When it Takes a Community to Conceive a Child: Why Being Informed About Raising a Donor-Conceived Person Benefits Everyone
by Sarah Rivers Deal, PhD, LPC
If you are considering donor assistance to create your desired family, you may have already been down many unsuccessful, rocky roads in your fertility journey. What was once private information is now more public, including doctors, nurses, mental health professionals, and administrative red tape that only seems to lengthen your timeline. The inclusion of these additional health providers in your life may feel unwelcome and intrusive, however, I am here to share with you the importance of incorporating the mental and emotional landscape of your experience to promote the overall well-being and healthy psychological adjustment of your intended family.
I’d like to share the experience I’ve gained, both as a mental health provider with 24 years of clinical experience (12 of those years specializing in infertility counseling, reproductive trauma, and third-party/donor reproduction) as well as an individual who utilized donor assistance years ago on her path toward parenthood.
When you are a fertility patient, one of the many boxes you must often check when considering utilizing a donor is the “Third Party Reproduction Psychological Consultation,” which is conducted by a licensed mental health professional in the state where you reside. This meeting is required by most fertility clinics, which is a positive sign as it indicates how much the clinic is complying with the guidelines set by the American Society for Reproductive Medicine (ASRM). These guidelines have been informed through decades of research to promote and protect the overall well-being (physical, emotional, and psychological) of patients and their intended families. That being said, fertility clinics and their staff cannot adequately attend to the vast, complex emotional and psychological landscape and therefore rely on the expertise of those mental health professionals adequately trained in third-party reproduction counseling to assist in exploring what is under the surface.
This is where the “Third Party Reproduction Psychological Consultation” comes into play. Let’s delve into what this meeting is and what it is not.
This meeting is psychoeducational in nature, which means that the main goal is to inform and educate intended parent(s) from the plethora of research regarding donor-conception and donor-conceived families. I’ve had many individuals and couples arrive to this meeting with a defensive tone and posture, believing that I am judging their ability to be good parents. This isn’t the case, although a therapist cannot simply leave her clinical judgement at the door when practicing in her professional capacity. Although it may vary depending on the practitioner, I try to discuss the following with intended parent(s):
To summarize, my three main goals during the 90-minute meeting are:
1) Inform through best practices research and my clinical experience
2) Support intended parents on their journey by providing a compassionate environment and various resources to assist long-term
3) Promote and protect the well-being and psychological adjustment of donor-conceived persons and their families.
In a nutshell, I’m here to help more than hinder.
It's important to consider what this meeting is not. Although we will likely be addressing emotional experiences, this consultation is not a therapy session. For intended parents utilizing an unidentified (formerly termed “anonymous” donor), it is not a psychological evaluation in the standard sense. Intended parent(s) do not have to complete standardized psychological assessments and/or “pass” these tests. When I first start the consultation meeting, I address these intentions, and the tension and reluctance typically diminishes. It is important to note that the use of standardized psychological testing comes into play more when evaluating the candidacy of potential donors and gestational carriers (and for good reason).
Each year, I attend the Jefferson Infertility Counseling Conference in Philadelphia, which informs my work tremendously. On the last day of the conference, we are honored to hear from a panel of donor-conceived persons about their experiences. It is these people and their families that I keep in mind when I conduct the third-party consultation meetings. They are there to share with us what they want the professionals to discuss with intended parents during our consultation meeting. We are fortunate to have longitudinal research and panels of people to inform us on how best to do this, what we call “best practices.” Donor conception has been a form of family building for a century or more; intended parents are not alone and are not expected to have all the answers up front.
Due to the lifelong implications, I encourage intended parents to be choosey when it comes to who conducts their third-party consultation meeting. Since it won’t likely be covered by insurance (remember, it’s not a therapy session), one might as well find a well-trained provider. In my professional opinion, I recommend seeking out a mental health professional that meets the following criteria:
To conclude, donor assistance provides new hope to families who in times past would have no opportunity to carry and birth a child. It is both a beautifully complex and challenging choice. Reproductive medicine has come a long way and mental health professionals are simply trying to keep up with the ethical, legal, and psychological aspects that are continually evolving. Intended parents who are informed make better choices for their desired family, which then promotes the overall well-being of all vested parties.
Resources:
Covington, S.N. (2022). Fertility Counseling: Clinical guide, 2nd ed.
Cambridge, UK: Cambridge University Press.
Covington, S.N. & Hammer Burns, L. (2006). Infertility counseling:
A comprehensive handbook for clinicians, 2nd ed. Cambridge, UK:
Cambridge University Press.
To find an ASRM provider: https://www.reproductivefacts.org/find-a-health-professional/
When Mother's Day HurtsWhen Mother’s Day Hurts“There is, I am convinced, no picture that conveys in all itsdreadfulness, a vision of sorrow, despairing, remediless, supreme.If I could paint such a picture, the canvas would show onlya woman looking down at her empty arms.”-Charlotte BronteAs Mother’s Day approaches, I’ve been speaking with several of my clients who’ve struggled to become mothers and/or have lost a child in utero about what this day means to them and how they feel. I’d like to share some of the themes that have emerged through our discussions. Unfair. For many women, the veneration of mothers on this day is deeply painful. Feelings of anger, irritation, envy, and confusion arise. Why me? Why haven’t I become a mother after so much effort? Why did I lose this much sought-after pregnancy? The women I see in my practice have typically spent months, sometimes years, trying to birth a healthy baby. They may have sacrificed tremendous time, energy, and spent the reserves of their emotional and financial resources to try to conceive. They may have given birth and held a dead baby in their arms. The legacy of their losses becomes their new reality, and they must learn to navigate the world with the constant presence of someone’s absence. This, my friends, is unfair. Isolation. Infertility and/or pregnancy loss is often a silent struggle. Research reports that women who are struggling to become mothers experience increased feelings of anxiety, depression, isolation, shame, guilt, and loss of control. Depression levels in people with infertility have even been compared with patients who have been diagnosed with cancer, and couples tend to report that infertility or pregnancy loss have been the “most difficult” events in their lives thus far. This silent sorority of women is estimated to affect 1 in 8 couples (or 12% of married) who struggle to get pregnant or sustain a pregnancy (Rooney & Domar, 2018). That’s roughly the size California, folks! And yet, we don’t talk about it enough, and that’s especially true for men. Sadly, when these discussions do come up, well intended yet uninformed family, friends, or coworkers can say thoughtless, hurtful comments. This can further the cycle of silence. Grief/Loss. If you wonder what that constant tension is in your body, that heavy feeling that sits on your chest – it’s grief. Feelings of anger, depression, anxiety, fear – all different colors of grief expressed. Loss is ever present in the stories of those struggling to create their families, and it doesn’t just disappear when a baby arrives. For some of my clients, the losses can be layered, so let’s take a look at some of them:What’s been lost?Loss of the experience of pregnancy and birth – you feel you are missing out on one of the most miraculous events of lifeLoss of sense of belonging – you don’t quite fit amongst your friends, family, or society at largeLoss of being in control – of your body – of your life. This wasn’t how it was supposed to beLoss of feeling healthy and normal – your identity shifts from “healthy person” to “infertility patient”Loss of feeling competent – you feel you can no longer achieve what you set out to doLoss of sexual intimacy, identity, and privacy – what had been the most private and intimate acts is now publicThe Eagles band has a song titled “Hole in the World” and I think it certainly applies here - -There's a hole in the world tonightThere's a cloud of fear and sorrowThere's a hole in the world tonightDon't let there be a hole in the world tomorrowIdentity Disruption. Talking with a client who had experienced three recurrent pregnancy losses in the recent past, she noted how her relationship to mother’s day had not transitioned the way she expected, from honoring your mother figure to honoring yourself as a mother. She further described feeling excluded from parenthood and being relegated to still sit at the “kid’s table.” For so many women, they had constructed (whether conscious or unconscious) a reproductive narrative, a story of the family they would have one day and the role they would play in that family. And this story can be largely influenced by the dominant cultural narrative regarding becoming an adult – separating from your parents, establishing your own residence, taking responsibility for your life, and creating your own family. Being denied these important rites of passage and roles can be experienced as an existential crisis. Who am I? Where do I belong?Heroism. The people that I’ve had the privilege to work with during their parenting journey are nothing short of courageous as they attempt to create life against the odds. Some of those people came home with a baby, while others made the heartbreaking decision to be childless due to financial constraints and/or unwillingness to undergo fertility treatments. Some of them only have pictures of the child that never breathed air. As Dr. Ilona Laszlo Higgins expressed in her book “Creating Life Against the Odds,”The struggle of these individuals to create and nurture children goes well beyond the desire to produce a new generation in one’s own image, or to have a living repository for one’s inheritance. It is about the sense of completion that comes from the conscious commitment to be responsible for the well being of another. It is the wisdom that comes from the ashes of loss, translated into new life. (Intended) parents such as these set an example for all of us about the hard work of love. I couldn’t agree more. Society often pathologizes and judges the lengths these folks go to in order to become parents. I’ve had several clients exclaim, “I would never do that,” and then when faced with no other alternative, start down the path they said they would never go. To me, these individuals aren’t crazy, they’re heroes. They are willing to recreate their story and consider what could be versus what should have been. They grieve their losses and nurture their wounds, then carry on. On this day, it is my hope you can do the following for yourself:Practice being with grief, in whatever form it takes, unconditionally and nonjudgmentally. Be with your deeply wounded self.Acknowledge that there’s a missing piece to your life puzzle. A hole in your world.Take good care of yourself. Far from being selfish, self-care in grief is courageous.Forgive yourself. You did nothing wrong. Create a ritual to acknowledge what or who is missing. Write a letter, bury an object, say a prayer, light a candle, carry flowers, whatever honors the void. Ritual acts, whether private or public, are ways in which we give way to the feelings of love, pain, and connection. References/Recommended further readings:Cacciatore, J. (2017). Bearing the unbearable: love, loss, and the heartbreaking path of grief. Wisdom Publications, Somerville, MA. Fast Facts About Infertility. Available at: http://www.resolve.org/about/fast-facts-about-fertility.html. Resolve: The National Fertility Association. Higgins, I. L. (2006). Creating life against the odds: the journey from infertility to parenthood. Xlibris Corporation. Jaffe, J., Diamond, M., & Diamond, D. (2005). Unsung lullabies: understanding and coping with infertility. St. Martin’s Press, New York, NY. Rooney, K. & Domar, A. (2018). Dialogues Clin Neurosci. Mar; 20(1): 41–47.
Read Blog Post