Out of the Dish

Talking to Children About Their IVF Origins

In The Beginning

It's been nearly a quarter of a century since Louise Brown of Great Britain provoked global controversy simply by being born. Louise was a typically adorable, photogenic infant whose conception in a Petri dish made her the cover story of 1978, "The World's First Test Tube Baby."

How times have changed.

A million children have In Vitro Fertilization origins in common. Their beginnings may be atypical, but not unusual. Any shock value still adhering to IVF is largely vestigal.

Evolution from tabloid sensation to essential infertility treatment doesn't mean IVF is easy-certainly not for the prospective parents. It's a safe bet that the people lucky enough to have genetic progeny via IVF have weathered emotional, social and financial tempests in their family-building quest.

While the language and practice of reproductive science and medicine treat IVF as routine, many societies do not. Entrenched cultural and religious biases against IVF (and other assisted reproductive technologies) can leave the infertile feeling bereft and isolated, especially in communities that regard childbearing as a duty.

In Korea, for example, the societal landscape is shaped by Confucianism, which "overemphasizes the obligation of childbirth," says Eunhee Pack of Agimo (which translates to "Women Who Want A Baby"), a two-year-old Korean infertility support organization. But, she adds, "Most Korean people have two contradictory ideas. Though they agree suitable medical treatment is important for patients, that agreement can't be applied to infertility…they think ART is too artificial and dangerous a treatment."

Infertile couples in Japan, a country that also reveres bloodlines and childbirth, face a somewhat different challenge. "In 1999, 1% of all babies born in Japan were conceived through IVF, but most people still don't know what it is," reports Yukari Semba, who works for Friends of Finnrage, Network for Infertile Women in Japan. "They tend to think IVF children are somehow different from other children."

Yet, Ms. Semba says, Japan's declining birth rate has become such a pressing issue that the national and local governments "encourage infertile women to take treatment."

The task for those of us who pursue IVF, regardless of where we live, is to make peace with that choice even before beginning treatment. It means taking an honest look at what motivates us. It means accepting-without shame or blame-that we cannot make babies the way most other people do. It means reconciling sometimes-hostile belief systems with assisted reproduction.

Support often comes from the least-expected quarters.

One New York City Catholic priest advises couples it is reasonable to tell children you made the decision to have a child "with 'divine' guidance and the help of a doctor. Procreation is an act of collaboration with God guiding you through the decision."

Remember, the goal of traditional IVF is a biological child who inherits traits from both partners, no differently from a baby conceived naturally. It is only the mechanics of uniting the sperm and ovum that are "non-traditional."

"In general, the Dutch are quite open about their fertility problems," reports José van der Schoor-Knijnenburg, Executive Officer of Freya, the Patient Association for Fertility Problems of the Netherlands. "The biggest exception is donor sperm…Although it's changing-very slowly - because a child's right to know its biological beginnings is taken very seriously. Male infertility, in general, is still more sensitive than female."

For all of us, then, the key is developing a genuinely healthy attitude toward reproductive alternatives. It will take time. Most infertility patients wrestle with the moral, religious, personal and medical quandaries of ART. We struggle to maintain self-esteem when procreation goes from a private act to one requiring the repeated and often-escalating interventions of countless specialists.

But, in the final analysis, if you elect IVF you've got to discover a way to make it okay. Consider how fortunate we are: 25 years ago there wasn't this choice to make.

Comfort with the decision is not the same as telling everybody about it. Or justifying it to anyone. How much you say and to whom you say it is a personal matter that depends on individual temperaments and circumstances.

Rather, comfort is a state of mind, one that you'll be able to communicate to the genetically connected child you're hoping for. Children are intuitive. Even the youngest possess an uncanny feel for a parent's attitudes and moods.

Elizabeth Carr, 20, the first IVF baby born in the United States, may have the best view of this. "In my mind, since my parents never treated it as special, different or abnormal, it didn't faze me."

As the doyenne of the U.S. contingent of IVF kids and a lifelong observer of the ART-effect, Carr comments, "How parents feel can have a direct impact on the child. If the parents feel ashamed, so will the child-even if it's not articulated. If the parents are comfortable and can talk to the child openly, then I don't think the child will have any problems."

She didn't.

To Tell The Truth: How Much Do IVF Kids Need To Know

Some people bombard their kids with excruciating detail about IVF as soon as they ask, "Where do babies come from?" Others reflexively dodge the subject. Neither response is likely to be helpful.

"It's healthy to tell children about their reproductive beginnings, but you have to do it in a way that's appropriate and respectful," says Dr. Elaine Gordon, a clinical psychologist in Los Angeles.

One significant caveat: Approaches to telling must be adapted to specific cultural and societal pressures and, perhaps, reconsidered in countries where reproductive options are not generally sanctioned. "We're obligated to protect children," remarks Dr. Gordon, who specializes in infertility issues. "In a culture that would ostracize a child, telling might be crazy." New York City psychotherapist Patricia Mendell, MSW, agrees that, optimally, children should know their medical and family histories, regardless of how they were conceived. For IVF kids, infertility and ART treatments are the start.

Just go easy.

"You have to assess your child's cognitive levels and emotional readiness to process what you're saying," says Ms. Mendell. "Don't feel impelled to tell everything you did about your infertility. They don't need a blow-by-blow description that might make them feel guilty because you went through so much."

Although there's little formal research on the subject, Ms. Mendell notes a growing consensus that "a child's psychological understanding and adjustment is profoundly influenced by how the parents feel about forming that family in the first place."

Talking about IVF matter-of-factly, without defensiveness, opens the door to a lifelong dialog with your kids. That ongoing conversation will demystify assisted reproductive technologies and help them see IVF in the same positive light you do.

So think about the stories you'll tell from the get-go. All children love to hear how they came to be, how much they are wanted and loved. It'll be an oft-told tale that you can enrich with age-appropriate detail to satisfy your intellectually and emotionally developing offspring.

When They're Very Young: Between 3 and 5

Be prepared. "Where did I come from?" is likely to come at you sometime during the preschool years. Children have been out there talking to each other, noticing pregnant women and their friends' new baby sisters and brothers.

First, determine what it is your child is asking at that moment. Does she want a birds-and-bees primer or is he asking for the name of the city in which he was born? Make sure you answer the question that was asked. Kids will take in only so much so there's no point inundating them.

"You come from mommy and daddy" might suffice.

The key thing at this age is to lay a solid foundation in gentle, loving language that makes your child feel secure and confident.

Keep things simple but honest. Talk and read about all the ways families are created, including yours. Let kids know that differences are normal because normal is what they want to be.

Children don't usually push for more information, but if they do, Ms. Mendell recommends uncomplicated images: a seed that was planted in mommy's uterus and, after many stages and nine months, it grew into a baby. But don't be surprised if two weeks later, your child announces the seed was really a fully formed, tiny version of him or herself just waiting to pop.

"Little children are literal-minded," said Ms. Mendell. "Kids try to relate everything to their own concrete experience. If you talk about eggs, kids often picture a carton in the supermarket. So choose the language carefully."

If you do discuss infertility with them, it will be enough to say you needed the help of a wonderful doctor. Kids understand that doctors make people better. IVF is way beyond them.

"If you are going to tell about their (reproductive) beginnings, you have to create the opportunities without it seeming forced," says Dr. Gordon. "You want a soft sell and sweet stories."

The Curious Grade School Age: Between 6 and 10

Around this time, a child's capacity for conceptual thinking takes off. With varying degrees of sophistication, they get the idea of biological reproduction, the role of sperm and egg, and what an embryo is. At the earlier end of this age spectrum, you might introduce the idea of the loving relationship between a man and a woman, but save the specifics. "You can make the point about values, that you need to care for someone," says Ms. Mendell.

At age eight, nine or ten, your kids may be want to know more about intercourse, natural conception and IVF. They'll need to know about physical closeness and intimacy, how the sperm joins an ovum. Be sparing in your account. As fascinated as they are by sex, kids at this age also find it downright disgusting, if not incomprehensible.

When you talk about IVF, refer back to your earlier conversations about needing a doctor's help. Keep it basic. Use the correct anatomical and medical terms and discuss the many reasons people elect the treatment and your problem in particular.

Explain how the doctor used the technology to encourage the union of sperm and ovum then put the resulting embryo in the uterus to mature just like any other baby.

By 9 or 10, kids need to understand reproduction in the context of an intimate relationship, notes Ms. Mendell. She suggests telling them that wanting a child is one expression of the closeness that partners feel for each other. "Let your kids know you wanted a child for the very same reasons and the only difference was how the sperm and ovum got together," she advises.

Tread lightly when you talk about infertility and IVF. Don't overtell. "If you can't stop talking about it, if you corner your children, sit them down and say there's something extraordinarily important, you set off an alarm," warns Dr. Gordon.

Hurtling Toward Adolescence: Between A Rock and Adulthood

At eleven or twelve years, children are on the cusp of understanding life's complexities. They begin asserting independence and taking a broader perspective. They may worry about inheriting your reproductive problems; they may get furious that they weren't conceived like everyone else.

This is the time they might need the complete and unvarnished truth. You might be uncomfortable with their questions. They may want to know every detail of your infertility. If you're an older first-time parent, they might wonder what took you so long and what that's got to do with making babies. Answer everything you can and be kind, even if you feel exposed and vulnerable.

After all the years of tender forthrightness, you'll be surprised by the strength of the trust and love you share with your kids.

When A Big Deal Isn't

"With my parents, it was straightforward; IVF was the only route," says Elizabeth Carr. And being straightforward when you're the first couple in the U.S. to carry and deliver an IVF baby is no mean feat.

Motivated by the desire to educate an uninformed and anxious public, the Carrs allowed their experience at the Jones Institute in Norfolk, Virginia, to be chronicled. There were interviews and television appearances, newspaper headlines and magazine articles. Nevertheless, Elizabeth Carr's parents were relentlessly determined to make this no big deal.

They succeeded. It wasn't until a Mother's Day reunion at the Jones Institute when Elizabeth was seven, that she got it. She was watching a Nova documentary about her conception and birth. Dr. Howard Jones, the eminence grise of IVF, was giving Elizabeth a step-by-step explanation of everything they saw on the screen.

"That was the first time I realized how different my conception was from all my friends, that it wasn't the norm," she says with a trace of wonder. "It finally sunk in how much my parents went through to get me at that time."

Three years later, when she was 10, there was Ms. Carr at another Mother's Day Reunion holding Jones Institute's IVF babies 1,000 and 1,001. "A lot of us stay in touch and we laugh about how we're all 'test tube' babies. Our parents are all from the same school and don't treat us any different. Like my mother always said, we want to raise a child, not a prima donna."

Since those early days when anti-IVF protesters picketed the Jones Institute, there's been what she calls "cultural evolution." Not an eyelash flickers when the subject of IVF comes up.

"It's not as unacceptable anymore. There are still people out there who are uncomfortable and IVF is not for everybody," Ms. Carr says. "But from the beginning, no one had anything against the Carrs having a child. They may have had a problem with IVF but there's never been anything negative said about my parents or me personally."

That cultural evolution makes it easier for parents to be open with their IVF kids. Slowly, we are finding a common language.

For Ms. Carr the bottom line is "no secrets."

"My point of view is that if the parents felt comfortable enough to go through with IVF, they've got to be ready to accept the consequences, positive or negative. Every child will respond differently but parents have got to handle it as best they can."

Special thanks to: Patricia Mendell, MSW
Elaine Gordon, PhD
for their professional guidance in developing this fact sheet.
This fact sheet was funded by an unrestricted educational grant from Organon, Inc.