Rene Danford has a message for her in vitro fertilized babies, and she has told it to them many times: "You are special. A doctor helped create you."
Whether to tell her children about their origins was never really a question for Danford or her husband. And she saw no reason to wait until they were grown. Practically from Day 1, she started a conversation she planned on sharing with them for many years to come.
"I spent $45,000 to get success and had to fly across the country. You're darn right I'm going to tell them," says Danford, 38, a New Orleans mother of two in vitro fertilized babies, now ages 1 and 3. "I'm very proud of this. I want to tell my kids where they came from."
A mere decade or so ago, such sentiments would have been rare. IVF and other forms of assisted reproduction were often kept secret, not just from children, but from family, friends and co-workers as well.
But that has largely changed. Just as adoptions have become more open, so has information about infertility, in vitro pregnancies, donors and surrogates, and the like.
"There's been an evolution in thinking," says Barbara Cohen, an Annapolis social worker who counsels surrogate mothers and others in fertility clinics. "We have borrowed from the adoption world. We know it's better to give information."
Still, the change in social norms begs the question: How do you talk to your children? It's a question that has no easy answer, and, even among experts, there is some disagreement over how -- and even whether -- to go about it in certain circumstances.
"Frankly, we don't really have empirical data about whether telling a child or not telling them is good or bad," says Dorothy Greenfield, associate professor at the Yale Center for Reproductive Medicine & Infertility in New Haven, Conn.
Greenfield usually advises couples to be as open as possible. In cases of routine IVF, where both parents are donors, the egg is fertilized in the lab and the resulting embryo implanted in the mother, this is usually not considered particularly controversial anymore. Some parents might choose not to discuss the information because they simply deem it irrelevant and on a par with talking about Mom's facelift, Dad's ulcer or some other private medical condition.
Not so in cases where sperm or egg are donated. There, Greenfield sometimes encounters resistance from parents who wonder how children will react to the news and whether one partner's lack of biological involvement will harm their bond with the child.
Most choose openness
Yet, even in most of those cases, parents are choosing to talk. One major reason is that advances in DNA mapping and gene therapy make it far more likely a child's genetic origins will need to be documented -- to predict or treat certain diseases, for instance.
"It's usually easier to live day to day in an open field than with family secrets," says Linda Hellmann, a Baltimore psychotherapist who specializes in infertility issues.
Anne C. Bernstein, a Berkeley, California psychologist and author, recommends that the conversation begin as soon as a child shows interest in his or her origins. That should probably take place well before adolescence, she says, when identity issues become a little more problematic.
"It's perfectly fine to be talking to children when they get home from the hospital," says Bernstein, whose book, Flight of the Stork: What Children Think (and When) About Sex and Family Building (Perspectives Press, 1994), is often recommended reading in fertility clinics. "It gets parents comfortable talking about something they might otherwise have anxiety about."
A recently released children's book, Our Beautiful Work of A.R.T. (Beaver's Pond Press, $19.95), has been billed as the first children's book geared specifically toward helping parents teach youngsters about their clinical origins. (ART stands for Assisted Reproduc-tive Technology, which is the technical name for IVF and its related procedures).
"Dreams come true when a baby is born, / But when we tried to have you our hearts were torn," the book begins. "Mommy and Daddy had been trying so long, / We had to go to the doctor to see what was wrong."
With its simple language and brightly colored artwork, the book is appealing and not at all technical or graphic. To concoct a baby, for instance, the doctor's office is seen with a batter-filled "mixomatix" in the "Sugar-N-Spice Everything Nice Kitchen."
Author Rozanne Nathalie says readers have shown enthusiasm for her work. With financing from fertility drug maker Serono Inc. drugs, she has written companion children's books to explain egg donations and surrogate mothers to youngsters as well. A former Las Vegas fertility clinic worker who helped recruit egg donors nationwide, she thinks the book can be introduced to children as young as 12 months.
"People feel it's about time," says Nathalie, 31.
Answer what is asked
Experts generally agree that parent-child conversations of these matters should be matter-of-fact and uneventful. Language should be specific and not euphemism-filled, but should only include as much detail as a child can handle.
"The most important thing is that a child should never feel deceived," says Linda Applegarth, head of psychology for Cornell's Center for Reproductive Medi-cine and Infertility in New York City. "Secrets end up being much more destructive than the truth."
Psychologists also recommend that the information be offered in a positive context -- not "This is how much I suffered to have you" but more like: "We're so glad we had help to create our family."
"And remember to answer the question they are asking, not what you think they're asking," says Cohen. "When they ask, 'Where did I come from?' you don't give a blow-by-blow account if all they want to know is that you used to live in Ohio."
Still, it's not easy to decide when to tell. There are two schools of thought, says Applegarth: Either tell them right away, or wait until they are old enough to understand the basics of biology, anywhere from kindergarten to third grade.
Which philosophy is better? That's up to the family involved, she says.
"Some parents will never, ever tell the kids for whatever reason, but most others start talking about it when the child is 8 or 9," says Dr. Jairo Garcia, head of the IVF program at Johns Hopkins Hospital. He suggests parents get advice on how to go about that from their local chapter of RESOLVE, the Boston-based national infertility association.
Rena Makres of Lutherville, a mother of twin 6-year-old boys who were conceived in vitro, says she's still not sure how she will talk to them about it, but senses that now is not the right time. They "just wouldn't grasp the issue," she says.
"I have no need to keep it from them," says Makres, who is president of the Maryland chapter of RESOLVE. "If they asked, I'd explain it. But at this age, I don't think they'd understand."
Mary Carrier's twins are just 7 1/2 years old, yet she's been talking to them about IVF for years, but not necessarily including a full description of what was involved. She has not, for instance, discussed the fact that a donor was involved.
"They understand that something different happened when I got pregnant," says Carrier, 44, a Carroll County homemaker who has also been active in the fertility support group. "They don't feel odd or different. They just feel lucky."
Advocates hope that the increased openness among IVF parents has reduced the stigma associated with fertility treatments. While many of these procedures are still relatively new -- the first test-tube baby was born in 1978--- in vitro fertilization now accounts for more than 20,000 pregnancies each year.
But they also acknowledge that not every parent will be comfortable disclosing much information to their children. And when children do find out, they may find the knowledge frustrating and finite -- states don't mandate public access to information about sperm or egg donors, nor do private companies keep much background information anyway.
Surrogate parenting, frozen embryos, and other recent advances make the issue even more complicated -- and that's why most fertility clinics have therapists and support groups available to patients from the first day they walk in the door.
"If a parent does feel some shame or stigma is attached to this, they had better resolve that first before they talk to their children," says Hellmann. "Some people are just very private. It's not necessarily more right to be open. It just has to be consistent with your own temperament."
How to start talking
Parents who want to talk to their children about in vitro fertilization and related issues need not find the chore daunting, says psychologist Anne C. Bernstein. Here are some of her suggestions to make it easier:
1. If you conceived through IVF without outside donors, don't sweat it -- talking is purely optional. "Most parents don't discuss the circumstances under which a child is conceived, so you don't have to either," she says.
2. Talk sooner rather than later. By the teen years, children are sorting through enough identity issues without being additionally burdened.
3. Make sure you are the first to talk about this with the kids. Finding out from other sources can harm the trusting relationship between parent and child.
4. The discussions with young children should be matter-of-fact. It "just is what it is," not something that makes them different or unusual. They can learn later in life that some children are conceived in a different way.
5. Don't assume this is a single discussion, but think of it as part of a dialogue that will continue -- and raise a lot more questions -- as the child gets older.
6. Use specific language like ovum and sperm even with your preschooler. It's just simpler and less confusing in the end than using euphemisms.
7. Try practicing the conversation -- giving thought to saying neither too much nor too little. You might say, for instance, that "Daddy had a sickness that hurt his sperm, and we had to get some from another man," and that may suffice.
8. Give reassurance about how happy you are with your family. If you are able to talk about these issues freely and without defensiveness, your children will feel much better about themselves.
9. And yes, it's appropriate to talk to a young child about how he or she has two mommies or two daddies. The children of same-sex couples need to know how to respond to other children who will no doubt be puzzled by their situation.
Resources
RESOLVE: The National Infertility Association www.resolve.org 888-623-0744
Maryland chapter, RESOLVE www.path.jhu.edu / resolve 410-243-0235
American Society for Reproductive Medicine www.asrm.org 205-978-5000
American Infertility Association www.americaninfertility.org 888-917-3777
Center for Disease Control, Reproductive Health Information Source www.cdc.gov / nccdphp / drh / 770-488-5200
Society for Reproductive Endocrinology and Infertility www.socrei.org