Below are some articles I have written that you may find helpful. They are available as PDFs you can download for reference.
- Gamete Donation: Findings on Disclosure and Anonymous Donation
- Single Parenthood: Building Families with Donors and Surrogates
- Heterosexual Couples Using Donor Insemination
- Building Healthy Donor Conceived Families
- Genes Make People, People Make Families
- The Family is All Right: Disclosure and Open Donation
- Infertility, Reproductive Medicine, and the Role of the Psychologist
- The Role of Mental Health Professionals in Infertility Counselling in the United States
- Disclosing Origins: Children Born Through Third Party Reproduction
- How Do We Deal With It As A Couple?
- Secondary Infertility
- Talking to Children About Their Donor Origins
Gamete Donation: Findings on Disclosure and Anonymous Donation
By Madeline Licker Feingold, Ph.D., AFA Mental Health Advisory Council
Mental health professionals often are in the position of helping people build families with the help of egg or sperm donors. At times we see people who have been trying to get pregnant on their own, sometimes for years, and are devastated that they have not been able to conceive a child. We also see same sex couples or single parents who seek gamete donation as their first choice method for family building.
When couples or individuals walk through our doors, we may encourage them to envision their future family in our consultation rooms. Therefore, one goal when meeting with intended parents is to provide them with information about donor conceived families so that they can make informed decisions about how to proceed with gamete donation.
Once the “future children” are brought into the room, questions are at the forefront of intended parents’ minds. Should they tell their children about the donor? When should they tell? What will their children want to know? Fortunately, clinical and empirical data exist about the effects of disclosure of donor origins and donor anonymity and this information may serve as a foundation for raising healthy children and building strong donor conceived families.
> To read the rest of the article, download the PDF by clicking here
Single Parenthood: Building Families with Donors and Surrogates
By: Madeline Licker Feingold, Ph.D.
If you are considering single parenthood, there are many questions to explore. Addressing these questions will help you feel secure about your decision and establish a strong foundation for building a healthy family. Some of the most significant questions are:
- Do I have the emotional and financial resources to parent on my own?
- Do I have a solid support system and am I willing to reach out to others?
- Do I have a flexible work schedule and is my work environment family friendly?
- Do I believe that children can feel stable, happy and secure with one parent?
- If something happens to me, is there someone who would assume parenting my child?
- Have I talked to other single parents and do I have a realistic idea about what parenthood entails?
- If my ideas about building a family involved having a partner, have I grieved my loss and am I ready to embrace being a single parent?
Once you decide upon the path of single parenthood, you may have questions about building your family with the help of egg or sperm donors and surrogates:
- How should I choose a donor and should the donor be anonymous or identified? Should I ask my friend to donate?
- What should I look for in choosing a surrogate?
- How should I talk to my child about the donor/surrogate?
- What do I say when my child asks, "Do I have a daddy (mommy)?"
These are complicated questions that require information gathering and contemplation. I offer the following considerations to help you begin your family building journey.
> To read the rest of the article, download the PDF by clicking here
Heterosexual Couples Using Donor Insemination
By: Madeline Licker Feingold, Ph.D.
"My husband is the one who really needs to talk to you, but he won't make an appointment."
Approximately 15% of all couples in their reproductive years experience infertility, and there is a general consensus that men and women are affected at similar rates, with roughly 40% of infertility attributable to a male factor, 40% to a female factor, and 20% to unexplained causes. Even though infertility strikes men and women equally, and men and women may feel similar emotions upon being diagnosed, their experience of infertility may be quite different. Society encourages women to express feelings, which helps them seek the support of others and utilize available resources. Men, on the other hand, generally are taught to suppress emotion, increasing isolation and diminishing the possibility of receiving help.
Common Feelings Associated with Infertility
Infertility provokes a painful life crisis that negatively affects marital, sexual, familial, and social relationships. Although much more has been written about a woman's reactions to infertility, both men and women may become overwhelmed by feelings of depression, anxiety, anger, guilt, and grief. Additionally, because sex and reproduction are linked in our minds, infertility causes many men and women to feel ashamed and embarrassed about their masculinity or femininity and to experience a sense of inadequacy and low self-esteem. Irrespective of the cause of infertility, both men and women may feel profoundly damaged and unworthy of their spouse's commitment.
> To read the rest of the article, download the PDF by clicking here
Building Healthy Donor Conceived Families
By: Madeline Licker Feingold, Ph.D.
AFA Mental Health Advisory Council
"Sally," she quickly answered, when I asked if they had picked out a name for their child. They hoped for her eyes, his athleticism, and both of their senses of humor. They tried for years to conceive and wanted more than anything else in the world to be parents.
Unfortunately, I was not having a conversation with a newly pregnant couple. Instead, I was sitting across from a couple who recently received devastating news from their reproductive endocrinologist. After several attempts with IUI and two failed IVF cycles, during which they rode the rollercoaster of hope and despair, this couple learned that they could not have their own child. They also were told that they were candidates for donor egg and would have a high likelihood of success in becoming pregnant with this treatment. They called me, a psychologist specializing in infertility counseling, because they wanted to move ahead but felt stuck. She wanted to be a mother, and he wanted to be a father. She had always wanted to be pregnant. But they were worried and uncertain about a donor egg. "Would it feel like our child?" they asked.
> To read the rest of the article, download the PDF by clicking here
Genes Make People, People Make Families
How Heterosexual and Same Sex Couples and Single Parents Can Talk to Their Children about Donor Origins
By: Madeline Licker Feingold, Ph.D., AFA Mental Health Advisory Council
"Ultimately, children become neurotic not from frustrations, but from the lack or loss of societal meaning in these frustrations."
-Erik H. Erikson
Erik Erikson (1902-1994) was a renowned psychologist who wrote prolifically about child and adolescent development. His theories about identity have been applied to collaborative reproduction to support the importance of providing donor conceived children with information about their donor, as well as to encourage parents to disclose donor origins to their children at an early age. Erikson's work also provides a foundation for how to talk to young children about their donor beginnings and set the stage for healthy family development.
Helping Children Understand their Donor Origins
Erikson proposes that children can manage frustrations and confusions as long as parents offer their children explanations for their actions and decisions. When parents provide meaning for their children's experiences, children feel secure. Problems likely arise when children do not understand their situation and parents do not intervene to help them.
Current research in collaborative reproduction supports Erikson's ideas. Children who have been told about their donor origins have not rejected the non-genetic parent or responded negatively to the information. Additionally, when children learn about their donor origins at a young age, they seem to have a more positive experience about their donor conception than those who are told later in life. Furthermore, just because people are not told of their donor origins does not mean that they remain unaware. Many donor conceived people report growing up feeling uncomfortable in their family because they knew that information was being withheld. They could not understand their family experience, and nondisclosure seemed to produce significant psychological distress.
> To read the rest of the article, download the PDF by clicking here
The Family is All Right: Disclosure and Open Donation
By: Madeline Licker Feingold, Ph.D. and Elaine Gordon, Ph.D.
AFA Mental Health Advisory Council
I'm not going to tell my child about the donor. I'm going to carry him. I'm the mom. It will be confusing.
We're planning to tell our child about the donor, but we want to use an anonymous donor. There is no need to know who she is. We don't want her to know us. It will be disruptive.
If you are planning to build a family with a sperm or egg donor, you may share these sentiments. Many people believe that disclosing donor origins will damage the parent-child bond with the non-genetically connected parent. They fear that a genetic connection to a donor could trump the maternal or paternal relationship. Other parents may plan to tell their child about the donor but want the donor's identity to remain anonymous. They worry that an identified donor could damage the integrity of their family by inserting herself or himself into the family and causing disruption.
> To read the rest of the article, download the PDF by clicking here
Infertility, Reproductive Medicine, and the Role of the Psychologist
By: Madeline Licker Feingold, Ph.D., ACPA Member
Infertility, the inability to conceive or have a viable pregnancy after one year of regular unprotected sexual intercourse, is a health-related problem of substantial prevalence which affects approximately one in six couples in their childbearing years. The desire to have a child is such a profound experience that the inability to conceive on one's own produces a monumental life crisis. Infertility deleteriously affects an individual's marital, sexual, familial, and social relationships. People are devastated by their losses and frequently are overcome with feelings of depression, anxiety, shame, anger, envy, low-esteem, and grief. In fact, when not quickly resolved, infertility assumes the characteristics of a chronic illness with a constant interplay of physical, cognitive, affective, behavioral, and social factors and the concomitant experience of stress. The psychologist plays a crucial role in the treatment of the emotional components of infertility by using individual, couples, and group therapy to reduce personal distress, resolve relationship and marital problems, and validate and normalize the infertility experience by reducing feelings of shame and isolation.
Over the years infertility treatment has changed dramatically due to advances in medical technology. Once diagnosed, some couples will be able to use the assisted reproduction technologies to achieve a pregnancy with their own genes. However, others will learn that their genes are not viable, and that they require either donor egg or sperm to achieve a pregnancy. Finally, other couples will find that they require the services of another woman to carry their pregnancy for them. The psychologist plays several roles in third party reproduction. She meets with intended parents and conducts psycho-educational consultations to inform them about the major issues as- sociated with family building with donor gametes. Additionally, the psychologist evaluates and screens donors and gestational surrogates for appropriateness and insures they have informed consent regarding the medical procedures they will undergo and the psychological consequences of their participation.
The Role of Mental Health Professionals in Infertility Counselling in the United States
By: Madeline Licker Feingold, Ph.D.
Counselling is a traditional role for mental health professionals. Counsellors provide support to patients, address marital and sexual problems, and devise various therapeutic interventions aimed at improving psychological adjustment. These are the roles that most people, both lay and professional, associate with mental health practitioners. However, counselling is but one of the many tasks required of the mental health professional involved in reproductive medicine in the United States. As is so often the case, scientific progress causes paradigms of treatment to change. Due to the medical advances in infertility treatment the role of the mental health professional has expanded dramatically over the years.
Until the 1970s, infertility largely was ignored in the psychological literature. When infertility was discussed from a psychological perspective, the influence of traditional psychoanalytic ideas was evident. One's difficulty in conceiving a pregnancy, or maintaining a pregnancy, was attributed to unconscious conflicts. If the conflicts concerning pregnancy were analyzed, the symptom would disappear. Fortunately, medical and psychological advances helped produce a paradigm shift in the psychological thinking concerning infertility. It became apparent that whatever the aetiology, iinfertility produced enormous psychological distress. Patients with reproductive difficulties arrived at therapists' offices with symptoms such as stress, depression, despair, low-esteem, marital conflicts, and anxiety. The mental health professional, then and now, helps patients cope with infertility by supporting them in grieving their loss, addressing marital concerns, making appropriate referrals to self help resources, and discussion alternative ways to family build.
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Disclosing Origins: Children Born Through Third Party Reproduction
By: Madeline Licker Feingold, Ph.D.
In my capacity as a clinical psychologist with a specialty in reproductive medicine, infertile couples entrust me with their personal reproductive struggles. My first visit with a couple is often following a heart-shattering consultation with a reproductive endocrinologist. After many tests, medication trials, and perhaps several in-vitro fertilizations, these couples are given the devastating news that they cannot have a child that is genetically related to them both. However, in the same medical discussion, these couples are presented with the good news that they can possibly have a child by using donor egg or sperm, depending on the nature of the reproductive problem.
Initially, many couples view the option of using donor gametes as part of a reproductive continuum, and subsequently wonder why they have feelings of depression in the face of receiving hopeful news about having a child. In fact, the use of donor egg or donor sperm is not a treatment for infertility, but rather an alternative way of family building. Nonetheless, these couples must grieve for their losses.
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How Do We Deal With It As A Couple?
By: Madeline Licker Feingold, Ph.D.
Q: We just discovered our infertility. How do we deal with it as a couple?
A: I am reassured that you used the term "our infertility" in your question. The single most important step for a couple is to realize that infertility is the couple's shared difficulty regardless if it is due to a male or female factor. Infertility treatment is focused on helping couples have a child and build a family, which is a life decision that couples make jointly.
If there is a problem becoming pregnant, it is not one partner's "fault", but rather a painful experience that both partners must weather together. Accepting the infertility diagnosis as a couple's problem may decrease feelings of guilt and self-blame which often place a severe strain on the couple's relationshiop.
The discovery of a fertility problem marks the beginning of a physically, emotionally and financially difficult period for the couple. Infertility is a life crisis and a time of major disruption for couples. As with any crisis, there is a risk for disharmony and conflict, but conversely, there is a chance for couples to become closer and more intimate.
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Secondary Infertility
By: Madeline Licker Feingold, Ph.D.
Although over three million Americans are affected by the painful experience of secondary infertility, it generally remains an unacknowledged and invisible condition. Secondary infertility is defined as the inability to become pregnant, or to carry a pregnancy to term, following the birth of one or more biological children. Even though the couple already has a child, the couple experiences secondary infertility as the loss of a child, the loss of pregnancy, and the loss of childbirth.
Even though secondary infertility has a higher prevalence rate than primary infertility, couples are far less apt to seek treatment for this condition. When their first child is conceived with ease, many couples are caught completely off guard by the difficulty of having a second child because they hold the belief that past fertility ensures future fertility. Physicians, too, may downplay the possibility of secondary infertility in their previously fertile patients and encourage the couple to "keep on trying". These couples are vulnerable to feelings of self-blame, particularly if they seek treatment at a later time and the interventions are unsuccessful. Often they feel regretful at not having taken a more aggressive approach to treatment when they were younger, as advancing age is often an issue in secondary infertility.
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Talking to Children About Their Donor Origins
By: Madeline Licker Feingold, Ph.D., Reproductive Clinical Psychologist
When couples learn they can not create a child with their own gametes, they are thrown into a significant life crisis and often experience profound feelings of grief and loss. Inherent in a couple's dreams of having children and becoming parents is the underlying assumption that they both will be genetically connected to their offspring. Genetic ties are integrally linked with thoughts of motherhood, fatherhood, and family; the loss of these links shatter couples' dreams.
I meet with couples after they learn the devastating news that they can not have a child who is genetically connected to both of them. After acknowledging their pain and helping them grieve, I ask them to elaborate on their dreams of parenthood. I hear wishes of helping children grow into happy adults, sharing love and interests with a child, playing ball, discussing ideas, and enjoying each others' company. Parents wish to experience the wonder of parenthood. I point out that genes can not do any of the activities they described--only people can interact with children and encourage their growth and development. In fact, parenting is a verb which means "to raise and nurture".
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