Signs and symptoms
The failure of the metanephros to develop in cases of BRA and some cases involving unilateral renal agenesis (URA) is due primarily to the failure of the mesonephric duct to produce a ureteric bud capable of inducing the metanephric mesenchyme. The failed induction will thereby cause the subsequent degeneration of the metanephros by apoptosis and other mechanisms. The mesonephric duct(s) of the agenic kidney(s) will also degenerate and fail to connect with the bladder. Therefore, the means by which the fetus produces urine and transports it to the bladder for excretion into the amniotic sac has been severely compromised (in the cases of URA), or completely eliminated (in the cases of BRA). The decreased volume of amniotic fluid causes the growing fetus to become compressed by the mothers uterus. This compression can cause many physical deformities of the fetus, most common of which is Potter facies. Lower extremity anomalies are frequent in these cases, which often presents with clubbed feet and/or bowing of the legs..Sirenomelia, or "Mermaid syndrome" (which occurs approximately in 1:45,000 births) can also present. In fact, nearly all reported cases of sirenomelia also present with BRA.It is associated with childhood polycystic kidney disease which is autosomal recessive in origin Other anomalies of the classic Potter sequence infant include a parrot beak nose, redundant skin, and the most common characteristic of infants with BRA which is a skin fold of tissue extending from the medial canthus across the cheek.
Due to the developmental implications of forming healthy parent-child relationships in early infancy, the finding that egg donor mothers were less sensitive and structuring towards their infants raises concern about attachment styles among egg donor families, and the impacts it may have on infants future socioemotional development. Telling the child
Most psychologists recommend being open and honest with children from an early age. Groups for donor conceived children make a strong case for the rights of children to have access to information about their genetic background. For donor conceived children who find out after a long period of secrecy, their main grief is usually not the fact that they are not the genetic child of the mother who raised (and, usually, gave birth to) them, but the fact that their parents lied to them, causing loss of trust. Furthermore, assuming that egg-donor conceived children have essentially the same reaction as sperm-donor conceived children, the overturning of ones lifelong understanding of who ones genetic parents were may cause a lasting sense of imbalance and loss of control. Telling the children that they were donor conceived is recommended, based on decades of experience with adoption (and more recent feedback from donor-conceived children) showing that not telling children is harmful to the parent-child relationship and to the child psychologically.