Monthly Archives: June 2009

96 Ounces of Water a Day — Help’s Keep the Contractions, Bleeding, and BP Issues at Bay…

When I was pregnant with my son in 2000 I experienced all kinds of issues regarding bleeding, premature contractions, and blood pressure.

Every time I found myself in L & D I heard the same thing: “How much water are you drinking?” And I would mumble: “Not nearly enough”

Shortly thereafter I was assigned to a special group through our HMO that did nothing but contact their high risk patients every other day and talk to them about water intake. Once I got on board and began drinking my 96 ounces of water a day all of the above stopped.

Amazing what one simple act can do for a pregnancy. I learned so much about why water in important – and here’s my public service announcement about water and pregnancy and why it’s important.

While it is always a good idea to keep the body hydrated, there are certain times when changes in the body call for more water. One of these times isduring pregnancy. Water can be the answer to alleviating many side effects of pregnancy, aid in preparing the body for these physiological changes, and just overall make mommy and baby healthier.

Water is a vital part of pregnancy. The fluid acts as the body’s transportation system, and carries nutrients through the blood to the baby. Also, flushing out the system and diluting urine with water prevents urinarytract infections, which are common in pregnancy.

Perhaps the biggest reason to drink water however is to keep the body hydrated. Dehydration in pregnant women can be very serious. Hormones (gotta love those hormones!) change the way women store water during pregnancy, so they begin to retain water, and drinking plenty of water combats that. Much of that water is used in the amniotic sack. Amniotic fluid alone needs to replenish itself every hour by using roughly a cup of water stored in the body. Replacing that water will insure the fetus is protected within the womb.

Since the blood volume increases to nearly double by the eighth month of pregnancy, it is necessary to drink even more water to compensate. Thicker blood can lead to hypertension and other cardiovascular problems.

Because dehydration can cause contractions, lack of water in the third trimester can also cause premature labor. Premature labor can have many health risks to the newborn baby. However, some cases of premature labor have been stopped just by giving the mother enough water to re-hydrate her body.

Pregnant women should be sure to drink at least eight 8-ounce glasses of water each day, which is in addition to the normal in take of other recommended foods. The benefits of drinking water during pregnancy include healthier skin, less acne, washing away of unnecessary sodium, less chance for pre-term labor or miscarriage and better bowel movements.

Drinking water can, believe it or not, also help prevent that nausea known as morning sickness, as doctors recommend drinking plenty of fluid between meals. Drinking water for health benefits of the mother and baby are evident. Doctors in fact ask mothers to steer clear of diuretics like caffeine and alcohol, so water is the obvious alternative for fluid intake. Also, since doctors often ‘prescribe’ exercise in pregnant women, fluids will be lost through perspiration. As we know, pregnant or not, those fluids also need to be replaced.

So please drink, your baby will love you for it.

Sources:

http://www.freedrinkingwater.com/water-education/water-pregnancy.htm

The Frozen Embryo Dilemma – A Matter of Privacy, Responsibility and Choice

The American Fertility Association published an amazing article about left over frozen embryos — this is a must read for everyone.

It’s a private issue gone very public. It’s a complex web of personal philosophy, religious orientation and social conscience about which everybody, and we mean everybody, has a strong opinion. But the fact is, and should be, what you do with the frozen embryos you don’t use is your decision and yours alone.

Of course it never feels like the quite right time to discuss this touchy topic.
Maybe you’re taking your first steps on the infertility treatment path. Along with all the mind-numbingly complicated instructions, you’re handed a form asking you what to do with excess embryos before you have a single one.

Maybe you already beat the odds. With absolute devotion, you danced the assisted reproduction tango, created viable embryos and made a baby. Or two or three. Your family is complete. Your head is bursting with school, soccer, recitals and bedtimes. Frozen embryos?

Or maybe you’ve given up on treatment, leaving behind the heartbreak, the disappointment and possibly, a few fertilized eggs. You’ve moved on.

So chances are pretty good that those embryos, protected in liquid nitrogen, aren’t at the top of your to-do list. None of us who have experienced infertility anticipates having any embryos, let alone extras. After we’re done with ART, we tend to ignore or deny the delicate question of disposition of the unexpected surplus.

At some point, though, all of us with cryopreserved embryos will have to make a final and forever decision about them. It’s not easy. They’re our unique responsibility and our unique burden. Because while our embryos remain suspended in time, we don’t.

Hence, this fact sheet, a guide to anticipating some of the quandaries we confront and exploring the choices we have.

The Options

A good initial cryopresevation consent agreement usually outlines three disposition choices:
Thawing without intent to transfer. Lucinda Veeck, M.L.T.,D.Sc., Director of Embryology at the Center for Reproductive Medicine and Infertility in New York City, says at her program, 53% of the 364 patients who have gone through with their choice have elected this option.

Donation for research. While raging controversy and federal limits have restricted directed giving to stem cell research, there are myriad other well-accepted research initiatives, such as staining for DNA and genetic analysis that rely on embryos. And despite the ban on federal funding for stem cell work, privately funded institutions are moving forward. Reports Dr. Michael Alper of Boston IVF, one such center, “There is no shortage of donations. At CRMI, Dr. Veeck reports that about 41% of patients have gone the research route.

Donation to other infertile people. Logistically and emotionally complex, donation for transfer has its own guidelines established by the American Society of Reproductive Medicine. It’s a many-layered effort by both the donors and recipients, requiring a six-month quarantine of the embryo, blood and genetic testing and retesting of donors, blood tests for the recipients. Both parties must sign informed consent documents addressing relinquishment and acceptance of parental rights should children result, as well as liability, among other things. Whether or not it is an anonymous transaction, both donors and recipients are strongly urged to get psychological counseling. “We’ve only donated embryos from two patients because of the difficulties inherent to follow-up testing,” remarks Dr. Veeck. “And in the 6% group desiring to donate, most have not actually given away their embryos yet.”

How Was I Supposed To Know?

These days, even before there’s an embryo, there’s the consent form. That daunting document demanding that a patient know, ahead of time, what to do with remaining embryos…if there are any. For infertile people, that’s one incomprehensibly huge “if.”

So hopeful patients fill in the blanks with the best intentions. The rub is that when it actually comes time to act on that initial agreement, people often find that first choice isn’t the one they want after all. It’s important to remember that first consent form is not the actual disposition form. You can shift gears at any time.

Changes of heart happen for a million different reasons: divorce, the death of a spouse, economic hardship, a multiple birth after the first cycle. Sometimes the partners in a relationship simply aren’t on the same page – one may want more children, the other has no interest. One partner may see the embryos as their potential children, the other regards them as left over sperm and eggs.

Inevitably, life’s constant evolution leads to embryos that sit, sometimes for an embarrassingly long time.

“People have them frozen and then forget about them,” says Dr. David Hoffman, Medical Director at IVF Florida/Reproductive Associates in Margate, Florida. “But they still don’t want to get rid of them. I don’t think patients think of a frozen embryo as a person, but it’s tough to let go.”

Dr. Veeck adds, “Many patients respond by doing nothing. They continue paying for storage fees rather than make a decision. And I think that’s the appropriate thing until they’re quite sure what they want to do.”

Behind the Choices

The language of disposition seems straightforward and precise. In fact, most people are sandbagged by how profoundly affected, confused and conflicted they are when it comes time to commit.

So, most elect to do nothing. Make no mistake; doing nothing is making a decision. Endless postponements means someone else-a family member or the clinic—may get stuck on the horns of what is rightfully your dilemma.

Overwhelmingly, frozen embryos are intended for use by the couples that created them. But IVF centers around the country report that the sheer number in storage is putting a squeeze on space, with some embryos in residence for a decade or more. Increasingly, centers are attempting to contact patients who haven’t been active for several years. It can be an onerous and difficult task, and on occasion, pointless.

At CRMI, Dr. Veeck puts the abandonment rate at about 10%. That’s after three registered letters, using search agencies and making countless phone calls.

Not all clinics have the wherewithal or the intention of going to such lengths. But most clinics will not dispose of embryos without an explicit, legal go-ahead from patients. For the most part, says Dr. Hoffman, “couples usually pop up out of nowhere” when they’re notified that unless they respond, the embryos will be discarded.

Contrary to all the hype, Dr. Hoffman notes there are “very few not spoken for. The government thinks there are huge numbers out there. But there aren’t a lot of abandoned embryos at all.”
In other words, the vast majority of us with excess embryos are left to wrestle with our personal convictions and moral codes.

What Gives Meaning

For some people, contributing their embryos to research in an effort to help others gives them a sense that their assisted reproductive efforts have lasting value. “It’s a way of giving back to medicine and it makes them feel good,” says Dr. Alper of Boston IVF.

For others non-viable thawing provides closure. “It’s interesting, but people are very relieved when their embryos are discarded,” observes Adele Kauffman, Ph.D., and program psychologist at Reproductive Science Center in Waltham and Boston. “Embryos in the freezer are unfinished business. Once it’s done, they feel they’ve come full circle.”

Still others, impelled by altruism, empathy, or religious beliefs to help other infertile people, want to offer their frozen fertilized eggs for transfer.

“Initially, I thought it would be the option everyone would choose,” says Dr. Veeck at CRMI. “But when they think that they might have offspring out there and not know them or how they’re going to be brought up, they usually reconsider.”

In a recently published article, Dr. Craig Syrop at the University of Iowa Hospitals and Clinics, notes that of 365 couples with embryos stored after two years, 12% “indicated a willingness to donate to other couples (was) nearly equal to the desire of couples to donate to research.” But, he finds, when faced with the “reality of clinic visits for counseling, STD testing, and informed consent before embryos are donated and utilized” interest wanes and research outstrips donation to others by nearly 2 to 1.

The Donation Drama

Embryo donation for transfer is a media magnet, drawing tremendous attention when some began referring to transfer donation as “embryo adoption.” It is not.

“Adoption is a specific legal framework with specific guidelines around parental rights and obligations and applies to only living children,” says Susan Crockin, a Boston area attorney specializing in reproductive matters. She calls donation for transfer a “positive, but limited” option. She notes that five states have laws on the books dealing with this form of embryo donation, but nowhere is it the legal equivalent of adoption.

While the federal government is on the cusp of launching public education campaign advocating “embryo adoption,” Crockin calls it a misnomer that may make people feel good but “glosses over the legal reality.” At a minimum she recommends a legal agreement between donor and recipient; and consider, in those states without an embryo donation law, that the recipients go to court to have themselves declared the parents of a resulting offspring to avert the risk of custodial claims by the genetic parents or the extended family.

However, things blur on the psychosocial front where, psychologists say, the adoption parallel is stronger.

Embryo donors and recipients should expect that resulting offspring will want information about their genealogy, their genetic makeup, and their biological parents. Donors must be prepared for the possibility of a knock on their door one day even if the transaction was strictly anonymous. As decades of experience with adoption have shown, kids will come searching. Furthermore, laws protecting anonymity are subject to change.

“We’re in uncharted territory here,” said Dr. Elaine Gordon, a Los Angeles psychologist. Dr. Gordon says she’s getting more inquiries about embryo donation for transfer but many go nowhere.

“They find it too complicated and overwhelming in terms of what’s required,” she observes. “If they’re going to do it right, does it mean engaging in a relationship with the recipient couple and do they want to participate in that?”

She suggests that “responsibly done” ovum donation might provide the best model, with both parties entering into a “contract detailing terms of contact, if any, and information disclosed and exchanged. If the two parties can come to a meeting of the minds, the exchange can take place, facilitated by psychological, medical and legal experts.”

Embryo Donation Programs

There are several embryo donation programs, including the Christian faith-based agency, Snowflakes, that promotes “adoption.” At the root, all the programs facilitate matching donors with potential recipients and work through the details of the exchange.

“We’re a private (non-sectarian) agency and we liaise between the recipient and the donor,” explains Eileen Dover, executive director of Genesis Family Services in Holly Pond, Alabama.
Recipients send in a $100 application fee, list their requirements and are put on a waiting list until the right match pops up. The total agency cost to recipients is $1,800 but they’re also responsible for shipping, donor medical testing, notary feels, and a flat $250 attorney fee. Donors, who also can specify requirements for a receiving family, fill in a standard questionnaire, including medical history. Genesis’ simple-language but comprehensive contract requires adherence to the ASRM guidelines, but the agency leaves that to the donor’s doctor.

While Genesis doesn’t require psychological counseling, the contract calls for recipients to pay for up to three sessions for the donor, if the donor chooses. Dover also says, “we ask recipients to get counseling as well, but that’s their responsibility.”

Genesis advocates closed donations but will go with client’s wishes for open ones.
“We try to encourage transferring four embryos,” says Dover. “If you have 10 embryos (eggs that are fertilized, frozen but haven’t started dividing yet), you may get four to six that live through the thawing process. If they’re blastocysts (5-day-old embryos), there’s a darn good chance they’re going to do well and I don’t think any physician would do more than two or three.”

In Fullerton, California, Snowflakes operates on the assumption that this is an adoption. “In our program, we focus on the end result which is the child. That’s the same in all adoptions,” says JoAnn Eiman, a Snowflakes spokesperson.

The Christian faith-based agency requires recipient families undergo a homestudy, a fundamental process in traditional adoption, but controversial in embryo donation for transfer. As Eiman explains it, about 20% of the homestudy is about child abuse and Department of Justice background checks. “The other 80% is preparing the parent for a non-genetically linked child,” she says. The agency does both closed and open donations, depending on the preferences of the parties.

Snowflakes fees to recipients are about $4,000 for the matching, legal contract, shipping, coordination, rematching if required and lifetime support.

Begun in 1997, the first Snowflakes baby was born in 1998. In 1999 there were a couple of matches but no births. But by 2002 there were a total of 18 babies born and this year, Snowflakes expects another 23.

Do donors who’ve gone this far change their minds? “Most don’t but it happens,” said Eiman. “Typically when the donor couple gets a profile on the adoptive family they say ‘Oh my goodness, this is real. They’re going to take them and raise them.’ When they get the packet that’s when it hits them.”

It’s a whole new world, agrees Dover at Genesis. “It remains to be seen whether (donors) really get that they’re going to have children out there. They say, ‘Yes, I understand.’ But what’s going to happen 20 years down the road? I think about that when I’m whiting out the records and I think someday someone might want to look at that.”

When It’s All Too Confusing

Okay. We’re all pretty clear that the “what is to be done” with extra frozen embryos is at best confusing. The American Fertility Association strongly urges that you weigh the following to help ease the strain:

Nobody has control over your embryos but you.

You are not obligated to stick with your first decision or your second or third. The no-turning-back point comes only after you’ve formally and legally relinquished ownership of your embryos.

Know that it is absolutely fine to wait as long as it takes for you to make the decision that feels right for you. No government, social or religious entity should force you into taking an action that, in your gut, you know is a personal mistake. Because you will have to live with this decision forever.

Donating to other couples is a real and generous alternative. The AFA recommends you thoroughly explore the legal, psychological and emotional implications and potential long-term ramifications. You must feel confident that you can deal with the possible outcomes down the road.

Thawing without intent to transfer is a perfectly reasonable option that most couples do choose, finding it provides the unexpected relief of closure. Yes, there may very well be grief and counseling or support that can serve you well.

We at The American Fertility Association will continue to report, write and provide you with as much information about this topic as we can. But, as one of the leading patient advocate groups, The AFA is always available to you, to answer questions, provide support and referrals. Please call our toll-free number (888) 917-3777. It always helps to talk with those who’ve been through it, too.

"Egg Donation: Why I gave up my right to remain anonymous

I read this great post which was published by Gail Anderson a delightful individual owns and operates The Donor Concierge which is a surrogacy and consulting service located in California.

“Egg Donation: Why I gave up my right to remain anonymousBy Laura Witjens, Chair of the National Gamete Donation Trust, egg donor and mother 08 June 2009.

Following a change in the law that came into force on 1 April 2005, British people conceived using donated egg, sperm or embryos can ask for identifying information about the donor when they reach the age of 18. Here Laura Witjens, egg donor and mother of two, writes about why she elected to remove her anonymity and potentially become identifiable to any children born from her donation.

I’ll never know what made me watch breakfast television that morning. Being a single working mother with two one-year olds, it was a luxury I could ill afford. But I did, and one of the items changed my life forever. The same day, I contacted a fertility clinic and told them I wanted to be an egg donor.

It was the year 2000 and discussions about the removal of anonymity from egg and sperm donors were only just taking place between patient groups and other fertility organisations. For me, at the time just a willing and partly-informed donor, the notion of being known to any resulting offspring wasn’t even a blip on the radar. The counsellor who I saw at the clinic was satisfied I knew what I was doing and, other than the known medical ones, no other long-term implications were discussed. Some months later the deed was done: 13 healthy follicles were harvested and I left the clinic with the feeling I’d done something momentous. Just how momentous, I only found out years later.

Not satisfied with the information available, as well as certain parts of the process, I made another life changing step. I contacted the National Gamete Donation Trust (NGDT) and asked if I could volunteer. I became a Trustee and, motivated by the pending removal of anonymity and differences of opinion with other Trustees, I went on to become the Chair. It’s a position I’ve held for the last six years and in this time I’ve taken part in many gamete donation discussions.

I firmly believe in leading by example, a philosophy I carry through to my work as a business woman and as Chair of the NGDT. So, with such an emotive subject, how could I lead an organisation without putting my money where my mouth was? If I truly believed in the identity of the donor being disclosed to the donor-conceived person, the legislation at the time of my donation shouldn’t have been relevant to me. I knew that re-registering as a known donor with the Human Fertilisation and Embryology Authority (HFEA) might be futile, since the family created out of my donation would never realise that their donor was willing to be known. Still, it was a matter of principle for me, and one that required substantial soul searching.

I asked myself the many questions that many donors in my position might ask: Can I empathise so much with these people that I’m prepared to open my door, my life, my family at a time that suits them? At the same time, can I be distant enough and accept that whilst I am prepared to make important steps towards that person’s wellbeing, I will never find out if indeed they are well? More importantly, how would my children deal with this? They had absolutely no say in my choice to become a donor, but it’s known that many donor-conceived people are more curious about their half-siblings than their donor. In other words, it wouldn’t be me they were after; they would want to meet my own ‘flesh and blood’ children.

Through the NGDT I had access to donor-conceived young adults, donor conception parents and various fertility professionals. But not surprisingly the act I was contemplating was, and to a large extent still is, uncharted territory. It seemed no one could help me find the answers I needed. As not just a donor but also heading the NGDT, I did not just want to accept it – I had to wholeheartedly support and embrace it.

My answers came through my children. By then my seven year old daughter and son were developing into individuals with their own quirks, traits and habits. I divorced their father when they were one and remarried when they were four. In other words, I have my own social experiment going on with twins fathered by one man, raised by another.

My children have taken on habits from both men. Unlike donor parents, however, I know where this comes from and can share that with them when appropriate. This may seem rather trivial from the outside, but I know from experience that it does matter to them.

I donated to help other people less fortunate than myself. I went through weeks of unpleasant injections and examinations, believing I was doing the right thing. ‘Doing the right thing’ has been my drive through all of this: being a donor, leading the NGDT, raising awareness. And now doing the right thing means giving the children I helped to conceive access to information about me.

I have since re-registered and am happy to make myself available to the child born out of my donation. If I can help to give them understanding about themselves I will gladly help. It may seem like a little thing, but I know from experience it could mean the world to them.”

Three Day vs Five Day Embryo Transfer

We know that the primary reasons embryos don’t make it to blast is they don’t have the genetic instructions to continue — and we can’t change or improve the genetics or egg quality of an embryo. If you have faith in your lab there really is no risk with continuing to culture those embryos to blast stage.

Some say that embryos are better in the uterus at day 3 while others say they are not because if you were having a baby the old fashioned way the embryo remains in the fallopian tube until day five or blast stage. And really if we think about it (Ask your RE I bet he agrees with me) the uterine environment on day 3 isn’t the same as your fallopian tubes. And on top of that with what labs do regarding sequential culture systems that help grow embryos to blast — those kinds of conditions in the lab are as close to the fallopian tubes as you are going to get. So with all that being said maybe embryos are better off in the lab until blast.

Now — the reason we grow embryos to the blast stage in the lab is to weed out those embryos on purpose that don’t have the genetic potential to grow into babies. So the risk folks talk about I think doesn’t really exist. I mean think about it — if they make it they make it — if they don’t they don’t. Now I know there is always the risk that zero embryos make it to blast in the lab but I bet my bottom dollar that the issue is genetically related and not something to do with the lab. ie egg quality or sperm quality issues.

There’s also lots of reasons that labs do three day transfers – first of all it’s less expensive and cheaper. It’s less work for the lab and I think there less liability (i.e. the lab has the embryos for a shorter period of time, the patient always makes it to transfer, and last but not least if the cycle doesn’t result in a positive pregnancy test the program still looks fine) So with all that being said I am thinking that day three embryo transfers are done for a myriad of reasons.

So I have to say this about blast transfers — just because you have a blast transfer doesn’t mean you are automatically going to have a baby. Now when your embryo reaches blast stage it’s okay to think that these embryos are capable if implanting right where they are supposed to and go on to develop into a baby. There are still a few potential obstacles to overcome — the embryos are transferred into the uterus and they have to attach to the wall of the uterus and then go on for the next ten days completing the implantation process. That process is out of the control or the hands of the clinic, and like I have always said it’s really a crap shoot at that point.

What we do know is at the blast stage embryos are capable of implanting, whereas day three embryos we don’t know for sure if they even going to make it to blast — what we do know however is lots of 3 day transfer result in babies.

My son is the result of a three day transfer.

Lots to think about. Yes?

A Little Education Goes A Long Long Way…

“What do you mean the donor I painstakingly selected can’t donate with your clinic!?!”

“I am sorry, but this donor as donated six times, and ASRM guidelines state that donors should donate no more than six times in their reproductive life, and this clinic adheres to ASRM guidelines. You are going to have to find another egg donor, I am so sorry.”

The patient held the telephone in her hand and she blinked, she had no words. This scenario was incomprehensible to her. Finally when she found her voice she said:

“Why didn’t you tell me this BEFORE I selected my donor?”

The patient hung up and cried. And cried. And cried some more.

The above should never have happened – and I mean ever. It’s a tough enough journey as it is to go through the shots, the tests, the transfer, the waiting – oh my gosh the waiting. But to be told that the egg donor you agonized over can’t donate for you because she’s maxed out and no one told you the magic number.

Who’s to blame?

It would be nice to point the finger and say – “It’s the clinic’s fault for not telling me.” Or “It’s the agencies fault for even having her up there in the first place.” But really you can’t blame anyone – but you can become an educated consumer.

Right. Now.

Here are the basics about egg donors:

The following is a list of important qualities to look for in a potential egg donor. Ideally, egg donors should:

Be between the ages of 21 and 30** and exhibit maturity, responsibility, and dependability
Be in good physical health as documented by history and testing
Be in good psychological health as documented by history and testing
Be of proportionate height and weight [being overweight may affect egg quality, as well as necessitate higher doses of stimulation drugs to create follicles, which translates to additional costs for the recipient/intended parent(s)]
Be drug free
Be a non-smoker of tobacco and marijuana
Have regular menstrual periods and is not using Depo-Provera
Have an FSH (Follicle Stimulating Hormone) level on cycle day three (3) of no more than eight (8), preferably under six (6)
Have an E2 (Estradiol) level on cycle day three (3) of less than fifty (50)
Have an Antral follicle count*** of at least fifteen (15) combined count.

** Donors younger than 21 may not be emotionally mature; donors older than 30 are not at peak fertility. Always follow your reproductive endocrinologist’s advice regarding age.

***Antral follicles are small follicles (about 2-8 mm in diameter) that a reproductive endocrinologist can see, measure, and count with ultrasound. Antral follicles are also referred to as resting follicles. Vaginal ultrasound is the best way to accurately assess and count these small structures. The antral follicle counts (in conjunction with female age) are by far the best tool that we currently have for estimating ovarian reserve and/or chances for pregnancy with donor eggs through IVF.

In the United States due to the risk of infectious disease, if you are an egg donor you have to wait six months to one year after receiving a tattoo or body piercing before she can donate. In some instances if the egg donor has written and signed proof that the tattoo was administered with disposable needles, then she doesn’t have to wait the usual six months to a year to donate your eggs. Most tattoos clinics do use disposable needles to donating after a tattoo should not be a problem.

An egg donor is not eligible to donate her eggs if she falls under any of the following criteria:

 Persons who spent 3 months or more cumulatively in the United Kingdom from 1980 through the end of 1996.

 Persons who are current or former US Military members or civilian military or dependents of a military member or civilian employee who resided at US military bases in Northern Europe (Germany, Belgium and the Netherlands) for 6 months or more cumulatively from 1980 through 1990 or elsewhere in Europe (Greece, Turkey, Spain, Portugal and Italy) for 6 months or more cumulatively from 1980 through 1996.

 Persons who spent 5 years or more cumulatively in Europe from 1980 until present (including time spent in the UK from 1980 through 1996).

 Persons who received any transfusion of blood or blood components in the UK or France between 1980 through present.

 Persons or their sexual partners who were born in certain countries in Africa (Cameroon, Central Africa, Republic, Chad, Congo, Equatorial Guinea, Gabon, Niger, or Nigeria) after 1977. Or, persons who have received a blood transfusion or any medical treatment that involved blood in the countries listed in this paragraph.

Has the egg donor spent more than 6 (six) months cumulatively in any of the following countries from 1982 through current? If so, then she is ineligible:

Albania Austria Belgium Bosnia-Herzegovina Bulgaria Croatia Czech Republic Denmark Finland France Germany Greece Hungary Ireland Italy Liechtenstein Luxembourg Macedonia Netherlands Norway Poland Portugal Romania Slovak Republic Slovenia Spain Sweden Switzerland United Kingdom Yugoslavia.

United Kingdom includes the following: England, Northern Ireland, Scotland, Wales, the Isle of Man, the Channel Islands, Gibraltar, and the Falkland Islands.
These are the kinds of things Mom’s and Dad’s to be starting out don’t typically know. And why should they? This is the job of the egg donation agency and the clinic.

However, I am of the opinion that it’s always a good thing to be informed – as it saves a lot of heartache in the long run.

ANONYMOUS VS. KNOWN DONORS: How do I choose?

Dr. Susan Treiser from IVF New Jersey is one of PVED’s newest Medical Advisors, and we feel extraordinarily grateful to have her on board.

Below is an article Dr. Treiser authored regarding anonymous donors vs. known donors and how to decide which is the best fit for your particular situation.

ANONYMOUS VS. KNOWN DONORS: How do I choose?

Author: Dr. Susan Treiser, Medical Advisor

Patients who embark on the journey of parenthood via egg donation are faced with many choices and decisions along the way. Which doctor should I chose? Which facility fits my needs the best? How will I handle disclosure to my child?

During this time, one of the most important decisions to be made is choosing which type of donor is appropriate for you. With egg donation becoming more and more common in the United States, options for donors are abundant. At the root of this decision is the choice between using an anonymous donor versus an agency or “known” donor.

An anonymous donor is defined as a potential donor of oocytes who undergoes a thorough medical, psychological, and genetic screening. Her identity, including her name, demographics, date of birth, and current photograph, are not released to potential recipient families. She is compensated a set fee determined by the fertility clinic for her time and effort during the donation cycle. Matching with anonymous donors is usually done by the center’s Egg Donation team, who together help to choose the right donor based on the recipient’s physical characteristics, and traits that a recipient has decided are most important, like education, musical or artistic ability, and personality. Anonymous egg donation is a safe haven for donors who want to help an infertile couple, but can still retain a sense of distance from the genetic contribution they are making and not be involved or even aware of the existence of a pregnancy or child resulting from their efforts. This also is a good option for recipients, whom while they understand that the genetic contribution is coming from another source, can keep the identity and mental picture of their donor at arms length. While no identifying information is given, recipients receive the donor’s complete medical history, screening completed by a genetic counselor, a toddler picture, and written answers to questions inquiring about academic strengths and weaknesses, personality traits, and goals and accomplishments, which offers information, but can also provide the recipient with a sense of the donor’s character, sense of humor, and future ambitions.

Agency donors are available through the numerous Egg Donor Agencies throughout the US. These donors are screened and managed by a third party, who will help match and coordinate your cycle with a donor that fits your needs. They can live anywhere in the country, and understand that traveling to a particular fertility clinic is part of the process.

These donor agencies are particularly helpful when looking for donors of a specific ethnicity, for example of Asian or of Indian decent, donors that are difficult to find in the anonymous donor population. These donors are screened similarly to an anonymous donor, however recipients do have the benefit of seeing an adult picture. One of the down sides to using an agency donor is the added costs of travel and lodging for a donor who has to fly in for her screening and then for her cycle. There also is the added fee paid to the donor agency for their services. Also, because these donors are “known”, a donor-recipient contract is required in most clinics, which adds the cost of legal representation and time spent to draft these documents. Finally, these donors also have more freedom to request higher compensation fees for their efforts, based on their level of education or the number of successful cycles they have completed. Agency donors are the perfect “middle of the road” option for a recipient who does not want a personal relationship with their egg donor, but who would like to see an adult picture, or have the opportunity to contact the donor in the future in the event of a medical issue with their child. A psychological consultation is encouraged in these situations, as knowing the identity and contact information of the donor brings up a host of new issues, including how much contact is preferred, will the donor keep the recipient informed of changes in her living arrangements and medical history, how much information is required, and for how long after the donation? All of these details should be reviewed with a psychologist who specializes in fertility, and noted in the written contracts.

Choosing the appropriate donor, whether known or anonymous, is a big hurdle in the egg donation process. Your fertility center should facilitate this process for you, by providing you with options, information, and access to psychological and legal professionals. Whichever path you choose, our objective is to help you find the right fit for you and your family toward the goal of parenthood.

Dr. Susan Treiser is a board-certified Reproductive Endocrinologist and is co-founder and co-director of IVF New Jersey. Dr. Treiser also serves as director of the IVF New Jersey laboratories.



A native of Canada, Dr. Treiser attended Georgetown University School of Medicine in Washington, D.C., where she obtained both a PhD in pharmacology and her medical degree.

Following medical school, Dr. Treiser completed her residency in obstetrics and gynecology at Robert Wood Johnson Medical School in New Brunswick, New Jersey, and was awarded a fellowship in reproductive endocrinology at Columbia University College of Physician and Surgeons in New York City.

At Columbia, Dr. Treiser excelled in her field. She was awarded a faculty appointment as clinical assistant in obstetrics and gynecology and helped hundreds of patients achieve their dream of parenthood through the university’s in vitro fertilization (IVF) program.

Despite her success, Dr. Treiser was confident that she could make infertility treatment more individualized and compassionate outside the university atmosphere. Teaming up with her colleague, Dr. Michael Darder, she left Columbia to establish an advanced practice of fertility specialists – IVF New Jersey – that would rival the success of large university-based programs.

One of the few board-certified women in her field, Dr. Treiser is known for her caring, competent approach to reproductive care. She is the author of A Woman Doctor’s Guide to Infertility and has been published in Science magazine. In 2000, Dr. Treiser was the only medical speaker at the International Seminar of Reproductive Ethics, a yearly symposium held at Princeton University. In that same year, together with Dr. Darder, she received the 2000 Zenith Award from the New Jersey chapter of RESOLVE, a national infertility support group. Dr. Treiser was instrumental in establishing the egg freezing program at IVF New Jersey in 2005.

**The information contained on this article is for educational purposes only and is not meant to provide or address any specific diagnosis or treatment plan. Any information found on this website is general in nature and should not be substituted for specific medical advice provided by the appropriate health care professional. The use of any information found on this website should be discussed your health care professional before being inserted into your treatment plan.

You understand that your use of this website is at your own risk and that PVED, its affiliates, sponsors or contributors assume no liability for any damages arising directly or indirectly from any information provided herein

Talking With Children About Ovum Donation 2009 AFA

Talking With Children About Ovum Donation 2009 from the AFA

Talking with Children about Ovum Donation

Introduction

The first birth of a child conceived through ovum donation occurred in 1984. Since then an increasing number of fertility patients have used egg donation to become parents. As a result the number of children born via egg donation has increased every year. Although the exact number of children born from egg donation is not known, estimates are that between 1995 and 2007 there were 51,223 births recorded from fresh donor oocyte cycles in the US. During that same period, 12,157 births were recorded from frozen donor oocyte cycles, resulting in a total of 63,380 births. This is an underestimate of the actual number of children born since many of those births included multiple infants. Estimating a 35% rate of multiples then the actual number rises to more than 85,500 children. Including estimates from 1991-2006 for Australia and New Zealand the number is well over 90,000 . These statistics do not include Canada, Israel, Europe and other countries.

Considering Ovum Donation

The process of becoming a parent through egg donation entails multiple decisions. These decisions include reaching a level of comfort with the loss of one’s genetic connection; deciding on a donor, and thinking about whether to disclose donor conception to others. For many parents the decision to use an egg donor is not an easy one.

In our clinical experience, we find that parents often seek guidance about disclosure. Prospective parents wonder if they should tell family and friends that they are considering using egg donation. And, if they do tell, parents wonder what others will think if they find out. Frequently, in the process of making the decision, potential parents may share their thoughts with many friends and family members. Some even discuss detailed information about the donor they selected. Few focus on the fact that once the information is out, it can’t be taken back. This leaves the door open for children to inadvertently find out about their donor conception or to be upset that so many others know the details of their conception before they do. One needs to balance the need for support with the need to respect your child’s privacy.

The most difficult decision for parents is whether to tell their children they were born with the assistance of ovum donation. Parents want to know how and when to discuss donor conception, what language to use, how they will feel, how their children will react and whether it will negatively affect their relationship with their child.

For many their first and last discussion about disclosure happens if their IVF program requires them to meet with a reproductive mental health professional before their IVF cycle. The purpose of this meeting is usually two-fold: to explore the readiness and the concerns of the potential recipients before they undergo egg donation and to discuss the disclosure question. For many recipients, the goal of the interview will be simply to “pass” the meeting and go ahead. It can be difficult to really appreciate disclosure at this point, when you don’t yet have a child. We hope that our fact sheet can be a resource for you both before conception and after.

The Decision to Not Disclose

The decision to disclose or not disclose your children’s donor origin is influenced by a number of factors. These include personal history, the community’s acceptance of “alternative families”, values and beliefs about parenting, comfort level with “openness” in discussing family and personal matters in general, personal feelings about a child’s right to know his/her genetic origins, whether they think they can keep it secret and the risk of inadvertent disclosure. The influence of others also plays a part, including family, friends, mental health practitioners, medical professionals, the media, the internet and books.

Many parents have told us that they consider their choice not to disclose a private family matter. They do not feel that everyone has a right to know his or her genetic origins, that there is really “nothing to tell”, since the “donor just gave some cells”. Not telling the child or others may be chosen in the belief that it provides protection for oneself, ones child and the family unit. Sometimes the decision not to tell is based on fear that the child will not accept the mother as a “real parent”, fear that family will not accept the child, fear about how the child will feel and fear that knowledge of the donor conception will harm the child’s self-esteem. The child, in their opinion, may experience donor conception as problematic, placing a wedge between the mother and the child. Others are concerned that their child might share the information indiscriminately with friends and family who may then say hurtful things to their child. Because some religious faiths remain wary of advances in assisted reproductive technology, not telling may also provide a safeguard against ostracism within one’s faith. Some point to the limited information that they were given about the donor as the reason not to tell their child. Their feeling is that limited information is more upsetting than not knowing their origins. And for some, the fact that there is no commonly known way to tell their child makes disclosing something they feel inadequate to do or fear causing harm if they do.

At first glance, non-disclosure may seem like the easier road to take. It appears to avoid a whole range of potential negative consequences. However, keeping the donor conception a secret from your child does not necessarily make it easier.

If you are thinking of nondisclosure as an option, consider the following points and discuss them with your partner and possibly a mental health professional that specializes in third party reproduction.

• Will having a secret have any negative consequences for you, your child or your family? Are you and your partner in agreement about your decision to not disclose? If no, will having this disagreement cause growing problems in your relationship? Is there a risk one partner will tell anyway, without agreement from the other? Will it interfere in your relationships with the child?

• What are the medical implications of secrecy? Secrecy may require lying about your child’s “family” or genetic medical history. Will you tell your obstetrician, pediatrician? If you don’t tell, what are the implications for your obstetric care and your child’s medical care? Will needless tests be ordered or will test results be skewed because the physician was unaware of the use of an egg donor.

• Maintaining the secret becomes more complex and problematic as the child is able to access their medical information or becomes aware of discrepancies in family medical history. What will happen if there is a genetic illness in your family and the child then believes that he is at risk for it? What if you learn that the donor passed on a risk of inheriting a certain illness? One mother stated that each time her children asked about family characteristics or medical concerns she felt her nose growing longer like Pinocchio’s.

Increasingly students are learning a great deal about genetics and inherited characteristics. A recent science exhibit for children gave out a list of physical characteristics that are genetic: whether you can roll your tongue, earlobe placement, hairline features, etc. Imagine your child coming home from a science project and asking why she is the only one with a trait when neither of the parents have it.

Disclosure

We obviously do not know how all ED parents feel 10 or 20 years later. However, some parents tell us that they regret the decision not to tell. They feel isolated and have no one with whom they can discuss their feelings. The non-disclosure feels harder to carry on over time. Children’s as well as other’s questions about who they look like are uncomfortable. For some, they imagined they would tell when their child was old enough; now, many years have gone by, they don’t know if they can do it and the issue of secrecy remains unresolved. At the same time, research shows that many parents have told someone else, in the family or outside the family, raising a serious possibility of the donor offspring finding out from someone else. As one donor offspring stated, “Telling the truth from the onset gives parents great freedom from the burden of secrecy.” Reports from an earlier generation of donor sperm offspring suggest: 1. Children not told that they were conceived with the help of a third party sense that the parents are hiding something from them. 2. Offspring who find out inadvertently as an adult, or from someone else, experience a range of negative feelings, including feeling betrayed by their parents for not telling them and angry that others know more about their lives than they do. A recent New Zealand study that re-interviewed DI couples 14 years after treatment, found that a number of families still wanted to disclose, but were struggling with how to do it, felt a great need to talk about it to the researchers and had not had access to infertility counselors.

In general, disclosing parents feel that their children have the right to information about their genetic origins, that secrets in families can be harmful, and the potential harm for non-disclosure outweighs any risks in disclosing. Those who do disclose believe that they can continue to have a close relationship with their children after disclosure, that they can explain donor conception in a positive way, and that disclosure does not threaten the family. Parents favoring disclosure take into account the possibility that children might learn about their genetic origins from someone else or by accident. This could result in damage to the trust between parents and children. In the future, DNA testing will make it easy to determine whether any child is genetically linked to his or her parents. From this point of view, parents gain greater control and protect their families better by sharing.

When parents consider egg donation, they may imagine being able to control the information their child will have about their origins. This changes when the child can access this information him/herself. Remember, saying to others that there is no heart disease in the family, when your family has heart problems, will no longer go unnoticed by an adolescent. Parents who decide to tell their children when they are young are in a position to shape the initial disclosure discussion, using language that is comfortable to them and to create the family story in the way they would like it to be told.
A number of experts feel that maintaining secrecy about ovum donation is not the better choice for children and families. An Ethics Committee Report, from the American Society of Reproductive Medicine in March 2004, “supports disclosure from parents to offspring about the use of donor gametes in their conception”. The report noted the risk of an unplanned discovery and the negative impact that holding secrets can have on individuals and families.

Parents who use gamete donation are increasingly choosing to be open with their children about the use of a donor. Current research indicates
• Parents report feeling anxious about how and when to tell their child their conception story
• When children learn at a young age, they do not typically have a negative response and deal well with the information
• Disclosure does not lead to rejection of the non-genetically related parent or damage the relationship
• Parents rarely regret disclosing
• Parents frequently report feeling relieved after disclosing genetic origins information with their children

Talking with Children

Parents who choose to talk with their children about their genetic origins must decide when and how they will convey this information. We often hear parents say that they would wait “until the child is old enough to understand”. More often than not, they mean that they don’t want to discuss it until the child can understand the biological facts of reproduction. Many recipients have told us that they think of adolescence or even young adulthood as a time when their child will be old enough to understand. Given the challenges of the teen years for both parents and children, this is the least optimal time to first disclose. If children learn before puberty, the fact of donor conception can be incorporated in the developing sense of self; later disclosure will require a greater adjustment to the established identity and sense of self. Some parents have postponed telling because of uncertainty or worry. However, it is never too late to talk to your child about their donor conception. It may be more emotional or challenging but with patience, older and adult donor offspring can work through their feelings about their donor origins.

It is our belief that children should ideally learn about their donor conception in the early years. It is a time to tell the story of how you became a family. It is important for parents to understand that disclosure is not about a child’s accurate grasp of the biology of conception or the facts of IVF. And sharing is not dependent on your child’s intellectual development. As parents, we can find ourselves discussing complex concepts with young children, prompted by their questions about death, loss, and religion, for example. So, as with other complex issues, we can start talking with the young child in very simple terms. Since most young children have an evolving understanding of reproduction in general, there is no reason to expect that a young child gets the facts all right.

Keep in mind that sharing information is a process that evolves as children’s needs and ability to understand grow. The casual discussion and re-sharing of the information over time in the context of family life gives parents and children an opportunity to revisit and add facts to the story. Frequently over time, a shift happens for parents, as the child becomes older and verbal; the language may change as the story is reshaped and owned by the child.

Often though, children’s questions catch us off guard. One mother noted that her young daughter “started asking questions as we were driving to the grocery store”. As Mikki Morrisette states in her book Behind Closed Doors, “Children go off script. Off Script is the uncomfortable or surprising or profound moment when your child asks questions or makes a comment that you didn’t expect.”

“My mommy said a nice lady helped her have me by giving an egg. How did she know which egg was me?”(Jenny age 5)

It is important that parents remember that while genetics may play a role in what your child is like; genetics do not define who you are as a family. Don’t worry if you say too much or the information is too complex. Children remember only the information that is understandable at that stage of development. So don’t expect them to be accurate or reliable in the understanding of the facts.

• “Mommy said she had bad eggs that were not good. So this doctor helped mommy and daddy find a good egg that a lady wasn’t using and that was me. I am not sure what daddy did but I think he helped somehow with a special machine that put me in mommy’s tummy where I ate and ate until I was big and came out.”

When a child wants to understand something in more depth, they will usually ask questions: such as how the egg gets from the donor to mommy. Their questions will tell you something about their thinking process.

Researchers have found that families and individuals tend to remember facts more accurately if they encounter them in a story and not a list. We present some suggestions below. However, It is important for parents to remember that the only “correct script” is the one that works for your family.

By the age of three or four, young children often understand that babies grow within the mother’s body, so

A simple story might include the following

• mommy and daddy wanted a baby and were not able to make one

• they then decided that they would ask for help

• they found many caring people who gave them a lot of help

• they found a special lady who gave her eggs

• they used clinics and doctors to help them

• The result was the special baby that made mom and dad very happy.

A story that refers to a doctor and others who helped so that the child could be born is well within the grasp of a preschooler’s understanding. The story is presented in a positive way and donor egg seems normal to your child. Early stories can introduce the concept of help from a donor, and begin to normalize donor conception. As one exuberant young child said, “I’m sure glad you and Dad live in modern times, so you could have ME!

Although it is our experience that young children can begin to make sense of sperm, eggs and uterus in their conception story, some parents have instead chosen to elaborate with more factual details at a later age. In a study of California parents, “Strategies for Disclosure: How Parents Approach Telling Their Children That They Were Conceived With Donor Gametes”, many of the parents who had decided that they would tell their children at “the right moment” . . .” “around 9 to 11 years of age” found themselves disclosing to their children at an earlier age, around 6. In our clinical work, we find that many parents have chosen to elaborate on circumstances of their child’s conception in the early primary school years around age 7. Parents have found this is the stage when they really begin to feel the importance of disclosure if they have not done so before. This seems intuitively to parents to be a good time as they see their child moving out of the stage of magical thinking and increasingly using rational ideas to explain things. Because children at this age have established a sense of security and a sense of self, they are adaptable and resilient at this stage of life.

One parent in anticipation of telling his (or her) offspring decided to start creating the background for the eventual disclosure by doing the following: “I knew that I had to tell my child and so I decided to start a tradition that every Christmas we would give anonymously to a family. Our hope is that these gifts with no name would be a metaphor for the anonymous donor. We want our son to feel good about the lady that gave the egg that helped create him.”

Remember, it is normal to be nervous about discussing donor conception with your child. Even parents committed to disclosure have anxiety and ambivalent feelings about it. Many parents dread the first time. It is a tremendous relief to have that first step over. Do not worry if you feel you didn’t say it quite right the first time. You will have more opportunities. Parents can be taken by surprise to find that their own feelings of sadness and anger about infertility are stirred up by discussing it with their child. This is natural. It gets easier with time. Remember that being comfortable with disclosing is a work in process. If parents waited to be totally comfortable with telling their child there might never be a “perfect time” to disclose.

“My daughter Jamie is now 8. I’ve constantly thought about the moment that I would begin to tell her about the donor. Yet, I just can’t seem to bring myself to do it. Once I tell her, life will be different forever and the difference is what I live in fear of for her and for me. Yet, I want to tell soon, because she needs to know.”

Those who convey openness and interest in their children’s feelings and questions are better able to help their children come to terms with the personal significance of their conception story. Likewise, as they work on understanding what a donor is, children are capable of responding with acceptance and insight. Commenting about their sperm donor one boy said: “We should buy that man a present”. In talking about their egg donor one girl said, “So, without the donor I wouldn’t have been born?”

Middle Years

Pre teens (ages 10 – 12) begin to wonder about the donor in ways that are more specific: they wonder what she looked like, whether the parents have a picture of her, and what her personality is like. They are interested in the donor’s physical and genetic characteristics in their process to understand what the donor conception means to them. One girl brought this up by asking her mother “why don’t I look like you? when my friend looks like her mother”. Growing understanding of conception, genetics and society’s view of parenthood is often accompanied by expression of empathy for the parents. One 12 year old boy informed his mother, “I am sorry Mom, that you had to go through so much.” If you have a picture or more in-depth information on the donor, this is a good time to ask the child if he or she wants to have more information.

Adolescence

While telling your child that he/she was a “precious gift” will delight young children, it will not answer all the questions of your older child and adolescent. The onset of puberty is marked by a steady growth in the ability to think abstractly. Moving into adolescence, children begin to think about themselves and their families in greater complexity. As adolescents strive to establish greater independence, they may have more questions about the choices you made that led to their birth. As adolescents have an increased ability to take the point of view of another person, they are more likely to wonder about everyone involved in their conception. Adolescence is about developing a sense of self and establishing the independence necessary for adult functioning. Issues of identity become important to adolescents, as is the ability to make sense of their worlds for themselves. To make these developmental leaps, adolescents can desire more information about the donor in order to understand the unique aspects of their own identity. A good relationship with parents can coexist with offspring’s interest in the donor. As an adolescent’s abilities and range of feelings expand, their parents’ task is to provide the stability their children need to integrate a sense of self as they move toward adulthood. While identity development may be more complex for donor-conceived teens, donor conception itself does not necessarily result in a negative effect on your child’s identity. Donor conception is unlikely to be the single defining factor in your child’s personality and identity.

What if your child expresses interest in the donor? With parental disclosure becoming more common, donor programs are responding by providing a great deal more information about donors. While you might not want to think about the donor now as you are starting your family, you might later wish you had received and kept the donor information. Your adolescent will be grateful.

“When I first thought of doing donor I decided to go to an anonymous program because I did not want to know much about the donor. Now that my kids are here I wish I knew more… and even had a picture. The one thing I knew about the donor was she loved animals. Funny, my husband and I are scared of dogs. My son is also fearful but my daughter wants to stop and pet every animal on the street. I laugh each time it happens and am thankful for the donor and her qualities. Now I wish I knew more. How can I tell my kids if I don’t know anything?”

Does this mean you’re not my real parent?” This statement is one that many parents through ovum donation fear the most. In fact, there is little evidence that teens actually say this to their parent. We have rarely heard of cases where teens, though gamete donation or adoption, actually pose this statement or accusation. They are likely to work at the meaning of their genetic connection to the donor and the meaning of genes in a family, but they do not reject their parents. They are unlikely to see the issue as “real parent” vs. “Not real parent”

• As award winning filmmaker Barry Stevens puts it: “Throughout life when people ask, ‘Who’s your real father?’ I … stop … and say, ‘My real father is the man who raised me’. That’s real to me… There’s a sperm donor and a … father and these roles both exist.

All parents share similar worries about how their child will react to disclosure. It is our belief that knowledge of one’s donor conception does not inflict psychological damage on offspring. Donor offspring who have known of their origins from the beginning have said that they are glad their parents are open with them and always ready to answer their questions.

Seeking Counseling

Speaking with a mental health professional with expertise in reproductive issues can resolve impasses and help in making important decisions about discussing ovum donation with children. The counselor provides the support that helps recipients explore a fuller range of feelings and concerns. Many mental health counselors report a growing number of parents returning for counseling, seeking help around help with disclosure. With the help of organizations like The American Fertility Association, parents may also develop a network with other families who have chosen egg donation.

SUMMARY

Your child’s understanding of their donor conception is a process that occurs over several years. They reflect on what they have been told, ask questions and come to understand the role of genetics, the meaning of family, and their thoughts about the donor. We believe that your children can grow up confident and comfortable with their donor conception. As one donor offspring said, “Yes, I was grateful to know the truth about myself. My mother knew that it would create as many questions as it answered, but respected and trusted my ability to decide what this meant to me” It is important as parents to keep in mind that your child’s questions about a donor should not be considered pathological or a rejection of you as their parent. Instead it should be seen as healthy and a natural part of their development and understanding their identity (who am I?).

Parents ultimately must make their own decisions about telling children. In deciding to tell others outside the family, parents must gauge each relationship and assess the impact that telling will have on the child and the family in the future.

To review
• Disclosure occurs in stages, sometimes with planned conversations and sometimes in response to children’s questions.
• Young children (age three or four) usually know that a baby comes from a mother’s body.
• Most children around age seven can understand more complex concepts
• During adolescence, donor offspring may want more information about the donor to help them better understand their own personalities and appearance.
• The counsel of mental health professionals and support from organizations such as The American Fertility Association can be a helpful resource.

We recommend the use of storybooks about egg donation written for children there are several available now.

Some Questions Children May Ask

Preschoolers might ask, “Where did I come from?”

Mommy and Daddy wanted to have a baby very much. We tried and tried but we couldn’t. Then we went to a doctor who helped us. “You grew inside Mommy, in the uterus, for nine months. That’s how all babies are born. Mommy took care of you there until you were ready to be born. Then you came out and Mommy and Daddy saw you for the first time. We were so excited to finally hold you.”

Some children ask, “How did I get inside you?”

The doctor helped place you inside Mommy’s uterus where babies live after they are first made.

Most young school-aged children are ready to be told more about their genetic origins And might ask, “How was I made?”

To make a baby you need an egg from a woman and sperm from a man. The sperm and egg grow into a baby. We couldn’t use Mommy’s eggs (you may want to give a reason) so we went to see a doctor who helped us find a donor.

“What’s an ovum donor?”

An ovum donor is a special woman who gives her eggs to another woman who wants to have a baby, but can’t use her own eggs. Most of the time, she gives her eggs without ever knowing or meeting the people she is helping. We learned some things about the donor we used, but we never met her and we don’t know where she lives. (This explanation will vary if it is a known donor.) You may want to reflect with your child that he or she would not have been in your life without the donor. It is also important to share your feelings that he or she is the child you were meant to have.

Why would someone give her eggs?”

The donor is someone who likes to help others. And she feels good about helping a couple like us become a family.

“What made you pick this donor?”

When children ask questions like this, it provides an opportunity to share how you chose your donor. Explanations may include:

• the emotional connections you made to a donor;
• personal statements a donor wrote in her application;
• family background or personal characteristics;
• the program/doctor helped to make a match and you trusted them;
• speaking or meeting the donor and knowing her feelings about helping us

What’s a gene? And who do I look like?

Genes are an important part of the egg, just as they’re an important part of the sperm. Genes determine traits like the color of our hair or eyes, whether our hair is straight or curly, and how tall we are. Genes influence how we will look and grow. Some of your genes are from the donor and some are from your father (if this is the case). Sometimes you look like Daddy because you came from his sperm and sometimes you look like our donor because you came from her egg and sometimes others may think you look like me because the donor looked similar to mommy.

Many of the questions listed above may come up again as adolescents struggle to understand who they are. What follows is a sampling of additional questions that may emerge during this time.

“Will I ever meet my donor?”

Here you have to explain the limits of your situation. You may have used an anonymous donor program. You may have used a registry or a donor finder. The following suggests a possible response to an adolescent who asks to meet the donor:

We were grateful to the donor, who made this decision hoping to remain anonymous. She also wanted us to be able to be our own family. Still, we can understand your curiosity. When you’re ready, when you’re an adult, finding out about the donor may be something you decide to do, and we would support your search. In the meantime, we can talk about it to try to answer any questions you have.

If you have a picture or more in-depth information on the donor, you may want to ask the child if he or she wants to have more information.

Frequently asked questions from parents:

How will I feel like I am the mom?

Attachment and bonding start during pregnancy and grow from birth on. Your child’s attachment to you is a powerful force that cements the relationship. Developing your confidence as a mother is a process that happens over time for all new mothers. In that way, you will develop your identity as any other mother. It may also be true that at times you feel sadness out of a longing to have this child that you love come from your genes and look like you.

Won’t my child be confused if he knows about the donor?

Children are able to understand that individuals have connections with all different sorts of people; certainly, they understand the difference between Mom, Aunt, and Grandmother. Contrary to one’s fear, children understand the difference between donor and mother at a very young age.

What do we call the donor?

Our donor; not genetic mother, not biological mother, not real mother. We like to use the word “our” donor because it suggests that the donor “belongs to” your entire family, not just your child.

What if my child wants to meet the donor?

There is no way of predicting which child will want to know or meet their donor and who will not be interested. In fact, sometimes, the parents are more interested in the donor than their children.

However,

““If the desire for a biological connection is strong enough to make adults choose donor conception over adoption then …it is possible … to imagine that the desire for a biological connection will be felt …by the donor conceived” offspring.

“It can be terrifying for the non-biological parent to think about a child having contact with the donor…… have faith that your children know the difference between real and biological.” When donor conceived children search out their roots, it is not to find replacement parents; it is to complete their own identities.”

About the Authors:

Patricia Mendell, LCSW, is a psychotherapist in private practice. She is Co-Chair of The AFA, facilitator of their Ovum Donor Seminars, and has written and spoken extensively on fertility, pregnancy loss, disclosure, family, and parenting issues. As a therapist and fertility survivor, Patricia is well aware of the impact decision making choices have on people’s lives. She believes that with the right support system and practical educational tools one can feel confident in tackling any of life’s challenges. http://www.patriciamendell.com, 718-230-9383, 212-819-1778

Jean Benward, LCSW is a psychotherapist in private practice with over 25 years experience with issues surrounding adoption, infertility, and donor conception. She served as a member of the ASRM’s Mental Health Professional Group Executive Committee for seven years. Her clinical experience includes several years as an adjunct professor and clinical supervisor for graduate students in child and family therapy. officejeanbenward@sbcglobal.net, 925 820 9023.

BIBLIOGRAPHY FOR EGG DONOR PARENTS/CHILDREN

BOOKS FOR PARENTS

Burns, Jan & Pettle, Sharon, Choosing to be Open about Donor Conception: the experience of parents, Donor Conception Network.

Ehrensaft, Diane, Mommies, Daddies, Donors, Surrogates: Answering Tough Questions and Building Strong Families. 2005. Guilford Press. A book for anyone who has used, or is thinking of using, gamete donation to have a family.

Glazer, Ellen, Having your Baby Through Egg Donation. 2005. Perspectives Press. Covers multiple topics, including finding and selecting a donor and how couples and individuals make the decision. Also has tips on sharing information with the family and talking with children born through egg donation.

London, Nancy, Hot Flashes and Warm Bottles: first time mothers over forty.2001. Celestial Arts. A guide to the unique issues experienced by first time mothers over age 40, including mothers via egg donation

Lorbach, Caroline, Experiences of Donor Conception: Parents, Offspring and Donors Through the Years. 2003. Jessica Kingsley Publishers. Based on interviews with parents, she looks at the process of deciding to use donor conception, choosing a donor, and discussing the decision with others.

Montuschi, Olivia, Telling and Talking: Discussing Donor Conception: A guide for parents. 2006. http://www.donor-conception-network.org http://www.choosingsinglemotherhood.com

a. Telling and Talking with 0-7 year olds
b. Telling and Talking with 8-11 year olds
c. Telling and Talking with 12-16 year olds
d. Telling and Talking with people aged 17 and over

Morrissette, Mikki, ed. Voices of Donor Conception. Behind Closed Doors: Moving Beyond the Secrecy and Shame. 2006. Be-Mondo Publishing. First person essays from parents, donor conceived offspring and advise of two experts dealing with families affected by donor conception.

Rosenberg, Helane PhD & Epstein, Yakov PhD. Getting Pregnant When You Thought You Couldn’t. 2001. Warner Books. The authors, psychologists and parents through donor egg, use interactive charts to help couples explore the psychological challenges of donor egg.

Vercollone, Carol F. MSW, Moss, Heidi MSW, & Moss, Robert PhD. Helping the Stork – The Choices and Challenges of Donor Insemination. 1997. MacMillan. The authors are mental health professionals who formed their families using sperm donation. Useful for couples considering donor egg. Topics: the disclosure debate, parenting after a donor pregnancy, talking to children about donor conception.

BOOKS FOR CHILDREN

Bourne, Kate, Sometimes It Takes Three to Make a Baby . Describes how Mum and Dad became parents with eggs donated by “a kind lady”. Goes into some detail about eggs, sperm, embryos and the uterus appropriate for 8-10 year olds. Vivid illustrations make it easy to read to young children. http://www.mivf.com.au

Celcer, Iréné E, Hope and Will Have a Baby: the Gift of Egg Donation. This book provides the framework for parents to introduce children to their own egg donation story. It helps parents become comfortable with answering questions as they create their unique family story. http://www.hopeandwill.net

Clay, George Anne, Krebs, Lisa, Why Don’t I have a Daddy? 2008. Authorhouse. This book presents the basic facts of anonymous donor conception in a simple but loving manner ( 4 yrs +).

Gordon, Elaine, Mommy, Did I grow in Your Tummy? EM Greenberg Press. Santa Monica Explains infertility, IVF, and alternate ways to become a family including donor gametes and surrogacy. Nicely color illustrated. http://www.elainegordon.com

Lee, Kyme & Fox, What are Parents. 2004. This book talks about what it means to be in all kinds of families that are uniquely special. The book talks about family on a very basic level that children can understand and not feel like they are alone in being in a non-traditional but loving family. http://www.StoryTymePublishing.com

Martinez Jover, Carmen, A Tiny Itsy Bitsy Gift of Life: a Children’s Egg Donor Story. Pally and Comet have everything in life except a baby bunny. The book is colorful and suited to young children. http://www.atinyitsybitsygiftoflife.com

Martinez Jover, Carmen, Recipes of How Babies are Made. This book helps parents share the way they were born with their children through the illustrations that children can easily visualize all these complicated methods and easily understand them. http://www.carmenmartinezjover.com

Nadel, Carolina, Mommy, was your tummy big? A mother elephant explains her use of donor eggs to her child. Appealing illustrations and simple words. http://www.carolinanadel.com/books.html

Parr, Todd, The Family Book . 2003. Little Brown and Company. The author shows us how families can be different from each other in some ways, but how all families are similar as well.

Richardson & Parnell, And Tango Makes Three. 2003. Simon & Schuster Books.The story of two male penguins who were given the chance to nurture an egg and the chick that they hatched. This book is a wonderful way to introduce children to the concept of different types of families.

Simon, Norma, All Kinds of Families,1975. 1987. Albert Whitman & Co. This picture book describes many different types of families and explores what they all have in common. (ages 4-8)

Stamm, Linda, Phoebe’s Family: A Story About Egg Donation. Mother explains to her daughter step by step how they became a family with the help of an egg donor. http://www.tapestrybooks.com

Tax, Meredith, Families,.1996. Feminist Press, Six year-old Angie introduces readers to her multicultural group of friends, who are loved in many different types of families. Feminist (ages 4-8)

Our Story. For children conceived through egg donation. “Mummy and Daddy tried for a long time to have a baby. The doctor said we couldn’t use Mummy’s eggs, and this made Mummy and Daddy very sad. http://www.donor-conception-network.org

Before You Were Born…..Our Wish for a Baby: The Story Of A Donor Egg. This book does not use the words egg or sperm. The term donor is used. http://www.xyandme.com