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In a few weeks the holiday cards will begin arriving. First a trickle–one or two a day –and then something of a family pictures tsunami. Working with infertile individuals and couples, I know how painful this can be. Many get to a point where they cannot even open these greetings of the season. Too many cards hold surprises—a third child, people whose wedding seemed minutes ago now have two children and worst of all, a family photo with a mom way too visibly pregnant.

For me, the annual cascade of photos is a very different experience and one that brings great delight. For me the cards are not simply photos of children: they are photos of stories. As I admire the children, I remember the back stories: the miscarriages, still births, quandaries over egg donation and adoption, worries about surrogacy and puzzles over embryo donation. I remember the mother who survived a life threatening delivery and went on to welcome her second child through surrogacy and the dad who said he never wanted to adopt and then became the over—the—moon dad to three daughters from China.

The cards have many stories but they bring with them one message and that is surely my message for the holiday season: people “get to baby.” That phrase—“get to baby” or G2B—has become my watchword and one I share with all my clients. I’ve seen it again and again—people who want to be parents or to expand their families with a second or third child find a way to do so.

New York Times, July 19.2016
I.V.F. Does Not Raise Breast Cancer Risk, Study Shows
BY CATHERINE SAINT LOUIS

Several years ago, the notion of “the good enough mother” became popular in psychology. The idea was that striving for some idealized notion of parenthood was fruitless and even harmful. By contrast, parents who accepted that they could not be perfect, served themselves and their children well. Lately, I have been thinking about how this approach relates to egg donation. Along the way, I’ve become a strong believer in “the good enough donor.”

Many women embarking on egg donation find their “good enough donor” with relative ease. She is usually someone who resembles the intended mom in broad brushed strokes. The good enough donor is ready and willing to donate and she has communicated some things about herself that resonate with the intended parents. They like what they see in the photos she sends and what they read in her responses to questions on their donor agency questionnaire. Their good enough donor is someone they feel they can relate to, someone who shares their values to some degree and either has interests and talents similar to or complementary to theirs. And perhaps most important, the good enough donor is likely to have an ample number of “good” eggs.

Were that it was that simple. Unfortunately, not everyone subscribes to the idea of the good enough donor. There are some people on a quest for what I would call “the idealized donor” For them, the search for a donor is not “short and sweet;” it is long and arduous.

There was a piece on today’s Morning Edition (NPR) that began something like this, “Here’s a story of the lengths one couple went to have a baby.” As someone who counsels people struggling to build their families, my ears perked up, curious as to what would follow.

The very short version, of what was a sixteen month saga, was that a gay couple had a baby through an egg donor and surrogate in Thailand. When baby Carmen was born, the surrogate tried to claim custody, saying that she did not know that the intended parents were gay and she did not support gay parenthood. Last week the Thai court ruled in favor of the biological father, Bud Lake and his husband, Manuel Santos. Morning Edition was now turning its attention to the relieved parents, celebrating with them and asking Mr. Lake what advice he’d have for others considering surrogacy. He responded, “Be sure to vet your agency. Our surrogate should never have been a surrogate.”

I agree with Lake’s advice to “vet your agency,” but wish that NPR had asked him to elaborate on this comment rather than simply dismissing his surrogate as inappropriate. Even in NPR’s brief account of the tale, there were several red flags that pointed to agency shortcomings that went beyond proper selection and screening of surrogates.

The first thing that jumped out to me was that this surrogate/gestational carrier did not seem to know that her “IP’s” were a gay couple.

Dr. Avner Hershlag, Chief of the Center for Human Reproduction of North Shore University Hospital, writes:

I strongly object to Dr. Andreas G. Tzakis’s characterization of gestational carriers as ‘a class of people who rent their uterus.’ This is an insult to our patients and the women, often close relatives, who carry a baby for them. This experience has brought out the best in these families, with so much love and compassion in the utmost act of giving.

“As long as a woman who carries a pregnancy for another woman is ready to take on the usual risks of pregnancy, this existing widely used method should weigh against the experimental transplantation.”

Uterus Transplants May Soon Help Some Infertile Women in the U.S. Become Pregnant (New York Times, November 12, 2015)

Author Denise Grady quotes Dr. Andreas G. Tzakis, the director of solid organ transplant surgery at the Cleveland Clinic on the ethics of uterine transplant (which he considers superior) versus surrogacy: “You create a class of people who rent their uterus [sic], rent their body [sic], for reproduction. . . It has some gravity. It possibly exploits poor women.”

Many things have the potential for exploitation. This does not mean that surrogacy, as it is practiced in the US, is actually exploitative. Although this new surgery is an exciting, new field for transplantation surgeons, it has the potential to exploit women by having them undergo unnecessary, dangerous surgery when there are safer alternatives, such as surrogacy.

The class action lawsuit filed in April 2011 will likely go to trial next year, according to a front page article in today’s NY Times.

The suit claims that the ASRM’s guidelines capping donor compensation to 10K, although technically not a law, is in effect illegal price fixing. Some agencies have been flouting this cap for a while, as there is no legal limit on egg donor compensation. We at NAFG do not, however, because as members in good standing of the ASRM and SART, we pledge to abide by these guidelines, and only to work with clinics that also abide by them. A representative from the ASRM a few years ago read our Web site text with a fine tooth comb, pointing out all the places we needed to add yet more references to their guidelines. So these guidelines remain a powerful force: their purpose is to self-regulate the industry so the government does not step in and regulate it for us.

The article mentions donor compensation as high as 75K; I have never encountered anything like this. If it is true, it is rare. However, qualified (clear their screenings and make a good number of high quality eggs) and desirable (highly educated and attractive) donors are very hard to find. Without the compensation cap, donors can demand their own prices, making the field even more competitive.

As outdated as the compensation cap is, we at NAFG have found the order it imposes useful.

This study was based only on the self-reported statistics by the participating SART clinics; available on the SART Web site. It is no surprise that frozen are somewhat less successful; these statistics have always been clear, although they are improving.

Still, frozen offers a number of advantages over fresh, such as the elimination of cycle synchronization (which can be difficult for the donor and recipient to coordinate); indeed, there is a lower cycle cancellation rate with frozen eggs. In some cases, frozen eggs cost less than fresh cycles.

At Northeast Assisted Fertility Group, we have a selection of frozen eggs from donors who have donated successfully in the past, and offer them in larger batch sizes (than the typical frozen egg bank offers). This mitigates the risks. These factors were not taken into account in the study.

(JAMA. 2015;314(6):623-624)

http://jama.jamanetwork.com/article.aspx?articleid=2425734

Unborn Child Faces Uncertain Fate in Sherri Shepherd’s Divorce War.

http://nypost.com/2014/07/14/unborn-child-faces-uncertain-fate-in-sherri-shepherds-divorce-war/

We have seen a marked increase in straight and gay European, Asian, and South American singles and couples coming to us as intended parents eager to pursue surrogacy. It is important to establish a proper legal foundation for these transnational cases (as well as for those involving donor eggs). The immigration component is critical–we always insist on a cooperative relationship with counsel from the home country of the intended parent(s).