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January 23, 2024 ART Law & Practice

Are Mental Health Drugs a “Poison Pill” for Prospective Surrogates and Egg Donors?

Lori S. Meyers

Increased awareness of mental health issues is something we all care about, and today’s sensitivity to why and how we are impacted by our surroundings allows us to be more mindful toward ourselves and others to create goodness in our lives, both in heart and mind. Life isn’t always easy, and we see physicians addressing the stress and anxiety prevalent in young women by prescribing medications designed to assist and expedite psychological healing. These medications may include selective serotonin re-uptake inhibitors (SSRIs), otherwise known as “happy pills,” designed to address emotional problems and relieve instability in daily life. The careful monitoring of their protocols is critical to long-term success in maintaining positive attitudes and life changes without leading to addiction and other adverse outcomes.

Mental Health of Surrogates and Egg Donors

Good mental health is a key requirement for any reproductive arrangement. Some women considering becoming an egg donor or a surrogate may not be eligible. All prospective surrogates and egg donors must undergo a thorough psychological assessment with a qualified mental health professional. How will mental health medications be taken into account during the psychological evaluation and screening for surrogates and donors?

Those taking certain medications may face a choice of continuing to take their medication to be mentally healthy and risk being disqualified or discontinuing their medication to ensure qualification. It’s at this stage that agencies and intended parents are highly critical of health records and lifestyle choices. Could the use of medications become a “poison pill” to end a potential match for a candidate that intended parents might otherwise love and want to select?

Surrogates: No Current Use of Medication Tolerated

Dr. Guy Ringler of California Fertility Partners points out that intended parents tend to be highly reluctant to tolerate the use of any medications that might interfere with the efficacy of protocols during the embryo transfer procedure as well as the goal of a healthy pregnancy when there is so much at stake. Interview with Dr. Guy Ringler, California Fertility Partners, at the Men Having Babies Conference in Brussels, Belgium (Nov. 11, 2023) (notes on file with the author). American Society for Reproductive Medicine guidelines further support screening out surrogates experiencing mental health challenges and rejecting candidates currently taking prescribed medications.

Intended parents make a significant financial investment and must take into account the emotional impacts, as well as general health concerns. For a surrogate experiencing true clinical depression who is reliant on medication in her daily life, discontinuing use could cause severe imbalances and could lead to post-partum depression after the birth.

Post-COVID, agencies struggled to find available qualified surrogates. As a result, concerns were raised in the industry that agencies were under extreme pressure to push through surrogates that may just not be the right match. In some cases, the use of SSRIs or reporting mental illness may be underplayed, undisclosed, or even hidden to encourage or complete a match. Thus, agencies and mental health professionals must utilize safeguards and guidelines to ensure proper completion of psychological assessments and be sure to gather accurate and truthful information about potential use of mental health medications that could ultimately affect a fertility treatment or cycle.

The journey towards conception can be emotional and not without moments of stress. Surrogates are expected to maintain the best overall heath possible throughout the entire journey, including the birth, to encourage her own healthy post-partum recovery. Thus, there is little “wiggle room” or acceptance for taking any kind of supplemental medication during the embryo transfer procedure and pregnancy.

Egg Donors: Medication Use on Case-by-Case Basis

Similar to the analysis for surrogates, women who are currently diagnosed with clinical mental health illness and are currently taking antidepressants or other medications are discouraged from donating their eggs. Egg donation also requires a clean medical and mental health history, and candidates must be able to pass psychological screening. Potential donors may be reluctant to provide such disclosures and could be incentivized to move forward financially with a donation when the genetic lineage and history is critical to the future well-being of a child.

Samantha Lavy, LMFT, MA, of JSRC Group suggests that mental health practitioners follow “best practices” whereby the IVF doctor has flagged potential concerns first and provides specific mental health information prior to the initial review and psychological assessment. She points out that while this offers the best basis for evaluation, such information is not always provided prior to the screening. Information is gathered via the medical records and self-reporting forms and questionnaires completed by the candidates associated with agencies and filled out in doctor’s offices. Lavy suggests that some women who have experienced “situational depression” in the past, such as extreme stress during a divorce or a temporary period of loneliness during the COVID pandemic, might still be able to successfully become egg donors. For example, a potential donor who has suffered from anxiety or depression in the past and was prescribed and utilized medication such as Lexapro, Zoloft, or Wellbutrin for situational psychological illnesses might not be automatically disqualified. Interview with Samantha Lavy, JSRC Group, at the Men Having Babies Conference in Brussels, Belgium (Nov. 11, 2023) (notes on file with the author).

Donor candidates may feel stigmatized by taking medications and the association with mental instability. Concealing emotional problems and medication from others is common due to the fear of negative reactions if the truth of their mental state is revealed. A careful and complete assessment must be made regarding any medications taken in the past, as well as any side effects or reactions to such drugs.

Depression and anxiety are serious mental illnesses that can have a profound effect on every aspect of life. The donor will be evaluated, and, ultimately, the intended parents make a decision on a case-by-case basis, taking into account the recommendations of physicians and psychologists.

The Health and Well-Being of the Baby

It is possible that the timing of the match may play a huge role in the outcome of the choice, depending on other personality traits and physical characteristics. The selection process becomes much more complex when an intended parent is invested in a particular surrogate or donor, both financially and personally.

The goal of any third-party reproductive arrangement is the birth of a healthy baby, involving the cooperation of everyone involved. Intended parents heavily rely on their team of professionals to complete careful analysis and assessment of the information provided by donors and surrogates in the selection process. The underlying screenings, evaluations, and fertility treatment all have a direct impact on the future health and well-being of the child and are of critical importance.

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Lori S. Meyers

Meyers & O’Hara, LLP

Lori S. Meyers is an attorney with Meyers & O’Hara, LLP, an assisted reproductive technology law firm in Sherman Oaks, California, with over two decades of experience in third-party reproductive law.