Donor conception is often the last resort for many patients on their journey to parenthood. Pragmatically speaking, using donor gametes has nothing but advantages – there is a higher chance of pregnancy, less chances of miscarriage or implantation failure, it works well even for older patients and the list goes on. Many patients however are still wary of the procedure.
Those considering undergoing a donation treatment express various concerns. To help address the five most common questions about donor conception, we invited Jana M. Rupnow, psychotherapist and author of “Three Makes Baby”, a guide to raising children conceived through donor gametes. Through her own experience with infertility, she has helped countless patients struggling with their own reproductive issues.
As a counsellor, Jana understands the importance of the journey each patient goes through; over countless hours of consultations and listening to people’s stories, she has developed deep respect for anyone who embarks on the journey to parenthood despite all of the obstacles and troubles. She also learned what the most common concerns expressed by patients undergoing donor conception treatments are.
A lot of the expressed doubts and uncertainties had to do with emotions – questions such as “will my child be upset when they learn the truth” or “will I feel like the real mum or dad” are common, as are feelings of confusion. Jana likens this to “genetic bewilderment”, a term used in adoption to describe the feeling of confusion stemming from the realisation of what it means to be genetically different from your child. In donation conception families, it is common for parents who are not genetically related to their children to feel this sense of bewilderment. Understanding this is what led Jana to learn more about the concerns, anxieties and uncertainties expressed by donor conception families.
What she came to understand was that some concerns tend to pop up more than others. Five particular uncertainties seemed to appear more often than others:
These rather broad categories describe the most common sources of confusion and fear in donor parents-to-be. Each category has different strategies and coping methods associated with it; the only trick is to understand which category you fit in.
Emotional distress describes every anxiety related to the emotional and mental aspects of donor conception. Fears over your child being upset when they realise their origin, worries about potential challenges they may face, uncertainty over your own feelings towards a donor conceived child – all of these neatly fit into this category.
Infertility and the process of treating it are emotionally intense; it is a struggle which asks a lot from us – both physically, as well as mentally. It is no wonder, then, that the emotional centre of the brain works overtime during the infertility process. We become chronically emotional and as we fall deeper into our own heads, the feelings we experience become more and more intense. We begin to worry that our child will experience the same emotions.
One of the strongest emotions felt during the infertility process is grief. Treating infertility works the first time only in a very small minority of cases; for most patients, it is a long struggle full of loss – from failed attempts, to negative pregnancy tests, to miscarriages – small wonder, then, that grief appears so frequently. It becomes paramount then, that you take care of yourself mentally; figure out your feelings and deal with them before taking on even more challenges. Jana’s book contains strategies and coping mechanisms for dealing with grief on your own terms, as well as methods for distinguishing your feelings from those of your own child.
Worries over parent legitimacy are common in donation scenarios. It is very common to wonder if you’re going to feel like the actual parent to your child if the two of you don’t share a genetic bond. Parents who express that concern also worry that they might treat their child differently due to their origin, or that the child may wonder about the identity of their donor.
Parenting, however, is not so much about biologic or genetic links, as much as it is about attachment and bonding. The child’s origin doesn’t matter; we have a natural capacity for bonding which only requires us to spend enough time together. These worries stem from a lack of experience with non-biological families; the common assumption is that family is biology – which couldn’t be further from the truth.
Sometimes our worries stem from social differences – infertility is still a taboo topic for a lot of people. Being open about infertility can be perceived as an admission of weakness or defeat by our family and friends. It’s natural, then, to not want to bring any attention to the topic. After all, we can’t know for sure how those close to us may react to the news, or how they would treat us after learning about our condition. Many people undergoing fertility treatments don’t talk about their experiences simply because they want to be treated and feel like other, “normal” families.
As Jana writes in her book, the correct approach is to establish your own feelings before worrying about others. How much weight do you place on “fitting in”? While embracing your differences may require a small period of adjustment at first, it’s no different to the process of acclimation into a different culture. Although it feels like a bit of a challenge at first, over time it only gets easier.
Cultural differences are a related category of anxieties. If you come from a more traditional culture, it’s very common to worry about your family rejecting your child based on some deeply-held beliefs. This is a legitimate concern – there are many places, cultures, and families that will have a hard time understanding your circumstances. These challenges are perhaps some of the most difficult you can face, but they aren’t impossible to overcome.
The way many people in these cultures deal with such issues is through secrecy. This, however, is not a healthy approach. A secret is very hard to keep; doubly so if it has medical implications. What if your child’s doctor asks a question you can’t answer? What if your child figures out the truth on their own? Secrecy is not the way forward – but privacy is. The line between secrecy and privacy is a fine one, but it can be managed. Simply put, do not hide the truth from your child, but maintain your family’s privacy. The rule of thumb is simple – secrecy is when we keep information from people that need to know, privacy is when we keep personal information to ourselves.
The last concern is perhaps the easiest one to tackle – the lack of know-how. How and when should we talk to our child about their origin? What words should we use? How do we give our child the tools to help with any challenges they might face?
The way you talk to your child will obviously depend on their age. Jana’s book contains various strategies and phrases you can use when breaking the news to your child. It’s also important to consider the child’s perspective – children are inquisitive by nature, and much cleverer than we’d like to admit. If their parents are avoiding a certain topic, the child will pick up on it and start to wonder. The responsibility of establishing an open environment in which this topic can be raised falls to you; the child won’t raise the topic on their own.
Yeah, that’s a really great question. It is a very common challenge – that one member of the couple is ready to tell or talk about it and the other one is not. In that case, what I suggest is that you take some time to work through the exercises in my book, because what that will do, is to help you identify what your partner’s concern is, some of the thoughts and challenges they are having about it, and then how to address it. So, it really depends on what is bothering your partner, and if you can elaborate on that, then I am happy to elaborate on an answer as well. Sometimes people just don’t know what language to use, or how to say it, or think “my child is too young, they’re not going to understand, and so why would I talk to them about it?” But, what we do know, is that children can absorb information and that the younger you tell them, the more effortlessly they are able to take it in and accept it as part of their story, and then later, as they get older, maybe some more challenges might come up, they have the foundation of knowledge already to build on, and that confidence, and it’s usually very positive when you’re little, as you can just tell stories and have cute little story books, and they usually don’t have so many challenges around that point, so it’s a great time to establish a really positive language around donor conception. But I would say, just grab a copy of my book, and see if it can help you identify some of the issues that are going on there.
Yes, I do have patients coming back, and that’s when we’ve established a relationship and in fact, I talk about a case like this in the book, Taylor and Jack. They came back to me afterwards when their daughter was three because Taylor was having trouble dealing with the loss they’d gone through – with their last embryo, they were able to become pregnant but it ended in miscarriage quite late in the pregnancy – they had even named their baby. What she found, was that even after she had used a donor egg and had a baby, and was so happy as a parent, she was still grieving that miscarriage and the loss of that biological child that she was pregnant with. She wanted to come back to me and talk through that grief and work through the issues that she had and didn’t work on back then, which is completely normal. Grief does come up later sometimes, when your child is here, I always tell parents not to worry about that, but just to take a look at it and take care of themselves and to reach out for help if they need it and talk to somebody, because that grieving process is very important for you to get to that full acceptance of who your family is today. I had to go through it myself, even after we brought our daughter home from China, I remember feeling a lot of grief still, and feeling guilty that I shouldn’t be grieving or feeling bad. I had great advice, I think it was from a book about adoption that I read, “The secret thoughts of an adoptive mother”, which said not to feel guilt on top of grief – that we shouldn’t feel guilty for grieving, and I thought it was very important – to give you permission to feel that and not feel that guilt, which will help you to work through it. Hopefully, that helps.
You can start as early as possible. There are now many many children’s and baby books on the market about egg donation and some of them are really great. You can start by reading storybooks to your child, and they just take in that information naturally as part of their story, and then you can keep talking about it throughout the years in different ways, which I give examples of how to do in my book. So, if you feel comfortable, I would say start right away, as this gives you the opportunity to practice, and you can get used to the language and saying it out loud. it helps you to get comfortable with it before they really realise fully what is going on. Children don’t understand the actual technical aspect of conception until they’re around seven years old, so they won’t really understand what you’re talking about, but you’re using very basic and simple language, so they can form concepts around that, and it just enfolds naturally over time that way. You also asked about not telling the child about the donation – there are only a couple of situations, which I mention in the book: one, if your child has special needs and the information would be too complex for them to comprehend and would just make it too confusing, then you may just want to talk to your doctors about that and see what they are able to comprehend. The other time I don’t recommend telling them, or recommend that you wait, is if you are going through a family crisis. Sometimes, during a divorce, this information gets spilled out by an unhappy parent or family member during a fight, and that can be really difficult for children to have two pieces of upsetting information to find out at the same time. So, I would say if you are going through some sort of family crisis right now and you haven’t told them yet, then don’t tell them yet and just wait a little bit until things settle down. Hopefully, that answers your question.
Thank you for sharing your question – sharing that feeling is so hard, but I understand that you are not alone and a lot of women feel that way – they feel these feelings of failure and inadequacy. However, men feel it too, for example, if their sperm count is low, they also feel the same feelings of inadequacy, so I would just like to remind you that it’s usually a medical condition which causes that, so I like to think about lifting the shame around that medical condition, that we want to understand that even though we do naturally tend to feel shame, that it is something that you can’t control. So, when you look at bonding with the baby, it can be a genuine concern, as a lot of times we will bond with the idea of our baby before we even conceive – we can form a bond with an idea or a concept, and any time we lose that bond, we feel loss. A lot of people think about what their baby would look like before they even conceive, or imagine how they would share their genetic traits with their partner, so to lose that can be a core loss for many people – when you have that broken bond and that broken dream, you really do have grief, and so that all is a part of it. Bonding usually happens once you’re pregnant with the baby, and even after the baby is here, you start to form an attachment process – attachment is what happens over time, with repeated care and sharing of life’s events, so that is how we bond and attach long-term, caring for our child. If there’s something that gets in the way, like depression, then yes, you want to take care of yourself and go see your doctor, and you would like to do the best that you can to get the help you need for that, because depression can interfere with bonding across the board, whether it’s a biological child or not. So, that’s a good concern – it’s good that you’re thinking about it and it’s definitely not silly at all, and it’s very legitimate for you to feel that way. Your husband is probably doing his best to understand, but you’re right, it’s not always the same for husbands – they have different ways of coping and dealing with infertility that are natural and healthy for them, but are often not like how we, women, cope with infertility. Women tend to want to “tend and befriend” and talk about it, and talk it through, whereas men need to distract and compartmentalise and shut it out and shut it down. This can create some tension between a couple, when you have different ways of dealing with that sadness, grief and challenge. I talk to couples all the time about this, and I think I even have an older youtube video out there about the challenges between couples, so you can look that up and watch that for even more information about how to communicate with your husband.
I think I need a little more clarification on the last part. Let me start by saying that anything you are feeling is not irrational – infertility and this process brings up so many emotions, so it’s okay. Like I said in my book, it really is a guide to working through your feelings, and I have checklists, where you can mark off “I’m feeling like this, or I’m feeling sad, angry etc”. I would just say, understand that what you’re going through is difficult, and if you need support, then you get that support – if it’s your male friend, and he’s supportive to you, then that’s fantastic – wherever you can get support, is important. Feel free to retype about the last part and elaborate on your question and I’ll be happy to answer it.
Oh, of course, yes, it’s definitely possible. I actually talk about that in my book, it’s called “the preschool years” and you have an entire chapter dedicated to that topic and how to talk to your child in the preschool years, so when they are five, and you can use simple language and phrases. I’m actually going to turn to that page now in the book: remember, you use the concept – children at five years old don’t understand how conception happens yet, but you can still use concepts that they can definitely understand, which gives them a foundation to build on. As they get older and their brains become more advanced, and the information more complex, they can learn to comprehend that better. So, think of it like you’re building in stages – at five years old, use basic language, and each stage is different, and I talk about that in my book – through the years – from preschool to middle childhood to adolescence and teenage years. You want to use a positive tone with a five-year-old child, you want to tell them you needed a little help to have a baby, and that you got a gift, or a seed – different people use different words to describe this concept. Again, there are tons of storybooks that you can purchase to help you with that language, so you can just read them a story about it. Grab a copy of my book for actual phrases you can use, and you will be able to get the information there that you need.
I think what you’re asking is that you’ve had a baby through egg donation and you’re thinking that sometimes people feel guilty about that. I imagine that that happens – most of the patients and the clients that I see do usually talk to me more about that beforehand. Sometimes they do come back and talk about guilt, but I think usually it’s more often grief rather than guilt if that makes sense. If you can elaborate on what type of guilt, or just more specifically what you mean and what they are feeling guilty about, that would be helpful.
That is a good question, and I think you will have to make that own judgment based on your culture or country that you live in. I think what you can do, if you do feel like that is too complicated to tell because of your culture or country, then there are words and scripts in my book on how to talk to your child about it when they are older, and you can tell them why. You can say that you didn’t want to tell them sooner because of what might happen in your lives, and this was your way of making sure you didn’t have to deal with some of the extreme challenges that you couldn’t address. I address some challenges in the book which we could all manage, but you may have some extreme challenges that I’m not familiar with, living here in the US, so there are terms and things you can say when they are older to help explain why, and that is something you can look into in the book as well. Out of curiosity, where do you live? Of course, if you feel like sharing that.
I would say that there is no way to necessarily reconcile it, and I’m certainly not in the business of trying to convince you to do something that you don’t feel comfortable with. What I do, is once people have made the decision for themselves and they do want to move forward, then I help them and say “hey, you’re going to do this, so here are some things you need to prepare for and here are the challenges ahead”. I would just say, again, that there is a big grieving process when you can’t have your own children, or you can’t have a biological or genetic child – that is a core loss and you will grieve that, and it will be difficult to go through, but just allow yourself to feel those feelings and there is no rush. I do have some patients tell me that they didn’t necessarily realise that they didn’t need to rush through to their decision and they could have taken their time to work through some of their emotions, but you have time to work through it too after to process – it’s never too late to be able to address your own concerns about this.
Well, there are research studies that have been done about adult donor-conceived children, and the reports vary. There are some that do fine and are well adjusted and there are others who struggle a little bit more – it all depends on the circumstances. It depends on when they were told, how the family dynamic was, if they were a family that functioned pretty well and were happy and healthy, or if they struggled in some unrelated areas. What we also see is some more recent research that suggests children in donor conceived families are just as well adjusted as some families who have had biological children. We can also look to the adoption community, where we see that many adopted children are very well adjusted as well. There are of course a lot of exceptions, for which there may be lots of reasons – I would say if you’re open, adaptable and accepting, then you are going to be minimising the psychological problems which they may have. We also find that children have less psychological issues and fewer feelings of betrayal or identity issues if they find out when they are a little bit younger than if you were to spring it on them when they’re a teenager, as they tend to struggle more with identity confusion at that age. However, more research needs to be done on families that have been donor conceived.
It sounds like you are just beginning the process. You definitely want to be comfortable with the process – it’s a big decision, and if you don’t feel like you’re on the same page then you might want to just have some meetings with him, or even talk to a counsellor or a consultant about it, and just see what the concerns are that you’re having, and if it’s something that you still want to move forward with. I can definitely see that the position that you’re in can be difficult and that you may want to take a step back and then have some more conversations around it if you can. If you are already in the process, and I missed something there, then you definitely want to talk to somebody – talk to a counsellor together and talk through it so you can feel more at ease with the situation.