Some people may pine for the good old days when parents could tell children that the stork delivered them. Today that discussion is much more complex, thanks to “assisted reproductive technology.”

The first “test-tube” baby was conceived in 1976. She was the product of an egg from her mother and sperm from her father, but conceived in the lab, not in her mother’s body.

Then, during the 1980s, sperm from men other than the father and eggs from women other than the mother became available for in vitro fertilization.

Since then, thousands of children in the United States have been conceived with such high-tech methods, or what today is called “assisted reproductive technology” (ART). Indeed, in 2007, 57,564 American children were so conceived, according to the Centers for Disease Control and Prevention.

Moreover, the ART combinations today can be astounding, experts say. A child may have three parents instead of two. A child may live in a family with two biological mothers—one the egg mother and one the womb mother. A child may have myriad half siblings from an egg donor or sperm donor, for example, or a twin born in a different womb or at another time.

Not surprisingly, ART has ushered in a wealth of psychodynamic issues, and perhaps none is more crucial than the question: Should ART children be told how they were conceived?

Some psychiatrists, psychoanalysts, and psychologists with an interest in the subject think that they should. They explained why at the American Psychoanalytic Association meeting in New York City in January and in interviews with Psychiatric News.

The Danger of Leakage
“If a child is not informed of his or her biological origins, there may be the unconscious transmission or leakage of such information in families that decide to not tell,” Diane Ehrensaft, Ph.D., reported. In addition to being an Oakland, Calif., clinical psychologist who works with adults and children impacted by ART, Ehrensaft has written a book on the subject—Mommies, Daddies, Donors, Surrogates.

ART children who are not told how they were conceived may also have attachment difficulties, Ehrensaft believes, because both the secret and the discomfort that often accompany not telling can still be transmitted to the child either unconsciously or in subtle innuendoes. A recent British study found that ART children who were not told were more likely to have a conduct disorder than ART children who had been told, raising the question of whether something in the process of not telling disrupted the youngsters’ relationship with their parents.

Not telling ART children the truth may also prompt them to distrust adults in general, said Anna Balas, M.D., a New York psychiatrist and psychoanalyst who has worked with some ART children.

“ART children should be told the truth, not just for their benefit but for that of their parents,” New York psychiatrist Ann Maloney, M.D., asserted. “To carry a secret through your whole life takes a ton of psychodynamic energy.” John Ross, Ph.D., agreed. Ross is a psychologist and psychoanalyst. Maloney and Ross are also married and have two daughters conceived via ART.
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Start Off Early and Simple

So if an ART child is to be told about his or her origins, when do you do it and how? The general consensus of these experts is that you start off early in life with a truthful, but simple explanation.

For example, some years ago, a little boy with two lesbian mothers would run up to men and ask them, “Are you my daddy?” The mothers asked Ehrensaft what they should tell him. She wasn’t sure. But today, she said, this is what she would suggest: “You have a mommy and a mama who wanted you, and we found a man who helped us have you. It takes an egg and a sperm to have a baby. We had an egg, but we needed a sperm. So the man helped us by giving us sperm so that we could have you.”

When their first ART daughter was age 3, this is what Maloney and Ross told her: “It takes one cell from the mommy and one cell from the daddy to make a baby. But sometimes either the mommy or the daddy has problems with their cells. You can go to a special doctor and get a cell. So mommy went to see a special doctor to get a cell, and then we got you.”

Then, as an ART child grows older, the truthful, simple explanation about their conception can be amplified in a more sophisticated manner. For example, as Maloney and Ross’s first ART daughter grew older, and they discussed her conception, she came to understand that a cell meant an egg or a sperm.

And if there is more than one ART child in a family, conversations about their conceptions might be shared with both of them to create an atmosphere of openness and truthfulness and to have the information well received by the children involved. This is what Maloney and Ross did. In fact, they fondly recalled the time when they told their younger ART daughter, in their older daughter’s presence, that she had been kept in a freezer for three years before being implanted in her mother’s womb. She walked over to the kitchen refrigerator and announced, “I’m going in the freezer!”

Yet being told how they were conceived may not preclude ART children from having other psychological issues later, these experts agreed.

For instance, children always fantasize, but those who know that they are the product of ART may have particularly grandiose fantasies, such as “Could my father be the president of the United States?,” Marie Tasini, M.D., a Los Angeles psychiatrist and psychoanalyst, commented.

When ART children reach adolescence, said Ehrensaft, they may want to meet the egg donor or sperm donor who helped create them because “they are looking for a reflection of self and their own identity. This desire may trouble their parents; they will need to be reassured that their child is not looking for a substitute or better parent.”

Some ART teenagers who do not know whom their biological mothers or fathers are worry about incest, Ehrensaft noted. “One of them asked me, ‘Do I have to have a DNA test every time I go on a date?”

Indeed, legislation needs to be passed to help ART children in this regard, Ehrensaft stressed. “The wind is shifting internationally so that the offspring of sperm donors have access to information about them. But this is not the case in the United States. We have no regulations.”

Yet ART children have one thing going for them that some children conceived in the conventional way do not—parents who wanted them enormously and who were willing to go to great lengths and sacrifices to have them, these experts concurred. And the children know it and appreciate it, Ross believes. For instance, “One of my ART daughters had a fantasy that she had been bought for a lot of money,” he said. “Which was true! She was conceived in vitro with the help of an egg donation, which wasn’t cheap.”

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Joan Arehart-Treichel
Psychiatric News   April 16, 2010
Volume 45 Number 8 Page 8