In this webinar, Giuliana Baccino, Psychologist and PhD in Health Sciences has been discussing psychological criteria for recipients, and she has addressed a very important, and difficult question on egg donation treatment and if it is for everyone.
Nowadays, we are used to seeing different types of families in day-to-day life. Some of them are created through egg donation treatments, but are donor eggs for everyone? This is a question that is often asked. What should be looked at when egg donation is recommended to a couple or a woman? The first thing could be mental and physical illnesses, but there is no scientific evidence that tells us whether these kinds of illnesses can harm the relationship or the woman and the child or not. There is no scientific evidence regarding socioeconomic status or the motivation for being a mother. However, there is clinical evidence regarding age. There is evidence of when it is better to have kids and when there might be some issues regarding age.
During the first consultation with a woman who wants to undergo egg donation, there is always a question: Why do you want to become a mother? Possible answers:
The next question always follows: Why do you want to become a mother through an egg donation treatment? Possible answers:
There are different types of answers, so do you think that these 3 first scenarios or answers are the same when we are talking about a future mother-child relationship? Do you think that it will be the same for this future mother-child relationship if this mother went through the treatment because her doctor says so?
The second thing that should be looked at is age. We should be looking at risks and benefits for the woman and the future child. There are medical risks related to older age, for example, low birth weight, and premature birth significantly increase when the maternal age is over 40. When a woman is over or equal to 43, there is an increased risk of preeclampsia, intrauterine growth retardation, stillbirth, and placenta abruption. Other risks include gestational diabetes, hypertension, premature rupture of the membranes, etc., all these risks are needed to be clear and explained to the patients before they go ahead with the treatment.
There are also benefits for women of an older age to have children. Medical benefits are, for example, non-transmission of their genetic illnesses, and endometrial preparation is easier than ovarian stimulation. Psychosocial benefits involve greater financial and economic security in older ages and more nurturing child-rearing.
There might also be some risks and benefits for the future child. The medical risks include pre-term, lower birth weight, transfer to the neonatal ICU, neonatal death as well as 5 minutes Apgar score less or equal to 7 or intrauterine growth restrictions. It has also been demonstrated that daughters born to mothers aged between 40 and 49 years old lived almost 9 years less than daughters born to mothers aged 20-29, while sons born to older mothers lived almost 6 years less than sons born to younger mothers. Some data on the child’s expected age at the time of the mother’s death showed that a woman at 35 years old at the child’s birth is expected to live 81 years, so she will share with her son 46 years of her life. The mother’s probability of death by the child at age 5 is 0.54, but looking at a mother who is 55 years old at the child’s birth, she will share approximately only 28 years of the child’s life and the probability of death by the child at age 5, is 2.70
This kind of information also needs to be taken into account when you’re deciding to go for egg donation treatment. You have to be informed not only because of you but also because of your offspring.
Regarding psychosocial risks, all children report feelings of embarrassment and experience testing on their parent’s age, they have increased difficulty relating to parents who are so much older, and they engage in less active play with their parents because of the older age of the parents, the children feel they grow up earlier than their peers, for example, they also have a constant fear of the risk of parental death and when this loss is in childhood, that the child is at risk for emotional and behavioural problems as psychiatric disorders including anxiety, depression, post-traumatic stress disorder, alcoholism, etc.
It has been reported that they have also lowered self-esteem and they are put in a caregiver role to take care of their parents to help them more and so they have less time for school, work, extracurricular activities and friends.
There are also some benefits for the future child, for example, lower risk of exposure to physical punishment and abuse and financial and economic security. The research has demonstrated that once they are parenting, older parents begin to acknowledge that they are worried about how their age and death may impact their child.
Taking it all into account, do you think that a woman is suitable for an egg donation treatment at any age?
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I’m not a medical doctor, so I would prefer for a medical doctor to answer your question but what I have to say is that at 47 years old, it’s very, very difficult to have a child with your own eggs. It’s really difficult, but you should consult a medical doctor, and he or she will indicate what’s better for you. I would suggest not to wait too long to consult as well.
It depends on the country, for example, in Spain, there is a consensus that we do not do treatment to a woman that is over 49 years old. Some clinics don’t start the treatment when the woman is 48, others start it when a woman is 49-50 maximum but not more. In some other countries the age limit is even 42 years old, and in others like the USA more than than 53 years old, so it depends on the country.
Not in Spain, but in other countries it is possible. The European Parliament is trying to unify the legislation regarding egg donation, but until today, it depends on the country. In Spain, you cannot have the identity of the donor. In other countries, it is possible.
I would prefer that a medical doctor answers this question because it’s not exactly my field, as I am a psychologist, but it’s very difficult to find a woman of 50 years old having a child with her own eggs unless she has been having children in the last 15 years. Sometimes, we hear stories about our grandmothers that had their last baby at 49 or 50 years old, but they have been having one child after another, and this is different than having the first child at 50 years old. The chances that the woman who wants to try at 48 is almost the same as 50, those are very, very low chances, but I prefer that a medical doctor can explain it to you.
Sometimes we hear that women remain pregnant when they are 50 years old, and they are not telling us that they used a donor egg treatment because not every woman is telling everyone that they are undergoing an egg donation treatment. They always say I got pregnant, I am lucky, and that’s it, but almost always, they were lucky because there was a donor behind it, and they are not saying these things.
Psychologists do have space in fertility institutions. If they work as a team with the fertility institutions as they respect doctors and medical doctors respect them, but I don’t know if it is compulsory to start a medical treatment and the psychological treatment at the same time. I don’t know if that should be so strict. There has to be a recommendation of the psychological unit or psychological department for you to attend as a patient if you want it and that the medical doctors can encourage patients to equate their doubts, their fears with the psychologist. But to make it compulsory, I don’t know because it may harm the psychologist-patient relationship.
In some countries, yes, it is mandatory before people undergo an egg donation treatment. In Spain, it is not mandatory, it’s recommended, but it’s not mandatory. I think that making it mandatory would work because when something is mandatory, we go to the session, and we may say whatever the psychologists want to hear because we don’t want to be there. I can tell you whatever you want to hear, so you sign the paper, and I go out. Maybe, it’ll better if it is your choice and only your choice to come with me and talk about the situation.
Yes, there are because they do not give themselves enough time to process the idea of not having a child with their genes. This is not a decision that you can take from one day to the other, this is a process, and when you do not go through this process well yes, some women regret their decision, and sometimes they provoke a miscarriage to themselves. These are situations, very difficult situations for professionals and the patients, but sometimes there are consequences if you are rushing with egg donation first, they want to do it, and then they will think about it, and this is the beginning of a project, and having a baby is not the end of a project. At the beginning of a project, you have to think a little bit more and consult with specialists.
Yes, of course, in Spain, the consent forms inform the patient, for example, the legal responsibilities that they have with the child, and they explain that the child will never know the identity of the donor as well as the recipients. I think that in the rest of the countries, they may do the same, but I really don’t know because I don’t know the consent forms in every country. In the fertility field, we always try to explain very well to patients what they may expect and whatnot.
The first thing that the child needs to know that she was very, very wanted, very desired and that you did this all and you have gone through this to have him or her in their lives because you love them no matter what, if you are genetically related to them or not. We usually recommend starting telling the children when they are 3 until they are 8, not after because in adolescence, it will be a little bit difficult for them if they have found out that they are from egg donation treatment. We recommend starting telling them when they are very little with a little story, simple story, and then it will come more complex when they grow up. This is not a recommendation only for older parents, this is a recommendation also for young parents that do an egg donation or a sperm donation treatment. The first one to know has to be the child, not your parents or your neighbors or whatever, first the child and then if you want to tell the others. You may tell the truth to others, or you may leave it open. There’s no need to tell others if by others you mean your neighbors or your cousins, I don’t know if there is a need to explain to every single person what kind of treatment you did because it’s the same as you don’t explain what you ate yesterday or whatever. Who definitely needs to know is your child, and if you want to tell afterward the others, you can tell in a polite way that we had him or her through an IVF treatment with donor eggs. I don’t think that people need to know everything about our lives, our children need to know it, I’m not sure about the others.
You may tell the truth to others, or you may leave it open. There’s no need to say this to others if by others you mean your neighbors or your cousins, I don’t know if there is a need to explain to every single person what kind of treatment you did because it’s the same as you don’t explain what you ate yesterday or whatever. Who needs to know is your child, and if you want to tell the others afterward, you can tell in a polite way that we had him or her through an IVF treatment with donor eggs. I don’t think that people need to know everything about our lives, our children need to know it, I’m not sure about the others.
There are a lot of such books. I personally have a few that I can share with you after, but there are a lot of them. The most important thing is that different books are depending on the age because it’s not the same if you want to tell him or her at 3 or 4 years old and if you want to tell him or her at 7 or 8. In my case, 3 little books that go together, and you can read them between 3 and 5, or 6-8 and 9-11 because it’s not the same as what we are telling them when they are 5 or 11.
Everyone needs to know about their origins if it was through adoption, through an IVF treatment or an egg donation treatment, or a spontaneous conception because children ask, so it’s better always to tell the truth of how they are here and why. I think they need to know everything.
If you know about the culture of the donor, you may tell them, but you don’t always know. We have to take into account that we do not mix ethnicities, we don’t give an Asian egg donor to a Caucasian recipient or an Afro-descendant donor to an Asian patient, so the ethnicity sometimes will be the same as yours because it’s not legal to mix it. I think that nothing has to be forced, you have to raise him with love, patience, with all the good that you have despite the culture, etc.
