“She Looks Just Like You”

What Are We Not Seeing with Donor-Assisted IVF?

Magazine Issue
July/August 2024
“She Looks Just Like You”

“Unfortunately, the odds of conceiving with your gametes are poor,” the doctor says after a barrage of tests that’s lasted through two period cycles. “Extremely poor.”

Isabelle, a 43-year-old lawyer of Mexican descent, with tattoos peeking out from under the sleeves of a fitted sweater, slumps in her chair upon hearing the doctor’s pronouncement. Curtis, her Welsh Italian partner, uncrosses his arms from his bearlike chest and places a hand on her knee.

“So basically, you’re telling us we can’t have a baby.” Although Isabelle’s voice is measured, it belies strong emotions: grief, anger, despair.

“No, I’m not saying that.” The doctor’s voice is firm but kind. “You can—just not with your own egg. Have you considered using a donor egg?”

Back in the 1990s, when I first started practicing therapy, a story about someone turning to a donor to conceive a child would’ve verged on science fiction. But these days, broach the topic with a colleague in the hallway, talk about it with a neighbor or friend, and there’s a good chance they—or someone they know—has benefited from a fertility treatment involving eggs, sperm, and embryos. The Society for Reproductive Technology, which tracks data for nearly 400 U.S. fertility clinics, estimates that there were over 20,000 IVF transfers using donor eggs in 2021—up 19 percent from the previous year. Many insurance companies have begun to cover much of the cost.

And yet our culture’s acceptance of this pathway to parenthood—in terms of how we talk about and emotionally support donor-assisted IVF—lags far behind the technology. Even well-intentioned, highly trained therapists can overlook subtleties that shape a parent’s experience, and miss the mark in how therapy can provide help.

Some of the challenges people using donor gametes go through are easy to imagine, such as the highs and lows of trying to conceive, the grief that follows failed attempts, and—for heterosexual couples—the grief of giving up the hope of conceiving a child “the old-fashioned way.” But what about the strange, seldom discussed experience of selecting a donor? How do you make a choice that will shape, for better or worse, a human being’s ethnic and racial identity, temperament, and medical future based on curated bios that read like profiles on a dating site?

How do you succinctly describe the emotional experience of entering your child into a donor sibling registry? What about the palpitations in your chest as you toggle between the feeling of gratitude for having the option to conceive and the discomfort of confronting high-stakes questions like: Should I choose the donor who has similar physical attributes to me or the one with an advanced engineering degree? Should I go with the one listed as healthiest who never graduated high school over the one who volunteers at animal shelters and has a family history of lymphoma? What matters to me that gets passed down through genes?

For LGBTQ+ couples or single people, using a donor egg or sperm may be the first path they try when starting a family. For many heterosexual couples, it’s usually an option they consider later, one that may require addressing pregnancy losses, working through medical trauma, and letting go of old narratives about how they expected to conceive a child.

“She Looks Just Like You”

Once Isabelle and Curtis decide to use a donor egg, they’re surprised by how much there is to discuss: Is it enough that the donor has brown hair and brown eyes? How do they confidently assess if she’s healthy? Does it matter how she likes to spend her time? After much research and debate, they settle on a donor of half-Mexican descent. In the only picture of her in the database, she looks nothing like Isabelle, but she has no red flags in her medical history.

Amazingly, the procedure works: from Curtis’s sperm and the donor eggs, they get four healthy embryos—four chances at a viable pregnancy—and the first attempt at implantation is a go. Despite their worries that pregnancy could fail at any moment, as it has in the past, Isabelle carries the baby to term and gives birth to a healthy girl.

In the whirlwind of doctor’s visits and birthing classes and acquiring the right baby gear, their concerns about donor profiles and talking to people about IVF journeys vanish. They tumble headfirst into the throes of parenting a newborn—Jolene, after Isabelle’s mom. Jolene won’t drink from a bottle, wakes three to five times a night, struggles with reflux, has eczema, and stuns her parents every day with the miracle of her existence.

“Oh my goodness, look how adorable she is!” coos Curtis’s mom one afternoon. Although she lives halfway across the country, she’s visiting because Curtis announced that Jolene was on the cusp of walking, and she didn’t want to miss this milestone.

Lying under a mobile of stars, Jolene grins and stretches her arms toward her grandmother. Isabelle feels proud and hopeful. Although she’s always sensed that her mother-in-law has never completely accepted her, Jolene’s birth has created a bridge that unites them around a common passion.

“She looks just like you,” her mother-in-law murmurs. “Your mouth and chin are exactly the same.”

Isabelle stiffens. Clearly, her mother-in-law has momentarily forgotten the details of Jolene’s conception. The IVF clinic’s donor support group, which she was required to join, didn’t prepare her for moments like these, when she feels adrift in a strange emotional limbo, uncertain whether to address the reality of her daughter’s genetic makeup. She and Curtis never talked about what to say. Despite there being a meme-able script for every other moment a parent might face, she’s never seen anyone post about this one.

Isabelle has bought kids’ books on donor-egg conception that she hopes will help Jolene feel proud of, or at least comfortable with, her own birth story. She’s committed to being honest and proud of her daughter’s conception. Allowing this exchange with her mother-in-law to slide by without calling it out feels cowardly. By remaining silent, is she amplifying a free-floating sense of shame about how her daughter came to exist? But how can she gently remind her mother-in-law that she and Jolene don’t share genes—that any resemblance is a coincidence—without deflating a happy moment?

Before Isabelle can figure out what to say, Jolene spits up, her mother-in-law grabs a burp cloth, and the moment passes as they scramble to mop up the mess. Later, as Jolene gurgles happily in her bouncer near the dinner table, Curtis remarks, “You know what, Mom? I think she has your eyes.”

“You’re not the first person to tell me that,” his mother beams in response. “Women in my church group have said the same thing when I showed them a picture. Isn’t it amazing? I wish your father could’ve met her, bless his soul. Maybe she’ll grow up to have his knack for science.” She gives Curtis’s hand a squeeze.

Isabelle knows this warm interaction probably feels incredibly meaningful to both of them, particularly since they haven’t always had an easy relationship, but there’s a part of her that wants to run out of the room screaming. The whole celebratory who-does-Jolene-resemble conversation feels like an affront. Remaining engaged during conversations like this is challenging. Who cares who she looks like! Jolene is my baby, too!, she thinks.

Isabelle tries to ground herself by pressing her feet solidly against the floor and clenching her hands under the table. She’s read about how biology supports attachment between parents and their genetic offspring, but these theories have always struck her as reductionistic and misleading—more of a biological tendency than a hard-and-fast rule. A queasy feeling remains in the pit of Isabelle’s stomach long after dinner is over.

“What’s wrong?” Curtis asks later that night, noticing her silence as she washes out the infant tub once Jolene has gone to sleep. “Did my mom upset you?”

Isabelle shakes her head. “No. I’m just tired.”

There’s no other baby in the world she’d rather parent. Jolene is perfect in Isabelle’s eyes. So why does she feel so unsettled and alone?

Parental Claiming

At birthday parties and playgrounds and family celebrations, people continue to comment about Jolene’s resemblance to Curtis, or to draw connections between her facial features and Isabelle’s. Whenever this happens, even though she’s come to expect it, Isabelle feels a pang of sadness, then guilt, then insecurity. How should she respond? Even in the doctor’s office, when answering reasonable questions like “Is there eczema in your family?” she finds she has to steel herself before saying, “Nope, and there’s none in Curtis’ family, either, but we used a donor egg to conceive. It wasn’t listed in the donor profile, but you never know with these things.”

At night, while rocking Jolene to sleep, Isabelle wonders what combination of magical words she’ll need to weave together to help her daughter easily grasp the intricacies of her birth. None of the books she’s bought feel quite right. In some way, they make the process seem superficial and silly. She’s determined to speak about it with Jolene in a way that doesn’t imply mommy was broken and couldn’t fulfill her part of the egg-sperm equation.

A few months later, Isabelle sits in a chair across from me at the start of a therapy session. Luckily, I’m familiar with the unique challenges parents like her face, having worked with patients coping with infertility and pregnancy loss for more than 25 years. I’ve written several books and articles on the subject and taught other therapists about reproductive trauma and loss.

“That donor helped us grow our family—it’s been an enormous gift—so part of me knows this is a minor concern in the grand scheme of things,” Isabelle says. “But it still grates on me. All the little moments of confusion, uncertainty, guilt. We chose a no-contact donor, and I get that she wants to remain anonymous to us, but what if there’s a medical concern? Do we turn to the Donor Sibling Registry? I felt relieved when we chose this route, like it solidified my place as Jolene’s ‘real’ mom, but now I wonder if we made a mistake. What if Jolene asks to meet the donor one day? What if she becomes obsessed with meeting . . . what do you even call her? Jolene’s genetic mother? I’ve read the blogs and posts of donor-conceived children expressing anger and resentment about not knowing where they came from. Will Jolene grow up angry?” Isabelle takes a breath. “I hate feeling this way.”

“You’ve been carrying a lot inside,” I affirm.

“Would I be more relaxed if my partner was a woman, and it was just assumed a donor helped us conceive? Or if neither Curtis nor I had any genetic connection to our daughter because we’d adopted her? I’m not saying those paths to parenthood don’t come with their challenges, but why do these comments get to me? Is there something wrong with me?”

“There’s nothing wrong with you,” I assure her. “When people see a newborn, their knee-jerk reaction is to try to figure out who the baby looks like. It happens all the time. There’s even a name for it: resemblance talk.”

Isabelle sits back in her chair and looks peaceful for the first time since our session began. “Resemblance talk, huh? I like that it has a name.”

“That’s what it’s called.” I smile ruefully. “It can be especially difficult for the parent of a donor-conceived child. One little throwaway comment can subtly undermine the legitimacy of your parenthood, opening the floodgates for all kinds of emotions.”

“That’s it,” Isabelle nods. “I don’t think Curtis would understand this. He’s not having the same kind of feelings.”

“It might be worth exploring what being a parent means, in your view,” I say. “Is it a person’s physical resemblance to a child, or is it their commitment, love, and care?”

“I’m clear on that. But I still get blindsided every once in a while,” Isabelle concedes.

“Maybe we can brainstorm ways to respond to people’s remarks,” I suggest.

“So what could I say to, ‘She looks just like you”?

“What would you like to say if you could let your emotions fly and there were no repercussions.”

“I’d like to say, ‘Who cares if she looks like me? Being a parent isn’t about creating a mini-me!”

“There’s a lot of energy in that response,” I remark.

Isabelle sighs, relaxing. “I think ultimately what I’d like to say is just, ‘Thanks. We don’t share genes, but I’ll take the compliment.’”

Over the course of the next few months, Isabelle works on resolving her deeper insecurities about being Jolene’s mom, some of which are related to donor-egg conception, some not. When I explain how the woman who carries a pregnancy influences which genes are turned on or off in the developing fetus, a phenomenon studied in the field of epigenetics, she’s curious and interested. Understanding parental claiming, the term for the process of feeling like you have the right to parent a child that’s not genetically your own, helps her develop more compassion for her own process. “Attachment to a child takes time,” I remind her. “Even for a genetically related parent.”

The Donor-Egg Talk

During a session with Curtis, I help Isabelle broach a topic they’ve been avoiding: when to tell Jolene her origin story.

“We need to tell her when she’s a baby,” Isabelle insists. “Like, as in now. So it becomes integrated into her personal narrative from the start.”

“It’s better to wait,” Curtis counters. “It’s not developmentally appropriate yet. She’s not going to be able to explain it to her friends in kindergarten. What if they make fun of her?”

“This difference of opinion is common in couples who conceive a child using a donor egg or sperm,” I tell them when arguing about whose perspective is correct gets them nowhere. “Parents tend to fall into two camps: the planting-a-seed camp and the waiting-for-the-right-time camp. Keep in mind that with the advent of DNA tests like 23&Me, complete donor anonymity is pretty much vanishing these days, so it’s important to be prepared for your child’s curiosity.”

We explore the pros and cons of planting the seed and waiting, and in the end, Curtis agrees to help Isabelle create a collage for Jolene about how she came to be: one with sonogram pictures, a photo of the park across from the IVF clinic where Isabelle sat after every appointment, and phrases about IVF they hope she’ll adopt when she tells her story to others.

“I know it’s irrational, but part of me is angry that she’s your whole life now,” Curtis admits in one of their sessions. “I guess when people mention that Jolene looks like me, I feel important. I’m not trying to lord the DNA thing over you, but it seems like the only advantage I have in the parenting arena. I know that sounds petty, but it’s the truth.” To Isabelle’s surprise, this admission reduces her anxiety about sharing her daughter’s birth story more openly.

One day, Isabelle brings what appears to be a notebook to an individual session. “It’s Jolene’s book,” she says, turning the pages. She explains the pictures and her reasoning behind her word choices in the text.

The story itself is straightforward: two elephants have been dreaming about having a baby. They encounter different obstacles on their journey—dark caves, rushing rivers, thick jungles—but their desire and love for their unborn child are so great that they never give up. When they can’t make their baby by themselves, they get the help of doctors. When the doctors can’t help, they get additional help from an egg donor—an elephant who lives far away and has lots of extra eggs to give. Finally, thanks to all the people who’ve supported them, a baby starts to grow inside one of the parents. The story ends with a picture of three elephants snuggled together in a lush valley.

“It’s beautiful,” I remark. “You wanted a new language for your story, and here you are, creating it.”

“Curtis says I should publish it,” Isabelle laughs as she slides the book into her purse. “I do like the idea of helping parents communicate the truth: there are lots of different ways to become part of a family that loves you.”


Janet Jaffe

Janet Jaffe, PhD, is a clinical psychologist, who mentors other mental health professionals in learning about reproductive psychology. A cofounder and codirector of the Center for Reproductive Psychology in San Diego, CA, she’s in private practice and the coauthor of Unsung Lullabies: Understanding and Coping with Infertility and Reproductive Trauma: Psychotherapy with Infertility and Pregnancy Loss Clients.