Assisted Reproduction  

 
A different look [1.1]

 

 

The civil code states:    Father cannot be proved
  Mother is known with certainty…

     

That is to say that the mother is certain through birth …and the paternity must be proved by marriage (what would not be contemplating the children born from adulterous relationships). Therefore, the father is uncertain.
Science and its action subvert this idea. The father is now certain beyond marriage through the DNA tests. The mother, instead, is not that certain anymore: the biological mother (through ovule donation) may not be the one going through the pregnancy and delivery.
Reproduction Assisted techniques make as face a new challenge: to comprehend and interpret the new subjectivities and psychological implications surrounding the multiplicity of processes conforming them.
My aim in this article is to reflect on this topic and the different subjects involved, laying special emphasis on the unconscious component and its implications.


 

 

1.     Reproduction Assisted techniques

 

¿Where do kids come from? Since the theories omitting the biological aspect such as the stork, Paris or the cabbage weakened, answering that question started to become easier for parents. However, these days it has turned again into a difficult question to answer. Kids can come either from the sexual union of mum and dad or their non-sexual union, meaning for example their ovules and spermatozoids joined in an In vitro fecundation, or else the mother and a semen donor, the father and an ovule donor, two donors and the mother’s womb, two donors and a third woman who lent us her uterus…

Assisted Reproduction Techniques are techniques of gynecological manipulation meant to help, modify or substitute processes which are supposed to occur spontaneously in the feminine genital apparatus.

They must be differentiated from those genetic manipulations in which the embryo’s genome is modified.
 

 

 

 

The techniques are:

AI. Artificial Insemination

It consists in introducing spermatozoids through a catheter in the feminine genital apparatus (in the uterus). The man’s spare sperm is frozen for a future fecundation.

 

CAI. Homologue or Conjugal Artificial Insemination

It is the one done with the husband’s semen.
It is prescribed when there is impotence, low quality of the spermatozoids, immunological incompatibility between the sperm and the vaginal secretions.
This technique can also be carried out freezing the sperm, before chemotherapy, radiations or husband’s surgery.
It also introduces the possibility of having children by frozen semen once the husband is dead.
It is also carried out when there’s sterility without apparent reasons.

DAI. Heterologue or Donor Artificial Insemination

It is the one done with a donor’s semen, used when the man lacks of viable sperm in his semen or to avoid the transmission of a serious genetic defect.
It is also carried out in the case of heterosexual women without a couple or homosexual ones.

 

IVF. In Vitro Fecundation

Fecundation is carried out in a test tube for the embryo to be later implanted in the maternal uterus previously having stimulated the ovule and trained the semen. These two therapeutic tools are used in mostly all the techniques.

SET. Embryo transference or subrogated maternity

The embryo formed in the genital apparatus of an In Vitro or artificial inseminated woman is transferred to another woman.

Assisted reproduction is nowadays being used with marketing purposes. Single mothers, mothers and grandmothers at the same time, menopausal mothers, widow mothers, etc.
 

 

   

 

Who is the mother?

 

The mother is not certain anymore.

The woman whose womb nests the baby and gives birth is called expectant, uterine, gynecological or carrier mother. The woman, from which the later fecundated ovule was obtained, is called genetic or biological mother. We can also add a social mother, for example in the case of adoption. However, all these names don’t reflect the desire for a child. I wonder: where that desire is? Who has it? Whose wish is satisfied? Who makes it real?

 

Different kinds of subrogated maternities

The subrogated mother can go ahead with the pregnancy of the in vitro fecundated embryo with the ovule and spermatozoid of the couple who hired her.

 

The woman is inseminated with the sperm of the man whose wife is sterile (out of wedlock procreation of a legitimately-recognized child has always existed without the intervention of science in people’s private lives)

 

In the third case, we can find the biological mother (ovule donor), the expectant mother (gives birth) and the social one (who adopts or brings up)…so…who is the mother?

2.     

 

 

 

So as the insemination consent doesn’t make the man be a father, the gestation contract doesn’t express the expectant woman’s desire to have a child.

 

In France renting a uterus is prohibited because, among other reasons, it cannot be promoted that a mother abandons her baby after birth. At the same time, it encourages and allows the “birth in X” which is the agreement through which the mother can put her child up for adoption after birth without being registered at the hospital. This law, purely social, opens a different possibility other than abortion for those pregnant women who don’t want to be mothers and also attempts to avoid babies´abandonment, making it at the same time possible.

 

In Great Britain using another woman’s uterus is accepted only if the later giving of the baby is voluntary and without profits.

 

In the United States this practice is authorized, and there are agencies in charge of making the contact between the woman and the requesting couple.  

 

Science has broken the typical parental bonds when moving forward. There are mothers who carry pregnancies of their sterile or non uterus daughters, sisters who donate their ovules among themselves, etc. This is the diversity we can find nowadays with the help of science and professionals thirsty for victories. I think that, leaving aside the improper judgment about the apparent monstrosity this represents, our position as health professionals should plead for the analysis of each case in particular to get into subjectivity.

Furthermore, we must promote the use of other energetic medicines such as acupuncture and homeopathy to get, in a more natural and respectful way with the body, a better ovulation and spermatic quality as well as the different emotional states a person goes through such as fears, anxieties, etc.

I’m especially interested in highlighting the major role emotional aspects play, in spite of the scarce or null importance science and the professionals in charge of carrying out Assisted Reproduction Techniques (ART) give them, impelled, among others, by strong economical interests.      

 

 

 

 

I find myself facing this topic with the possibility of looking at it from the different elements or characters involved: the science, the couple, the woman and her body, the donors and the boy or girl resulting from these techniques…knowing that each of them is a whole topic itself.

 

From the psychological point of view it is known that listening is fundamental. When the patient comes feeling emotionally uneasy, we should try to decipher those symptoms and put them into words so they can show the significance they embrace.

When the gynecological exploration and its complementary studies show a feminine organism capable of experiencing the biological process of maternity but that doesn’t actually happen, being able to listen becomes essential to start drawing some sort of hypothesis. And I say hypothesis because we don’t know beforehand what is really happening to that woman for not being able to get pregnant,

The difficulty in getting pregnant by natural means has a significant value related to the woman’s unconscious; it cannot be known at first what it means for the patient.

 

We every time more see in our consultation patients who have put off pregnancy for professional, academic or other reasons, among which I include the esthetical progresses which mislead the image.

From adolescence until the first alarm coming from the biological clock (35 years approximately), the wish to have a child is not clearly accepted nor rejected in many cases. Then, a conditioning social factor appears “it’s time to become a mother”. At this point, beyond accepting or not this statement, we should ask why? What is expected from maternity? Why to be a mother?

 

Deciphering those questions may lead us to help the patient make conscious what is happening to her: for instance the desire for a child to strengthen her identity…or to save a couple…or to establish her femininity…or to what she believes will make her feel “complete”, etc.      

Knowing and understanding this desire will help her re-elect what she wants. Otherwise, this burden will be carried by the procreated child.

 

According to psychoanalysis the wish to be a mother goes beyond the biological fact.

The psychical apparatus is dual: it is composed by a conscious and an unconscious part.

Getting pregnant without having the desire as well as not getting it when wanting, are situations which may be expressing the ambivalence between the conscious and the unconscious wish[1].

 

When there is sterility without apparent reasons, medicine sets multiple studies and stressing explorations for the one undergoing them.     

It doesn’t suggest or respect the possibility of a concomitant space with the medical request useful to be able to listen and clear out the confusion frequently heard between the social demand of becoming a mother (“having the age”, “it is the couple’s desire”) and the wish to have a child.

When the fact of becoming a mother turns into a femininity test, it is possible to understand why, when the objective is not achieved, the woman is capable of offering her own body to any kind of medical manipulations as well as having a great difficulty to symbolize maternity[2]

 

 

And what is to symbolize maternity?

 

It is to develop the imaginary with visions, representations, ideas, words, etc which foresee the action.

The desire for a child from a psychoanalytical point of view is not natural, but a consequence of each woman’s childhood history.

That is why, unlike an instinct, that wish may be built or not, according to each case.

This history leads to the identification with the features of the own sex and among them the assumption of the maternal ideal.

However, the demand of a child (requested to the sanitary system) may not correspond to that wish but to what is called the desire for maternity, to be distinguished from the other.

This desire for maternity is many times confused with femininity due to the lack of non- maternal feminine symbols in our culture.

Instead of making a symbolization process facilitate real maternity, a child’s gestation is expected to generate a feminine position. This is why there are women undergoing everything with the aim of achieving it because more than “having” is her “being a woman” what is at stake
[3] .
 

Medical discourse and psychological listening 

 

Nowadays science offers the possibility of certainly applying on the real body what was short ago situated in the imaginary and symbolical field. Science and technology make omnipotent fantasies, which have always fed mythology and literature, come true, such as procreation without sexual contact (among others the Immaculate Conception).

Medicine treats the body as if it was only dealing with organs, but it is precisely in the way the body works where sexuality and the unconsciousness are involved. The medical discourse, easily playing the role of the Master who has the knowledge, limits the problem to the gynecological field and so it opens, looks, examines, analyzes and promises however failing in most of the cases.
In order to defeat that failure, medicine is capable of abusing the feminine body taking it to the limit of its possibilities as it occurs in an ovarian hyper stimulation getting more than fifteen ovules per cycle, eluding the limits of nature.

The subjective and emotional dimension of the people involved in these processes shouldn’t remain hidden as it is what determines failure or success and its consequences in most of the cases
[4] . It would be wise to recommend couples that before choosing these techniques they took the necessary time to get informed, reflect and elaborate the emotional effects the situation implies. This task requires the psychological ear, to help the couple stop and understand what is happening to them, what the proposal is about, etc.

Each woman faces the possibility of being a mother based on her history as a daughter, the type of relationship with her mother, the narration and image of maternity she has been transmitted. The social and cultural demands together with her own affective history will determine the subjective way in which she will face this issue. That’s why the preventive work with these people when having to make a decision is so important.

 

 

It is essentially required that the psychotherapeutic and follow-up job would be carried out by professionals guided by an independent ethic without connections of any type with the institution in charge of the Assisted Reproduction Techniques.

 

 

Not everything possible to be done should or must be done. People’s psychic resistance shouldn’t take place.

The participation of donors many times brings to light the situation of great emotional vulnerability of the couple. The “anonymous savers” may be an important factor of disequilibrium in the couple whose intimacy and sexuality has already been invaded.

Asking from a professional position is essential:
- Reasons for a donor artificial insemination instead of an adoption.
- How is the resignation to biological maternity tolerated?
- What is the place of that child who cannot be conceived by natural means?
- Asymmetry in the couple because of donors.
- The position when facing the truth: silence/secret/lie

Certain elements may help us diagnose the situation:
 

Age of the couple
Time the couple has been looking for a pregnancy.
Frequency of sexual intercourses
Previous pregnancies or abortions
Conflicts (individual or as a couple)
Recent mourning of a child
Fantasies when facing pregnancy difficulties
Feelings during the process (individual and as a couple)
Mourning to be elaborated when not being the biological father/mother of the kid
Guilt for infertility
Feeling of the couple regarding maternity/paternity
Let them think about the ambivalence related to the wish for a child
External pressure to get pregnant
Include the sterility without apparent reasons as a symptom of conflict within the couple
Other illnesses

 

 

The child

A child exists as such before birth as long as he is desired by his parents. The symbolic element gives him a place in the world since he is given a name, is included in the history which precedes him and is attributed a place in his parent’s discourse. There from it is deduced that a person cannot be only limited to biology nor can the desired child be limited to the fecundated gametes.

Childhood curiosity is essential for the cognitive and emotional development of a child and it is based on his desire to know where he comes from, how children are made. The drive for knowledge (3-5 years) relapses into sexual aspects (S. Freud “Three essays on the theory of sexuality” 1905), and the child builds the most diverse theories about sexuality and children’s origin but he doesn’t know about the existence of two fundamental elements: semen and vaginal orifice. From here can emerge a remainder, leaving a permanent damage in the drive for knowledge
[5].

Likewise, the way adults manipulate the knowledge is supported by a law which legislates in favor of anonymity when donors are involved. That’s why it is necessary to listen to the couples who need donors before technically taking part in the issue, due to the possible fantasies of rivalry, guilt and debt related to self oedipal representation as well as rivalries with the other progenitor. The knowledge that implies the being is essential for children who were born by assisted reproduction techniques, so they can construct their subjectivity/ identity. Within that construction it is mostly important the information about the characteristics of their conception and their peculiar genetic origin
[6].

The UNESCO preserves the children’s right to know about their origin, that is to say, receive information about the donor’s identity.

Germany, Austria, France, Switzerland Sweden, United Kingdom and the USA plead and naturally allow revealing the donor’s identity when adulthood.
 

4.

 

 

It keeps and promotes the secret about the child’s origin as well as the donor’s anonymity, legislated by law about Assisted Reproduction Techniques of the 11/22/88, still today under revision.
The knowledge about the genetic origin is important for the development of a “clear sense of identity” apart from avoiding the pain and psychological repercussions suffered because of silences, secrets and lies about the origin
[7].

Since long time ago, I have been wondering what will happen when these children conceived by donors meet once they are adults. It wouldn’t be bad to think in advance about the possible incestuous fantasies this circumstance may provoke.

There from comes our preventive labor in this work

The Family Romance is, according to Freud, the day-dreamed construction that every kid makes of his family in a certain moment during childhood. In that construction the kid imagines that there are different parents from the ones he has. They can be either kings, princesses or all-powerful characters…that is to say, all what the real parents are not. This construction is built by any kid: biological, adopted or conceived by donors. In the last case, the fantasy will be that the biological parents are healthy, generous, younger, intelligent, altruistic… or the other way about.

From the couple’s point of view the secret about the child’s origin is kept “in order not to harm the child

In this point there is a double fear: on the one hand, the trauma of conception: parent’s depressive anguishes because of the unresolved mourning of the biological factor are projected on the kid. On the other hand, the trauma caused by the fear of the kid willing to find his biological father or mother, which responds to theft fantasies of the parents.

The kid, consequence of a successful assisted fecundation, can also constitute a danger since he reminds his parents, just by existing, of their own non-elaborated difficulties.

The kid represents the place where parents´ anguishes and fantasies are projected.

I would like to highlight that father and mother are symbolic functions that decisively contribute to the sense of belonging to a family. What counts for the kid is not the genitor man (biologic) but the active presence of an image to feel identified with in order to start building his own identity. That is why it is so important how the man-father lives his paternity.

Nowadays human beings are reluctant to accept the limitations life presents us, and this difficulty may make us resort to science looking for answers. It is about having a child no matter how, instead of accepting the impossibility of it.

The subjective and emotional dimension of the people involved in these processes shouldn’t remain hidden as it is what determines failure or success and its consequences in most of the cases. As I said before, it would be wise to recommend couples that before choosing these techniques they took the necessary time to get informed, reflect and elaborate the emotional effects the situation impl

 

 
B
ibliography

 

      • S. Freud. “Three essays on the theory of sexuality”. (1905)
• S. Freud. “Family Romances”. (1909)
• R. Bayo, G. Cánovas, M. Santis. “Aspectos emocionales de la TRA” (Barcelona 2004)
• J. Lacan. “Les complexes familiaux” (Paris, 1938)
• J.A. Miller, E. Laurent “L` autre qui n` existe pas et ses comissions d` etique” (Paris 1996/97)
• S. Tendlarz. “Un niño de la ciencia” (Buenos Aires 1995)
• S. Tendlarz. “El psicoanálisis frente a la reproducción asistida” (Buenos Aires 1998)
• M. López Carrillo. “Donantes de óvulos. Los riesgos que nadie les cuenta”. Mujer y Salud magazine (Barcelona 2002)
• G. Cánovas. “La maternidad como mandato” Mujer y Salud magazine. (Barcelona 2002)
• S. Tubert. “¿Esterilidad idiomática o psicosomática?” Mujer y Salud magazine (Barcelona 2002)
• R. Bayo. “¿De dónde vienen los padres?” Mujer y Salud magazine (Barcelona 2002)
• E. Giberti. “Bioética y reproducción asistida” (Buenos Aires 2003)
 


[1] G. Cánovas. “La maternidad como mandato” Mujer y Salud magazine. (Barcelona 2002)

[2] S. Tubert. “¿Esterilidad idiomática o psicosomática?” Mujer y Salud magazine (Barcelona 2002)

[3] G. Cánnovas. “La maternidad como mandato”. Mujer y Salud magazine (Barcelona, 2002).

[4] R. Bayo, G. Cánovas y M. Santis. “Aspectos emocionales de las TRA” (Barcelona, 2004).

[5] R. Bayo, G. Cánovas y M. Santis. “Aspectos emocionales de las TRA” (Barcelona, 2004).

[6] R. Bayo, G. Cánovas y M. Santis. “Aspectos emocionales de las TRA” (Barcelona, 2004).

[7] R. Bayo, G. Cánovas y M. Santis. “Aspectos emocionales de las TRA” (Barcelona, 2004).

 


[1.1] Paper published in the magazine of Psychologyst's Official Association of Catalunia, Spring, 2006

 


 

View menu on the left