, the most consistent finding was the centrality of the desire for motherhood as a lifelong goal, often prioritized over forming a stable partnership [31, 38, 39]. Many women had always envisioned themselves as mothers and, when faced with the absence of a suitable partner, chose to pursue motherhood on their own. Age-related concerns were also prominent, with several women citing the urgency of declining fertility as a decisive factor in initiating ART [29, 38]. Although many had been in stable relationships previously, these did not lead to parenthood due to incompatibility, timing issues, or partners’ reluctance to have children [31, 42]. Importantly, while single motherhood was often a pragmatic response to life circumstances, it was also framed as a deliberate and empowered decision. Some women explicitly sought to challenge traditional family norms by embracing and legitimizing new family models [50, 51]. The decision was typically made after a period of reflection and personal stability, with most women having been single for several years and possessing the financial and social resources necessary for parenthood [42, 52]. These findings collectively underscore the intentionality of single women who choose motherhood via ART, highlighting both individual motivations and broader cultural transformations in the understanding of family. However, financial barriers may be excluding single women from ART, reflecting broader inequities in how reproductive health services are funded or subsidized, unevenly supporting reproductive autonomy. Some authors have argued that it is not only country wealth, but rather consumer affordability of treatment that drives country differences in ART usage. Countries where ART treatments are more affordable due to insurance mandates or public subsidies have higher ART usage [56, 63].

The studies consistently show that SMC benefit from considerable support within their social networks (family and friends) and that SMC benefit most when healthcare systems acknowledge their distinct circumstances and tailor support accordingly. In Norway, even before fertility treatments were legal for single women, SMC emphasized the importance of openness about their decision to conceive, being recognized by healthcare professionals, and having their unique needs considered [50]. In Sweden, while many SMC experienced generally positive care from maternal health services, researchers noted a tension: equal treatment didn’t always align with tailored support [37]. Similarly, in Denmark, conventional antenatal programs failed to address SMC needs—they advocated for specialized information and valued small-group preparation with like-minded peers [40]. Together, these findings point to a clear need for healthcare providers to move beyond standardized care—recognizing SMC’s resilience, yet offering individualized, peer-supported resources that validate their solo parenting journey. However, a study examining Swedish healthcare staff’s attitudes toward assisted fertilization found that professionals feel insufficiently prepared—both technically and emotionally—to address SMC needs, citing knowledge gaps and uncertainty in how to communicate with SMC [64].

Findings from the reviewed studies suggest that single motherhood by choice does not negatively impact the quality of mother–child relationships or child development outcomes. On the contrary, the literature consistently reports positive relational and psychological outcomes for both mothers and their children within these family structures. Studies addressing the mother–child relationship [34, 43, 45] report high levels of maternal satisfaction, emotional well-being and secure attachment. Interestingly, single mothers reported higher levels of joy and lower levels of anger, suggesting a strong sense of fulfillment in their maternal identity.

In terms of child adjustment, the reviewed studies reported favorable outcomes. Children conceived by single mothers via ART were described as socially and emotionally well- adjusted. These findings challenge prevailing assumptions that single-parent families formed through ART pose risks to child development. Supporting these findings, a study by Diez et al. [65] that assessed 98 children (mean age = 5.36) found that those raised by SMC exhibited good psychological adjustment and strong social competence. Notably, no significant differences emerged between these children and those in two-parent ART families. Moreover, nurturing parenting significantly predicted better psychological adjustment and social competence in children, underscoring the importance of family processes over family structure in shaping children’s psychosocial outcomes. Consistent with these results, a longitudinal study for the first five waves (2000–2012) of the UK Millennium Cohort Study found that children conceived through ART exhibited higher verbal cognitive abilities at ages 3 and 5 compared to naturally conceived peers, that consistently decreased over time and virtually disappeared by age 11 years. The ART-related cognitive advantage of the initial years was primarily linked to the selective characteristics of ART parents rather than the presence of two parents. Specifically, high education and employment status of the mother had the strongest association with children’s cognitive ability together with a high socioeconomic stability. The age of the mother was also positively related to children’s cognitive scores, but the effect was considerably smaller [66].

Regarding children’s feelings about donor conception, results indicated that most children tended to display neutral or mixed emotional responses upon disclosure, with no clear evidence of distress or harm [33, 46]. In line with these findings, a study by Jadva et al. [67] involving anonymous online questionnaires completed by donor offspring members of the Donor Sibling Registry (a US-based global registry facilitating contact between donor-conceived individuals and their donor or donor siblings), found that children expressed curiosity when learning about their donor origins. However, those informed later in life were more likely to experience negative emotions such as confusion or anger. Children raised by single mothers were more often told of their conception at a young age, likely prompted by early questions from the children themselves regarding the absence of a father. In contrast, donor-conceived individuals in heterosexual-couple families were typically informed later, often well into adolescence or adulthood. Notably, many mothers anticipated their children might eventually seek information about the donor, reflecting an openness to donor identity exploration over time [33, 46].

Overall, the evidence suggests that single motherhood by choice through ART is associated with positive family dynamics and child well-being. The absence of a second parent does not appear to detract from the quality of the mother–child relationship or hinder child development. Instead, the intentional nature of these family formations, coupled with high levels of maternal commitment and preparation and support from women’s social network may contribute to the positive outcomes observed. The rise of single motherhood by choice through ART represents not only a shift in reproductive practices but also a broader transformation in societal understandings of family. In some contexts, legal and institutional frameworks governing assisted reproductive technologies remain restrictive [19, 20] or ambiguous [16], heavily shaped by conservative religious and political ideologies [14, 19, 20]. Consequently, some professionals refuse to provide treatment, justifying their decision on the basis of a woman’s marital status and the notion of a child’s “right to a father” [16, 19]. Nonetheless, the increasing visibility and normalization of SMC offer a valuable foundation for advocacy efforts aimed at expanding ART access for single women, while promoting greater inclusivity and reproductive justice. Positive findings in the literature—highlighting both maternal well-being and healthy child development—provide persuasive evidence in favor of legal and cultural changes that embrace and support diverse family structures.

One of the limitations of the study is the number of countries analyzed. Most of the studies were conducted in Europe, very few in the US or Australia and none in countries in the Middle East, Asia, Africa or Latin America. In addition, this review was restricted to articles published in English, which may have excluded relevant studies in other languages and limits the global representativeness of the findings. There is evidence suggesting that, as demand for ART services is increasing, couples and individuals who do not have access to the desired services in one country are choosing to travel to countries that offer these services without restrictions. However, despite the documented increase in cross-border reproductive care [18], of all the studies included in this systematic review, only two explicitly addressed whether single women accessed ART services in countries other than their own [50, 51]. In fact, quantitative data on individuals seeking fertility treatment abroad remain limited, and most studies—often implicitly—assume that ART procedures are carried out exclusively on residents of the country being analyzed. Until it became legal in France, single women purchased sperm online from international sperm banks or seeked treatment abroad in countries with legal permission, often at high costs. Although the exact number of women who pursued these techniques is difficult to determine, it was estimated that approximately 2,400 single or homosexual women traveled to Spain and Belgium each year for ART with sperm donation [54].

Another limitation of this review is that it is based primarily on maternal accounts, as interviews with children were deliberately excluded to maintain a focused scope.

Building upon the current findings, future research should aim to diversify the scope of studies on SMC. While the characteristics of SMC are less accessible in countries with restrictive ART policies, future research could usefully explore public attitudes toward ART and single motherhood in these settings, as societal acceptance plays a crucial role in shaping both policy and access. Additionally, prospective longitudinal studies would be especially valuable for capturing the evolving nature of mother–child relationships, child development outcomes, and donor identity disclosure over time and the psychosocial impacts. Including children’s perspectives directly would provide a more comprehensive understanding of their experiences, well-being, and perceptions of mother–child relationships. Research should also explore interventions that enhance healthcare professionals’ readiness—both technically and emotionally—to support SMC. Furthermore, the experiences of women engaging in cross-border reproductive care warrant investigation, as this growing phenomenon raises important questions about access, inequality, and reproductive justice on a global scale. A tracking system for ART recipients across borders would significantly advance research revealing actual use of ART despite legal restrictions in the country of origin. Such a system would help identify single women’s access to ART despite legal restrictions in their home countries and enable analysis of their demographic profiles and motivations when seeking treatment abroad.

Finally, more systematic data collection efforts across countries—including low-income contexts—are essential to gain a more comprehensive and inclusive understanding of the global landscape of ART and family diversity.

Conclusions

This systematic review highlights that SMC share notable demographic similarities: they are typically well-educated, financially stable, and in their late 30 s or early 40 s when pursuing parenthood. Many of these women often delay childbearing due to the absence of a suitable partner and initiate ART treatment in response to perceived age-related fertility decline. For most, motherhood represents a deeply held personal aspiration, frequently prioritized over conventional family structures. While some women frame the decision as a pragmatic solution to life circumstances, many portray it as a deliberate and empowered choice that reflects broader shifts in societal understandings of family—that is, a move away from the traditional nuclear model (a heterosexual couple with biological children) toward greater recognition of diverse family forms, evolving gender roles, and expanded reproductive autonomy. Importantly, the review reveals that SMC benefit significantly from robust social support networks and tailored healthcare services that acknowledge their unique circumstances. Findings consistently show that SMC report high levels of satisfaction and emotional well-being, and that mother–child relationships are strong and nurturing. Furthermore, child development outcomes among donor-conceived children raised in these families are positive, with no evidence of increased behavioral or psychological difficulties. Children generally exhibit curiosity about their donor origins, particularly when informed early, and mothers tend to support openness and identity exploration, contributing to healthy emotional adjustment.

These findings challenge traditional assumptions that two-parent households are inherently superior and underscore the intentionality of SMC families. These findings underscore the need for more inclusive reproductive health policies and services that support diverse paths to parenthood, advancing both reproductive justice and family diversity on a global scale.

Abbreviations

ART

Assisted Reproductive Technologies

CASP

Critical Appraisal Skills Program

HFEA

Human Fertilization and Embriology Authority

IFFS

International Federation of Fertility Societies

IUI

Intrauterine insemination

IVF

In vitro fertilization

MAR

Medically assisted reproduction

PRISMA

Preferred reporting items for systematic reviews and meta-analysis

SMC

Single Mothers by Choice

Authors’ contributions

Conceptualization: NZ, LP; systematic literature search, article selection, and data curation: NZ, L.P.; data review: LP, G.L., S.M.; manuscript and figure preparation: NZ., L.P.; manuscript review: NZ, LP, GL, S.M. All authors have agreed to the published version of the manuscript and have provided critical feedback and discussion.

Funding

This research was funded by the International SEK University.

Data availability

The data used and/or analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.