PSYCHOLOGICAL PROTOCOL FOR EGG, SPERM AND EMBRYO DONATION AND SURROGACY
Statement of Purpose
This document describes best practices for the psychological screening of potential egg, sperm and embryo donors and gestational carriers. Our goal is to support greater consistency and reliability in the evaluation of gamete donors, gestational carriers and embryo donors.
The purpose of the psychological screening of gamete donors and gestational carriers is to minimize the risk of psychological harm to these parties, estimate their ability to comply with the demands of being an ovum donor or gestational carrier, ensure informed consent, and protect all parties from undue harm now and in the future.
Who Performs Psychological Screening? Mental Health Professional Qualifications
Psychological screenings must be performed by a licensed mental health professional with a minimum of two years of experience in reproductive medicine or under the supervision of a seasoned mental health professional versed in reproductive medicine. The mental health professional must be licensed in the state in which the evaluation takes place. A qualified mental health professional is one who has knowledge in both reproductive medicine–best obtained through active membership in ASRM and the Mental Health Professional Group–and knowledge about psychological evaluations–obtained through coursework in psychological assessment, training and consultation. All evaluations must be conducted by a mental health professional who has command of ethical and practice guidelines specific to egg, sperm and embryo donation and surrogacy. At the current time, the only body providing training to mental health professionals in the field of reproductive medicine is the Mental Health Professional Group (MHPG) of the American Society for Reproductive Medicine (ASRM), which offers mentorships within MHPG, as well as annual conferences.
Best practices are that mental health professionals screening candidates for egg donation and surrogacy have participated in the online MHPG discussion group; been mentored by experienced reproductive psychology professionals; and have attended conferences related to collaborative reproduction.
Psychological Screenings: Best Practices
The purpose of the psychological screening is to determine if a potential donor or surrogate meets the requirements for being a donor/carrier. The screening is one of many factors that will be considered by agencies and medical personnel in determining appropriateness.
It is optimal that psychological tests are administered in person. Psychological tests are standardized tests. They are to be administered by strict criteria dictated by the company that creates and publishes the test. These criteria do not vary from practitioner to practitioner.
A psychological screening has four components:
Interview: A full in-person clinical intake. During the clinical intake, the mental health professional utilizes his/her specialized training to assess, observe, and interpret the candidate’s psychological status, level of functioning, emotional stability, and history. During this time, the professional will also assess whether the candidate meets guidelines and criteria to be an egg donor or candidate, according to established ASRM guidelines.
For both surrogacy and egg donation with a known donor, the evaluation process should include the donor/gestational candidate and her spouse or live-in partner (if applicable.)
Testing: The in-person administration of at least one standardized, objective psychological test such as the Minnesota Multi-Phasic Personality Inventory-2 (MMPI-2), or the Personality Assessment Inventory (PAI). Tests that are done by telephone are invalid.
The results of these tests are valid only if they are administered in accordance with the administration procedures published in the professional manuals associated with each test. All mental health professionals must adhere to the standardized administration procedures and to the copyright laws associated with each test without exception.
Evaluations of egg donors and surrogates are considered high-risk assessments. This reflects the importance of these evaluations with regard to the candidate, the intended parents and the offspring. Participation as a donor or surrogate holds tremendous psychological and physical risks and has long-term consequences to all parties. It cannot be underestimated that because of these risks, and the fact that these women will be participating in creating human life and building families, all aspects of testing should optimally take place in person.
Testing can never be done over the telephone and tests must never be mailed.
Report: The health professional will obtain consent from the candidate, at which time the candidate will be informed who the client is and who will receive the report. At times, the agency will be the client and receive the report; at other times, the report will go to the treating physician. At no time will the report be given to the candidate without first meeting with the mental health professional for a complete explanation of the contents of the report. Candidates and intended parents do not routinely receive reports. A comprehensive written report is the synthesis of all pertinent information relating to their mental status, test results, and participation in the collaborative reproductive arrangement, and their suitability to do so.
Intended Parent Consultation: This is a psychoeducational consultation concerning the potential implications involved in creating a family through egg, sperm or embryo donation or surrogacy. The goal is to help parents make informed decisions about family building regarding the sharing of information with the child and others, the long-term impact on the family, grief and loss issues, and readiness to proceed with such an arrangement. This consultation would also include a discussion of the intended parents’ expectations regarding future contact or relationship with the carrier and/or donor.
Locating Qualified Mental Health Professionals
When a donor or surrogate candidate is unable to get to the office of the mental health professional most often utilized by an agency or IVF clinic, the agency is advised to request of that mental health professional a referral to a similarly qualified professional in the candidate’s locale. Through both the ASRM and MHPG directories, as well as personal collegial contacts, it is almost always possible to locate a qualified mental health professional within a three-hour drive of the candidate’s home. While this may be inconvenient, it is indicative of the many ways in which a candidate will be inconvenienced during the process for which she is applying, and is necessary in order to receive a thorough and complete screening according to best practice.
A thorough evaluation in accordance with this protocol serves to protect all stakeholders involved in collaborative reproductive arrangements: donors, intended parents, surrogates, and offspring. In addition, this process serves to ensure that physicians, attorneys, mental health professionals, and agencies follow best professional practices.