Monthly Archives: June 2009

There Are Lines That You Do Not Cross

The frenzy over the death of Michael Jackson is mind blowing – the question about his children’s genetics, incredibly distasteful.

Nancy Grace, Larry King, TMZ, US Weekly, People Magazine – they are all saying things like:

“Who’s the real father?” “Who’s the real mother?” “Who’s he biological father?” “Who’s the biological father?”

And I say “Who cares? And it I any of your business?”

Michael Jackson was the legal, social and only father those children had. He loves his children and the only concern he should have ever had was selecting the right guardian for his children in the event of his death – which he did. He chose his mother Katherine Jackson to be his children’s guardian.Just like every other family –
Michael Jackson was the only one entitled to select that guardian.

Aside from the fact that Michael Jackson the King of Pop died – there are three children who have been orphaned in this tragic situation. And if in fact these three children are the product of donor sperm or donor egg for that matter — and their father hadn’t for whatever reason had and important conversation with his children about their story and their origins then they are certainly finding out in one of the most damaging ways ever.

There are lines you don’t cross and those lines are to do with children. These kids didn’t sign up for this – and I want to ask the Nancy Graces of the world if she would want her children talked about like this, in this fashion. After all, there’s question about Nancy Grace and her children because Nancy was almost fifty when she conceived her twins – You can bet your bottom dollar that Nancy would be the first to shut down every single question or conversation that came her way in regards to the genetics of her children.

Where is Debbie Rowe in all of this? Who knows, but I would like to think something like this would be private and not become a spectacle for everyone to leer at.
In the meantime, the media needs to learn the basic definition of what the term Mother and Father mean, and they need to butt out of Michael Jackson’s reproductive life. Pick apart his personal life, his alleged drug use, his big spending, his eccentricities, but really do the right thing and leave his children alone.

They just lost their father for God’s sakes.

I Used an Egg Donor by: Suzanne Schlosberg

IVF? Adoption? These tools for becoming a parent are discussed openly. But using another woman’s eggs to get pregnant? It’s the new taboo.

By: Suzanne Schlosberg

My husband, Paul, and I launched Operation Procreation in perhaps the least romantic spot in the Southern Hemisphere: the windowless room of a $10-a-night hostel in Chile, decorated with faux oak paneling, brown industrial carpeting, a blinding overhead fluorescent light and, on the night table, a statue of the Virgin Mary. Paul was so creeped out by the stained, scratchy bed sheets that as I undressed, he disappeared, fully clothed, into his sleeping bag.

Married one year, we were on one of those last-hurrah vacations—what we expected to be our final chance, before retirement, for a kid-free, carefree, overseas holiday. My monthly window of opportunity landed on a weekend when every hotel room in town was booked; but at age 37, with my biological clock ticking loudly, I would not be deterred. Scratchy sheets or silk, we were going to have sex.

I managed to lure Paul out of his sleeping bag (“We can keep the lights off!” “Remember, I’m almost 38!”), and as we struggled to ignore our surroundings, we laughed nervously, like two novice skydivers about to jump out of an airplane. “Oh my god!” I said. “What if this procreation thing works?”
We never thought to ask: What if it doesn’t?

What if it doesn’t?
In every fertility book I’ve read—and I’ve read plenty—there’s a final chapter called “Other Paths to Parenthood” or “There’s More Than One Road to Motherhood” or something similar. These chapters talk about egg donation and adoption, about grieving the loss of your fertility and accepting a different path. When you’re starting fertility treatment, these are the chapters you avoid. You think they’re for other people—women who began trying to conceive at age 42 (Hey, what did they expect?) or who lost an ovary to cancer (Unfortunate, but at least they have options). You suspect it would be awful to be in their shoes, but you barely give the scenario a passing thought. Given all the high-tech procedures you’ve heard of—IVF, ICSI, PGD—you’re confident that something will work for you. Maybe not on the first try, but eventually.

At least that’s how my own thought process unfolded. Then one day, a year and a half after our trip to Chile, Paul and I found ourselves in our fertility doctor’s office facing bewildering news: We’d never conceive using my eggs. After four cycles of intrauterine insemination and two miscarriages, we decided to try in vitro fertilization, but we crashed right out of the starting gate. All 11 of our embryos, the products of Paul’s sperm and my eggs, had flunked genetic testing. There was no point in transferring any of them to my uterus, the doctor said, and there was no point in trying again. Although I was barely 39, it appeared that my eggs already had exceeded their use-by date.

“I’m sorry,” the doctor said, gently. “I didn’t expect this at all. But you’d be a very good candidate for donor-egg IVF.”

At every stage, Paul and I had been in sync, emotionally, about what to do next, but that changed the morning the embryo transfer was canceled. My sweet redheaded husband had burst into tears, and despite my hugs and assurances that we’d figure something out, he seemed inconsolable.

Nothing’s so bad that it couldn’t be worse
I was deeply disappointed, to be sure, but I wasn’t devastated or even shocked. After four years and 50 dead-end blind dates on Match.com, where Paul and I ultimately met, I’d developed an all-purpose coping strategy: expect disaster. If you prepared for the worst and got something better, I figured, you could only be pleasantly surprised.

I immediately thought of my Grandpa Julius’ favorite saying: “Nothing’s so bad that it couldn’t be worse.” It was true. I hadn’t been attacked by flesh-eating bacteria or kidnapped by terrorists or diagnosed with cancer. Surely there were circumstances more dire than harboring expired eggs.

These days, in vitro fertilization is so common that the stigma has virtually vanished; of my six friends who underwent IVF, only one kept it quiet. But donor-egg IVF is a different story. According to the U.S. Centers for Disease Control and Prevention, a substantial 12 percent of all IVF cycles in the U.S., about 16,000 a year, involve eggs retrieved from a donor; and donor-egg IVF has the highest success rate of any fertility treatment—52 percent nationally, upward of 75 percent at the top clinics. Yet few women admit to going this route.

Plenty of celebrities—TV commentator Nancy Grace, political wife Elizabeth Edwards and actress Geena Davis, among them—have given birth in their mid- to late 40s, and you can bet that nearly all have used donor eggs because the odds of a woman 44 and older conceiving via IVF with her own eggs are 0.8 percent, according to CDC statistics. But no one has come right out and said so. Desperate Housewives star Marcia Cross, who gave birth last year to twin girls at age 44, came the closest, telling the media, “When a woman gets older, they get donor eggs, which doesn’t make the baby any less beautiful or perfect. One’s own eggs only last so long.” But she has never indicated whether she used donor eggs herself.

Even at my own fertility clinic, when a pregnant donor-egg IVF patient “graduates” to the care of a regular obstetrician, the doctors ask, “Do you want your OB to know you used a donor?” They seem to view egg-donor IVF as a touchy subject. Remarkably—alarmingly—some women who use donor eggs don’t even tell their own children.

The logical next step
After our fertility doctor broke the news, we told him we’d mull over the idea of using an egg donor and get back to him. But I was already sold. Unbeknownst to Paul, a few days earlier I had scrolled through an egg-donor website—just in case—and surprised myself by how quickly I warmed to the concept.

Before we’d started down the road of fertility treatment, I had this vague idea that egg-donor IVF must feel like a second-rate option, a distressing last resort. But as I perused the donor database, it seemed nothing of the sort. It simply felt like the logical next step—between IVF and adoption—and I was grateful that technology offered us a back-up plan. Of course, some of the donors needed some serious help in the marketing department (one English major described herself as “calm, cool and collective”), but overall they seemed like an endearing bunch. A law student/snowboarder, a nurse with a flair for graphic design, an aspiring writer who’d climbed mountains—certainly among them was a worthy substitute for me, if it came to that.

And so, when it did, I was a step ahead of my husband. Paul had never considered that we might flunk out of IVF and at first couldn’t fathom using an egg donor. He couldn’t quite articulate why, but when I pressed, delicately, I got to the bottom of his objections: He worried he wouldn’t love our children as much if their DNA wasn’t entirely ours. He thought we should consider trying straight-up IVF again, on the off chance that a healthy egg or two would surface, but I vetoed that idea, pointing out that I was not a pincushion.

The doctor had told us about one couple with our diagnosis who had nonetheless tried again four times and ended up using donor eggs anyway. Given the physical discomfort of daily shots, the emotional costs of another failure and the high price tag—about $15,000 each time—no way was I going down that road.

Besides, who could say the Schlosberg genes were better than anyone else’s? Certainly we have our strong points, including longevity; even my grandma Ruth—a lifelong chain smoker who stocked her Oldsmobile with emergency fudge cookies—lived to nearly 90. But in my clan, we also trend toward bunions, psoriasis, uncontrollable hair frizz and barely enough collective mechanical aptitude to operate an electric toothbrush. If somebody’s DNA had to be sacrificed, I reasoned, better mine than my husband’s. At least the undesirable traits in Paul’s family—voting Republican, a fondness for holiday lawn ornaments—were not genetic.

If all this sounds entirely too rational, I did eventually have my own meltdown. A few days after the appointment, I spent a morning sobbing, mostly over having to wait so long for what came so naturally to others. I even resented couples who’d succeeded with regular IVF. No lawyers, psychologists or donor agencies involved—how easy they had it!

Pressing on…
But these feelings faded after a few days. I defaulted to the approach I’d relied on during my dating days: press on, and meanwhile, do something fun. When I was single, I’d taken up road-bike racing. I’d quit competing before our trip to Chile, but now, with several months to wait before we could try with a donor, I cranked up my training. Better, I figured, to be infertile and fit than infertile and flabby.

Besides, becoming parents was still well within our control, something I had decidedly lacked during my quest for a mate. Sure, infertility sucked, but it sucked a lot less than my years of dating guys with the emotional depth of a dust mite. After all, there aren’t any adoption agencies for husbands.

What I liked best about donor-egg IVF was that we’d both get to play a role in the creation of our child. Paul would provide the sperm; I’d provide the womb. Now all we needed were a few good eggs—that and my husband’s blessing.

Given the depth of Paul’s despair, I was surprised when after just a couple of weeks, Paul announced, “Let’s do it! Let’s find a donor.” On our doctor’s recommendation, he’d read a book about egg donation and felt we could be as happy as the families included in the book. He saw online that there were plenty of smart, athletic donors to choose from, but what really made him turn the corner, Paul said, was the procedure’s high success rate. There was a great chance that we’d make a quick transition from being fertility patients to being parents.

Months later, Paul told me that from the beginning, he knew he’d come around, and he thanked me for giving him space to go through the decision-making process at his own pace. I never told him how hard it had been to keep my mouth shut.

Finding the right donor
With donor-egg IVF, you have two options: finding a donor you know or selecting an anonymous donor through an agency. Most friends assumed we’d prefer a familiar donor. Three even offered me their own eggs. (I thanked them profusely before explaining that they were, oh, about 15 years too old.) Several people asked whether I’d considered my younger sister as a donor. But the very idea of mating my sister’s eggs with Paul’s sperm would complicate our family dynamics in ways I didn’t even want to imagine. “At least you’d know what you were getting,” one friend said.

Comments like that drove me nuts. What DNA merger isn’t one big roll of the dice? In some respects, though, I understood the sentiment. After all, we did find it comforting to have even partial genetic input and to know that our baby would be exposed to all the right nutrients in utero. Still, we harbored no illusions that we had more control than any other couple trying to have a baby.

And so, Paul and I began our donor-egg hunt, securing the passwords to several agency websites so we could get beyond the headlines and read the complete donor profiles.

Back when I was active on Match.com, I’d been clear about my search criteria: I wanted a smart, athletic guy who could use “I feel” in a context other than “I feel like pizza tonight.” But now? What exactly were Paul and I looking for? Someone who looked like me? Someone who looked like Julia Roberts? How much weight should we give a donor’s GPA or SAT score or the disconcerting revelation that her favorite food is “anything from the Olive Garden”?

This was like Match.com all over again, only it wasn’t. I wasn’t seeking a date or a friend—just a batch of healthy eggs. Did it really matter if the donor was funny or adventurous or “cheerful, athletic and goal-oriented”?

Somehow, I came to realize, it did. I was drawn to women I could relate to, like the bike racer/schoolteacher who was lousy at math and who wanted to use her $5,000 egg-donor fee for a cycling tour of Spain. Paul, meanwhile, drifted toward women who looked like that blonde criminologist on CSI: Miami. He was particularly enamored with a pretty, green-eyed donor who appeared to be my polar opposite—an aspiring chemist in possession of her low-voltage electrician’s license. Though I was hardly aiming to clone myself—ultimately I found hair and eye color were low priorities—the idea of using her eggs didn’t exactly excite me because we were so different, and I wanted to feel excited about my choice.

Like the best of the Match.com guys, some donors clearly had put effort into their essays. Others, though, were coasting on their genes, like Sage, a 5-foot-10 volleyball player with hazel eyes and a strikingly angular face. She left blank the questions about her aspirations and fondest childhood memories, revealing little besides the fact that her brother is a 6-foot-4, blond lifeguard.

“Man, who does she think she is?” Paul said.

Narrowing down the list
After three months of searching—and learning that our top choices had a long waiting list—we narrowed our list to two available donors. One was the blonde chemistry student; I had to admit she was smart, cute and well rounded, plus her family had impressive longevity. The other was the bike racer who loathed calculus. She wasn’t available for three months due to her work schedule, but I was willing to wait because I liked the idea that we seemed similar—we competed in the same sport and shared a fear of indefinite integrals.

We contacted the aspiring chemist, via her agency, and learned she was available right away. But my gut pulled me toward the bike racer. I simply had a good feeling about her, and in the end, that was enough for me. Paul deferred to me.

We chose not to meet our donor. Some therapists strongly advise a get-together, on the theory that it will be reassuring to the child to know that his or her parents met and liked the donor. But we already had several pictures of our donor. We knew she had a master’s degree and a National Geographic subscription, a fondness for Hugh Grant movies and “an outdoorsy and outgoing family” with no known medical problems. We knew she was willing to meet our child, if he or she so desired, at some point in the future. What more did we need? What if we met and had a personality clash? Why jeopardize the good feelings we already had about her?

Following my clinic’s instructions, we consulted with a therapist, who told us most recipient couples don’t meet their donors, and she felt that was a reasonable choice. Once we signed a contract with our donor—she relinquished all rights to any embryos created; we paid her $5,000 fee plus travel expenses to my clinic, 200 miles from her home—the process went smoothly. For six weeks, Paul injected me daily in the stomach and hip with drugs to suppress my ovulation and prepare my uterine lining for the embryos. Meanwhile, the donor, supervised by my doctor, took hormone injections that stimulated her ovaries to produce extra eggs.

The morning her eggs were surgically retrieved—six months after our canceled IVF, two years after our trip to Chile—they were fertilized by Paul’s sperm. Five days later, we had 18 embryos. During a short procedure, the doctor inserted two of the most robust ones into my uterus. The rest were frozen.

I spent the next two days on bed rest, mostly watching reruns of The Office on TiVo. I knew the odds of success were high, but as usual, my gut said: expect disaster.

When you have an IVF transfer, the nurses implore you not to take a home pregnancy test and instead to wait for your blood test 10 days later. Some urine tests aren’t sensitive enough to detect pregnancy hormones so early; why risk unnecessary disappointment?

The moment of truth
But the day before my blood test, I impulsively dug up an old pregnancy test in my bathroom and went for it. Instantly, the stick turned blue, and for the first time, I let myself feel optimistic. The next day I received the official results: not only was I pregnant, but my hormone levels were sky high, suggesting twins.

My boys arrived loud and healthy, and they’re now 12 months old. Ian is the fearless one, diving off steps, pinning his brother in a headlock and mowing down whatever or whomever happens to be in his way as he crawls across the room. Toby is the softie, always showering his family with Oprah-style hugs and slobbery kisses. I adore them more than I could possibly describe.

I’m immensely grateful to our donor, and I hope that she did not endure too much discomfort and was able to use her $5,000 for that bike trip to Spain. Still, I rarely think about her, and I imagine the situation is mutual.

In a few years, Paul and I will start telling our boys about the circumstances of their conception, a conversation likely to evolve in interesting ways and span well over a decade. We’ll tell it to them straight and hope that they grow up feeling as we do: that our family was lucky enough to benefit from some remarkable technology and the kindness of a bike-racing schoolteacher named Jill.

When a friend said to me recently, “I’m sure your boys will be tall, like you are!” I nodded before remembering, and reminding her, that genetically, my children aren’t related to me. I had to laugh. When you’re busy playing hide-and-seek and reading The Very Hungry Caterpillar and scraping peas off the floor, the last thing you think about is your babies’ DNA.

96 Ounces of Water a Day — Help’s Keep the Contractions, Bleeding, and BP Issues at Bay…

When I was pregnant with my son in 2000 I experienced all kinds of issues regarding bleeding, premature contractions, and blood pressure.

Every time I found myself in L & D I heard the same thing: “How much water are you drinking?” And I would mumble: “Not nearly enough”

Shortly thereafter I was assigned to a special group through our HMO that did nothing but contact their high risk patients every other day and talk to them about water intake. Once I got on board and began drinking my 96 ounces of water a day all of the above stopped.

Amazing what one simple act can do for a pregnancy. I learned so much about why water in important – and here’s my public service announcement about water and pregnancy and why it’s important.

While it is always a good idea to keep the body hydrated, there are certain times when changes in the body call for more water. One of these times isduring pregnancy. Water can be the answer to alleviating many side effects of pregnancy, aid in preparing the body for these physiological changes, and just overall make mommy and baby healthier.

Water is a vital part of pregnancy. The fluid acts as the body’s transportation system, and carries nutrients through the blood to the baby. Also, flushing out the system and diluting urine with water prevents urinarytract infections, which are common in pregnancy.

Perhaps the biggest reason to drink water however is to keep the body hydrated. Dehydration in pregnant women can be very serious. Hormones (gotta love those hormones!) change the way women store water during pregnancy, so they begin to retain water, and drinking plenty of water combats that. Much of that water is used in the amniotic sack. Amniotic fluid alone needs to replenish itself every hour by using roughly a cup of water stored in the body. Replacing that water will insure the fetus is protected within the womb.

Since the blood volume increases to nearly double by the eighth month of pregnancy, it is necessary to drink even more water to compensate. Thicker blood can lead to hypertension and other cardiovascular problems.

Because dehydration can cause contractions, lack of water in the third trimester can also cause premature labor. Premature labor can have many health risks to the newborn baby. However, some cases of premature labor have been stopped just by giving the mother enough water to re-hydrate her body.

Pregnant women should be sure to drink at least eight 8-ounce glasses of water each day, which is in addition to the normal in take of other recommended foods. The benefits of drinking water during pregnancy include healthier skin, less acne, washing away of unnecessary sodium, less chance for pre-term labor or miscarriage and better bowel movements.

Drinking water can, believe it or not, also help prevent that nausea known as morning sickness, as doctors recommend drinking plenty of fluid between meals. Drinking water for health benefits of the mother and baby are evident. Doctors in fact ask mothers to steer clear of diuretics like caffeine and alcohol, so water is the obvious alternative for fluid intake. Also, since doctors often ‘prescribe’ exercise in pregnant women, fluids will be lost through perspiration. As we know, pregnant or not, those fluids also need to be replaced.

So please drink, your baby will love you for it.

Sources:

http://www.freedrinkingwater.com/water-education/water-pregnancy.htm

96 Ounces of Water a Day — Help’s Keep the Contractions, Bleeding, and BP Issues at Bay…

When I was pregnant with my son in 2000 I experienced all kinds of issues regarding bleeding, premature contractions, and blood pressure.

Every time I found myself in L & D I heard the same thing: “How much water are you drinking?” And I would mumble: “Not nearly enough”

Shortly thereafter I was assigned to a special group through our HMO that did nothing but contact their high risk patients every other day and talk to them about water intake. Once I got on board and began drinking my 96 ounces of water a day all of the above stopped.

Amazing what one simple act can do for a pregnancy. I learned so much about why water in important – and here’s my public service announcement about water and pregnancy and why it’s important.

While it is always a good idea to keep the body hydrated, there are certain times when changes in the body call for more water. One of these times isduring pregnancy. Water can be the answer to alleviating many side effects of pregnancy, aid in preparing the body for these physiological changes, and just overall make mommy and baby healthier.

Water is a vital part of pregnancy. The fluid acts as the body’s transportation system, and carries nutrients through the blood to the baby. Also, flushing out the system and diluting urine with water prevents urinarytract infections, which are common in pregnancy.

Perhaps the biggest reason to drink water however is to keep the body hydrated. Dehydration in pregnant women can be very serious. Hormones (gotta love those hormones!) change the way women store water during pregnancy, so they begin to retain water, and drinking plenty of water combats that. Much of that water is used in the amniotic sack. Amniotic fluid alone needs to replenish itself every hour by using roughly a cup of water stored in the body. Replacing that water will insure the fetus is protected within the womb.

Since the blood volume increases to nearly double by the eighth month of pregnancy, it is necessary to drink even more water to compensate. Thicker blood can lead to hypertension and other cardiovascular problems.

Because dehydration can cause contractions, lack of water in the third trimester can also cause premature labor. Premature labor can have many health risks to the newborn baby. However, some cases of premature labor have been stopped just by giving the mother enough water to re-hydrate her body.

Pregnant women should be sure to drink at least eight 8-ounce glasses of water each day, which is in addition to the normal in take of other recommended foods. The benefits of drinking water during pregnancy include healthier skin, less acne, washing away of unnecessary sodium, less chance for pre-term labor or miscarriage and better bowel movements.

Drinking water can, believe it or not, also help prevent that nausea known as morning sickness, as doctors recommend drinking plenty of fluid between meals. Drinking water for health benefits of the mother and baby are evident. Doctors in fact ask mothers to steer clear of diuretics like caffeine and alcohol, so water is the obvious alternative for fluid intake. Also, since doctors often ‘prescribe’ exercise in pregnant women, fluids will be lost through perspiration. As we know, pregnant or not, those fluids also need to be replaced.

So please drink, your baby will love you for it.

Sources:

http://www.freedrinkingwater.com/water-education/water-pregnancy.htm

The Frozen Embryo Dilemma – A Matter of Privacy, Responsibility and Choice

The American Fertility Association published an amazing article about left over frozen embryos — this is a must read for everyone.

It’s a private issue gone very public. It’s a complex web of personal philosophy, religious orientation and social conscience about which everybody, and we mean everybody, has a strong opinion. But the fact is, and should be, what you do with the frozen embryos you don’t use is your decision and yours alone.

Of course it never feels like the quite right time to discuss this touchy topic.
Maybe you’re taking your first steps on the infertility treatment path. Along with all the mind-numbingly complicated instructions, you’re handed a form asking you what to do with excess embryos before you have a single one.

Maybe you already beat the odds. With absolute devotion, you danced the assisted reproduction tango, created viable embryos and made a baby. Or two or three. Your family is complete. Your head is bursting with school, soccer, recitals and bedtimes. Frozen embryos?

Or maybe you’ve given up on treatment, leaving behind the heartbreak, the disappointment and possibly, a few fertilized eggs. You’ve moved on.

So chances are pretty good that those embryos, protected in liquid nitrogen, aren’t at the top of your to-do list. None of us who have experienced infertility anticipates having any embryos, let alone extras. After we’re done with ART, we tend to ignore or deny the delicate question of disposition of the unexpected surplus.

At some point, though, all of us with cryopreserved embryos will have to make a final and forever decision about them. It’s not easy. They’re our unique responsibility and our unique burden. Because while our embryos remain suspended in time, we don’t.

Hence, this fact sheet, a guide to anticipating some of the quandaries we confront and exploring the choices we have.

The Options

A good initial cryopresevation consent agreement usually outlines three disposition choices:
Thawing without intent to transfer. Lucinda Veeck, M.L.T.,D.Sc., Director of Embryology at the Center for Reproductive Medicine and Infertility in New York City, says at her program, 53% of the 364 patients who have gone through with their choice have elected this option.

Donation for research. While raging controversy and federal limits have restricted directed giving to stem cell research, there are myriad other well-accepted research initiatives, such as staining for DNA and genetic analysis that rely on embryos. And despite the ban on federal funding for stem cell work, privately funded institutions are moving forward. Reports Dr. Michael Alper of Boston IVF, one such center, “There is no shortage of donations. At CRMI, Dr. Veeck reports that about 41% of patients have gone the research route.

Donation to other infertile people. Logistically and emotionally complex, donation for transfer has its own guidelines established by the American Society of Reproductive Medicine. It’s a many-layered effort by both the donors and recipients, requiring a six-month quarantine of the embryo, blood and genetic testing and retesting of donors, blood tests for the recipients. Both parties must sign informed consent documents addressing relinquishment and acceptance of parental rights should children result, as well as liability, among other things. Whether or not it is an anonymous transaction, both donors and recipients are strongly urged to get psychological counseling. “We’ve only donated embryos from two patients because of the difficulties inherent to follow-up testing,” remarks Dr. Veeck. “And in the 6% group desiring to donate, most have not actually given away their embryos yet.”

How Was I Supposed To Know?

These days, even before there’s an embryo, there’s the consent form. That daunting document demanding that a patient know, ahead of time, what to do with remaining embryos…if there are any. For infertile people, that’s one incomprehensibly huge “if.”

So hopeful patients fill in the blanks with the best intentions. The rub is that when it actually comes time to act on that initial agreement, people often find that first choice isn’t the one they want after all. It’s important to remember that first consent form is not the actual disposition form. You can shift gears at any time.

Changes of heart happen for a million different reasons: divorce, the death of a spouse, economic hardship, a multiple birth after the first cycle. Sometimes the partners in a relationship simply aren’t on the same page – one may want more children, the other has no interest. One partner may see the embryos as their potential children, the other regards them as left over sperm and eggs.

Inevitably, life’s constant evolution leads to embryos that sit, sometimes for an embarrassingly long time.

“People have them frozen and then forget about them,” says Dr. David Hoffman, Medical Director at IVF Florida/Reproductive Associates in Margate, Florida. “But they still don’t want to get rid of them. I don’t think patients think of a frozen embryo as a person, but it’s tough to let go.”

Dr. Veeck adds, “Many patients respond by doing nothing. They continue paying for storage fees rather than make a decision. And I think that’s the appropriate thing until they’re quite sure what they want to do.”

Behind the Choices

The language of disposition seems straightforward and precise. In fact, most people are sandbagged by how profoundly affected, confused and conflicted they are when it comes time to commit.

So, most elect to do nothing. Make no mistake; doing nothing is making a decision. Endless postponements means someone else-a family member or the clinic—may get stuck on the horns of what is rightfully your dilemma.

Overwhelmingly, frozen embryos are intended for use by the couples that created them. But IVF centers around the country report that the sheer number in storage is putting a squeeze on space, with some embryos in residence for a decade or more. Increasingly, centers are attempting to contact patients who haven’t been active for several years. It can be an onerous and difficult task, and on occasion, pointless.

At CRMI, Dr. Veeck puts the abandonment rate at about 10%. That’s after three registered letters, using search agencies and making countless phone calls.

Not all clinics have the wherewithal or the intention of going to such lengths. But most clinics will not dispose of embryos without an explicit, legal go-ahead from patients. For the most part, says Dr. Hoffman, “couples usually pop up out of nowhere” when they’re notified that unless they respond, the embryos will be discarded.

Contrary to all the hype, Dr. Hoffman notes there are “very few not spoken for. The government thinks there are huge numbers out there. But there aren’t a lot of abandoned embryos at all.”
In other words, the vast majority of us with excess embryos are left to wrestle with our personal convictions and moral codes.

What Gives Meaning

For some people, contributing their embryos to research in an effort to help others gives them a sense that their assisted reproductive efforts have lasting value. “It’s a way of giving back to medicine and it makes them feel good,” says Dr. Alper of Boston IVF.

For others non-viable thawing provides closure. “It’s interesting, but people are very relieved when their embryos are discarded,” observes Adele Kauffman, Ph.D., and program psychologist at Reproductive Science Center in Waltham and Boston. “Embryos in the freezer are unfinished business. Once it’s done, they feel they’ve come full circle.”

Still others, impelled by altruism, empathy, or religious beliefs to help other infertile people, want to offer their frozen fertilized eggs for transfer.

“Initially, I thought it would be the option everyone would choose,” says Dr. Veeck at CRMI. “But when they think that they might have offspring out there and not know them or how they’re going to be brought up, they usually reconsider.”

In a recently published article, Dr. Craig Syrop at the University of Iowa Hospitals and Clinics, notes that of 365 couples with embryos stored after two years, 12% “indicated a willingness to donate to other couples (was) nearly equal to the desire of couples to donate to research.” But, he finds, when faced with the “reality of clinic visits for counseling, STD testing, and informed consent before embryos are donated and utilized” interest wanes and research outstrips donation to others by nearly 2 to 1.

The Donation Drama

Embryo donation for transfer is a media magnet, drawing tremendous attention when some began referring to transfer donation as “embryo adoption.” It is not.

“Adoption is a specific legal framework with specific guidelines around parental rights and obligations and applies to only living children,” says Susan Crockin, a Boston area attorney specializing in reproductive matters. She calls donation for transfer a “positive, but limited” option. She notes that five states have laws on the books dealing with this form of embryo donation, but nowhere is it the legal equivalent of adoption.

While the federal government is on the cusp of launching public education campaign advocating “embryo adoption,” Crockin calls it a misnomer that may make people feel good but “glosses over the legal reality.” At a minimum she recommends a legal agreement between donor and recipient; and consider, in those states without an embryo donation law, that the recipients go to court to have themselves declared the parents of a resulting offspring to avert the risk of custodial claims by the genetic parents or the extended family.

However, things blur on the psychosocial front where, psychologists say, the adoption parallel is stronger.

Embryo donors and recipients should expect that resulting offspring will want information about their genealogy, their genetic makeup, and their biological parents. Donors must be prepared for the possibility of a knock on their door one day even if the transaction was strictly anonymous. As decades of experience with adoption have shown, kids will come searching. Furthermore, laws protecting anonymity are subject to change.

“We’re in uncharted territory here,” said Dr. Elaine Gordon, a Los Angeles psychologist. Dr. Gordon says she’s getting more inquiries about embryo donation for transfer but many go nowhere.

“They find it too complicated and overwhelming in terms of what’s required,” she observes. “If they’re going to do it right, does it mean engaging in a relationship with the recipient couple and do they want to participate in that?”

She suggests that “responsibly done” ovum donation might provide the best model, with both parties entering into a “contract detailing terms of contact, if any, and information disclosed and exchanged. If the two parties can come to a meeting of the minds, the exchange can take place, facilitated by psychological, medical and legal experts.”

Embryo Donation Programs

There are several embryo donation programs, including the Christian faith-based agency, Snowflakes, that promotes “adoption.” At the root, all the programs facilitate matching donors with potential recipients and work through the details of the exchange.

“We’re a private (non-sectarian) agency and we liaise between the recipient and the donor,” explains Eileen Dover, executive director of Genesis Family Services in Holly Pond, Alabama.
Recipients send in a $100 application fee, list their requirements and are put on a waiting list until the right match pops up. The total agency cost to recipients is $1,800 but they’re also responsible for shipping, donor medical testing, notary feels, and a flat $250 attorney fee. Donors, who also can specify requirements for a receiving family, fill in a standard questionnaire, including medical history. Genesis’ simple-language but comprehensive contract requires adherence to the ASRM guidelines, but the agency leaves that to the donor’s doctor.

While Genesis doesn’t require psychological counseling, the contract calls for recipients to pay for up to three sessions for the donor, if the donor chooses. Dover also says, “we ask recipients to get counseling as well, but that’s their responsibility.”

Genesis advocates closed donations but will go with client’s wishes for open ones.
“We try to encourage transferring four embryos,” says Dover. “If you have 10 embryos (eggs that are fertilized, frozen but haven’t started dividing yet), you may get four to six that live through the thawing process. If they’re blastocysts (5-day-old embryos), there’s a darn good chance they’re going to do well and I don’t think any physician would do more than two or three.”

In Fullerton, California, Snowflakes operates on the assumption that this is an adoption. “In our program, we focus on the end result which is the child. That’s the same in all adoptions,” says JoAnn Eiman, a Snowflakes spokesperson.

The Christian faith-based agency requires recipient families undergo a homestudy, a fundamental process in traditional adoption, but controversial in embryo donation for transfer. As Eiman explains it, about 20% of the homestudy is about child abuse and Department of Justice background checks. “The other 80% is preparing the parent for a non-genetically linked child,” she says. The agency does both closed and open donations, depending on the preferences of the parties.

Snowflakes fees to recipients are about $4,000 for the matching, legal contract, shipping, coordination, rematching if required and lifetime support.

Begun in 1997, the first Snowflakes baby was born in 1998. In 1999 there were a couple of matches but no births. But by 2002 there were a total of 18 babies born and this year, Snowflakes expects another 23.

Do donors who’ve gone this far change their minds? “Most don’t but it happens,” said Eiman. “Typically when the donor couple gets a profile on the adoptive family they say ‘Oh my goodness, this is real. They’re going to take them and raise them.’ When they get the packet that’s when it hits them.”

It’s a whole new world, agrees Dover at Genesis. “It remains to be seen whether (donors) really get that they’re going to have children out there. They say, ‘Yes, I understand.’ But what’s going to happen 20 years down the road? I think about that when I’m whiting out the records and I think someday someone might want to look at that.”

When It’s All Too Confusing

Okay. We’re all pretty clear that the “what is to be done” with extra frozen embryos is at best confusing. The American Fertility Association strongly urges that you weigh the following to help ease the strain:

Nobody has control over your embryos but you.

You are not obligated to stick with your first decision or your second or third. The no-turning-back point comes only after you’ve formally and legally relinquished ownership of your embryos.

Know that it is absolutely fine to wait as long as it takes for you to make the decision that feels right for you. No government, social or religious entity should force you into taking an action that, in your gut, you know is a personal mistake. Because you will have to live with this decision forever.

Donating to other couples is a real and generous alternative. The AFA recommends you thoroughly explore the legal, psychological and emotional implications and potential long-term ramifications. You must feel confident that you can deal with the possible outcomes down the road.

Thawing without intent to transfer is a perfectly reasonable option that most couples do choose, finding it provides the unexpected relief of closure. Yes, there may very well be grief and counseling or support that can serve you well.

We at The American Fertility Association will continue to report, write and provide you with as much information about this topic as we can. But, as one of the leading patient advocate groups, The AFA is always available to you, to answer questions, provide support and referrals. Please call our toll-free number (888) 917-3777. It always helps to talk with those who’ve been through it, too.

The Frozen Embryo Dilemma – A Matter of Privacy, Responsibility and Choice

The American Fertility Association published an amazing article about left over frozen embryos — this is a must read for everyone.

It’s a private issue gone very public. It’s a complex web of personal philosophy, religious orientation and social conscience about which everybody, and we mean everybody, has a strong opinion. But the fact is, and should be, what you do with the frozen embryos you don’t use is your decision and yours alone.

Of course it never feels like the quite right time to discuss this touchy topic.
Maybe you’re taking your first steps on the infertility treatment path. Along with all the mind-numbingly complicated instructions, you’re handed a form asking you what to do with excess embryos before you have a single one.

Maybe you already beat the odds. With absolute devotion, you danced the assisted reproduction tango, created viable embryos and made a baby. Or two or three. Your family is complete. Your head is bursting with school, soccer, recitals and bedtimes. Frozen embryos?

Or maybe you’ve given up on treatment, leaving behind the heartbreak, the disappointment and possibly, a few fertilized eggs. You’ve moved on.

So chances are pretty good that those embryos, protected in liquid nitrogen, aren’t at the top of your to-do list. None of us who have experienced infertility anticipates having any embryos, let alone extras. After we’re done with ART, we tend to ignore or deny the delicate question of disposition of the unexpected surplus.

At some point, though, all of us with cryopreserved embryos will have to make a final and forever decision about them. It’s not easy. They’re our unique responsibility and our unique burden. Because while our embryos remain suspended in time, we don’t.

Hence, this fact sheet, a guide to anticipating some of the quandaries we confront and exploring the choices we have.

The Options

A good initial cryopresevation consent agreement usually outlines three disposition choices:
Thawing without intent to transfer. Lucinda Veeck, M.L.T.,D.Sc., Director of Embryology at the Center for Reproductive Medicine and Infertility in New York City, says at her program, 53% of the 364 patients who have gone through with their choice have elected this option.

Donation for research. While raging controversy and federal limits have restricted directed giving to stem cell research, there are myriad other well-accepted research initiatives, such as staining for DNA and genetic analysis that rely on embryos. And despite the ban on federal funding for stem cell work, privately funded institutions are moving forward. Reports Dr. Michael Alper of Boston IVF, one such center, “There is no shortage of donations. At CRMI, Dr. Veeck reports that about 41% of patients have gone the research route.

Donation to other infertile people. Logistically and emotionally complex, donation for transfer has its own guidelines established by the American Society of Reproductive Medicine. It’s a many-layered effort by both the donors and recipients, requiring a six-month quarantine of the embryo, blood and genetic testing and retesting of donors, blood tests for the recipients. Both parties must sign informed consent documents addressing relinquishment and acceptance of parental rights should children result, as well as liability, among other things. Whether or not it is an anonymous transaction, both donors and recipients are strongly urged to get psychological counseling. “We’ve only donated embryos from two patients because of the difficulties inherent to follow-up testing,” remarks Dr. Veeck. “And in the 6% group desiring to donate, most have not actually given away their embryos yet.”

How Was I Supposed To Know?

These days, even before there’s an embryo, there’s the consent form. That daunting document demanding that a patient know, ahead of time, what to do with remaining embryos…if there are any. For infertile people, that’s one incomprehensibly huge “if.”

So hopeful patients fill in the blanks with the best intentions. The rub is that when it actually comes time to act on that initial agreement, people often find that first choice isn’t the one they want after all. It’s important to remember that first consent form is not the actual disposition form. You can shift gears at any time.

Changes of heart happen for a million different reasons: divorce, the death of a spouse, economic hardship, a multiple birth after the first cycle. Sometimes the partners in a relationship simply aren’t on the same page – one may want more children, the other has no interest. One partner may see the embryos as their potential children, the other regards them as left over sperm and eggs.

Inevitably, life’s constant evolution leads to embryos that sit, sometimes for an embarrassingly long time.

“People have them frozen and then forget about them,” says Dr. David Hoffman, Medical Director at IVF Florida/Reproductive Associates in Margate, Florida. “But they still don’t want to get rid of them. I don’t think patients think of a frozen embryo as a person, but it’s tough to let go.”

Dr. Veeck adds, “Many patients respond by doing nothing. They continue paying for storage fees rather than make a decision. And I think that’s the appropriate thing until they’re quite sure what they want to do.”

Behind the Choices

The language of disposition seems straightforward and precise. In fact, most people are sandbagged by how profoundly affected, confused and conflicted they are when it comes time to commit.

So, most elect to do nothing. Make no mistake; doing nothing is making a decision. Endless postponements means someone else-a family member or the clinic—may get stuck on the horns of what is rightfully your dilemma.

Overwhelmingly, frozen embryos are intended for use by the couples that created them. But IVF centers around the country report that the sheer number in storage is putting a squeeze on space, with some embryos in residence for a decade or more. Increasingly, centers are attempting to contact patients who haven’t been active for several years. It can be an onerous and difficult task, and on occasion, pointless.

At CRMI, Dr. Veeck puts the abandonment rate at about 10%. That’s after three registered letters, using search agencies and making countless phone calls.

Not all clinics have the wherewithal or the intention of going to such lengths. But most clinics will not dispose of embryos without an explicit, legal go-ahead from patients. For the most part, says Dr. Hoffman, “couples usually pop up out of nowhere” when they’re notified that unless they respond, the embryos will be discarded.

Contrary to all the hype, Dr. Hoffman notes there are “very few not spoken for. The government thinks there are huge numbers out there. But there aren’t a lot of abandoned embryos at all.”
In other words, the vast majority of us with excess embryos are left to wrestle with our personal convictions and moral codes.

What Gives Meaning

For some people, contributing their embryos to research in an effort to help others gives them a sense that their assisted reproductive efforts have lasting value. “It’s a way of giving back to medicine and it makes them feel good,” says Dr. Alper of Boston IVF.

For others non-viable thawing provides closure. “It’s interesting, but people are very relieved when their embryos are discarded,” observes Adele Kauffman, Ph.D., and program psychologist at Reproductive Science Center in Waltham and Boston. “Embryos in the freezer are unfinished business. Once it’s done, they feel they’ve come full circle.”

Still others, impelled by altruism, empathy, or religious beliefs to help other infertile people, want to offer their frozen fertilized eggs for transfer.

“Initially, I thought it would be the option everyone would choose,” says Dr. Veeck at CRMI. “But when they think that they might have offspring out there and not know them or how they’re going to be brought up, they usually reconsider.”

In a recently published article, Dr. Craig Syrop at the University of Iowa Hospitals and Clinics, notes that of 365 couples with embryos stored after two years, 12% “indicated a willingness to donate to other couples (was) nearly equal to the desire of couples to donate to research.” But, he finds, when faced with the “reality of clinic visits for counseling, STD testing, and informed consent before embryos are donated and utilized” interest wanes and research outstrips donation to others by nearly 2 to 1.

The Donation Drama

Embryo donation for transfer is a media magnet, drawing tremendous attention when some began referring to transfer donation as “embryo adoption.” It is not.

“Adoption is a specific legal framework with specific guidelines around parental rights and obligations and applies to only living children,” says Susan Crockin, a Boston area attorney specializing in reproductive matters. She calls donation for transfer a “positive, but limited” option. She notes that five states have laws on the books dealing with this form of embryo donation, but nowhere is it the legal equivalent of adoption.

While the federal government is on the cusp of launching public education campaign advocating “embryo adoption,” Crockin calls it a misnomer that may make people feel good but “glosses over the legal reality.” At a minimum she recommends a legal agreement between donor and recipient; and consider, in those states without an embryo donation law, that the recipients go to court to have themselves declared the parents of a resulting offspring to avert the risk of custodial claims by the genetic parents or the extended family.

However, things blur on the psychosocial front where, psychologists say, the adoption parallel is stronger.

Embryo donors and recipients should expect that resulting offspring will want information about their genealogy, their genetic makeup, and their biological parents. Donors must be prepared for the possibility of a knock on their door one day even if the transaction was strictly anonymous. As decades of experience with adoption have shown, kids will come searching. Furthermore, laws protecting anonymity are subject to change.

“We’re in uncharted territory here,” said Dr. Elaine Gordon, a Los Angeles psychologist. Dr. Gordon says she’s getting more inquiries about embryo donation for transfer but many go nowhere.

“They find it too complicated and overwhelming in terms of what’s required,” she observes. “If they’re going to do it right, does it mean engaging in a relationship with the recipient couple and do they want to participate in that?”

She suggests that “responsibly done” ovum donation might provide the best model, with both parties entering into a “contract detailing terms of contact, if any, and information disclosed and exchanged. If the two parties can come to a meeting of the minds, the exchange can take place, facilitated by psychological, medical and legal experts.”

Embryo Donation Programs

There are several embryo donation programs, including the Christian faith-based agency, Snowflakes, that promotes “adoption.” At the root, all the programs facilitate matching donors with potential recipients and work through the details of the exchange.

“We’re a private (non-sectarian) agency and we liaise between the recipient and the donor,” explains Eileen Dover, executive director of Genesis Family Services in Holly Pond, Alabama.
Recipients send in a $100 application fee, list their requirements and are put on a waiting list until the right match pops up. The total agency cost to recipients is $1,800 but they’re also responsible for shipping, donor medical testing, notary feels, and a flat $250 attorney fee. Donors, who also can specify requirements for a receiving family, fill in a standard questionnaire, including medical history. Genesis’ simple-language but comprehensive contract requires adherence to the ASRM guidelines, but the agency leaves that to the donor’s doctor.

While Genesis doesn’t require psychological counseling, the contract calls for recipients to pay for up to three sessions for the donor, if the donor chooses. Dover also says, “we ask recipients to get counseling as well, but that’s their responsibility.”

Genesis advocates closed donations but will go with client’s wishes for open ones.
“We try to encourage transferring four embryos,” says Dover. “If you have 10 embryos (eggs that are fertilized, frozen but haven’t started dividing yet), you may get four to six that live through the thawing process. If they’re blastocysts (5-day-old embryos), there’s a darn good chance they’re going to do well and I don’t think any physician would do more than two or three.”

In Fullerton, California, Snowflakes operates on the assumption that this is an adoption. “In our program, we focus on the end result which is the child. That’s the same in all adoptions,” says JoAnn Eiman, a Snowflakes spokesperson.

The Christian faith-based agency requires recipient families undergo a homestudy, a fundamental process in traditional adoption, but controversial in embryo donation for transfer. As Eiman explains it, about 20% of the homestudy is about child abuse and Department of Justice background checks. “The other 80% is preparing the parent for a non-genetically linked child,” she says. The agency does both closed and open donations, depending on the preferences of the parties.

Snowflakes fees to recipients are about $4,000 for the matching, legal contract, shipping, coordination, rematching if required and lifetime support.

Begun in 1997, the first Snowflakes baby was born in 1998. In 1999 there were a couple of matches but no births. But by 2002 there were a total of 18 babies born and this year, Snowflakes expects another 23.

Do donors who’ve gone this far change their minds? “Most don’t but it happens,” said Eiman. “Typically when the donor couple gets a profile on the adoptive family they say ‘Oh my goodness, this is real. They’re going to take them and raise them.’ When they get the packet that’s when it hits them.”

It’s a whole new world, agrees Dover at Genesis. “It remains to be seen whether (donors) really get that they’re going to have children out there. They say, ‘Yes, I understand.’ But what’s going to happen 20 years down the road? I think about that when I’m whiting out the records and I think someday someone might want to look at that.”

When It’s All Too Confusing

Okay. We’re all pretty clear that the “what is to be done” with extra frozen embryos is at best confusing. The American Fertility Association strongly urges that you weigh the following to help ease the strain:

Nobody has control over your embryos but you.

You are not obligated to stick with your first decision or your second or third. The no-turning-back point comes only after you’ve formally and legally relinquished ownership of your embryos.

Know that it is absolutely fine to wait as long as it takes for you to make the decision that feels right for you. No government, social or religious entity should force you into taking an action that, in your gut, you know is a personal mistake. Because you will have to live with this decision forever.

Donating to other couples is a real and generous alternative. The AFA recommends you thoroughly explore the legal, psychological and emotional implications and potential long-term ramifications. You must feel confident that you can deal with the possible outcomes down the road.

Thawing without intent to transfer is a perfectly reasonable option that most couples do choose, finding it provides the unexpected relief of closure. Yes, there may very well be grief and counseling or support that can serve you well.

We at The American Fertility Association will continue to report, write and provide you with as much information about this topic as we can. But, as one of the leading patient advocate groups, The AFA is always available to you, to answer questions, provide support and referrals. Please call our toll-free number (888) 917-3777. It always helps to talk with those who’ve been through it, too.

"Egg Donation: Why I gave up my right to remain anonymous

I read this great post which was published by Gail Anderson a delightful individual owns and operates The Donor Concierge which is a surrogacy and consulting service located in California.

“Egg Donation: Why I gave up my right to remain anonymousBy Laura Witjens, Chair of the National Gamete Donation Trust, egg donor and mother 08 June 2009.

Following a change in the law that came into force on 1 April 2005, British people conceived using donated egg, sperm or embryos can ask for identifying information about the donor when they reach the age of 18. Here Laura Witjens, egg donor and mother of two, writes about why she elected to remove her anonymity and potentially become identifiable to any children born from her donation.

I’ll never know what made me watch breakfast television that morning. Being a single working mother with two one-year olds, it was a luxury I could ill afford. But I did, and one of the items changed my life forever. The same day, I contacted a fertility clinic and told them I wanted to be an egg donor.

It was the year 2000 and discussions about the removal of anonymity from egg and sperm donors were only just taking place between patient groups and other fertility organisations. For me, at the time just a willing and partly-informed donor, the notion of being known to any resulting offspring wasn’t even a blip on the radar. The counsellor who I saw at the clinic was satisfied I knew what I was doing and, other than the known medical ones, no other long-term implications were discussed. Some months later the deed was done: 13 healthy follicles were harvested and I left the clinic with the feeling I’d done something momentous. Just how momentous, I only found out years later.

Not satisfied with the information available, as well as certain parts of the process, I made another life changing step. I contacted the National Gamete Donation Trust (NGDT) and asked if I could volunteer. I became a Trustee and, motivated by the pending removal of anonymity and differences of opinion with other Trustees, I went on to become the Chair. It’s a position I’ve held for the last six years and in this time I’ve taken part in many gamete donation discussions.

I firmly believe in leading by example, a philosophy I carry through to my work as a business woman and as Chair of the NGDT. So, with such an emotive subject, how could I lead an organisation without putting my money where my mouth was? If I truly believed in the identity of the donor being disclosed to the donor-conceived person, the legislation at the time of my donation shouldn’t have been relevant to me. I knew that re-registering as a known donor with the Human Fertilisation and Embryology Authority (HFEA) might be futile, since the family created out of my donation would never realise that their donor was willing to be known. Still, it was a matter of principle for me, and one that required substantial soul searching.

I asked myself the many questions that many donors in my position might ask: Can I empathise so much with these people that I’m prepared to open my door, my life, my family at a time that suits them? At the same time, can I be distant enough and accept that whilst I am prepared to make important steps towards that person’s wellbeing, I will never find out if indeed they are well? More importantly, how would my children deal with this? They had absolutely no say in my choice to become a donor, but it’s known that many donor-conceived people are more curious about their half-siblings than their donor. In other words, it wouldn’t be me they were after; they would want to meet my own ‘flesh and blood’ children.

Through the NGDT I had access to donor-conceived young adults, donor conception parents and various fertility professionals. But not surprisingly the act I was contemplating was, and to a large extent still is, uncharted territory. It seemed no one could help me find the answers I needed. As not just a donor but also heading the NGDT, I did not just want to accept it – I had to wholeheartedly support and embrace it.

My answers came through my children. By then my seven year old daughter and son were developing into individuals with their own quirks, traits and habits. I divorced their father when they were one and remarried when they were four. In other words, I have my own social experiment going on with twins fathered by one man, raised by another.

My children have taken on habits from both men. Unlike donor parents, however, I know where this comes from and can share that with them when appropriate. This may seem rather trivial from the outside, but I know from experience that it does matter to them.

I donated to help other people less fortunate than myself. I went through weeks of unpleasant injections and examinations, believing I was doing the right thing. ‘Doing the right thing’ has been my drive through all of this: being a donor, leading the NGDT, raising awareness. And now doing the right thing means giving the children I helped to conceive access to information about me.

I have since re-registered and am happy to make myself available to the child born out of my donation. If I can help to give them understanding about themselves I will gladly help. It may seem like a little thing, but I know from experience it could mean the world to them.”

“Egg Donation: Why I gave up my right to remain anonymous

I read this great post which was published by Gail Anderson a delightful individual owns and operates The Donor Concierge which is a surrogacy and consulting service located in California.

“Egg Donation: Why I gave up my right to remain anonymousBy Laura Witjens, Chair of the National Gamete Donation Trust, egg donor and mother 08 June 2009.

Following a change in the law that came into force on 1 April 2005, British people conceived using donated egg, sperm or embryos can ask for identifying information about the donor when they reach the age of 18. Here Laura Witjens, egg donor and mother of two, writes about why she elected to remove her anonymity and potentially become identifiable to any children born from her donation.

I’ll never know what made me watch breakfast television that morning. Being a single working mother with two one-year olds, it was a luxury I could ill afford. But I did, and one of the items changed my life forever. The same day, I contacted a fertility clinic and told them I wanted to be an egg donor.

It was the year 2000 and discussions about the removal of anonymity from egg and sperm donors were only just taking place between patient groups and other fertility organisations. For me, at the time just a willing and partly-informed donor, the notion of being known to any resulting offspring wasn’t even a blip on the radar. The counsellor who I saw at the clinic was satisfied I knew what I was doing and, other than the known medical ones, no other long-term implications were discussed. Some months later the deed was done: 13 healthy follicles were harvested and I left the clinic with the feeling I’d done something momentous. Just how momentous, I only found out years later.

Not satisfied with the information available, as well as certain parts of the process, I made another life changing step. I contacted the National Gamete Donation Trust (NGDT) and asked if I could volunteer. I became a Trustee and, motivated by the pending removal of anonymity and differences of opinion with other Trustees, I went on to become the Chair. It’s a position I’ve held for the last six years and in this time I’ve taken part in many gamete donation discussions.

I firmly believe in leading by example, a philosophy I carry through to my work as a business woman and as Chair of the NGDT. So, with such an emotive subject, how could I lead an organisation without putting my money where my mouth was? If I truly believed in the identity of the donor being disclosed to the donor-conceived person, the legislation at the time of my donation shouldn’t have been relevant to me. I knew that re-registering as a known donor with the Human Fertilisation and Embryology Authority (HFEA) might be futile, since the family created out of my donation would never realise that their donor was willing to be known. Still, it was a matter of principle for me, and one that required substantial soul searching.

I asked myself the many questions that many donors in my position might ask: Can I empathise so much with these people that I’m prepared to open my door, my life, my family at a time that suits them? At the same time, can I be distant enough and accept that whilst I am prepared to make important steps towards that person’s wellbeing, I will never find out if indeed they are well? More importantly, how would my children deal with this? They had absolutely no say in my choice to become a donor, but it’s known that many donor-conceived people are more curious about their half-siblings than their donor. In other words, it wouldn’t be me they were after; they would want to meet my own ‘flesh and blood’ children.

Through the NGDT I had access to donor-conceived young adults, donor conception parents and various fertility professionals. But not surprisingly the act I was contemplating was, and to a large extent still is, uncharted territory. It seemed no one could help me find the answers I needed. As not just a donor but also heading the NGDT, I did not just want to accept it – I had to wholeheartedly support and embrace it.

My answers came through my children. By then my seven year old daughter and son were developing into individuals with their own quirks, traits and habits. I divorced their father when they were one and remarried when they were four. In other words, I have my own social experiment going on with twins fathered by one man, raised by another.

My children have taken on habits from both men. Unlike donor parents, however, I know where this comes from and can share that with them when appropriate. This may seem rather trivial from the outside, but I know from experience that it does matter to them.

I donated to help other people less fortunate than myself. I went through weeks of unpleasant injections and examinations, believing I was doing the right thing. ‘Doing the right thing’ has been my drive through all of this: being a donor, leading the NGDT, raising awareness. And now doing the right thing means giving the children I helped to conceive access to information about me.

I have since re-registered and am happy to make myself available to the child born out of my donation. If I can help to give them understanding about themselves I will gladly help. It may seem like a little thing, but I know from experience it could mean the world to them.”

Three Day vs Five Day Embryo Transfer

We know that the primary reasons embryos don’t make it to blast is they don’t have the genetic instructions to continue — and we can’t change or improve the genetics or egg quality of an embryo. If you have faith in your lab there really is no risk with continuing to culture those embryos to blast stage.

Some say that embryos are better in the uterus at day 3 while others say they are not because if you were having a baby the old fashioned way the embryo remains in the fallopian tube until day five or blast stage. And really if we think about it (Ask your RE I bet he agrees with me) the uterine environment on day 3 isn’t the same as your fallopian tubes. And on top of that with what labs do regarding sequential culture systems that help grow embryos to blast — those kinds of conditions in the lab are as close to the fallopian tubes as you are going to get. So with all that being said maybe embryos are better off in the lab until blast.

Now — the reason we grow embryos to the blast stage in the lab is to weed out those embryos on purpose that don’t have the genetic potential to grow into babies. So the risk folks talk about I think doesn’t really exist. I mean think about it — if they make it they make it — if they don’t they don’t. Now I know there is always the risk that zero embryos make it to blast in the lab but I bet my bottom dollar that the issue is genetically related and not something to do with the lab. ie egg quality or sperm quality issues.

There’s also lots of reasons that labs do three day transfers – first of all it’s less expensive and cheaper. It’s less work for the lab and I think there less liability (i.e. the lab has the embryos for a shorter period of time, the patient always makes it to transfer, and last but not least if the cycle doesn’t result in a positive pregnancy test the program still looks fine) So with all that being said I am thinking that day three embryo transfers are done for a myriad of reasons.

So I have to say this about blast transfers — just because you have a blast transfer doesn’t mean you are automatically going to have a baby. Now when your embryo reaches blast stage it’s okay to think that these embryos are capable if implanting right where they are supposed to and go on to develop into a baby. There are still a few potential obstacles to overcome — the embryos are transferred into the uterus and they have to attach to the wall of the uterus and then go on for the next ten days completing the implantation process. That process is out of the control or the hands of the clinic, and like I have always said it’s really a crap shoot at that point.

What we do know is at the blast stage embryos are capable of implanting, whereas day three embryos we don’t know for sure if they even going to make it to blast — what we do know however is lots of 3 day transfer result in babies.

My son is the result of a three day transfer.

Lots to think about. Yes?

Three Day vs Five Day Embryo Transfer

We know that the primary reasons embryos don’t make it to blast is they don’t have the genetic instructions to continue — and we can’t change or improve the genetics or egg quality of an embryo. If you have faith in your lab there really is no risk with continuing to culture those embryos to blast stage.

Some say that embryos are better in the uterus at day 3 while others say they are not because if you were having a baby the old fashioned way the embryo remains in the fallopian tube until day five or blast stage. And really if we think about it (Ask your RE I bet he agrees with me) the uterine environment on day 3 isn’t the same as your fallopian tubes. And on top of that with what labs do regarding sequential culture systems that help grow embryos to blast — those kinds of conditions in the lab are as close to the fallopian tubes as you are going to get. So with all that being said maybe embryos are better off in the lab until blast.

Now — the reason we grow embryos to the blast stage in the lab is to weed out those embryos on purpose that don’t have the genetic potential to grow into babies. So the risk folks talk about I think doesn’t really exist. I mean think about it — if they make it they make it — if they don’t they don’t. Now I know there is always the risk that zero embryos make it to blast in the lab but I bet my bottom dollar that the issue is genetically related and not something to do with the lab. ie egg quality or sperm quality issues.

There’s also lots of reasons that labs do three day transfers – first of all it’s less expensive and cheaper. It’s less work for the lab and I think there less liability (i.e. the lab has the embryos for a shorter period of time, the patient always makes it to transfer, and last but not least if the cycle doesn’t result in a positive pregnancy test the program still looks fine) So with all that being said I am thinking that day three embryo transfers are done for a myriad of reasons.

So I have to say this about blast transfers — just because you have a blast transfer doesn’t mean you are automatically going to have a baby. Now when your embryo reaches blast stage it’s okay to think that these embryos are capable if implanting right where they are supposed to and go on to develop into a baby. There are still a few potential obstacles to overcome — the embryos are transferred into the uterus and they have to attach to the wall of the uterus and then go on for the next ten days completing the implantation process. That process is out of the control or the hands of the clinic, and like I have always said it’s really a crap shoot at that point.

What we do know is at the blast stage embryos are capable of implanting, whereas day three embryos we don’t know for sure if they even going to make it to blast — what we do know however is lots of 3 day transfer result in babies.

My son is the result of a three day transfer.

Lots to think about. Yes?