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|"Reach high, for stars lie hidden in your soul. Dream deep, for every dream precedes the goal."
-Pamela Vaull Starr
Psychological Aspects of Embryo Donation
|Miracles Waiting is honored to have Psychologist, Dr. Patricia P.
Mahlstedt, as one of our expert advisors. She is a world-renowned
psychologist who helps couples deal with the emotional issues of
Assisted Reproductive Technologies. Dr. Mahlstedt completed her
undergraduate degree at Southern Methodist University, her Masters
Degree at the University of Texas in Austin, and her Doctorate at the
University of Houston in the field of Counseling Psychology. During her
undergraduate years, she attended the Goethe Institute and the
University of Munich in Germany. She is currently in Private Practice
in Houston, Texas.
Dr. Mahlstedt has professional affiliations with several Psychological
Associations, has been a keynote speaker at various conferences, and
has given presentation on the psychological impact of infertility and
the emotional issues involved in treatment options throughout the
United States, as well as Mexico and Canada. She is currently a member
on the Medical Advisory Board of Infertility Network in Houston, and
has published numerous articles on all aspects of infertility and donor
issues. Dr. Mahlstedt brings over 25 years of experience, knowledge,
and understanding in the field of infertility to our discussion.
Dr. Patricia P. Mahlstedt
4200 S. Shepherd, #250
Houston, TX 77098
1. What are the psychological issues that some recipients may have when undergoing treatment using donated embryos?
Dr. Patricia Mahlstedt has graciously provided the content for this
page in collaboration with Miracles Waiting in the hope of helping our
visitors have a better understanding of the pychological aspects of the
Embryo Donation process. The Miracles Waiting team is truly grateful
for her help.
Psychological Questions Regarding
I imagine that entire books could be written
responding to this question, as it involves so, so many areas of the
infertility process – its emotional impact on the individual and
couple; personal, financial, sexual, and spiritual concerns related to
treatment decisions; and family-of-origin attitudes toward assisted
reproductive technologies – as well as the known challenges and unknown
possibilities involved in embryo donation itself.
Those of you who are choosing embryo donation are truly
pioneers in this option and will be responding to this question with
more authority than I have now for couples like you in twenty
years. Right now, choosing to parent through embryo donation
involves a leap of faith that you will be able to handle and assimilate
with grace the
multiple uncertainties that you might face. I recommend that you,
as couples, learn to communicate very well about complex issues,
surround yourself with others who are learning about similar issues,
and find professional support that can encourage and support you in
positive and wise ways.
Overall, before embarking on embryo donation I
suggest that you grieve the many losses involved in your infertility
and that you share with and forgive each other for the
misunderstandings you experienced during the treatment period. I
also recommend that you recognize that becoming a parent in any way
involves a leap of faith, because regardless of where your children
come from or how they were conceived, parenting is both the most
rewarding and the most challenging life experience you will ever
have. There are no easy paths for parents and children, and if natural conception guaranteed emotional satisfaction and success, just think of all the arrogant parents there would be in the world!
2. Are there some effective ways to get past these issues or ways to work through them?
Yes, thankfully there are! Some can be done
alone, some with friends, and some with professional support.
First, you must identify the personal wounds of your own journey and
how they fit into your life right now. It is easier for most
people to do that through discussions with other people who have
experienced infertility, since listening to others articulate their
feelings often broadens your awareness of your own as well.
Sometimes marital relationships are strained to the point that having
discussions alone about future alternatives is impossible, and here is
where professional guidance is helpful.
In my 25 years of practice in this field, I have
never seen an individual or a couple who was not able to work through
emotional challenges when they wanted to and were committed to doing so in a disciplined way. In other words, both desire and
action are necessary to identify and integrate the emotional issues of
infertility as well as the future challenges of embryo donation into
3. What types of things are typically
discussed in a psychological evaluation that is required by clinics
before doing a cycle with donated embryos?
Many clinics do not require psychological
consultations for embryo donation in spite of ASRM guidelines to do
so. However, in my limited experience in this area, a session
with me would not be called an evaluation, but would be referred to as a psycho-educational
consultation. It would involve a review of the infertility
experience both medically and psychologically, a discussion of
attitudes currently held about embryo donation including unknowns,
fears, questions both about parenting and child development, and
sources of support available to the recipients. If a known
donation, it would involve a joint meeting with the donors in order to
ascertain future plans for the families and children.
I would provide resources for support and education in this new area of family-building.
4. Are the recipients being evaluated on whether or not they will be good parents?
In my experience, true pass-fail evaluations only happen in Embryo Adoption, and these are usually handled by agencies who sponsor embryo adoptions.
The psychological consultation for embryo donation
is similar to the one for any other type of gamete donation. It
involves a discussion of the losses of infertility and the multiple
leaps of faith involved in embryo donation. As I have said, I
think questions about how parents or children might feel about lifetime issues; how “extended families” might interact; how parents and friends have responded; and when, with whom and how
the “truth” about this life event will be shared are discussed in this
consultation. In other words, the intention of the psychological
consultation with recipients in embryo donation is more educational
than psychological, though the backdrop for it is, of course, the human
experience of all participants. Whether marriages are ready and
able to communicate about complex emotional issues is probably the most
important factor in choosing this means of creating a family.
Along with that, I also believe that all kinds of faith help to
integrate difficult processes into one’s life in positive ways.
An addendum to this question involves the role of
the donor couple. I believe very strongly that they should be
required to meet with a mental health professional who will encourage
and help them to “dig deep” for all feelings involved in making their
decision. The act of donating embryos represents both a loss and
a gift, and all aspects of both need to be examined very carefully
5. What can psychological counseling offer donors and recipients?
HELP!!! Need I say more? There are just
so many questions, concerns, and unknowns to handle, and learning ways
to integrate those things into a positive family experience is not
easy. Dealing with uncertainties is never easy, but when those
uncertainties involve one’s children, they are even more difficult to
manage. Parents always want guarantees that the choices they make
for their children are the right ones, don’t you think?
And it is possible that initial doubt might rear its
ugly head later when/if children have problems, marriages falter, or
parent-child relationships are disappointing. You risk-takers must
be careful about attributing painful, but common family struggles to
your child’s means of conception. That would be analogous to
blaming adoption for any adoptees’ problems or the adoption for any
parent-child relationship. Without guidance from others who have
already navigated around these traps, you will be more vulnerable to
stepping into them yourselves!
6. How does a recipient deal emotionally with the fact that they will be raising a child that is not genetically related to them?
Briefly, a day at a time…in the same ways that
people deal with parenting issues with children genetically related to
them. Moreover, if people have the belief that a child
“genetically related to them” will turn out a certain way or fulfill
their own unmet needs, they might reason that a child conceived through
embryo donation is less able to do that. In my experience, people
have to live with the realities of who their children really are and what parenting experiences they will have with those real children all the time!
However, the loss of the genetic child never goes
away completely. It is normal to yearn for the child who has your
eyes, your mother’s grace, your father’s warmth, as well as
characteristics that you value about yourself. Those are,
however, the parents’ losses, and they must be attended to by the
parents. A child is not a loss. In other words, parental
feelings toward any child are
the parents’ responsibility, and that is very different from “raising a
child that is not genetically related to you.” In one, the focus
is on the child; in the other, the focus is on the parents.
Any child has strengths and limitations that you, as parents, will
learn to appreciate and accept no matter how or where that child was conceived!
7. How does a donor deal emotionally
with the fact that their donation could result in children that are
biologically related to the children that are already born to them?
To be honest, I do not know. Embryos are not
like children who are subsequently adopted, and that is the only
framework I have for defining this challenge. Embryos were
initially created to be the children of the donating parents.
They were not transferred because a clinician or physician chose other
embryos to be transferred to the recipients/now donors. Whether
or not children will see the arbitrary nature of that decision as a
positive or a negative, I do not know.
I think that this aspect of embryo donation – that
the embryos were initially created by the donating couple for
themselves and then not
selected to be transferred by someone else – is what troubles some
people. On the other hand, the alternative to donation is what
many donor couples are trying to avoid.
So many things could influence a donor’s emotional
resolution of that decision and the subsequent events. For
example, what if something were to happen to their own children?
What if the children subsequently conceived were “more like them” than
their own children? What if the children conceived through the
donation see the donors as their “real” parents? Of course,
these things would not happen in an anonymous situation, but in a known
donation, they are a risk.
Actually, I have rambled on and not answered your
question. How donors will feel about potential children “out
there” will depend entirely on how they cope with other uncertainties
in their lives, their overall emotional maturity, and their willingness
to seek professional help when daily thoughts go to “those other
children” too often.
8. What are some common fears or apprehensions about using a donor, whether via sperm, egg, or embryo donation?
Fears concerning parenthood usually focus on
unknowns and are also experienced by people who conceive
naturally. They involve such questions as: How will I
relate to my child? Will she love me? Will my parents
accept our child? Concerns unique to gamete donation are Will my
children see me as their “real” mother/father/parents? Will I be
able to deal with criticism from family or friends? How will I
handle “stupid comments” from people in general? How and when
will I disclose the information about his/her conception with our
child? Are we protected from the donor’s claiming our child in
the future? What access to information in the future will be
I am sure there are many more, but these are the most common.
9. If a recipient is feeling
uncomfortable with using a donor to help them achieve a pregnancy, are
there ways to help them work through these feelings?
Yes! Counseling is very, very important in
moving forward to using donor support for achieving a pregnancy.
Several years ago, I wrote an article with Dorothy Greenfeld on
assisted reproductive technology and the need for psychological
support. It was published in Fertility and Sterility, and it identifies psychological issues and ways of dealing with them.
10. Why does the subject of whether or
not to tell children about their genetic origins seem to be such an
emotional or “hot” topic for many people?
Sometimes that amazes me, also. Conceiving
through donor gametes is such a thoughtful, carefully-planned,
intentional thing to do that the child’s story is very special,
especially when parents are on the same page and have resolved the pain
that their infertility caused them. (Incidentally, “resolving”
pain does not mean that it goes away forever, only that you have found
a place to put it in your life that creates peace most of the time…like
any other major loss.) I imagine it is a hot topic because people
who are ashamed or think it should be private for some other reason
want to have that choice. So, encouraging people to do something
that they are fearful of pushes buttons. Hiding a loss, however,
does not make it go away, and there are many reminders like questions
from a child’s physicians about his medical history, comments from
others about who he looks or acts like.
My experience has been that people who plan to be
honest with their children conceived through donor gametes do not think
of disclosure as a hot topic. Only those who are uncertain or
emphatic about it view it in emotional ways. At least, that is my
11. What is your viewpoint on disclosure vs. nondisclosure to the children born from embryo donation?
My viewpoint is that it is in the child’s best
interests to be told the truth about his means of conception.
“Why not disclose?” has always been my response to this question.
Several characteristics of secrets make them a bad idea in this
situation. One is that they are often used to hide something bad,
something that the secret holder feels bad about. It usually
involves an unacceptable act or behavior on the part of the secret
holder. In my opinion, embryo donation is not a bad thing and
only hides a couples’ infertility and a child’s accurate history.
Those truthful things are a part of a child’s history. If it is
in any way painful or distressing for the child, then a parent must
help her to understand those feelings and work them out.
A second characteristic of secrets is that they are
not kept. Keeping a secret from someone you love is very
difficult, and the more you love a child, the more difficult it will be
to hide the truth. Not only that, but close relationships with
extended family are compromised in some ways when such an important
thing is kept from them. That is especially true when the
relationships have been significant in a person’s life.
A third thing about secrets is that they are often
exposed in very traumatic ways. I have seen this on many
occasions in all sorts of situations. Because it may be a part of
a child’s medical record forever, it is very likely that he will
“discover” it at some point.
But most important in the use of donor eggs, sperm,
or embryo, it should be something parents look forward to sharing with
the person conceived in this way. It should feel like a positive
story for all involved.
12. What is your viewpoint on disclosing to family or friends?
It is entirely up to the parents of the child.
In general, I believe that it is a positive option for creating a
family and that happy parents will want to share it! Keeping
secrets is very difficult.
13. How can parents go about telling their children of their origins, and at what age should they be told?
In this issue, adoption and embryo donation have
several things in common: the planning that precedes it, the lack
of genetic connection to the children, and when to tell.
I have a donor conception paradigm that I give
clients who are considering this option. Over it is the caption LOVE STORY.
That symbolizes the lengthy journey that most couples or individuals go
along to get to this point. It is the emotional and medical pain,
the multiple sacrifices, the compromised relationships, the risks, and,
finally, the leap of faith that is taken to conceive through gamete
donation. Like I mentioned above, it is a thoughtful, loving
decision, and parents are eagerly anticipating the arrival of a child.
Under the caption is a triangle. On one point
is the donor; on the other two points are the parents, mom and
dad. Because parents loved each other and wanted to be parents,
they decided to have a baby. When the natural method did not
work, they went to the doctor who helped them find a
helper/donor. With his/her/their help, you, the child, was
I emphasize that the egg or sperm donor is not a
parent but a helper. I do not know how you will want to refer to
the embryo donor couple. I have read books in which the donors
are referred to as the “birthparents,” but I personally am not
comfortable with that. Even though the donor “created” the
embryos, I still think of them as donors and the recipients as the
Whatever words you use, most professionals believe
that telling early, preschool, is better in that it becomes just
another aspect of a child’s life. Once again, it is a positive
story and one that the child will value in the same way the parents
do. Of course, the story changes and takes on greater and
different meaning as a child grows up.
14. How can parents provide
information to their children about the unique way they were conceived
without feeling uncomfortable or making their children feel strange or
“Being uncomfortable” is something parents have to
work through by dealing with the aspects of embryo donation that might
contribute to those feelings. They can either do that alone as a
couple, with other couples who have created families in the same way,
by reading the multiple books that are available on the topic of gamete
donation, through support groups, or with professional help. The
children will only feel “weird” if their parents feel that way.
Remember, kids conceived through egg donation in this country are 20
years old now. Young adults in their 20’s now do not, in general,
think of egg and sperm donation as “a big deal.” Those concepts
are explored on nighttime television and on daytime talk shows all the
time. They have become an everyday topic for most young people.
As a result, your children will grow up in a
generation that is even more familiar and comfortable with the assisted
reproductive technologies and will probably know other kids who were
conceived in similar ways. In other words, children conceived in
today’s world will not hold the same feelings about most things that
their parents do.
So, don’t project your discomfort on your kids, and they probably will not feel it!
15. We don’t want people to treat our
children differently because of the way we chose to build our
family. Is there an easy way to tell family and friends so that
they aren’t judgmental about our decision?
The overall answer is that it depends upon your
family and friends! It also depends upon how open you have been
all along and how comfortable you are with your decision.
In general, however, I think that people who are close to you will mimic your attitudes about this decision. If you are happy about it, they probably will be, also.
Often we all forget that others do not know as much
about all of the technological advancements in reproductive medicine
and have only heard the “horror” stories on TV and Radio.
Therefore, it is up to you, first of all, to educate them about the
multiple options. Send them information about the “facts” of
embryo donation as well as the process you went through to make the
Then be willing to listen to their discomfort,
because I do believe that many well-intentioned people will be
uncomfortable with embryo donation. As I mentioned above, even
the most informed people in this field are uncertain about the language
to use when discussing donors, recipients, and siblings in the embryo
donation triangle. For example, what do you call children who
came from embryos created in one cycle by one couple but transferred to
two different women? Are they siblings? The reason I
mention this is that those situations will be the ones that friends and
relatives will want to talk about. That is why your being
comfortable with their discomfort is so important.
From experience, how your friends and family treat
your children is something over which you have no control.
However, I have a hard time imagining how grandparents will not love
their children regardless of their means of conception? I imagine
friends will be the same, but there may be a learning curve here that
is similar to one parents of adoptees experience.
Honestly, I just do not know yet how others will
respond to embryo donation since it is such a new option.
However, I do know that being honest with significant others in your
life; providing information via conversations, books, letters, emails,
etc.; allowing them to learn and adjust to it something new to
them; and dealing with your own feelings will enrich your relationships
with everyone that matters. Anyone who cannot share your joy as
parents of children conceived through embryo donation will probably not
be an integral part of your life.
16. Since embryo donation is so new, how can we find the right professional to work with for counseling?
Professional organizations that are familiar with mental health professionals in the field are:
American Society for Reproductive Medicine (ASRM)
American Infertility Association
Physicians in reproductive medicine
Friends and acquaintances who have worked with a counselor
Follow the links to other collaborative information provided by experts for the Miracles Waiting site in other areas related with Embryo Donation:
Family Formation Law
|Nearly 400,000 embryos are stored in the United States,|
88.2% are targeted for patient use, and
2.8% are available for research.
FERTILITY AND STERILITY