Mental Health in Third-Party Reproduction

July 1, 2024
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The Fairfax EggBank Roundtable Series Launched in 2023 with the goal of engaging industry leaders in dialogue aimed at addressing practice patterns in emerging and non-standardized areas of practice.

Fairfax EggBank hosted a roundtable on the topic of Mental Health in Third-Party Reproduction in Q2 2024. We brought in experienced experts who work with intended parents wanting to use donor eggs to discuss their best practices and guidance on mental health for donor egg recipients. We will review the questions asked to the panelists and give highlights of their answers and the discussion.

Panelists:

  • Andrea Braverman, PhD, Thomas Jefferson University
  • Ellen Winters Miller, LMFT, Fertility Counseling Center
  • Lisa Becht, MD, FACOG, HRC Fertility
  • Melissa Lindsey, The Donor Conceived Community
  • Natalie Sofia, RN, Dominion Fertility

Does your clinic require a psychoeducational consultation for all intended parents moving forward with the use of frozen donor eggs?

The 2021 ASRM Gamete and Embryo Donation Guidance document strongly recommends psychoeducational consultation for all intended parents conducted by a qualified, licensed mental health professional who has training and education in third party reproduction. This is an opportunity for intended parents to learn more about the donor egg IVF process. Many physicians and nurses recommend a mental health consultation to give intended parents the chance to discuss the donor egg IVF process in detail and to encourage a dialogue about their feelings towards the frozen donor egg process.

Clinics require these consultations to take place before the frozen eggs can be shipped to the clinic to ensure intended parents fully understand the entire process and the magnitude of what is to come next.

ASRM guidelines recommend that both intended parents attend the psychoeducational consultation. Most Mental Health Professionals (MHPs) require both intended parents to be present during this consultation, but if only one intended parent shows up that is very concerning. Both intended parents should be present if they plan on raising the donor conceived child together.

We have one time to talk to them (IP’s) about their hopes for the selection (of a donor) and their hopes to get pregnant, but our primary goal will be to foster the growth of a healthy, well-adjusted individual and that includes knowing about their genetic origins.

Ellen Winters Miller, LMFT, Fertility Counseling Center

What do you consider to be best practice for this type of consultation?

This consultation is not a mental health evaluation. It is intended to be an educational consultation where intended parents can learn more about the donor egg IVF process and provides them with a safe space to process all their concerns. Also, this is an opportunity to discuss the intended parents’ wants and dreams for their future child.

Common topics for discussion during the psychoeducational consultation are:

  • Intended parents’ questions/concerns about the donor egg IVF process
  • The importance of donor selection
  • Intended parents’ thoughts around parenting the donor conceived child
  • Intended parents’ concerns revealing that the child is donor conceived
  • Processing the reactions of their immediate family members
  • Feelings of grief the intended parents may be experiencing

It is common for intended parents to come up with additional questions after the consultation. In those situations, physicians can send patients back to the mental health professional to further their education.

I’ve definitely had patients that have been going through the experience (donor egg IVF process), sometimes even once they’re actually pregnant, asked me certain questions where I’ve actually sent them back for a revisit (with a Mental Health Professionals) to be able to go through those new questions now that they’ve gotten a little bit further into the experience.

Lisa Becht, MD, FACOG, HRC Fertility

Why do I have to do it? They feel a certain way about it (psychoeducational consultation) a discomfort about it and honestly most of the time I tell them, I know you don’t want to do it. It’s going to be more beneficial when you’re done. You’re going to be so happy that you actually did meet with somebody. Most patients will come back to me and say ‘You’re right. I feel really good about my decisions. I feel really good about going forward. You know, we’re much more comfortable now.

Natalie Sofia, RN, Dominion Fertility

What are common concerns relayed by intended parents?

The immediate concern, once intended parents are looking into donor egg IVF, circles around the potential egg donor required for this process. Questions such as “Who is this donor? How are they screened? Why did they donate their eggs?” are very common initial questions.

I would say that first kind of big concern is, who is this donor.

Lisa Becht, MD, FACOG, HRC Fertility 

After doing some research, parents tend to express fear around not being the biological parent, concerns around telling their children they are donor conceived, and the real-world implications of easily accessible genetic testing, such as 23and Me and Ancestry.com. The psychoeducational consultation allows intended parents to discuss these concerns.

What strategies or resources do you suggest to help intended parents process the many emotions that they may be feeling?

Self-care is crucial for intended parents during this process. Mental health providers often suggest relaxation techniques to help them manage their stress levels. This is especially important for women who are undergoing the IVF process, relaxation techniques can help women feel in control of their body.

In addition to encouraging intended parents to prioritize their health and self-care, connecting with fellow donor conceived parents is crucial to normalizing this experience.

There are many great resources out there to help parents of donor conceived people:

What are your red flags when speaking with a potential intended parent?

Red Flag #1: The intended parents believe the donor will be 100% anonymous, which is not a possibility in today’s age. Advances in technology, such as at-home DNA testing, have made it challenging to maintain absolute anonymity. It is also possible that the world’s interconnectedness and evolving technology may continue to further impact donor privacy in the future.

Red Flag #2: A woman may demand the use of donor sperm when she is unable to use her own eggs to conceive, or vice versa whereas a man will demand the use of donor eggs when he is unable to use his own sperm. This is a major red flag since the couple is so focused on a possible imbalance of parenting or power, that they are losing sight of the long-term effects of this decision. A similar red flag is if both partners are not on board with using donor eggs, this will cause issues down the line.

Reg Flag #3: When intended parents choose not to disclose the use of donor gametes to conceive to immediate family members, but then choose to tell the child they were donor conceived. They are putting the burden of this knowledge on the donor conceived child and making it seem like it’s something that should be hidden.

Red Flag #4: Assuming all egg banks and agencies work the same. This is a misconception as all egg banks and agencies have their own processes when it comes to donor screening, genetic testing, ID release, etc. Many intended parents will work with one egg bank and then impulsively switch to another, not understanding that the work they did with the egg bank they started with will not transfer to the next one they ultimately decided to work with.

Many parents assume that all banks or agencies and clinics are equal and so they think that there are laws in place that everybody’s following the same rules.

Melissa Lindsey, The Donor Conceived Community

What do you believe is most important for intended parents to know?

No matter if they use a donor egg IVF or donor egg IVF with a gestational carrier the intended parents are still the parents of that child. There is a whole team of support to help intended parents throughout this tough journey. The entire journey is worth it once their child comes into the world and they are finally parents.

The donor egg IVF process is never perfect, and the discussion doesn’t end once the child is born. Honesty is imperative when it comes to this process. The goal shouldn’t be to hide the use of a donor or pretend that a donor was never used. The goal should be for the donor conceived person to feel well-adjusted and be able to have open discussions with their parents about the use of donor eggs.

There’s lots of different things that define being a parent. So even if it’s not your genetic material in that egg, you are still the parent of that baby.

Lisa Becht, MD, FACOG, HRC Fertility

You know, it’s not one discussion that does it, it’s not a one and done, it’s an open dialogue between the donor conceived child and their parents. They get to practice and modify as they go and they’ll have a lifetime of discussions.

Melissa Lindsey, The Donor Conceived Community 

Interested in working with Fairfax EggBank?

Contact our team by calling 888-352-5577 or email [email protected].

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