Questions contemporaines

Questions contemporaines

Article de : Christine Anzieu-Premmereur
Pédopsychiatre et psychanalyste, membre de la SPP, directrice du département parents-bébés du Centre de Psychanalyse de l'Université de Columbia de New-York.
Gustave Klimt
Gustave Klimt

Egg donor pregnancy and issues in motherhood

Publié le 08/04/18

Medical intervention for reproduction is very liberal in the US, so buying sperm and eggs on the Internet is easy. Many pregnancies in the past years had been successful after IVF, from ovum coming from other women selling their eggs. The embryo created in the medical lab can be transferred to the woman’s uterus or kept frozen. We talk about egg donor, but this is a market exchanging human biological products and money, not a donation.
The choice to be involved in a medical process for procreation makes the couple facing new thoughts about reproduction, life and sexuality. Receiving gametes from anonymous donor puts the couple in a primary process associating representations of reproduction with unconscious infantile sexuality fantasies. At the same time with the pain at being infertile and giving power to the medical institution that will function as a third in their dynamics, the couple faces the conflicts associated with the satisfaction to overcome their limits at getting a child, and the feeling of debt and transgression. Anxieties associated with the representation of egg’s donor play an important role during the pregnancy and the development of motherhood and parenthood.

After the birth of the child, the complexity of the meeting with the real child, the projections of the narcissist issues regarding its origins, and the splitting in the couple between the father being entitled to claim the baby as his and the mother’s doubts about her right to do so, puts the mother-infant dyad at risk. We have to think about the baby’s psychic development in this specific context.
Egg donor pregnancy is not a pathology and doesn’t develop more disorders in children than any conflicted pregnancy, but there are specific traumatic experiences in the parents that can be explored to make us more attentive on how to help the couples dealing with the new technologies.
The mutual identification between mother and infant is under the mother’s own infantile unconscious representation of being a female. This specific interaction helps the mother’s cathexis of her capacity to contain babies. That makes the girl facing ambivalence between envy towards the mother’s body possessions and regression to a narcissistic symbiosis. Buying the eggs of another woman makes the woman dealing with envy, depression and rivalry.
The uterus can be experienced as a sexual organ or as a silent part of the body, assimilated to the digestive system in an anal investment. The capacity for representation of the internal organs is here at stake. Sometimes the uterus is not differentiated from a representation of the mother’s one.
This undifferentiating makes the woman pregnant after an egg donor and a non-sexual impregnation, having the fantasy not only at having stolen the mother’s eggs, but at being in a symbiotic relation again with her mother’s body. This is observed in hypochondriac anxieties. For some the first pregnancy, even with medical intervention, is the moment of owing her own uterus, but for most of those women, this leads to a repetition of infantile issues, that could eventually play a role in the cathexis of the baby after the birth, and the relationship with a baby girl.

A woman infertile or too old to produce eggs will have trouble at recovering a sense of her creativity and of an erotic part of her body. The uterus is seen as her own mother’s property as it was in the girl’s fantasy and with the medical intervention, it becomes the fetus’ one when the pregnancy is successful, with the doctors checking on the it on a regular basis, under the husband’s supervision: Some women experienced their reproductive organs as stolen by the next generation and disconnect themselves from the pregnancy or start to develop paranoid anxiety. Investment in the baby as a future source of love and pride is at stake. Defense mechanisms against the aggression towards the fetus and when facing intense guilt towards their own mother make the pregnant women regaining the anal cathexis of their body they had during toddlerhood. Digestive issues during the pregnancy are permanent, and after the birth, preoccupation with control of dirt, cleanliness and expulsion are important, leading to problems at taking care of the baby’s body. Breast feeding is disgusting and unpleasant, the infant’s vomiting and feces are source of horror and feelings of persecution. Depression is often hidden behind hypochondriac preoccupation, with a difficulty at creating a representation of herself as a mother and of the child as a person. Buying eggs in the internet is experienced as a transgression that is source of omnipotence and shame. This will play an important role later on, when the parents will choose to tell the child or not about this unusual conception and its origins.
A patient reported the dream, after she knew that the fecundation between the egg from the donor and her husband’s sperm was successful: She is pregnant from her mother’s lover and is full with disgust, she is guilty of wanting an abortion and feels trapped in the pregnancy; losing her freedom, she is depressed and her life is ruined. Another reported that dream during a pregnancy she kept secret from her parents: She is on the sea, swimming, hopeless to find the ground; she is looking for her mother who is too far away and she could die from exhaustion.
Time plays an important role for those women, after years or months of failures to get pregnant, medical interventions, anxiety and narcissistic damage. There is a sense of triumph at being pregnant, with a masochistic compromise to conceive a baby at any price. Some women cannot choose the egg donor’s system, being hurt by their own infertility and having concern for the future child’s well-being. Some will go for it, making real the idealized wish to conceive a baby, to pay for what they think has been a sinful life in their youth.

Then there is the time of the pregnancy, limited and well structured, when the psychological development of a woman into a mother can take place; With heavy medical support, a lot of anxiety about the quality of the pregnancy and the survival of the fetus, there is a strong ambivalence towards the foreign egg. The level of insecurity and controlling reactions in the partner plays an important role. The anal issues related to the baby’s arrival aggravate those anxieties.
Few months after the birth, after emotional turbulence and anxiety at meeting with a baby difficult to adopt, some women have to deal with the pressure of the doctors at getting a new pregnancy as fast as possible, in order to benefit from the frozen eggs. Mothers feel their body as a tool for producing babies when they are not ready to invest in a new child.
Dealing with an imago of omnipotent mother idealized in her reproductive capacities and source of aggressive feelings, some of those pregnant women develop a disgust for the female body, cannot look at themselves in a mirror while pregnant. One of them described how horrific it was for her to see her mother’s detested body while looking at herself.
In my clinical experience with egg donor pregnancies, I met with specific issues:
 -The question of the ability to love and to identify with the new baby.
-The regression to infantile sexuality, with strong defenses that led to inability to touch the infant and breastfeeding problems.
 -The maternal masochism when at the same time having a fantasy of being omnipotent and eternal.
 -The prevalent narcissistic cathexis into the child, with the goal make that precious baby a precocious preforming child.
-The observation of intense negative reactions in babies, with the risk of developing destructiveness instead of pleasure and libidinal cathexis.
I have treated many cases of women in their late 40s who got a last chance of becoming pregnant after having been single for long. Having eggs from a donor was their only way to get the idealized pregnancy. They chose anonymous donors on the internet, speculating about origins, eye color, intellectual capacities and imaginary capabilities. They suffered a great deal of doubts during that process, with envy at the husband’s capacity to have his sperm impregnating the egg. During the pregnancy under intense medical surveillance, the dreaming process about the baby was poor. The anxiety to carry the precious pregnancy in a depreciated body associated with the weird sensation to be a container for a foreign creation made difficult the regressive fantasy of symbiotic relation with the fetus. The split between mother and fetus became acute at the end of the pregnancy. As soon as the baby was born, and far more when they had a baby girl, those mothers experienced the new creature being very welcome by the father and the grandparents as a prefect girl, the mother felt depreciated, depressed. Immediate rivalry was in place, to the huge distress of the new mother.
Most of those new mothers coming for consultation with their infant, were dealing with despair at not being able to love their newborn, or thinking they gave birth to a child who couldn't attach to them. Some had dissociated themselves from any feeling and sensation, functioning in a concrete mechanical behavior, like in the ‘blank depression” described by Andre Green. They couldn’t find any pleasure in the body contact with the child. I had to label their negative feelings as sadness and anger, sometimes projected in to the baby.
The trauma of the past sterility, the miscarriages, IVF, medical treatments and anxiety over their pregnancy had made them sensitive to any judgment about their capability for mothering a child.

We observe how becoming a parent signifies confronting a “developmental process of mourning” for the future parent (Palacio Espasa, 2004) who must cede the place he had occupied as the child of his parents. The presence of the infant makes the couple to assume the role of the parent, in an interactive dynamic between identification with the child and libidinal and aggressive drives. I observed that most of couples consulting after egg donor pregnancy have developed a masochistic relation to the baby.
There guilt feelings towards their own parents and the donor result in submission to accept all the child’s demands without any limit, in a need for expiation, while projecting into the infant a grandiosity associated with all the narcissistic wishes that are part of this kind of difficult pregnancy. The mother feels being unworthy; any symptom in the baby, feeding, sleeping, anal issues, reactivating infantile sexuality fantasy and conflicts, is interpreted as an accusation. Aggression is projected into the baby, and most baby girls are felt as mean and destructive, left in a manic state of non-contained agitation. The sadomasochistic quality in the dyad with the strong superego source of intense guilt, plays a role in the child’s low self-esteem and depressive reactions. 
There is a traumatic impact of medical interventions in reproduction. It’s important for psychoanalysts to be aware of the role of preventive interventions, and to make the gynecologist as the pediatricians aware of the signs of lack of libidinal investment in the pregnancy as in the baby. Most of the suffering in those cases is quite silent, but will have a strong impact in the child’s development. Psychoanalytic interventions can help to work with the parents with their representations of the origins of the child that interfere with the infant’s own needs.

Anzieu-Premmereur C., Cornillot M. (2003) Pratiques psychanalytiques avec les bébés. Dunod Paris.
Freud, S. 1905 Three Essays on the Theory of Sexuality. S E 7 London: Hogarth PressFreud, S. 1918 From the history of an infantile neurosis. S E 17 London: Hogarth PressGreen, A. (1993). The dead mother. Psyche, 47(3): 205-240.
Palacio Espasa, Francisco (2004) Parent-Infant psychotherapy, the transition to parenthood and parental narcissism: Implications for Treatment, Journal Child Psychotherapy,30 (2):155-171.
Winnicott, D. W. (1956) Primary maternal preoccupation In Through Paediatrics to Psycho-Analysis pp. 300-305 New York: Basic Books, 1975.

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