To tell the truth
Many parents who use donor eggs to conceive have trouble explaining it to their children
MEDFIELD - Cara Birrittieri is set to have a talk with her 3-year-old daughter any day now, something that has been on her mind since Victoria was just a fetal ultrasound image.
"Part of me wishes I didn't have to tell her," Birrittieri said, as the girl raced by the living room holding a doll. "The love is so intense for this kid - I mean, she is mine."
Yet, in the months to come, Birrittieri plans to explicitly tell Victoria the way in which she is also part of another woman - a graduate student in her 20's who donated the egg that helped create the preschooler.
This particular version of a child's origins is so complicated, and sometimes so painful, that some parents never try.
"It's easier not to tell," said Birrittieri, a 48-year-old former television health reporter. "Most women go through hell with infertility, and this was their last chance. Rather than grieve the loss of the child they didn't have, they make this child that child."
Research shows that as many as 44 percent of parents who used egg donors have no plans to tell their children the truth about their origins, a figure that surprises psychologists and fertility specialists who had expected a higher rate of disclosure at a time when openness is encouraged about such matters.
"The technology is so far ahead of the psychology," said Alice Domar, a psychologist and director of the Mind-Body Center for Women's Health at Boston IVF, the state's biggest fertility clinic.
Therapists say they know these talks with children are never easy, and must be done slowly in age-appropriate ways, but they had assumed parents using egg donation would want to be open, embracing the latest psychological wisdom as easily as the newest reproductive technologies.
The most current thinking about disclosure comes from vast research done on adoption and sperm donation, two of the most common options used to address infertility. Researchers found children kept in the dark about their origins often felt betrayed when they later learned the truth, and more so, if they discovered accidentally through a relative or family friend.
Also, given the mounting evidence about the powerful role of genetics in health, many psychologists say children have a right to know their medical history.
Still, even as psychologists advise openness, many parents who used the latest in egg-donation technology have no plans to tell their children, citing the complexity of the narrative, a desire to protect the child from being seen as a "science fiction" curiosity, or a belief that it remains a deeply private family issue.
Some mothers, who gave birth and nursed the child, are reluctant to tell their child anything that diminishes their role as the mother
"People need to be educated," said Ellen Glazer, a Newton social worker who wrote a book about egg donation. "They are so vulnerable."
A 2005 study of 148 couples who used a West Coast infertility clinic for egg donation, found that 27 percent had already told their children; 53 percent had not yet disclosed, but said they would at some point in the future; 12 percent did not plan to tell; and 8 percent remained "undecided." A 2004 study of British parents who used egg donors found that 56 percent planned to tell their children, while 44 percent had decided against telling or were undecided. Researchers say there is a shortage of reliable data because many parents using egg donation decline to participate in studies.
A 52-year-old former Waltham resident said he and his wife have no plans to tell their 7-year-old son that he was conceived with his father's sperm and a donor egg, largely because they don't want to upset him with a hard-to-understand story. The father, who asked that his name not be used to protect his family's privacy, also said his wife does not want to introduce the image of a potential second mother.
"She wants to keep the status," he said. "She's worried that talking about the egg donation will change her status."
Since the first egg-donor baby was born 24 years ago, research has focused on the striking success of the procedure for helping older women get pregnant. In 2005, the most recent year federal statistics are available, about 6,500 women successfully delivered babies with egg donors, an 88 percent increase from five years earlier. The growth in successful deliveries through egg donation is even higher in Massachusetts: In 2005, there were 280 women who delivered babies using egg donors, more than double the number in 2000.
Explaining egg donation to a child is not easy. In talking to Victoria, for instance, Birrittieri will have to explain that her womb nourished another woman's egg, which had been fertilized with Birrittieri's husband's sperm. Additionally, she will have to explain to Victoria that her 8-year-old brother has a simpler story: He is the product of both of his parents' genes.
Birrittieri, who has written a book about a woman's biological clock, couldn't conceive a second time.
Other factors may also discourage disclosure, including religious considerations. The Catholic Church, for instance, opposes high-tech fertility procedures, including egg donation.
Miriam Ornstein, a child psychiatrist in Cambridge, said she had expected that nearly all prospective parents would agree that children should know the truth, even if their understanding is very basic in the early years.
But many people she's counseled, she said, have mixed feelings about telling their children.
Several fertility organizations are trying to coax prospective parents into confronting the issue earlier in their child-raising years.
Two years ago, the Society for Assisted Reproductive Technology put out an ethics paper encouraging parents using egg donors to tell their children. In the past five years, nearly a dozen books have been published helping parents to explain egg donation to their children, or to better understand their own post-birth emotions. Last summer, Resolve of the Bay State, a fertility group, held a seminar, "Talking with Children about Their Origins," for prospective parents, and similar events are planned, said Rebecca Lubens, head of the group.
A 51-year-old Cambridge woman, who gave birth to twins through egg donation, has used a Dr. Seuss book, called "Horton Hatches the Egg," to explain their entry into the world. When asked how they came to be, she tells her twins, "Mom had a helper."
By introducing her 9-year-old twins to their egg donor from the start, Kimberly Kay, a nurse practitioner who recently moved from Westborough to Palo Alto, Calif., has eliminated any secrecy from her egg donor scenario. The donor is her niece, and the niece is included in pictures of the twins' birth and she joins them at family gatherings.
Kay, who was 45 when the twins were born, said she was committed to letting the information slowly absorb into her childrens' minds - and their inevitable questions unfold in time.
After a class on human reproduction last summer, her son recently approached her saying, "Tell me again how this worked?"
When she reiterated the egg donor scenario, he replied, "So technically - Tracy's my Mom?"
"So technically, genetically," she answered, trying not to be defensive, "that's where you came from."
Source: http://www.boston.com/news/health/articles/2008/02/04/to_tell_the_truth/
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Category: Donor Egg, infertility
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