The Psychology of Third-Party Reproduction: Supporting Patients and Families
For individuals and couples navigating third-party reproduction, the medical aspects often feel front and center. But alongside medications, procedures, and lab results, there are deeply personal, psychological, and ethical considerations. That’s where reproductive mental health professionals come in.
Understanding the Role of Mental Health in Fertility Care
Third-party reproduction is a form of assisted family building that relies on another individual’s help to achieve pregnancy. This may involve:
Donor sperm – a donor provides sperm to fertilize a recipient’s egg, often through intrauterine insemination (IUI) or vitro fertilization (IVF).
Egg donation – when a donor's eggs are retrieved, fertilized with sperm in a lab, and the resulting embryo is implanted into the recipient's uterus.
Embryo donation – in which donated embryos, created from donor sperm and/or eggs, are implanted into the recipient's uterus.
Surrogacy/gestational carriers – when a gestational carrier (surrogate) carries a pregnancy for intended parents.
These pathways support people who cannot conceive or carry a pregnancy conventionally, including those experiencing infertility, single individuals, same-sex couples, or families facing significant genetic concerns.
Mental health professionals trained in fertility and third-party reproduction help patients process emotions, prepare for complex decisions, and anticipate future challenges. Their role is not only to safeguard patients’ wellbeing, but also to ensure that all parties (donors, intended parents, and gestational carriers) enter into these arrangements with clarity and stability.
The following case examples illustrate the range of challenges where a reproductive mental health professional can make a profound difference.
When Families Struggle with Embryo Disposition
After pursuing fertility treatments for four years, Sue and Melissa turned to in IVF with donor sperm. On their third attempt, Sue became pregnant. Later, when they tried again using one of their remaining embryos, Melissa carried the second pregnancy.
Now, as parents of two children, the couple still has four unused embryos. Their clinic recently contacted them about renewing storage or donating. Even though they know their family feels complete, Sue and Melissa can’t imagine donating the embryos, fearing that someone else would be raising “their” children.
In therapy, they found space to process the grief, attachment, and moral weight of these decisions.
When Donor Relationships Become Complicated
Michelle and Ron welcomed their child through open embryo donation. In this arrangement, the donor couple, John and Sylvia, specifically “chose” Michelle and Ron to receive their embryos. Before the transfer, the couples participated in a joint consultation with a reproductive mental health professional to explore expectations and discuss what their ongoing relationship might look like.
After the baby’s birth, Michelle became distressed by Sylvia’s desire to “keep in touch.”While she had initially agreed that some contact could be valuable, she now feels the closeness threatens her role as mother. Ron doesn’t share the intensity of her concerns, leaving the couple at odds.
Therapy provided space for Michelle to process her insecurity and for the couple to set boundaries, manage expectations, and safeguard their family’s stability.
When Hidden Mental Health Histories Surface
After much reflection, Rhonda decided to become a single mother by choice and use the eggs she had frozen years earlier. Her longtime friend, Will, offered to be her sperm donor, and both were referred to a reproductive mental health professional for separate psychoeducational consultations.
During Will’s screening, it emerged that he had a past suicide attempt and a strong family history of bipolar disorder. Although Rhonda wanted to proceed, the evaluation raised serious concerns, underscoring the critical role of mental health professionals in safeguarding all parties in third-party reproduction.
They are now scheduled to meet with the reproductive mental health professional together to ensure the implications are fully understood.
When Gestational Surrogacy Raises Unexpected Questions
After multiple miscarriages, John and Becky decided to pursue parenthood with a gestational carrier. When their physician asked how they envisioned a relationship with her, Becky was surprised: “What do you mean? What relationship? I just want her to carry my baby and move on.”
They had imagined a straightforward arrangement, never considering what kind of relationship they might develop with their gestational carrier. Their physician required them to meet with a reproductive mental health professional before proceeding. That consultation opened space for difficult but necessary conversations about expectations, boundaries, and the lived reality of surrogacy, not just the medical transfer of embryos.
The Expanding Role of Reproductive Mental Health Professionals
More Than “Clearance”
Third-party reproduction involves an interdisciplinary team: patients, donors, gestational carriers, physicians, attorneys, and agencies. Within this team, reproductive mental health professionals act as both gatekeepers and educators.
According to the American Society for Reproductive Medicine (ASRM), psychological screening and counseling are recommended to protect the wellbeing of all parties (2022; 2024). Evaluations can determine whether donors or carriers are appropriate candidates, while consultations help recipients anticipate psychosocial challenges.
The Gatekeeper Role
Historically, egg donors were the only gamete donors required to undergo psychological evaluations. Today, there is growing recognition of the need for sperm donor evaluations as well. These assessments explore mental health histories, genetic risks, and psychological resilience, ensuring that the donation process won’t cause undue harm or carry unacceptable risks.
Gestational carrier candidates are also evaluated. In accordance with ASRM guidelines, mental health professionals provide psychological “clearance” before any legal contracts are signed. This protects both intended parents and carriers by ensuring everyone enters the arrangement with informed consent and realistic expectations.
The Educator Role
Not all meetings are evaluations. Many are psychoeducational consultations, designed to prepare recipients and intended parents for the emotional and relational aspects of third-party reproduction.
For gamete or embryo recipients, consultations create space to process grief over lost genetic connections, explore openness with donor-conceived children, and plan for embryo disposition decisions.
For intended parents considering surrogacy, consultations raise questions they may never have anticipated:
What qualities are important in a gestational carrier?
How much communication do you want before, during, and after pregnancy?
What role do cultural, religious, or geographic factors play?
How will you navigate differing views on prenatal care or childbirth?
These conversations ensure that families are prepared not just medically, but emotionally and relationally, for the journey ahead.
Why This Matters for Mental Health Professionals
As more individuals and couples pursue family-building through third-party reproduction, the demand for skilled reproductive mental health professionals is growing. These professionals play a vital role in:
Protecting the mental health of donors, carriers, and intended parents.
Addressing grief, loss, and identity in family building.
Navigating ethical and legal complexities in donor and surrogacy arrangements.
Supporting long-term wellbeing for donor-conceived individuals.
With fertility treatments advancing rapidly, mental health providers who understand these unique dynamics are in high demand.
Your Next Step: Build Your Expertise in Fertility Mental Health
At the Seleni Institute, we offer specialized fertility coursework designed for mental health professionals who want to expand their practice and better support clients utilizing and navigating third-party reproduction.
Our evidence-based CE courses will help you:
Understand the psychosocial dimensions of fertility care.
Gain confidence in conducting evaluations and consultations.
Apply ASRM guidelines in clinical practice.
Support clients with empathy, clarity, and competence through one of the most complex experiences of their lives.
Explore the coursework here and join the growing community of mental health professionals advancing reproductive care.
