Category: Egg Donation

The Poly-Parent Households Are Coming

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Poly-Parent Households

The Poly-Parent Households Are Coming

The Poly-Parent Households Are Coming.  Consider the following scenario: Anna and Nicole, 36 and 39 years old, have been close friends since college. They each dated various men throughout their twenties and thirties, and had a smattering of romantic relationships that didn’t quite work out. But now, as they approach midlife, both women have grown weary of the merry-go-round of online dating and of searching for men who might — or might not — make appropriate fathers for the babies they don’t yet have. Both Anna and Nicole want children. They want to raise those children in a stable, nurturing environment, and to continue the legacy of their own parents and grandparents. And so they decide to have a baby — a baby that is genetically their own — together.Poly-Parent Households

Such an idea may sound fantastical. But technologies that could enable two women (or two men, or four unrelated people of any sex) to conceive a child together are already under development. If these technologies move eventually from the laboratory into clinical use, and the history of assisted fertility suggests they can and they will, then couples — or rather, co-parents — like Anna and Nicole are likely to reshape some of our most fundamental ideas about what it takes to make a baby, and a family.

To date, most major advances in assisted reproduction have been tweaks on the basic process of sexual reproduction. Artificial insemination brought sperm toward egg through a different, nonsexual channel. I.V.F. mixed them together outside the woman’s body. Little things, really, in the broader sweep of life.

And yet even these have had profound consequences. Humans are reproducing in ways that would have been truly unimaginable just several decades ago: Two men and a surrogate. Two women and a sperm donor. An older woman using genetic material from a much younger egg.

Each turn of the technological screw has been generated by the same profound impulse — to allow people to conceive babies they desperately want, and to build families with those they love. Each development has, in many ways, been deeply conservative, intended to extend or re-create life’s most basic process of production. But as these technologies have expanded and evolved, their impact has become far more revolutionary; they’ve forced us to reconceptualize just what a family means, and what it can be.

For most of human history, after all, families across the Western world were defined in largely biblical terms: one man, one woman, with children conceived through sex and sanctified by marriage. Everyone else was just a bastard.

NYTimes.com, August 12, 2020 by Debra L. Spar

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The Hidden Costs Of Starting A Family When Queer

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The Hidden Costs Of Starting A Family When Queer

The Hidden Costs Of Starting A Family When Queer – Jac Ciardella sat at his kitchen table in New Jersey and inserted a syringe into a navel orange. His hand flexed as he squeezed the plunger, pushing water into the fruit’s rind. He needed the practice. He was about to inject fertility drugs into his wife, Candice Ciardella, and he wanted to get it exactly right. He knew how painful it could be. gay money
 
Just a year earlier, in February, 2017, the spouses’ positions were swapped: Candice, now 37, was administering the shot for Jac, who’s 40. Jac is a transgender man, and both he and his wife have undergone in vitro fertilization (IVF) in order to have a child.
The couple’s fertility journey started in 2015. The original plan had been to use donor sperm to impregnate Candice. But after six unsuccessful attempts at intrauterine insemination (IUI), they decided to try IVF on Jac, with the idea that Candice could carry one of his fertilized eggs. Candice began giving her husband shots of the hormone human chorionic gonadotropin (hCG), to make him produce extra eggs. 
 
“For years, needles were just part of the routine for us,” Candice says. “I think we had more empathy for one another because we both knew what it felt like. When it comes to the shots and the appointments, not many spouses can say: ‘I know exactly what you’re going through.’ We can.”
 
The process was emotionally taxing for both of them, but especially for Jac. “Someone’s head is between your legs, and it’s awkward for anyone — but, being transgender, it’s extra awkward,” Jac says. “Mentally, I’m feeling like I’m not supposed to be in that position. For me to feel comfortable going through IVF while still keeping my sanity and my integrity was huge.” 
 
Three cycles of IVF weren’t successful, and testing revealed no clear issues that would cause infertility. So in 2018, the Ciardellas decided to try IVF again, on Candice this time. 
 
“It was emotionally defeating. If you can survive IVF and infertility, your marriage should be able to survive just about anything else,” Jac says.  “It’s humbling and debilitating and cruel.” Adding to their stress was the financial strain. The Ciardellas were acutely aware that each failed cycle of IVF and IUI was costing them — big time. “You’re talking about tens of thousands of dollars going out the door,” he says. “It takes toughness.”
Jac and Candice’s story is unique, but the financial burden they faced is not. Most LGBTQ+ couples who want children have to confront the fact that starting a family will be expensive. Adoption, fertility treatments, and surrogates are all costly, often lengthy processes.
 
The Ciardellas say their insurance only covered their testing for issues that could cause infertility, such as blocked fallopian tubes. They had no financial help with the sperm, the IUIs, or the rounds of IVF. All told, over the course of three years, the couple would spend about $120,000 on four IVF cycles, $20,000 on fertility drugs, plus over $10,000 on IUI. “I got those numbers imprinted on my brain,” Jac says. “We always knew that to be parents, we’d need to be cutting into a good chunk of change — but we didn’t expect it to be quite that much.” 
 
Sandy Chuan, MD, a fertility specialist at San Diego Fertility Center, confirms that the costs of conceiving via fertility treatments can be shockingly high for LGBTQ+ couples. 
 
She says sperm samples can cost $600 to $900 per vial. One IUI attempt without insurance costs about $700 to $1,000, plus the donor sperm. “I usually tell my clients to ballpark around $1,500, but they might need to do three to six rounds,” Dr. Chuan explains. If IUI is unsuccessful, the next step is IVF, which Dr. Chuan says can cost as much as $15,000, plus $4,000 to $5,000 for medications to stimulate egg production. The price point for procedures can vary by state and market.
 
Refinery29.com, by Molly Longman, June 15, 2020
 
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How Co-parenting Has Equipped Queer Families To Handle The Coronavirus Pandemic

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Co-parenting Coronavirus

Co-parenting families are drawing on the resiliency that comes from living on the margins in the Coronavirus pandemic.

Co-parenting families are drawing on the resiliency that comes from living on the margins in the Coronavirus pandemic. Four months ago, Lisa Lo, from Calgary, separated from the father of her two young children, ages two and five, in part because she wanted to open her marriage to relationships with both men and women.Co-parenting Coronavirus

Lo, whose name has been changed to protect her family’s privacy, is polyamorous, and she’s had three relationships since her separation, one of which has ended, and two of which have been complicated by pandemic living arrangements.

Some of these relationships have brought big feelings, but through it all, Lo is mindful of keeping an emotional balance for her kids, who spend most of their time with her. “They pick up on my emotions,” she said. “If I’m happy, they’re happy. If I’m stressed and upset, then they’re stressed and upset.”

But that was all pre-pandemic: “Now, dating has been put on hold,” she told HuffPost Canada. Lo’s priorities are different these days. She is very much focused on the challenges COVID-19 poses to all multi-household families: creating consistent self-isolation protocols, navigating the handing-off of children, communicating in a time of stress, finding legal counsel.

To create a situation that worked for everyone, Lo had to have hard conversations with her ex-husband about whether to integrate any of her existing polyamorous relationships into their isolation cohort.

They settled on Lo living with one somewhat-ex-partner (it’s complicated). They are also still employing a nanny in both households, in part, because this is supportive of Lo’s mental health. The negotiations about child schedules and hand-offs between households have been complex.

Lo has also been challenged by some of her loved ones about having non-immediate family members in her household “pod” during the pandemic. But, she was able to take that in stride.

She said being queer has given her a lot of practice with tough discussions: “I’m used to being outspoken about things that are unconventional. I’m done being in the closet about anything.”

Rachel Farr is an assistant professor of Psychology, and she runs the FAD (Families, Adoption, and Diversity) research lab at the University of Kentucky. She said that for LGBTQ2 families, this pandemic both feeds into existing patterns of resilience and creates new ones.

“Some of the emotional dynamics I think are true for any family trying to negotiate [this pandemic],” she told HuffPost, “but there are added layers of sensitivity and vulnerability for queer families, who also face stigma and various forms of silencing through institutional discrimination or lack of legal protections.”

Huffingtonpost.ca by Brianna Sharpe, April 23, 2020

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Fresh Eggs For IVF Offer Slightly Better Birth Outcomes

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Using fresh donor eggs for in-vitro fertilization (IVF) provides a small but statistically significant advantage in birth outcomes compared to frozen donated eggs, research finds.

The national study in the journal Obstetrics & Gynecology was the largest head-to-head comparison of the two IVF approaches, measuring the likelihood of a good perinatal outcome, defined as a single baby without prematurity and with a healthy birth weight.fresh eggs

“Our study found that the odds of a good birth outcome were less with frozen than with fresh, but it was a small difference,” says lead author Jennifer L. Eaton, medical director of assisted reproductive technology and director of the Oocyte Donation Program at the Duke Fertility Center.

“From a clinical standpoint, given that frozen eggs have many benefits such as ease, cost, and speed, the decision to use fresh or frozen donor eggs should be made on an individual basis after consultation with a physician,” Eaton says.

Eaton and colleagues, including senior author Alex Polotsky of the University of Colorado Advanced Reproductive Medicine, studied three years of data from the Society for Assisted Reproductive Technology. Nearly 37,000 IVF attempts were analyzed, including 8,381 (22.7%) that used frozen eggs and 28,544 (77.3%) using fresh.

Controlling for factors such as the quality of fertilized eggs and the age of both mother and donor, the researchers found that fresh eggs resulted in a good perinatal outcome in 24% of fertility attempts compared to 22% of the attempts with frozen eggs. Implantation, clinical pregnancy, and live birth rates were all significantly higher among the women using fresh eggs vs. frozen.

“As IVF with donor oocytes has become standard treatment for women with decreased egg supply or advanced reproductive age, there has been an increased demand for donor oocytes, making frozen eggs an attractive option,” Eaton says. “In general, IVF with frozen donor eggs is cheaper and faster than with fresh donor eggs.

Fututiry.org by Sarah Avery-Duke, February 7, 2020

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Opinion – The Big IVF Add-On Racket

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IVF Add Ons – This is no way to treat patients desperate for a baby.

There are few things as unsettling as sitting in an in vitro fertilization clinic hearing you need a team of experts — embryologists, lab techs and nurses along with a reproductive endocrinologist — to help you become pregnant.embryo

What comes next can be a blur. First, you meet with the clinic’s financial counselor to assess whether you have enough money for a complex, invasive $15,000-$20,000 IVF cycle. What follows are drug injections, blood tests, invasive ultrasounds, surgical egg retrieval, and fertilization ahead of an embryo transfer. Before your first hormone shot, you’re well into head-spinning, unfamiliar territory.

Then the doctor tells you there are “add-ons” you might want to consider.

Might you have interest in endometrial scratching? What about vasodilation, human growth hormones, intralipids, assisted hatching, oocyte activation, physiological intracytoplasmic sperm injection, or embryo glue? Post-fertilization, there is also embryo pre-implantation genetic testing to consider. Interested?

These extras come with price tags ranging from hundreds to thousands of dollars. All are presented as ways to increase your chances of a pregnancy. What are you willing to try? What can you afford? The ball is in your court.

This is no way to treat patients at their most vulnerable.

That’s the conclusion my colleagues and I arrive at in a new paper on the ethics and regulation of IVF add-ons.

An add-on is anything that is not essential to carry out an IVF cycle. Such measures, patients are told, will improve the likelihood of a live birth — and yet our examination revealed a startling absence of robust research into the effectiveness and the safety of these add-ons. Despite this, their use is widespread, and regulation of them is minimal.

The most expensive add-on category is pre-implantation genetic testing. These tests were originally developed to identify embryos at risk for genetic diseases. Today, however, they are primarily sold, at a cost of $6,000 to $12,000, as a way to screen for chromosomal abnormalities that could lead to failed implantation or miscarriages.

In October, however, a large study found that a single abnormal cell does not doom an embryo and determined that one of the tests, PGT-A, made no difference to rates of live births. Worse still, patients who opted not to transfer embryos based on the test’s results may have lost potentially viable ones.

There is also endometrial scratching, a procedure, sometimes costing as much as $500, that purposely irritates the endometrium, the innermost lining of the uterus, before IVF While it’s promoted as increasing the chance of an embryo implanting, a recent large randomized trial found no benefit. Beyond significant patient discomfort, risks include bleeding, infection and uterine perforation.

Then there are intralipids, an emulsion of soybean oil, egg phospholipids and glycerin administered intravenously and described as a way to decrease natural killer cell activation in the immune system and ostensibly aid in embryo implantation. This emulsion is priced around $400 per infusion; typically several are recommended. Side effects include headache, dizziness, flushing, nausea and the possibility of clotting or infection. A meta-analysis last year found that intralipids and other forms of immunotherapy should not be used in routine clinical practice.

Such procedures are often presented to patients in the form of a stack of papers, written in legalese or medical jargon. Resourceful patients might take to the internet to learn more, where searches might deliver densely written scientific articles, and ads might direct them to companies or clinics eager to promote their own brands of add-ons.

Why is all this happening? It’s because IVF remains an under-regulated arena, and entrepreneurial doctors and pharmaceutical and life science companies are eager to find new ways to cash in on a growing global market that is projected to be as large as $40 billion by 2024.

NYTimes.com, December 12, 2019 by Pamela Mahoney Tsigdinos

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Couples win lawsuit over donated eggs with genetic defect

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Two couples that gave birth to children with a genetic defect later traced to donated eggs won a lawsuit against a New York fertility doctor and his clinic in the state’s highest court Thursday.

The two children, both born in 2009, have Fragile X syndrome, a genetic condition that can lead to intellectual and developmental impairments. The parents, identified by initials and last names in legal papers, were told the egg donors were screened for genetic conditions.genetic defect

The parents are seeking legal damages for the added expenses of raising a disabled child. The amount of the damages was not set by the court and will likely be determined in further legal proceedings.

The case hinged on the state’s medical malpractice statute of limitations, which bars lawsuits filed more than two and a half years after the alleged act of malpractice — or the patient’s last treatment by the physician.

The lawsuits were filed two years after the children were born, when the condition became apparent, but more than two and a half years following the final treatment at the clinic. The egg donors were tested after the children were born and found to be carriers of the Fragile X mutation, according to court filings

Attorneys for the Reproductive Medicine Associates clinic and physician Alan Copperman argued the suit was filed too late, because the statute of limitations began counting down when the women ended fertility treatment after becoming pregnant, and not when the children were born or when the genetic abnormality was diagnosed.

December 14, 2017 – AP via New York Daily News

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Lesbian couples can now have children who are a part of each of them

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Over the years I’ve had many lesbians tell me they want children but don’t see themselves being pregnant. It’s not part of their “body image.”

At some level, I understand this feeling. Our gender identity and sexual identity are tied up in our body image and feelings of sexual desire. Being pregnant and carrying a baby inside is an incredibly unique, womanly experience. Men have no idea what this is like, despite how much some may try.

As an experienced obstetrician who’s cared for many pregnant women throughout their pregnancies and deliveries, and as a gynecologist who has cared for and has performed gynecologic surgeries for women for the past thirty years, I’ve seen first-hand the many phases of reproductive health (and experiences with ill health) that only women can experience.IVF

I understand that some women may not identify with parts of that spectrum. For a lesbian couple it is sometimes easy to decide who will carry the pregnancy, while other couples struggle mightily with this uniquely lesbian decision. For single lesbian women, the choice can become more complex: to carry oneself and maybe go into new self-awareness territory, or to utilize the reproductive assistance of a gestational carrier.

We usually reserve gestational surrogates for women with a clearly defined medical need for surrogacy, yet lesbian women can often have very real issues that educate their life choices. Is body image a medical necessity for surrogacy? I believe that it can be if it’s tied into a woman’s sexual identity and sense of self.

We are very fortunate to live in a country where reproductive options are now available for all individuals regardless of gender, sexual identity, or marital status. This is not the case across Europe and other parts of the world. In my practice I see many patients from across the globe – from China, Europe and elsewhere – who travel for reproductive treatment options that are illegal where they live.

All women, and in particular lesbians, who might consider having children someday should talk with their doctor about reproductive options available, or ask for a referral to a fertility specialist to review the treatments that may best apply to their situation. It is imperative that lesbian women seek out a practice that is comfortable providing care to lesbians and same-sex couples.

By Dr. Guy Ringler, LGBTQNation.com – September 12, 2017

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