Following the judgment of the Constitutional Court of 9 April 2014 which had called the ban on the heterologist fertilization provided for in Italy by law 40 of 2004 on medically assisted procreation (PMA), the possibility for many couples has been reopened to be able to access this type of technique without having to turn to foreign centers of PMA.
The couples who come to PMA’s request after a long period of “generative failures” can present emotional and relational consequences that risk affecting the acceptance and effectiveness of the same medical procedures.
Even in the last European Congress of the European Society of Human Reproduction and Embryology (Eshre) the importance of Psychological Counseling For couples and women who face heterologist fertilization.
The consultancy activity concerns all the aspects connected to the PMA and is divided into three specific moments:
• decision -making: which provides, before the start of the treatment, the support and information on all the emotional and relational implications of the decision to undertake a PMA path
• support: accompanies the couple in moments of difficulty and difficult decisions during the PMA
• Therapeutic: the couple or individual is helping to cope with the negative consequences of the diagnosis of infertility or any failure of the treatment.
Each medically assisted procreation technique involves specifications psychological difficultiesin relation to the type of medical procedure used (more or less invasive), at the time of treatment, at the high frequency of controls and the probability of success.
In general, couples who come to formulate a medically assisted procreation application have already experienced frequent disappointments and failures in the period preceding the request.
Already law 40/2004, in light of this, provided for the presence of a Psychologist consultant in the centers of PMA and medical staff who proposed the possibility of a psychological consultation.
The elective intervention in the field of infertility is the integrated one, in which psychological advice represents a fundamental part of the diagnostic-therapeutic programs. The team work with other specialists allows you to intervene ad hoc on the individual by personalizing and planning Step by step the process to follow.
Supply psychological support First, during and after treatment, to explore the emotional repercussions of the condition of sterility, deepen the attitudes towards pregnancy, the birth of a child and parenting, are the main objectives of psychological advice in the field of infertility.
Psychological support can facilitate the elaboration of mourning and the reinterpretation of the situation when the intervention has no success and the possibility of a life without children should be accepted. In this context, psychological advice does not only have the objective of reducing the levels of anxiety and the frustration of the couple who arrives at the medical consultation, but can be configured as a useful tool for the prevention of Psychological and psychosexual consequences.
The need for accurate information and psychological support emerges even more in cases of heterologous artificial insemination, in which conflicting emotions multiply in relation to the insertion, in the generative process, of an external donor.
In fact, heterologous fertilization consists in the use of an external donor of eggs or spermatozoa in the event that the couple is infertile; It differs, therefore, from the homologous fertilization in which both seed and egg come from the couple itself.
There heterologist fertilization It places new issues to be addressed for the couple who decide to take this path. Access to “something” that comes from the outside of the couple itself, could require a work to process the “foreign” element, which on the one hand will allow the achievement of the lens, on the other it will be there to remember their inability to generate, especially for the person who was infertile.
Profound elaboration is required by the spouses with respect to psychological factors implicated And the possibility of analyzing the couple’s fantasies and expectations to bring the ideal child back on the level of reality, and to deal with the physical and character aspects not completely borne by the genetic heritage of the two parents.
The choice of having children, following the path of the donation of Gamets (egg or spermatozoa), entails the overcoming of many doubts that the couple is primarily and then the parents towards the children who will come or who have already been born.
Among the main concerns of couples who face a path of heterologist fertilization The difficulty emerges in communicating on the origins to the son, born through a donation of gametes. The issue of origins assumes a particular value in those families who conceived thanks to assisted reproduction.
Very frequently, the moment comes when people who conceived their children through the donation of eggs or sperm, are faced with a great dilemma: “How do we explain to our child what are its origins?”. Based on the results of various studies conducted on the psychological effects deriving from communicating this circumstance to the child or not, it is concluded that there are no right or wrong decision.
In order not to communicate the origin to the child, parents are the indication of doing the same with the remaining family members and with the circle of friends. In this way we try to avoid the risk of becoming aware of one’s origins by others and losing confidence in their parents. Those who decide to communicate it to the children must keep in mind that, according to various specialists, the most appropriate age groups have been identified to face this issue.
It is recommended to act when they are small, between three and five years, or later, when they are between ten and twelve years old, but not later. In both cases, parents are asked to prepare the moment and to give relevant explanations in a simple and natural way, always adapting them to the degree of maturity of the child.
Over the years, couples have increased that undergo a heterologous insemination who are oriented to reveal the donation to the child while before only a small percentage felt to deal with the topic; Other couples are willing to reveal it to the age of the child.
Most of the couples who intend to maintain the donor’s secret to his son brings as motivations above all to do not want to create problems and confusion between genetic and social parenting, emotional, recognized because “is it ours and therefore why tell him?”. Sometimes it emerges to want to protect the child from any family and/or social discriminations as they are considered not genetically just proper.
Behind these reasons, the need to keep sterility is often hidden, so that family and social stigmatizations are feared for infertility and fear that the child can be questioned and refused in our parental role. Other parents decide to silence an assisted reproduction treatment, because they have lived it with pain and fear to transpare this feeling when they talk about it.
From a Psychological point of view Absolute indications on the opportunity or not to reveal the origins to the child cannot be given. In principle, the secret has an implicit dose of “poisonousness” and risk.
It would therefore be desirable that there was a revelation at the right, gradual, clear, that avoids the non -said, the misunderstandings and risks that perhaps can run away to say something that pierces the secret in moments of anger, anger and conflict and with the harmful consequences that this can produce in the child or in the adolescent he listens and suffers. On the contrary, clear responses will help the child build their personality without complex or secrets.
You can open the theme on the origins even to children of 4-5 years because at this age the child already wonders what his place is in the history of the family and also wants to make sure he is the result of a love story.
Of course, everything must be explained in a simple way and suitable for the ability to understand the child, perhaps supporting himself in the story with proper fairy tales and images. If the secret remains there is the risk that the child think that it is a reason for shame. In fact, a child hides the things he is ashamed of and tends to think that the things that concern him, and of which his parents never talk to him, are necessarily embarrassing.
Hence the need to speak clearly to the child of his origins as soon as he begins to ask questions. We must avoid imposing answers to questions to the child that he does not ask himself, but, at the same time, we must make sure that he feels free to formulate all the questions he wants. Undoubtedly, however, there is also a right to secret, inviolable, that no one can force us to reveal.
The important thing is the “how” it is said or how the secret can be held so that it is a revelation motivated by anguish and guilt, it is a secret ordered by fear can have negative effects. The quality of individual and couple elaboration is therefore important to want to maintain the secret and to reveal how it was conceived.
It is good to remember that for the child it is essential to feel the intensity and quality of the desire to have wanted to conceive and then raise with love despite infertility.
The child needs to feel the result of a desire for love It is thus recognized during growth to develop and integrate a positive internal and relational emotional world that are the foundations for basic safety and for their identity.
If so, it is not the known or less parenthesis of the how, of the technical gesture of a heterologist fertilizationwhich can affect the power and consistency of emotional ties and gratitude to the parents who wanted and recognized him as their son.
Finally, it is good to keep in mind that explaining to a child who is a child born from their parents, but without the genetic equipment of one of them, can be really complicated and even embarrassing.
In order to be supported in this delicate task, parents can always contact a psychologist-psychotherapist who deals with the issues related to infertility to receive the indications and the specific advice for their case.
