By Nancy Freeman-Carroll, Psy.D.
Most parents get a little nervous the first time their young child asks the question, "Where do babies come from?" This question, and the answer, are both more complicated when the child asking was conceived with assisted conception—IVF, donor egg, or donor sperm. Although it often makes parents squirm, this inquiry is an important step in a child's awareness of himself and the people around him.
A typical first answer might be something like, "when two people love each other they can make a baby." This answer is simple--short and sweet. For a preschooler, this is usually enough information to begin the ongoing conversation about intimacy, sexuality and family most parents hope to have with their children. The first words on the topic are not so straightforward for individuals who have struggled with infertility.
Briefly, assisted conception usually means the use of a donated gamete to conceive a child. A gamete is a reproductive cell, such as a mature sperm or egg that is capable of joining with a gamete of the opposite sex to produce the fertilized egg that will grow into an embryo, then a fetus, and eventually become a baby. Families choose donor gametes when there is no other way to conceive a child. Some reasons for this include: infertility, which affects about 10% of the population; advanced maternal age (i.e. over 35); same-sex coupling; and the wish of an unpartnered person to have a child.
The American Society for Reproductive Medicine recommends families explain the use of assisted conception to their children. When the need for donor gametes is most obvious (e.g. in families with gay or lesbian parents), children typically grow up knowing something about it. Although many heterosexual families intend to tell their children, their qualms about how to start this conversation can get in the way.
Parents' concerns are understandable. The discovery that one cannot conceive a child without a donor gamete is a life-altering event that is, at best, a significant emotional adjustment, and at worst, a trauma. The acceptance of this reality can be slow and painful, and may remain unresolved even after a baby finally arrives.
Parents may postpone telling their children, friends or family because they worry that disclosure will be painful and stigmatizing, for their children, and for themselves. However, when parents delay talking, they can miss the opportunity to make donor conception one of the basic things a child knows about herself from a young age. In my experience, nearly everyone who uses donor conception has questions about how to talk about it with their kids.
When talking to a child about donor conception, I recommend the following:
- Start early. Talking with the child, even before she can understand, gives parents time to get used to telling their story; to identify and mange the painful feelings that remain attached to the decision to use donor conception.
- Remember children will be curious. Children will approach the idea of donor conception with interest because they have no preconceptions about what is the "right" or typical way to be conceived, or who is in a family.
- Explain that 3 things are needed to make a baby:
A special cell from a man or daddy that is called a sperm cell
A special cell from a woman or mommy that is called an egg or ovum cell.
A special place inside a woman's or a mommy's body where the baby will grow.
- Explain that sometimes these 3 parts come from the two people who will be the baby's parents AND sometimes another person is needed to help make the baby. It is possible that two or more people may be needed to help make a baby. We call these peoples donors.
- Identify what kind of donor was needed for your family. Parents should emphasize their love for each other and their determination to create a family. They can also introduce the known facts about the donor.
The advantage of early disclosure is clear: there is time for children to learn gradually about assisted conception, just as they learn about so many other things that define their families and themselves. However, it is never too late to provide information about donor conception.
Research conducted with adolescents suggests that teens told for the first time about their donor conception are able to empathize with their parents' effort to create a family. Teens recognized the difference between a parent and a donor, and awareness of donor conception did not change the role of the parents in their lives. The teens asserted that children are entitled to this information because it's relevant to their identity.
Families begin when parents conceive the idea of a child--the child grows first in the mind of the parent(s), in plans to get pregnant or obtain assistance to create a pregnancy, and in dreams for the future. When children ask "Where do babies come from," they are also inquiring about their parents' thoughts and feelings; they are asking, "how did you get ready for me?" What they most want to hear from their parents is, "Listen, this is the story of how I began to think of you! This is the beginning of our family."
Nancy Freeman-Carrol, Psy.D., is Supervising Analyst at the William Alanson White Institute and an active member of the Mental Health Professionals Group of the American Society of Reproductive Medicine. She is in private practice in Manhattan.