5.) KP:  In addition to general fertility counseling, you are also known as a specialist in “third party reproduction” — can you talk about that? 

Diane: Third party reproduction is when you use a gamete donor or a surrogate in order to achieve a pregnancy.  In the case of gamete donation, many women (and couples), have a strong desire to experience pregnancy.  Not all women.  Some women are fine with not having that experience, but many women feel it’s central to their experience of having a child.  They want to see the pregnancy all the way through, they want to ensure great prenatal health.  They want to give birth and nurse.

Egg donation has been around since 1983 – that was when the first successful egg donation took place.  But, it’s only become more known and publicized in the last 5-10 years.  It had been more of a closeted experience, much like sperm donation had been for many, many years.  Way back when, when the King wasn’t able to produce, the Queen would be inseminated with somebody else’s sperm and nobody would be the wiser.  So, while sperm donation has been going on for a long time, the technology for successful egg donation is relatively new. The cycles of the “intended mother” and the egg donor are simultaneously coordinated.  The donor is then given stimulation drugs and the eggs are harvested from her and then inseminated with the sperm of the intended mother’s partner.  Embryos are then created through in-vitro fertilization.  Then, those embryos are transferred back to what is defined as the “biological mother.”

The DNA is from the egg of the donor, but once the embryos are transferred back into the intended mother, she is technically defined as the “biological mother” because she will be giving birth to a child…hopefully, if all goes well.

It can be quite complicated emotionally because people have to come to terms with releasing or giving up their own genetic material.  And, that is a very primal instinct; so people hold on to that dearly.  So, part of my process, in working with women who need to make a choice to go to donor if they are ever going to be pregnant, is helping them grieve the loss of their genetics.  Also, to explore what it really means to use a donor to them and to help them create a new and healthy story around that.

There is the educational piece around what it really means to be a parent.  The goal is to be a parent and parenting and family is about attachment and bonding.  The genetics really aren’t as important as people often believe that they are.

I want to also note that gay men have really opened up this whole arena, because in the last 10-15 years, many gay male couples have used a surrogate, used an egg donor to have a child.  So, the entire process has become much more open based on the exposure that the gay male community has given it.  It’s become accepted in that community, and it’s kind of spilled over into the heterosexual community that this is an option and there is no shame around it.  It’s not inexpensive, but it can be done.

I also work with people on how to talk with their young children about their conception and to family members about this process.  In the mental health community, we’re very pro disclosure.  We believe, as you know, that secrets are not good in families, so a lot of my work goes around helping people feel comfortable about this decision and not having shame around it.  Not having shame when they talk to their young children in very basic ways about their conception, and introducing the fact that there was this third person (or more if using a surrogate) that helped us have you.  Making it very much the fabric of their lives, their story.

When parents are comfortable and casual about discussing their children’s origins then the child will be comfortable and confident about where they came from and their story.  That’s also another big piece.  A lot of times when people do have a child through donation, they’ll come back to me and say, gee my child is 4 or 5 years old and I’m really struggling with how to talk to them about their conception.  Then, we’ll work on that piece as well.

There is one caveat: if disclosure would harm the child in some way.  Perhaps there’s a relative that isn’t stable and might say something inappropriate to the child, then maybe under those circumstances, you choose not to tell that relative or maybe you wait a while.  There is some discernment required, if the potential exists, that the information may be misused in someway. But the general consensus in the mental health community is to tell often, tell early and be honest and relaxed about it.

KP:  The openness, not being secretive – that’s great that you can facilitate that process.  It’s certainly interesting to hear about the history about egg donation, that 3rd party reproduction has been going on for years, but people just don’t often talk about it.  It does sound positive, however, that people are starting to be more open.

Diane:  Yes, but we still have a long way to go.  The San Francisco Bay Area is probably the most open place about these kinds of issues.  I was at a conference a few years ago on the East Coast and it’s a very different mentality there.  It tends to be driven somewhat regionally.  We’ll see where it goes.  My particular perspective is that it’s about your values.  If you value honesty and integrity as a parent and a person and you believe your child has a right to know the truth about their origins, then that’s what you’re going to transmit.

Next: What are the specific tools you use when working with patients who are struggling with infertility?