Introduction
Roberto and Bridget were both successful, busy professionals who were not planning to have children. Then one day, after years of being happy as a two-person family, Bridget realized that she had changed her mind—she wanted to have a baby. She raised the issue with Roberto, and after many talks and much planning, he agreed. Their life together would feel more complete if they had a child to share it with. Unfortunately, by this time, Bridget was thirty-eight, and her eggs were no longer of a high enough quality to create a successful pregnancy. Even after several rounds of fertility treatment, she still wasn’t pregnant. That was when she and Roberto decided to use an egg donor.
Lori and Christina were in love, and they badly wanted to share their love with children. They both had grown up with siblings and still maintained close relationships with them. They hoped to have two kids who could develop similar deep bonds, so they came to us for help finding a sperm donor and embarking on their journey. Though they had some misconceptions about the process and many questions, and it was initially difficult for them to agree which of them would carry the first pregnancy, they were committed to learning all they could, as well as to open communication and compromise with each other.
Like Lori and Christina, Benjamin and Brian also wanted children, but complicating matters for them was the fact that Brian’s family was very traditional and had never been supportive of their relationship. This was hard for Brian, who didn’t know how his parents would react to their decision to have children. On top of that, money was going to be an issue. It would not be easy for Benjamin, a special education teacher, and Brian, a video editor, to pay for the costs associated with using donor eggs and a gestational carrier. Between a loan and some financial assistance from Benjamin’s family, they were able to make a feasible plan.
Joanna had been in a serious long-term relationship in her twenties, but in the years after that, her relationships were more casual—not because she was avoiding commitment but because she simply didn’t form a deep connection with anyone. She had always wanted to have a child, however, and by the time she was thirty-one, she was seriously considering single parenthood rather than waiting to find the right partner. She joined the online support group Single Mothers by Choice and chatted with several women who had become single parents and others who, like her, were considering it. She also talked with her sister and a close friend, both of whom would be crucial pieces of her support network should she decide to try to conceive with a sperm donor. After weighing all that she’d learned, she decided that she was ready.
All these people eventually became pregnant and had babies using donor conception. All of them had challenges during the process, as everyone does, but they were able to overcome those challenges and build the families they dreamed of because they educated themselves and they had supportive professionals to guide them through the process. Both are necessary. It’s our desire to provide you with that education and be your first guide in donor conception. We see hundreds of patients a year, and over the years, we’ve helped thousands become parents. Every day, patients tell us that they’ve learned critical information that they hadn’t considered, that we spared them from making choices they might later regret, and most important that they feel confident, finally, in embracing donor conception. It truly brings us joy when we help set someone on the right path, when we help them feel understood in their struggle, help them manage the stress of the process, and let them know they are not alone. And of course, nothing brings us more joy than when our patients conceive, get pregnant, and have a child. We often say “we work for baby pictures”! With this book, we will walk you through all you need to know to begin the journey of donor conception and feel confident that you are making the right choices for your future family.
The patients profiled above also had something else that was key: a strong desire to become parents that carried them through the emotional difficulties and the inevitable temporary setbacks. The donor-conception process can be confusing, expensive, time-consuming, and emotionally unsettling. It can be fraught with difficult emotions like shame, loneliness, and hurt. It’s not for everyone, and reading this book will help you determine if it’s for you. For those who go through the process, their deep yearning to become a parent outweighs the challenges. The reward—finally holding your baby in your arms—we know will make all the work worth it.
If you’re considering donor conception, or if you’ve already decided to pursue it, you know how unfair it feels. If you have infertility, it can feel like your body has let you down while it seems like everyone around you is getting pregnant and having babies. If you are in a same-sex relationship, it can feel like a cruel injustice that you can’t simply conceive at home, or even have fertility treatment reimbursed by your insurance carrier like heterosexual couples can. For single parents-to-be, you may wish you had a partner but feel you can’t wait any longer to start a family, or you may be determined to do it on your own. Either way, it can feel daunting to face donor conception alone. Like same-sex couples, you may feel insecure, judged, and criticized for your choice by the outside world.
We are here to tell you that it is unfair. We wish we could revitalize eggs or create an embryo with two sperm, two eggs, or one sperm or one egg. Science is not there yet, but donor conception is a wonderful option. If you’re reading this book, it’s likely that you are willing to go to the ends of the earth to build your family. But where do you start? How do you know which questions to ask? As you saw in those patient profiles, people’s stories are different. Still, everyone faces the same basic journey and many of the same challenges. For starters, we’re guessing that you want advice on how to choose a donor, speak to your future children about their donor origins, and talk about all of this with others. Our book is your guide to navigating your journey from the moment you accept that you need and want to use donor conception. You’ll find answers to those questions and many more.
In short, this is your all-in-one guide to not only demystifying an incredibly challenging process—for many, the most difficult process of their lives—but also inspiring confidence that the journey will be a successful one, providing crucial support and encouragement every step of the way.
Who We Are
Together, we have nearly fifty years of experience in donor conception, and we bring professional as well as personal experience.
Lisa
Although I am the happy mother of three children, it wasn’t easy getting here. After marriage, I discovered that a medication my mother took while pregnant with me led to a deformity of my uterus. This structural defect caused me to have several miscarriages and years of fertility treatment.
I had always dreamed of being pregnant. I played with dolls as a child and fantasized about my future family. I used to tell my girlfriends that I couldn’t wait to have a huge belly and feel the baby grow inside my body. I had always assumed pregnancy “would just happen” when I wanted it to happen. Why not? This was my plan. It was also my husband Keith’s plan. So, after spending my young adult life trying not to get pregnant, Keith and I began to try to get pregnant. I’ll never forget one day when I was pregnant and he said, “I have never been so happy.” I felt the same. But it never lasted. Later, watching his heartbreak worsened the pain our infertility was causing me every day.
Eventually, Keith and I did what most desperate people would do—try everything. We tried immunological treatments, drank smelly concoctions from an herbalist in a six-story walk-up in Chinatown, and did acupuncture. I visualized and didn’t visualize. I meditated and prayed, and then I didn’t. I tried many different diets, supplements, meditations, you name it. Nothing worked. Our neighbors complained because the concoction I was cooking every day with turtle nails and horse whiskers (not really but something like that) was so strong you could smell it down the hallway in our apartment building. Imagine what that tasted like!
We turned to surrogacy—this at a time when surrogacy was not very common on the East Coast, which was where we lived. There were many problems with our gestational carrier match, and we eventually needed to end the relationship and end the process. We were exhausted and depressed. Our moods were low, and we had very little energy. My self-esteem was in the toilet. I felt terrible about my body.
If you have been up and down the fertility roller coaster, you know that besides the emotional drain, there can also be a drain on finances and your time. For some, the process is relatively quick, but for others it is long and fraught with difficulties. We were in the second camp.
When I came to the place where I wished for the pain to end, and my desire to become pregnant was outweighed by a desire to parent, I wanted to turn to adoption. Keith wanted to keep trying. Our new marriage was in turmoil. We were both in individual therapy and couple’s therapy. Finally, we mended our relationship and decided to adopt. We were sad and exhausted. The world of fertility treatment had been grueling, and now we were starting all over in a different world. And yes, the adoption world had its own challenges, but today, I can say that we wouldn’t change our journey because we have the children who were meant to be ours.
Professionally, I have specialized in fertility treatment for more than two decades. I continue to learn every day and share what I have learned with others new to this field. Most of all, I love helping people through the difficult process of family building when getting pregnant “the old-fashioned way” is not an option. It has always been important to me to help create change in a predominantly heterosexual, white male medical field to include the needs of everyone wishing to become a parent.
I know what it is like to struggle, to want a child and not know where to begin. I also know what it feels like to find a new strategy, a shortcut, or a stress-reduction method that works for you. Those moments are gifts, especially when you’re worried about making mistakes and feeling desperate to realize your dream.
Mark
My household is one of energies and questions. We have two busy, bouncy, destructive, inquisitive boys—boys without a mother but with two loving parents. We are a family built out of intention and love through the help of many hands and hearts. We are a family built using the assistance of an egg donor and two gestational carriers.
At random times, my two boys will acknowledge that their family is different; at times, they’ll complain that they have two dads; at times, their friends say they are lucky. My husband and I regularly talk with them about the very special person who gave some of her very special cells so Daddy and Papa could have a family. While we acknowledge this very special person, they have not asked—yet—who she is.
It was not easy for me to get here. I struggled with coming out, and one of the biggest reasons was that I really wanted to be a father. How could I be a father as a gay man? I came from a very traditional Greek Orthodox background, which meant that I had to move past a typical pathway to parenthood and open my eyes to the fact that being a parent is about loving and wanting a child—and intent. Intent means you want this child and you’re going to work hard to be the best parent possible. I had to get past the fact that my traditional family that I was raised in did a good job, but my family was going to be raised in a different way, and it would be okay.
Within two months of meeting my future husband, we took a trip together. At that point in time, I was committed to being a single father if necessary, and then he walked into my life. In the midst of a five-hour drive before a long weekend, I let him know that if he did not want to have children, we should not continue to have a relationship. I suggested that we spend the weekend together and then talk about it on the way back. On the return trip, he told me he was on board.
Greg and I started our journey to donor conception with tremendous enthusiasm and excitement. As somebody with many years in the fertility field, I thought we had this. But along the way, we had struggles finding the right donor, and we encountered several hurdles with our surrogacy journey as well. Not only was this roller coaster of hope and disappointment painful for us, but it was also incredibly frustrating. As a fertility doctor, I had been helping people build families for years, but most of these people were not LGBTQIA+ individuals. At that time, there were limited options for people in the LGBTQIA+ community who wanted to become parents. In spite of all the knowledge and experience I had, I couldn’t overcome the limitations of our heteronormative culture.
At the same time, I know that I am fortunate. In the 1970s and ’80s, being a part of the LGBTQIA+ community was much tougher, and the AIDS epidemic made things beyond complicated. Men had to give up on the idea of having a family to live as their true selves. If it was a struggle for me to become a father, it was a virtual impossibility for earlier generations. Thankfully, this has changed in the United States and many other countries, and it is changing across the world.
I have learned much through my twenty-five years helping others build their families. I also learned a great deal from being the patient, particularly about choosing a donor, perhaps the biggest choice patients face. At its core, choosing a donor might seem like a straightforward task, but there is nothing in the collective intelligence of humanity that ever prepares someone for that. It’s a choice imbued with hope and excitement as well as anxiety—and so much more. I advise parents-to-be about their donor choice every day, and it has not gotten easier. In fact, it has gotten more challenging. Thankfully, now there is the opportunity to meet your donor, more genetic information available, and a greater acceptance of family building by LGBTQIA+ individuals.
It took more than two years for my partner and me to get our first family-building journey underway. My hope is that we continue to pave the path for the people who come after us so it will be easier and faster. To this end, I began our fertility clinic, Illume Fertility, and Gay Parents to Be to provide information and great science to help all different families-to-be reach their dreams.
You Are Not Alone
Donor conception, in various forms, has been practiced for longer than we can record. In recent history, there are many documented stories of doctors who inseminated (sometimes with their own sperm) the wives of men who were infertile without their consent, or inseminated women and told them not to tell their children of their origins. When the first egg donor baby was born in Australia in 1983, curiosity about families using this technology increased.1
But times are changing—fast. Once shrouded in secrecy, the modern family, built with the assistance of gamete (egg or sperm) donation, is coming out of the shadows and growing exponentially. As more people see friends, family members, and celebrities use donor conception to build their families, the process has become much more mainstream and accepted. Donor sperm programs and egg banks have grown enormously in the past decade, and the news is full of politicians, athletes, and entertainers like Elton John, Anderson Cooper, Andy Cohen, Camille Guaty, and Natalie Imbruglia who have used donor gametes to have their children.
There is not a national registry that tracks the utilization of donors across the country for donors or donor-conceived children, and many people inseminate at home on their own, but several sources report findings that validate the experiences we have every day: The donor market is growing rapidly. The National Institutes of Health provides a “low estimate” of 132,660 sperm donations between 2013 and 2015, and 440,986 between 2015 and 2017 in the United States alone.2 It is clear that, as a recent report from the UK put it, “Fertility treatment using donor eggs and sperm is on the increase (both IVF and donor insemination).”3
Why the increase? At least two factors seem to be playing a role. As more women have entered positions of power, they have felt the loosening of social stigmas and gender stereotypes, and many now feel empowered to become single mothers or delay childbearing. Since a woman’s eggs age dramatically in her thirties, women who delay childbearing often find they are not able to use their genetics to conceive and often need to use a donor to build their families.
At the same time, passage of the Marriage Equality Act in 2011 and the legalization of same-sex marriage in all fifty states in 2015 helped create a sense of security for same-sex couples who want to marry and create families. Increasingly, there’s a feeling of safety and acceptance of LGBTQIA+ families in our communities. And you can see the results in a recent report from the Family Equality Council that found that more than three million LGBTQIA+ millennials are looking forward to having children4—they don’t see the barriers that previous generations have seen, and they are aware that they have the option of assisted reproductive technology. There is a national registry that has tracked the utilization of egg donation in male intended parents since 2017, and it has grown year over year. As of 2020, the majority of cycles involving an egg donor and a surrogate were for male intended parents (2017: 48.5 percent; 2018: 54.6 percent; 2019: 59.2 percent; 2020: 61.1 percent).5
A Guide to the Practical and the Emotional
Even though donor conception is growing, you are surely well aware that it is not exactly mainstream yet, and if you’re like most people starting the process, you may feel like an uninformed outsider. You may have consulted Dr. Google, but unfortunately, there is a lot of conflicting and false information on the internet. You may have gotten information or stories from relatives or friends, but those relatives or friends may not have correct or full information. Layered on top of this lack of knowledge is the fact that your decision to pursue donor conception may be one of last resort—a choice that comes out of suffering coupled with a desire to bring children into your home. Whether you’ve suffered deeply or your experience has been relatively smooth, everyone who goes through this process will likely need help managing their feelings and their relationships with their partners and with others.
What this means is that in order to successfully navigate the donor-conception process, you need guidance on both the practical and the emotional aspects. This book provides everything you need to know about all the medical processes, the important facts and variables you need to consider when choosing a donor, the important ways you can prepare your body for pregnancy, and other hard facts. You’ll also learn tips and strategies for managing emotional challenges that come with this process: managing the pain of infertility, letting go of old goals in favor of new ones, preparing for single parenthood, learning how to choose your donor, dealing with family and friends, handling difficult ethical dilemmas, disclosing to your future child, and more.
Our information and advice are based on the latest research available, but we also rely on our personal experience and our hearts. This is our passion—we’ve devoted our careers and our lives to it. It’s difficult for us to watch people reinvent the wheel or discover important information after it’s too late. We wish there had been a manual to help us through our journeys. That’s why we wrote this book. We hope it will be your manual.
You’ll get the most out of this book if you read it cover to cover, but you can also use it as a reference, flipping to certain sections as needed. You may find that you don’t need some sections right now, but you may return to them after your child is born—for example, to hone your child’s narrative or revisit ideas about coping with friends and family. Many of the families with whom we meet are curious about “what’s next” and how to prepare for it. This is not an outrageous idea. Chapters such as chapter 9, “Disclosure: What Your Child Needs to Know (And Why It’s Helpful to Start Practicing Now),” provide a look ahead, but—as the chapter’s subtitle implies—we encourage you to read them and start thinking about that future now.
Copyright © 2023 by Lisa Schuman and Mark Leondires