The AFA Blog

Gay Dads and Lesbian Moms and the Transition to Parenthood

 

 by Kim Bergman, PhD

 After 14 attempts over 18 months of donor insemination I was finally pregnant--something I had wished for and wanted for years. That's why I was so surprised at my reaction when at 8 months pregnant I visited my friend Holly (who was a month ahead of me) right after the birth of her second son. I walked into her hospital room and saw him in her arms, tiny and pink and looking entirely too fragile and delicate. Holly immediately handed him to me (she was an expert at this, having an older daughter already). I held this tiny creature, watched his eyelids flutter, marveled as his mouth sucked reflexively and thought to myself, "No way am I prepared to do this in just one month!" It was like slow motion and one of those voice-overs saying, "Do not attempt this at home".

 My wife and I went home and proceeded to have about three days of the worst anxiety ever. Here is a peak inside my brain during those few days:

 --what were we thinking

--we have no idea what we are doing

--babies are so tiny and fragile

--what were we thinking

--what if I mess this up completely

--OMG

--how will we do it

--what were we thinking

--how will I ever leave the baby 

--what if something happens

--what were we thinking

 over and over....for several days!

 My reaction was utterly terrifying and took me completely by surprise. Over the next month my anxiety gradually subsided and on the wonderful day that my daughter was born (almost exactly 15 years ago as I write this) it was joy, and not anxiety that I felt.

 While there is really NOTHING but parenthood to prepare you for parenthood. I have found that sharing our common experiences can help ease the transition into this new phase of life, and knowing in advance some of the ways that parenthood changes us can lesson the anxiety.

 There are lots of baby books that seek to prepare people for parenthood so I am not going to talk about the emotional ups and downs, sleepless nights and endless diapers of being a new parent. Instead I am going to focus on some of the emotional issues that my wife and I, and other LGBT parents face as we make the transition to parenthood.

 For me one of the biggest deals about becoming a parent was that it was a total identity shift. As a lesbian, I thought that maybe I wouldn’t be able to be a mom at all. I hear this time and time again from the gay men and lesbians that I help on the path to parenthood. For many of us being gay or lesbian seemed incongruent with being a parent, yet we had the compelling urge to be mommies and daddies. So we find ourselves living our dream of becoming parents, and our identities have quite a transition to go through to catch up.

 For starters, gay men and lesbians who are new parents have to adjust to being the center of a lot of attention. If you live in a big city where there are a lot of other gay families you will probably be admired and ogled over. If you live in a smaller town or one where there are few or no gay families you may be the object of some hostile attention. Either way, people will likely stare a lot, and this can take some getting used to.

 The thing that goes hand in hand with this attention is a whole new level of coming out. Babies with two mommies or two daddies out their parents everywhere they go. And as the kids get older this becomes more and more of an issue when "passing" by not correcting someone’s hetero-assumptive comment has some very real consequences for a child overhearing. If we are not yet out to co-workers and employers, having a baby will make that omission hard to live with. This continual coming out can be a bit jarring at first.

 For many gay men and lesbians, our parents and family of origin have been less than supportive and we fear that our becoming parents will be a source of stress and judgment. We worry about how homophobic family members will treat our children. My mother-in-law had to have a real “talking to” when she treated my two children differently (I gave birth to one and my wife the other). We let her know that she had two grandchildren or none; happily she chose two, but we would have made the difficult choice to let her go if we had to. Many folks that I work with report fearing that their parents will not accept their children, but an almost equal number come back and tell me that once the baby was born their parents’ or in-laws’ reactions ranged from slowly accepting their grandchildren to immediate complete turnarounds as they fell in love with the baby at first sight, their homophobia dropping by the wayside. Babies can be that magical!

 To learn even more about how other gay and lesbian parents make the transition to parenthood, I did a research project to better understand the experiences of the gay men that I work with. What I discovered made me proud, and I hope that you will find it helpful:

 •     In most respects, life changes resulting from parenthood were very much like those experienced by heterosexual couples: closer relations with co-workers, a transition away from single friends toward other couples (straight and gay) with children, and less time for sleep, exercise, and hobbies.

•     Gay dads were more likely to scale back their careers in order to care for their children than heterosexual dads.

•     These fathers reported that their self-esteem and their closeness with their extended families increased after becoming parents.

•     The fathers in my study reported that their relationships with peers at work improved because of the shared parenting experience. 

•     The couples had been together an average of 12 years, and none had dissolved their relationship after becoming parents.

•     Most fathers reported that relationships with their families of origin had become closer, and that having a baby increased recognition of the couple as a family. 

•     Gay dads in my study derived pleasure and pride in taking care of their children.

•     They also received increasing validation from their families and their communities.

•     Being a parent contributed to greater meaning in their lives.

 While none of these findings surprised me it’s always good to have research to back up your ideas and personal experience.

 No matter how you create your family, the transition to parenthood is one of the most glorious experiences one can have.  And, while there are some unique issues that lesbian and gay parents may face, in the end the baby is the common denominator, and that tiny adorable bundle of magic will get you through it all. But buckle up!

 (My kids are now 15 and 12, so I am working on the next chapter in parenting, “The Transition to Parenting Teens,” which I am expecting to be as exhilarating a roller-coaster as those first 6 weeks of parenting a newborn!)

Kim Bergman. Ph.D.is the founder of Fertility Counseling Services, Inc., providing all aspects of psychological services to individuals and agencies in the field of fertility and assisted reproduction. Dr. Bergman also is a co-owner of Growing Generations LLC.

 

Kim Bergman Ph.D. 2011. All Rights Reserved.  Permission granted to The AFA

Live in the Mount Rushmore State? Better not need a donor.

by Steven Snyder, Esq.

"Fertility is an apolitical condition.  It affects those who share political beliefs with independents, liberals, and conservatives alike.  Treating infertility is about creating new families, a quintessentially universal dream that cuts across all political, religious, and social demographics.  Those who succeed in having the children they so desperately want generally become more conscious role models and more involved members of both their communities and society as a whole.  Allowing those who struggle with infertility to exercise their procreative liberty through all medical and social options available to them has only positive benefits for our society and our national stability.

Fertility comes in all shapes and sizes.  Infertility is caused equally by female factor, male factor, and undetermined reasons.  It is caused by genetic anomalies, physiology, disease, and, in all liklihood, our environment.  Sometimes infertility can be successfully treated with medications or straightforward medical procedures using the affected parent(s)' own reproductive components (egg, sperm, and uterus).  Sometimes successful treatment requires the voluntary cooperation and support of third parties who willingly and happily provide one or more of those missing components.  These third parties, these "reproductive saviors," come in the form of sperm donors, egg donors, and gestational carriers.  These people know the value of having a family, and they choose to help those who cannot realize this dream without assistance.

Clearly, the medical and social options to treat infertility have outdistanced the legislative infrastructure that is necessary to support the intended parentage of the children who result from the various treatments.  Although most states have statutes that automatically establish parentage when sperm donors are used, thereby offering a simple solution to male infertility through sperm donation, few states have similar statutory support for egg donation or gestational surrogacy.  Furthermore, the existing sperm donor statutes only apply to a very narrowly defined traditional family, one that no longer necessarily dominates our social structure.  Our current legal framework for fertility clearly discriminates against women who suffer from infertility and non-traditional families, whether intentionlly or inadvertently.  Our overall social and political objective should be to correct this imbalance and facilitate equal opportunity for infertile women and non-traditional families to have children.  It is simply the socially responsible thing to do.

When the Baby M decision was issued by the New Jersey Supreme Court in 1987, surrogacy was virtually unknown, and it typically involved a genetically-related carrier, also known as a traditional surrogate.  This combination startled society and lawmakers, and, in the next five years, approximately ten states passed legislation that banned or restricted such arrangements.  Then the medical advances eliminated the surrogate's genetic relationship through IVF, and the California Supreme Court issued its decision in Johnson v. Calvert in 1992 affirming the legal parentage of the intended parents in a gestational surrogacy dispute.  Since then, society has generally accepted surrogacy, and every state that has passed legislation relating to surrogacy has either distinguished it from adoption and/or baby-selling or expressly allowed it.  Things were moving in the right direction.

That brings me back to the apolitical nature of infertility.  Infertiliity legislation should be continuing to move forward in all states to facilitate family building of all varieties, including surrogacy.  Unfortunately, that is not the case.  The fiscal conservatives who have been brought into power are also social conservative who oppose infertility treatment in general and surrogacy specifically.  This is nowhere more evident than in South Dakota (see below) where extremely regressive and onerous legislation to criminalize surrogacy has been introduced.  Physicians, agencies, and persons who participate in "commercial" surrogacy are guilty of felonies, and individuals who participate in non-commercial surrogacy are subject to fines of at least $30,000.  The law says the resulting child is placed with the surrogate as the parent unless the surrogate is unfit, and if the surrogate does not want the child, the child may be placed for adoption.

This proposed legislation is out of place in intent, content, and time.  It ignores the reality and general social acceptance of surrogacy, and it abridges various constitutional rights by trying to inappropriately legislate parentage against the parties' intent.  This will not be the last ill-advised and regressive social policy that comes out of the numerous conservative state legislatures that have been placed in power.  Those who experience infertility should be prepared to make themselves heard to protect and further the rights of the infertile by strenuously lobbying against and soundly defeating such legislation.  They shoud make themselves heard whether they are fiscal conservatives, liberals, or independents.  If this is not done, the rights of many to build stable families will be unfairly and inappropriately impaired."

___________________

State of South Dakota 

EIGHTY-SIXTH SESSION

LEGISLATIVE ASSEMBLY, 2011

592S0685

HOUSE BILL NO. 1218

Introduced by: Representatives Hunt, Bolin, Brunner, Cronin, Feickert, Gosch, Greenfield,

Hansen (Jon), Hickey, Hubbel, Jensen, Kirschman, Kloucek, Kopp,

Munsterman, Nelson (Stace), Russell, Steele, Van Gerpen, Venner, and Wick

and Senators Novstrup (Al), Kraus, and Schlekeway

1 FOR AN ACT ENTITLED, An Act to prohibit surrogate mother contracts, to prohibit

2 enforcement of such arrangements, and to establish standards to award custody of children

3 born as a result of such arrangements.

4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF SOUTH DAKOTA:

5 Section 1. The Legislature finds that:

6 (1) The enforcement of surrogacy agreements and contracts is contrary to the best

7 interests of children, to the State policy that custody of children should be determined

8 based upon the best interests of the children, that such arrangements are exploitive

9 of women, that such arrangements are contrary to a mother’s interest in her

10 relationship with her child, and contrary to the State’s interest in protecting the

11 relationship between a mother and her child; and

12 (2) That surrogacy arrangements and contracts, whether written or oral, are in direct

13 conflict with numerous public policies of the State of South Dakota, including: the

14 State’s policy prohibiting offers of money or payment of money in connection with

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1 an adoption; the State’s policy against trafficking 1 in children; the State’s policy that

2 no surrender of a mother’s parental rights or waiver of her constitutional right to her

3 relationship with her child will be enforced if made prior to the birth of her child; and

4 (3) That surrogacy agreements and contracts are in direct conflict with, and are designed

5 to terminate and destroy, the mother’s parental rights, her relationship with her child,

6 and her fundamental liberty and interest in that relationship, contrary to the

7 established public policy and laws of the State of South Dakota.

8 Section 2. Terms used in this Act mean:

9 (1) "Surrogacy," an arrangement, whether or not embodied in a contract, written or oral,

10 entered into by two or more persons, including the mother, sometimes referred to as

11 the "surrogate" or "gestational carrier" or "surrogate uterus", and an intended rearing

12 parent or parents, who agree, prior to insemination, or in the case of an implanted

13 embryo, prior to embryo transfer or embryo implantation, to participate in the

14 creation of a child, with the intention that the child will be reared as the child of one

15 or more of the intended parents, other than the mother;

16 (2) "Commercial surrogacy," a surrogacy arrangement involving the payment, or

17 agreement to pay, money or any valuable consideration to a broker/intermediary, or

18 the payment, or agreement to pay, money or any valuable consideration (other than

19 payment or reimbursement of medical and hospital expenses currently allowable

20 under adoption law) to a mother;

21 (3) "Broker/intermediary," a person, or an agency, association, corporation, partnership,

22 institution, society or organization, which knowingly seeks to introduce or to match

23 a prospective mother with a prospective biological father, or other intended parent,

24 for the purpose of initiating, assisting, or facilitating a surrogacy arrangement;

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1 (4) "Intended parent," a person, whether male or female, whether or not genetically

2 related to the child born as a result of a surrogacy arrangement, who is intended to

3 be the person or one of the persons who would raise the child following birth;

4 (5) "Mother," the woman who carries and gives birth to the child, whether or not she is

5 genetically related to the child.

6 Section 3. No physician, licensed by the State of South Dakota, or agent or employee of such

7 a physician shall assist in the process of insemination or embryo transfer or implantation that

8 is in connection with, or is in any way associated with, a surrogacy arrangement. A physician

9 or other person who knowingly or in reckless disregard violates this section is guilty of a Class

10 6 felony. The prosecutor who prosecutes such violation, and the court before whom the violation

11 is brought, shall, separately and independently of each other, report such violation and

12 conviction to the Board of Medical and Osteopathic Examiners.

13 Section 4. Other than the mother and the intended parents, any person, agency, association,

14 corporation, partnership, institution, society or organization, their agents and employees, which

15 engage in, promote, profit from, solicit a woman for, or otherwise assist in, commercial

16 surrogacy arrangements in the State of South Dakota, is guilty of a Class 5 felony.

17 Section 5. Any person or entity who acts as a broker/intermediary in connection with a

18 surrogacy arrangement, whether or not the person is paid or receives other consideration, is

19 guilty of a Class 6 felony.

20 Section 6. Any person, agency, association, corporation, partnership, institution, society or

21 organization, and their agents and employees, who offers, gives, or receives any money or other

22 consideration or thing of value in connection or association with a surrogacy arrangement is

23 guilty of a Class 6 felony.

24 Section 7. A surrogacy contract or arrangement, whether entered into in South Dakota, or in some other state,

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1 is unenforceable in South Dakota. A custody dispute concerning a child

2 born as a result of a surrogacy arrangement shall be resolved under South Dakota law.

3 Section 8. The mother of a child born as the result of a surrogacy arrangement has the right

4 to primary physical custody of the child following birth. If the child is in her custody following

5 birth, the mother shall keep the custody of the child if she so chooses, before and during the

6 pendency of any legal action to determine custody, unless there is proof by clear and convincing

7 evidence, that she is unfit or she poses a substantial harm to the child. If the child is not in her

8 custody following birth, the mother may exercise her right to take custody of the child, by

9 notifying the person or entity in whose custody the child then resides, in writing, anytime within

10 one hundred twenty days of the date of the child’s birth. Upon proof that such intention was

11 delivered to one or more persons in whose custody the child then resides, the court shall enter

12 an order awarding pendente lite custody to the mother. Any claim that the mother is unfit or

13 otherwise presents a likelihood that she will harm the child can only be made after the child is

14 placed with the mother, and all proof of such allegations shall be established by clear and

15 convincing evidence.

16 Section 9. At a final hearing to determine placement of the child born as a result of a

17 surrogacy arrangement, there is a legal presumption that custody of the child should be placed

18 with the mother. This presumption may be overcome by a demonstration, based on clear and

19 convincing evidence, that the mother fails to meet minimal parenting standards necessary to

20 satisfy the basic needs and welfare of the child. Such determinations may not be based on

21 consideration of economic or social class.

22 Section 10. The intended parent in a surrogacy arrangement which is not a commercial

23 surrogacy arrangement and who is not in violation of the provisions of any of sections 3, 4, 5

24 and 6 of this Act is not guilty of a crime, but is subject to civil penalties of not less than thirty

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1 thousand dollars and not more than fifty thousand dollars for a first offense, and not less than

2 fifty thousand dollars and not more than eighty thousand dollars for a second offense. An

3 intended parent who is guilty of a third offense is guilty of a Class 1 misdemeanor.

4 Section 11. The intended parent or parents has a duty to provide financial support for a child

5 born as a result of a surrogacy arrangement, whether or not the intended parent has custody of

6 the child. There is a presumption that the noncustodial parent of the child born as a result of a

7 surrogacy arrangement should be given parenting time or visitation, unless it is demonstrated

8 that such visitation would be contrary to the best interests of the child. The parenting time

9 should be liberal, based on the facts of the particular case, consistent with the child’s best

10 interests.

11 Section 12. If a surrogacy arrangement is repudiated by either party, the mother is entitled

12 to have all medical and hospital expenses, including prenatal care, and the medical and hospital

13 expenses of the child incurred during child birth and for treatment for any condition of the child

14 immediately following birth, paid for by the intended parent or parents, even though the

15 surrogacy arrangement is unenforceable and the mother has custody of any child born as a result

16 of the surrogacy arrangement.

17 Section 13. If neither the intended rearing parent or parents, nor the mother are willing or

18 able to assume custody of the child, the child shall be placed for adoption in accordance with

19 statute. Until such time as adoption of the child is final, both the intended rearing parent or

20 parents and the mother are obligated consistent with their respective financial abilities, to pay

21 financial support for the child.

22 Section 14. In disputed multi-state surrogacy arrangements within the jurisdiction of the

23 South Dakota courts, South Dakota law applies.

Steven H. Snyder, Esq., is the founding and principal partner of STEVEN H. SNYDER & ASSOCIATES, ATTORNEYS AT LAW in Maple Grove, Minnesota.  Mr. Snyder is Chair of the Reproductive & Genetic Technology Committee of the Family Law Section of the American Bar Association and  chair of the legal advisory group for the American Fertility Association.

Photo: CBS News

 

 

 

 

 

 

 

 

 

 

 

The Unsung Heroes Behind Surrogacy

 

by Iris Waichler, MSW, LCSW

The recent birth of Nicole Kidman’s daughter has brought surrogacy back into the spotlight.  Surrogacy is a treatment option for women who are unable to successfully maintain a pregnancy and have a health baby on their own.  There are two types of surrogacy, traditional and gestational.  Traditional surrogacy is when the surrogate is inseminated with sperm from the infertile woman’s husband or partner and there is a biological connection to the baby.  Gestational surrogacy is done more frequently. It means the intended mother or an egg donor’s eggs are used and the intended father or a sperm donor gives sperm to create an embryo.  The resulting embryo is transferred to the gestational surrogate There is no biological link between the surrogate and the baby. Surrogacy is generally an option when other infertility attempts have been unsuccessful. It is the most complicated family building option in terms of medical, financial, legal, and societal challenges. 

            Sharing a pregnancy with another woman presents its own set of challenges. A surrogate can be a family member, friend, or complete stranger.  They dynamics of this most delicate of negotiations can be influenced by the existing relationship between the parties involved.   Each surrogate arrangement involves mapping out a unique agreement   with ongoing dialogue between the consenting parties about what role the intended parents will play in the pre-natal care, pregnancy, labor, and birth of the child.  Issues like what role will the surrogate play in the child’s life after birth must also be explored. What happens if something unexpected like a medical problem during pregnancy occurs?  Who makes decisions about the medical treatment for the baby and the surrogate? 

            In her recent New York Times article, “Meet the Twiblings,” Melanie Thernstrom described taking time out to meet the husbands of the two women who eventually became her surrogates. I remember saying “bravo” out loud as I read that.  I thought about it and realized that was the first time I heard somebody recognize the significance of the husband of the surrogate. Ms. Thernstrom said “The role of a gestational carrier’s husband is in some ways more difficult then that of the carrier herself.”  I thought Fie, her surrogate, stated it beautifully.  These husbands are “a bystander to a miracle who partakes in the inconvenience of his wife’s pregnancy but has fewer of the emotional rewards.”  The surrogate and her husband as a team must respond to questions and concerns that arise from their own children, other family members, friends, and sometimes the judgments imposed by society.  The husband is directly impacted in the event that a medical problem arises during the pregnancy.

            Hilary Clinton said “it takes a village to raise a child.”  In the world of infertility it sometimes “takes a village” to create a child.  It takes a special woman to agree to be a surrogate and give the ultimate gift to people wanting to build a family. I believe it takes a special husband to support his surrogate wife in making this possible.  We should honor and acknowledge the role of these men and women. You can be sure the lucky families that find them do.

 Iris Waichler, MSW, LCSW, has a Master’s Degree in Social Work and has been a licensed clinical social worker for over 30 years.  She has done workshops, individual, and group counseling with people experiencing infertility.  Ms. Waichler is the author of the award winning Riding the Infertility Roller Coaster: A Guide to Educate and Inspire.  She currently writes freelance infertility and health related articles.

 

Off Camera

  By Jamie Schenk DeWitt

 In today’s world of 24/7 media coverage, and people’s obsession with anyone famous, celebrities are using their influence to change the social and political landscape.  They have moved beyond their traditional movie screen roles to the world stage to express their views on poverty, social injustice and man's inhumanity to man.  I applaud these efforts and the change that has occurred because of their actions. 

One area where celebrities are not consistently honest is in the realm of infertility.  Before I went through infertility treatments, I never questioned the pregnancy of a celebrity in her late thirties or early forties.   There was always a wonderful picture of her pregnant belly and a warm fuzzy story in People Magazine announcing the birth of her baby or babies. Yet after having experienced IUI (Intrauterine insemination) and IVF (In vitro fertilization) I now have to wonder if that same starlet spent months staring at a negative sign on a pregnancy stick or had to hear a nurse repeatedly telling her that unfortunately she was not pregnant, but to try again.  

Don’t get me wrong.  I am not saying that every celebrity who gets pregnant has to announce whether or not she conceived naturally or through artificial insemination.  People are entitled to their privacy.  I only wish that women who were in the spotlight struggling with infertility issues would raise their voices and share their fertility journey to motherhood in order to educate other women about the realities of infertility. 

More and more young women are graduating from college and entering the work force focusing on their careers and personal lives.  They put off marriage and children waiting until their late thirties.  It is important that we arm them with the facts about their biological clocks, so they can make educated decisions about how to be in charge of their fertility. 

When I was thirty-five years old, I received a phone call from my OBGYN informing me that my FSH levels (follicle stimulating hormone) were extremely elevated for someone my age.  My OBGYN was basically telling me that I had “old eggs that were of poor quality.”  I feel that education and awareness can prevent other females from receiving this call.

There are some celebrities who are willing to use their status to educate people about infertility issues. I want to take this opportunity to thank them. Giuliana and Bill Rancic are two such people.  They have openly shared their infertility struggles with their TV audience on their reality series, Giuliana and Bill.   In addition, they have spoken about this issue on The View, in US Magazine and wrote about it in their new book, I Do, Now What?  After having spent a year trying to get pregnant naturally, Giuliana underwent fertility treatments.  She got pregnant via IVF but unfortunately, eight weeks later, she had a miscarriage.  Throughout the couple’s attempts to have a baby, they honestly shared their feelings about the experience, how it affected them and what they learned.  

In an exclusive interview with AOL Health Giuliana states, “It’s just that for some reason, through the years, infertility has been a very taboo subject. These women in Hollywood … I think they just like people thinking they’re perfect. They don’t want to admit they have flaws. They feel like it’s going to somehow hurt their careers. They don’t want to show that they need medical help; they keep it very hush-hush. I felt like I had been duped, in a way, by a lot of these women. I’ve been interviewing actresses for the last 10 years, so I would see them and I’d go, “They’re so fabulous. I want to live like that! I’m going to focus on my career, and then at 40, I’m going to have twins!” I would talk to these women and be like, “So, ‘blank actress,’ you’re 41, and you just had twins and that is so amazing.” And they would say, ‘Well, twins run in my family!’ I remember, someone told me that as you get older, your chances of twins are more likely. Well, now I know that’s because at 40, you’re doing IVF. So that’s why this is important to me. Regular women need to see women in the spotlight having problems.” 

Rancic continues, “My thing was, I knew nothing about any of this. I thought I was still so young. We did IUI and that didn’t work. We did more tests, and [the doctors] said, “You’re 35, and your eggs are old.” And I’m like, what? I was so shocked, and I said to myself, had I known it was going to be so hard to get pregnant maybe I would have frozen my eggs at like 30 or 28."

Thank you again Giuliana and Bill for openly sharing your experience and being pioneers willing to step out from behind the camera to honestly share your fertility journey to parenthood.

For a more detailed list of starlets and celebrity couples that have been openly discussing their struggles with infertility please check out: http://abcnews.go.com/Entertainment/slideshow/celebrity-infertility-battles-10542271

Photo: Celebrity Baby Scoop

The Amazing Story of the Birth of the “Twiblings”

by Iris Waichler, MSW, LCSW

           For those of you who haven’t read it I strongly encourage you to read Melanie Thernstrom’s New York Times Magazine article called “Meet the Twiblings” at http://www.nytimes.com/2011/01/02/magazine/02babymaking-t.html.

Ms. Therstrom and her husband use an egg donor and 2 different gestational carriers that end up giving birth to twins that are born 5 days apart. I loved this article for many reasons.  She candidly discusses a multitude of issues that will be familiar to many who experience infertility.  Examples include:

1.      Beginning infertility treatment later in life.

2.      Finding a doctor that will show empathy but be honest about your best chance for success in having a healthy baby.

3.      Unscrupulous surrogacy and egg donation agencies.

4.      Legal challenges of surrogacy.

5.      Societal judgements about infertility treatment, surrogacy, and egg donation.

6.      What role do you want your egg donor and surrogate to play in your new family’s life?

We learn about Ms. Thernstrom starting out at age 41 meeting her eventual husband.  She undergoes 6 treatment failures in her attempt to have a baby. Her doctor poses a critical question that changed her life.  He asked “Is your goal to have the experience of being pregnant or is your goal to have the best chance of having a healthy baby?”  I believe that question is not asked often enough by physicians.  It is the primary question those who have had repeated fertility treatment failures need to ask themselves.

This article is filled with valuable information those in the midst of infertility treatment can apply. There is a wonderful description of meeting the 2 women who eventually become her surrogates. Fie, one of the surrogates, goes over the surrogacy agreement line by line and she and Ms. Thernstrom carefully discuss scenarios so they have a clear agreement about how to proceed. They talk about whether the surrogates will provide breast milk after the baby is born? Consider questions you must ask like who pays living costs if your surrogate is unable to work due to the pregnancy?

The surrogate’s husbands were involved and met with the Thernstroms. The role of the surrogate husband is important and is rarely considered.  Their support is invaluable during their wives pregnancy.  Ms. Thernstrom observed her surrogates in their roles as parents and that was a major consideration for her in choosing them.

We learn about Ms. Thernstrom meeting her egg donor.  It was important for her to meet the donor.  Some choose to use an anonymous donor.  She describes looking at the woman who became her egg donor and thinking “When she flashed a smile, I wondered if I had caught my first hint of my child’s grin.”  There is that natural inclination for the perspective mother to make comparisons between herself and her egg donor.  Consider your feelings about that and what role if any you want your egg donor to play in your future child’s life.

The Thernstrom’s speak with the director of their egg donor agency about disclosure. She recommends “tell everyone or tell no one.”  Disclosure is one of the more challenging aspects of infertility.  You need to decide if you want your child to hear directly from you in your own words about their birth.  You may risk your child possibly learning from someone else. How  will that impact your child and your relationship with him/her?

Using a surrogate or an egg donor requires a huge leap of faith. You have to trust that the donor is honest about their medical history.  You want to believe your surrogate will take all the necessary steps you would to be as healthy as possible during the pregnancy.

Ms. Thernstrom coins the phrase “twiblings” to describe her children.  The same egg donor was used and the embryos were transferred the same day. The kids were born 5 days apart from two different gestational carriers. She also uses the word “Fairy Goddonor” to describe her egg donor.  Much like Sarah Palin’s word “refudiate” I hope these words should become an accepted part of English language.

            I thought a lot about this remarkable story. This particular case involved a small “village” of people united together to create a family. I applaud the courage of Ms. Thernstrom for telling her story in such a public forum.  She has gotten both praise and unwelcome comments from friends, professionals and strangers.  I realized that all of us have a unique story to tell about how we become a family. It is our choice how and whether to tell it or not

Nurturing the Nature of My Child

 

by Iris Waichler, MSW, LCSW

           Many of us have been exposed to the argument about what shapes the personality of children, nature or nurture. Nature represents heredity and nurture equals environment in this equation.  It is an especially compelling question for those of us who have a child through adoption or through the generosity of a donor.  What impact does genetics have?  How effective can I be as a non-biological parent?  These were thoughts that I had after the birth of my egg donor daughter. 

            We chose a donor that had my physical characteristics.  Grace was born with dark brown hair like mine.  She had dark hazel eyes with wisps of brown. My eyes are brown.  Over the 10 years since she was born there have been several comments about how much we look alike.  As far as I know she does not have the “cancer gene” that my family members carry.  I have followed the lessons learned from the genome research examining our DNA and genetic heritage with great interest.

My 35 years as a social worker have led me to lean on the side of nurture. It feels safer, more familiar, and something I sometimes fool myself into thinking I have some control over.  I have heard those stories about identical twins raised apart that do end up differing in behaviors and other ways. I am perhaps naively optimistic that my behavior, parenting effectiveness, and the home/life environment we have created can help her grow into a healthy, intelligent, happy adult. I have reluctantly let go of my desire to see her become a softball all star. She shows no interest in sports of any kind.

Shortly after Grace was born I went to a lecture about raising an only child. The psychologist speaking told us that genetics does play a part in creating ability and some traits (aside from physical) are influenced by the child’s environment.  I do know Grace and I share the same sense of humor, a discipline about completing our work, and the joy of spending time with good friends and family.  Our values are similar as is our love of pop culture.

The conclusion I have drawn from all of this is rather than nature vs. nurture it is really a combination of nature in conjunction with nurture.   I remember that psychologist I heard use the words “cause and effect.”  I think now after a mere 10 years of parenting under my belt I have a better understanding of what she meant.  Even if we are born with a genetic disposition, there is not a 100% guarantee that something will occur in this predetermined way.   Medical interventions are available.  Lifestyle changes have a big impact.  Behaviors can be shaped and nurtured.  I choose to believe anything is possible.

Iris Waichler, MSW, LCSW, has a Master’s Degree in Social Work and has been a licensed clinical social worker for over 30 years.  She has done workshops, individual, and group counseling with people experiencing infertility.  Ms. Waichler is the author of Riding the Infertility Roller Coaster: A Guide to Educate and Inspire. She currently writes freelance infertility and health related articles.

Source:

http://www.theafa.orgplay/library/article/what_to_expect_when_expectinga_donor_child/

 http://www.ivf.net/ivf/behaviour-nurture-not-nature-says-ivf-children-study-o5597.html

The Emotional Challenges of Choosing Egg Donation

by Iris Waichler, MSW, LCSW

 I was 42 years old when I started my infertility journey. My only treatment option was an egg donor.  My husband asked if it would be hard emotionally bonding with the baby we desperately hoped would come.  I had talked to others who expressed doubts about not having a genetic link. They were afraid of its impact on their ability to bond and parent.                                                                                 

I honestly never experienced these reservations.  I understood I would not have a genetic link but a “biological” one.  I knew my blood would flow through my future baby. My baby was dependent on me to survive during my pregnancy. Those bonds were strong for me. My genetic history was not problem free.  My mother died of breast cancer.  I had additional cancer history in my family. I was grateful that my future baby would not inherit that.

I remember sitting at our kitchen table with a pile of forms submitted by potential egg donors.  We had waited 9 months to receive them. We couldn’t believe this moment had come. There was information on their ages, physical characteristics, ethnic/racial backgrounds, education levels, and work histories.  Some explained why they wanted to be donors.  Medical and psychological information was available. What surprised me was how uncomfortable I felt having to make a choice.  I didn’t like being in the position of deciding if a college education was better than a high school education.  Maybe she didn’t have the money or support needed to go to college.  Perhaps she didn’t want to go to college.  We had to make choices with the limited information in front of us. We used an anonymous donor and didn’t have photos to influence us.     

Finally something I could control during infertility treatment yet I felt conflicted about having to make decisions based on our donor information. I was aware the choice we made today could potentially impact our lives forever.  This moment was one of the most challenging during my infertility experience.  One donor had completed high school. I read more and learned there was a history of alcohol use in her family and she was working in a bar. That was a red flag for me.  Was that fair? 

I realized we were totally dependent on the information presented to us.  We had to trust that women who generously offered to be egg donors were honest about their histories.  We knew the agency we were working with had an excellent donor screening program.  It is a leap of faith and you hope for the best.  You just do your research to ensure the donor and program used are reputable.

Years later I was privileged to meet a panel of egg donors at a conference. I wondered how it felt being on the donor side and what their donation reasons were. Their explanations were diverse. Their conviction that egg donation was the right thing to do to help others who couldn’t have a child was universal.  None of them expressed a desire to know the children born as a result of their egg donation. They happily accepted the necessary sacrifices.

When you select an egg donor carefully consider what is important to you.  Do you want to meet your donor?  Should you share an ethnic background?  I wanted my child to have physical characteristics similar to mine since we would not have that genetic link.  Those of us who become parents as a result of egg donation are given the greatest gift one can imagine.  I never forget that.  I try to be the best parent I can as a way of thanking her.    

Iris Waichler, MSW, LCSW, is a licensed clinical social worker who has counseled people experiencing infertility.  Ms. Waichler is the author of the award winning book “Riding the Infertility Roller Coaster: A Guide to Educate and Inspire”. She currently writes freelance infertility and health related articles.

What Lessons do Our Kids Teach us about Disclosure?

 

  by Iris Waichler

         There is some debate in the infertility community about how and when to disclose to your children how they became a part of your family.  My husband and I were united in our belief that our daughter should know she was an egg donor baby.  We agreed to start as early as possible.  I created a disclosure book for her when she was 2.  It has pictures of daddy dating mommy, daddy and mommy getting married, an embryo and lab, our daughter’s hospital bracelet, and baby pictures. Accompanying the photos was age appropriate text explaining how much we wanted a child, a generous gift lady gave us her eggs, and the joy her birth gave us in creating our new family. We read it often. I wondered what she understood.

            When she was 3 we were at fantasy kingdom. I was close by and heard a woman ask my daughter if she had any brothers or sisters.  My daughter told her “my mom’s eggs are too old and she couldn’t make any more babies.”  The woman turned ashen and slowly backed up into the pretend fire station.  It was my first opportunity to see how she had understood her conception. 

            Every year at school they do a program to teach kids everyone is special and unique.  In 4^th grade her teacher asked the kids to tell something about themselves nobody else knew.  Her teacher tearfully told us at our parent teacher conference how my 9 year old daughter had proudly shared with her classmates she was born because of the generosity of a gift lady who donated her eggs to help create Grace for our family.  It gave the next child the courage to share his autism diagnosis.                                                  I have counseled others about disclosure.  I tell them make sure you are comfortable with disclosing before you discuss it with your child. Keep it age appropriate.  If you don’t disclose and your child learns how he/she was conceived how will it impact your relationship?  Remember disclosure is a process that continues as your child grows and needs more information to understand who they are, where they came from, and how they fit in your family.

            Since that teacher conference I have thought about the lessons my daughter had unknowingly taught us.  She did tell me about what she said that day in class. Understanding her origins is not a source of shame but a source of pride for her.  Being an egg donor baby doesn’t make her feel different or abnormal. It is simply a part of who she is.  She won’t be afraid to talk about it with us or her friends if new questions arise.  She has several friends in our playgroup who were also egg donor babies. They all know it and will be there for each other if the time comes they want to discuss it as peers.  I like to believe our starting the disclosure process early and normalizing it helped her get to where she is today.   At least I hope so.

Iris Waichler, MSW, LCSW, is a licensed clinical social worker who has counseled people experiencing infertility.  Ms. Waichler is the author of the award winning book “Riding the Infertility Roller Coaster: A Guide to Educate and Inspire”. She currently writes freelance infertility and health related articles.

A chance to listen, learn and speak at PET's Debate: Paying Egg Donors - A Child At Any Price?

by Lisa Marsh, The AFA's London Correspondent

There are times when I feel very fortunate to live within easy commuting distance of central London and last night was one of those.  Instead of the usual household chores and evening TV shows, I popped into London to attend a debate organized by the Progress Educational Trust (PET) at the Royal Society of Medicine: "Paying Egg Donors: A Child At Any Price." It was well worth the effort, to be privy to the information and opinion of several eminent speakers on the panel, as well as those audience members from the fields of medicine, counselling, government, related charities and scientific research.

One thing about which there is no debate is the extreme shortage of egg donors in the UK. The Human Fertilisation and Embryology Authority (HFEA), which currently regulates the providers of fertility treatment such as IVF using donor eggs, will be considering various models of compensation in January, 2011, as a possible means of boosting supplies of donor eggs. as well as reversing the increasingly popular choice among British residents to travel abroad for fertility treatment.  At the last HFEA Open meeting on the 8th of September, 2010, which I attended, its chair, Prof. Lisa Jardine, made no bones about the fact that she is concerned that fertility treatment providers in foreign countries may not be subject to the same stringent oversight as in the UK, therefore creating a risk to patients. Others' objections to "fertility tourism" may be equally concerned about the loss of revenue to UK fertility clinics, exploitation of egg recipients' desperation for a baby, and the trading of human, genetic tissue (gametes) as a moral issue.

Currently, in the UK, egg donors are only compensated for their expenses, which include loss of earnings for days of work missed; a daily maximum of £61.28 or a total of £250.  The questions regarding payment were these:

1. Should compensation merely compensate for lost earnings, or for additional factors such as risk to the donor, drug treatment, sexual abstinence and/or pain and discomfort? If the latter, then how much compensation is reasonable, to leave the donor no worse off than she was before the egg donation, but no better off financially?
2. Is egg sharing morally favourable because the donor is giving her eggs to another woman, or is it merely a financial transaction (trading of human eggs for financial gain) by another name (donors receive a discount on their IVF)?
3. Should egg sharing be limited to altruistic donation in which the donor has no expectation of any financial payment, or other compensation?
4. If there is no legal barrier to a woman giving her eggs to someone else, why shouldn't she be able to sell them?

One panel member, Brenda Almond of the Philosophical Society of England, likened the trading of genetic material, cells, to the slave trade.  She cited libertarianism, as a philosophy holding that the vulnerable should be protected, to support her assertion that human eggs, which could one day become embryos and eventually, a living child, need protection. I assume what she meant is that the children who are born of those eggs are not able to assert free will over how the transaction takes place.  She also posed the question of whether, by performing donor egg IVF, clinicians are violating the "do no harm" rule, as there is inevitably emotinal impact upon the donor, the recipient, the donor's children and the recipient's child.

While I don't doubt that Ms Almond holds sincere views on the subject, these controversial views, were, in my opinion, stated for effect last night. While I don't subscribe to her views, I was very open to hearing everyone, but found her to be the least persuasive of all the speakers. My belief is that the slave trade argument doesn't apply, as :

1. the egg is not "human flesh;"
2. if produced by the donor, but unused to create a pregnancy, it would otherwise go to waste; and
3. there is no human child, if the egg is not fertilized with the intended father's sperm and carried in the intended mother's womb.

Opinions diverged widely during the debate, much of it focusing on what the donor could reasonably expect to receive for giving her eggs to intended parents. In egg sharing a woman, who is already planning to have an egg retrieval for her own IVF, can expect to receive £2 - 3,000 worth of fertility treatment as a benefit.Several people present last night voiced opinions that egg sharing is really egg trading because of the value of the benefit received, making it a financial transaction by another name.

But, what of the healthy, fertile woman who doesn't need IVF? She may want to give her eggs to a specific woman; a sister, friend or stranger, completely from a place of generosity. There are avenues for making this gift, such as Altrui - an egg donation scheme that matches donors and recipients. One such woman, Laura Witjens, Chair of the National Gamete Donation Trust, and a mother, sat on last night's panel, personally advocating a payment to egg donors of approximately £700.  She believes that amount would be enough to cover the donor's costs, and constitute a gesture of appreciation for the value attached to the donation, without being potentially exploitative....not enough money to change the donor's life, pay off their debt, etc... Interestingly, while Witjens' twins were naturally conceived, she stated that if she had been infertile, she absolutely would have paid for eggs to become a mother.

Some of the people present at the PET debate, both on the panel and in the audience, batted back and forth the idea that knowing their biological mother received payment for the egg that created them would be psychologically damaging. Some people may have difficulty coping with the knowledge that they sprung from a donated egg, regardless of the issue of payment. How is this scenario any different from adoption, where adoptive parents must prepare themselves for educating their child about their origins in a sensitive and understandable way? Raanan Gillon, Chair of the Institute of Medical Ethics, countered that argument in the best way possible; saying "the alternative to having a donor-conceived child be upset about the egg being bought, would be that they don't exist at all." Quite right. How many people would wish they had never existed and their parents never having had children, rather than any payment being made to the donor?

In regard to the argument of almost-inevitable harm, I have to ask: "so what?" The donor should be provided with counselling prior to carrying out the egg retrieval and donation, to ensure that she understands the physical risks and emotional ramifications involved.  Her existing or future children can be raised with the message that Mom did something generous to allow another woman to have a child who would not otherwise have been able to do so. The recipient is surely informed about all of the angles of the process and should be counselled up until she conceives, if not afterward as well. The donor-conceived child is the one who needs the most attention and sensitivity.  Yes, there is a risk, especially in cases of anonymous egg donation, when there will be a loss of genetic connections with biological maternal relatives. This could cause feelings of not belonging, incomplete sense of identity.  However, anonymous donation was not the topic of the evening.

In the case where the donor-conceived child will have the right to seek their biological mother at the age of 18, his parents have the responsibility of preparing their child adequately for what he may discover. Prof. Brian Lieberman, Medical Director of Manchester Fertility Services, called for all of the exchanges taking place in egg donation to be open and transparent. I believe it was he who said that his overriding concern for the donor-conceived child is that they are able to feel proud of who they are and how they are created. That, to me, is the goal in raising any child, conceived naturally, through assisted reproduction techniques or adopted. That message is one of love and belonging.

Much was made of the US free-market model for egg donation, the range being quoted as anywhere from £8 to £19,000.  While Prof. Gillon did not see payment for eggs, in itself, morally objectionable, the consensus of most panel members and speakers from the audience was that if payment was made it should be a regulated, fixed fee, rather than a market-driven fee like in the US.  Among that group, a lump-sum fee of an amount between the current £250 and Laura Witjen's suggested £700 seemed to be favoured; the amount resting on the difference between inducement and coercion.  For those willing to embrace a fee at all, this amount was sufficient as an inducement to give something of value, the egg, to someone else which requires the donor to experience some physical risk and inconvenience. Anything more, in their opinion, could make a change in the donor's lifestyle, therefore running the risk of coercing that person to do something which they might otherwise believe immoral or otherwise wrong. Dr Sue Avery, Director of the Fertility Centre at the Birmingham Women's Hospital and a panel member, felt that the "lump sum argument is fallible, because any amount will be an incentive to someone to do something they would not otherwise wish to do."

You may be interested to hear my contribution to the debate. I had had no intention, whatsoever, of speaking; however at the end of the evening, I felt it necessary to point out that it was all well and good debating ethics in a vacuum, but it should not be forgotten that real people are involved here.  The British government, associated with the Church of England, promotes family values. The evidence is undeniable that most people want to create families and they are not willing to let a diagnosis of infertility come between them and a baby. The country is proud of the breakthroughs in medical science that have occurred here, and more money has been made available for fertility treatment through the National Health Service (NHS). However, there are still many couples who find themselves shut out, some by the severe shortage of donor eggs available.

I shared with the PET audience that my husband and I never got to the point where I was told I couldn't go any further because of a shortage of donor eggs. We felt let down by the medical system here that moved at a snail's pace in responding to my infertility and then told us I was too old to qualify for IVF under NHS regulations. At 42 years old, with few quality eggs left, using donor eggs would have had to be my next step if we had gone further. (I am one who, like the cliche, miraculously conceived naturally 3 months after my failed IVF cycle.) I have clients who are in the same position now that I was in ten years ago. Faced with the probability that their own sub-standard eggs mean they will never conceive, I believe that most women would be willing to pay something in appreciation for this priceless gift from another woman.

As Laura Witjens pointed out, "patients vote with their feet." If they cannot get access to the assisted reproduction techniques they need to create their families in the UK, they will seek them out elsewhere, even if payment must be made. If the government wants those needing fertility treatment to stay in this country, it has to make concessions to the needs and desires of those concerned. It can't rely upon "in the best of all possible worlds..." but, instead, must make the world we live in as easy to negotiate as possible, in a positive way, aimed at a positive result.

If you have been an egg donor, used donor eggs or just have an opinion about whether payment should be made to an egg donor, and if so, how much, I would like to hear from you.

Lisa Marsh is an American fertility coach who lives and works out of London, U.K. and London correspondent for The American Fertility Association's blog page.  You can find more information about Lisa’s work at http;//yourgreatlife.typepad.com  or follow her fertility and miscarriage-related Tweets on Twitter @yourgreatlife.

Desperate Housewives

by Merry Armentrout

Fall is here (at least in New England).  The leaves are starting to change color, the air is getting crisp and my TiVo is ready to roll.  I have a handful of favorite shows, and last week was full of season premiers for the fall line-up.  Idon't consider myself a TV junkie, but do relish those few hours a week where I'm able to see what kind of trouble my favorite characters (fictional and real) get themselves into and out of.  

I wrote a blog on the TV show Glee last season.  I think the show is wonderful, but I'm actually more impressed with the subjects the show broaches- infertility, adoption, LGBT family building, to name a few.  These are the things The American Fertility Association supports, and the conversations we want to take place in the mainstream- such as a prime time TV show. 

You can also find these conversations on Wisteria Lane.  Desperate Housewives capped off season six with Gaby, played by Eva Longoria, offering to donate her eggs to a gay couple, but at the last minute changes her mind, causing the Lee and Bob to break-up.  Though this television show is fictional, the issues it raises are reality for many people.

The AFA is dedicated to educating and supporting all men and women concerned with family building - including hopeful lesbian, gay, bisexual and transgender (LGBT) parents. One way this is achieved is through third party reproduction.  There are many reproductive options for gay men and lesbian women, including a resource directory to find such services.

I have to admit, I'm a bit biased toward Desperate Housewives. Brenda Strong, the voice of Mary Alice Young on the show, is the national spokesperson for The American Fertility Association.  Strong struggled with infertility, and found yoga helped alleviate the stress brought on while undergoing fertility treatments. 

It might seem like a little thing, including infertility and family building in a TV show.  But it's the little things that become part of the bigger picture in today's reality for hopeful parents.