By: Piave Pitisci Lake, M.D., Member of The AFA Mental Health Advisory Council
We all think about heredity when we think about having a baby. Who will the baby look like? Who will the baby be like in personality or temperament? Who do we want the baby to be like? Will the baby be healthy or have the illness that “x” relative had? There are some things we hope will be avoided and some things we hope will be passed on. We generally think that we will see something of ourselves, or our family, in our children. After all, our children have 50% of our genes. For those using donor gametes to conceive, the dreams and fantasies (the template) of what our children will be like are half complete.
We all have assumptions about what is nature (genetics) and what is nurture. Who we are is, of course, determined on the most basic level by our genes. But the role of genes in determining what we look like, whether we have certain diseases or are at increased risk to have certain diseases, our mental abilities, interests, talents, etc., is very complex.
Diseases, conditions, and traits (abnormal and normal) can be inherited through single-gene defects, chromosomal abnormalities, and in a multifactorial way. Human cells have 46 chromosomes-22 pairs of autosomal chromosomes and 1 pair of sex chromosomes (XX, XY). Chromosomes are made up of many genes. Genes are made of DNA. Each chromosome of a pair contains the same genetic information, but there might be slight differences. We have identified many disorders caused single-gene defects or chromosomal abnormalities. These can be detected through information about family history as well as genetic or chromosomal testing. We can also predict the risk of inheritance of these diseases with significant accuracy. Diseases that are inherited in a multifactorial way are also genetically determined and may be found to cluster in families, but the specific genes are not well known. In addition, the expression of the disease depends on the interaction of multiple genes and environmental circumstances. The risk of inheritance of these conditions is less clear. It depends on the disease in question, its severity, and the number of family members affected.
Recipients of donor gametes generally expect that donors are free of identifiable genetic or chromosomal disorders that have a known risk of being passed along to offspring. The American Society for Reproductive Medicine includes guidelines on the minimum genetic screening for gamete donors. Through family history and genetic screening, donors with a personal or first-degree (parents, siblings, offspring) family history of disorders caused by identifiable gene or chromosomal defects, or present in multiple family members are excluded because of the predictable risk of disease to offspring. Disorders such as Bipolar illness and Schizophrenia are examples of illnesses in which there is an increased risk of inheritance to an offspring if multiple family members are affected. In these cases, the relative risk is not likely to be as high as with single-gene or chromosomal disorders, but the risk is high enough that a donor with that history would also be excluded.
After being assured that donors have had the appropriate screening for diseases with known, predictable risks of disease inheritance to offspring, recipients are asked to take a leap of faith about the donor they choose and what their child might be like. This is the area where ideas about nature versus nurture influence the choice of donor and can help recipients articulate their assumptions about what they think their child will be like and what they thought their child would be like if their own genetics were present.
Physical appearance is a typical area of concern. Most parents assume that their child will share some physical features with their genetic ancestors, if not themselves. This is often true. But it is also not uncommon for offspring to not bear the expected resemblance to their parents and siblings. Temperament/personality is another characteristic that we tend to think is more genetically determined than it might actually be. We like to say, “Oh, he acts just like his father (mother, aunt Jane). If you have been around infants, it is pretty clear that each is different. Their cries, their reactions are each different, even when they come from the same genetic parents. This is probably hard-wired. However, an infant’s temperament is not static. A child’s environment exerts a tremendous amount of influence on how a child adapts his innate responses to his environment. Mental ability is also likely to be hard-wired initially. However, it is clear that one needs an appropriate environment in order to reach one’s intellectual potential. The level of education a person achieves can be an indication of innate ability, opportunity and/or learned behavior. However, the lack of an education is not necessarily a reflection of how smart someone is. Specific talent may be something innate as well, especially in those truly gifted individuals, but for the vast majority of people the right environment strongly influences level of achievement. Many like to think their children will share their interests in life. Again, some show preferences early in life or may develop their specific interests later, but in many instances, the things to which you have been exposed and the activities in which the important people in your life are engaged play an important role in developing an individual’s interests.
Ultimately, who we are, who our children are and the factors that influence our development are very complex and beyond our ability to reduce our offspring to simple cause and effect. We like to think we have an idea of what our children will be like if we are using our own gametes because we are familiar with what has come before us and because genes from a familiar gene pool are being used. We also have ideas of the parts of ourselves we would like to see (or not see) in our children. Maybe they can be a better version of us. For recipients of donor gametes, half of what will influence whom the child will be is unknown. Recipients are forced to speculate based on information available in the donor profile or from meeting the donor and their own assumptions about what this will mean for their offspring. As much as genes determine who we are, it is the interaction of genes and environment that shape us and, on many levels, the result of this process is unknowable. Our children are who they are, not whom we think their genes say they are.
About Dr. Lake
She received her Bachelor’s Degree in Italian Literature from Bryn Mawr College in 1992. She was graduated from Tulane School of Medicine in 1997. She completed her residency in General Adult Psychiatry at the McGraw Medical Center of Northwestern University in Chicago in 2001 and served as Co-chief Resident during her fourth year of training. She became a diplomate of the American Board of Psychiatry and Neurology in 2002. She is a member of the American Psychiatric Association, the American Society of Reproductive Medicine, and the Mental Health Professional Group of ASRM.
Dr. Lake has been in private practice as a general adult psychiatrist in Charleston, SC since 2002. She works individually with adults18 years to geriatric ages. She utilizes psychopharmacology and psychotherapy to treat a variety of problems, most commonly depression and anxiety. She has a special interest in treating those with infertility issues, women with perinatal and postpartum mood problems, and mood problems related to hormones. She also performs 3rd party evaluations, screenings and psychoeducational meetings for gamete donors, gestational carriers, and donor gamete recipients/intended parents.