PGS – New Study addresses impact of preimplantation genetic screening on donor oocyte-recipient cycles in the United States

Preimplantation genetic screening, or PGS, as practiced in donor oocyte-recipient cycles over the past 9 years, has not been associated with improved odds of live birth or reduction in miscarriage rates.

PGS Study ObjectivePGS, PGD

Our objective was to estimate the contribution of preimplantation genetic screening to in vitro fertilization pregnancy outcomes in donor oocyte-recipient cycles.

PGS Study Design

This was a retrospective cross-sectional study of US national data from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System between 2005 and 2013. Society for Assisted Reproductive Technology Clinic Outcome Reporting relies on voluntarily annual reports by more than 90% of US in vitro fertilization centers. We evaluated pregnancy and live birth rates in donor oocyte-recipient cycles after the first embryo transfer with day 5/6 embryos. Statistical models, adjusted for patient and donor ages, number of embryos transferred, race, infertility diagnosis, and cycle year were created to compare live birth rates in 392 preimplantation genetic screening and 20,616 control cycles.

PGS Results

Overall, pregnancy and live birth rates were significantly lower in preimplantation genetic screening cycles than in control cycles. Adjusted odds of live birth for preimplantation genetic screening cycles were reduced by 35% (odds ratio, 0.65, 95% confidence interval, 0.53–0.80; P < .001).

PGS Conclusion

Preimplantation genetic screening, as practiced in donor oocyte-recipient cycles over the past 9 years, has not been associated with improved odds of live birth or reduction in miscarriage rates.

November 2017, American Journal of Obstetrics and Gynecology 

Click here to read the entire text of the study.

Irish government to pay for couples to have IVF treatment and outlaw commercial surrogacy

The Government will today commit to funding IVF treatment for couples unable to conceive from 2019.

Minister for Health Simon Harris is to bring a memo to Cabinet this morning outlining proposed regulatory measures for the area of assisted human reproduction.IVF

It is understood Mr Harris will commit to outlawing commercial surrogacy and the payment for egg, sperm or embryo donors.

The memo will provide for an ethical framework with clear rules for the welfare of the child, woman and informed consent.

Speaking on his way into the Cabinet meeting on Tuesday morning, Mr Harris said that by the end of the year he wants to clarify for families what financial assistance would be available for IVF from 2019.

“I made it very clear that I want to put in place supports to help subsidise the cost of IVF for families,” Mr Harris said.

“One in six of us could experience infertility challenges at any time and I would like to by the end of the year be in a position to provide clarity to families in terms of what supports we may be able to provide from 2019.”

Mr Harris said the Assisted Human Reproduction Bill will “regulate this whole area”.

“I hope to send it to the Oireachtas Committee subject to Cabinet approval for pre-legislative scrutiny and get it passed into law in 2018 with the idea of having public subsidies for IVF for 2019,” he said.

The Irish Times, October 3, 2017

Click here to read the entire article.

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

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

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

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

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

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

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

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

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

Click here to read the entire article.

TIAA adds LGBT benefit to help female couples with family planning

Investment advisory firm TIAA has added reciprocal IVF assistance to its family planning benefits package as an LGBT inclusion measure.

The New York City-based firm officially added the benefit July 1 after conversations with its LGBT employee resource group during Pride Month in June.

“The addition of reciprocal IVF [meaning one partner supplies the eggs to be used for IVF, while the other partner is the gestational carrier of the pregnancy] could significantly help female couples achieve their family planning goals, and we want to provide them with the same support other employees already receive,” says Skip Spriggs, senior executive vice president and chief human resources officer at TIAA. “It wasn’t a cost issue, but it was about creating the right environment.”TIAA

Prior to this benefits addition, employees had to go through a pre-certification process with a claims administrator to verify infertility, says TIAA. Now, employees can have IVF services covered without verifying that they tried natural or artificial insemination. Similarly, female couples don’t have to provide infertility to gain access to IVF as a covered benefit, the firm says.

Only 57% of employers offer a type of infertility service coverage, and 25% of the employers cover IVF, according to Mercer’s 2016 “National Survey of Employer-Sponsored Health Plans.”

by Amanda Eisenberg, August 21, 2017 – benefit news.com

Click here to read the entire article.

What Donor Conceived People Think of Donor Conception

The number of donor conceived children (donor sperm, donor egg, and donor embryo) is expanding.

In many ways it feels that we are standing on a precipice. We have such an opportunity in front of us to avoid some of the mistakes made in the past with both sperm donation and adoption, and yet I fear we are not learning.  Donor conceived children may have the answer.

The real experts on the best way to raise a child conceived by donor sperm, egg, or embryo are the adults that were conceived by donor conception way back in the day (or not so way back). I recently read the results of a fascinating survey of 82 donor conceived adults on We Are Donor Conceived.IVF

The people who responded to the survey were from around the world, mostly female (84%), raised by heterosexual parents (82%), and conceived by donor sperm (81 out of 82). They were born between 1954 and 2000, with 42% being born in the 1980s.

Donors and Donor Siblings are Important

According to We are Donor Conceived, 65% of respondents agree with the statement “My donor is half of who I am”. 94% indicated they often wonder what personality traits, skills, and/or physical similarities they share with their donor. 96% of respondents said they would like to know how many donor siblings they have, and a strong majority indicated they are open to forming a relationship with their donor (87%) or donor siblings (96%).

Eighty-six percent of the respondents thought that anonymous donation should not be allowed.

When Did They Find Out They Were Donor Conceived

The results on when they found out they were conceived by donor surprised me because I assumed that more of them would have found out later in life. The survey, however, found that 61% were five years or younger when they found out.

by Dawn Davenport, August 24, 2017 – Creatingafamily.org

Click here to read the entire article.

A Baby or Your Money Back: All About Fertility Clinic Package Deals

Trying to have a baby with the aid of modern reproductive technology can feel like visiting a gambling parlor with the highest possible stakes.

So consider the pitch that many fertility clinics now put in front of people like Kristi and Carleton Chambers.

After several miscarriages, the Leesburg, Va., couple took their doctors up on an offer to hand over $50,000 — $20,000 more than what they might have paid for the in vitro fertilization and other services that they needed at the time. In return, the clinic promised multiple procedures until they gave birth, and if it didn’t work, they would get a full refund.IVF

The catch? If they made a baby on the first try, the practice would keep all their money. That is exactly what happened — to their great joy. After their baby boy was born, the couple eventually signed up for a similar deal and ended up with twins.

Welcome to the fertility casino, which frequently presents the rarest of scenarios: A commercial entity offers a potentially money-losing proposition to customers in exchange for a generous supply of in vitro fertilization procedures. People pay tens of thousands of dollars for the privilege, and when they come out with a newborn in their arms they’re often thrilled to be on the losing end financially.

So who wins? The house. Doctors (and third-party companies that help manage these programs and may take on any financial risk) keep careful track of their data. So they set prices at profitable points given the odds.

Here’s how the house can stack the deck: By admitting only people who have a better-than-even chance of bearing a child early in the process. Those people, however, may not need to pay extra for such a plan, given that their clinics picked them precisely because they were such good bets.

“It’s kind of like the clinic bets on your success, and you bet on your failure,” said Sarah Burke, a Pittsburgh woman who became a parent after enrolling in such a program.

Some of the overall performance numbers of fertility clinics are available in federal databases, but at my request, FertilityIQ, an information clearinghouse and doctor-review service, recently gathered some additional data.

Of the 54 people it found who had enrolled in a baby-or-your-money-back program, 30 of them achieved success not just in the first I.V.F. “cycle” (when doctors retrieve eggs) but on the first transfer — that is, the first time, after retrieval, that doctors attempt to implant an embryo or embryos they created with those eggs. A total of 67 percent were successful in the first cycle, which is at least 20 percentage points or so higher than the birthrate that similarly aged women nationwide experience in any I.V.F. cycle.

So are those two sets of women comparable? Not exactly.

three-parent babyWhile we shouldn’t make too much out of a sample size this small, FertilityIQ’s founders, Jake Anderson and Deborah Bialis, believe that doctors cherry-pick patients who have a high likelihood of success. According to Mr. Anderson and Ms. Bialis, a married couple who were themselves treated for infertility before becoming parents, medical professionals screen the harder cases out — say, people with more problematic diagnoses or those who are older or have a high body mass index.

That’s what happened to Johanna Hernandez of Marana, Ariz., who — after two miscarriages and struggles with I.V.F. — couldn’t get into a program that offered multiple rounds and a refund. “We’re in such a precarious position,” she said. “At the beginning, there’s no way to know that you’re going to need these programs. But at the end, they just won’t help you.”

Ms. Hernandez and her husband paid for additional à la carte treatment, had one more miscarriage along the way and now have a baby boy.

Another way for doctors to improve the odds of producing more babies would be to implant more embryos during each transfer. The American Society for Reproductive Medicine frowns on this, given the additional risks that come with twins and triplets. It has also warned of this possibility in a position paper on the package deals and refund programs, which are known in the industry as “risk-sharing.”

New York Times – April 14, 2017 by Ron Leiber

Click here to read the entire article.

Conscious Surrogacy – Making the Best Decisions For Your Family

Is there such a thing as conscious surrogacy? Yes, and those considering surrogacy will be confronted with some serious ethical questions.

Conscious surrogacy is a process. It is critical to understand some of the questions, and dilemmas, that you will face if you choose surrogacy to help you have your family.  If you are prepared to answer these questions before your surrogacy journey, and if you are comfortable with your answers, then you are ready to have these conversations with a potential surrogate mother.

What are some of the questions that you will face on your conscious surrogacy journey?

Do I want a single embryo or double embryo transfer? Do I want twins?  One of the first questions you will have to consider is whether you want to try and have twins with your surrogate mother.  Many choose this option for economic reasons.  If you know that you want more than one child, consecutive surrogacy journeys may not be an option.  But there is much more to consider.

conscious surrogacy

Twin pregnancies are much harder on the surrogate mother.  It can mean doctor ordered bed rest for your surrogate and more doctors’ visits, particularly in the third trimester.  Twin pregnancies also bring a higher risk of complications for the surrogate, such as preterm labor, and hypertension.

Twins arrive earlier. A normal singleton pregnancy is 40 weeks.  Most twins arrive early, at or before 36 weeks, which means that one or both of the children may require an extended hospital stay in the NICU (neonatal intensive care unit.)  Some doctors state that in 50% of twin pregnancies, a NICU stay is required.  This by itself may give parents pause about choosing a double embryo transfer.  Studies show that consecutive singleton births result in better medical outcomes than a single twin birth.  With all the information, you can make a conscious decision.

Do I want PGD or PGS? Preimplantation genetic diagnosis or screening is now being offered by most IVF facilities.  PGD or PGS allows a parent to view the genetic material of their child before an embryo is implanted in a surrogate mother’s womb.  PGD/S can show whether a child has any genetic disorders, the sex of the child and other genetic traits that may complicate a pregnancy.  While infertile couples who use IVF (in vitro fertilization), or anyone with a preexisting genetic condition,  may be familiar with PGD/S, couples or individuals who have their families with the assistance of a surrogate mother will most definitely be asked whether they want the information that PGD/S provides.

Knowing whether there is a genetic complication prior to embryo implantation may be in the best interests of all parties, however, choosing the sex of your child before it is born ventures into an ethical quagmire. Most families do not have this information and, while the technology exists, you must ask whether you want the information that it can provide.  The mental and physical health of your surrogate mother must be a priority in making this decision.

Do I want to selectively reduce if complications arise? Perhaps the most important questions you will confront is whether or not to selectively reduce, or abort, an embryo or fetus if there is a danger to the surrogate mother or to the child.  In reality, no state will enforce a gestational carrier contract which requires selective reduction.  The surrogate mother will always have the final say.  But you must know what you want first before you can discuss it with your surrogate.

While abortion is one of the most controversial topics in American society, it is routinely a part of conversations that intended parents have with their surrogate mothers. Surrogacy agreements attempt to cover all possible outcomes and obstacles that can arise during a surrogate pregnancy.  The most important aspect of this topic is being able to communicate your beliefs and desires with your surrogate.

There are many more issues that intended parents will face. Conscious surrogacy is about understanding the major decisions surrounding these issues and being able to come to a place of peace with each one, first with yourself, then with your surrogate mother.  Respecting her autonomy during the pregnancy will take you a long way toward reaching this goal.  Maintaining open and honest communication with your surrogate mother will also help to ensure that the journey is successful for all involved.

For more information about surrogacy, please visit http://www.timeforfamilies.com or email me at Anthony@timeforfamilies.com.

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New standards will tighten rules governing sperm and egg banks in Canada

Rigorous screening requirements would apply to those who donate sperm and eggs within Canada as well as abroad, when intended for export to Canada.

 

Sperm and egg banks will be required to review donors’ medical records and conduct more genetic testing under proposed new Canadian standards for assisted reproduction, which will be unveiled within two weeks, the Star has learned.

Developed by the Canadian Standards Association at the request of Health Canada, the new draft standards are intended to bring the country’s woefully outdated regulatory framework around assisted reproduction into the 21st century, says Dr. Arthur Leader, chair of a CSA subcommittee on assisted reproduction.Human Sperm Cell

Rigorous screening requirements would apply to those who donate sperm and eggs within Canada as well as abroad, when intended for export to Canada. Most donated sperm and eggs used in Canada comes from abroad.

Had these improvements already been in place, it’s unlikely the sperm of a U.S. man who turned out to have been diagnosed with a number of serious mental illnesses, including schizophrenia, would have made its way across the border, Leader says.

“If there had been a validated medical record, they would have caught this case,” he said.

Chris Aggeles had been advertised by Georgia-based sperm bank Xytex Corp. as exceptionally healthy, based on a medical history questionnaire he had filled out. His sperm was subsequently used in the creation of at least 36 children in Canada, the United States and Britain.

But the truth about his health was revealed only after Xytex mistakenly released his name to some mothers in an email. Until then, he had been anonymous.

Angie Collins, a Port Hope, Ont., woman who is mother to a nine-year-old boy created from Aggeles’ sperm, is thrilled about the proposed changes, particularly the requirement for sperm banks to check donors’ medical questionnaire against their health records.

Collins is one of a number of mothers who is suing Xytex.

“Until now, the honour system has been the relied-upon method and it is clearly ineffective. This would help to prevent situations like ours from arising. Parents would not have to spend years wondering if their child will or will not inherit the donor’s known debilitating mental health conditions,” she said.

The CSA’s new draft standards are intended to underpin improvements to the regulatory framework of assisted human reproduction legislation. They are being released for public commentary.

“Suggestions are most welcome because we want the best standards in the world. The hope is that Health Canada will reference these standards in their entirely in their regulations,” Leader said.

The news of the pending release of the draft standards comes a week after Health Canada announced plans to strengthen and clarify the regulations in the Assisted Human Reproduction Act.

Canada’s current semen regulations are focused primarily around screening donor sperm for sexually transmitted infections such as HIV, Hepatitis B and C and gonorrhea.

There exist no regulations for donor eggs or donor embryos.

TheStar.com by Theresa Boyle – 10/7/2016

Click here to read the entire article.

New York’s Changing Family Law

New York’s changing family law finally appears to be catching up to the realities of LGBT families, at least incrementally.

A series of decisions from various New York courts is informing New York’s changing family law in ways never before imagined. Currently, in Manhattan, a court is struggling with how best to protect a child born in Ethiopia, which would only allow a single mother to adopt, now that his lesbian parents have split up.  Another recent decision out of the Kings County Family Court is one of the first to acknowledge the complexities of how we create our families, and offers sage advice as to how best we can protect them.

New York's changing family law

This new line of cases comes hot on the heels of the New York Court of Appeals case known as The Matter of Brooke S.B., which I have written about extensively.  Up until this decision, many lesbian parents who had not adopted the biological children of their partners or spouses were considered legal strangers to the children that they had raised since birth.  They were blocked by the court from seeking custody and visitation when their relationships faltered.  The Matter of Brooke S.B brings New York’s changing family law in line with many other states which recognize “de facto” parents for the purpose of custody and visitation and prioritizes the best interests of the child in making these critical decisions.

The court in Brooke S.B. was careful not to expand the definition of parentage beyond the facts of each specific case, which means that we will be seeing more and more litigation attempting to address situations that do not fall squarely in the fact pattern of Brooke S.B., like the current case in Manhattan.

In a move to address confusion created by a 2013 decision from Kings County Surrogates Court, where Judge Margarita Lopez Torres denied a lesbian couple a step parent adoption because she held that a marital presumption of parentage existed when a  child is born to a married couple, Brooklyn Family Court has offered its opinion.  New York’s Appellate division, Second Department held the opposite of Lopez Torres (Paczkowski v. Paczkowski, — N.Y.S.3d —- (2015)), creating much confusion for the LGBT community.  Brooklyn Family Court Judicial Hearing Officer (JHO) Harold Ross, in a decision titled The Matter of L., et. al, held that as long as uncertainty exists for LGBT couples who create their families with assisted reproductive technology (ART), then second parent adoptions are the best way to secure those families from this uncertainty.

The bottom line of New York’s changing family law is that with each new case that tests the limits of the court’s definition of family, hundreds of thousands, if not millions, of dollars will be spent to “make new law,” when there already exists a remedy that is affordable and is respected across the country and around the world, second and step parent adoption.  The process may be time consuming but the benefit is priceless and I believe that JHO Ross understood this and made New York’s changing family law easier for us all to grasp.

For more information, contact Anthony@timeforfamilies.com.

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Ethical Surrogacy – Making the Right Choices

Ethical surrogacy is, and must be, the goal of an intended parent (IP) who is looking to have a family with the assistance of a surrogate mother.

Because of the different parties involved and the roles that they play, there must be a guiding, ethical roadmap for intended parents to follow to ensure that everyone has a successful and positive experience, an ethical surrogacy. Up until very recently, no such roadmap existed for intended parents.  Doctors have such guidelines in the ASRM (American Society of Reproductive Medicine) Recommendations for Practices Utilizing Gestational Carriers.  Attorneys also have such guidance in numerous articles and section committees dedicated to issues surrounding surrogacy.

Respect Ethics Honest Integrity Signpost Meaning Good Qualities

Now there is a place where intended parents can go to review best practices and baseline protocols for ethical surrogacy, ensuring that each IP has the tools to create an ethical journey. Men Having Babies (MHB), a non-profit organization of which I am the board chairperson, recently introduced A Framework for Ethical Surrogacy for Intended Parents, available online in English, French, German, Spanish, Italian and Hebrew.  This comprehensive document is supported by several LGBT organizations in America and abroad.

What is Ethical Surrogacy?

MHB’s ethical surrogacy framework revolves around the notion that surrogacy can be a wonderful and fulfilling experience for all parties involved, even if the surrogate is compensated for her efforts, risk and inconvenience. While compensation is part of the process, the act itself is not commercial because the IPs are not buying anything, particularly a child, which is a claim made by some anti-surrogacy activists.  A surrogate efforts should be compensated, even if the journey does not result in a pregnancy or in the case of a miscarriage.

How can Ethical Surrogacy be Achieved?

Regulation is the key to achieving ethical surrogacy. Having laws in place that require independent representation for all parties ( in their home languages), ensuring that all parties are vetted medically and psychologically, limiting compensation so as not to create irresistible incentives for participation and making surrogacy legal in each state and in each country so IPs and surrogate mothers do not have extraordinary distances between them, all work together to create an ethical surrogacy environment.

Reasonable and appropriate legislation should be enacted to allow perspective parents, donors and surrogates enter into legally enforceable agreements for surrogacy arrangements without having to cross state lines or country borders. This fosters more successful and fulfilling relationships between surrogate mothers and IPs.  Steps must also be taken to limit any medical risks that donors and surrogates face in the surrogacy process.

Baseline Protocols for Providers

Several baseline protocols should be implemented by service providers to ensure an ethical surrogacy experience including, but not limited to: informed consent from all parties, medical screening, social and psychological screening, independent legal representation (with language interpretation is required) before any treatments begin, medical insurance review from the surrogate mother and an agreement regarding contact during and after the surrogacy journey.

Best Practices

Best practices are suggestions for “above and beyond” thinking that is required of IPs because so much of the integrity of the journey depends on them. Among these suggestions is the creation of a long term vision about your family.  Who will be the biological parent?  How many journeys do you anticipate? What will the relationships be during and after the surrogacy?  How will you explain your family make-up to your child?  These questions are just a few of those that need to be asked and answered in the surrogacy process.

Above all, the autonomy of your surrogate mother must be respected and supported. While it may be your child that she is carrying, it is her pregnancy.  Insuring that she knows that you, as IPs, understand this distinction is critical to supporting her autonomy.  Her family and community will also play a role in her pregnancy, so getting to know her circle of support is a wonderful way of bolstering that support, making the journey a happy and healthy one for your surrogate mother.

While the MHB Framework for Ethical Surrogacy for Intended Parents goes deeper into the specifics of making your journey an ethical one, this article is designed to begin a conversation about the quality and success of your surrogacy journey.  After all, your family is worth it!  For more information, go to timeforfamilies.com or email Anthony at Anthony@timeforfamilies.com.

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