Why Donate Remaining Embryos?
Couples who choose to donate their own remaining embryos to another person or couple often feel strongly that these embryos represent an opportunity for life and for someone else to have a child of their own. A common sentiment from people who donate their embryos is the desire for the embryos to be "put to good use." Those people that used third-party assistance themselves may desire to help someone else, just as they themselves have been helped.

For others, there may be a strong sense of emotional connection to the remaining embryos, a sense that these embryos represent potential children or siblings to the child that resulted from the cycle. This emotional connection may prompt the donating person or couple to want to give the embryos an opportunity to become a life and to experience personhood.

Preparing to Donate Embryos
For the person or couple donating, it is important to explore the finality of donating their embryos, as well as the implications for themselves and their own children of not having a traditional parent-child relationship or sibling relationship with any offspring resulting from the donation.

Many clinics or agencies require a consultation appointment with a mental health professional prior to donating embryos. The purpose of this conversation is to explore the psychological and emotional aspects of embryo donation and to clarify goals, values, and preferences with regard to some of the decisions that will be encountered.

Why Choose Embryo Donation to Build Your Family?
Embryo donation is a family-building option that people may choose for a variety of reasons. Many are drawn by the lower price tag, relative to an IVF cycle using donor eggs, donor sperm, or both. Relative to adoption, perceived advantages of embryo donation may include a potentially shorter wait time, being able to participate more equally in the matching or choosing process, control over the prenatal environment, and the option of a more private or anonymous arrangement if desired. For those patients that are part of a couple where either donor egg or donor sperm would otherwise be required, embryo donation may be viewed as a way that both partners can be "on the same playing field" so to speak, in that if both partners can't be genetically related to the future child, then neither partner will be.?

Preparing to Receive Donated Embryos

For people with a history of fertility challenges who are considering becoming recipients of embryo donation, it is important to identify and begin to work through the range of complex feelings that may accompany this decision. There may be grief and loss at giving up a genetic connection to one's future child or, for single people, at giving up the dream of pursuing parenthood with a partner. Some people experience shame and inadequacy related to the inability to conceive without assistance. Anger and blame are also common emotions and may be directed at oneself, one's partner, God, or friends and family who appear able to conceive with ease.

Other potential feelings include helplessness about the lack of control one has over such an important life goal and hopelessness about successfully becoming a parent. While some degree of resolution relative to these feelings is helpful in being able to embrace a new direction in family-building, it is unrealistic to expect that all of one's negative feelings need to be completely resolved before one begins a new form of treatment.

Many clinics or agencies require consultation with a mental health professional prior to receiving donated embryos. The purpose of this meeting is to provide support and education, assist the recipient(s) in exploring the psychological and emotional implications of embryo donation, and promote clarification of goals, values, and preferences with regard to some of the decisions recipients will face. Options for Information Exchange or Contact

If the clinic or agency allows for such options, consultation with the mental health provider may include clarification about whether or not there will be any exchange of identifying or non-identifying information between the parties now or in the future, whether or not there will be any contact between the parties now or in the future, and how decision-making will be handled regarding any embryos still remaining after the receiving person or couple completes their family. There exists great variability among clinics and agencies with regard to their allowance of different options along these parameters.

There are two very important points to remember in thinking about exchange of information and contact between recipients and donors. The first is that feelings about these matters often change over time. Prior to becoming parents, recipients of embryo donation may find themselves more focused on their own fears and anxieties about what contact with the donating party might mean. They may worry that if the child knows of the embryo donation and/or has information about or access to the donor(s), that he won't view the parent(s) as the "real parent(s)."

However, research indicates that it continues to be the person that nurtures, cares for, and "parents" the child that holds the primary attachment and significance for the child. Typically once recipients actually become parents, they become much more secure in this understanding. As a result, many become much more open to considering some level of contact with the donor(s), potentially seeing it to be in their child's best interest.

The second important point is that children will conceptualize the meaning and significance of the role of third-party assistance in their conception differently at different developmental stages and, often, differently than their parents do. Genes don't make a family or a parent-child relationship, but they are significant. Your child is likely to have curiosity about this part of where she came from. Your child may even grow up to desire contact with the donors. Research shows that when children do have a desire for contact, it is not because they are looking for a parental figure, but because they are curious about an important part of the equation of where they came from.

"Directed or ‘Known' Embryo Donation"

Many of the above comments also apply to "directed" or "known" donation situations, in which the parties have been known to one another prior to the decision to give or receive embryos. However, in the case of directed donation it becomes especially important for both parties to clarify whether the identities of the giving and receiving parties will be made known to the existing and future children involved.

It is important for all parties to realize that how the adults view the significance of this genetic connection and how they conceptualize its meaning may be very different than how the children involved in the situation will. That is, while the donating and receiving parties may view the donation as an opportunity for the receiving person or persons to have a child of their own, the resulting child may go through a period of development in which the genetic connection to the donating person(s) becomes more significant, giving rise to questions, curiosity, and a desire for contact.

Differences Between Embryo Donation and Embryo Adoption
While some individuals use the terms embryo donation and embryo adoption interchangeably, the term "embryo adoption" is actually somewhat of a misnomer, as law within the United States does not permit a living being to be adopted before its birth. However, agencies exist that advertise their services as embryo adoption. These agencies may appeal to those who believe that life begins when the egg is fertilized and becomes an embryo. For people that attribute such personhood to their embryos, there may be a desire to work with an agency that views the embryos in a similar light.

Agencies that facilitate embryo adoption frequently have a religious bias, follow a "pro-life" mission, and may only place embryos with married heterosexual couples. Such agencies typically follow a traditional adoption model, requiring a similar screening process for the prospective parents and potentially allowing the donating parents to play a role in selecting an appropriate person or couple with whom to place their embryos, when desired. In choosing a placement for the embryos, the donating parents may consider their thoughts and feelings about meeting the receiving parents as well as future contact with the receiving parents and, potentially, also with the resulting child.

Choosing an Embryo Donation Agency
There is a great deal of variability among clinics and agencies in what options are available, particularly in terms of exchange of information and contact between the parties. Additionally, sometimes clinics and agencies limit the number of embryos a couple may receive and/or the number of pregnancies resulting in a healthy live birth the clinic or agency will facilitate. This may be problematic if a person or couple desires more than one child and would like for those children to be genetically related to one another.

For this reason, it is vital that the parties involved take the necessary time to clarify goals, values, and priorities so that they can choose the type of clinic or agency that will allow for the options one feels strongly about. It is not uncommon for people experiencing a sense of urgency about becoming parents to compromise on options important to them, such as the opportunity for future contact with the donating persons, and later to have great regret about this.

Talking to Kids About Embryo Donation
Before having a first conversation with children about embryo donation, intended parents should ideally have done some work in resolving any lingering feelings of grief and loss regarding having given up a genetic connection to their child.

When disclosing at a younger age, many parents choose to follow their child's lead, in terms of questions and curiosity about pregnant women, where babies come from, and the like. When children begin voicing curiosity about such things, particularly about where they came from, it can be an ideal time to introduce the story of embryo donation.

Many people worry that a child will be confused, overwhelmed, or simply won't understand complex information at such a young age. Information, however, can be given in age-appropriate language that will help provide a very important foundation of understanding that a child can build on in complexity over time. Young children ask questions about a multitude of complex topics, such as life and death, religion, human prejudice, politics and, as adults, we provide the best explanations we can, knowing that full understanding will be an ongoing process that will happen gradually over time.

Particularly when disclosing at later ages (seven to nine-plus), it may feel helpful to talk with a support person ahead of time in order to clarify personal feelings and to talk through where your child is developmentally at this time and what she needs from the conversation. This could be a godparent, relative, close friend, or trained professional. It can also be helpful to have someone with whom to debrief afterwards.

For older children, it is helpful to choose a time when nothing particularly stressful is going on in their lives, such as starting a new grade or a big test coming up. The best setting is typically at home, rather than at a restaurant or while on vacation. Choosing a time when you would be together naturally, rather than setting an "appointment" to talk about something, will help the topic seem more natural. It can be helpful to remember that children will only be able to digest so much at one time, so stick to the basics and don't feel like you need to explain everything at once. Be sure to use a warm tone of voice and don't forget to convey how much you wanted the child. Most parents report a sense of relief after having their first conversation with their child about third-party assistance.

At the end of your conversation, you'll want to ask if your child has any questions and also want to let the child know that this is a topic that is open for talking about more whenever the child wants or needs to. However, you may need to reinforce this message by looking for opportunities to refer back to the topic, such as when you find out a friend is newly pregnant or following a television show about genetics, adoption, or families.

Parents may say something along these lines:

"It takes certain ingredients called a sperm and an ovum to make the beginnings of a baby, which is called an embryo. An embryo needs a special place inside a woman's body called a uterus to grow into a baby. While it takes the right ingredients to make an embryo and the right place for an embryo to grow to make a person, it takes love, caring, and sharing to make a family. We wanted a baby very much and had the love and caring to share, but didn't have all the right pieces and needed some help. Thankfully, there was a doctor who knew a special person or couple who understood how much we wanted to be parents and wanted to help by giving us the best gift we could imagine, the embryo that would grow into you."

Questions or Concerns Kids Conceived Through Embryo Donation May Have
Children conceived through embryo donation may have many of the same questions and curiosities as children conceived through egg or sperm donation. Similar to those conceived through egg or sperm donation, children conceived through embryo donation may be curious about what each of the donating people looks like, what their personalities are like, and whether or not he shares any traits with them.

They may also be curious about whether or not the people who donated the embryos had children of their own or whether they donated embryos to any other families. Parents can be honest in answering what they know or don't know about the donating person or couple and their own family. When you don't have the information the child is asking about, it can certainly help to offer empathy about the wish to know, and to ask the child what they think the answers may be.

There are some differences between embryo donation and egg donation that may be important in the questions and curiosities expressed by children conceived in this way. For one thing, children conceived through embryo donation are not genetically related to either parent and, as such, they may potentially have more questions and curiosities about the person or couple that donated the embryos. Also, given that the donating person or couple could have chosen to use the embryos for their own additional family-building but chose instead to donate them, there may be questions about this. Children may ask why they chose to donate their embryos or even why they used some of the embryos themselves to build their family but donated others and may wonder how this decision was made.

Embryo donation is new enough that we don't have much information about what it might mean to the resulting offspring that a person or couple, rather than using the embryo for their own family-building, chose to donate it to another person or couple. Rather than focusing on the couple "giving away or giving up" their embryos, it may be more helpful to emphasize to your child that the gift of the embryo came from a place of goodwill and generosity, and that the donating person or couple knew the parents wanted so much to have a baby and wanted to help.

Ultimately, however, if a child does voice feelings of sadness, confusion, or feelings of rejection about having been "given up," it is important to offer empathy for this point of view. In this case, it may be helpful to further convey to the child that the donating person or couple was very thoughtful about the future they wanted for their embryo and that, though their family was complete, they felt happy and excited about giving this embryo the potential for life in a loving family with people who very much wanted to be parents.

Britta Dinsmore earned her doctorate in counseling psychology from the University of Oregon in 1998. She has been licensed as a psychologist in the State of Oregon since 1999 and maintains a private practice as well as serves as a psychological consultant to Oregon Reproductive Medicine.

Dr. Dinsmore provides individual and couples counseling for patients experiencing fertility challenges, assisted family-building decisions, and pregnancy loss. Additionally, Dr. Dinsmore provides psychological evaluations of egg donor and gestational carrier candidates. A particular area of interest and expertise for Dr. Dinsmore is contact between parties involved in third-party assistance.?

Dr. Dinsmore is a member of the American Society for Reproductive Medicine's Mental Health Professional's Group and also has served as a mental health advisor to PVED. Currently, Dr. Dinsmore serves on PVED's executive board as the organization's Director of Mental Health. Dr. Dinsmore is also the mother of a ten-year-old son conceived through egg donation.

Dr. Dinsmore may be reached via brittadinsmore@comcast.net or her website, www.brittadinsmore.com