DEAR ASK A THERAPIST: Do you have recommendations on how to discuss familial gamete donation with the children of the donor? We are a heterosexual couple with male-factor infertility and are discussing the possibility of my husband’s brother being our sperm donor. He already has a daughter and may have other children in the future, and he is worried about how he would talk to them about being the donor of their cousin. – INTENDED PARENT

DEAR INTENDED PARENT: Thank you for this question about family donations; talking about how families are created is very important.

Under the right circumstances, family donations can be a wonderful option when faced with fertility challenges. Your child would grow up knowing all branches of their genetic family tree, and you can be reassured that there are no mysteries about family medical or psychiatric history.

Your brother-in-law’s concerns about explaining this to his children are understandable but need not be an obstacle. Children have an uncanny ability to hold seemingly dual concepts at the same time, often in ways that adults have more difficulty. They can understand that their cousins are also half siblings, and your child(ren) will eventually understand that their uncle is their genetic father. When those conversations start very early and continue in ways that weave into the tapestry of your families, there is never shock because it is integrated as “normal.”

Depending on the age of your brother-in-law’s children, a statement about Dad helping Uncle and Auntie be a mommy and daddy is a good start. Books explaining that it takes sperm and egg to make the beginnings of a person could help his children understand that he gave the sperm that made their cousin. Kids do not have to understand all of the details about reproduction to have ideas introduced and reintroduced.

These arrangements can be wonderful in the right family. To move forward, most clinics require mental health consultations, and the standard protocol is to have three meetings with a mental health professional. There is an educational meeting for you as intended parents, a meeting with the prospective donor and his partner, and a meeting with everyone to make sure all are on the same page about the future. These are extremely important meetings, and we encourage you not to skip them, even if you feel like you have already talked about this together. In those meetings you would also have a chance to get more clarity about how to have the conversations with all people in your family, including the children.

We wish you well, and please let us know if you need referrals or more information.

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