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Fertility Treatment

Fertility Treatment, Third Party Donation

Navigating the Decision to Become an Egg Donor

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Egg donor advertisements are everywhere. On popular music streaming sites. On Craigslist and Facebook. In campus newspapers or even fashion magazines. Most egg donation advertisements mention the thousands of dollars you can receive to provide eggs, and how your sacrifice can bring joy to people who desperately want a child but have been unable to conceive on their own. You might think egg donation is a good way to make money in a short period of time while helping someone have a baby. But before becoming an egg donor, there are a lot of things you should consider. The egg donation process is complicated. From first thinking about becoming an egg donor to being selected and going through hormone injections and retrieval surgery and recovery, there is a lot of information you will need to know in order to best advocate for yourself. You will be undergoing medical tests and procedures, psychological counseling, possibly genetic testing and counseling, negotiating legal contracts and having surgery under anesthesia. Here, you will find out more information about navigating the initial decision to determine if egg donation is the right choice for you. Why Do Women Become Egg Donors? Most women first think about becoming an egg donor when they see or hear an advertisement that states they can get paid thousands of dollars for their eggs while helping someone else have a baby. Some may find out about it from a friend or co-worker. Or see an article in a fashion magazine or online. Or perhaps they know someone who has struggled with infertility and feels a personal calling to help ease the trauma of involuntary childlessness. Some women do not intend to have children of their own and see egg donation as a way of not letting their eggs “go to waste” and of continuing their genetic contribution without the responsibility of parenting. While most donors receive substantial financial compensation, others do not get compensated at all and do it in order to help a friend or relative, like a sister or aunt who cannot use her own eggs. Whatever the reason, it is a personal decision that deserves serious consideration from all angles. What Should You Consider Prior to Becoming an Egg Donor? Current You vs. Future You When you are considering egg donation, it is difficult to know how your perspective might change over time. While some women who donated years prior remain happy with their decisions to donate, some have mixed feelings, and others express regret. Former donors who later have their own children may have a change of perspective over time. They may wonder about the children out in the world conceived from their eggs, may want their own children to be able to meet their biological half-siblings, or may perceive their donations differently after having their own children. Some worry that their donor-conceived children will find them when they do not want to be found, but most hope to someday meet the children born from their eggs. Once you provide eggs for another person’s child, it is a decision you will never be able to take back. Some former donors—for whatever reason—are not able to conceive their own child after helping other families have children with their eggs. Before deciding to provide eggs think about how you might feel about having genetic children being raised by other people in the event you are unable to have your own children? Potential Health Factors Most advertisements and information about egg donation on agency or clinic websites emphasize that egg donation is safe. Agencies and clinics advertising for egg donors often provide information on their websites that state the "risks are less than 1%." But there is no evidence derived from research with egg donors to support this claim. Different types of complications do occur and the most truthful thing an egg donor recruiter or physician could tell you is that no one knows what the risks are or how often they occur. This is important to understand when you fill out the informed consent form before becoming an egg donor. Immediate complications directly connected to egg donation include things like Ovarian Hyperstimulation Syndrome (OHSS), which is characterized by extreme bloating and in its severe form can be life-threatening. Ovarian torsion, when the ovary twists in the body, cutting off blood supply, is another immediate complication that can occur. The frequency of these complications in egg donors has not been sufficiently studied. Potential long-term complications are even less well known. There have been no studies comparing reproductive cancer rates, endometriosis, infertility or other disorders among egg donors compared to women who have not donated their eggs or undergone hormone injections for fertility treatment. Realistic Understanding of Egg Donor Compensation One of the main reasons women decide to provide eggs for compensation is to pay college tuition or student loan debt. If financial need is your primary motivation for becoming an egg donor, it is important to know that while many advertisements state very large dollar amounts for an egg donation cycle—$10,000, $30,000 or even $50,000 or more—when you actually sign up at an agency advertising these amounts, they will probably offer you a much lower compensation than was originally advertised. Very rarely do agency advertisements apply to a specific set of intended parents or recipients who are ready to pay $50,000 for someone to provide eggs. A more likely scenario is that once you sign up, your profile will be put into an egg donor online catalog and intended parents will choose from there. The going rate—regardless of the advertised amount—is usually between $5,000 and $10,000 in the United States and may vary from agency to agency, clinic to clinic and state to state. Some women with specific, high-demand traits may get paid more, as well as experienced donors whose eggs have resulted in a successful pregnancy. While it is rare to get paid more than $10,000 for a first egg donation cycle, some agencies do specialize in “high-demand

Fertility Treatment

Getting HER Pregnant: What Nobody Tells Intended Parents About Surrogate IVF

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Prepare for some awkward moments, a whole lot of TMI, and a few things no one mentioned to you about the getting-her-pregnant part surrogacy. The intended parent(s) in this process can start by expecting the unexpected and knowing that there will be a myriad of things that may not have been mentioned on the dotted line of your surrogacy agreement. Here are 6 things to expect when preparing for your gestational carrier’s in vitro fertilization (IVF) cycle. Read: What to Include in a Surrogacy Agreement Tests For Everyone! Preparing for the surrogacy transfer will require several appointments and multiple tests for the initial screening process. In the surrogacy screening process, if the intended mother or egg donor will contribute her egg(s) she will have to undergo specific testing to ensure she can withstand the physical toll that comes along with an IVF stimulation and retrieval. The overseeing fertility clinic will test both the intended mother and intended father or partner for Social Disease Testing. This includes STD panels and various bloodwork requirements as part of the US FDA regulations, no matter if the embryo has been previously frozen or if this surrogacy will undergo a fresh IVF transfer. As for that amazingly selfless gestational carrier, she will also have to undertake the full panel of Social Disease Testing as well as her spouse or partner. The process of gestational carrier screening is similar to a basic fertility workup. There is a lot of time, love, money, and hope invested in preparing for the best possible outcome, a healthy pregnancy, and resulting birth. These tests make sure that all parties involved are cleared for take-off, medically speaking. Embrace the TMI A topic of great discussion will be the nebulous prediction of menstrual cycles. If you have never been interested in another woman’s menstrual cycle, you will now! The IVF transfer date will be easier to forecast once your gestational carrier starts her period. This also will be the defining moment that prompts her to begin taking the recommended medications to prepare for the upcoming embryo transfer. This glorious day is called calendar day 1 and it is a day that the intended parents, gestational carrier, and the overseeing doctor are anxiously awaiting. Do You Like Drugs? Let’s rephrase that, do you like paying for extra fertility drugs? Your fertility medication protocol just doubled. If you choose to go through a fresh transfer cycle, then the intended mother or egg donor will need to take a specific protocol of stimulation medications. Your gestational carrier will also have her medication protocol. She will be required to take various medications that will help prepare her body for the transfer and likely will be asked by the overseeing fertility specialist to take these up until the end of the first trimester if the transfer results in a viable pregnancy. Both the increased expense of medications and the requirement to take additional medications after a confirmed pregnancy can be a surprise to both the intended parents and the gestational carrier. The Transfer Feels Clinical Sorry, no love ballads are being played to set the mood. This is where you will need to cheer on your gestational carrier. She will be tasked to fill her bladder until it is uncomfortably full. The doctor who is guiding the catheter with the embryo(s) will need to be sure that they are placing them in the ideal location. A full bladder, when viewed with an ultrasound, helps guide them. Once the embryo(s) are transferred, everyone will anxiously await the beta test 14 days later. It is a controlled process, but if the result of the transfer results in a positive pregnancy it is nothing short of a medical miracle to all involved. Emotions Are Elevated x2. Whatever your reason for choosing to build your family through the option of surrogacy, it is a safe assumption to state that this may not be how you envisioned growing your family. With that, comes a broad spectrum of intense emotions. Visiting a fertility clinic when trying to get her pregnant and not yourself or your partner, might dredge up a mixed bowl of feelings and even introduce new ones, such as guilt. Recognize it, and be kind to yourself through this process. Your gestational carrier will be working on her own set of elevated emotional challenges. It is an extreme amount of pressure and attention on a surrogate mother from day 1 to the day of your baby’s delivery. The fertility medications and pregnancy hormones just help escalate that to a new level of emotional complication. Recognizing what she may be experiencing and giving grace in times of stress goes a long way. Read: Fostering a Healthy Relationship With Your Gestational Carrier Call Me. Maybe? Finally, the two-week wait is over! In surrogacy terms, this might even feel a bit longer because now there are more people eagerly waiting for the news. So who calls whom to confirm the pregnancy results? The answer— it depends. It will fully depend on each fertility clinic’s protocol. Some clinics will default to who the patient is, whereas others will contact who the intended parents would be. If the order of who is in the know first is important to you or your gestational carrier then communication is the key. Ask your clinic before beginning your transfer protocol as to what their communication policy is for surrogacy partnerships. Also, consider talking to your gestational carrier too. Although we want more than ever to have all beta results be positive, the gestational carrier may not want to be in the position to have to be the voice of bad news if the transfer ends in a negative beta test. There is a lot more to surrogacy than what is in the textbooks. Knowing that each surrogacy partnership and situation is unique, and will undoubtedly come with its own set of challenges, will help you prepare for those no-one-told-me-this moments. And if your transfer is successful, the pregnancy

Fertility Treatment, oldposts

Are Egg Donors Patients Too?

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Over the past several years, I have had conversations with almost 100 egg donors for my egg donor research project and my documentary film. In these conversations I’ve heard repeated complaints from the young women who provide eggs for someone else’s children: “I don’t feel like I’m the real patient.” “I feel like I’m just a product to them.” For anyone using an egg donor—or any professional who works with egg donors—it is important to ask: Do egg donors have a legitimate point? If so, how does “feeling like a product” affect young women’s experiences as egg donors and what can be done to improve donor care? Some minor adjustments can vastly improve egg donors’ experiences. These are young women who take on considerable risk so someone else can have a child. Is there a way to do better by them? As a researcher, I spent many years talking to people about their experiences with infertility. In my early 30s, I was also concerned about my own ability to conceive when, after surgery to remove two dermoid cysts, I was left with a single, patched up ovary. I am not unfamiliar with what it feels like to face the trauma of involuntary childlessness and failing ovaries. I thought, “If worst comes to worst, I’ll have to use an egg donor who looks like me.” In that space, I had no concept of what that actually might mean for the hypothetical woman who might have helped me have a child. I understand how someone might become so fixated on achieving the joy of a successful pregnancy and the birth of a newborn baby—whether an intended parent who has struggled for years or a professional in the industry wanting to help them—that it is possible to lose sight of the humanity of young egg donors in the process. Not the Real Patient In a recent online article, donor egg IVF was defined as: “An in vitro fertilization (IVF) process that uses the eggs of a donor rather than those of the patient.” In response to the post, I asked: “Are egg donors patients too?” The language on the post has changed since I first responded—which is a good thing—but it reflects an underlying perspective that needs to change, that a donor is somehow different than the real patient. Unfortunately, many egg donors’ experiences reflect the “not a real patient” experience. After waking up from her egg donation cycle through The World Egg Bank, Rae—a 26-year-old donor—asked her egg donor coordinator for a copy of her medical records. Her coordinator refused to provide her with any records from her cycle. Since egg donors are not seeking treatment when they donate/provide eggs, HIPAA laws requiring access to medical records do not necessarily apply. Kate, who I interviewed for my documentary film, was 19 when she donated in an open donation to a single intended mother. She started one cycle, which the doctor quickly canceled stating she wasn’t producing enough eggs. On the second cycle, he increased her dosages of fertility drugs. Still, she produced very few eggs and they died off quickly. The physician knew before he even started Kate’s cycle that she had low ovarian reserve from her lab results, but never shared that information with her so she could decide if donating eggs was the right decision. “My intended mother told me the doctor didn’t want to put bad energy into the cycle, so they didn’t tell me. And they still haven’t told me. Nobody contacted me after I donated my eggs—not the agency, not the doctor, not anyone,” Kate said. “I absolutely feel like I have a right to my medical information. They shouldn’t have kept that from me.” These stories are unfortunately not uncommon. In my research, many donors have told me how they were refused copies of their medical records or were denied information or explanations about their anomalous genetic tests results after frantically calling to find out what the results meant. “The doctor said my medical records didn’t belong to me. They belong to the intended mother, so they wouldn’t even tell me what the results of my genetic test meant. I kept calling because I was scared and no one would talk to me,” Jenna, a first-time donor at 21, told me. In some clinics, even donor follow-up care is lacking: Several days after her third donation, Brittany, 22, was rapidly gaining weight, and it was getting hard for her to breathe. In one of her earlier donations, she was given a check-up the week following her egg donation. With this new clinic, she was surprised that not only did they not schedule a follow-up visit for her, but she could not even get them to respond: “This last time I donated my eggs I was in a lot of pain, and I was swelling up with a lot of fluid. I couldn’t even breathe,” Brittany said. “But the clinic didn’t care. They didn’t even return my calls. When I finally got a hold of the nurse, she just said, ‘Oh, that’s normal,’ and brushed me off. Since when is gaining 10 pounds in less than a week normal? I ended up having to go to the emergency room. I was literally passing out.” Feeling Like a Product “The doctor told me I’m an egg-making machine because I produce a lot of eggs. I feel like I’m just a product to them.” – Amanda, 27, 6-time egg donor Most articles written about egg donation are aimed at helping intended parents—especially intended mothers—sort through their feelings about using an egg donor, and how to find the right donor. Although unintentional, the language used in many of these blogs and articles highlight exactly why egg donors feel more like products and like their humanity is dismissed. Their looks, test scores, and body measurements come under online scrutiny, with women some considered more valuable than others. One advertisement announced a “Black Friday Special”,” with $500 off an egg donation

Fertility Treatment

Family Building with Reciprocal IVF

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Reproductive technologies now allow for greater options for family building, not only for people who experience infertility but also for same-sex couples. Reciprocal IVF is one way for women to choose to start a family together. Reciprocal IVF (also known as partner IVF) is an option for lesbian couples where both partners can be physically involved in the conception of their child; one partner contributes the egg and the other partner carries the pregnancy. We were fortunate to connect with Karyne and Kate who are documenting their experience with reciprocal IVF through their podcast The Gayest Show On Birth. FS: Tell us about a bit about reciprocal IVF and how it became your method of family building. K&K We always knew that we wanted a family, even before we got together. And we wanted to try to have our own family, with our own genetics. Further, Karyne knew that she didn't want to carry the baby. But Kate offered up that we could do reciprocal IVF. We decided to try it that way first because Karyne is nearing 40, and this might be the last shot to get some good eggs! FS: What about finding the right reciprocal IVF service provider. What are key qualities that you'd recommend looking for? K&K We went through the Glow Fertility Program, which offers a discount on IVF treatments. We figured that anyone that they partnered with would be a good recommendation. We are lucky to have a few IVF clinics in the Bay Area we could go to (including one by our house), but we decided we'd give the one that Glow partnered with a shot. We had a fantastic experience at the clinic we chose, from the moment we walked in the door. Our clinic has friendly employees, quick responses, and good success rates. We decided that success rates of the clinic weren't as important to us as friendly and knowledgeable staff. We didn't expect to have any fertility issues, and many of the numbers that are available are for people who have actual problems conceiving. We didn't feel like we fit into that category. FS: Both partners have a physical role in the process with reciprocal IVF. How did you decide which role works best for which partner? K&K Karyne has always known that she didn't want to carry, but was OK with not being genetically related to the child. When Kate suggested doing reciprocal IVF for the first try, Karyne was over the moon. That way both of us would have an extra strong physiological bond to the baby. FS: Selecting a sperm donor feels like it could be an overwhelming task. Can you describe the process you went through to decide on a donor? K&K We always say that choosing a sperm donor is a little like online dating: you're not offered a lot of information, and you just sort of have to go with your gut. The easiest thing for us was to narrow it down to one sperm bank and stick with that one. The one we chose is very small (located in Berkeley, California), and has very strict regulations when it comes to how many births can come from each donor. It's crazy that there are no federal (or even state!) standards when it comes to sperm donors; there's not even a federal registry of sperm donors, so theoretically, the same guy could donate at several different banks and have tons of kids! So once we narrowed it down to the sperm bank we were going with, we made a spreadsheet to compare the few donors we were interested in. Because it would be Karyne's genetics, we tried to choose someone who kind of looks like Kate. And one we really felt connected to (from the profile provided). FS: What has been the biggest surprise you have encountered with your reciprocal IVF experience so far? K&K We're constantly surprised by how little information there is out there for reciprocal IVF. Even our clinic had a little trouble when it came to billing us (since we're splitting up the IVF process between the two of us). But that's one of the reasons we wanted to start the Gayest Show on Birth podcast; so we could offer some information to other people who are going through the same IVF process as we are! FS: What would you want people who are not familiar with same-sex family building to know about reciprocal IVF? K&K Reciprocal IVF is when you use one partner's egg, the other partner's uterus. There are many paths to making a family, and this is one that works for us! FS: What would you want other individuals who may be interested in undergoing reciprocal IVF to know? K&K Splitting up the work bringing this baby into the world has been kind of a blessing. There are a lot of moving parts, and both of us being able to have a hand in everything (from self-injecting hormones to numerous doctor appointments) has brought us closer together, and really makes it feel like we're building something together. Although both parents are 100% involved in bringing a child into the world, no matter how that child is brought into the world, reciprocal IVF has allowed us to feel more connected to the process. It's really crazy what modern medicine can do. FS: Are there any great resources on reciprocal IVF that you'd recommend? K&K Not many! We belong to a few LGBTQ* Facebook groups for same-sex couples trying to conceive, and we've found that many people in those groups are doing regular IVF or IUI (insemination). But again, that's why we're hoping that Gayest Show on Birth can answer some questions for people who are looking to doing reciprocal IVF (and even for people who aren't going through any kind of IVF!).

Fertility Treatment

What Are Your Options For Your Remaining Embryos?

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When you’re experiencing infertility, the last thing you think about is having more frozen embryos than you actually want to use. Simply having one child come from an emotional and complex in vitro fertilization (IVF) cycle is all that many people can focus on. But the reality is that many individuals or couples who undergo IVF will complete their family and still have embryos left over. What happens then? You may not know from the onset of your IVF procedure what your situation will end up being or the decisions you will be required to make, but there is some initial thought that needs to go into the process before any action takes place. This generally includes any legal contracts that need to be signed. Upfront, before fertility treatment takes place, most fertility clinics and storage sites require you to sign agreements for consent, stating exactly what you or you and your partner would want in any number of scenarios with any embryos created from IVF. These documents briefly address what you would want to be done with the embryos in the event of divorce or death—of you, your partner, or both. Until an embryo is transferred into the woman’s uterus, individuals or couples can change their minds of what they want to be done. This isn’t something most even think about, but in an unforeseen unfortunate event, this paperwork will determine the fate of your embryos. Once you know the outcome of your treatments, you’ll need to decide what to do with any remaining embryos. Fortunately, a number of options exist, including: 1. Keep Embryos in Long-Term Storage Thanks to the process of freezing, called vitrification, embryos can be rapidly frozen so they don’t accumulate any ice crystals. This leads to better success rates of embryos surviving a thaw. This option usually occurs when an individual or couple is unable to decide on any other option. It’s costly to store embryos, with the average clinic charging anywhere between $500 and $2,000 a year. Depending on the clinic, many will store embryos for up to ten years, but after that, they will often need to be transferred to a long-term storage facility off-site. This is to prevent endless and expensive storage of clients’ embryos and is definitely not the best solution for many individuals or couples. 2. Donate Embryos To Medical Research Another option for the remaining embryos is to donate them to medical research. Many times, these donated embryos are used for fertility-related research for improving IVF for other patients or training new embryologists. They could also be used for stem cell research for disease prevention or treatment. Some individuals or couples feel like they have benefited so greatly from the science of IVF that they want to give back and help with the progression of research. According to the American Society for Reproductive Medicine (ASRM) Ethics Committee, along with informed consent and confidentiality, donors should be informed of: The nature of the research The specific research project, if known The source of funding Any potential commercial value Any anticipated clinical applications 3. Disposal of Remaining Embryos This option means just that. Embryos are taken out of storage, thawed in the lab setting, and discarded respectfully as medical waste. Just as in the option of indefinite storage, this sometimes happens when individuals or couples can’t come to another decision of what to do with their embryos. 4. Compassionate Embryo Transfer Another option that some people may not be aware of is the process of a compassionate transfer of remaining embryos. A compassionate transfer is a transfer done at a point in a woman’s cycle when getting pregnant would be highly unlikely. The idea is for the embryos to die in a natural environment, rather than in a lab. It’s a decision that has people split—some may disagree due to the additional financial cost, while others choose it because they don’t want to discard their embryos. Some people aren’t comfortable donating their embryos to another family and don’t want to use them for medical research and need an option other than indefinite storage. It’s important to ask if a compassionate transfer is something your clinic would be willing to do. 5. Donate Your Embryos To Another Couple Sometimes referred to as embryo adoption (although not considered a legal adoption), donating embryos to another individual or couple in need is an option for helping others achieve pregnancy when you have completed your own family. It’s a big decision that is likely to come with complex emotions. Some struggle with the idea of embryo donation, as they feel like they are “giving away” their own children. It may not be the option for you if you feel similarly or have a difficult time letting go of control regarding what happens with your embryos. There are many times in the process of donation where you are in charge of decision making, such as your requirements on who your embryos can go to. But some aspects are out of your control, such as how that future child or children will be raised. Once you sign legal contracts relinquishing your rights, the receiving individual or couple signs their own legal contracts. Both parties then undergo physical and mental health exams, and the receiving individual or couple would then use the embryos by thawing and transferring them, just as in an IVF cycle. Considerations for Embryo Donation An embryo donation can be open or closed (just as in an adoption of a child) so you can decide if you want a relationship with the receiving individual or couple and any children they have that result from the donated embryos. There are more families waiting to receive then there are donated embryos, so there isn’t a concern about not having someone available to take your embryos. That said, it is ideal if you have more than one frozen embryo to donate. Intended recipients may prefer a group of embryos rather than a single one as it

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