The story of conception is no longer a single narrative: woman, man, sex, baby. At its most complex, it can involve five individuals: a sperm donor, an egg donor, a gestational carrier, and the intended parents. Not to mention petri dishes, hormone injections, and a good reproductive endocrinologist.
And the number of differently conceived children is growing. No one tracks the use of donor sperm, but egg donation swelled by 18 percent between 2003 and 2011. In 2010, 58,727 babies conceived through assisted reproductive technology were born in the United States. That's a lot of kids eventually asking, "Where did I come from?"
Child psychologists have long advised telling kids "early and often" about their origins, especially when those origins involve donor eggs or sperm. The American Society for Reproductive Medicine, in a 2004 ethics statement, also encouraged parents who use third-party reproduction (donor eggs, sperm, or embryos) to tell the truth.
"Secrets are hard," says Jacqueline Gutmann, a fertility specialist (and the doctor who worked with Botwin) at Reproductive Medicine Associates in Center City. "You don't want to have a kid find out in a way they shouldn't." When Gutmann began practicing 20 years ago, few families planned to disclose their use of donor eggs or sperm; today, she said, a majority intend to tell.
These days, parents don't have to flounder for the words: Websites, guides from infertility groups, and a raft of books can help adults talk about conception in a way that makes sense for a toddler, a 10-year-old, or a teen.
The latest is What Makes a Baby, a picture book published in May by sexuality educator Cory Silverberg. Illustrated with bright Keith Haring-esque figures (a blue egg and a yellow sperm dance together, each dressed in striped socks and high-top sneakers), the book explains conception for 3- to 7-year-olds without referring to family type or even the gender of the "grown-ups" who are making the baby.
Silverberg, who will give the keynote talk at Saturday's Philadelphia Family Pride conference, initially wrote the story for some friends - a family with a transgender (female-to-male) dad, his female partner, and their 4-year-old son.
"It turned out that the book is really good for single parents and parents who have adopted," Silverberg said. "A lot of married heterosexual couples have told me they love it because their kids have other kids in their lives whose families are different."
Silverberg is now writing two more books on conception and family-making, for older kids. Like the first, they will be open-ended, with space for parents to supply the details of their particular story. " What Makes a Baby is not a book that gives answers," he says. "This is a book that creates a platform for parents to have a conversation with their kids."
Wendy Horwitz, a writer and child psychologist who lives in Mount Airy, decided to wait a while to begin that conversation. Not because she thought her son, Noah, wouldn't understand the logistics of in vitro fertilization. Not because of the "ick" factor involved in talking about parental sperm and eggs. Horwitz waited until Noah was 12 because, for her, the story of his conception is laced with sadness: the miscarriages and nonviable embryos that were part of her seven-year effort to become pregnant with Noah and, later, with his sister, Anne.
"We had so many losses along the way," she explained, including a "vanishing twin" who died in utero when Horwitz was nearly four months pregnant. "I wanted to wait until Noah was mature enough to have the whole story." When that time came, Horwitz told her son that he was a "high-tech baby." She described the "flower of cells" she spied under the microscope just before the doctor implanted it in her uterus. "He thought it was cool and interesting. He was also a bit upset about the loss and didn't want to talk about that any further. I felt like I'd given him the chance to have this little slice of his identity and figure out what that meant to him."
There is no legal right to know your biological roots, "but I think there is an ethical right," says Arthur Caplan, a professor of bioethics at New York University's Langone Medical Center. Besides, he says, advances in genetic medicine have made it clear that medical history matters, and a curious kid, with a DNA kit from the drugstore, can find out if she's the genetic offspring of her parents.
Bette Galen, a social worker who lives in Montclair, N.J., decided to tell the kids herself. When her boy/girl twins, conceived 20 years ago from donor eggs, were 7, she sat them down and said, "We made our family in a different way . . . the part the woman needs to give wasn't working for me anymore, so we had to get a nice lady to help us out." Afterward, she recalls, the kids said, "OK, can we go play video games now?" and she cried for hours, relieved of the tension of holding onto the story.
Over the years, Galen said, she or the kids would occasionally refer to their donor, who is anonymous. At 9, her daughter asked, "Mom, do you think I'm going to have big breasts, like you?" Galen was speechless. A moment passed, then her daughter said, "Oh yeah, I forgot. I don't have your stuff."
"It was always completely OK to ask [my parents] questions, to wonder about our egg donor," said Jenny Goldstein, Galen's daughter, now a 19-year-old sophomore at East Carolina University.
She was frank with classmates about her manner of conception; in middle school, some kids called her "petri dish baby" and joked that she was a science experiment. That stung. But for the most part, Goldstein said, she enjoyed her "special" status as a donor-egg baby. "I'm very open about it. My friends think it's one of the coolest things they've ever heard."
As kids conceived through assisted reproductive technology become teens and adults, their visibility will change attitudes, said Caplan, the ethics professor. "Think forward. If we live in a world where kids are adopted and made with more reproductive technologies and with more parties involved, we will not fret about them quite as much. The kids will just think it's normal."
The last page of Silverberg's book features a crowd of people - older and younger, paired and unpaired - greeting a plum-cheeked baby in a cradle. And it poses a question: "Who was waiting for you to be born?"
For Botwin, that's the overriding message. Each night, when she tucks her son into his "big-boy bed," she points to the photographs on his shelf and names the people in them: "Mommy, Jacob [his babysitter], Meghan [his godmother], Michael [Meghan's dad and Andrew's surrogate grandfather] . . . ."
Botwin used an anonymous donor, so Andrew won't be able to meet him. But she'll tell her son what she knows: that his donor is 6-foot-3 and loves to play basketball. "I'll show him the donor's baby picture and let him listen to the audio file of his voice. I'll say every family is different, and these are all the people who love you so much."
Resources for Telling the Conception Story
Philadelphia Family Pride Family Matters Conference, Saturday, 9 a.m.-4 p.m., William Way Center, www.philadelphiafamilypride.org.
Conference features panels on "baby-making in the 21st century" and other topics. Cory Silverberg, author of What Makes a Baby, will speak at 9:30 a.m.
What Makes a Baby Picture book by Cory Silverberg; online readers' guide for parents includes answers to questions kids ask and a resource list. www.what-makes-a-baby.com.
Creating a Family Education and resources for infertility and adoption. Fact sheets on talking to kids about donor conception and assisted reproductive technology; book list for kids and adults, www.creatingafamily.org.
Donor Sibling Registry Education and support for donor families. Resource lists of videos and articles on donor conception, www.donorsiblingregistry.com.