How to Decide Whether to Use a Donor During Infertility

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By Shara Marrero Brofman, PsyD

When we think of the word "family," many of us picture a mom, dad, and two or more biological children. Carrying that image in our minds can make it very difficult when the path to building a family looks different than we thought it would. If you had planned to create a family with biological children, but are unable to do so, opening up to other approaches, such as using a sperm or egg donor, can require a lot of mental and emotional work. Here's a guide to beginning the process.

Make room for all your feelings
Arriving at the decision to use a donor often comes after an already physically and emotionally challenging infertility journey. So, acknowledging the grief and loss that you may feel can be a helpful first step. Of course, the experience of building a family can include wonderful, joyful aspects as well, but it's important to make space for the harder feelings, too. Emotions you may feel as you consider or pursue third-party reproduction may include happiness, hope and excitement, worry, anger, sadness, envy, grief and loss, ambivalence about having children, and guilt over how you are feeling.

It is OK and understandable to feel all of these emotions—and more. Starting a family is a complex undertaking, and it is normal to have complex feelings about it, especially when you are taking a different path to the future than the one you envisioned.

Talk about what is important to you and your partner
In addition to your specific medical, financial, and other life circumstances, discuss with your partner what matters to you about family. It can be time-consuming and feel overwhelming at first, but exploring your values will help you sort through your feelings and come to a decision that you both feel good about.

Here are some questions to get the conversation going:

• What is important to you about having a family? What aspects of parenting do you look forward to?
• Is it important that you have a genetic connection to your child?
• What would it be like if you had a genetic connection to your child, but your partner did not?
• What about if neither of you has a genetic connection?
• Is it important for you to have the experience of pregnancy and birth?
• Do you feel strongly about the possibility of breastfeeding your baby?

There are no right or wrong answers. It's just a matter of how you and your partner feel. Understanding that can help you make a decision that works for you.

Know that your emotions will evolve
Even after you make your decision, it's likely that you will continue to have thoughts and feelings about this process over the course of your life. That's totally OK, and you can also continue to get support around it. Partners also often have different feelings and views about family building, and those feelings are important to explore and understand.

Consider whether you want to know your donor
Another question is whether to use a known donor. Many families have been created using known donors. For example, if you are unable to use your own eggs, you could ask a female friend or a sister to be an egg donor. A male friend could be a sperm donor.

Using a known donor can be a meaningful option, but there are also very important considerations. Besides the more apparent ones, such as the nature of your relationship with the donor and how you each feel about the idea, think about how involved you envision the donor being in the child's life and what this might be like for the child. There are also legal implications to this approach, including possible custody issues. Mental health professionals and lawyers specializing in reproductive medicine can provide more information about this process.

You can also choose to use an unknown donor. Some unknown donors are comfortable being contacted when a child is 18 years old, and some prefer to remain anonymous. Gamete (sperm and egg) banks keep donors' preferences on file. You can think about what is important to you, and, importantly, what may be most valuable to your future children. Be aware that donor anonymity may be difficult or even impossible to guarantee because of DNA technology, online databases, and social media. Children, donors, and other family members may still end up finding or contacting each other in the future, with or without your involvement.

Know that you will be able to bond with your child
Attachment and bonding is another aspect of third-party reproduction that worries many people. It's understandable that this would be a concern, but the good news is that there is a lot of reassuring evidence showing that a genetic connection to a child is not a crucial part in this complex process. Many healthy children are raised by people who are not their biological parents, or even related to them at all. The right combination of nurturing, support, trust, and appropriate limit setting are what's most important in healthy attachment—not whether the child is genetically related to the caregiver. Still, children may have questions and feelings about whether or not they are genetically related to a parent. If you or your children struggle along the way, remember that support is available to you and your family as you all explore your thoughts and feelings.

Decide how you will talk about this as a family
Another big question for families built with a donor is how to explain things to a child and to other people. Research shows that children are interested in learning about their genetic origins, and they integrate the story in a healthy way when they hear their story at a young age and have opportunities to talk about it throughout life. Children's questions will change as they get older and gain a more complex understanding of themselves and the world, so think of the family conversation as ongoing, not something that has to be resolved in one family meeting when the child is a certain age.

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Children (like adults) do well when their experience feels normal, not shameful, wrong, or secretive. And they thrive in communities where there are others like them and where they feel they can trust others. So, it can also be helpful to connect with other families who have children as a result of gamete donation, surrogacy, or adoption. This can provide wonderful support for children and grown-ups alike.

As for whether and how to talk about donation with other people, you can think about what feels comfortable to you as a family. But most experts agree that children have the right to know their story from a young age, and that it's best to hear it directly from their parents, not from other family members or friends (whether intentionally or accidentally).

Here are some great resources to get started on these topics:

Family Building Options from RESOLVE
The American Society for Reproductive Medicine mental health professional group's bibliography for families

Whichever way you choose to start your family, make sure you have ongoing support. There are more ways than ever to think about family, and there are also more resources than ever to support you along the way.