Two third-party reproduction articles on the occasion of Father's Day

I saw both of these pieces today in the New York Times and found them really moving and thought-provoking, each in their own way.

The first, A Father's Day Plea to Sperm Donors, is an essay written by an 18-year-old young man conceived by his single mom and an anonymous sperm donor on what it's been like for him identity-wise and how he's handled the big question mark that is one side of his genetics. His essay calls for donor gamete children to be able to contact their donors and know about their origins. And his yearning is palpable: "I am sometimes at such a petrifying loss for words or emotions that make sense that I can only feel astonished by the fact that [my father] could be anyone."

The second, Baby Makes Four, and Complications, is a long piece about an unconventional family made up of a single mom and her very young son, and on a part-time basis by the boy's biological father, who is a gay male friend in a relationship, and who views the child not particularly as his son but sort of as a nephew. It's a somewhat self-indulgent psychological portrait of what it means to be a family - and how the concept of family is evolving and changing beyond traditional definitions. The plan is for this child to know at some point that his "uncle" is actually his father. Who knows what his reaction will be to this head scratcher. ("...Wait you're my biological father but you decided to take a role more like my uncle?!")

I liked both articles because they caused me to reflect on the choices Will and I are considering that might lead us to have a child who is not genetically linked to one or both of us. A child who might or might not know of their origins. It strengthens my already fairly firmly held belief that it would be psychologically easier for our child(ren) - if they come to us through third-party reproduction - to know as much about their donor origins as possible, including, potentially, the chance to meet their donors. It makes me think of the potential ramifications of using the donor embryos we have been offered. In that scenario, our child would be related genetically to neither Will or me, but would on the plus side be able to meet their genetic father and sibling (but on the downside never meet or know much about their genetic mother, since she would be an anonymous egg donor). And it drives home that if we go the donor egg route in the future that we would probably want to use an agency and specify an open donation arrangement so that our child could answer any identity-related questions they had when they get to an age (adolescence?) that those might come up.

I had a long and fascinating conversation last week with a bioethicist on my medical school faculty whose area of specialization is reprogenetics. Among many other things, we spoke about why people feel such a strong pull to have a genetic connection to their children - and where such a drive comes from. And she gave me a reading list (which I will share in a future post) of books discussing the ethics of reproduction and human genetics (PGD, microarray, etc).

Reading these articles today also reminded me of something. I tend to view my difficulty with giving up on a genetic child as a personal shortcoming. A limitation that is some sort of character flaw. (We've recently realized it is also the very real existence of our five chromosomally normal embryos. If they weren't out there, I think we'd be ready to leap off of the genetic track pretty rapidly. But they ARE there.) But it is not just my own comfort level with giving up on a genetic link that needs to be considered. It is also about our future offspring's potential feelings about that loss of genetic connection and what that might mean to him or her as they grow up. I don't want our children to ever suffer any pain or difficulty. And I hope that if we use third-party reproduction down the line that we won't be inadvertently causing our child some future strife or additional difficulties. I hope instead that they would take away the main message: that they were so, so wanted that we were willing to go to great lengths to bring them into our lives. That they are cherished and that we are just over the moon thrilled to be able to parent them.

Tell me what you think. How did these articles strike you? For those who have used third-party reproduction, how do you imagine any donor issues might affect your children down the line? Or am I the only one who thinks about these things?

Finally, Happy Father's Day - to now and future fathers.

Mo

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To Molly and Caroline

We wanted to take a moment to respond here to your comments on Mo's last post, as you left no way to reply to you directly. We are not sure where you come away with the impression that we see adoption as “inferior” or “second best” to any other family building option. (Although clearly you see some choices as superior to others.)  

We are fortunate to come from large extended families that are multicultural and multi-ethnic.  Like many families today, these families have been built in numerous, creative ways. Many of our nephews and cousins came into this world the traditional way. Others came through alternative pathways: several through IUIs and meds, four by IVF, two through surrogacy, and two through adoption.  Luckily, all of the children are loved individually and it makes no difference how or when they came into our lives.  And we do not judge their parents as less than for whatever choices they have made to be able to have children.

Adoption isn’t a lesser choice. But we would also like to point out that surrogacy and egg donation aren't lesser choices either. And adoption, while a wonderful choice, is by no means an easy or certain path; we would strongly argue that it is not "easier" than medical interventions - just different. (Those who have pursued both, please feel free to chime in.) To clarify, we have not been considering combining egg donation with a gestational carrier – those are two separate pathways we have contemplated. But we know two couples who have used an egg donor combined with a carrier and we would never presume to judge them for this decision.

Mo's posts, we believe, reflect the fact that we are conscientious and careful in all of our choices.  It may not be evident to some, but for many reasons that have nothing to do with love, adoption is not the best option or may not be an option at all for a given couple.  It is a complex process for sure and one that we have thoroughly investigated. Some details are private.  

We appreciate everyone's support. It hurts to be misunderstood and even more so to have others jump to conclusions regarding our intentions in loving a child.  

Mo and Will

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Do I really need a lawyer for egg or embryo donation?

Will and I went to a talk about legal issues in third-party reproduction. It was informative, but mostly, I found it frightening. My main focus has been on whether I can choose one of these paths if I need to and have it feel like the right step. Feel at peace with the decision. That's where my energy has been going. I trust the folks we are considering receiving donated embryos from. I know where they are coming from and where they stand; I know they are at peace with the family they have and aren't looking to parent again. And with an egg donor situation, I've focused on how to find an egg donor that felt compatible with us intellectually, physically, and that would result in a baby (most important part is the last one).

I hadn't really thought that I needed a lawyer to do egg donation or embryo donation. But going to this talk made me question myself. It was run by two third-party reproduction lawyers who talked a lot about contracts and statutes and case law. And it made me wonder: do we really need contracts and lawyers to negotiate all the details of the future? (they suggested THREE lawyers for embryo donation - one for genetic father, one for egg donor - who they say should be re-consented, and one for recipients - egads!). If the laws change about how embryos or donated eggs are seen now, would this be something that would negatively affect us? My questions felt so basic that I didn't voice them. I actually found the whole meeting quite anxiety-provoking. Somehow it just rubbed me the wrong way. I guess because what I'm trying to do here is start a family and having lawyers and contracts and what not involved, makes it feel so...business-like.

Those who have done embryo donation or egg donation, have you used a lawyer in the process? What purpose did it serve? Looking back, was it really necessary? Those who didn't use a lawyer, is this something you wish now you had done? Why or why not?

Mo

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What's it like to have a donor embryo baby?

We're considering a bunch of options on how to move forward. You've read many of our thoughts on the matter since we lost our sixth pregnancy in November. We now have a new possibility we're strongly considering.

A wonderful friend has completed building her family using embryos made from donor egg and her husband's sperm. She has offered us her remaining embryos. Eleven of them.

We are stunned by her and her husband's generosity. And we're really considering it.

But it also raises many questions. In my mind, I have a paradigm of what adoption is and how to explain it - to myself and to others, what donor egg is and how to explain it, what surrogacy is and how to explain it, but donor embryo is a whole new arena for me.

And it's a new arena for the world - one that is relatively unexplored. Much of the reading I've done on it says some version of: Congratulations on choosing embryo donation/adoption- you're a pioneer! (subtext: no one knows yet the social or personal outcomes of embryo donation, because it's brand new. Good luck!). If we went this route, we'd have (if we're lucky) a child or two who is not genetically related to myself or my husband Will. But who I would give birth to. Down the line, if we saw that my body could support a pregnancy, we might be emboldened enough to try again with our own wonky embryos.

But I have so many questions. I'm someone who does not take decisions like this lightly. I want to think through all the potential consequences. And so something like this that is so new, is, well, a little extra scary. Some of my many questions are: what would the impact on a child created in this way be down the line? We're in contact with the family who would donate to us and so our child will see these wonderful folks periodically. I'm also wondering how we would explain the donor embryo situation to the world, or if/ when we would even need to. And I'm wondering how our families would react and feel about this (would they love or feel bonded to the child any less?). And I'm wondering how our child/ren would feel and what identity issues they might face once they were old enough to really understand what this means (We'd tell them from the beginning, but I'm thinking late childhood/adolescence is when they'd really grasp the nuances).

So I'm hoping to hear from any of you out there who have used embryo donation as a family building option: what has it been like? What have been the most difficult parts of using donor embryo? Do you think you are any differently attached to your child than you would be if you were genetically related to them? (realistic or not, this is a fear of mine). How often do you even think about that fact? How's your family been accepting the child? Have you told other people in the world (beyond immediate family)? And if so, how has the world responded to you? What else would you want to share about your experience now that you've been through it - any things you wish you'd known then that you know now?

Feel free to comment anonymously if that allows you to be more open with your thoughts.

Thanks for your candor, your wisdom, your experience. We really appreciate it.

Mo

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From donor embryos to Ethiopia: Tales from an adoption conference

Finally, here's the what's what on the adoption conference we attended at the end of November:

There were hundreds of attendees and 90 different talks to choose from, so Will and I split up and attended some different talks throughout the day to get a sense of things.

We don't know whether we're even headed to adoption as a next step, should IVF #6 be a bust, but just in case, we wanted to arm ourselves with as much info as possible.

Here's the scoop on what we learned:

Talk #1: China's waiting child program - super long waits at this point to adopt from China unless you get a "special needs" child. "Special needs" can mean everything from cleft lip/palate to heart defect to club foot/feet to Chronic Hep B, etc. You can specify what you can deal with and wait times are reduced considerably.
What did we think? Kind of an attractive option. Since we're medical folks, we aren't intimidated by some of the medical issues (cognitive issues scare us more). Three of our nephews are half-Japanese/half-Caucasian descent so an Asian child would have cousins who look similar (and who are learning Mandarin at school), which is a plus.

Talk #2: Private domestic adoption - Listened to attorney discuss private adoption. Legalities differ from state to state, depending on where birthmom is. You place your own ads and hope for the best. You also pay birthmom's medical expenses and in some states living expenses. If she changes her mind, you're out of luck.
What did we think? Kind of scared me, honestly. After all of our losses, the idea of meeting a birthmom and getting attached to the idea that I would be able to parent the child she is carrying and then possibly having that child NOT go home with us...well, it makes me want to puke. Not sure I can do it. Somehow, although I know many people have happy stories to tell about it, this one felt really iffy to me.

Talk #3: Ethiopian adoption - Discussion by two large agencies on status of their orphanages and how their programs work. Thought wait times for this country might be less but they still hover around 2 years - unless you go the "special needs" route. Bummer.
What did we think? Things are rough enough in Ethiopia in terms of poverty and malnutrition that it would really feel like we would be making a huge impact on a child's life to adopt them from here, which appeals. Liked that the two orphanages discussed have small staff:child ratios and good nutrition. Really liked that you often get to meet the birthmom or family and can take photos, video, etc., which you could then share with child to help them understand where they came from, and that you can often stay in touch with birthmom/family sending letters/cards (no money/goods allowed). But the malnutrion/parasite/infection issues sounded alarming.

Talk #4: International adoption medical review - International adoption physician spoke about common medical and cognitive issues with international adoptees. He said that the kids have lots of physical issues (parasites, malnutrition, delayed growth and motor abilities, etc.) as well as cognitive issues (50-75% have cognitive delays). Basically, the way he put it, all international adoptees are special needs kids. So the ones labeled special needs have problems on top of problems. At the end of his talk, he said, "Most of these kids should eventually be able to hold a job as adults. And that's all you really want as a parent, really."
What did we think? Um, "holding a job" actually isn't all we hope for for our kids. Yikes! Of course, we'll love our kids no matter what but we hope for the best for them. Bottom line, this talk scared the bejeevers out of us in terms of international adoption. It was really hard to get a sense of whether we could expect our kid(s) to ever be able to approximate "catching up" over the years or how longlasting the impact of malnutrition, orphanage conditions, etc. would be. And the need for these kids is really great. No easy answers.

Talk #5: Embryo adoption - Not really "adoption" in the legal sense of the word, but this one was a talk on how to find donated embryos - supposedly there are a lot out there through various agencies and clinics. You have to do a homestudy and apparently sometimes you write an intended parent profile and the embryos' family "picks" you. Some of these are open arrangements to some degree, so that your child can know their genetic siblings. Costs are much less than donor egg, which is a plus.
What did we think? Intriguing option. Sort of cool, sort of another loss, to image that Will's genetics would no longer be a part of this. Questions about the religious/right-to-life agenda of some of the agencies. Don't want to support anything that might ultimately lead to narrowing options to women trying to conceive or deal with an unwanted pregnancy. We're Catholic, but obviously not too strictly practicing or we would never have done IVF (since it's verboten). Feel sort of excited and frightened by prospect of child knowing their genetic sibs. Also feel absolutely terrified about the gamble of adoptiong embryos (although apparently many are from donor eggs, which helps). Wouldn't the family have already used the best embryos to create their family? What if whatever is left doesn't work? We've made almost 40 embryos ourselves and have no kids. So, it's a scary prospect to gamble yet again.

So, overall, what did we learn? We learned we need to research a lot more as well as explore our own hearts to figure out where to go from here. There are many ways to adopt a child, from the blastocyst stage on up, but they involve what feels like considerable risk in terms of what that poor child may have gone through before they come to us and how that may strongly impact the person they will become. All of the options would require us to tolerate a great deal of uncertainty, which if anything as we've gone through IVF, has gotten harder for me. I feel like if I'm giving up on the idea of my genetic child, then getting a child should be an easy, straightforward process with minimal risk. But - ha! - of course, it is not. It looks to be a whole other roller coaster.

If you have any knowledge of any of these options, please chime in - the more the merrier. One thing I learned at the conference is that for me, hearing about specific situations trumps the abstract in terms of feeling more clearheaded about these options any day.

Thoughts? Experiences? Speak up!

Mo