The Hidden Costs Of Starting A Family When Queer

The Hidden Costs Of Starting A Family When Queer

The Hidden Costs Of Starting A Family When Queer – Jac Ciardella sat at his kitchen table in New Jersey and inserted a syringe into a navel orange. His hand flexed as he squeezed the plunger, pushing water into the fruit’s rind. He needed the practice. He was about to inject fertility drugs into his wife, Candice Ciardella, and he wanted to get it exactly right. He knew how painful it could be. gay money
 
Just a year earlier, in February, 2017, the spouses’ positions were swapped: Candice, now 37, was administering the shot for Jac, who’s 40. Jac is a transgender man, and both he and his wife have undergone in vitro fertilization (IVF) in order to have a child.
The couple’s fertility journey started in 2015. The original plan had been to use donor sperm to impregnate Candice. But after six unsuccessful attempts at intrauterine insemination (IUI), they decided to try IVF on Jacwith the idea that Candice could carry one of his fertilized eggs. Candice began giving her husband shots of the hormone human chorionic gonadotropin (hCG), to make him produce extra eggs. 
 
“For years, needles were just part of the routine for us,” Candice says. “I think we had more empathy for one another because we both knew what it felt like. When it comes to the shots and the appointments, not many spouses can say: ‘I know exactly what you’re going through.’ We can.”
 
The process was emotionally taxing for both of them, but especially for Jac. “Someone’s head is between your legs, and it’s awkward for anyone — but, being transgender, it’s extra awkward,” Jac says. “Mentally, I’m feeling like I’m not supposed to be in that position. For me to feel comfortable going through IVF while still keeping my sanity and my integrity was huge.” 
 
Three cycles of IVF weren’t successful, and testing revealed no clear issues that would cause infertility. So in 2018, the Ciardellas decided to try IVF again, on Candice this time. 
 
“It was emotionally defeating. If you can survive IVF and infertility, your marriage should be able to survive just about anything else,” Jac says.  “It’s humbling and debilitating and cruel.” Adding to their stress was the financial strain. The Ciardellas were acutely aware that each failed cycle of IVF and IUI was costing them — big time. “You’re talking about tens of thousands of dollars going out the door,” he says. “It takes toughness.”
Jac and Candice’s story is unique, but the financial burden they faced is not. Most LGBTQ+ couples who want children have to confront the fact that starting a family will be expensive. Adoption, fertility treatments, and surrogates are all costly, often lengthy processes.
 
The Ciardellas say their insurance only covered their testing for issues that could cause infertility, such as blocked fallopian tubes. They had no financial help with the sperm, the IUIs, or the rounds of IVF. All told, over the course of three years, the couple would spend about $120,000 on four IVF cycles, $20,000 on fertility drugs, plus over $10,000 on IUI. “I got those numbers imprinted on my brain,” Jac says. “We always knew that to be parents, we’d need to be cutting into a good chunk of change — but we didn’t expect it to be quite that much.” 
 
Sandy Chuan, MD, a fertility specialist at San Diego Fertility Center, confirms that the costs of conceiving via fertility treatments can be shockingly high for LGBTQ+ couples. 
 
She says sperm samples can cost $600 to $900 per vial. One IUI attempt without insurance costs about $700 to $1,000, plus the donor sperm. “I usually tell my clients to ballpark around $1,500, but they might need to do three to six rounds,” Dr. Chuan explains. If IUI is unsuccessful, the next step is IVF, which Dr. Chuan says can cost as much as $15,000, plus $4,000 to $5,000 for medications to stimulate egg production. The price point for procedures can vary by state and market.
 
Refinery29.com, by Molly Longman, June 15, 2020
 
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Planned Parenthood – In a divorce, who gets custody of the embryos?

In a divorce, who gets custody of the embryos?

In a divorce, who gets the embryos? In the summer of 2014, a newly minted Phoenix lawyer named Ruby Torres had a whirlwind few weeks that would end up determining the course of her life. After being diagnosed with bilateral breast cancer in the late spring, Torres, then 33, met with a fertility specialist in early July to see if she could preserve her ability to have children before chemotherapy-induced menopause. She was told she had just one chance—just one fertility cycle—to extract eggs ahead of her urgently needed treatment.divorce embryos

At the time, egg freezing was an iffy science; even after the advent of a flash-freezing process called vitrification, many unfertilized frozen eggs never survived the thawing process. Torres was advised to freeze embryos instead. Which meant she needed to find sperm. Immediately.

She had been dating a man named John Terrell for several years. They had a “good relationship”—at least in her eyes. Terrell initially declined to be Torres’ sperm donor (jacking off into a cup at a doctor’s office didn’t appeal to him, she recalled), but he eventually agreed after he learned that Torres’ ex-boyfriend had volunteered first. On a Friday in July, they signed a contract at a fertility clinic, which said that neither of them could use the embryos without the other’s consent. At lunch a few days later, they made the “rash decision” to get married. At the Bloom Reproductive Institute in Scottsdale soon after, Torres’ eggs were extracted and they made seven embryos together.

“I was happy that he had changed his mind,” Torres told me on the phone in February. “He was the man I was in love with. He was the one I wanted to be with and wanted to be the father of my children.”

In a divorce, who gets the embryos? Fast-forward two years later: The couple’s relationship had collapsed. The split was not amicable. According to Torres, the tail end was marred by infidelity and domestic violence (a charge that Terrell denies). Even though she remembers Terrell verbally giving her the embryos, the fate of their genetic material became the center of their divorce trial in family court. The judge eventually ruled against Torres, deciding that they must be donated to a third party. When Torres appealed, the court came down in her favor, ruling that her right to procreate outweighed her ex-husband’s desire not to. Then Terrell appealed the decision to the Arizona Supreme Court, which reversed the appeals court decision in late January: Torres cannot use the embryos without the consent of her ex-husband, and must donate them instead. Her hopes of having a biological child were permanently crushed.

Torres sees this as a simple issue, the right to have a baby: By denying her ownership of her embryos, she said, “you are taking my child from me.”

That’s one way of looking at it. Another way is through Terrell’s eyes: He believes his right not to become a parent trumps her desire to become one. His relationship with Torres was never serious, he claimed; they only dated “on and off.” According to family court testimony and a March phone call I had with his lead counsel at the Arizona Supreme Court, Eric M. Fraser, he married Torres to give her health insurance. He provided the sperm not because he saw a future with her, but because it was the “honorable thing,” especially since her cancer diagnosis seemed like “basically a death sentence.”

By the time their relationship ended, Fraser told me, Terrell was sure he did not want to create a baby with Torres. There was “no realistic way” he could have stayed out of that child’s life; they had overlapping friends and lived in a small community where everyone knew each other. Plus, the courts could not waive child support responsibility. No matter how many times Torres requested a preemptive child support waiver for Terrell in the event that she used the embryos—and she did request that—there was no way he could be off the hook for payments in case she died or got sick or went to jail. Unlike sperm donation or many adoptions, this wasn’t anonymous. Everyone would know he was the father.

According to estimates by reproductive endocrinologists, there may be about a million frozen embryos in the United States. There have been court battles over the fate of frozen embryos since the 1990s. But if the last few years are any indication, many more will become mired in divorce court. Torres and Terrell’s case is one of a handful of similar ones that have continued to pop up around the country, all involving the fate of embryos created by a couple who were once together and now are not. Many of them hinge on whether the right to be a parent is more important than the right not to be. There have been judges in Connecticut, MassachusettsTennesseeNew Jersey, and California who were swayed by arguments similar to Fraser’s, and therefore ruled against the spouse seeking to use the embryos. Most publicly, last October a judge in Louisiana dismissed a lawsuit filed against the actor Sofia Vergara by her ex-fiancé, Nick Loeb, for possession of their embryos. These cases sometimes go the other way: Courts in Illinois and Pennsylvania awarded embryos to women because they had no other chance of having a biological child. Legal experts suspect that one of these embryo cases will eventually reach the U.S. Supreme Court, having huge implications for abortion, stem cell research, and in vitro fertilization.

vice.com, June 1, 2020 by Nona Willis Aronowitz

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Better fertility treatments can mean much older parents. But how does this affect their offspring?

For nearly 40 years, fertility treatment has grown ever more advanced and so entrenched that it’s not uncommon for couples to begin their families in their late 30s, 40s or even 50s, producing much older parents.

Much older parents…  But even as questions about the technology to extend fertility have been answered — yes, children born through in vitro fertilization are healthy; yes, freezing embryos appears to be safe; yes, mothers can generally deliver babies safely well beyond the classic childbearing years — another important question is emerging: How old is too old for their offspring?

Offspring like Hayley, the 10-year-old daughter of a 58-year-old, Ann Skye.

“I knew that she was going to really need to build her own support system in life, or potentially would need to,” said Skye, who lives in North Carolina and works in public health. “I think that has really impacted the way we parented her. We were strong proponents of letting her cry [herself] to sleep for that same reason: She needs to be able to self-soothe.”

In December, two prominent psychologists and two reproductive endocrinologists published an opinion paper in the Journal of Assisted Reproduction and Genetics questioning whether it was time to establish age restrictions in the field. They wrote that research has shown that children often experience social awkwardness if their parents are a half-century older than them and face greater risk of autism and psychopathologies. These children are also more likely to serve in a caregiving role and experience bereavement as adolescents or teens compared with their peers whose parents gave birth in their 20s and 30s, they wrote.

Do those risks constitute the potential for “great harm” to the child and outweigh a person’s right to “reproduce without limitation or interference” at any age, the authors asked.

“It is a self-perpetuating issue; the more older patients that seek [fertility] treatment, the more people feel that it is reasonable to seek treatment, especially in an age where sensational births are widely celebrated as positive events in the media,” they wrote.

In the United States, the number of live births to mothers ages 45 to 49 increased from 3,045 in 1996 to 8,257 in 2016, and the number to mothers ages 50 to 54 increased from 144 births to 786 births over the same time period, according to the National Center for Health Statistics. The average age of women becoming mothers in the United States is now 26, up from 23 in 1994, according to the Pew Research Center.

WashingtonPost.com, May 30, 2020 by Eric Berger

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Fertility Clinics Stay Open Despite Unclear Guidelines

Fertility clinics stay open – Many providers have continued seeing patients through the pandemic, forcing them to choose between clients and staff safety.

Since March, fertility stay open clinics across the country have halted treatments for tens of thousands of people because of Covid-19, forcing patients to suspend their family planning. In recent days, some clinics have reopened, resuming services and procedures despite ongoing coronavirus concerns.

But shifting guidelines and minimal oversight have left clinics to decide for themselves when and how to resume in vitro fertilization, or I.V.F. At clinics where I.V.F. is ramping back up, or never slowed at all, some staff members are concerned about a lack of adequate protective equipment and safety policies.

On April 24, the American Society for Reproductive Medicine issued recommendations for restarting operations, leaving it up to individual clinics to determine how to proceed. The professional society had previously advised fertility clinics to avoid starting new treatments, postpone nonemergency surgeries and shift to telemedicine.

The shutdown generated a flurry of media attention and pushbackfrom fertility doctors and patients. Most clinics paused starting new I.V.F. cycles, which are highly time-sensitive. But a few remained open, even operating at full capacity, causing the industry to debate when to resume care and what counts as medically urgent.

“Fertility treatment is by no means elective,” said Leyla Bilali, a nurse at a fertility clinic in New York City, referring to the consensus that infertility is a disease. “It’s just, right now, it’s not a matter of life or death.”

Clinics that stayed open scrambled to implement protocols compliant with the Centers for Disease Control and Prevention, such as temperature checks, masks and physical distancing. Still, people have gotten sick. At Reproductive Medicine Associates of New York, seven staff members have tested positive for Covid-19. At Vios Fertility Institute in Chicago, clinicians have reported flulike symptoms but have not been tested because of limited test availability. And several employees at Extend Fertility, an egg-freezing clinic in Midtown Manhattan, fell ill with possible cases of Covid-19.

“We really didn’t feel it was appropriate to go out on a limb, outside major A.S.R.M. guidelines, and keep things open,” said Dr. Bat-Sheva Maslow, M.D., a reproductive endocrinologist at Extend Fertility who tested positive and recovered from the virus in March. “Covid-19 is almost impossible to control at this point. That weighed very heavily with us.” Extend Fertility has since closed its offices to virtually all patients.

Amid the pandemic, clinics face a dizzying array of vague and, at times, conflicting instructions from states, cities and health agencies like the C.D.C. Doctors must interpret guidelines as they see fit — often the case in fertility services, which are largely paid out-of-pocket and where patient care and profit can be at odds.

Because of unclear guidance, in most states it is difficult to tell whether remaining open during the pandemic is legal or if fertility procedures are considered an essential service. New York is an exception: On April 7, the state’s health department issued an advisory deeming infertility treatment an essential service, thus exempt from closure. New Jersey’s governor, in an executive order responding to the coronavirus crisis, made a similar but less specific exemption, referring to general family planning services but not directly to infertility.

NYTimes.com, by Natalie Lambert, May 1, 2020

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How Co-parenting Has Equipped Queer Families To Handle The Coronavirus Pandemic

Co-parenting families are drawing on the resiliency that comes from living on the margins in the Coronavirus pandemic.

Co-parenting families are drawing on the resiliency that comes from living on the margins in the Coronavirus pandemic. Four months ago, Lisa Lo, from Calgary, separated from the father of her two young children, ages two and five, in part because she wanted to open her marriage to relationships with both men and women.Co-parenting Coronavirus

Lo, whose name has been changed to protect her family’s privacy, is polyamorous, and she’s had three relationships since her separation, one of which has ended, and two of which have been complicated by pandemic living arrangements.

Some of these relationships have brought big feelings, but through it all, Lo is mindful of keeping an emotional balance for her kids, who spend most of their time with her. “They pick up on my emotions,” she said. “If I’m happy, they’re happy. If I’m stressed and upset, then they’re stressed and upset.”

But that was all pre-pandemic: “Now, dating has been put on hold,” she told HuffPost Canada. Lo’s priorities are different these days. She is very much focused on the challenges COVID-19 poses to all multi-household families: creating consistent self-isolation protocols, navigating the handing-off of children, communicating in a time of stress, finding legal counsel.

To create a situation that worked for everyone, Lo had to have hard conversations with her ex-husband about whether to integrate any of her existing polyamorous relationships into their isolation cohort.

They settled on Lo living with one somewhat-ex-partner (it’s complicated). They are also still employing a nanny in both households, in part, because this is supportive of Lo’s mental health. The negotiations about child schedules and hand-offs between households have been complex.

Lo has also been challenged by some of her loved ones about having non-immediate family members in her household “pod” during the pandemic. But, she was able to take that in stride.

She said being queer has given her a lot of practice with tough discussions: “I’m used to being outspoken about things that are unconventional. I’m done being in the closet about anything.”

Rachel Farr is an assistant professor of Psychology, and she runs the FAD (Families, Adoption, and Diversity) research lab at the University of Kentucky. She said that for LGBTQ2 families, this pandemic both feeds into existing patterns of resilience and creates new ones.

“Some of the emotional dynamics I think are true for any family trying to negotiate [this pandemic],” she told HuffPost, “but there are added layers of sensitivity and vulnerability for queer families, who also face stigma and various forms of silencing through institutional discrimination or lack of legal protections.”

Huffingtonpost.ca by Brianna Sharpe, April 23, 2020

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New York State Legalizes Gestational Surrogacy

 

New York State Legalizes Gestational Surrogacy

A protracted battle over the future of compensated gestational surrogacy in New York was resolved on April 2 when state lawmakers approved a budget that included legislation proposed by out gay Manhattan State Senator Brad Hoylman and Westchester Assemblymember Amy Paulin that legalizes gestational surrogacy once and for all.legal surrogacy in New York

Although New York was one of just a small handful of states that had yet to legalize the practice, which entails a surrogate carrying a baby who has no biological relation to her, the campaign to pass such legislation in the state was stymied last year by concerns that the surrogates who carry babies — as well as those women donating eggs — were not afforded sufficient protection and rights. The bill put forth by Paulin and Hoylman, who had his two daughters via surrogacy, cleared the upper chamber last year but never reached the Assembly floor following resistance from some women in the lower chamber, including out lesbian Assemblymember Deborah Glick, who told The New York Times that gestational surrogacy was “pregnancy for a fee, and I find that commodification of women troubling.”

Among other issues with last year’s bill, Glick and others expressed uneasinessabout the reality that most working people could not afford to spend tens of thousands of dollars to have children through gestational surrogacy. The bill primarily benefits wealthier individuals in addition to those who are looking for financial compensation by donating eggs or carrying babies.

Hoylman, however, told Gay City News in February that he hopes the push towards universal healthcare means that such reforms could eventually alleviate some of the healthcare costs of surrogacy.

The dispute over the future of surrogacy in the state continued into this year when Manhattan State Senator Liz Krueger and Assemblymember Didi Barrett of Dutchess and Columbia Counties introduced a separate surrogacy bill that would have included, among other provisions, a controversial eight-day window during which the surrogate and intended parents would share legal responsibility for the child — raising questions about whether the surrogate might refuse to turn the child over or seek some ongoing legal relationship with them — something Hoylman described in a February interview with Gay City News as a “non-starter.”

The eight-day window was not included in the final version of Hoylman and Paulin’s bill, but some elements of Krueger’s legislation appear to have been incorporated, such as additional protections for the surrogate and the egg donor. Hoylman and Paulin had long defended their own bill as boasting the “strongest protections in the nation for surrogates” by placing significant responsibility on the intended parents to pay for her healthcare, legal representation, and other costs tied to the pregnancy. Additional protections for egg donors were also included in this year’s bill.

By Matt Tracy, Gay City News, April 2, 2020

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Legal Surrogacy in New York – Albany lawmakers pass landmark legislation

Legal Surrogacy in New York – Albany lawmakers pass landmark legislation

Legal Surrogacy in New York – Albany lawmakers pass landmark legislation, The Child Parent Security Act.  In a marathon budget session, New York lawmakers passed The Child Parent Security Act, the most protective and forward-thinking surrogacy legislation in the country.  Only Michigan and Louisiana continue to ban gestational surrogacy for LGBT individuals and couples, Michigan banning gestational surrogacy for all Michiganders.legal surrogacy in New York

While legal surrogacy in New York seemed doomed after it failed to be brought to the floor for a vote last year in the Assembly after passage in the Senate and vocal support of the Governor, this year the Child Parent Security Act was tied to the budget.  This move forced lawmakers to affirmatively support or oppose the Bill, something that they had been reticent to do in June of 2019.  The bill becomes the law of New York on February 15, 2021.

The reality of legal surrogacy in New York is the product of a massive effort on the part of many organizations and individuals.  From Men Having Babies to The Women’s Bar of New York, several organizations have stepped up to the plate to make legal surrogacy in New York a reality.  Ron Poole-Dayan, Executive Director of Men Having Babies, the non-profit organization that has spearheaded educational and ethical surrogacy initiatives around the world, said, “The CPSA is the most comprehensive, thoughtful and ethical surrogacy legislation ever drafted. It is particularly important now in the midst of a health crisis, to pass this legislation that provides New Yorkers an ethical and affordable path to the realizing their parenthood dreams.  This is landmark legislation and we are proud of our lawmakers for taking this important step to help LGBT families prosper.”  “It’s an amazing day and it’s nice to be able to celebrate in these dark times.  The bill only passed when the issue grew into a moment and everyone played an important role,” stated Denise Seidleman, the New York attorney who was instrumental in drafting the legislation.

“We are overjoyed for New York families, as they finally are able to access gestational surrogacy if they need it to build their family.  This has been a marathon, with many teammates along the way.  This kind of win takes people raising their voice and advocating – we thank everyone who did just that.  A huge thanks to RESOLVE advocate Risa Levine, and the Protecting Modern Families Coalition that got this over the finish line. We are honored to work alongside an incredible coalition,” said Barb Collura, CEO and President of RESOLVE, The National Fertility Association.

“This is a game changer!  It will bring so much opportunity for our local IP’s, as well as our local clinics and potential surrogates.  Being an east coast based agency, Circle has a lot of intended parents who live in NY and the entire tri-state area,” said Jen Rachman, the New York Representative for Circle Surrogacy, a Boston based surrogacy agency.

How This Law is Unique

legal surrogacy in New YorkThis legislation is unique in several ways.  First, it contains a Surrogates Bill of Rights, which is the first of its kind in the country.  It provides specifically for independent counsel, health and welfare decision making authority during the pregnancy and full medical and legal informed consent of all New York women acting as surrogate mothers for intended parents.  It also provides for psychological counseling, life insurance and the ability of the surrogate to terminate the agreement prior to embryo transfer. 

The Child Parent Security Act also creates two formal, but voluntary, registries, one for egg donors and the other for surrogate mothers, which tracks information on the number of times someone has served as a donor or surrogate, their health information and any other information that the Health Commissioner deems appropriate.  The legislation also allows for consultation with The American Society of Reproductive Medicine (ASRM) to develop the best medical screening guidelines for potential surrogates.

Establishment of Parentage

The Child Parent Security Act, while creating legal surrogacy in New York, also provides for the establishment of parentage for intended parents of surrogacy, as well as lesbian couples who use a known sperm donor to assist them in having their families.  The process is known as a Pre-Birth Order and allows a court to issue a court order which terminates the rights of the surrogate and her spouse, or the known sperm donor, and affirms the legal parentage of the intended parents in a fully recognized court order which goes into effect at the moment of birth of the child.  The law also officially recognizes parentage orders from other states, ensuring that NY parents who have previously had children with surrogates in other states and obtained birth orders in those states to establish parentage, can rest assured that the other state’s order will be recognized by statute in New York.

Before this law’s passage, intended parents who resided in New York had few options to establish parentage.  Second or step parent adoption, a time consuming and somewhat invasive process, was the only way of establishing parental rights in New York.

The Ethics of The Child Parent Security Act

Regulation is the key to achieving ethical surrogacy. The Child Parent Security Act provides for more than just baseline protections and suggested protocols for an ethical journey.  The Surrogates Bill of Rights is a huge step toward ensuring that the process is balanced and that the woman acting as a surrogate mother has agency and support throughout the process.  The law also provides for the security of parentage, which assures that all parties are working toward a single goal of creating a family for the intended parent or parents. 

New York Adapts to Modern Family Creation

New York, in the midst of a global pandemic, and under the powerful and consistent guidance of Governor Andrew Cuomo, has brought its family law into the 21st century.  Many, myself included, could not comprehend how such a progressive and diverse state could lag so far behind the rest of the country in its recognition and support of assisted reproduction.  I was fortunate to sit on the Governor’s commission for the passage of The Child Parent Security Act and am a constituent of Assemblyperson Deborah Glick, who had opposed the legislation until last June.  To her credit, she met with me to discuss the legislation and I was able to correspond with her staff about surrogacy on several occasions. 

The passage of this legislation was truly a collaborative effort and the hard work of every person who worked on the coalition to pass the Child Parent Security act deserves credit for making legal surrogacy in New York a reality.  Whether a cancer survivor, an infertile couple or an LGBT New Yorker, this law now allows for the option of remaining in New York to create a family.  Finally, I want to thank Governor Cuomo for having the confidence in this law’s wisdom to add it to the budget bill.  This strategy was instrumental in its passing and the Governor deserves a great deal of credit and gratitude.  Legal surrogacy in New York!  I have waited to celebrate this moment for years!

April 2, 2020 by Anthony M. Brown, Esq.

Contact Anthony at anthony@timeforfamilies.com

How Coronavirus Is Affecting Surrogacy, Foster Care and Adoption

How Coronavirus Is Affecting Surrogacy – The pandemic is not just impacting parents and pregnant people — all prospective parents are facing new challenges.

How Coronavirus Is Affecting Surrogacy – Covid-19, the disease caused by the novel coronavirus, has upended life for those who are or hope to become pregnant in the United States. Fertility doctors have indefinitely postponed all advanced fertility treatments, and some major hospitals in hard-hit areas are trying to ban partners and doulas from delivery rooms.

But the pandemic is affecting expectant parents forming families through surrogacy, foster care and adoption as well.

Global travel restrictions have left surrogacy agencies in the United States scrambling for exemptions for their international clients — particularly for those whose surrogates are scheduled to give birth in the next month or two.How Coronavirus Is Affecting Surrogacy

Circle Surrogacy, an agency based in Boston, has 15 international clients with due dates before May 1. “We’ve had our legal team prepare letters for each of these families, which has gotten many of them into the country despite travel bans,” said Sam Hyde, the agency’s president. Still, he said, his foreign clients were at the mercy of individual immigration officials. “Some have been sympathetic to the plight of our clients, others have not — it’s really been a case-by-case basis.”

 

Some intended parents, as clients of surrogacy agencies are known, who are currently struggling to gain entry into the United States are hoping to do so after completing a 14-day quarantine in a country with less severe travel restrictions.

Last week, for instance, Johnny and Patty — a Chinese couple working with a surrogate living in South Carolina — traveled from Shanghai to Phnom Penh, Cambodia, to begin two weeks in isolation at a local hotel. The couple, who work for an international company and use these westernized names, asked that their last name be withheld since surrogacy is still relatively uncommon in China. They hope to complete their quarantine in time to witness the birth of their daughter, who is due in mid-April, and claim guardianship over her.

But with travel restrictions tightening seemingly daily, they worry their effort may still be in vain. “First we bought plane tickets to travel through Thailand, but now travel is restricted there,” Johnny said in an interview from their hotel on the second day of his quarantine. “Then we tried Dubai, but that is now also restricted.” Traveling via Cambodia, he said, was the couple’s “last hope” to reach the United States in time for their daughter’s birth.

Though they would be disappointed to miss the delivery, the couple said they were even more concerned, in that scenario, about the baby’s well-being in the ensuing days before they are allowed to travel. “Who will take care of our baby if we can’t arrive before she’s born?” Patty said.

Will Halm, a managing partner at International Reproductive Law Group, said surrogacy agencies were creating contingency plans for clients living abroad who may be prohibited from entering the United States over the next few months. “Plan A is absolutely to have parents in the U.S., joyfully watching their child being born,” he said. “If they can’t get into the country in time, that’s when we look to plans B, C and D.”

 

In one of the better scenarios, agencies hope friends or family members living in the United States can temporarily assume guardianship of the baby until the intended parents are granted entry into the country. As a backup, however, caseworkers are also preparing strangers — health care professionals, child care providers and even surrogates themselves — to care for the newborns until travel restrictions are eased.

“These babies will not be abandoned,” said Dr. Kim Bergman, founder of Growing Generations, a surrogacy agency with dozens of international clients who may be impacted by travel bans in the coming months. “We have an army of former surrogates who are ready and eager to act as helpers and guardians for as long as necessary.”

The ongoing crisis has created an uncertain environment for foster care parents and children as well. “Basically, everything is on pause until things are back to normal,” said Trey Rabun, who works as a services supervisor at Amara, a foster care agency based in Seattle, Wash. — one of a growing number of states ordering its citizens to work from home.

Amara, whose staff members are included in the state’s proclamation, has been able to continue some aspects of the licensing process for foster parents online, such as initial interviews. But other critical components, like home inspections, need to be done in person, Rabun said.

As a result, the number of foster homes, already all too scarce in Washington before the crisis hit, will remain static for the state’s over 10,000 foster care children until the pandemic subsides and business returns to normal, Rabun said. Of bigger concern to him, and other foster care professionals throughout the country, is the impact that “stay at home” orders may have on children not yet accounted for in the system.

“We know abuse and neglect happen more in high-stress situations,” Rabun said. But the people who would normally notice and report these sorts of problem, like teachers and doctors, will be unable to do so in the days and weeks ahead. “No one has eyes on them,” he said.

With courts and other government offices closed in many states, parents who had hoped to finalize adoptions within the next couple of months are also now navigating a drastically changed landscape — particularly for parents completing adoptions abroad.

 

Early in the year, when the coronavirus was barely registering as a news story outside of Asia, Holt International — an agency that facilitates adoption placements between Chinese orphanages and adoptive parents in the United States — was already closely monitoring and responding to the outbreak.

NYTimes.com, by David Dodge, April 1, 2020

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The UK Supreme Court awards damages for commercial surrogacy

A landmark ruling by The UK Supreme Court awards damages to a woman for Californian commercial surrogacy following a delay in detecting cancer in smear tests and biopsies.

Louisa Ghevaert provided expert evidence on surrogacy to the UK Supreme Court, donor conception and fertility law in this case and comments:UK Supreme Court

“This legal ruling from the UK Supreme Court is an important watershed in the development of medical negligence, fertility and surrogacy law in the UK. It enables a ‘surrogacy’ head of claim in cases where a person’s fertility and ability to conceive a child has been lost or impaired through medical negligence, including claims for overseas commercial surrogacy in appropriate cases. It marks a real step forward in recognising the value and importance of individual fertility and surrogacy. However, there is still more that needs to be done to preserve and protect people’s fertility and their ability to have children”.

Background

The Defendant admitted failing to detect signs of cancer from smear tests in 2008 and 2012 and biopsies in 2012 and 2013. As a result, the  Claimant developed invasive cancer of the cervix which required chemo-radiotherapy treatment that rendered her infertile and caused severe radiation damage to her bladder, bowel and vagina.

Due to the late cancer diagnosis and the increased size of the tumour, the Claimant was unable to have fertility sparing surgery and suffered a complete loss of fertility. This was a devastating blow as she had always wanted a large family of her own.  She was so devastated by the diagnosis that she postponed her cancer treatment twice to obtain further medical opinions about the viability of fertility sparing surgery. On learning this was not available to her, she underwent a cycle of ovarian stimulation in June 2013 and harvested and froze 8 mature eggs.  A few days later, she underwent surgery followed by chemo-radiotherapy. This caused irreparable damage to her uterus and ovaries so she could not conceive or carry a pregnancy and it caused her to enter premature menopause.

The Claimant therefore sought damages to enable her to enter into a commercial surrogacy arrangement in California to have a much wanted family of her own. In contrast to the informal and legally restricted nature of surrogacy in the UK, commercial surrogacy in California operates through a well established system which offers legally binding surrogacy arrangements and pre-birth orders in the Californian court.

Legal Ruling

The case was first heard in the English High Court in June 2017, where a limited damages award for two altruistic UK surrogacies was made in the sum of £74,000.  

Louisa Ghevaeart Blog, April 1, 2020

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ASRM Guidelines on Fertility Care During COVID-19 Pandemic

ASRM Guidelines on Fertility Care During COVID-19 Pandemic: Calls for Suspension of Most Treatments

ASRM Guidelines on COVID-19: The American Society for Reproductive Medicine (ASRM), the global leader in reproductive medicine, today issues new guidance for its members as they manage patients in the midst of the COVID-19 pandemic.  Developed by an expert Task Force, of physicians, embryologists, and mental health professionals, the new document recommends suspension of new, non-urgent treatments.ASRM guidelines COVID -19

Specifically, the recommendations include:

  1. Suspension of initiation of new treatment cycles, including ovulation induction, intrauterine inseminations (IUIs), in vitro fertilization (IVF) including retrievals and frozen embryo transfers, as well as non-urgent gamete cryopreservation.
  2. Strongly consider cancellation of all embryo transfers, whether fresh or frozen. 
  3. Continue to care for patients who are currently ‘in-cycle’ or who require urgent stimulation and cryopreservation.
  4. Suspend elective surgeries and non-urgent diagnostic procedures.
  5. Minimize in-person interactions and increase utilization of telehealth.

The above recommendations will be revisited periodically as the pandemic evolves, but no later than March 30, 2020, with the aim of resuming usual patient care as soon and as safely as possible.  ASRM has been closely monitoring developments around COVID-19 since its emergence. Data on its impact on pregnancy and reproduction remains limited. However, the task force used best available data, and the expertise and experience of the members to develop the recommendations. Until more is known about the virus, and while we remain in the midst of a public health emergency, it is best to avoid initiation of new treatment cycles for infertility patients. Similarly, non-medically urgent gamete preservation treatments, such as egg freezing, should be suspended for the time being as well. Clinics who have patients under treatment mid-cycle should ensure they have adequate staff to complete the patient’s treatment and should strongly encourage postponing, the embryo transfer.

Ricardo Azziz, CEO of the ASRM stated, “This is not going to be easy for infertility patients and reproductive care practices. We know the sacrifices patients have to make under the best of circumstances, and we are loath to in add, in any way. to that burden. And it will not be easy for our members. The disruption to routines, the stress on staff members and the very real prospect of economic hardship loom large for ASRM members all over the world.  But the fact is that given what we know, as well as what we don’t, suspending non-urgent fertility care is really the most prudent course of action at this time.”

Dr. Racowsky added, “We should recognize that the situation on the ground is fluid, and as such we will continue to revisit and review our recommendations at least every two weeks, to provide providers and their patients with the best information and support we possibly can.”

ASRM Press Release – May 17, 2020

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