The decision to create your family with the assistance of third-party reproduction i.e., donor egg, donor sperm, or gestational surrogacy is a difficult one. Choosing this family building option ultimately involves grieving the loss of having a child who is genetically related to both or either of you, and/or grieving the loss of the experience of pregnancy and carrying your child. Once an individual or couple feels comfortable moving forward with third-party reproduction, the next decision involves whether to use a known or anonymous/previously unknown gamete donor or gestational carrier (GC). A known gamete donor or GC is a family member, friend, or acquaintance with whom the recipients or intended parents have a preexisting relationship.
Why Choose to Work With a Known Gamete Donor or GC?
There are numerous reasons why an individual or couple may consider building their family with the assistance of a known gamete donor or GC. First, in the case of egg and sperm donation, if the donor is a relative, there may be a sense of comfort in using gametes with some type of genetic link. A strong familial resemblance between the donor and recipient may also be an important factor in the decision. In a same-sex couple, the assistance of a family member as an egg or sperm donor can also allow for a genetic connection to both members of the couple. Other individuals find solace in maintaining a broad family connection and may wish to work with a brother-in-law as a sperm donor, or a sister-in-law as an egg donor or GC. When we include friends, as well as family members, the preference for a known arrangement may be a matter of trust; there is a perception that the donor or GC will provide greater and more accurate medical, educational and social history. It also creates an opportunity for the donor or GC to be known to the child, develop some form of a relationship with the child, and in the case of gamete donation, for the child to have access to updated health information. Finally, in some situations, the use of a known gamete donor or GC may decrease the cost of and/or the waiting time to receive treatment.
Who is an Appropriate Candidate to Be a Known Gamete Donor or GC?
First, check with your treating physician to identify basic requirements for a known donor or GC. For example, your medical practice may have established a minimum and maximum age range for gamete donors and GCs. Likewise, most practices require that a GC has previously carried a pregnancy to term and delivered a child. This is related to important medical information obtained when a woman has experienced pregnancy, childbirth, and the postpartum adjustment period, as well as the ability to provide full informed consent since a potential GC cannot anticipate how it would feel to relinquish a child unless she has previously given birth. Before you ask or accept the offer of a family member or friend to help you create your family, you should have an idea of minimum qualifications.
Second, gamete donation and gestational surrogacy requires a significant commitment of time and often, emotional energy, on the part of the donor or GC. Prior to the initiation of treatment, there is usually a medical and psychosocial evaluation process. Speak with your doctor and the practice’s mental health professional to find out exactly what will be required of the donor or GC during the work-up and treatment process. Also be aware of the potential medical and psychological risks (e.g., perceiving the resulting offspring as their own (for donors); difficulty relinquishing the baby (for GCs)) of treatment for a donor or GC. Before you decide to ask or accept the offer of a family member or friend to be a donor or GC, carefully consider whether it is realistic for that individual to commit to the process at the current time.
How Do I Ask?
Obviously, it is far more comfortable for everyone when the friend or family member comes forward and offers to be a gamete donor or GC. Sometimes someone has made an offer in the past or even expressed a general statement such as, “if there is anything I can do to help you…” and thus, they have paved the way for you to now ask for their assistance. However, often there has been no such offer, or you may not even have been open with others about your family building plans or your struggles with infertility. The prospect of asking for such an important gift and the potential that the person will say “no”, can be anxiety-provoking and heighten feelings of vulnerability. What may work best for all parties is to write the proposed donor or GC a letter or email, allowing them and their spouse/partner the time and space to think about the request without feeling the pressure of an immediate response. The letter should make it easy for the potential donor or GC to decline the request. For example, you may include statements such as, “you don’t even need to respond to this if you don’t want to,” or “we understand if this is not something you are interested in pursuing and we just appreciate you taking the time to think about it.” You may wish to let them know other options you are considering e.g., an anonymous gamete donor or identifying a GC through an agency. The letter might also mention that the potential donor or GC could speak with a physician, a member of the donor team, or the practice’s mental health professional to obtain more information prior to making a decision.
It is important to prepare yourself for the possibility that the person you ask, or that person’s spouse/partner, may say “no”, either initially, or after they have had the chance to ask questions of medical or mental health personnel, or even after they have had a number of conversations with you. As mentioned previously, being a gamete donor or GC involves a commitment of time and emotional resources for both the collaborator and his/her spouse/partner and their family. There are also lifelong issues to consider. You only have one family, and good friends are not easily made; you do not want to do anything to harm those relationships. Try to keep in mind that whether the person you asked thought about the possibility briefly or for weeks, the fact is that they care enough about you to have even considered helping you on your journey.
What Issues Should We Discuss?
Most clinics require known donors, recipients, GCs and intended parents to participate in a psychosocial counseling and evaluation process with a mental health professional who has an expertise in the area of third-party reproduction. However, it can be helpful for you and your spouse/partner to discuss various treatment and lifelong issues with one another, as well as, with the gamete donor or GC and their spouse/partner, to determine whether this arrangement is the best way for you to create your family. Below are some questions for all parties to consider separately and with one another, regardless of whether the donor or GC volunteered or you asked for their assistance:
- How might this arrangement affect the relationship between all parties? How may other family members or friends respond to this collaboration?
- What are everyone’s expectations for treatment? For example, expectations each party has regarding the number of treatment cycles, the disposition of embryos for known gamete donation, and number of embryos transferred for a known GC arrangement, etc.
- What are all participants’ feelings about whether, when, and how to disclose to a child born from the process? Also, to the children of the gamete donor or GC?
- What are everyone’s expectations about the future role of the donor or GC in the child’s life (e.g. does the donor or GC desire to have a greater or lesser level of involvement in the child’s life than that with which you are comfortable?)
There needs to be an understanding and consensus on these, as well as other issues, for a known collaboration to be a positive experience for all of the parties, including any children born from the process or existing children.
How Do I Even Begin to Thank My Family Member or Friend for Such a Precious Gift?
This is a common question and concern among individuals and couples who work with a known gamete donor or GC. Research tells us that friends and family members are usually motivated to help because of their relationship with you and their empathy for the difficulties you have had in achieving parenthood i.e., their motivation is altruistic. We have found that in general, donors and GCs appreciate being thanked. However, planning some type of thank you can also be integral to achieving a sense of closure for all parties. People often think about a “gift” as a means to thank a donor or GC. However, depending on the person and your relationship with them, a thoughtful note, or some type of thank you ritual (e.g., making a donation to a charity of their choice in their honor; an outing, spa day, or special trip) may be a more appropriate gesture.
In summary, building your family with the assistance of a known egg or sperm donor, or gestational carrier has implications for you, the donor or GC, their spouse/partner, and any resulting or existing children in each of the respective families. Taking the time to carefully consider the treatment and lifelong issues better prepares all parties for what can be an emotionally challenging, but rewarding process.
Dr. Erica Mindes is a Licensed Clinical Psychologist in Virginia and an Associate with the psychotherapy practice of Covington & Hafkin, which specializes in reproductive health issues. She has an office in Richmond, Virginia where she provides counseling to individuals and couples struggling with infertility, the stress of treatment, and pregnancy loss, as well as, those considering family building options through third-party reproduction. She has conducted research and written on the psychological responses to infertility and infertility treatment, and recently co-authored the chapter, “Counseling Known Participants in Third-Party Reproduction” for the book, Fertility Counseling: Clinical Guide and Case Studies. Dr. Mindes is a member of the American Society for Reproductive Medicine Mental Health Professional Group (MHPG) and serves on the MHPG Executive Committee.