Cover Story

Kathy Giordano knew before she married that she and her husband would have to undergo infertility treatment if she were to have a child. Her husband, Tom, had suffered from Hodgkin's disease and banked some of his sperm when he learned that chemotherapy might compromise his fertility.

After one failed attempt at in vitro fertilization (IVF) using the stored sperm, Giordano went for a second round at the clinic where she is now employed, Reproductive Medicine Associates (RMA) in Morristown, N.J.

This time it worked. "I got pregnant, and we were so excited," the 42-year-old fertility nurse recalls. "Tommy was born about three weeks early, and it was one of the happiest days of my life." Now 5, Tommy is described by his preschool teacher as the mayor of his class--extremely social and popular. "He's the happiest little guy," Giordano says. "We feel really lucky."

Giordano's joy is shared by many who undergo the rigors of IVF and other kinds of assisted reproductive technology (ART), says Madeline Feingold, PhD, director of psychological services at the Alta Bates In Vitro Fertilization Program in Berkeley, Calif. "These kids are the antithesis of an accident," she says. "They are so wanted."

Sleepless nights

Of course, life isn't entirely rosy following an ART birth. Infertility clients face the same challenges every new parent faces: wailing babies, sleepless nights, disrupted schedules. And they do this in the wake of stressful treatments, often at older ages than those who conceive naturally.

People who have given birth via ARTs face other common issues too, infertility experts say. These include dashed fantasies of a perfect baby that never cries and is always gurgling and cooing; depleted finances from costly infertility treatments; and ongoing self-esteem problems. To amplify matters, clients may also feel they can't complain about the normal stresses of parenting because they've "gotten what they wanted," notes Andrea Mechanick Braverman, PhD, director of psychological and complementary care at RMA: "It's almost as if they don't have the same rights as someone else to be tired after being up all night with a newborn," she says. They may also worry they've exhausted all of their support networks, she says.

Another big challenge is multiples. IVF treatments in particular, designed to maximize a woman's chances of becoming pregnant, may yield twins, triplets or more.

"For them, that's like winning the lottery!" Braverman says. "But they're not initially thinking about the fact that it's that much harder than having one child." One client of hers with multiples told her, "It's like going from a man-to-man defense to a zone defense."

Meanwhile, some ART clients face challenges unique to their particular situations, infertility experts say. Single moms who have used donor insemination, for instance, may need more outside support than others. Lesbian and gay parents and their children may confront discrimination and legal complications surrounding the identity of the child's second parent (APA addresses this issue in a 2004 policy statement on sexual orientation, parents and children, at www.apa.org/pi/lgbc/policy/parents.html). Heterosexual couples who have conceived with donor sperm or eggs face delicate psychological and social issues, including their own feelings about having a child who doesn't share both parents' genes, and whether and how to tell their child and others how the child was conceived (see sidebar, page 54).

A lot like other families

That said, ART parents, including those who have undergone IVF, surrogacy or egg and sperm donation, are generally as well-adjusted and capable as those who have conceived naturally, and their kids are doing well too, studies suggest. Some of the most rigorous work in the area is being done by psychologist Susan Golombok, PhD, of the City University in London. She is conducting a range of longitudinal studies on people who have undergone ARTs--including heterosexual couples and lesbian and single moms--and comparing them with those who conceived naturally or who adopted children.

In a 2001 article in Child Development (Vol. 72, No. 2, pages 559-608), for instance, Golombok found that children in families that underwent IVF were as well-adjusted on a range of social and emotional measures as matched youngsters who were adopted or conceived naturally. A study in Human Reproduction by Golombok and colleagues, published online March 29, reports on the third wave of a longitudinal study of youngsters who are now 3 and their parents. Families that conceived via donor egg or sperm, surrogates or naturally were a lot alike with one exception: Women who had conceived via an assisted method were more warm and interactive with their children than those who had conceived naturally.

So far, other studies examining levels of anxiety in ART parents are largely inconclusive. But it's worth noting that clinical reports indicate IVF parents are reluctant to vent their parenting concerns and may need particular encouragement to express their feelings.

Easing the transition

On the clinical end, psychologists are helping ART clients prepare for and handle parenthood when it comes. Encouraging clients to engage early on in stress reduction, support groups and couples counseling helps not only during treatment, but once a baby comes, notes Feingold.

Fears can be especially strong if a baby is the product of donor sperm, eggs or both, Grill adds. In fact, it often takes time for couples unsuccessful with IVF to decide to use donor gametes, she says, and some decline for emotional reasons.

For those who decide to take this route, Grill helps them to grieve the biologically, genetically shared child they had hoped for and to imagine and work through how they'll feel once their child is born.

"People need to figure out how they'll react when people say things like, 'Whose eyes does this child have?'" she says.

Fortunately, concerns about bonding tend to evaporate once the child is born, says psychologist Jan Elman Stout, PsyD, an infertility specialist in Chicago and chair of the Mental Health Professional Group of the American Society for Reproductive Medicine.

"I've had the gift of watching how this unfolds for people," she says, "and the shift is so significant once they are actively parenting. What a parent wants is to nurture and form attachments and share values and activities with a child. And you get all of that."

Tori DeAngelis is a writer in Syracuse, N.Y.

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