From IVF to surrogacy, these women became moms through assisted conception. Here's how they talked to their kids about it.

It took three rounds of IUI (intrauterine insemination) followed by three rounds of IVF (in vitro fertilization) before Lauren Manaker became pregnant. Her daughter is now 8, and has known for the past few years about the way in which she was conceived. According to Manaker, a registered dietitian based in Charleston, S.C., the conversation kicked off when she had to pay a visit, for work purposes, to the fertility clinic she and her husband had gone to. She decided to take her little girl, then 4 or 5, along, and used the trip to help introduce, at a basic, age-appropriate level, some details about their family's fertility journey.

"I explained where we were going, and I said, 'these doctors helped us make you,'" Manaker tells Yahoo Life. Over the years she's gone into more detail about the process. "We've progressed to explaining that my eggs weren't working very well, so we needed some help with doctors." While she's had to clear up some confusion — at one point her daughter told a friend that that's how all babies are made — she feels good about her decision to be transparent about undergoing IVF.

"My whole thought process was, the earlier we talk about it, the less of a big deal it is. Like, it's just normal for her," she says. "I didn't want something to come up when she's 19 years old, because really it's her story — and then she feels betrayed because I was keeping a detail about her life from her."

She also hopes to push back against any shame or stigma associated with infertility.

"We're removing the taboo," Manaker says. "Being conceived via IVF is nothing to be ashamed about, and I think the earlier we speak about it and normalize it, that helps the overall big picture."

For parents who have started their families with the help of assisted conception — whether that means IUI, IVF, surrogacy or donated sperm or eggs — how and when to discuss the experience with their children can be a complicated, personal decision. According to Ali Domar, a senior staff psychologist in the department of obstetrics and gynecology at Beth Israel Deaconess Medical Center and associate professor of obstetrics, gynecology and reproductive biology at Harvard Medical School, it's a conversation that is important to have early on.

"A healthy family is based on trust and honesty," says Domar, the chief compassion officer at Inception Fertility. She adds, "No matter how much child came into the world, it shouldn't be a secret. It shouldn't be a thing that has the potential to cause shame. And the earlier the kids find about their origins, the more natural it feels to them and the less likely they are to think it's an issue."

That's something Lori Day, an educational psychologist and consultant based in Massachusetts, saw first-hand after she opened up to her daughter about getting pregnant, after four years of trying, through a gamete intrafallopian transfer (GIFT), a form of assisted conception in which fertilization of the egg takes place in the fallopian tube. For Day, sharing her story involved a series of conversations — the first of which occurred when her daughter was 4, when, after trying in vain to have a second child, and struggling with excruciating endometriosis, Day underwent a hysterectomy. Ahead of her hospitalization for the procedure, Day prepared a booklet explaining to her little girl that "there were parts in Mommy's tummy that gave her pain and didn't work the way they were supposed to work, and that a doctor was gonna help me in the hospital."

The next conversation unfolded when her daughter, who is now 31, was 6 years old and started asking about how babies are made. On account of her background in child development, Day had long planned to discuss "the birds and the bees" before going any further. "I wanted to be sure she understood how most people are conceived and just the concept of it before I introduced the concept of how she was conceived," she explains. That happened when her daughter was about 7.

Day reminded her daughter of the time she had gone to the hospital. "I just basically said, 'I was born with some medical problems that made it hard for me to have a baby the way other people have babies,'" she shares. "And I said, 'But Mommy and Daddy wanted a baby so badly that we had a doctor who helped us to be able to have you. And then I explained how it works to her."

At the time — Day's daughter was conceived in 1991 — children conceived through assisted conception were often referred to as "test-tube babies." Day asked her little girl if she'd heard the term, then explained what it meant. "And she said, 'Oh, so I'm a test-tube baby.' And she was like, 'Cool!'"

So "cool," in fact, that "she was telling her friends at school because she thought it was the coolest thing and it was great," laughs Day. "Just looking back, it worked out fine. There was no issues. She never had trouble understanding it, or she never felt bad about it or anything. And she always was fascinated with it."

In high school, Day's daughter even wrote a research paper about reproductive technologies, prompting her mom to take her to visit the Boson clinic where she'd been conceived. There, they met Day's old doctor. "He said to me, 'You haven’t changed a bit,'" she remembers. "He said to my daughter, ‘But you have! Last time I saw you, you were smaller than the head of a pin!”

Both Day and Manaker gave birth to their own biological children, but many parents have conceived with the aid of surrogates, or by using donated eggs, sperm or embryos. According to Domar, in these situations it's even more imperative for parents to be transparent with their children about their background. She likens it to research showing the benefits of telling children that they are adopted earlier rather than later, and points to the proliferation of genetic testing companies like 23andMe which can easily unravel a family secret. Domar herself has heard from former patients who have never been transparent with their now-grown, donor-conceived children, and are now agonizing over how to break the news. "It's pretty easy to have a conversation with a 3-year-old about this," she says, noting the abundance of books discussing unique family situations in age-appropriate ways. "It's a lot tougher with a 25-year-old."

Her advice: "I think any time there is a third party involved in conception, you have the best long-term outcome the earlier you start the conversation, because that way it's the most normal and comfortable for your child."

Gina (not her real name) has taken that approach with her family. She underwent IVF to conceive her oldest child, a girl who is now 7, but had to have her uterus removed shortly after giving birth following surgery to remove a tumor on her placenta. She and her husband have gone on to welcome two more children, using their own embryos, with the help of a gestational surrogate they connected with through the surrogacy agency and advocacy platform Surrogacy Is. It was during the surrogate's first pregnancy that Gina realized her then-2-year-old daughter had twigged that a baby was coming. "Mommy, there's a baby in your belly," the little girl told Gina.

"She must have understood more than I knew when I was talking on the phone or to friends," Gina says. "I told her, 'Yes, we are going to have another baby but he is not growing in my belly. My belly is broken so I needed help and he is growing safely in someone else ... but he is growing in my heart.' She did not understand so she looked down my shirt to see if she could see her baby brother. From there, we continued to talk about it."

Gina's daughter ended up joining her and the surrogate for doctor's appointments. Her little brother, now 4, is also in the loop. When the surrogate became pregnant with Gina and her husband's third and youngest child, "he knew we had another little baby on the way and that I was not pregnant."

"There has never been a secret about anything, because there is nothing to hide," she tells Yahoo Life.

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