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by Merle Bombardieri, LICSW


It's so tempting. You love to be helpful. You love to be generous. You're fertile. Your sister isn't. One day you're reading a magazine article about surrogacy or the donor egg technique, and you begin to daydream. You see yourself pregnant with your sister's and brother-in-law's baby, and then you picture yourself in the delivery room, magnanimously handing the baby over to the couple, who are tearful and grateful. Or you picture yourself having dozens of eggs retrieved, resulting twins that your sister, despite premature menopause, is able carry and deliver.

Maybe your sister called you, sharing her fantasy and asking you to think about helping her out. You think of wonderful phrases, like "the gift of life", "making sacrifices for the one you love", "sisterly love."

Before you start making insemination appointments or head for the donor egg clinic, it's a good idea to take stock. Just because you love the idea doesn't mean it makes sense. Conversely, just because you're worried and scared doesn't mean it can't work. How do you figure whether joint baby-making your sister and brother-in-law would be a dream come true nightmare?

As a clinical social worker in private practice specializing in fertility decision-making, I have devised some specific questions and points that help sister and other relatives or friends evaluate the suitability of donating eggs or providing a womb to their infertile loved one. Here is a sampling of the values clarification questions I have devised (see below if you like to order the complete set.)

1. Understand the mechanics.

There are three basic ways one woman can help another have a baby:

ln simple surrogacy, the donor sister is artificially inseminated with her brother-in-law's sperm. This can be done informally at either sister's home or in a doctor's office. The surrogate sister is both the biological mother, providing the egg and the gestational mother, providing the womb. In IVF surrogacy, also known as host uterus surrogacy, the donor provides the womb but not the eggs, which are retrieved from the infertile sister and fertilized in a petri dish by the donor's brother-in-law. The embryos that develop as a result are then implanted in the donor's uterus. The donor is the gestational mother but not the biological mother. The infertile sister has the satisfaction of providing the genes even though she can't carry the pregnancy.

In the donor technique, the donor, after taking fertility drugs, has eggs removed through a non-surgical procedure. They are then fertilized by the donor's brother-in-law, grown in a petri dish and implanted in the infertile sister's uterus. The donor is the biological mother, but the infertile sister has the pleasure of carrying the pregnancy.

2. Have medical evaluations to make sure your dream has a good chance of coming true.

For instance, if you have had two miscarriages, your uterus may not be a good bet for surrogacy, but you might make a terrific egg donor. Attempting surrogacy may make less sense than adoption if your brother-in-law has a low sperm count. Or if you're diabetic, a pregnancy may not be medically indicated, no matter how eager you are to help.

3. Ask the right psychological questions.

For instance, if the infertile sister has always envied the fertile one, will she be able to tolerate seeing the "lucky one" glowingly pregnant with her husband's baby? Will the sister who donates the egg feel she has a right to complain about the recipient couple's discipline techniques? How will the recipient husband feel about having the donor sister present at family events? Will the donor sister be considered an aunt or a second mother?

4. Consider secrecy issues.

Will other family members know about the method of conception? Will the child be told about his or her origins? If you answered "no" to either these questions, proceed with caution, because secrets have a way of coming out anyway or eating away in subtle but unhealthy ways in family interactions.

5. Consider ethical issues.

Who will raise the child if it is sick or disabled? Who will make abortion decisions the surrogate contracts rubella or finds out she is carrying spina-bifida baby? Are you going to worry that you may unfair to the child to conceive her in a way so new we don't have research or childrearing guidance yet?

6. Consider medical risks of procedures.

Will you still be glad you did surrogacy if you can't successfully have your own baby in two-years time? What if your ovaries were damaged during egg retrieval and you yourself needed an egg donor to conceive in the future? Many clinics and mental health professionals prefer to work with donors whose families are already complete.

7. Consider legal issues.

Will the donor sister receive custody if the recipient couple divorces? Are there laws in your state that complicate your surrogacy arrangements? I recommend that sisters draw up a contract to spell out the intentions in such matters as #'s 5 and 6 above, also include whether the donor will receive money or other compensation and whether the donor will receive money if medical problems develop as a result of her contribution. Ideally there should be a separate lawyer for each sister. Save money on legal fees by putting in writing ahead of time what your desires and concerns are.

8. Look for psychological blind spots.

It's so easy push ahead on an idea that is appealing. The momentum of a shared family mission can cloud good decision-making. I recommend the following arrangement for sisters who are both married. The sessions could all be done by one clinician, but that is not necessary.

a. Individual session with donor sister
b. Couple session with donor sister and her husband
c. Individual session with recipient sister
d. Couple session with recipient sister and husband
e. Session with both couples

Husbands involved may also want individual sessions to discuss concerns they may be having trouble expressing to their wives.

It is essential to consult with a psychotherapist who is:

1) Knowledgeable about infertility, both medical and psychological aspects
2) is knowledgeable about the specific medical technique you are considering
3) is open-minded, e.g. you don't want to see someone who thinks surrogacy is unethical or that only neurotically attached sisters would consider the egg donor technique.

If you are considering one of the high-tech procedures -- donor egg or IVF surrogacy, your program will have one or more screening sessions that may include some of the combinations listed above. However it may be wise to see an independent practitioner to work out the above issues. The reason? Clinics are screening -- they're looking for trouble spots and trying to say "no' if they think you might wind up unhappy or even sue them. You're better off discovering and resolving the problems before you walk into the clinic..

Good luck with your decision-making!

OPTS NOTE: Merle Bombardieri, LICSW, BCD is co-founder of Fertility Counseling Associates in Lexington, MA. She is the former clinical director of RESOLVE, the national infertility Organization. She is author of The Baby Decision and an article about sisters as surrogates and egg donors in the September 22, 1991 issue of The Boston Globe Sunday Magazine.

For a longer version of her decision-making questions, send $6.30 (includes postage and sales tax) to Fertility Counseling Associates, 33 Bedford St., Ste 18, Lexington, MA 01720. She is also available for one-hour telephone consultations which can be conference calls including sisters, husbands, etc. For the name of on infertility counselor in your area, contact your local RESOLVE chapter, or National RESOLVE at (517) 623-1156.


2007 OPTS - The Organization of Parents Through Surrogacy