Thursday March 19th, 2009 11:51 AM

Patricia Mendell, LCSW, Reprinted with permission from The American Fertility Association Infocus Magazine Spring 2002-revised October 2008

Preparing to parent with a child conceived by a donated egg or sperm involves many decisions. For many these options are a wonderful way to build a family, but they are not for everyone. Often, the complexity of these choices are overlooked by the recipients who are psychologically exhausted, overwhelmed and totally focused on the end result, “the baby”. Few think ahead to the realities of parenting children born by these alternative methods. Many want to believe that “getting” a baby by egg or sperm donation will cure their infertility. Though it is a cure for their childlessness, it is not a cure for their infertility.

In the rush to procure a donor, I have found that many recipients fail to take the time and ask themselves the following questions: Is this option psychologically right for me/us?; Will I be comfortable that ½ of all my child’s genetics will not be mine?; How much involvement do I want or need to have in the selection of my donor?; What information do I need to know about the donor?; Am I comfortable with disclosing to my child and others his/her origins?; and What does it mean for our life and the child’s if we choose not to disclose? In fact, in March 2004, the Ethics Committee of the American Society of Reproductive Medicine (ASRM) came out in support of informing offspring of their conception by gamete donation (egg/sperm/embryo).

Many recipients want to believe that getting pregnant will erase the fact that they are using a donor. While some do take the time to grieve the loss of their own genetics, fewer seek out trained mental health professionals in the field of reproductive medicine to explore their concerns and options. In fact, selecting a donor involves many choices. Options include: anonymous versus known donation, using a family member as your donor, agency donors, sperm banks, selecting donor characteristics, and disclosure issues to the child, family and friends, including would the donor be willing to be meet or speak to the potential child in the future. Frequently, many recipients spend no time thinking about their “wish list” for their donor, while others are obsessed over what characteristics their donor must possess. Many times, couples have difficulty discussing their different preferences with one another. In programs that require recipients to undergo psychological counseling, it is not surprising to find that few recipients have discussed their feelings prior to meeting with the counselor. Frequently, this meeting is the first time recipients have openly discussed using and selecting a donor. In fact, recipients who do succeed in becoming parents, often have expressed regrets that they did not ask more questions about their donor, when they had the opportunity. For others, they regret that they told too many people about their need for a donor without fully realizing that the information they were sharing was the child’s story to tell, not their own.

The denial that a donor is needed can often add to the discomfort of exploring the numerous choices available to recipients in the donor selection process. Discomfort in accepting that they will not have a genetic connection to the child and that the donor will never be a duplicate of themselves, often impedes the need for an open discussion. Many recipients willingly entrust the choice to the reproductive program, in their attempts to minimize the role of the donor. Fewer are aware of the choices and limitations of their IVF programs. Others just assume the program will change their standards to meet their requests as consumers. In fact, recipients are often asked to make an enormous leap of faith with the donor staff that they will match them with the right donor. For this reason, it is important to never underestimate the impact that the egg donor team will have on the donor selection process for recipients. In a survey taken by the Institute for Reproductive Medicine and Science at Saint Barnabas Medical Center, a number of years ago, the staff was surprised to learn that the most important reason recipients listed for choosing an egg donor was the team recommendation. Their judgment that this was a good match was the key factor in the recipients’ selection of their donor. For this reason, recipients should always request a meeting with the donor egg team in order to formally ask for specific donor characteristics. In most donor egg programs, recipients only meet with some or all of the team members once, twice or not at all, before the match is made. The meeting to discuss their donor preferences can take place sometimes months or even a year or more before recipients are matched to their donor. When thinking about selecting a donor or a program recipients should think about the importance of the following donor characteristics: what physical attributes are important to them, do they need to see a picture of the donor, ethnicity, medical, genetic and mental health histories, education, personality traits, religion, does the donor already have children, is she a repeat donor, would they want to meet the donor and have the option to contact this donor in the future.

For those donor egg recipients who will not or cannot trust that the IVF team will select the right donor for them, the option to use an independent donor agency or a family member is a necessity. When working with an IVF program, donor egg recipients need to ask the program’s policies on what options for selecting a donor are available to them. Not all IVF programs share the same policies of who is an acceptable egg or sperm donor. Some programs will only permit recipients to use donors recruited by the program anonymously. Other programs will accept an approved independent donor agency or a family member. Still others will allow recipients to bring in a donor from any source, as long as the donor meets all the standards set by the program. In deciding to use a family member, recipients need to be counseled as to the pros and cons of this choice. Although using a family member can be a wonderful choice and avoids any genetic bewilderment with the child, it is not for everyone. Family members who agree to undergo the donation must be counseled concerning their true feelings about donating to their relative. The possibility of coercion should be ruled out.

For those recipients who use a donor egg agency, they need to understand that the agency will involve many extra expenses and will often require many hours of work on their part to find the donor that they feel is right for them. Many state a number of reasons for using an agency to select their own donor such as: the need to be in control of the selection process; the need to see pictures of the donor; the need to obtain extensive information and verification of the donor’s education, genetic history, and medical and mental health histories; the need for a specific ethnic or religious background; the need for specific personality traits or family background qualities; the need to know, or someday, meet the donor or have their child be able to meet the donor; and the need to be able to contact the donor for a specific medical issue. Extra costs for this agency donor can range from $5,000 to $50,000, depending upon the agency and the donor chosen. Although there are many reputable agencies that are careful in soliciting and screening donors on their backgrounds and psychological stability, the screening process does vary. Recipients should understand that medical review of the donor is not part of the agency process and is often done at the expense of the recipients, once a donor is selected by them. It is for this reason, that the choice to use an agency may be influenced by not only the finances of the recipients, but also their need to control the selection process and future options to contact this donor.

For recipients in need of a sperm donor, the selection process is very different than in egg donation. Sperm versus egg donations vary greatly as does the information available on the donors. In sperm donation, couples are usually given the names of various, approved sperm banks and told to select their own donors. The level of information they can obtain on sperm donors varies. Some sperm banks supply extended donor profiles, pictures, audio interviews, and the willingness of the donor to be contacted when the child is eighteen. Many programs will restrict the use of known donors; family members or friends. Recipients should inquire with their doctor or reproductive program as to their policies on the use of sperm donors. Meeting with a trained mental health practitioner can enable recipients to explore their discomfort and concerns with this family building option. Again, some recipients, in their attempts to minimize their need for a donor will request that their partner’s sperm be mixed with the donor’s sperm. Not only is this practice not sanctioned by the ASRM, but this choice sets up a lack of clarity in the child’s genetic origins often creating negative repercussions in the child’s development and the life of the family.

I think it is important for recipients when selecting a donor to imagine that you are the child asking the questions: Why did you need a donor? and Why this donor? Being able to feel good about your donor choice will enable you, as parents, to convey positive feelings to the child. Your mindfulness in your donor choices will be conveyed over and over again to your child as they grow, develop and change in their understanding of their genetic origins. For many recipients the birth of their donor child(ren) is the beginning of their becoming a family. It is important to remember that parenting will become more about being consistent and caring on a daily basis with your child’s emotional needs, than about the donor’s contribution.