Life After Assisted Conception (ART) by Nancy Freeman-Carroll, PsyD

From: NYSPA Division of Psychoanalysis nyspa@nyspa.org
Subject: Psych-e-News
Psych - e - News
An Online Magazine from the
New York State Psychological Association
Division of Psychoanalysis
Issue #7 Winter 2010
In This Issue
Life After Assisted Conception (ART)

Carly told me that she felt she was the only mother on the playground with her secret. She had been hiding from the other mothers the fact that her own twin boys had not been conceived in "the normal way" because she feared rejection by "the motherhood club." Carly was so preoccupied by enormous self-consciousness and sadness that she hadn't noticed the other women in her neighborhood who had also needed infertility treatment. As she and I began talking about this, we came to see times in her past that she had felt different from others. Those earlier experiences had laid the ground for feeling so powerfully isolated now. The deeper understanding of this aspect of herself helped to reduce her self-consciousness, and her mood lightened. It gave her room to consider the way she, and not "the motherhood club," experiences being a mother.

The psychological impact of infertility can last a long time, even after the birth of a much-wanted child. The discovery and treatment of infertility can strain coping mechanisms, leaving even the most confident individual surprised by a profound sense of inadequacy and failure. When the treatment is successful and a child is born, the pain of trying to have a baby can now subside. But its toll--feeling powerless, alienated from peers, and battered by the losses--may linger. In the support groups I have run in my office for parents who created their families with Assisted Reproductive Technology (ART), men and women talk about unresolved feelings: the unfairness of medical conditions, the mystery of infertility, and regrets for waiting to have children.

Guilt, self-criticism, anger and despair related to infertility can be confusing and disruptive, particularly when projected onto others. Some parents worry, for example, that their child will be stigmatized and not accepted as a "real" part of their extended family or socially ostracized at school. I help them to see that their own unresolved feelings are the source of these worries. In order to move on, they must acknowledge and accept these feelings, and let go of the idea of conception as they thought it "should be."

Assisted conception represents a "final frontier" in social and scientific terms. Parents using it today are adventuring into unknown terrain and can feel lost and alone. Although thousands of children are born through ART every year, assisted conception often remains hidden.

Conception occurring outside of the womb is commonly referred to as In Vitro Fertilization (IVF). IVF may use the parents' own ovum and sperm to conceive, or one or both can come from a donor, with the possible addition of a surrogate mother to carry the embryo as it develops. Gamete (ovum or sperm) donation is a complicated and sensitive psychological experience for both men and women. For example, a woman must accept both the loss of a genetic connection to her child and the addition of an ovum from another woman. This mental adjustment strains her sense of self, identity, and physical integrity. Each of these areas is vulnerable to the influence of past traumas, and the legacy of the woman's own early family experiences. For men, the need for a sperm donor may be equated with inadequate masculinity and provoke a similar crisis. Some women feel the most discomfort as they search for a donor like themselves, reflecting a desire for sameness that may be impossible to satisfy; for others, worry about the donor's otherness increases during pregnancy or heightens post-partum depressive feelings.

ART families are both similar to and different from families created through adoption or sexual intercourse. I encourage couples to define family for themselves and use this idea to think about genetics, biology, and environment. While genes matter, their significance is mysterious and intricately connected to the context in which they merge. Truths arise that may seem contradictory: Donors contribute genetic material, but they are not parents to the child conceived with donor gametes. Healthy families created with ART learn to balance what they know about and what they can only guess.

When should I tell my children? What if I have very little to tell them about the donor? Will they ask me if I'm still their mother or father? What should I say? What will it mean to me if they want a relationship with the donor? Most parents seek help with these questions as their children reach preschool age. At this age, some parents also admit to pain about feeling different from their children--in appearance, talents, or personality. In general, men and women are relieved to come together to talk about the simple pleasures and complicated realities that shape their lives thanks to the possibility of assisted reproduction.

Talking about conception with a child is also a way of talking about sexuality, and parents may bring the same discomfort and inhibitions to both topics when discussing them with their child. One parent began by reading her four-year-old daughter a storybook about ovum donation and asked me in amazement, "Is everything okay if she doesn't ask a lot of questions?" This mother had expected her daughter to want to know more about her donor, but found instead that her little girl enjoyed the story and treated it like any other book she liked: She asked to hear it over and over again. The mother's anxiety betrayed both her wish and her fear about talking with her daughter. Both benefited when mother was able to consider in advance what she wanted her child to know, aware that the two of them will say more and more over time.

Recent studies (notably the work of Susan Golombok in England) show that families created with donor gametes are doing well; families who disclose information about the use of donors may be doing even slightly better, with more openness and less conflict reported between teenagers and parents. In my professional work with families created with ART, we find ways to speak about donor gametes and the meaning of family and genetics, so that the families created with assisted conception can accept the ambiguities involved, and thrive.

Nancy Freeman-Carroll, PsyD