How to talk about donor conception: ‘We wanted our children to know where they came from’

When Gearóid Kenny Moore’s son came in the door from Montessori one day last year and said “Where did I come from, Daddy?” it sparked the first of many conversations that Gearóid and his husband were prepared for.

“We had a very definite plan on what we wanted them to know – we wanted them to know everything,” says Gearóid, a spokesman for Irish Gay Dads. He and Seamus Kenny Moore are the parents, through surrogacy, of four-and-a-half-year-old twins, Sean and Mary, and their 19-month-old sister, Anne.

“At this point we have told them every baby has to live in a lady’s tummy before they were born.” When they explained to the twins they had met the woman, a friend, in whose tummy they had lived, “they said ‘Oh yeh’, and that was the end of it”.

For now.

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More details about the way the children came into being will be shared as they get older. The egg donor involved in their conception at a US fertility clinic was “known and traceable”, which meant the couple could contact her.

“We have an appropriate but distant relationship with her,” says Gearóid of the paediatric nurse who donated the eggs. She lives with her husband in Washington state, but never wanted children of her own. However, she is happy to receive information from Ireland about the children and the couple send an email about once a year.

[ His biological father turned out to be his mother’s fertility doctor ]

“Our hope is that when the children get to a particular age and know more about their story and the people who helped them to get on to the planet, that they would have the ability to contact her. She has said she is very interested and open to hearing from them at some time in the future – albeit the relationship will be unusual,” Gearóid adds.

Elaine Cohalan and Jenny Synnott are taking a similar, open approach with their four-year-old daughter Cate. At this age she has very little understanding of such matters, Elaine points out, but the sperm donor is part of the family’s life. “We don’t like to use the word donor, but we talk about him; how he helped us to have her, and he’s very special. We intend to build on that story over time. We are very careful to use language she can understand at this stage, but also very adamant that she won’t even remember being told, it will be so much in her fabric that she knows.”

They talk to Cate about different family units and have children’s books about diversity. “She has other people in her life who have two mums or two dads,” says Elaine, who is chairperson of Equality for Children, a campaign for the rights of children of LGTBQ+ parents. “To a child who grows up with diversity in their life, diversity is usual.”

Without transparency, children of same-sex couples or solo parents would inevitably reach a stage when they would be questioning their genetic origins. Children of heterosexual couples are likely to presume their mothers and fathers are their biological parents, unless told otherwise.

To all parents who have used donor conception, be they same-sex couples, heterosexual couples or solo parents, psychologist Dr Ciara Byrne’s advice is to tell the children “early, often and with pride” about their origins. Research shows that children from families who were open about donor conception are psychologically well-adjusted and have more positive relationships with their parents, compared to adolescents in families who were not open about their conception journey early on.

One of the lessons learnt in the traumatic fall-out from adoptions in this State was the importance of openness and traceability. The right of donor-conceived children to know their genetic heritage was addressed in the Child and Family Relationship Act 2015. Since May 2020, when the Act was commenced, the use of unknown donors is no longer permissible in Irish fertility clinics. Details of the sperm and/or egg donor(s) must be supplied to the National Donor-Conceived Person Register and these will be available to the child on reaching 18 years of age.

However, donors can only be registered through clinics. Cohalan says she knows of many couples, including themselves, who don’t have fertility problems and don’t need medical intervention. There are safe and non-invasive procedures that can be done at home. They and the donor would gladly comply with the legal requirements for his registration, but they are prohibited. While Cate will always know who he is, there is no legal record. If children were to remain unaware until adulthood that they were donor-conceived, it would be on applying for a copy of their birth certificate that they would find out, as it must be noted in the register of births.

This is ultimately about protecting the children’s psychological wellbeing, as providing parents with these skills decreases the likelihood they will avoid these conversations

—  Dr Ciara Byrne

When a copy of the birth cert is issued, although no reference to donor-conception is made on that, the person will be told that further information relating to them is available from the register. Parents should spare their adult children such surprises. Instead, these conversations would ideally start in the pre-school years, says Byrne, “so that the child never remembers a time when they did not know how their family was created, or that donor conception is anything other than an ordinary part of their story”. It should be integrated into talk of the family “by making comments here and there in light and playful ways”.

The manner in which parents communicate this information can have a huge bearing on their children’s response. “They can be helped to feel pride in their family unit, or they can learn to be embarrassed about it and try to hide it.” Heterosexual couples, who are unlikely to be questioned on this by their children, may struggle to find the right time and way to broach the subject.

“What we find is that parents often intend to have these conversations – they know it is the right thing to do and that having secrets in families breeds mistrust,” says Byrne. “However, what prevents or delays parents is a lack of tools and knowledge about how and when to have the conversations.”

[ Ireland’s baby-making business: From egg freezing to IVF and everything in between ]

The National Infertility Support and Information Group runs workshops, led by Byrne, to guide parents of donor-conceived children on what to say at different developmental stages. “This is ultimately about protecting the children’s psychological wellbeing, as providing parents with these skills decreases the likelihood they will avoid these conversations, and thus is an opportunity to prevent a rupture in parent-child bond and negative identity development,” she explains.

The group also commissioned a series of picture books about donor conception by the children’s author Sadhbh Devlin and the illustrator Tarsila Krüse. The first to be written for Irish families, under the title A Special Gift, they cover egg donation, sperm donation and double donation, with a fourth to be published on March 6th about the child of a solo mother.

“It was an honour to be asked to do this, because it is one of the more difficult topics,” says Devlin, who underwent in vitro fertilisation to have her now 12-year-old twin daughters. Although that didn’t involve donors, she understands difficulties around fertility.

From the get go you talk about it and they know their origins. This is their birth story and it normalises it for them

—  Ciara Merrigan

As a parent, she tends to turn to relevant books for her children when they have any kind of issue. “I have always felt a lot more confident with a book in my hand – they help to find the words.” In preparing to write these story books on donor conception, Devlin noted that those from other countries were very much written from the parents’ perspective.

“My experience of writing a picture book is always centring the child. Children at age three-plus very much see themselves as the centre of the universe.” The story is set around a child’s birthday, which they wouldn’t get to celebrate if there hadn’t been a donor in the family. The different editions are adapted to suit the nature of the donation.

The text is very simple, she explains, but the book includes tips for reading it to a child and offers the chance for wider conversations. “It is all about being age-appropriate,” she adds. “As they get older, there will be other books.”

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Ciara Merrigan and her husband, Michael, have four-year-old twins through international surrogacy. “From the get go you talk about it and they know their origins,” she says. “This is their birth story and it normalises it for them.” She has found books about surrogacy written for children helpful in that regard. “They are learning through characters that this is a normal way to come into the world as well.”

About 70 per cent of surrogacy cases involve egg donor conception, says Ciara, chairperson of Irish Families Through Surrogacy. The group was set up in 2019 to campaign for appropriate legislation to cover families formed in this way. Currently there is no provision in Irish law for surrogacy, and the birth mother is regarded as the legal mother. The Irish father has to prove a genetic link for the baby to be granted citizenship but there is no legal recognition of his partner as parent nor, if her eggs were used, of her genetic link.

Elaine’s wife, Jenny, is not recognised as Cate’s second parent either, because Elaine is the birth mother of Cate. “My wife, I and daughter all live together. The State recognises my wife and I as a legal family unit and my daughter and I as a legal family unit, but not the three of us,” she says.

Likewise Gearóid, as the non-biological father, is not in the eyes of the law a parent of his children. He had to wait until after the twins turned two to apply for guardianship. “If anything were to happen to the legal parent in that two-year period, it leaves the child vulnerable,” he says. “It also makes practical things, like bringing your child to the doctor, a problem because you have no legal right to do so until you become a guardian.”

[ The serial sperm donor: One man, hundreds of children and a burning question: why? ]

The Health (Assisted Human Reproduction) Bill 2022 is intended to legislate for many of the complex issues surrounding the increasing variety of ways families are now formed. But the decision to include provisions for international surrogacy further delayed it and there is still no timeline for its passage through the Oireachteas.

How the National Donor-Conceived Person Register works

The country was still in the throes of the first Covid lockdown when new legislation came into force for people who need assistance from a donor to conceive a child.

Since May 2020, when the Child and Family Relationship Act 2015 commenced, people undergoing donor-assisted procedures in fertility clinics can only use gametes (sperm or eggs) from known donors. A key principle underlying the Act is the protection of children’s right to identity, says a spokesman for the Department of Health, which is responsible for the National Donor-Conceived Person Register. This register ensures that children will be able to access information on their genetic heritage in future years.

Clinics are required to submit details of every treatment involving any form of donation within six months of the treatment, whether successful or not. Live births must be notified to the department by the clinics within 12 or 13 months of the donor-assisted procedure and the donors’ details are entered into the register. Children can request that information when they turn 18.

All sperm donations used in clinics here come from overseas because no clinics here are authorised to act as a sperm bank or to do known-sperm donation. However clinics are permitted to facilitate known-egg donation, as Sims IVF does at its Clonskeagh centre in Dublin.

[ LGBT families in Ireland still caught in legal loophole ]

“Patients can bring a potential donor with them, usually a friend or a family member, and we can facilitate an egg donation cycle,” says Graham Coull, Sims IVF’s scientific director. Donors, ideally between the age of 21 and 35, will undergo extensive medical assessment and counselling prior to being accepted as a donor.

The National Infertility Support and Information Group is seeing more and more people with fertility problems opting for donor conception, says its chairperson, Caitriona Fitzpatrick. “It is being talked about more; even politically, it is more in the ether too.”

About 15 per cent of those who attend Sims IVF for in vitro fertilisation and intracytoplasmic sperm injection use donor sperm, whereas for intrauterine insemination it is about 46 per cent.

There are countries, eg Spain and Czech Republic, where only anonymous donation is allowed by law. This means that Irish clinics can no longer bring donor samples into Ireland from these countries

—  Graham Coull, Sims IVF

“The difference comes from the fact that the majority of the extra intrauterine-insemination patients are either single women or lesbian couples, who have no need for full IVF cycles, as what’s missing from their attempts at a pregnancy is only the sperm,” Coull explains. As for the use of egg donors, “our programmes are only ramping up again post-Covid, but from past experience we expect around 20 per cent of patients to request donor egg”.

Sims IVF uses two sperm banks, one in Denmark and the other in the US. It also has two egg-donation programmes, one in the UK and the other in Portugal, where the legislation is similar to Ireland and donors must be identifiable. However, in addition to being identifiable, donors must also sign a legal document agreeing to inclusion of their information in the NDCPRdonor register, otherwise their donations cannot be used in treatments here.

While Sims IVF fully supports the move to open/identifiable donation, says Coull, the ban on the use of anonymous donors has obviously limited the number of available donors and countries from where donors can be sourced.

“For example, there are countries, eg Spain and Czech Republic, where only anonymous donation is allowed by law. This means that Irish clinics can no longer bring donor samples into Ireland from these countries, which would have traditionally been a large provider of donors. Patients can still avail of treatment in these countries, but they must travel and cannot bring their embryos back into Ireland.”

[ ‘It’s like a weird Tinder’: Meet the mums going it alone with the help of donor sperm ]

However, if anonymously donated sperm and/or eggs were used to create embryos that were stored in an Irish clinic before May 2020, intending parents are permitted to use these. Also, those who already have one donor-conceived child born before the law changed, can use gametes from the same donor if they are already stored in a clinic here, but this exemption expires in May. In the case of every donor-assisted procedure, clinics have to submit the patients’ details, the date and nature of treatment, and the donor’s full name, their date of birth, their nationality, their address at the time of donation, the place of donation (the clinic or donor bank site) and the date of donation. The onus is also on the clinics to follow up with details of live births.

“The parents have a responsibility to provide this info to the clinic,” says Coull. “They sign a legal document prior to every donor treatment cycle, agreeing to provide the child/children’s name(s), date of birth, place of birth, sex and address the child will reside at to the clinic for addition to the registry at the appropriate time.” While that registry is currently maintained by the Department of Health, the long-awaited Health (Assisted Human Reproduction) Bill 2022 will provide for the establishment of an Assisted Human Reproduction Regulatory Authority, which will take over the registry.