Hi everyone! I’m thrilled to have fertility therapist and author, Jana Rupnow join me on tonight’s show.
Jana Rupnow’s book, Three Makes Baby, helps parents navigate conversations with children conceived from a donor egg or sperm.
Here’s a recap of our conversation, which you can also watch here.
Jana, can you start off by telling us more about your story?
Sure. My husband and I had our first child naturally and so were surprised when we struggled to conceive a second. We experienced secondary infertility due to male factor infertility.
This led us to adopt and grow a family in a different way than originally expected.
How do you respond to people who think of your adoption as a Plan B of sorts?
Yes. I don’t think of it that way. It’s not my second choice. It became my new dream. A dream that I couldn’t see. That’s the way I explain it to my daughter too. I don’t want her to ever think of her being part of our family as a second choice or as a plan B.
I’m tearing up. I think that needs to be on posters in every single fertility clinic. It’s such a powerful sentiment for patients to keep in mind. Thank you for sharing that.
I love following you on Instagram, thank you for sharing what you do there and in your book.
What is the book, Three Makes Baby, about?
It helps parents emotionally and psychologically prepare for using donor conception. It also guides parents on how to talk to their donor-conceived child about donor conception in an age-appropriate way.
So this is a tremendous resource. This is a one-of-a-kind book. This is a new resource.
Yes, that’s right. This is the first book of its kind that helps with the emotional preparation as well as serving as a practical guide. It’s broken down to be easy to understand and implement with example talk scripts, etc.
You’re a licensed therapist so you’re prepared to help people think through these moments in life.
Yes, that’s right. I see clients in person and on the phone about fertility challenges, how to handle them, and what to do next.
What led you to fertility and donor conception-counseling work?
My interest started when I experienced my own fertility challenges.
Then I was doing adoption counseling — mostly international, but when international counseling stopped I switched over to third party reproduction counseling.
My fertility doctor really made me aware of the need and gap in the marketplace. There were not enough counselors for donor conception. That led me to get more training specific to this area and I’ve now been working with people for 10 years.
And all of that work has informed your book, right?
Yes, absolutely. 10 years of experience. I started to have parents come to me with concerns that, outside of me, there were no resources to help address. It’s why I have compiled the top five concerns I hear from people and put them into the book. I want to help parents work through their concerns regardless if they work with me.
Many people start with a feeling of confusion and so it helps people break down what they’re feeling.
What are some of those concerns? Can you share them with us?
Oh sure. One is that they fear they won’t feel like real parents to their donor child. Or that the donor parent(s) will be more involved in the child’s life than the adoptee parent.
They are also concerned about their child’s feelings and if they will feel upset about being donor conceived.
They worry about social differences. How will they explain it to family and friends? If it comes up in school, how will they help their child with the challenges?
They’re also concerned about how to talk to their child about it. Some people still come to me and don’t want to tell their child. I really encourage them to tell their child because it’s too difficult to keep it a secret for a lifetime.
When is the right time to start to talk about this with a child?
It’s best for the family and healthiest to start talking about it right away. You can read storybooks when they’re a baby. This helps people to get really comfortable with the language so that when questions from their children get more complex they are able to handle them with more ease. So my advice is to build the foundation immediately and start talking about it right away.
Can you give me some examples of language you may use? Help me understand what you may say.
When you’re rocking your baby you can coo and sing and say “We’re so lucky to have you. Mommy and daddy got a special gift and you’re here because of that special person.” When you’re changing their diaper, giving them a bath, or rocking them- just tell them a story.
How do you react when a child is a teenager and says something hurtful like, ‘you’re not my mother!”
Be prepared as a parent! Know that when they say something like that they don’t really mean it. There’s likely something else going on. My daughter said it to me before she was a teenager. She said it when she was in middle school and I knew not to take it personally.
I did use it as an opportunity to talk about it later once she calmed down and to bring up her adoption with her. So you don’t have to ignore it. You can talk about it, but know that when they’re lashing out they’re still just learning and being kids. They need you as the parent to be the guide.
From a psychological standpoint, when should the parents start therapy?
Starting right away is best. While parents are preparing for donor conception and even during the pregnancy they can start to work through the grief of losing the ability to have a genetic child.
Along the lines of grief, many of my patients are fearful that the grief will never go away. I’m curious what your experience is with that.
I think grief does take time to get through. If you allow yourself to feel grief over time I do think it will lessen. You will have moments, but it will get less and less as time goes on and as your family grows.
I have patients that are excited, but still grieving. How do you reconcile those two conflicting feelings?
You just learn to hold the tension between the two and accept that you can have mixed feelings. I tell patients all of the time that they may still experience sadness even after the baby comes. I encourage them not to pile guilt on top of grief. It’s okay to feel what they are feeling. Be compassionate with yourself and know that those are normal feelings.
Have you seen situations where one of the partners is ready for donor conception and the other partner isn’t? What are your professional tips for when that issue arises?
Absolutely. So that’s why I designed the book so that each parent can go through the worksheets separately and identify what their concerns are. Often what we find is one partner or spouse has a lot of concerns in a particular area where the other person doesn’t. That helps us identify an area for them that will require more love and attention.
For example, it may be around parent legitimacy. In other words, one parent is concerned they may not feel like a real parent to the child. In this instance, we want to talk about and address issues like attachment and what it means to be a parent and what it means to be genetically related in your family. And to understand what that means for your family.
I’ll say that 70% of the time when I’m talking with a couple about donor conception there’s a partner (usually male) that suggests it’s like them having sex with another partner. How do you address that? It may sound silly, but it actually is something that crosses people’s minds.
Those are hard feelings to overcome. I think both partners need to be really open and communicate with each other about how they feel. It can come up when they’re selecting a donor. Often this manifests as jealousy or just feeling weird about it. It’s why having opportunities to sit down and talk it through is so important. I think another thing to keep in mind is that if you’re using egg donation and carrying and growing the baby inside of you — then that’s a way to reconnect. It’s all about communication.
Why have we been so bad about communicating about this? Why has it been such a secret?
It began in secrecy. Secrets were a way of protecting a man from his sterility. It was also a way of protecting the child from feeling illegitimate.
This began so long ago and we’re really just trying to rewrite old narratives. We are also working to help people understand that it’s a medical condition to experience infertility and so nothing to feel ashamed about.
Yes, donor conception is becoming a more common way for people to have a family. One thing that I’d love to hear your opinion on is people learning they have DNA siblings from tests like 23andme. How do you help people navigate that type of news?
I think we’re looking at a new social script. Something that’s new to our culture and it’s hard to make sense of. In some cases, people have upwards of 100 DNA siblings. We can’t manage that many relationships. So it is difficult for those half-siblings. Part of what I think is helpful in making them know it’s okay to feel whatever they feel and to know that it’s complicated.
How do you even tell a child that they might have twenty half-siblings in the future?
Yes. That’s something I help prepare parents for and you’d be surprised the number of people that haven’t given that any thought. They have to realize that might be a possibility and educate their children on it.
I have seen Facebook groups for DNA siblings to communicate with each other and bond about characteristics that they may share. I see that as a very special thing that they’re connected through the Universe through love. However, I can see that someone may not want to pursue donor conception knowing that’s a possibility.
Have things changed in the last ten years as you’ve done this type of therapy work with people?
Yes, things have changed in the last two years. All of a sudden people are talking about it and social media is really changing the dialogue around donor conception and making it less secretive. That’s a good thing for kids born through donor conception. Otherwise, the kids carry the shame if we don’t lift it for them. They didn’t have a choice in the matter so they shouldn’t be the ones carrying it.
How can we as doctors help? What advice would you give to all fertility doctors? How can we do a better job of preparing our patients for donor conception?
What’s really key is for physicians to tell their patients that they need education. Consultation or education is better received than telling someone they need counseling. If that’s the first step before any serious consideration of donor conception then everyone wins. The couple considering it also benefits in some way. They learn something. They also then have resources long term for their family and everyone benefits. So it’s really encouraging patients to get educated early in the process.
Do you have any opinions about egg banks? Or how the whole egg banking industry is taking care of egg donors? Especially as it relates to how egg donors are being counseled — I’m curious about your thoughts.
Egg donors traditionally are counseled pretty well because they do have to be screened to go through the medical procedure. In my experience, I’ve seen egg donors get proper screening and counseling. On occasion, I do encounter an agency that’s encouraging a donor to go through with the process before they are fully ready. However, that seems to be happening less and less.
How do you see the future changing for donor conception? You’ve said things have changed even in two years. What do you predict will happen in the future?
I see it moving towards known donation or open ID. Now that we know you can’t be anonymous through DNA testing. Couples will be encouraged and open to a more transparent donation process so that their children can be equipped with the information key to helping them form their identity. It also means their children won’t have to go back and piece together this information on their own. I think known donation is healthier for everyone.
I want you to talk more about the book. Can you share more with us?
Okay, sure. Yes, I’m excited about it because I wrote it from my perspective as a counselor, but also from my personal experience.
Donor conceived individuals and adopted individuals do both feel a genetic loss.
Thank you for writing the book. Here’s another question for you. How can a parent deal with the emotions of their donor-conceived child needing a donor?
Yeah. That is a tough one. There are feelings like insecurities that come up for parents. Maybe they’re concerned they’re going to be replaced. I tell my clients that you can’t replace the years of attachment that grow between a parent and a child. That’s such a precious time that is irreplaceable. You’re forming and changing every day as a child, and as a parent, if you’re there to support that growth then your bond is irreplacable. So for a donor conceived child to find their biological donor later in life and to view them as a parent figure is not as common as you would think. It’s not to say that it doesn’t happen, but I’d say it’s the exception vs. the rule.
Do you think it might be healthier for children to know who their donor is, as they’re growing up? Or do you think it doesn’t make a difference?
I think it can be healthier for some people to know. It can make a difference. There are certain personality types that are very curious about where they came from and their identity. For them, that knowledge can really help them developmentally. Still, there are other people that report that it doesn’t matter so much.
I think it’s good to have that knowledge for kids that really do want access to that important information.
There’s also a huge donor access gender gap. The amount and type of access to information is vastly different between egg and sperm donors.
I think it’s harder to make sperm donation profitable for agencies if you’re collecting more information. I have heard from some of my clients that they get photos and videos from donors, but perhaps not to the degree of what they receive from egg donors.
Thank you — I really appreciate all of the work you do and knowledge you’re sharing with all of us. You’re doing really important work to lift the veil around donor-conception and we are all grateful.
I hope this was informative for you as a reader, or watcher of the show. Let’s close with this quote for re-framing what it means to be a donor-conceived child.
“You weren’t my second choice or plan B. You were my dream. The dream I couldn’t see.”
As always, please comment below or send me a note if you have any questions about this show or if you have a suggested topic for a future show.
You can also catch more of me and topics like this through The Egg Whisperer Show. The episodes are live-streamed on YouTube, Facebook, and Twitter and on Wednesdays at 7 PM PST. Subscribe to the podcast too!