Thursday, September 27, 2007

Italian Court Rules on Embyro Screening

The Italian court has ruled in favor of the couple who wishes to screen their embyros for a genetic blood disorder. See article here.

I am often asked about pregenetic implantation diagnostic screening (PGD) and what I did during my IVF cycles. PGD was not practiced when I was cycling and I have to say I'm thankful for that. It would be one more decision my husband and I would have to make among the thousands we were already making. My IVF physician recently told me that I was not a candidate for it so I probably would not have chosen to have my embryos tested. But, if I had a genetic or inheritable disease similar to this Italian couples, I would do PGD. Most ethicists agree that PGD should be available to couples for this reason and not as a standard practice in an IVF center.

Oprah Special on Surrogacy in India

It appears that Oprah will air a special on surrogacy in India with the focus on the surrogate women who carry the children for the infertile couples. It appears that the practice is very common in India and that the women take very good care of their health and the unborn child. The full article can be found here.

In my experience, the women that I have worked with take very good care of themselves during the process and pregnancy. In fact, they usually take better care of themselves than when they were pregnant with their own children. I know that can be an issue that couples struggle with when they find out they have to use a surrogate to have a child. I know it was one I struggled with and one of the reasons why it took me 3 years after my IVF physician told me I needed a surrogate to start searching for one. I know how I would eat and what I would do when I was pregnant and I knew that my surrogate may not do the same. Did I know my surrogate probably ate Ritz Bits with cheese everyday of her pregnancy. You bet. Were my children born healthy? You bet. I had to give up control and realize that while my surrogate was pregnant my children would get all the nutrients they needed. It was my surrogate who may not get the nutrients that her body needed. Once I realized that, I was fine. And my children are fine and very healthy six-year olds.

Friday, September 21, 2007

51-year Brazilian Grandmother to Give Birth to Twin Grandsons

What a wonderful story and gift this mother is giving her child. I have a client whose mother is now carrying her second child for her so I know how very special this is. The full article can be found at the following link: 51-year Brazilian Grandmother to Give Birth to Twin Grandsons.

Tuesday, September 18, 2007

Georgia Lawmakers to Decide How Many Embryos Are Too Many

In an article published in the Atlanta Journal-Constitution, Sonji Jacobs reports that Georgia lawmakers are concerned about property rights over unused embryos and have formed a subcommitte to discuss the issue. Couples undergoing IVF are concerned that lawmakers would limit the number of embryos that can be created and the number of embryos that can be transferred to the uterus. Currently, no other state legislates embyros; however, other countries do legislate the number of embryos tha can be created and transfered, but those countries also have socialized medicine.

I agree with the couple in the article that it is a decision that should be left up to the couple and the parties involved and not the state legislature. Read the complete article here.

Monday, September 17, 2007

Rise in Egg Donation Shocking?

I don't think anybody is really surprised that egg donation is on the rise, considering that women, for a variety of reasons, are having children later and later. Biologically, it becomes more difficult for a woman to conceive her own genetic child the older she gets. Further, more gay and lesbian couples are choosing egg donation and surrogacy over adoption to create their families, especially in California, where the laws are very favorable to all couples, whether heterosexual, gay or lesbian.

What is surprising is that in a recent article the donor's friends found it surprising that the donor would consider it. While I had a failed egg donor cycle, I considered egg donation while a student at UCLA. I got busy and forgot about it, but I remember reading the add and thinking that is sounded like a great idea. Now, I work with young women who donate their eggs to help create families for couples struggling with their fertility. It is a precious gift that these young women give. Yes, they get paid, and sometimes well above the ASRM-recommended $10,000, but they also inject themselves with powerful hormones and undergo a medical procedure under general anesthesia. They should get paid.

One other note about the article: while most IVF centers will only work with donors 21 years of age and older, there is no legal requirement that a donor must be 21 years old. IVF Centers are concerned about maturity, but age alone is not the only factor that determines a young women's ability and maturity to understand the egg donation process. Please click here for: Women: Can you put a price on your eggs? Willing donors increase nationwide by By Mindi Westhoff.

More Gays and Lesbians in Australia Are Becoming Parents Through Surrogacy

The gay couple featured in the article below lives in Australia but came to the United States for their surrogacy and are expecting their second child. I have worked with Australia couples seeking a surrogate, whether heterosexual or gay or lesbian, as they laws are not favorable in their country and offer very little protection for the Intended Parents: See full text of Rainbow Children article here.

Orlanda Surrogacy and the Fight For Custody

This case represents the importance of having a legal contract in place prior to the medical procedure taking place, especially crucial in a traditional surrogacy case where the carrier is genetically linked to the child she gives birth to. When I am consulting with clients seeking a traditional surrogate, a woman who donates her eggs, as well as carries the child for the couple, I advise them of how critical it is to have the legal contract in place prior to the start of any insemination, whether at home or adminstered by a liscensed physician. In fact, after our consult, most couples feel traditional surrogacy is not worth the risk, and they choose to work with a separate egg donor and gestational carrier.

Surrogacy case delivers fight over custody

Rene Stutzman, Sentinel Staff Writer

September 16, 2007,0,1117330.story

Tom and Gwyn Lamitina of Oviedo wanted a baby.

They found a Jacksonville schoolteacher willing to bear a child for them and struck a deal. But before the baby was born, they had a falling out, and the mother refused to give up the child.

Today, 4-month-old Emma lives with her mother, but the Lamitinas are fighting to take her away. A Jacksonville judge is expected to decide in the next few days where the baby will live.

It is a heart-wrenching tale with a tough issue at its core: Who gets a baby conceived by two strangers when their deal falls apart before the child is born?

The mother, Stephanie Eckard, 30, decided long before the child was born that the baby would stay with her, according to her attorney, Kelly B. Hampton. As the biological mother -- the child was born from her egg -- that's her legal right, he said.

But Tom Lamitina, 45, a roofer, says the baby is his daughter, too. She would be better off living with him, his wife and their 21/2year-old son in Oviedo, he says.

So, he's spent $30,000 in the past several months on lawyers, hoping to bring home a baby girl he has yet to meet.

Surrogacy on rise

There are no statistics on how many surrogate mothers give birth in Florida each year, according to attorneys who specialize in the field. One of Florida's busiest, Charlotte Danciu of Delray Beach, said she has handled "several hundred" in the past three years.

Lawyers call Eckard's case a "traditional surrogacy," in which the woman who bears the child provides her own egg. Danciu said three-fourths of her cases, however, involve doctors implanting the fertilized egg of the intended mother into the womb of the surrogate.

For the Lamitinas and Eckard, there were no doctors and no lawyers -- at least no lawyers until it was too late.

Neither Tom Lamitina nor Stephanie Eckard is new to surrogate childbirthing. Lamitina's first child was born to a surrogate mother. That transaction, he said, went smoothly.

Woman found on Web

When he and his wife, Gwyn, 46, decided to have a second child, they turned to the same Internet Web site where they had found their first surrogate mother.

That's where they met Eckard, a divorced mother with two children who has given birth to two other children for couples, according to her lawyer.

Lamitina and Eckard made contact in April or May 2006. A few days later, Tom Lamitina had a face-to-face meeting with her, and they agreed to the deal, he said.

On May 15, Tom Lamitina traveled to Eckard's home in Jacksonville for their first attempt at home insemination, according to the couple. They went to separate rooms. He provided the sperm. Then in private, she used a syringe to complete the procedure.

After four to six attempts, Eckard became pregnant. She sent news to Tom Lamitina with balloons and a card of congratulations.

Never signed a contract

She also asked him to sign a contract, one based on a boilerplate for surrogate mothers that she found on the Internet. It required him to pay her$1,500 a month until the baby was born, he said.

He signed it. She never did, according to her attorney.

Their unstructured approach to nailing down parental rights was a big mistake, said Patricia Strowbridge, an Orlando adoption attorney who also handles as many as two dozen surrogacy cases a year.

"There's almost a limitless ability for people to get themselves into a legal quagmire," she said. "When people start dealing with creating children in their own sort of creative ways, they're going to wind up with huge legal problems because parental rights are very difficult to assess in this situation."

She said Eckard has the stronger case.

Smoking leads to breakup

The relationship between the Lamitinas and Eckard began to come apart about two months after Eckard got pregnant. In mid-October, Eckard and her family visited SeaWorld and stayed overnight with the Lamitinas, according to the couple.

While she was there, Gwyn Lamitina caught Eckard smoking a cigarette, something outlawed by the contract, she said.

After a series of discussions that turned increasingly hostile, the Lamitinas cut off their monthly payments to Eckard, saying they would pay only after the baby was born, they said.

Tom Lamitina accused Eckard of switching his sperm with someone else's.

That's about the time Eckard hired an attorney, insisted on DNA testing and pressed Tom Lamitina to renegotiate their contract, Tom Lamitina said.

The DNA tests proved the baby was his, but there was no new contract.

Lawsuit follows birth

Baby Emma was born May 9. Two weeks later, Eckard sued Lamitina, asking for custody and child-support payments.

"We're asking for sole custody," said Hampton, her attorney.

"We don't even want him to have any kind of visitation."

Tom Lamitina is bitter about the whole thing.

"I just felt that I was robbed," he said.

Circuit Judge W. Gregg McCaulie in Jacksonville could rule on where BabyEmma should live as early as this week.

Rene Stutzman can be reached at or 407-324-7294.

Copyright © 2007, Orlando Sentinel

Surrogacy and Gay Couples

More and more men are choosing surrogacy to create their own families, rather than adoption. California law does not restrict a couple's right to be a parent based on marital status, so gay couples can place both their names on the birth certificate of their child. Please see the article below:

Men having babies
Panel discusses issues of surrogacy and gay couples

by amy zimmer / metro new york

WEST VILLAGE. Minnette Trent, a married Texan with three kids, became a surrogate and carried twins for a gay couple more than a year ago. She’s already signed up to do it again for another couple.

“Be not afraid,” Trent told the crowd gathered yesterday at the Lesbian, Gay, Bisexual & Transgender Community Center’s third annual “Men Having Babies” workshop. The LGBT center is trying to help the rising numbers of people in their community who are interested in surrogacy navigate the complicated medical, legal and emotional process.

“What your focus should be on is how you’ll decorate the nursery and whose mother you’ll name it after,” Trent said. “Surrogates don’t go into the process because we want another child of our own. We do it because we like being pregnant and we want to help people. We don’t want phone calls every day asking if we’re taking vitamins.”

New York and New Jersey outlawed surrogacy following the notorious “Baby M” trial 20 years ago. Panelists talked about looking for surrogates in other states, such as Massachusetts or Connecticut.

“When my husband and I started the process [of surrogacy] in 1991, we turned to this center and they connected us with the only two agencies at that time that did this work,” said John Weltman, a lawyer who founded the Boston-based Circle Surrogacy, Ltd, 12 years ago.

His agency carefully screens surrogates, who must already be mothers. Only one in 30 become “carriers,” and, while a few years ago, only one in 10 wanted to work with a gay couple, now Weltman said it’s eight in 10.

“They don’t have to deal with issues of infertility,” he said. “And gay men know how to treat a woman. They know how to send her flowers.”

Weltman and his husband have two sons, one from each, and both from the same mom. Weltman borrowed money from his family to pay for one child. For the other, he traded legal services.

Stuart Miller, CEO of Growing Generations LGBT surrogacy and egg donation firm, took out a second mortgage on his house for the process.

He and his partner are “16-weeks pregnant with an egg donor and surrogate. … We didn’t want to meet our egg donor, but said our child can meet her after the age of 18.” But they’re friends with the surrogate. “We just sent [her] to see BeyoncĂ©.”

It ain't cheap...

There are two forms of surrogacy. Gestational surrogacy is when a surrogate is impregnated through in vitro fertilization using the couple’s sperm and a donor egg. Traditional surrogacy is when the surrogate is artificially inseminated. For gestational surrogacy, lawyers’, psychologists’ and doctors’ fees, plus the surrogate’s $20,000, add up to roughly $110,000, according to Circle Surrogacy, Ltd. That doesn’t include a $25,000 Lloyd’s of London health insurance policy in case a carrier’s insurance won’t cover the pregnancy.

Friday, September 14, 2007

Share Your Eggs and Receive a Discount for IVF Treatments

I am not sure if IVF Centers provide the same service in the U.S., but in England, if you share your oocytes (eggs) for research you received a discount of around $3,000 U.S.

Women aged 21-35 attending the Newcastle Fertility Centre (NFC) in the north of England are to be offered reduced price in vitro fertilisation (IVF) treatment in exchange for donating some of their oocytes (eggs) for research (see BBC news). Women who agree to donate half of the eggs harvested as part of the IVF process will receive a £1500 reduction in the price of their treatment. Researchers from the North East England Stem Cell Institute will use the donated oocytes to generate human embryonic stem cells, which will then be used for medical research.

The Human Fertilisation and Embryology Authority (HFEA) granted a temporary licence to the North East England Stem Cell Institute last year giving them permission to approach women requesting ‘altruistic egg donation’ (see previous news), and followed this with public consultation leading to a decision earlier this year that women should be allowed to donate their eggs for research if they wanted to (see previous news). This decision required that safeguards to prevent possible coercion of women donors be put in place, and did not permit payment of donors, although expenses of up to £250 were permissible.

NFC Head of Department Professor Alison Murdoch pointed out that egg sharing conferred no additional physical risk to the women and said: “We expect this to open the door to some infertile women who may now find it less difficult to meet the cost of IVF” (see NFC website news). However, others have expressed concern that women donors are being exploited, because women who are unable to access NHS treatment or to afford the full cost of private IVF treatment may be more likely to donate than women who can access NHS treatment, or to pay for IVF.

Seminole County Surrogacy Custody Case Awaiting Judge's Ruling

A Seminole County couple must wait for a judge to decide if they will gain custody of a baby girl conceived by a surrogate mother.

The surrogate and the couple who hired her told very different stories of how their relationship went sour in a Duval County courtroom on Wednesday.

The Oviedo couple, Tom and Gwyn Lamatina, battled the surrogate, Stephanie Eckard of Jacksonville, to gain custody of a four-month-old girl named Emma.

Eckard claims that early in her pregnancy they started bickering over the issue of paternity.

"That's what he told me over the phone was that he wanted a DNA test because of everything falling apart and I told him he could wait until the child was born to do the DNA test," Eckard said. "I don't like [amniocentesis], and he stated that while you never know, I might have switched the sperm."

When they began bickering, Eckard had not yet signed the surrogacy contract and never did, despite cashing a $1,500 check from the Lamatinas.

In May, Eckard delivered a baby girl that was a product of her egg and Tom Lamatina's sperm.

Eckard said she decided to keep the child after an alleged phone conversation with Tom Lamatina, during which he told her he no longer wanted the baby.

Lamatina admits making such a statement but claims it was because Eckard's attorneys were harassing him.

"At a weak moment in time I said, my wife told me, 'Go ahead and tell them you don't want the child so she can send you an affidavit saying you don't want the child and you won't have to pay child support for 18 years,'" Lamatina said.

In addition to keeping the baby, the surrogate mother also sought child support from the Lamatinas; the Lamatina's want full custody.

The Lamatinas already have a little boy through a successful surrogacy and said they are ready for their little girl.

Copyright 2007 by WESH.COM. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Thursday, September 13, 2007

Doctors Not Obliged To Call Embryos "Unique Living Beings"

WASHINGTON (AFP) — A US state supreme court ruled Wednesday against a woman who had brought a malpractice suit against her doctor for not telling her she was carrying "a complete, unique, irreplaceable human being" before performing an abortion.

Plaintiff Rosa Acuna consulted her gynecologist, Sheldon Turkish, in 1996 in New Jersey, complaining of abdominal pain.

On examining Acuna, who has two daughters, Turkish told her she was around seven weeks pregnant.

A few days later, Acuna returned to Turkish's medical practice and asked him to terminate the pregnancy.

She subsequently filed a complaint against him, accusing the doctor of not adequately informing her that her unborn child was "a complete, separate, unique and irreplaceable human being," and that she would be murdering "an existing human being" and member of her family if she aborted the fetus.

The case went through the courts in the northeastern state until it reached the New Jersey supreme court, which ruled in favor of Turkish.

"We know of no common law duty requiring a physician to instruct the woman that the embryo is an 'existing human being', and suggesting that an abortion is tantamount to murder," the court said in its decision.

Doctors are only required "to provide their pregnant patients seeking an abortion with material medical information, including gestational stage and medical risks involved in the procedure," the court ruled.

"We do not find that the common law commands a physician to inform a pregnant patient that an embryo is an existing, living human being and that an abortion results in the killing of a family member," the decision said.

Monday, September 10, 2007

Embryo Adoption: A Donor's Story

Stephanie M. Caballero
Originally posted by Bonnie J. Bernard M.Ed.

Emily and Tom Walters* knew they wanted children from the beginning. Before the beginning, actually. "My husband and I started trying to conceive four months before our wedding," recalls Emily. "I knew I could still fit into my dress if I got pregnant that first cycle." Neither one expected to be seeking reproductive assistance after two heartbreaking years of infertility. Emily credits their support group for getting them through two more difficult years, three rounds of IVF, and the eventual birth of their first child five years ago.

Both Emily and Tom were surprised when they conceived their 3-year-old twins and 18-month-old toddler naturally. Although the couple felt their family was complete, they still had nine embryos in cryostorage when they came across the concept of embryo adoption on the Internet. Because destruction was not an option for them, they decided to learn more about the possibility of donating their frozen embryos.

That is when they contacted Embryos Alive, an Ohio-based embryo adoption agency that matches donor embryos with adoptive families across the country. Then they began the process of selecting an adoptive couple. They received several dossiers, which are profiles and pictures compiled by the prospective adoptive parents. For Emily and Tom, their choice centered on finding someone who wanted the best for their children and would do anything for them. "I loved looking at all the family pictures and reading about their lives," says Emily. "I loved picturing the potential mothers waddling about in the ninth month of pregnancy so excited."

The Walters originally wanted an open adoption but were willing to accept what the adopting parents wanted. "I had to remember that I was once on their side of the fertility fence. On that side, you are completely broken up; it seems like the world is laughing at you and wants to take advantage of you. On our side of the fence, you realize that fate takes you and you have to just sit back and wait until fate lets you off the ride. When it does, you'll be holding your child. However you managed to find each other, it was meant to be," says Emily.

Working with Bonnie Bernard, Executive Director of Embryos Alive, proved cathartic for Emily and Tom. Because Bonnie suffered years of infertility and is now an adoptive mother, she was able to empathize with the Walters. Bonnie shares the Walters' desire to help couples realize they are not alone with this intensely personal issue. ""I went through four years believing we would have to live childfree," Emily recalls. "I thought I would die. I was so depressed that I cried almost daily. When we found out I was pregnant, I felt on top of the world. Whatever little thing I can do to ease someone else's pain, I would love to do."

They admit they were concerned that the children might wonder why they were given up for adoption. "But it's a very different type of adoption than traditional adoption," explains Emily. "The embryo adopting mother is the real mother through and through." Reflecting on their decision to be embryo donors, Emily says, "I did it because I loved our embryos and they deserved a chance. Of course, now that my son in 18 months old, I would like to have another. But I'm 41 and need way more sleep these days!"

*Names have been changed for privacy.

Ethics Behind Artificial Birth Still Murky

Stephanie M. Caballero
By Karen Lindell

Assisted reproductive technology, in all its forms, raises ethical and moral questions. Issues such as how to handle stored embryos that aren't used, whether to remove embryos when more than one develops, sorting out surrogacy legalities and figuring out who's in charge of keeping clinics in line.

Little regulation exists in the U.S. fertility industry. Clinics are required to report their pregnancy rates to the Centers for Disease Control and Prevention each year, and the Food and Drug Administration requires screening of those who donate sperm, eggs and embryos, but oversight ends there.

"Reproductive medicine has the feeling of being a wild, wild West without many sheriffs," said Art Caplan, chairman of the department of medical ethics and director of the Center for Bioethics at the University of Pennsylvania in Philadelphia. Caplan is concerned that the U.S. does not have a system for following up on the health of children conceived using new technologies.

"We don't keep a registry to see whether the kids are sicker (or) smaller or have learning disabilities," he said. "The tendency is to say, You had a baby, so everything is fine.' We don't do a good job monitoring, like we do with drugs."

Caplan said the lack of regulation also leads to discrimination and screening inconsistencies. With egg freezing, for example, he said, "Do you offer it only to married people? What about gay people, single moms getting older someone who doesn't have a job? How hard do you screen?

"It's also a justice issue," Caplan said. The average cost of an ART cycle is $12,400, but because fertility technology generally isn't covered by insurance, only the wealthy can afford the costly process.

Reproductive technology, Caplan said, "is a huge business. It's hard to get independent information. Many programs say, If you have the money, we'll do what you want.' A conflict of interest among people providing the technology doesn't lead them to push alternatives. They may not talk to you about adoption, for example, or childlessness."

That raises another question: With so many children in need of parents around the world, why go to such lengths to conceive a child? Why not adopt?

Caplan doesn't agree with the "who cares if it's genetic offspring or not" argument. "Some people want a genetic or biological relationship to their child," he said. "I can respect that."

And you could ask the same moral question of any couple who want to have children: "Why make babies if there are already a lot of babies around?" he said. "It's not a problem unique to the infertile."

Nancy Hemenway of Arlington, Va., is executive director of the International Council on Infertility Information Dissemination (INCIID, pronounced "inside"), a nonprofit organization that provides support and information related to infertility, pregnancy loss, adoption and child-free living.

"People going through infertility hate to hear, Why don't you just adopt?'" Hemenway said.

"I am both an advocate for adoption as well as infertility treatment depending on the individuals and their set of circumstances. The issues surrounding adoption are hugely complex. Adoption is not a fix for infertility."

Hemenway is the mother of two daughters: a 12-year-old born with the aid of fertility treatment and a 7-year-old adopted from Romania.

"I have two miracles," she said. "One grew under my heart, and one grew in it."

Infertility Can Be Devastating, But Science Can Offer A Helping Hand

Stephanie M. Caballero

By Karen Lindell

The drop begins even before she is born.

A woman has the most eggs stored in her ovaries when she's growing inside her mother.

As a 20-week-old fetus, she's got 4 million to 6 million. As a newborn, she's down to 1 million. As an adolescent, she's holding on to 400,000. At menopause, she's left with 1,000.

But the eggs start to fray around her 35th birthday — long before menopause. Their chromosomes no longer divide properly. Response to pregnancy hormones is sluggish.

Despite all the stories about wonders worked on eggs, sperm and embryos in science labs, no one has discovered a drug or procedure that can prod a human egg into being young again.

But scientists have found other ways to overcome the body's limitations and help infertile couples bring a baby into the world. Fertility technology has advanced considerably since Louise Brown, the first "test tube baby," was born in England in 1978.

From 1996, when the Centers for Disease Control and Prevention started officially keeping track of fertility-clinic birth rates, through 2004, the number of live births in the U.S. as a result of assisted reproductive technology (ART) more than doubled, from 14,507 to 36,760.

In 2004, 37 percent of ART cycles started by women younger than 35 who used their own eggs resulted in live births. The numbers are lower for older women who use their own eggs, dropping to 4 percent for those older than 42.

Using donated eggs or embryos, however, boosts the percentages for moms-to-be who are 35 and older.

According to the American Society for Reproductive Medicine, the majority of infertility cases are treated with medication, such as fertility drugs or surgery on the reproductive organs.

Assisted reproductive technology accounts for less than 3 percent of infertility services. But ART grabs the most hearts, especially when a celebrity like Brooke Shields is splashed across the cover of People magazine, marveling at her "miracle" baby.

The ART of in vitro

The most common form of ART is in vitro fertilization, or IVF. Here's the condensed version of how it's done, minus the many delicate and meticulous in-between steps and monitoring: A woman's eggs are removed from her ovaries, then fertilized with her partner's sperm in vitro (Latin for "in glass") in a laboratory. Three to five days later, the fertilized eggs are placed directly into the uterus. If all goes well, nine months later.

Other ART techniques, which we won't delve into in great detail here because in vitro fertilization comprises more than 99 percent of treatments, are gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT). ART, alas, is an acronym-heavy field.

Variations include implanting embryos that have been frozen and thawed from a previous ART cycle or, as Star reporter Anna Chang-Yen relates in the accompanying first-person article, using a donor's eggs.

Chang-Yen, 28, has premature ovarian failure, meaning she has run out of viable eggs before age 40. She and her husband, David, have asked Chang-Yen's older sister, Shanna Brittian, to donate eggs that will be fertilized with David's sperm and implanted into Anna's uterus.

Dr. Ashim Kumar and his team at the Fertility and Surgical Associates of California clinic in Thousand Oaks are leading Anna, David and Shanna through IVF.

During a recent interview at his office, Kumar discussed the most recent advancements in IVF.

ICSI: one egg, one sperm

A breakthrough that's actually been around for more than 10 years, but "a lot of people don't know is available," Kumar said, is intracytoplasmic sperm injection, or ICSI (pronounced IK-see).

During in vitro fertilization, eggs can be fertilized "naturally" by placing 50,000 to 100,000 sperm around each egg; or with ICSI, by injecting a single sperm into a mature egg. ICSI is used when a woman's partner has severe infertility problems or has undergone a vasectomy but wants to use his own sperm, not a donor's. Fertility doctors can surgically extract the man's sperm, even if he has had a vasectomy.

PGD: genetic screening

Preimplantation genetic diagnosis, or PGD, tests embryos for genetic disorders before the embryos are transferred to the uterus.

PGD, not yet offered widely (it was used in 4 percent of ART cycles in 2005), is for potential parents with inherited genetic disorders such as cystic fibrosis or muscular dystrophy. In the lab, doctors can determine which embryos are carriers and transfer only those without the defect.
"Unfortunately, when people run out of choices, they can go to the fringes of medicine. That's where a third or second opinion comes in." Dr. Ashim Kumar, of Fertility and Surgical Associates of California clinic in Thousand Oaks.

Photo by Joseph Garcia

"Unfortunately, when people run out of choices, they can go to the fringes of medicine. That's where a third or second opinion comes in." Dr. Ashim Kumar, of Fertility and Surgical Associates of California clinic in Thousand Oaks.

Other candidates for PGD, Kumar said, are women who have had repeated miscarriages. Recurring pregnancy loss, he said, might occur "because part of one chromosome in the egg or sperm breaks off and attaches to another, so there's missing material on one chromosome and additional (material) on another."

During in vitro fertilization, he said, "we can make a window in the shell of the embryo, extract one cell, fix it onto a slide and stain the slide to see what part of the chromosomes are present."

More controversial is using PGD for a nonmedical reason: choosing the sex of a baby.

Injuring without harm

Kumar also described a technique for women who can't get pregnant because embryos won't take hold in their uterus. Fibroids or polyps, which are often the cause, can be removed surgically.

But for cases when fibroids or polyps aren't the culprit, Israeli researchers have had success with "injuring the endometrium," a procedure that "sounds more invasive than it is," Kumar said.

The technique involves taking a biopsy of the uterus using an instrument called a pipelle before an IVF cycle. "It supposedly increases implantation rates by 50 percent," Kumar said. Researchers aren't sure why the pipelle treatment works. The technique is experimental, because only one group of researchers has studied it. Still, he said, his clinic offers the procedure because "the risk is minimal — maybe five seconds of discomfort — and the benefit is pretty significant. It holds promise for someone who's gone through failed IVF cycles."

Multiples, not by choice

Sometimes, baby makes two or three or more. One of the downsides (or upsides, depending on how you look at it) of ART, which offers the opportunity to implant more than one embryo, is the associated rise in multiple births (twins, triplets and beyond). Multiple gestation is more dangerous for the mom and babies, potentially leading to premature birth, low birth weight and other problems.

The ASRM has issued guidelines about the number of embryos that should be implanted, Kumar said, so patients should ask the clinic whether it follows those recommendations.

Multiple gestation raises an inherent conflict of interest, however.

"How we're graded (by the CDC) is our pregnancy rates, and it's easy to increase rates by replacing more embryos," Kumar explained. "But if you have a good IVF lab and do things carefully, you're going to get good pregnancy rates even by putting in fewer embryos," Kumar said, noting that his clinic follows a two-embryo guideline.

Many European countries, he said, will transfer only one embryo. But those countries pay for every cycle of IVF, unlike the U.S., where most insurance plans don't cover even one cycle. If a couple are spending their life savings on IVF, Kumar said, "it's unfair to say they have to accept a lower pregnancy rate by only putting one embryo back."

Freeze embryos, not eggs

Kumar also described a new ART procedure that hasn't had a high success rate: oocyte cryopreservation, or freezing unfertilized eggs for later use.
The micro manipulator attached to an inverted compound microscope is used in the IVF lab at Fertility and Surgical Associates of California for in vitro fertilization procedures.

Photo by Joseph Garcia

The micro manipulator attached to an inverted compound microscope is used in the IVF lab at Fertility and Surgical Associates of California for in vitro fertilization procedures.

Oocyte cryopreservation is not the same as embryo cryopreservation, a more reliable freezing procedure.

Embryos created through IVF can be preserved in liquid nitrogen, "and when we thaw them they have a very good chance of survival," Kumar said. Eggs, Kumar said, "have relatively high water content and are difficult to thaw and freeze effectively."

Freezing embryos lets women implant another embryo if a previous IVF cycle fails. The goal of freezing eggs is to preserve her fertility. For example, an unmarried woman in her 30s who wants to have a baby someday can freeze her eggs until she finds the right partner. "She'll then have the eggs of somebody who's younger and can conceive a baby with her own eggs," Kumar said. Or a woman going through chemotherapy can freeze her eggs before starting the treatment.

Yes, Kumar said, babies have been born from eggs that were frozen, but the chance of that happening is extremely low.

"Unfortunately, when people run out of choices, they can go to the fringes of medicine," Kumar said. "That's where a second or third opinion comes in. If somebody tells you they're one of five centers in the world or country offering this, you should think, Why is everyone else not offering this?'"

Despite all the fancy genetic work, Kumar said much of the increase in success rates for infertility treatment is "about improvements in the IVF laboratory. There's constant attention to what's happening in the lab — the culture medium, the air quality. Every little thing helps. If you leave an embryo on a countertop unheated for 15 seconds, it's not going to do well."

And he reminds patients who balk at what they perceive as low pregnancy rates for IVF (below 40 percent): "If you look at conception that occurs naturally in a young healthy couple, you don't have implantation rates of 60, 70 or 80 percent. It's just not true even in nature, a perfect system. I think we're trying to beat nature at its game, and it's fraught with complications. We shouldn't overestimate our abilities."

Sister's Love Offered Her Another Chance At bbaby

Stephanie M. Caballero

By Anna Chang-Yen

I could feel the air leaving my lungs, with nothing to replace it. Each second was more agonizing with the realization of what I had heard.

We could not have children of our own.

There was no chance.

In seconds, I imagined Christmases not seasoned with innocent laughter and screeching at the surprises from Santa's sleigh. No first steps, no first days of school, no graduations, no sharing hard-learned life lessons.

There, in the results of laboratory tests, lay all the little moments I treasured before they even existed, dashed into a million bits.

I breathed quickly and sobbed loudly. How could the doctor walk into that exam room, deliver a blow so crippling, then simply walk out again?

My husband, David, pulled me close and let me break down.

I remember feeling immediately as if it was impossible to go on.

But there was one possibility, one way to the other side, sitting excruciatingly — if only momentarily — out of reach.

For a small fortune, we could use someone else's eggs. My own ovaries refused to function, but someone else's could do the work. In vitro fertilization using donor eggs — that was possible. "An anonymous donor " I heard the doctor saying, "or a friend, a relative " and then: "a sister."


Until now, we had shared clothes, hairbrushes, friends and life experiences. But the doctor implied that my sister and I might share more.

There were times when we gave such cursory consideration to our bond as sisters.

She was a year and a half older than me and stamped her foot in protest when I tagged along to slumber parties and on school trips. I hated sharing clothes and being "Shanna's little sister."

They called us Shanna'n'Anna, a label that made us both cringe for want of individuality.

As adults, we discovered the importance of the bond we shared, of having come from the same place. I marveled at her strength as she gave birth to two girls.

As it became clear that I was having trouble conceiving, Shanna told me many times that she would help however she could — even offering to be a surrogate.

I dialed her number without thinking. I ran through the few facts I knew about egg donation, and she was undeterred by the difficulty of the task.

Her strength lay so close to the surface.

You couldn't ask for a surer thing. In the prime of her fertility, and at no lack for devotion, she was everything I could ask for.

Ebbs, flows

Since that first day almost two years ago in the doctor's office, while my husband and I have saved money for the procedure, I have found my strength and lost it again dozens of times over. Strength, it seems these days, is bought and sold in fear.

There are times I am too afraid to go on, terrified of disappointment, and times I'm petrified at the thought of never having tried.
From days at amusement parks, to dances and days at the park, sisters Anna Chang-Yen and Shanna Brittian have spent a lifetime sharing the bond of family. And now they have become even closer as Brittian donates her eggs to help Chang-Yen in her attempt to become pregnant.

Photo courtesy of Anna Chang-Yen

From days at amusement parks, to dances and days at the park, sisters Anna Chang-Yen and Shanna Brittian have spent a lifetime sharing the bond of family. And now they have become even closer as Brittian donates her eggs to help Chang-Yen in her attempt to become pregnant.

But finally, we had selected a new doctor and set a date.

And now, here it is at last.

On Wednesday, hope and medical science will rendezvous at the Thousand Oaks offices of Dr. Ashim Kumar.

I am continually amazed at the price of this journey — not in dollars and cents but in the sacrifice required, which Shanna so eagerly makes: hour-and-a-half drives to a poking, prodding specialist; coordinating coast to coast, from her home in South Carolina to mine in Oxnard; injections of drugs that could make her feel full and bloated; and a procedure that will require general anesthesia and a generous dose of discomfort.

Then, there are the psychological and emotional aspects of playing the role of aunt to a child who will be biologically her own.

We were raised with an unconditional love for family, and while this task is becoming the ultimate test, she is making it look like light work.

Gifts of life

There are so many things that one can buy these days to make life easier: gadgets and gizmos, aids and supplements, prosthetics and prescriptions.

But there are few people who you can depend on to do for you the things that really matter.

I continue to marvel at the fact that someone from whom so much has been exacted has still more to give.

It's no secret that her life has required sacrifice. She's a hard worker who has kept dinner on the table for her two girls by doing whatever it takes.

She tells me that as long as she's capable of helping, it is the only thing she knows to do.

But I am certain that her heart must know the magnitude of this gift.

I spend a lot of time these days thinking about probabilities. What is the probability that so many things in one's physical body could go wrong, and that so much in one's personal and family life could be so inspired? Surely it must be infinitesimal.

For all the times I've asked in self-pity, "Why me?" I must ask the same question for the good fortune of having her.

Even if this journey should end short of creating a new life, it will at least be an affirmation of a sister's love.

For now, I can only say a pre-emptive thank you, for a gift of such magnitude that it seems failed by words.
E.W. Scripps Co.

Thursday, September 06, 2007

Gay Dads Meet Kindred Spirits

By Stephanie M. Caballero
By Lornet Turnbull
Seattle Times staff reporter

Some men rocked and cradled young babies; others pushed gleeful toddlers high on the playground swings.

Among them were fathers still getting used to maladies like colic and diaper rash and others gearing up for back to school.

And all of them were gay -- dads of children ages 3 months to 10 years, who gathered for a picnic at Cal Anderson Park on Capitol Hill on Sunday to share stories of child rearing and offer each other support.

They included new dads such as Peter de Zoete and Frans Middendorff, originally from the Netherlands, who, hoping for twins, began making arrangements two years ago to have children through surrogacy -- and who, four months ago, brought home a baby boy and girl.

And Reade Cook and Kris Winkler, who arranged through private adoption to become parents to Markus, born in New York 18 months ago.

The fathers are members of Feather Boa Fathers, a support group for gay men who either already have children or are thinking about doing so, whether through adoption, foster parenting or some form of surrogacy.

It's a way, they say, for their children to get to know others growing up in families like their own.

Larry Nicholas, a psychotherapist from Capitol Hill who formed the idea for the group eight months ago, before his 4-month-old daughter, Orly, was born, said, "There's room in the Puget Sound for groups like this -- and there's a need."

The U.S. Census Bureau estimates that 19 percent of same-sex male couples in Washington -- about 1,423 couples -- are raising children younger than 18.

Nicholas arranged the group's first get-together through, an online community that helps people with shared interests plan events and form online clubs.

About 53 people -- gay men and their children -- attended Sunday's picnic in the children's section of the park. Some laid blankets on the lawn and watched as their children romped about. Others stood by as their kids explored the jungle gym.

Nicholas, 41, said he and his partner, Tom Underhill, began talking about having children on their second date.

"We have different clocks," he said, joking he didn't want to be raising children later in life.

The men were at the hospital when his daughter was born four months ago -- in the next room behind a curtain, he said.

"Fatherhood has been great," he said, adding, "We have a great support system."

Cook, 36, and Winkler, 45, have been partners for 10 years and about two years ago began adding children to their family.

Cook said the couple have a regular cohort of close friends -- also gay fathers -- in whom they find support, sharing baby-sitting duties and swapping tips.

Middendorff, 30, and de Zoete, 40, had been discussing having children for 10 years. But while they could marry in their native Netherlands, laws there prohibit surrogacy, in which a woman agrees to carry and bear a child that others would raise.

The men, partners for 14 years, were living in Hong Kong in 2005 when they first began making plans to have children through surrogacy. Twins Coco and her brother Jonas were born in Ohio in March.

"We were shocked at how many gay families we've met in the few months we've been in Seattle. Today, this is amazing," Middendorff said.

Added de Zoete, "It's good for kids to see other families with gay dads."

Wednesday, September 05, 2007

Blood Is Not Thicker Than Water When It Comes To Family

By Stephanie M. Caballero
British Psychological Society

Parents who have children via embryo donation or adoption have just as good relationships with their children as parents who are genetically related to their children. But more than half of all embryo donation families try to keep the origins of their children's birth a secret.

This is the finding of Dr Fiona MacCallum and Sarah Keeley of the University of Warwick. They presented their results on Friday 31 August 2007, at the British Psychological Society's Developmental Section Annual Conference at the University of Plymouth.

Dr MacCallum's research, funded by the Economic and Social Research Council, explores the importance of the experience of pregnancy and childbirth on the quality of parenting. They questioned 17 embryo donation families with a child aged between five and nine and compared them with 24 adoptive families and 29 families with genetically related IVF children.

The researchers found the quality of parenting and the formation of good parent-child relationships did not depend on a genetic link between parent and child, nor was the experience of pregnancy and childbirth vital for parents to bond with their child - as is the case with donated embryos.

In fact, embryo donation and adoptive families showed equally positive parenting. For example, the parents expressed high levels of warmth and affection towards their children and enjoying spending time and playing with their child. Dr MacCallum said: "All of these families show high quality parenting and all children from these families show normal social and emotional development."

The only difference between the three types of family was that embryo donation families were more likely to keep the method of family creation a secret from their child - with only 41 per cent saying they planned to tell their children how they were conceived compared to 89 per cent of IVF families. All of the adoptive families said they would reveal their child's history.

This could have family implications because as part of the draft Human Tissues and Embryos Bill, the government have recommended that children born from donated sperm or eggs should have this fact recorded on their birth certificates.

Dr MacCallum said: "The views of the donor conception parents are at odds with proposed moves towards openness. If new legislation enforces disclosure through birth certificates, information and support about how to discuss this issue with children must be readily available to all such families."

Monday, September 03, 2007

Gay Parents Find Similar Souls at 'Pride' Conference

by Stephanie Caballero

Paul Chavez

LOS ANGELES - The bouncing, little baby looks like any other with those chubby cheeks, hints of drool and gah-gah sounds.

This infant, named Joseph, is a bit different, though. He’s a foster child with two gay fathers.

Ken Martinez, 39, brought the baby to a recent “Parenting with Pride” conference where prospective gay-lesbian-bisexual-transgender parents mingled with others who already have started families.

The conference was started nine years ago by the “Pop Luck Club” - a Los Angeles-based support group for gay fathers. The group has about 275 families, including 250 children, said Larry Riesenbach, a group member.

Each year, the conference draws foster agencies, adoption lawyers and surrogacy and egg donor companies, Riesenbach said. Last year, the conference added a resource fair with 20 workshops for gay parents and their children.

Martinez, who also has a 2-year-old boy he adopted with his partner, said the conference helped allay his fears that his children would endure hardships for having gay parents.

After listening to the experiences of children with gay parents, he realized his own children would be fine.

“Hearing them talk today and be proud of who their family is was a great experience for me,” Martinez said.

Children of gay parents

Meredith Fenton, a program director for COLAGE, a support group for children of gay parents, held workshops at the conference for youths ages 8 to 16.

“We give them a safe space to talk about their experiences, school and what our experience was on coming out about our parents,” said Fenton, whose mother is a lesbian and whose father is straight.

The group has been participating for the past four years in the conference and has grown over the years with some of the same children returning year after year to share their experiences.

“All of them thought they were the only ones; just meeting was revolutionary for them,” she said. “Now they know, at least hypothetically, that there are other families with LGBT parents.”


Katrina Thompson, 31, says she has a 4-year-old son from a previous relationship and as a bisexual woman came to the conference to meet other parents like herself.

“The most useful part for me was the workshop on coming out and how it’s a continual process on coming out to yourself and your kids and your whole family,” Thompson said.

“That was useful to me to know I’m not the only one going through these kinds of things.”