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In March 2008, Portugal issued what is believed to be the first stamp on the topic of infertility.
Donor Egg Disclosure - The Great Debate
Phyllis Martin, M.Ed., LPC
Phyllis Martin counsels GIVF infertility and donor egg patients and prospective patients. For more information, visit www.givf.com.
Whether and when to tell a child conceived through donor gametes about how they were conceived has been a heated topic since 1984, when the first donor egg baby was conceived. As a counselor specializing in infertility, and specifically in donor egg, I've heard every potential donor egg recipient ask me "should I say something, to whom, when and how?!" If you have ever participated in online discussion groups, you will see supporters at both ends of the spectrum fighting their fears and each other by asking if the child's right to know is greater than the right of the parents to privacy. Over the years, the debate has shifted from secrecy to a more open public discussion.
Fear and protection are the two main motivators for parents to keep their method of conception to themselves and not disclose to anyone, including the child, that donor gametes were used. The fears are numerous. Parents worry that their angst and grief will pass to their child when they disclose. They fear that the grief over the genetic loss will make a child feel second best. They worry that the child will not feel part of the family or will not view his/her parents as "real" parents. The most pervasive fear tends to be that disclosure will open their child up to potential judgment, teasing, ridicule and, therefore, emotional turmoil. Some parents worry that disclosure could even result in some sort of parental rejection by the child. Mistakenly, they assume that the painful rollercoaster of infertility will never subside and that by telling a child of his/her conception, the pain will return in its full force and the parents will feel loss again, as well as burdening their child emotionally.
Some parents decide that they will remain silent until the child is an adult and better able to understand the concept and their decision, while having enjoyed a normal childhood.
Others intend to keep conception a private matter and try to ensure that a donor has the same blood type as the mother and that the physical characteristics are as close as possible to her as well. Some of the reasons for these choices are religious, familial, or cultural.
The second school of thought is to disclose their origins to the child. Parents who choose disclosure often say that "the child has a right to know", "I would want to know" and "I could not keep something like that a secret". These parents have a general sense that secrets in families can take on a life of their own and become damaging. They see the press accounts about some adoptions and other experiences and realize that when conception information is withheld, there is a sense of betrayal, anger and turmoil as adult children try to make sense of their history and selves.
Within the disclosure group, parents are usually confused about how and when to proceed. In my experience, there are some basic rules of thumb. First, keep the number of people who know your conception story small until you know how you plan to proceed. This will keep you in control of your information and minimize worry that someone will make a comment to your child too soon or in a manner with which you are not comfortable. Second, think about your own feelings about using a donor and what you would want to tell a child. Think of the positive aspects of why you chose a donor. Third, think about at what age you would want to disclose to your child and why. Are you telling him/her what hardship and misery you went through and how this was not a first choice or are you telling her how you tried and tried and are so thrilled that there was a process that could allow you to be his/her mother?
Some parents opt for explanation right from the beginning and tell their infant his/her conception story. While an infant cannot comprehend anything about this topic, starting early and repeating it often allows parents to practice their story and shape it into a comfortable story that the child will grow up having always known. This model is based primarily on adoptive families and we have seen the benefits in adult adoptees. Rather than feeling betrayed or labeled, these adoptees report always knowing. They do not recall a big discussion, but know it is part of their history.
Others wait until a child is old enough to understand reproduction and privacy -- generally when they are between eight and ten years old. Discussion may begin because a child asks questions about reproduction or where he/she came from. It may occur because the parents do not want to wait too long and risk avoiding the topic or having a teenager question his identity because he or she just found out and feels shocked. I do not recommend waiting until a child is a teenager or a preteen, as the main developmental task at this stage is to break from parents, gain independence and discover one's self. Adding a conception story at this stage that makes a teen different from peers, could cause the emotional turmoil so many parents worry about.
Each developmental stage requires age-appropriate language. I recommend that parents do not personify the anonymous donor or refer to her as someone in a parenting role ("other mommy", "egg mommy") and use the words "helper" "nice lady" or "donor" instead. This highlights the point that these donors have generally donated on condition of anonymity and their rights and contractual understanding need to be respected. The same rule applies for a known donor, when clear boundaries must be discussed before even proceeding with a donor cycle to ensure that each woman is very clear about the role, if any, she will have in the child's life.
Whatever you decide to do regarding disclosure, proceed slowly and understand that talking about using a donor is not a one time conversation, no matter what type of discussion you plan to have. If you do not intend to tell your child of his/her conception, it is important to ask yourself why and what will you do should something force the issue to be known.
Finally, donating an ovum does not make one a mom or mother. The definition of mother is defined by the role a woman has with a child. Adopted families understand that they are the parents. Parenting is not dependent on the genetic contribution, instead it is the lifelong doing, nurturing, loving and emotional support that parents provide.
What's New at GIVF
DR. LARRY UDOFF JOINS GIVF INFERTILITY DIVISION
Laurence C. Udoff, MD, a board certified reproductive endocrinologist, will join the GIVF Infertility Division on June 30. Dr. Udoff comes to GIVF from the University of Maryland Infertility program, where he is an Assistant Professor in the Department of Obstetrics, Gynecology and Reproductive Sciences. Dr. Udoff is a Phi Beta Kappa
graduate of the University of Delaware and graduated from the University of Maryland School of Medicine. Dr. Udoff is also a member of the prestigious Society for Gynecological Investigation (SGI). He has been the Principal Investigator on seventeen academic clinical research studies on reproductive sciences.
GIVF DONOR EGG IVF SUCCESS RATES CONTINUE TO SHINE.
GIVF's donor egg IVF program now offers the largest selection of fully screened and available donors in the country. Our ongoing clinical pregnancy rate is 71% for the twelve month period April 2007 through March 2008. For the last six months of that period, our ongoing clinical pregnancy rate is 79%. For additional information visit www.givf.com or call (888) 834-2229 for an appointment.
CYCLE IN THE SUMMER™ DISCOUNT IVF PROGRAM.
Based on overwhelming patient response last year, GIVF is offering its Cycle in the Summer™ program again in 2008. If a patient has her first retrieval on or before the last day of Summer, (September 22, 2008), she may purchase two IVF cycles at the highly discounted rate of just $11,200. For additional information visit www.givf.com
or call (888) 834-2229 for an appointment.
GIVF ATTAINS 17,000 PREGNANCIES In June, GIVF celebrated a new milestone: 17,000 pregnancies worldwid since GIVF's founding in 1984. The total includes pregnancies from IVF procedures performed at all GIVF clinics as well as MicroSort™ IUIs.
GIVF ACHIEVES VITRIFICATION PREGNANCY GIVF is proud to announce our first ongoing pregnancy resulting from a cryopreserved oocyte. This pregnancy was initiated using a new methodology called vitrification. In this process, eggs are cryopreserved prior to fertilization, then thawed, fertilized, developed and transferred at a later date. Oocyte vitrification is a breakthrough technology enabling women to delay fertility for a variety of reasons.
GIVF INTRODUCES STEMCHECK™ The Advanced Genomics Technology Center (AGTC) division of GIVF unveiled its latest offering, StemCheck™, at the 6th annual conference of the International Society of Stem Cell Research (ISSCR) in Philadelphia in mid-June. StemCheck™ is a series of assays designed to assess that cells used for therapy have normal chromosomes and express their genetic information correctly.
GIVF MAKES DONATION TO CHINA EARTHQUAKE RELIEF Responding to the tremendous human tragedy of the May 12, 2008 earthquake in Eastern Sichuan province, GIVF and its employees contributed $5,000 to the Red Cross relief fund established to provide aid and assistance to the victims of this disaster.
GIVF is now sponsoring a blog, "Infertility Bits", to provide a more frequent and informal discussion about infertility and reproductive issues. For additional information visit the blog at www.givf.com/blog.
Ask a Question
By Stephen R. Lincoln, MD, FACOG
I had a tummy tuck. Is it still possible to go through pregnancy?
A "tummy tuck", or abdominoplasty, is a surgical procedure generally performed by plastic surgeons. The procedure is often described as removing extra fat and skin from the abdominal wall, with surgical tightening of the abdominal muscles. This type of procedure generally does not affect one's ability to get pregnant, but there can be theoretical concerns for the actual pregnancy. If there is not enough room for the uterus to fully expand, there could be compromises in fetal growth and possible complications during the need for a Cesarean section, if a C-section is indicated.
There are a few reported cases in the medical literature of patients having normal pregnancies after a tummy tuck/abdominoplasty surgery without any complications. The risks are generally thought to be theoretical, but attempting pregnancy is generally believed to be safe with careful monitoring. There is also a risk of developing weakness in the surgically repaired abdominal area, particularly in the third trimester. Most plastic surgeons would recommend waiting at least six to twelve months after the procedure before attempting pregnancy to try and maximize the healing process.
Patients considering pregnancy after the procedure should consult with the plastic surgeon who performed the procedure as well as the obstetrician who will be caring for them throughout the pregnancy.
What to Expect at Your First Appointment
By Maureen Hanton, BS, RN, MPA
The first time visiting a fertility clinic is an important day for most couples; they arrive at the doors with a mixture of emotions. It may help to know what to expect. First, the appointment is usually longer than a regular doctor's visit. A typical first appointment at a fertility clinic can last two or more hours. Generally you can expect to speak with the physician for about an hour. The physician will listen to you as you relay your fertility journey, will ask you questions about your medical history and discuss diagnostic testing. He (or she) will answer any questions you may have about causes and treatment of infertility, as well as success rates of various types of advanced reproductive technology (ART). Together with your doctor you will discuss diagnostic and treatment options that suit your needs. After you speak with your physician, your nurse will help you implement the doctor's orders and will explain the testing he (or she) recommended.
You may also speak with a genetic counselor and a financial counselor at your visit, depending upon your individual needs. It can be a lot of information in one day! The following are some helpful hints that can help make your appointment go smoothly:
- Consider coming prepared with notes and or questions for the doctor.
- Bring your insurance and prescription cards with you to the visit.
- Bring records of previous treatment or pertinent OB/GYN records such as HSG reports or hormone testing.
- Bring your calendar. If you have vacation plans or work obligations, court dates, house guests or anything that cannot be rescheduled, let the physician or nurse know to help plan diagnostic testing and fertility treatment.
- Feel free to take notes and ask questions. It is very common for couples to get home and realize they forgot to ask something they wanted to ask.
- Please don't be shy about contacting your nurse if questions or concerns arise or if circumstances change. It is always OK (even encouraged) for you to call or e-mail staff with follow-up questions.
- Remember that the pace of therapy will be set by you. Doctors will make recommendations, but no one will require that you proceed with a given treatment or at a given timeline. If you are concerned that a recommended treatment is too aggressive -or not aggressive enough, feel free to voice that to your physician.
Emotionally speaking, the days and months leading up to your first appointment with a fertility specialist (reproductive endocrinologist or RE) can be stressful. Couples often question whether now is the right time to seek help, which clinic to go to, which doctor to request, etc. They research their insurance policies to ascertain what type of coverage they can expect with regard to fertility treatment. They may discuss as a couple how far they want to go down the fertility treatment pathway in terms of time or money spent. While you are discussing the practical matters, take time to discuss your priorities and share your feelings. Talking about all of these things can help to decrease stress along the way. As you proceed, remember:
- It is normal to feel a range of emotions. It is not uncommon to feel excited and hopeful at the prospect of getting pregnant, while at the same time nervous because you don't know what will occur. Many couples say they feel sad or resentful walking in the door of a fertility clinic because they are at a doctor's office when it seems that so many friends and family members are able to get pregnant on their own, with very little effort.
- Your spouse may be experiencing similar emotions to what you are feeling, but not necessarily at the same time or in the same order as you are.
- Fertility treatment can impact vacation plans, work schedules, finances, marriages, families and self-image. It can bring up a lot of emotions. Consider asking your clinic if they can recommend a counselor or support group. You may find this very helpful during your fertility journey.
A positive thought to remember is that most couples who seek help and continue treatment do conceive. Your first appointment is your first step to success.
Copyright © 2008 Genetics & IVF Institute