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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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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Fresh Eggs For IVF Offer Slightly Better Birth Outcomes

Using fresh donor eggs for in-vitro fertilization (IVF) provides a small but statistically significant advantage in birth outcomes compared to frozen donated eggs, research finds.

The national study in the journal Obstetrics & Gynecology was the largest head-to-head comparison of the two IVF approaches, measuring the likelihood of a good perinatal outcome, defined as a single baby without prematurity and with a healthy birth weight.fresh eggs

“Our study found that the odds of a good birth outcome were less with frozen than with fresh, but it was a small difference,” says lead author Jennifer L. Eaton, medical director of assisted reproductive technology and director of the Oocyte Donation Program at the Duke Fertility Center.

“From a clinical standpoint, given that frozen eggs have many benefits such as ease, cost, and speed, the decision to use fresh or frozen donor eggs should be made on an individual basis after consultation with a physician,” Eaton says.

Eaton and colleagues, including senior author Alex Polotsky of the University of Colorado Advanced Reproductive Medicine, studied three years of data from the Society for Assisted Reproductive Technology. Nearly 37,000 IVF attempts were analyzed, including 8,381 (22.7%) that used frozen eggs and 28,544 (77.3%) using fresh.

Controlling for factors such as the quality of fertilized eggs and the age of both mother and donor, the researchers found that fresh eggs resulted in a good perinatal outcome in 24% of fertility attempts compared to 22% of the attempts with frozen eggs. Implantation, clinical pregnancy, and live birth rates were all significantly higher among the women using fresh eggs vs. frozen.

“As IVF with donor oocytes has become standard treatment for women with decreased egg supply or advanced reproductive age, there has been an increased demand for donor oocytes, making frozen eggs an attractive option,” Eaton says. “In general, IVF with frozen donor eggs is cheaper and faster than with fresh donor eggs.

Fututiry.org by Sarah Avery-Duke, February 7, 2020

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Opinion – The Big IVF Add-On Racket

IVF Add Ons – This is no way to treat patients desperate for a baby.

There are few things as unsettling as sitting in an in vitro fertilization clinic hearing you need a team of experts — embryologists, lab techs and nurses along with a reproductive endocrinologist — to help you become pregnant.embryo

What comes next can be a blur. First, you meet with the clinic’s financial counselor to assess whether you have enough money for a complex, invasive $15,000-$20,000 IVF cycle. What follows are drug injections, blood tests, invasive ultrasounds, surgical egg retrieval, and fertilization ahead of an embryo transfer. Before your first hormone shot, you’re well into head-spinning, unfamiliar territory.

Then the doctor tells you there are “add-ons” you might want to consider.

Might you have interest in endometrial scratching? What about vasodilation, human growth hormones, intralipids, assisted hatching, oocyte activation, physiological intracytoplasmic sperm injection, or embryo glue? Post-fertilization, there is also embryo pre-implantation genetic testing to consider. Interested?

These extras come with price tags ranging from hundreds to thousands of dollars. All are presented as ways to increase your chances of a pregnancy. What are you willing to try? What can you afford? The ball is in your court.

This is no way to treat patients at their most vulnerable.

That’s the conclusion my colleagues and I arrive at in a new paper on the ethics and regulation of IVF add-ons.

An add-on is anything that is not essential to carry out an IVF cycle. Such measures, patients are told, will improve the likelihood of a live birth — and yet our examination revealed a startling absence of robust research into the effectiveness and the safety of these add-ons. Despite this, their use is widespread, and regulation of them is minimal.

The most expensive add-on category is pre-implantation genetic testing. These tests were originally developed to identify embryos at risk for genetic diseases. Today, however, they are primarily sold, at a cost of $6,000 to $12,000, as a way to screen for chromosomal abnormalities that could lead to failed implantation or miscarriages.

In October, however, a large study found that a single abnormal cell does not doom an embryo and determined that one of the tests, PGT-A, made no difference to rates of live births. Worse still, patients who opted not to transfer embryos based on the test’s results may have lost potentially viable ones.

There is also endometrial scratching, a procedure, sometimes costing as much as $500, that purposely irritates the endometrium, the innermost lining of the uterus, before IVF While it’s promoted as increasing the chance of an embryo implanting, a recent large randomized trial found no benefit. Beyond significant patient discomfort, risks include bleeding, infection and uterine perforation.

Then there are intralipids, an emulsion of soybean oil, egg phospholipids and glycerin administered intravenously and described as a way to decrease natural killer cell activation in the immune system and ostensibly aid in embryo implantation. This emulsion is priced around $400 per infusion; typically several are recommended. Side effects include headache, dizziness, flushing, nausea and the possibility of clotting or infection. A meta-analysis last year found that intralipids and other forms of immunotherapy should not be used in routine clinical practice.

Such procedures are often presented to patients in the form of a stack of papers, written in legalese or medical jargon. Resourceful patients might take to the internet to learn more, where searches might deliver densely written scientific articles, and ads might direct them to companies or clinics eager to promote their own brands of add-ons.

Why is all this happening? It’s because IVF remains an under-regulated arena, and entrepreneurial doctors and pharmaceutical and life science companies are eager to find new ways to cash in on a growing global market that is projected to be as large as $40 billion by 2024.

NYTimes.com, December 12, 2019 by Pamela Mahoney Tsigdinos

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Couples win lawsuit over donated eggs with genetic defect

Two couples that gave birth to children with a genetic defect later traced to donated eggs won a lawsuit against a New York fertility doctor and his clinic in the state’s highest court Thursday.

The two children, both born in 2009, have Fragile X syndrome, a genetic condition that can lead to intellectual and developmental impairments. The parents, identified by initials and last names in legal papers, were told the egg donors were screened for genetic conditions.genetic defect

The parents are seeking legal damages for the added expenses of raising a disabled child. The amount of the damages was not set by the court and will likely be determined in further legal proceedings.

The case hinged on the state’s medical malpractice statute of limitations, which bars lawsuits filed more than two and a half years after the alleged act of malpractice — or the patient’s last treatment by the physician.

The lawsuits were filed two years after the children were born, when the condition became apparent, but more than two and a half years following the final treatment at the clinic. The egg donors were tested after the children were born and found to be carriers of the Fragile X mutation, according to court filings

Attorneys for the Reproductive Medicine Associates clinic and physician Alan Copperman argued the suit was filed too late, because the statute of limitations began counting down when the women ended fertility treatment after becoming pregnant, and not when the children were born or when the genetic abnormality was diagnosed.

December 14, 2017 – AP via New York Daily News

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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

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A surrogacy fairy tale

Anthony Brown and his husband Gary Spino’s neighbor in their West Village apartment building in New York City wore all black, only went out at night and had a frequent cough.

She was, “the type of woman you’d see coming down the street and you might cross the street,” Brown says. Now and then the couple would see her coming home at night from grocery shopping and would help carry her groceries upstairs. One day after falling in her apartment the woman, named Janet, called the couple to help. The result was a seven-year friendship and the gift of Brown and Spino’s son, Nicholas.

Brown and Spino came to learn she suffered from Chronic Obstructive Pulmonary Disease, had lived all over the world and that she was also wealthy from family money. When she died, they discovered she had been so touched by their kindness that she left them half her estate. Because of her, the couple were able to afford surrogacy with Spino as their son’s biological father in what Brown calls, “a New York fairytale.”adoption new york,new york adoption,new york state adoption, stepparent adoption process,adopting step children,co parent adoption,2nd parent adoption,second parent adoptions,gay adoption new york,gay couple adoption, gay couples adopting

“It was a gift from God, truly. Or at least a gift from Janet,” Brown says. “We still have her picture and a heart-shaped urn that has some of her ashes. We sprinkled her ashes all over the world. We took her ashes to all the places where she had lived and tried to do her justice.”

As they embarked on their surrogacy journey, the couple went to a Men Having Babies meeting at the Gay and Lesbian Center and began gathering information. Brown, an attorney, would eventually go on to become chairman on the board for the organization.

While working with Men Having Babies, the group became a 501(c)(3) non-profit organization and started a grant. The grant used money from events the organization produced to help with its gay parenting assistance program.

The program now offers qualifying individuals and couples discounted services, donated free services and cash grants. So far the organization is in its fourth class of recipients and 13 babies have been born to parents who have utilized the gay parenting assistance program.

“It’s one of the greatest things in the world to be able to talk to the recipients and see myself in them and to know I would never have been able to have afforded the surrogacy route had it not been for the grace of a kind woman who lived in my building. So it’s a full circle moment for me personally,” Brown says.

Brown is also no stranger to the other side of surrogacy. Before having their son, Brown worked for a marriage equality organization in the early ‘00s. Brown and Spino met a lesbian couple through the organization who wanted to have a family with a known donor. Brown and Spino agreed to help and the partner Brown was working with became pregnant first. Through her, Brown has an 11-year-old biological daughter. The experience led Brown and Spino not only on their own journey to welcome their son into their family, but for Brown to embark on a passion project to help other gay couples expand their families.

In 2012 Brown went deeper on his mission to help others and started TimeforFamilies.com, a website filled with information for LGBT families to learn how to start families.

Brown covers topics such as surrogacy, estate planning, co-parenting and specific topics like having a known donor versus an anonymous donor. While Brown notes the majority of website visitors are from the New York area, people from Africa, Asia and Europe have also accessed the site. Gay families can also send in their personal stories and photos to be featured on the website.

By Mariah Cooper, 10/6/2016, WashingtonBlade.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.

Triplets With DNA From Both Same-Sex Parents Born In South Africa

I can only imagine how it feels to become a parent for the first time. The words thrilling, exciting, nerve-racking, and love, all immediately come to mind.

I’m sure that’s close to what South African dads Christo and Theo Menelaou felt – perhaps multiplied three times over – when they brought home their adorable triplet babies for the first time. Of course, triplets and newborns alone are enough to prompt a flurry of excitement. But there’s another reason Christo and Theo had to be especially excited: the couple’s triplets carried DNA from both of their same-sex parents — the first ever multiples with DNA from three parents. Human Sperm Cell

Of course, the couple went through a long journey to become parents. In an interview with Sky News, Christo Menlaou shared some of the couple’s previous experiences in pursuing adoption:

When you are gay, there is always the thought that it just may not be possible to be a parent no matter how much you would love to be. It’s very hard to be accepted for adoption and we were told we would always come after heterosexual couples. And then we just never thought we’d ever find a person who would want to be surrogate to a gay couple.
The Menalaous have two girls, Zoe and Kate, and a boy, Joshua, by a surrogate. Both dads reportedly used their sperm to fertilize one embryo each, and 10 weeks into the pregnancy revealed that one embryo had split – resulting in triplets, two of which are identical (Zoe and Kate) according to the Sky News interview with the dads. The triplets share both fathers’ DNA, the Associated Press reported.

The babies were delivered, prematurely, in July. And the adorable triplets are now home with their dads, after weeks of being monitored in the hospital, Sky News reported. The babies reportedly needed breathing assistance, and are still receiving care from nurses at home.

The gynecologist who delivered the triplets said the babies, born by surrogate with a split embryo resulting in triplets, was an “extremely rare” situation. “It is extremely rare,” Dr Heidra Dahms told Sky News. “I have never heard of this before.”

by Kimberly Richards, Romper.com – August 22, 2016

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Men Having Babies’ Gay Parenting Assistance Program Expanded to Help Prospective Surrogacy Dads with Discount on Fertility Medications

Men Having Babies (MHB) Gay Parenting Assistance Program (GPAP) announced today that EMD Serono, the biopharmaceutical business of Merck KGaA, Darmstadt, Germany, in the U.S. and Canada, will provide eligible prospective gay parents with up to a 75% discount on select fertility medications for use by their surrogates when redeemed at an EMD Serono participating pharmacy.

GPAP annually provides dozens of prospective parents with over a million dollars worth of cash grants, discounts and free services from more than fifty leading service providers. “GPAP was created to promote affordable surrogacy services for gay men, the first such program to do so,” said Ron Poole-Dayan, the executive director of Men Having Babies. “In the last two years more than 300 couples became eligible for substantial discounts off the cost of surrogacy services, and more than 40 couples have received direct Stage II financial assistance, including grants and free service. Ten babies were already born to Stage II couples, and many more are on their way.”

“Our mission at EMD Serono is to advocate for people who want to have a child,” said Craig Millian, Sr. Vice President, US Fertility & Endocrinology at EMD Serono. “We are excited to be the first manufacturer to provide financial assistance, in the form of discounted medicine, directly to the gay community. Most importantly, we are thrilled to work with Men Having Babies to try to help more and more people build families.”Men Having Babies

The collaboration will be officially announced at a special dinner reception at the upcoming Surrogacy and Gay Parenting conference in Dallas, TX, this Father’s Day, which EMD Serono is co-sponsoring. The conference is based on the successful model of programs MHB has already organized in NYC, LA, San Francisco, Chicago, Brussels and Tel Aviv. It will bring together under one roof community activists, experts, parents and surrogates who will share their experiences. Prospective parents at all stages of their journey are encouraged to attend – from those who are just beginning to weigh their parenting options to those who are already in process.

Some of the other sponsors of the Dallas conference are also major supporters of GPAP, including Simple Surrogacy and Fertility Specialists of Texas, which have already helped several couples that have had children or are currently pregnant.

“For a same-sex couple, conceiving a child through third-party infertility treatments can be incredibly expensive,” said Jerald S. Goldstein, MD, medical director and founder of Fertility Specialists of Texas. “Through strong support initiatives like the Gay Parenting Assistance Program (GPAP), having a biological child is becoming more of a reality for intended fathers worldwide. We are proud to partner with Men Having Babies and to be a continued participating infertility center with GPAP.”

NEW YORK, NY (PRWEB) JUNE 16, 2016

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