The Psychology of IVF: Emotional and Mental Readiness

IVF is increasingly a key option for LGBTQ+ families wanting to welcome biologically-related children into their lives. The medical aspect of the process is essentially straightforward: IVF involves bringing sperm and egg together in a controlled laboratory setting, leading to the creation of an embryo with DNA from both biological parents. After a few days, the embryo is implanted in the patient, or, if the patient does not possess a womb, into a gestational surrogate.

The IVF process, however, can be more complicated, especially in the psychological and emotional arena – and for queer parents-to-be, everything about the process can be both more creatively exciting but also more complex.

The reproductive health specialists at The Prelude Network – North America's largest fertility clinic network – understand the special considerations that go into uplifting and affirming queer families, but on an even more fundamental level that know they are working with people – not just cells and medical procedures – and they prioritize the psychological and emotional well-being of their patients.

The psychological part of the journey begins even before families come to The Prelude Network for individualized guidance through the IVF process. In fact, Nurse Claire Bettencourt of the Pacific Fertility Center in San Francisco, says, "I think the hardest thing is coming to terms with needing to use IVF, and then going through the process of finding your donor, whether it be a sperm donor or an egg donor."

Transgender patients might use sperm or eggs sourced from their own pre-transition lives and kept ready for use through cryopreservation, or freezing. For other families – two prospective parents with ovaries, for instance, or a couple in which neither possesses a uterus – a donor, a gestational carrier, or both might be needed.

Nurse Bettencourt is a third-party nurse, which means that she focuses on helping families obtain the donated genetic material and/or the womb they will need for their parenting journey. "For all of our patients, anybody providing eggs or sperm are provided the option to do genetic screening," she notes. "There's a lot of psychological evaluation, support, and education going into this, specifically for the LGBTQ+ community because they're often using donor tissues."

Third-party recipients also undergo what Dr. Alice Domar, the Chief Compassion Officer for Inception LLC (the parent company of The Prelude Network) refers to as "psycho-educational sessions."

"I would think of it in terms of, 'This is what you can expect from the process,' " Dr. Domar, who is also an associate professor at Harvard Medical School, explains, before adding a quip: " 'What to expect when you're not expecting yet.' "

Dr. Daniel Shapiro of Reproductive Biology Associates in Atlanta, Georgia, uses the term "psych testing" to describe the process third-party donors and gestational carriers complete before their gametes are used in IVF. Patients providing their own eggs, sperm, and/or uterus – what Dr. Shapiro calls "autologous" sourcing of those components for pregnancy – don't go through such screening, he notes, but either way, Dr. Shapiro adds, "everyone gets counseling."

"Something that I do for all of my couples who are using donor sperm donor egg gestational carrier, is I refer all of them to a psychologist," agrees Dr. Jenna McCarthy of IVFMD in South Florida. "And the first thing I say to them is, 'I don't think you're crazy. That's not why we refer you to the psychologist. And it's not an evaluation in any way, shape, or form. It's a counseling session.'

"What the psychologist does is she'll bring up some of the psychosocial decisions associated with using third party gametes," Dr. McCarthy adds. "And then she touches a little bit on the legal stuff without getting into anything where she'd have to have been a lawyer to do it. And then she'll also talk about things like disclosure; she'll talk about the donor sibling registry, which many couples are interested in."

Of course they are. The importance of psychological and emotional support extends to the children of parents who conceived using IVF. That can include not just the donor sibling registry, but planned disclosure of the identity of a donor.

"What the psych literature is showing more and more is that donor-derived persons really need to know who their genetic parent is," Dr. Shapiro points out. "Even if they don't want a relationship, they need to know." Exactly how that information is transmitted is negotiable: "Some are upfront disclosures," Dr. Shapiro clarifies. "Some are age-of-majority disclosure, where the donor agrees to be known, but not until the offspring is 18."

While all couples using IVF for family building need and deserve respect, attentive guidance, and emotional support, queer families, in particular, may lack that support outside of the clinical setting. "Sometimes it's hard for patients to just disclose what they're going through to their family members and their close friends," Nurse Bettencourt notes.

Dr. Domar points out that some queer parents-to-be face experience social rejection for wanting to fulfill the same parenting instinct that many others share. "A lot of people walking in the door have had people already discourage them from the process," Dr. Domar shares. "It could be their parents, saying, 'How can you bring a baby into this relationship? It's not normal to have two dads.' Or, 'It's not normal to have two moms.' "

Nurse Bettencourt notes that queer couples "might find additional support from online forums," and recognizes that it's a psychologically valuable thing "to be able to find a community that gives them a little bit of a reprieve, and to be able to talk about what they're going through without having to explain it."

A Prelude Network clinic is well prepared in this area, too. "Prelude Network patients have access to a portal which has a tremendous amount of information on it," Dr. Domar notes. "And as of next month, there'll be a whole resources section with all the psychological information."

Included at that Prelude Fertility portal is Dr. Domar's "Staying Sane" series of articles for prospective IVF patients that help guide them through "how to stay sane as you're thinking about doing IVF, and how to stay sane during the injection phase, how to stay sane while you're waiting for your pregnancy test results. There's a lot they can access through the information that we provide."

Crucially, Dr. Domar seeks in her "Staying Sane" articles "to normalize everything. There are some very common and typical psychological symptoms that probably 99% of people going through IVF have: Anxiety and depression and irritability, and a sense of being alone. I talk about, 'If you're depressed, you're normal. If you're anxious, you're normal. If you're irritable, you're normal.' And the one I talk about that not a lot of people do talk about is envy of other people's pregnancies, which is a huge issue for many, and no one ever talks about it."

It's important to be up-front about these matters, because, Dr. Domar explains, "Most people can handle the physical aspects – the injections, the clinic visits. But emotionally, going through an IVF cycle can be really hard."

That's why making sure that families feel respected, uplifted, and supported is part of the daily routine for the providers of The Prelude Network, and so is making sure that everyone involved in the family-building journey is on the same page and ready to accept the responsibilities of parenting.

As Dr. William Ziegler of the Reproductive Science Center of New Jersey puts it, "From the medical point of view, IVF is very straightforward. It's the psychological point of view, that's what we need as physicians need to focus on. We're medically trained, but we need to think outside of the science part of this and take into account that we're dealing with human beings with feelings, and everybody deals with this differently.

"Our job is to help them and to give them advice and our recommendations," Dr. Ziegler adds, "and they can take it as they will. There's a fair amount of, if not counseling exactly, certainly psychological awareness, emotional awareness, that you bring into this process."