Some clinics require people who are using donor insemination to have a session with a mental health counselor as a prerequisite. Many women are nervous about this, or take offense, especially if the clinic doesn’t require the same counseling session with married couples. I have regular contact with some of these counselors, who are affiliated with the Mental Health Professional Group of the American Society for Reproductive Medicine. One of them, New York-based Patricia Mendell, offered this advice on the types of questions she tends to ask women. She says that although the interview might serve a gate- keeping function, similar to the home study in adoption, it is often psycho-educational in nature.
Her advice is to try to relax about the interview itself, and see it as yet another learning experience on your journey to motherhood, such as attending this Choice Moms Expo. It not only reassures clinics that they are working responsibly with patients, but gives you an opportunity to talk things through, outside of your own head, in a kind of clarifying practice run before you start talking to family and friends
- How did you arrive at the decision to use donor sperm?
- How do you feel about using donor sperm?
- Have you decided to use an anonymous or known sperm donor? Do you understand the differences (including legal) in these two choices?
- If you plan to use an anonymous donor, are you working with a sperm bank that will give you as much information as possible about the donor for your child’s sake?
- Are you aware that sperm banks make different amounts of information available?
- Have you given thought to using a donor who agrees to be identified when the child is of age?
- If you decide to have more than one child in the future, will you want to order more sperm vials than you need now, so your children are full siblings?
- Is the clinic you are working with comfortable working with single women?
- Have you asked the clinic or the sperm bank the costs of storing sperm at their facilities? Unused vials cannot be returned when they are shipped and stored at the fertility clinic, but can be repurchased at some of the sperm banks if stored there. Ask about the costs of shipping and compare costs.
- If you decide to use a known donor, are you aware of the issues both legally and emotionally? Have you
discussed with the known donor the role he will play in the future in your child’s life? Are you comfortable with this role and is it clear?
- How does your donor’s health history compare with your own?
Non-Traditional Family Building
- How do you feel about being single?
- How do you feel about getting pregnant in an unconventional way?
- On a scale of 1-10, how sure are you that this is what you want to do?
- Have you shared your decision with others, both family and friends, and what were their reactions? Were their reactions a surprise to you? If yes, in what ways?
- Who will be your supports as you start this journey to parenthood? In what ways?
- Will you have any reactions from your employer about single parenthood?
- Do you have a job that will be compatible with becoming a parent? If yes, in what ways, and if no, do you have a plan B for work?
- What have been your thoughts on transitioning into parenthood?
- How do you expect to describe or define the donor to your child, family, friends?
- What kind of support system will you have from friends, family and work?
- Do you have financial resources for childcare?
- Would you be able to financially support multiples?
- What are your thoughts about multiples and the possibility of selective reduction?
- Does your healthcare insurance cover the cost of fertility treatments; IUIs with injectables or IVF?
- Does your income cover extra medical costs?
- Do you understand your fertility potential; age, and health status?
- If you use IVF, what are your thoughts about what to do with leftover embryos?
- If you need bed rest, what financial and physical support would you turn to?
A Counselor’s Role as Gatekeeper
As mental health practitioners who interview people seeking donor conception, we are asked to maintain
our boundaries and objectivity while straddling the roles of evaluator and educator. It is important that each time we interview potential recipients we ask ourselves two questions:
- Have I clearly presented my role as the gatekeeper to the recipient?
- Have I assisted the recipient in having a better understanding and knowledge of the many aspects of this family building option?
It is important that we do a thorough psychological history. At the same time, we are obligated to help them understand the many responsibilities they will have when choosing this option. Sometimes this is the first opportunity that a recipient has to fully discuss some of these questions.
As everyone does, potential recipients come to this process with years of emotional baggage. If they did not need assistance in using a donor, this baggage would never be explored. Many recipients feel angered by the psychological probing, while others are relieved to find a place to explore and share their feelings about their family building options. Typically, a mental health professional is asked to evaluate, educate and counsel recipients in one or two sessions. It is a very difficult dual role to serve as both educator and evaluator, to both assist and judge whether the recipient is ready to move forward, but the reality is that no one has been able to find a better way to serve both purposes.
One of the concerns in the Mental Health Professional Group for the American Society of Reproductive
Medicine is the fact that there is no one regulated standard for evaluating donors or recipients. Efforts
continue to be made through MHPG to establish a standard, yet there continues to be tremendous
variation among mental health practitioners. For many, their own bias is often a part of the evaluation, as
well as the limitations that are imposed by the practice or program that is being represented.
The bottom line is, the screening is not about whether a recipient is married or single or in a committed
relationship. Many programs mandate that regardless of a recipient’s marital status, the recipient is required to meet with a reproductive mental health professional who can educate them about parenting options, as well as screen them as to their readiness to undergo the rigors of treatment and the potential outcomes.