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EGG DONATION:
PSYCHOLOGICAL EXPERIENCES OF RECIPIENTS
Authors: Helane S. Rosenberg, Ph.D., Yakov M. Epstein, Ph.D.
This article is based on our experiences working with couples wishing to use an egg donor. To date, we have helped coordinate over 300 anonymous egg donor/egg recipient cycles. We have also worked with numerous couples who decided not to do an egg recipient cycle. In addition, we are the parents of twins who were conceived with the help of an egg donor. This personal perspective adds to the knowledge we have gained working with the hundreds of couples who have come to talk to us about egg donation.
HOW DO COUPLES BEGIN AN EGG RECIPIENT PROCEDURE?We will describe the process which takes place at the practices that we have worked with. While there may be variations from practice to practice, for the most part, what we describe is typically what happens to recipient couples.
Orientation Meeting
There are many different ways that couples get to the point of considering egg donation. For some couples, an egg donor procedure is the next step after they have tried every possible avenue to get pregnant with their own eggs. Some couples, on the other hand, knew even before they got married that they could not conceive with their own eggs. Some couples have considered the option of egg donation for months or even years before coming to a practice to discuss this option. Others have only thought about it for a few days and in some cases, may have just been told that day by their doctor that their only chance of experiencing a pregnancy is to use an egg donor. How long they have thought about being a recipient and why they need to be a recipient will influence how a couple responds to their orientation meeting.
Typically, the couple comes to a medical practice and has three sorts of meetings: a meeting with the medical doctor, a meeting with the mental health professional and/or the ovum donor coordinator, and a meeting with an office manager or someone else who discusses the financial side of the procedure. We'll talk only about the orientation meeting with the ovum donor coordinator and the mental health professional.
At that meeting, a discussion takes place about the following sorts of issues:
What is egg donation? How does it work and what's involved?
Although the couple may have been given this information in their meeting with the doctor, we find that they often had been focusing so much on their feelings of worry or upset that they did not fully understand everything the doctor said, or were unable to ask all the questions they had. So we take time to review material about such things as synchronizing the cycles of the donor and recipient, monitoring, and so on.
What sorts of success rates have practices around the country been having with this procedure?
Before considering doing this procedure, patients want to know whether they stand a reasonable chance of success. This discussion helps them compare the odds of getting pregnant using this procedure with other alternatives they may be contemplating.
What are the emotional aspects of being an egg recipient?
Typically, the discussion begins with a consideration of how this couple decided to think about the possibility of being egg recipients. The discussion then focuses on the unconventional nature of this procedure and whether the couple could feel comfortable giving birth to a baby conceived with the use of someone else's eggs. We talk about the images couples have of their baby. Often this discussion reveals that liked the color of their hair, or their dimples, or their thin ankles, or their musical ability or some other physical trait or talent that they believe they could have passed on genetically to their baby.
Having discussed these images, we focus them on grieving for their lost biological connection. It is at this point that many couples begin to reconsider whether they are really ready to stop trying with their own eggs or whether they want to try "one last time" using their own eggs. We try to have them project themselves into the future and consider how they feel if they succeed in getting pregnant using donor eggs. Will they berate themselves saying "I should have tried one last time with my own eggs?" If they feel strongly this way, we help them weigh all the factors for and against trying again with their own eggs: costs, time, emotions etc. Often, this phase of the discussion convinces patients that they need to take more time thinking over their decision about whether to be recipients.
Our discussion also focuses on the unequal biological contribution: the fact that the husband gets to contribute his sperm but the wife cannot contribute her eggs. Usually this is not a concern for the wife. She views her gestational contribution as equivalent to her husband's genetic contribution. Moreover, this discussion helps to focus her on what she likes and values about her husband and hopes her baby will inherit.
A final topic that we include in our discussion of emotional issues is religious and ethical concerns about being a recipient.
What are the legal aspects of this procedure?
Recipients are usually concerned about whether a donor might try to find the baby and claim it as her baby. Paradoxically, donors have the opposite concern, namely, that at age 18, the baby will find them and ask for a car or college tuition. We discuss the lack of clear-cut legal guidelines about this matter and assess how comfortable the couple is proceeding without any assurances.
What about disclosing to family and friends?
We ask couples to tell us whether they would tell anybody: family, friends, or their baby when it is older, that they used an egg donor. Surprisingly, many couples tell us they have not given any thought to this matter. We point out to them that valid arguments can be made either for disclosing or for not disclosing and that we will try to support the couple in whichever option seems right for them. However, we caution them about two things.
First, we note that the couple must be in complete agreement with one another about which of these two options they will pursue. Second, we point out that if they plan not to tell their child, they should never tell anyone else that they used an egg donor. We note that it would be emotionally very upsetting to a child to learn this information from someone other than his/her parents. Finally, we tell couples that they have lots of time to make a final decision, and that, while it is always possible to tell, it is never possible to "un-tell."
What are the parenting issues?
We ask couples to think about what it will be like for them to be parents. Many couples contemplating egg donation focus on how they might be considered different from others because they used an egg donor. But what they have not considered is how differently they would be viewed by others because they are typically so much older than other parents of young children.
What can go wrong?
We spend a great deal of time talking with couples about the many things that can go wrong in an egg donor cycle. This discussion focuses on things like:
- (1) the donor quits in the middle of a cycle;
- (2) thedonor gets pregnant before the cycle starts;
- (3) the donor prematurely ovulates;
- (4) the donor has very few eggs, or poor quality eggs, or even no eggs at all;
- (5) the husband has a poor sperm sample or sometimes is unable to produce a sperm sample;
- (6) the eggs don't fertilize;
- (7) if a pregnancy occurs, the recipient may miscarry;
- (8) the recipient may become pregnant with three or more fetuses and have to have a multi-fetal reduction with the possibility of losing all of the fetuses.
It is necessary for couples to know what they are getting themselves into and be prepared, ahead of time, for the stress that they will experience because of all of these factors.
What is involved in selecting a donor?
Having discussed all of this material, we talk with the couple about what they are looking for in a donor. During this discussion, the issues of grieving for the lost biological connection often resurface as women look for a donor who can provide the child with those qualities they hoped to pass on to their baby. We try to help the couples attain a balance between finding the qualities that are really critical to them and giving up some requirements that are less important. We point out that the more requirements they have in their donor, the longer it will take to find a donor who satisfies these needs. We point out how waiting to find the "perfect" donor delays the start of pregnancy and the opportunity to begin parenting.
WHO ARE THE RECIPIENTS AND WHAT ARE THEIR CONCERNS?As they participate in the orientation meeting and think about the issues we cover, most couples experience stress. In thinking about embarking on an ovum donor procedure, they have many questions, concerns and anxieties. They have two overarching strategies to lower stress and anxiety. The first approach is called social comparison. They can reduce their anxiety by comparing their concerns with those of others who are "in the same boat." The second approach is called social support. They can reduce stress and anxiety by turning to other people as a source of social support in this difficult endeavor.
To utilize the first strategy, they want to know "How are we like other couples who have been egg recipients and how are we different?" Specifically, they want to know:
- 1. Do most other couples tell anyone that they are doing an ovum donor procedure?
- 2. How does the decision to have an "ovum donor baby" typically affect a recipient's relationship with her partner?
- 3. Are recipients able to love their baby?
- 4. Do recipients later regret their decision to use an egg donor?
The answers to these questions are not simple. Some "types" of recipient couples do things differently from other "types" of recipient couples. In order to compare themselves with other recipient couples, it is important for the partners to understand the various "types" of couples and determine which category they belong to.
We have constructed a typology of egg recipient couples. In constructing our typology, the factors that we considered were:
1. Age factors:
How old is the woman?
How old is the man?
Are the partners roughly the same age, or is the woman more than 4 or 5 years older than her partner?
2. Marital factors:
Has the woman been married before?
Has the man been married before?
Does either of the partners have children from a previous marriage? If yes, how old are these children?
3. Life cycle issues
Did the woman start trying to have children at about the same time as her friends and relatives or did she decide to try much later in life or many years further into her marriage?
If the woman were to have a baby this year, would she be considered a "much older mom"?
Does this woman have a child that she gave birth to, or is she different from her peers because she never gave birth to a child?
4. Medical Issues:
Did the couple know, before they got married, that the woman had a medical problem that would prevent her from conceiving a child?
Did the woman go into menopause at a very young age?
How long has the couple been in treatment?
Couple status with respect to these factors influences whether others view them as "deviant" or "atypical." Sometimes these views are actually held by others; sometimes, others may not actually hold these views, but recipients may believe that others hold these views. In either case, the actual or perceived views have implications for the social support strategy of stress reduction.
If others actually consider these recipients to be deviant, they are less likely to offer social support for their attempts to become pregnant. If, on the other hand, recipients believe that others would consider them to be deviant, they may conceal the fact that they are using this treatment approach. Because friends and relatives do not know what they are experiencing, they are unable to afford support to these couples.
Now, let's consider eight different types of couples and how their characteristics may have implications for social comparison and social support.
Group 1: A woman who has a child or children from a previous marriage
This is a group who would be judged to be "unusual" parents by their peers because the woman is much older than most other mothers with babies. The woman is usually four to five years older than the man. Typically the woman is in her early to late forties. Not only is she "old to be the mother of a baby," but her friends also know that she has an older child or children -- sometimes one who is in her twenties.
Because they represent such an atypical life choice pattern, these couples report getting very little social support for the pregnancy quest either from family or from friends. Indeed, they often report arguments with family and friends who say to them "Are you crazy trying to have a baby at this stage in your life?" Many recipients are so sure that they won't get support that they conceal their treatment from family and friends. Then, if they get pregnant, they have to "invent a story" to explain how they had a baby so late in life.
So why, later in life, after having a child, and without support from family or friends, do these women want to have a baby? For one thing, most of these women seem to have enjoyed raising their first child and would like another similar experience. Sometimes the women are motivated to have a child as a way of feeling young in their new marriage and to be a part of the husband's younger social circle.
Because they get so little social support for trying to have a baby, making the commitment to select a donor and begin this procedure is particularly anxiety- arousing for these people. To alleviate the anxiety associated with making a commitment to select a particular donor, these couples typically employ one of two very different strategies.
The first strategy involves perseveration -- the inability to make up one's mind. They obsess over this and that characteristic and no donor seems "just right." While this may seem to be evidence of "pickiness", it should be understood for what it is: difficulty making a decision which is fraught with anxiety. The second strategy is the reverse. To avoid the anxiety of thinking about their choice, couples sometimes take the first "warm body" presented to them.
Group 2: Older husband has children from a previous marriage
Like the first group, this group, too, would be judged to be atypical, but this time because the husband is seen as much older than most fathers of babies. Therefore, typically, the husband is not as eager as the wife to have a child. Like the older woman in the first group, this man often fails to get support from family and friends. He too is asked "Why do you want kids now that you have grown children?"
Often the opposition to his having children comes from his own grown children who are either actively opposed or, at bes, resigned to the idea. Often the wife imposes having children as a condition to continue the marriage. Because the husband does not participate enthusiastically, the wife gets little social support from him. This, in turn, makes it very hard for her to deal with the procedure.
Not only doesn't the woman get support from her husband, she doesn't get it from family and friends. Typically, the woman was busy pursuing a successful career and got married later in life. Her friends see her as a "career woman" not as a "mom." Thus they don't expect her to try to have kids so late in life. Aware of these sentiments, she typically hides her treatment from everyone. So careful is she to conceal the information from everyone that she often requires the ovum donor coordinator to leave cryptic messages on her phone machine, lest someone accidentally hear a message and learn of this treatment.
But there is another side to this story. When they get pregnant, the women invariably tell us "Now my husband is thrilled." They treat the birth as a miracle that could never have happened to them without this procedure. The miracle, however, consists of the fact that a stranger, an egg donor, contributed an egg that made this baby possible. And since they conceal from their friends the fact that they used a donor, they have no one with whom to celebrate their success. To fill this void, these women typically stay in touch with the ovum donor coordinator while they are pregnant and after the baby is born.
Group 3: Secondary infertility with the same husband
There are many ways in which members of group 3 differ from members of Groups 1 and 2. In contrast to the first two groups, members of this group would not be judged as deviant or atypical. They have a child and usually became parents at an age comparable to most of their friends. They mention how much they enjoyed being pregnant and taking care of their infant. Also, unlike couples in the first two groups, members of this group are generally in their first marriage. They are also different from members of Groups 1 and 2 in that they can be characterized as "frantic". This is so because, like many Americans, they have an image of the ideal family consisting of a mother, a father, and at least two children. Their motivation for being recipients is to have a sibling for their only child.
Like the members of Groups 1 and 2, these women also lack social support. Indeed, their infertility is "the loneliest kind" of infertility. They are unable to get support of other infertile women who envy them their child. And they fail to get the support of the multi-child friends who envy them the luxury of only having one child to discipline. They also avoid telling their friends that they need to go to great lengths -- to use a donor to have a baby -- a strategy that might well garner them support. Like many of the members of Groups 1 and 2, Group 3 couples choose to keep the use of a donor a secret. However, their motivation for keeping it secret is a different one; they are worried that the "donor baby" will have second class status vis a vis the sibling who is genetically linked to the mother. So they are unable to receive the support needed to reduce their stress. Hence, they appear frantic in their dealings with the ovum donor coordinator to whom they turn as their only source of support.
There are also ways in which they are similar to members of the first two groups. Typically, only one partner is committed to this venture. Like members of Group 2, usually that one person is the wife. But although the husband can rarely be characterized as the "driving force" behind the pregnancy quest, he is also not usually adamantly opposed to the pregnancy the way many Group 2 husbands are. And like members of Group 2, when Group 3 recipients get pregnant they invariably say "Now my husband is thrilled".
Group 4: One step behind their peer group
Even though they might be considered older than the average parent of young children, members of Group 4 belong to an age group that is still having children. This group consists of women who have only recently gotten married. Typically, neither partner has been married previously or if previously married, has not had any children. These people tend to have had very successful careers and have no expectation that they will have any difficulty having children when they try. Part of their motivation for getting married is to produce wonderful children who will inherit the parents¼ wonderful characteristics. Therefore, these women want a donor who will "replicate" them.
The couples have not been in treatment very long and their friends know that the couples are pursuing infertility treatment. Their friends are aware of the many desirable characteristics these people possess. Knowing the great lengths to which these couples have gone, their friends root for them to become pregnant. So unlike members of Groups 1 and 2, they get a great deal of social support from their families who do not know that they are using an egg donor, but instead think they are using their own eggs with IVF.
The women are often very attractive and, in talking with the ovum donor coordinator, they typically mention how beautiful they are. Because they are keenly aware of these special qualities, and because they fully expected their child to inherit these characteristics, they are very difficult to satisfy in their choice of a donor. For them, the donor is their "stand-in," and only a donor "as good as they" will satisfy them. They want a donor who is beautiful with beautiful coloring, body, and features. Often the donor's physical attractiveness is more important to them than the donor's intellectual abilities.
In contrast to members of Group 1 and Group 2 who consider the pregnancy to be a miracle, members of Group 4 focus on the fact that "it should not have happened this way." Whereas a 45 year old woman in Group 1, for example, can think "There's no way that I, a 45 year-old, could have given birth to a baby without a donor," a Group 4 woman tells herself "A beautiful young woman like me should have been able to have her own baby without having to use someone else's eggs."
Up until the procedure and the pregnancy test takes place, they focus on whether the procedure will be a success. They call the ovum donor coordinator every day to find out how things are going. But once they get pregnant, they want to forget as quickly as possible that someone else had to help them get pregnant. So they never have any further contact with the donor coordinator. This is a marked contrast to members of Group 2 who keep in touch with the coordinator throughout the pregnancy and after the baby is born.
Group 5: Decided late in life that it's now time for children
Like most of the other groups described, members of this group are also atypical. They have been married for many years, are in their mid to late forties, and have never had children. They tend to be low risk-takers. They are very careful and weigh every aspect of the decisions that they make. For many years they considered the possibility of having children, but were never certain that it was the right thing for them to do. Now, at a rather late stage of their life, they've decided they should give it a try.
These people are motivated to do the procedure so that they can say that they tried. But they continue to be ambivalent about the decision to try. Sometimes, they engage in behaviors that reflect this ambivalence. For example, one such recipient who got pregnant, went into the sauna every day and used retin-a despite the fact that her gynecologist implored her not to do so. Inevitably, she lost the pregnancy.
In contrast to the frantic attitude displayed by members of Group 3, this group is in no hurry to select a donor. They are very uncertain that they are doing the right thing. They want to wait to make sure they got exactly the "right" donor. In contrast to members of Group 4 who place more emphasis on the physical attractiveness of their donor, members of Group 5 place greater emphasis on the intellectual abilities of their donor. They accept the fact that they could not have their own child, but they don't want a child who would not be like them intellectually.
Members of Group 5 tell us that they would never consider adopting a child. Members of Group 5 are not terribly motivated to do the procedure and don't really believe that it will work. These people get no social support from family or friends.
Group 6: Young married family that is not yet a family
This group is not judged as deviant by their peers. They got married at the same time as their friends got married. Like their friends, they began early to try to have a baby but were not successful. Chronologically, they are part of a group that is still capable of having babies. But they have a reinforcement history of repeated failure, so they really don't believe they are capable of having a baby. Their repeated failure is what drives them to feel old despite the fact that they are not chronologically old.
Friends and family expect them to be pregnant, and their friends offer them a great deal of social support. But their friends also are still getting pregnant, and when these friends get pregnant, or when they hear about a pregnancy or see a baby, they are upset and jealous of the mother or mother-to-be. On the other hand, they feel guilty about being jealous of their friends' success.
Because they have learned to feel helpless by their repeated failures no matter what they've tried, and because they are upset that they are jealous of their friends' good fortune, this is the most depressed group of all the 8 groups. They cope with their repeated failure by staying in constant contact with the donor coordinator in an attempt to exert control over all aspects of the procedure. They also use the coordinator as their source of social support because they don't feel comfortable talking with their fertile friends about their infertility.
Group 7: The young infertiles
Like Group 6, this group is also one that is not considered deviant. They are typically in their early thirties and in their first marriage. For some reason, they are in premature menopause or their eggs are of such poor quality that they can never fertilize. This group is very optimistic. In general, they have not had a long history of infertility treatment. They believe the procedure is going to work for them, and in fact, it really does. (About two out of every three couples in this category that we worked with have gotten pregnant.)
They have a great deal of social support from friends and family. Because they are not depressed, they are not frantic. For the donor coordinator, this group is very easy to work with. They want the donor to have a history of fertility and they don't want the donor to be older than they are. Both the husband and the wife are very committed to doing this procedure.
Group 8: The medically infertile
This group consists of people who knew before they got married that they could not have children of their own. Some, for example, were born without ovaries. Other had medical treatment for cancer that left them sterile. When they discussed marriage with their partner they disclosed that they could not have their own children. Their partner was understanding and supportive.
This group planned to either live childfree or to adopt. When they learned that the option of ovum donation existed, they were thrilled. This group has a tremendous amount of support from family and friends who are rooting for them to achieve what they thought they could never do.
SUMMARYEarlier in this paper, we reported four important questions that potential recipients ask us. In response to the first question (Do couples tell anyone that they are doing this procedure?), we see that the answer depends on which group we are talking about: some types do and some don't.
With respect to how the decision to have an ovum donor baby affects the relationship with the couple, again we see that there are variations depending on which group we are thinking of.
But the answers to the last two questions are the same for everyone. Nobody yet has told us that they are unable to love their baby. And nobody has regretted their decision to do this procedure. To the contrary, even the heretofore reluctant partner is thrilled with the baby when it is finally born.
We hope this article has given you some insights into the emotional aspects of being an egg recipient. We are always available to discuss questions or provide additional information. e-mail us at yepstein@rci.rutgers.edu or hsr@rci.rutgers.edu.
Copyright 1996. The American Surrogacy Center, Inc.(TASC), Marietta, GA
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