JBRA Assisted Reproduction 2015;19(3):148-150
REVIEW
doi: 10.5935/1518-0557.20150032
1CAPSIR - Argentine Center of Psychology and Reproduction, Buenos Aires, Argentine
CONFLICT OF INTERESTS
No conflict of interest have been declared.
ABSTRACT
This paper briefly reviews some aspects that affect people with infertility problems and children born through assisted reproduction techniques. Making a decision to have a child and accepting medical help represents an important moment in the life of a couple. All parents are confronted at some point, with the questions, that every child asks, that is: “How was I born?” All children need to know their origin. However, most parents are not comfortable providing the answer. In case of parents, who resorted to reproductive medicine, the answer requires a particular approach, mainly because it often revives painful and unresolved internal conflicts. Another problem is that parents do not feel comfortable to talk about the fact that medical help was required to conceive their child and that medical intervention sometimes requires the donation of gametes (eggs or sperm); or simply, they do not know how to talk to children about this issue. However, children have the right to know their origin. Our study indicates that some children with behavioral problems improved significantly after the family spoke openly about their origin. Children need to be told the truth. We cannot lie to them nor remain silent.
Keywords: Children, Assisted Fertilization, Procreative Origin
Every child asks or is curious about how they arrived in this world. They want to know how they were born and how and why they were conceived. These are the natural concerns and, to the extent they are addressed, they help the child understand the complex aspects of life and find his/her own place in the family history. In this study, we focused on cases in which this situation, common to all children, required medical intervention. Even for parents who, from the very beginning, have had a strong desire to share with their child the story of her/his conception, it may be difficult to do it. For others, it is not easy to decide to tell the whole story and to share the fact that they had to turn to medical profession for help, more so, if the treatment included an egg or a sperm donation in order to make the pregnancy possible.
Human sexual reproduction involves multiple facets; some imagined, some desired, others not yet thought of. Despite scientific advances in the field, nature, not fully tamed by man, still holds the key to the randomness of human reproduction. A diagnosis of reproductive disorders or infertility is hard to accept for both, men and women. Much has been written about the emotional effects thrust into the psychic apparatus causing endless outcomes, especially pain and suffering. We are talking about a disabling medical condition that affects all kinds of life projects. (Jadur & Duhalde, 2006).
At present, between 15% and 20% of the population have problems conceiving. The causes of these problems are multiple; 33% corresponding to a female factor, 33% to a male factor and 33% are mixed, where both females and males have disorders. The remaining 5% to 10% correspond to ESCA (unexplained infertility), which includes the “psychological factor”, according to the authors.
In recent decades, the formats of family ties and the formats of relationships between family members have undergone considerable changes (Golombok, 2006).
Family environments have become much more diverse. The novelty in these modes of parenting is that, in some cases, the conception of a child is different, due to scientific advances. Both medicine and biotechnology brought about the possibility to fix a problem in the body, when the expected child turns into a problem because of her/his absence. In addition, science enables the creation of new constellations of families with two mothers or two fathers (Roudinesco, 2003). We agree that although the gender studies’ theories contributed to deconstructing identity structures, denaturalizing female maternal functions and breaking the man-woman binomial, heteronormative discourse still reproduces a system that favors “consensual” models as natural and where culture continues to insist on the mandates that highlights the importance of
progeny. Today, a woman can make decisions about her body, her desire to have a child and her reproductive rights, which include contraceptives and termination of pregnancy. Men also have the right to choose. However, both man and woman abide by family and social mandates (Saal, 1998). We want to add, that both man and woman construct the desire to have a child. This desire arises from a configuration of narcissistic and objectionable aspects, inherent in one’s personal history. It is a crossover of
unconscious and cultural representations of motherhood, fatherhood and the family of feminine and masculine. For women, there is an additional natural factor to be considered. The female body is a carrier of pregnancy, which leaves a permanent mark and impacts gender issues and subjectivity, that does not conform any longer to certain ideals transmitted by culture.
For people facing different treatments in order to conceive an infant, each negative result leads to repeated attempts in different directions. That way some arrive at the point, where egg or sperm donation is suggested. The essential process of coming to terms with inability to use one’s own gametes have unequal vicissitudes in men and women. Woman, in such cases, can still achieve pregnancy, experience childbirth and lactation. The male is left out of the loop of biological reproduction. The processes to deal with the problem are very personal and in the intersubjective realm depend on the type of relationship the partners are in. The dream project to start a family with biological children is exposed to doubt and uncertainty. This may cause an anxiety of not being able to fulfill the need to become a parent, by giving genetic continuity to the family.
This anxiety may be deepened by a sense of loss of control over one’s body. The demand for a child and the desire to be parents in these cases requires to undergo an intrasubjective and intersubjective processing in order to allow the construction of the psychic space that every child needs to become a subject (Jadur & Duhalde, 2005). The process to untie and piece together the story of desire, affection, hope and sadness is unavoidable in order to have a child. This is true even in optimal emotional conditions, where there is a little mourning left to be done and where narcissistic wounds are already healing. This process must include information about the origin of a child’s conception.
Why and how to talk to a child about her/his conception? (Jadur & Duhalde, 2010)
All children have the right to know their procreative, biological-genetic origin. It is in their right to know whether they had been conceived through assisted reproduction, gamete donation or adoption (Daniels, 2004). The first space a child lives in is the one outlined by the desire of her/his parents: how they think about the unborn child, how they imagine the baby will look like when she/he is born, how they will love the baby and how they will take care of her/him. The parents think of details, like the colors of the walls of baby’s future room or who will take care of the baby when they are at work. By doing this, the parents create an affective space for baby’s arrival. This is the baby’s first cradle. This space is first inhabited by words and fantasies. These fantasies are not lost over time but instead, are enriched and become essential for the child’s development and emotional wellbeing. The trust between parents and children is essential to establish a relationship of strong bonds of love and secure attachment. This is based on the ability to share feelings and thoughts. When children are lied to or the truth is withheld from them, the possibility of constructing a proper relationship based on honesty is hindered.
It is difficult for a parent to live with a child and at the same time hide the truth from him/her. Words are essential for human psychic construction. Each phrase carved by affection, without mysteries, can build a solid bond of trust, love and respect. The only truth is the one everyone holds within him/herself, marked by personal experiences. Psychoanalysis and child psychology have provided a valid knowledge about the adverse effects of the “unsaid” in the constitution of a child’s subjectivity, and the damage family secrets can cause throughout generations. Contrary to popular belief, children have a particular ability to perceive that something they do not know about exists. Surely they cannot explain it, but somehow they know that something is hidden and “that, you cannot talk about it.” This produces a feeling of insecurity in a child. Not understanding what happens and not being able to rely on adults to put it into words, a child can manifest a range of symptoms that affect learning, behavior or sleep and are related precisely to the secret about the origin of conception.
Why may it be difficult?
It is known, that a first visit to a fertilization specialist, after a pregnancy fails, is painful. Since diagnoses are complex, it is even more distressing to decide what physician and treatment to choose, and when to start the procedures. It is also strenuous to carry out the very treatment. The expected results are difficult to achieve and the trials have to be repeated many times. It is also hard to discover that one’s egg or sperm lack the reproductive capacity (Jadur & Duhalde, 2010). In such cases, to prepare oneself to talk to a child about the history of conception implies to go back to these painful issues that wanted to be forgotten. The suffering is often stored deeply. This means that, for many couples, it is not easy to face the situation and find time and manner to address the issue. We may say that it was due to a random call of nature, but at the same time a new reality was constructed that gave a special framework for the pursue and achievement of pregnancy. On the other hand to talk to a child about the odyssey of conception offers parents a great opportunity to integrate their feelings, past situations, sensations and emotions present before the arrival of the baby. The tiny voice of a child can cause parents’ despair: “What will she/he ask?”, “How will we respond?” Nevertheless, it can also help, considering it is a part of the present and future story of the family.
What are the most common fears?
Generally unwillingness or inability to speak has more to do with unresolved conflicts of adults. It can generate fear of awakening the old pains and dusting off “forgotten” circumstances. What adds to the problem are the difficulties the parents face to talk about issue related to sexuality. This obstacle is common to all because it refers to the relationship with the body and to intimacy. The age at which children express curiosity about the difference between genders, provides a good opportunity to address the issue. It is also common to be afraid of rejection by the child when he learns the truth of his conception. This concern is common, especially in cases of egg or sperm donation. Adults sometimes hesitate: What makes parenting? Will they be less or bad parents because the process to become one was so difficult? Children are not confused about parenting. They recognize as parents the people who care for them on an everyday basis, those who give them feeling of security and affection, those who include their names on the family tree, recognizing them as a member of a family group.
Should we also talk to other people?
To keep hidden the fact of how the child was conceived, undoubtedly affects not only the parent-child bond, but also all kinds of ties within the family and friends’ circle. The energy required to sustain a false story and keep the secret safe, wear the parents out. At the same time, there is no guarantee that the truth will finally come through. Parenthood is not only an issue of biology but it is a symbolic construction that is part of life in a given family and cultural context. Emotional, social and religious factors play a role when it comes to making a decision to have a family and raise children. Parental expectations and the social context influence the very experience of parenthood. When parents can truly accept that their role goes way beyond genetics and can agree that we all have the capacity to love and raise a child, they are ready to share their experience with others.
Moreover, how is it possible that other people know this story but the child does not? (Jadur & Duhalde, 2010). The child is the one who needs to know it first. The reality is that medically assisted fertilization and gamete donation are different ways for a child to be born and raised in the family. It is just different, and it is different for the parents and other adults but not for the child. The child is here and she/he is who she/he is, thanks to the way she/he was conceived! If the child feels safe, loved and cared for, the way she/he was conceived will be just one more fact to understand. This fact would not prevent the child to feel happy within the family (Golombok, 2006). Presenting the events in a natural way is to show the child a diverse and constantly changing world.
How and when to talk to the child?
The best way to share the story of the conception is to make it part the family life from the very beginning of pregnancy. If the parents speak naturally about the circumstances of pregnancy, the fertility treatment or gamete donation, they can shift the story and readjust it over time to the child’s developmental level and capacity to understand. That is why we published a series of children’s books to talk about the conception in cases of assisted fertilization and gamete donation (Jadur & Duhalde, 2010). Reading the text together and looking at the pictures the children can talk about their own stories. In this process, it is always advisable to use the language the child is familiar with; to adapt the explanations, so they are straightforward and clear. Parents should allow themselves to speak in their own words. It is likely that the child will react differently than adults. Therefore, it is important to find an appropriate time, so the child can connect, disconnect and reconnect with the information she/he receives. Children need to hear the same story many times in order to process it properly. Repetition generates a more favorable context for them to fantasize and ask questions. It might be that the children take the story to their world, where they translate it into their own coding system, which comes from their favorite characters and their everyday games. Children need real and concrete information about the world around them. They need to play with new knowledge and find pleasure in the diversity that surrounds them. They also need to talk from the very beginning and at their own timing, about life and death. Childhood sexual fantasies, the phantasmal, continue to operate unconsciously in the child without interfering with the data supplied from reality. Psychological trauma has nothing to do with the unfolding to the child of the conception story but with the confusing and conflicting messages that the adults sent, denying a child what she/he can perceive. (Golombok, 2002).
Children need to become adults able to choose, to decide, to construct a lifelong project, is the environment in which adults use words to communicate clearly and not to conceal anything. Children have a right to know about their origins, as much as adults have a right to choose when and how to become parents. We wonder if mental health professionals and specialists consider these aspects.
Theoretical assertions are necessary because they enrich clinical practice. However, we have to admit, that when it comes to providing an input and exchange of information on the subject, the children’s needs are not taken into account.
We have to remember that there are thousands of children born through assisted reproduction techniques. These children are part of consecutive generations.
At present, the community at large does not take full advantage of the scientific developments and new technologies that accelerate access to research findings.
The role of psychoanalysts should be to encourage interdisciplinary discussion and exchange of ideas and to continually develop their knowledge in order to meet current demands.
Golombok, S. Parenting and the psychological development of the child in ART families. In Vayena E, Rowe PJ, Griffin PD, eds. Current practice and controversies in assisted reproduction: Report of a meeting on Medical, ethical and social aspects of assisted reproduction. Geneva: World Health Organization. 2002. p287-302.
Link
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