Though there are more ways today to create a baby than ever before - with help from a friend or stranger's sperm, egg, embryo or womb, just to name a few—questions continue to swirl about what and when to tell the resulting children about how they're related to whom.
Even plans that seem firm before conception can go awry once the child is born, according to a study published this month in Reproductive BioMedicine Online. Samantha Yee, a doctoral student and social worker at the Centre for Fertility and Reproductive Health at Mount Sinai Hospital in Toronto, interviewed 15 women who donated eggs to friends or family members, and 18 women who received eggs from pals and relatives.
No cash was exchanged in these "altruistic" arrangements, Yee says. But there were strings, and that became even more apparent as the infants got older.
"These women are typically close," Yee says. "During the pregnancy, they see themselves as part of the same project, driving each other to clinic appointments and so forth." Egg donor and recipient often know each other's friends and extended families, some of whom may not know about the arrangement.
Initially, everybody involved is so focused on getting pregnant, Yee says, they may not compare notes about what they're going to tell the child and others down the road. She interviewed the women after the babies were born.
"In some cases there was a mismatch in expectations of how they'd handle [the discussion of how the children were conceived]," Yee says. Typically the egg donor wanted to eventually tell the child about the arrangement, but sometimes the recipient didn't.
That sort of mismatch seemed especially complicated, Yee says, when the egg donor had children of her own - genetic half-siblings of the recipient's child. "Suddenly you have a situation where these women see each other all the time, and their children are close in age and good playmates, but there's a secret nobody's talking about."
As one donor put it, "In 25 years, what if [my own child] fell in love with [my donor egg offspring] ...I would never want my child to go through that."
In September, NPR's Jennifer Ludden reported on the trend towards telling children if they were conceived with donor egg or sperm, and on the desire on the part of some children to find their donors. There are fewer online resources than you'd expect on the issue. Resolve, the nonprofit that advises on infertility options, lists issues to consider when talking to children. And the Donor Sibling Registry addresses what to tell as part of its page on donor family issues.
"This type of egg donation can work beautifully," Yee says. "But it's really important that the people involved talk and think through ahead of time what they'll tell all the children. It's not just a one-time discussion."