The Infertility Consultant

I am honored that the Women’s Bar Association in Washington D.C. included one of my bylined articles in its “Raising the Bar” newsletter on the topic of delayed childbearing . You can read the full piece attached to this post. 

In regards to the law, I have found that family planning can be a tricky area to navigate, especially when infertility treatments are necessary.   For example, legal considerations specific to each state may influence a couple’s decision to pursue a certain treatment option.  I have hosted various sessions at WBA groups across the U.S. addressing this very topic.  I recently held this seminar in the Washington D.C. area and was able to educate female lawyers on the ramifications of delayed childbearing, estate and family planning issues, wealth preservation and state laws regarding surrogacy and other fertility treatments.  I hope to continue these sessions with other WBA groups in 2010.

In 2009, I interviewed with one of the health editors at Working Mother Magazine on the topic of surrogacy.  Her article, “Considering Surrogacy,” appeared in the November 2009 issue. 

In the article, I discuss why many people turn to surrogacy as a way to expand their families.  The piece also explains the differences between gestational surrogacy and traditional surrogacy, as well as the legal implications and how to find the best surrogate mother. 

I was very happy to be included in this article because Lotus Blossom Consulting is committed to helping couples through the entire surrogacy process.   We are proud of the work we have done in this area and look forward to helping more people achieve their dream of being a parent.  And a big thanks to Working Mother Magazine for raising awareness of this important issue!

Read the full article here. 

As one of the first infertility consultants in the U.S., I am very happy and honored to be featured in a recent Washington Times article about a new area cropping up in the fertility industry — fertility consultants.  For couples who need help conceiving, a fertility consultant can help navigate the whole process including medical, emotional, financial and legal options.  As the article states, a ”fertility consultant is part researcher, part consumer advocate and part sympathetic ear.”

My most important asset is my advocacy piece.  With egg donations, I can help widen the potential donor pool. This cuts down on wait time while also increasing the likelihood of getting the requested genetic attributes from donors. I can also help patients maximize dollars by reviewing insurance coverage and drug benefits.

To read more about the benefits of hiring a fertility consultant, click here for the full article.

Thank you!

Understanding the Healthcare Needs of Lesbian, Gay, Bisexual and Transgender Individuals

A growing number of medical societies, health plans, academic institutions, public health officials and others have recognized the need for healthcare providers to receive special training on how to meet the unique healthcare needs of lesbian, gay, bisexual and transgender (LGBT) individuals. This fall, the Gay and Lesbian Medical Association (GLMA) is hosting the 27th Annual Conference of the Gay and Lesbian Medical Association to address this need.

I am honored to be one of the featured speakers at this event discussing how gay and lesbian families can navigate the alternative family building journey through surrogacy.

The conference will be held on September 30 - October 3, 2009 at the Westin Washington, DC, City Center.  It is the world’s largest scientific meeting focusing on LGBT health, healthcare delivery, workplace discrimination, and healthcare education and offers up to 18 hours of continuing education for healthcare professionals. In addition to rich educational offerings, the conference provides ample opportunities to meet and socialize with other healthcare professionals, students and GLMA members.

More information about the Annual Conference, including a preliminary program of educational offerings, is available at www.glma.org/annualconference.

There are countless numbers of products available to women to slow the visible effects of aging, but what about the parts of the body that are out of sight? Now with egg freezing technology it possible to stop a women’s biological clock allowing them to “freeze” their fertility for the future.

Age matters in many aspects of life as well as in the creation of life. Women are most fertile between the ages 20 to 28 with their fertility decreasing in half by the time they are 35. By age 45, only a 1% chance remains each month of conceiving naturally. This is a startling fact considering the average age a woman has her first child has risen to record high of 25.1 with 20% of women waiting until they are 35 to begin their family.

An increasing number of women choose to delay childbearing due to further schooling, career choice, or are waiting to find their perfect partner. While those choices are understandable and personal, as women naturally age so do their ovaries; affecting their fertility.  Oocyte cryopreservation, commonly known as egg banking, provides women up to the age of 38 with a chance to slow down their biological clock and effectively storing their fertility for the future.

A women’s egg supply is finite therefore, freezing your eggs allows you to stop your biological clock until you are ready to conceive, increasing the odds of having a healthy successful pregnancy. Women are born with millions of eggs yet once they reach puberty only 300 of the 300,000 eggs left will have the chance to ovulate. The frozen eggs can be thawed at anytime to be fertilized with the sperm of choice and then refrozen as embryos for future in vitro fertilization treatment cycles.

Egg banking is also an option that is highly recommended for women who have been newly diagnosed with cancer but have not begun medical treatments that may negatively impact their fertility. While treatments such as radiation and chemotherapy are lifesaving, they can potentially leave women infertile.  The ability to freeze viable eggs before undergoing cancer treatments instills hope for a family in the future.

 Egg banking, the newest technology available in the infertility field, is a wonderful option for those women who plan to delay childbearing for personal reasons or for medically induced situations. Since women do not continually reproduce more eggs over a lifetime, the availability of egg banking technology allows women to protect a precious resource and helps to ensure their fertility until such time that they are ready to begin a family.

I saw an interesting article in the Associated Press earlier this week that has prompted me to write this post.  In the article, a Wisconsin doctor claims that the number one public health threat that no one’s talking about is the epidemic of sexually transmitted diseases.  He cited STDs as one of the major causes of infertility and infant mortality.  See article here.

If you’ve been trying to conceive and haven’t been successful, consider being tested for sexually transmitted diseases.  Many sexually transmitted diseases can lay dormat for years and many women who contract STDs do not develop visible symptoms and therefore, do not know to seek treatment.

According to the Centers for Disease Control, chlamydia and gonorrhea are the most preventable causes of infertility.  The CDC sites abour 2.8 million new cases of chlamydia every year in the United States and 718,000 new cases of gonorrhea.  Over time, these diseases can be silently damaging your ability to have a baby.  These STDs can cause an infection in your reproductive organs, known as pelvic inflammatory disease which can cause scarring of the fallopian tubes and make conception and pregnancy very difficult.

There are several ways to prevent STDs and moniter them, as follows:

• Always engage in protected sexual intercourse
• Get tested for STDs regularly.  The CDC recommends routine testing for all women over the age of 25.
• Learn the symptoms of STDs and seek medical help as soon as possible if any symptoms develop
• Talk with your sexual partners about their sexual health and past sexual activities
• Delay having sexual relationshiips as long as possible - the younger a person is when they begin to have sex for the first time, the more susceptible they become to developing an STD. 

The roots of commercial surrogacy in the United States began in the late 1970’s when a Michigan lawyer began the first surrogacy agency and set out to change the laws to make surrogacy legal. Now, surrogacy is legal in all but a handful of states, even though the specific laws vary from state to state. 

So it comes as no surprise that the United States has become the preferred country for surrogacy among international prospective parents.  Some of the primary reasons I am seeing from some of my international clients are as follows:

• Many European countries restrict couples from being able to explore surrogacy
• European countries often restrict the number of embryos that can be created
   – Doesn’t allow for opportunity to create future genetic siblings
   – Doesn’t provide a back-up plan if the first IVF attempt is not successful
   – With the cost of IVF being so high, multiple attempts at continued retrievals may exceed financial reserves
   – Frozen embryo transfers can often defray some of these costs
• In some countries, like Israel, surrogacy is restricted to married heterosexual couples. So gay couples are coming into the U.S. for help in having biological children of their own.”
• Advanced technologies are superior in US
• Economic recession has some U.S.-based clinics offering money back guarantees in the event a successful pregnancy is not achieved
• Favorable exchange rates have made it attractive in this economy to explore services in the U.S.
• Some programs are offering comprehensive packages to help international clients locate resources for their surrogacy arrangements in house
   – Streamlines the process with coordination all in one place
   – Identifies insurance protections and policies to mitigate financial risk factors during pregnancy or in the unlikely event of a catastrophe
   – Interpreters available well versed in medical and legal diction
   – Work closely with immigration attorneys to accomplish the necessary paperwork for visas, passports, birth certificates and social security status.

I am proud to announce that Lotus Blossom Consulting has officially established the Jude Andrew Adams Charitable Fund to bring hope and new life to families who are struggling to conceive. My motivation and intention in creating this grant is to offer a free fertility treatment for those who could not otherwise afford it.  To learn more about this fund and how it came to fruition, please click here.

Applications for a free treatment cycle are now being accepted.  The board of directors will select from applicants who meet the following criteria:

• Have a history of infertility, and provide a physician documented medical indication for exploring IVF treatment along with the application.
• Demonstrate a financial need; defined as a gross combined annual income less than $80,000. A copy of the last two years’ IRS tax returns and two of the most recent pay stubs is required.
• No insurance coverage for infertility treatments.
• Do not currently have any children.
• Be under age 40.
• Be current legal citizens of the United States and living in the United States at the time of the award and subsequent treatment.

 The grant covers the following costs:
• Cost of treatment for one IVF cycle
• Medications for one treatment cycle

Thank you all for your help and support for this great cause.

Earlier this week, President Obama officially declared the month of June to be Lesbian, Gay, Bisexual and Transgender (LGBT) Pride Month!  As the nation celebrates this occasion, it is a good time to bring an important issue to the forefront  – alternative family building.  As noted in a past USA Today article, there is an estimated six to 12 million children in the U.S. who have a lesbian or gay parent.  And an increasing number of same-sex couples are looking to expand their families. 

Unfortunately, there are even more obstacles for gay couples when trying to start their own families due to the political and legal issues involved.  It is important to financially, physically and emotionally prepare for a challenging road ahead.  Gay couples also must enlist an attorney to draw up contracts that protect not only themselves, but also their biological offspring.  Often adoption or co-parenting agreements need to be accomplished.

Cost is another factor to consider.  Insurance benefits for surrogacy and/or IVF treatments are often restricted since same sex couples do not meet the insurance’s companies definition of “infertility.”  And sadly, discrimination is widespread.  Same sex families are denied the benefits and protections of a marriage in most states.

For Citywide PRIDE month in Chicago, I have teamed with UBS and PricewaterhouseCoopers to help gay and lesbian couples plan and prepare for parenthood.  I will be leading a FREE session titled, “Conceivable Options:  Alternative Family Building ”  Details are as follows:

Date: Thursday June 18, 2009
Time: 11:30am - 1:30pm. Lunch will be served.
Location: UBS Tower, 38th Floor, 1 North Wacker Drive, Chicago

RSVP: By June 15, 2009.  Click here. 

Topics will include understanding insurance benefits (if available), how to enlist your human resources department to determine what benefits they may be able to provide and how to identify egg donors and surrogates from “surrogate friendly” states.  The discussion will conclude with tips for how to financially plan and prepare for treatment, and a Q&A session. 

Please try to join me!  If you’re not in the Chicago area, e-mail me.  I am happy to share my presentation notes with you, or discuss options over the telephone. 

One decision that is often overlooked in donor facilitated arrangements is the determination to disclose to future offspring their genetic origins. In the past this was always done anonymously and the secrecy continued over the course of a lifetime. However, recent studies on sharing genetic origins with offspring have proved that disclosure of genetic origin at a young age is healthy in maintaining a strong relationship and bond for all involved parties.

The three main factors that play into disclosure are does the child have an inherent right or need to know biological origins, and what is in their best interests? How disclosure impacts the recipient parents? And finally, when to disclose the information to offspring?

The best interests of child can be argued from both sides, a growing number of mental health professionals agree that a child has a fundamental right to know his biological origins. No one can predict if this medical information may be necessary in the event of a medical emergency or how access to this information may help an individual when he/she is ready to start their own family. It can be argued that this information is fundamental to an individual’s sense of self and personal identity. These values need to be analyzed on an individual basis consistent with thoughts and beliefs of that particular family unit. Maintaining secrecy can be difficult, especially family secrets. If discovered, by accident, the risks of impacting the relationships and family bonds could be jeopardized.

In a study performed by Lycett et al., (2004) the impact of disclosure was analyzed on families willing to share this information with their offspring. Out of 46 donor created offspring, 60% of the families had elected not to disclose genetic origins and the remaining 40% planned to disclose the child’s origins once the child reached adolescence. What was most interesting about this study is that between the two groups there were no differences between the disclosing and non-disclosing fathers. It was the non-disclosing mothers who reported a strain with keeping the secret. Thus, indicating that non disclosure impacts mothers more intensely than it impacts fathers. Many mothers fear the reaction from the child, and are concerned about placing a strain on the parent child bond. The study highlighted that these parental attitudes may in fact impact the parent-child bond as the children get older.

In contrast, a study performed by Van Berkel et al., (2007) in the Netherlands, where non-anonymous donation is standard and the only option available, investigated secrecy in open donation arrangements. Of the participants, the vast majority felt that origins of conception had no influence on their relationship with the child. The mothers did, however, show a greater level of concern about the disclosure plans and how the children would react to the information. Thus emphasizing the fear factor expressed by mothers is in the previous study. However when comparing being required to use open donation vs. anonymous donation, all mothers agreed that the genetic origin did not impact their familial relationships and or bonds with their children. The vast majority of the cases studied in the Netherlands, showed the children regarded the donor as an aunt or special family friend.

Disclosure is not something that occurs one time. Disclosure is a story that evolves over time and through a series of opportunities for parents to come to terms with their decision and to share with offspring the need to use donor gametes as well as the emotional decision that led them to this path. Disclosure involves the need to share that the importance of family and the need to become a family unit. The decision to disclose genetic origin greatly varies from family to family and is often impacted by the specific family unit, their structure and makeup, their religious, social and cultural values.

Finding the perfect stranger is hard work physically, emotionally and often spiritually. But in addition to identifying the perfect candidate, making the decision to disclose the biological connection involves a host of various feelings, emotions and considerations that may influence the type of donor you choose. When considering using a donor, it is important to consider how and if you plan to disclose to your offspring. The type of donor you choose may affect if, but also how and when you choose to disclose to your child their origin of conception since the donor you choose may play into the roles and relationships among parents, children and extended family.

Finally, it is essential to know when to make the decision to disclose genetic origins to offspring. Although there is no one right answer, recent data shows that sharing genetic origins with children at a young age is much preferred to divulging the information in adolescence. A recent study performed by Cambridge University researchers has found that disclosure of donor paternity at an early age lowers the likelihood of negative reactions from the offspring. The study findings published in the recent issue of Human Reproduction provides different perspectives regarding the response of the offspring depending on the age at which their biological origin is disclosed. Traditionally, donor conception has been treated with secrecy. A recent increasing trend towards openness of genetic origin has showed positive impact on children of all ages. In fact, most mental health professionals specializing in collaborative reproduction, encourage parental openness to reveal genetic origins to children as young as three years old. This trend can further be evidenced by the growing number of children books written about donor conception and geared for children between the ages of three and eight years of age.

Vasanti Jadva, from the Faculty of Social and Political Sciences, Centre for Family Research, University of Cambridge, UK, and colleagues, conducted a study which evaluated the difference in responses of children and adults, when informed about their genetic origin. The scientists analyzed the data obtained from anonymously completed online questionnaires by 165 members aged between 13 and 61 years, of the Donor Sibling Registry (a worldwide registry for donors).
The study results showed that, compared to offspring of heterosexual couples, children born to lesbian couples and single mothers received information about their donor conception at an earlier age. It was also noted that the mean age of disclosure was 14 years, with 19% of the offspring knowing about their paternity after the age of 18 years and 30% before three years of age. The study also showed that 38% of the offspring did not recall the exact age of disclosure since they were too young to remember.

Yet another study on donor conception conducted by Golombok et al. (1995), showed no adverse effects on child development or on familial relationships were evidenced when children were made aware of genetic origins at a young age. Yet, a higher incidence of negative feelings was reported among individuals who received information about their origin in adulthood compared to those who were informed about their genetic origin during childhood or adolescence.

In my years of experience working with hundreds of intended parent(s) who have conceived through donor gamete, I have found that many want to share openly with their children, but just don’t know where to begin. Disclosure can be uncomfortable primarily because it was not the pathway to parenthood of choice. I encourage my clients to focus on how fortunate they are to have access to advanced technologies and fertility treatments as well as a special donor who so generously and willingly gave of his/herself to share the essential piece necessary to conceive. This small shift in conjunction with a decisive disclosure plan and the knowledge that the psychological well being of the child and the family bond will not be severed, has enabled so many of my clients to come to the realization, “I am so fortunate today, to have my most wanted child, and so fortunate back then, to have the perfect stranger.”