We were honored to host Samantha Lavy, Licensed Marriage and Family Therapist and owner of JSRC group, in our Instagram Live. Samantha has years of personal and professional experience and a deep understanding of modern family building techniques as well as the intricacies of the process to support clients as they build their family. Her fertility services are specifically designed to support intended parents and fertility patients as they deal with the emotional side of the journey.
During our conversation, Samantha explained what is involved in the psychosocial screening process, what to consider in your decision regarding a known vs anonymous donor, how and when to tell your child their birth story, and how to manage transition points on your journey, among lots of other great, experience-based advice. Check out some of the main takeaways below:
Intended parents and gestational carriers undergo a psychosocial screening before the surrogacy journey starts. Samantha explains that this screening and all support throughout the journey is based on the fact that we’re all part of a system. As she explains, screening is done to assess the psychological and emotional readiness of everyone going through the process and to talk about the psychosocial element of being a surrogate or egg donor. Gestational carrier screening includes a personality assessment as per ASRM guidelines, as well as an interview with her and her partner, if she has one. The interview is done in person, or through a HIPAA-compliant tool like Zoom. The gestational carrier is asked questions about her life, what she wants to get out of this journey, her motivation as well as questions on her mental health.
Gestational carriers who have already carried for another couple are asked about their original motivation and when and how they decided to do it again. As lots of gestational carriers have big families, during screening they also talk about how surrogacy affects the whole family.
Gestational carriers are asked questions about their lifestyle, alcohol intake, recreational drug use, medical history, family history, previous pregnancies, and births. As Samantha explains, they then talk to the intended parents about their meeting with the surrogate.
Egg donor screening is similar to that of the gestational carrier. They’re asked about their lifestyle, prior mental health struggles and if there were any medical complications at some point. They’re asked questions to ensure that they’ve significantly considered what it really means to be anonymous and how they feel about the fact that, in this day and age, a child can reach out at any point. During screening, they’re asked to consider how much information they’re ready to share with the people in their lives, a future partner or future children.
During the screening for intended parents, the therapist tries to understand a little about their history and how they got to this point, including theirmindset going into this. Shealso helps answer any questions the intended parents may have about what a relationship with the gestational carrier might look like/what they want it to look like. This is done to see if relationship aspirations match. Journey expectations are looked into, as well as what the intended parents are worried about. The therapist also checks that both partners are on the same page as a couple and that they have the right type of support around them. If they have children, they talk about how to explain this process to them. By listening, the therapist can understand if the intended parents are ready to take this step. If they have concerns about intended parent readiness, the therapist helps them talk through it: any anxiety that intended parents may have will reflect in the way they manage their relationship with the gestational carrier. All of this is done to have the process go as smoothly as possible when it comes to relationships.
Can a gestational carrier or donor fail their screening?
Samantha notes that gestational carriers and donors are already well educated by the agency, so this doesn’t happen very often. There may be rare cases where it’s not advised to move forward at a certain point in time: for example if someone is going through something very stressful, such as illness in the family, a move, or a new demanding job that will make attending appointments hard to manage. The question to ask is if this is really a good time and the therapist helps the gestational carrier reflect on things a little bit differently, but still in a positive way. It’s better that these things are identified prior to starting out, rather than when the pregnancy is already underway.
Journey support is primarily about supporting the relationship. When intended parents are matched with a gestational carrier, sometimes they participate in a joint screening session – this ensures that the gestational carrier and intended parents are comfortable communicating and the expectations for their journey are all the same. The therapist checks in with the gestational carrier a few times throughout the journey to make sure that they’re feeling comfortable and that communication is happening in the way that they expected it to happen. Another joint session is held prior to the delivery to ensure that both parties have the same expectations about the birth.
Because of Covid-19, there may be added anxiety around how everyone is taking care of themselves. Everyone should be comfortable with what the other person is doing as rules change. There are also decisions that have to be made surrounding who will be in the delivery room as many hospitals have restrictions on the number of persons who can be present (ie. there may need to be a decision made regarding the gestational carrier’s partner vs an intended parent so opening lines of communication around this is crucial)
After the birth, the therapist touches base with everyone to make sure that all is well. Especially the gestational carrier, who is now in the next phase of her relationship with the intended parents. As Samantha explains, “Journey support can look all different ways, but in general those are the components that are created.” The idea is that the relationship is supported and that someone is being attentive to the carrier too.
“Relationships are always so different.” In her long years working with intended parents and gestational carriers, Samantha observes that for the most part, the intended parents and the gestational carrier find their rhythm and it works well. For the few outliers, therapists are there to provide support and ensure that both parties are on the same page in terms of communication.
As Samantha explains, “there’s really no right or wrong answer. It’s a very personal decision.” There are different levels of being a known donor. It’s important to think of the child and what you are going to say to them. Do you want your child to have access to the egg donor at some point? It’s a good idea to keep your options open, especially if you’re still unsure of what you want. As Samantha emphasizes, therapists are not here to encourage you to do one or the other.
While with same sex couples, everyone is going to know that there’s a donor, it’s different for couples where there’s a man and a woman – the opportunity for confidentiality is different. Considerations vary from person to person; therapists are very respectful, regardless of sex, gender and identity. Samantha does mention to her clients that times have changed and families are created in different ways. As adults, we harbour a lot of anxiety around family building, but when you talk to the younger generation, family is family. The situation is changing and it’s important to not take preconceived notions into your journey. There is only the right decision for you.
“There’s really no right or wrong answer. It’s a very personal decision… It’s a good idea to leave your options open. So if you aren’t exactly sure what you’re going to want in the future, it’s good to at least have the option of being able to contact the donor as you want to.”
It’s never too early. As Samantha notes, experts say children should be told as young as possible, even in the womb. This helps them differentiate between parents and donor. Share with them how much you wanted to be a parent. There are many books out there with information that is age appropriate. Start with lIttle bits of information which grow into a large story that an older child can understand. As Samantha explains, it’s so much easier to tell a small child than to tell a teenager if they’re hearing it for the first time.
In such arrangements, it’s important that everybody thinks through how comfortable they are with this decision and to ask themselves all the right questions: are they open to disclosing this information in the future? AsSamantha explains, it’s mostly about communication, how open they are with each other, how this impacts communication with their own families and what each side is ready to tell their children. As she notes, it’s more about relationships and communication and that no one is being coerced into donating. Coercion comes in different forms – it’s important that it’s the donor’s own decision and that they have thought it through in the context of being their own decision (and not because they feel obliged to donate to their sister, for example).
It’s important to be on the same page as a couple and also that you’ve personally come to terms with this step. If one person is more hesitant about using donor eggs, for example, that’s ok. Sitting with a therapist is a good place to talk through what’s happening, so that you don’t feel like you’re going into this on a different page. Instead, the therapist will help you look for strengths and make sure that you’re playing on those strengths and the points of support in your life as you work towards starting a family.
Samantha emphasizes that she doesn’t want anybody focusing on this infertility/family building process 24/7. Self care is important as well as activities as a couple – a date night, or a walk for instance. Find ways to enjoy life outside of the often difficult journey.
“There’s more to you than what you’re going through with infertility.”
If you have family around, understand how they can support you. If on the other hand, they’re asking too many questions and are making you feel uncomfortable, your therapist will help you set boundaries and how to communicate with those around you. Samantha finds that it helps to practice conversations in advance.
As Samantha notes, keeping intimacy alive throughout this process is very important. It’s also important for each partner to understand that they can’t always be the only support system for their partner, and that’s ok.
In terms of events you may be invited to (such as baby showers) but which you’re not comfortable attending, prepare in advance and avoid them if you think they may trigger you. Talk about it with your partner, and if you’re comfortable, with the person who invited you. As Samantha compassionately notes, when you’re trying to have a baby, everything can be a trigger and it’s really hard to prepare for that feeling. It’s important to communicate with your partner and express your feelings. You can also role play conversations in advance so that you’re prepared with a thought-out answer that you’re comfortable with when they happen.
And in all of this, and as Samantha notes, remember that this process is oftentimes successful so in an ideal situation you are going to have a baby. This is not to dismiss what you are facing while going through it, but a reminder that things will get better eventually.
Thank you, Samantha, for answering the many questions our intended parents so frequently ask around this process, as well as for supporting so many as they navigate the countless emotions involved on the family building journey.