Many fertility clinics strongly suggest or require ovum donation recipients to have a meeting with a mental health professional prior to their cycle. While it is often dreaded, patients almost always leave my office saying they are grateful they were asked to have the appointment, that they learned a lot, and feel much more prepared than before.
I have been meeting with patients pursuing gamete donation, embryo donation, and surrogacy for many, many years. I don’t call them, nor do I consider them, to be evaluations or assessments, despite the fact that the clinics tell patients they need a “psychological evaluation” before proceeding. My attempt to educate clinic staff has not been successful in changing their language, thus, patients often come in feeling defensive and angry.
Why does my doctor want me to see a therapist?
I attempt to immediately put them at ease by telling them the meeting is not an evaluation and it is not my job to decide whether or not they are worthy of becoming parents. Their response is visceral. Shoulders drop, faces relax, and they breathe. Then we can proceed.
I tell patients that I see my role as educative in two ways:
• to talk about the ways in which building a family through gamete donation is different from having a family the easy and inexpensive way; and
• to play the role of child advocate.
I tell patients that I try to represent the only person in the family-building equation without a vote, but is the sole reason for the endeavor—the unborn child. The children resulting from all the procedures have no voice in how it all happens.
I talk about what we do know about how individuals feel who come into families through donor conception and surrogacy, regardless of the single/married, gay/straight constellation of the family.
• We do know some things that make healthy families and we know from studies of donor egg and donor sperm offspring how people feel about their means of conception and all that goes with it;
• We do know that it is normal and common for parents to grieve the loss of a genetic link to an offspring; and
• We do know how most infertility patients feel after being in treatment for a period of time.
Many have recently written about “the brave new world” we are involved in, but I wonder when it will stop being a brave new world. Yes, the stakes keep getting higher as technology tests our ethical boundaries of what can be done, but should it be done? Surrogacy is now 30 years old. Donor sperm has been around forever and the first child born through egg donation is now 27. Many people now have “children” through gamete donation who haven’t been children in a long time. In fact, some parents through gamete donation are now grandparents. It’s not that new and we do know many things to be true. With some exceptions, the report I send to a doctor reflects the discussion of the many complex issues that accompany complicated family-building. Gamete-donation families are special needs families, as are adoptive families, and many other kinds of families. This requires unique preparation and knowledge. Special needs are not bad; they’re just special, aka “a little extra.” I call it parenting plus. Gamete donation families have all the stuff “regular” families have, with a healthy dose of “extra.”
Even in a brief consultation, we can get a rough idea of whether there is psychopathology (versus neurosis, thank goodness, or surely most of us would have never become parents), substance abuse, spousal abuse, or other issues that would make us significantly concerned about bringing a child into the household. In those cases, I recommend further counseling or whatever is needed. But most of the time, patients are as qualified to parent as anyone off the street, only now, because they have been required to see a professional, they are much better educated about certain aspects of family-building and parenting. I have many hopes for patients when they leave my office:
• I hope they have more questions and answers than when they walked in;
• I hope they think about gamete donation differently than when they resentfully made the appointment (if required by a physician);
• I hope they no longer think gamete donation is no big deal;
• I hope they envision what it would be like to grow up in a home where your parents didn’t have enough respect to tell the truth about who you are, or where parents were too scared to tell the truth;
• I hope they think about the fact that it won’t matter what other people say about gamete donation as long as they, as parents, are fierce protectors and advocates for the family they created and how they created it, thereby claiming children as one’s own;
• I hope they understand that infertility is a lifelong disease that goes into remission for long periods of time, and then springs up again at the least expected moments;
• I hope they leave my office armed with the response to the dreaded exclamation: “I don’t have to listen to you because you’re not my real mother”; and
• I want them to leave my office having shifted from being terrified their kid will someday say that to them, to looking forward to it because they are prepared and ready to help guide their child through the muddy waters of trying to figure out who they actually are.
And, finally, I hope they view mental health professionals not as a threat to their quest for parenthood, but as a partner in their goal to be the best parents they can be.
Carole LieberWilkins, M.A., M.F.T. is a Licensed Marriage and Family Therapist in private practice in West Los Angeles.
A specialist in the field of reproductive medicine, adoption and family building options, Ms. LieberWilkins became a founding member of Resolve of Greater Los Angeles and served on the Resolve Board of Directors in various positions for the next 14 years. Currently, she is a mental health advisor on the Board of Directors of Parents via Egg Donation.
Having created her own family through adoption and ovum donation, Carole approaches her work with personal insights, as well as professional experience. She provides individual, couples and group counseling, as well as donor and gestational carrier psychological evaluations, and psycho?educational consultations for intended parents.?
She is well known for her work regarding talking to children about family building, having helped hundreds of patients feel comfortable about talking with their kids about how they built their families. Her article on Talking with Children about Their Conception is highly respected and widely distributed to clients and patients. She has lectured on the topic of family building at important educational venues such as Resolve symposia, and meetings of the American Psychological Association and the American Society of Reproductive Medicine. Ms. LieberWilkins has also been an invited speaker for Kaiser Hospitals, as well as for industry?sponsored nurses’ symposia.?