When it Takes a Community to Conceive a Child

When it Takes a Community to Conceive a Child

When it Takes a Community to Conceive a Child: Why Being Informed About Raising a Donor-Conceived Person Benefits Everyone

by Sarah Rivers Deal, PhD, LPC

If you are considering donor assistance to create your desired family, you may have already been down many unsuccessful, rocky roads in your fertility journey. What was once private information is now more public, including doctors, nurses, mental health professionals, and administrative red tape that only seems to lengthen your timeline. The inclusion of these additional health providers in your life may feel unwelcome and intrusive, however, I am here to share with you the importance of incorporating the mental and emotional landscape of your experience to promote the overall well-being and healthy psychological adjustment of your intended family. 

I’d like to share the experience I’ve gained, both as a mental health provider with 24 years of clinical experience (12 of those years specializing in infertility counseling, reproductive trauma, and third-party/donor reproduction) as well as an individual who utilized donor assistance years ago on her path toward parenthood. 

When you are a fertility patient, one of the many boxes you must often check when considering utilizing a donor is the “Third Party Reproduction Psychological Consultation,” which is conducted by a licensed mental health professional in the state where you reside.  This meeting is required by most fertility clinics, which is a positive sign as it indicates how much the clinic is complying with the guidelines set by the American Society for Reproductive Medicine (ASRM). These guidelines have been informed through decades of research to promote and protect the overall well-being (physical, emotional, and psychological) of patients and their intended families. That being said, fertility clinics and their staff cannot adequately attend to the vast, complex emotional and psychological landscape and therefore rely on the expertise of those mental health professionals adequately trained in third-party reproduction counseling to assist in exploring what is under the surface. 

This is where the “Third Party Reproduction Psychological Consultation” comes into play. Let’s delve into what this meeting is and what it is not

This meeting is psychoeducational in nature, which means that the main goal is to inform and educate intended parent(s) from the plethora of research regarding donor-conception and donor-conceived families. I’ve had many individuals and couples arrive to this meeting with a defensive tone and posture, believing that I am judging their ability to be good parents. This isn’t the case, although a therapist cannot simply leave her clinical judgement at the door when practicing in her professional capacity. Although it may vary depending on the practitioner, I try to discuss the following with intended parent(s):

  • How the individual or couple decided to use a donor (this typically includes their fertility journey thus far)
  • If and how they have grieved the inability to have a child biologically related to both parents (if applicable)
  • Exploring the benefits and challenges of creating your family through donor-assistance
  • Exploring the long-term implications of using a donor (ex. donor identification; presence of half-siblings; feelings of parental insecurity, etc.)
  • Discussing the comfort and psychological openness in using a donor
  • Exploring current psychological coping skills to deal with challenges and discomfort
  • Exploring disclosure to the child
  • Providing information and support for disclosure of donor-assistance to the child and significant others

To summarize, my three main goals during the 90-minute meeting are:  

1) Inform through best practices research and my clinical experience

2) Support intended parents on their journey by providing a compassionate environment and various resources to assist long-term

3) Promote and protect the well-being and psychological adjustment of donor-conceived persons and their families. 

In a nutshell, I’m here to help more than hinder. 

It's important to consider what this meeting is not. Although we will likely be addressing emotional experiences, this consultation is not a therapy session. For intended parents utilizing an unidentified (formerly termed “anonymous” donor), it is not a psychological evaluation in the standard sense. Intended parent(s) do not have to complete standardized psychological assessments and/or “pass” these tests. When I first start the consultation meeting, I address these intentions, and the tension and reluctance typically diminishes. It is important to note that the use of standardized psychological testing comes into play more when evaluating the candidacy of potential donors and gestational carriers (and for good reason). 

Each year, I attend the Jefferson Infertility Counseling Conference in Philadelphia, which informs my work tremendously. On the last day of the conference, we are honored to hear from a panel of donor-conceived persons about their experiences. It is these people and their families that I keep in mind when I conduct the third-party consultation meetings. They are there to share with us what they want the professionals to discuss with intended parents during our consultation meeting. We are fortunate to have longitudinal research and panels of people to inform us on how best to do this, what we call “best practices.” Donor conception has been a form of family building for a century or more; intended parents are not alone and are not expected to have all the answers up front. 

Due to the lifelong implications, I encourage intended parents to be choosey when it comes to who conducts their third-party consultation meeting. Since it won’t likely be covered by insurance (remember, it’s not a therapy session), one might as well find a well-trained provider. In my professional opinion, I recommend seeking out a mental health professional that meets the following criteria:

  • Has a specialization in third-party reproduction and/or infertility counseling and has additional training beyond their own personal experience of infertility. (At a minimum, additional training would take the form of regular conference attendance, annual completion of continuing education that focuses on third-party reproduction, membership in ASRM’s mental health professional group (known as MHPG), and continued mentorship and peer supervision due to the rapidly evolving nature of reproductive medicine). 
  • Is fully licensed. If a mental health professional is still under supervision (an “associate” or “intern”), I will want to inquire if their supervisor has expertise in third-party reproduction. 

To conclude, donor assistance provides new hope to families who in times past would have no opportunity to carry and birth a child. It is both a beautifully complex and challenging choice. Reproductive medicine has come a long way and mental health professionals are simply trying to keep up with the ethical, legal, and psychological aspects that are continually evolving. Intended parents who are informed make better choices for their desired family, which then promotes the overall well-being of all vested parties. 


Covington, S.N. (2022). Fertility Counseling: Clinical guide, 2nd ed. 

Cambridge, UK: Cambridge University Press. 

Covington, S.N. & Hammer Burns, L. (2006). Infertility counseling: 

A comprehensive handbook for clinicians, 2nd ed. Cambridge, UK:

Cambridge University Press.

To find an ASRM provider: https://www.reproductivefacts.org/find-a-health-professional/