Public commentary (from you!!) is needed to demand that infertility treatment coverage be included as an essential benefit under the Affordable Care Act (ACA).  To include your voice and make sure your concerns and needs are addressed contact the Department of Health and Human Services before January 31st, 2012.

The decision to include infertility treatment as a covered essential benefit falls solely in the hands of Kathleen Sebelius, US Secretary of Health and Human Services.  You can email her at

EssentialHealthBenefits@cms.hhs.gov

For more information please read http://myemail.constantcontact.com/Infertility-Matters–Demanding-Essential-Benefit-Coverage.html?soid=1101342191383&aid=B44Urr44QiU

The article was in the October 10th/17th edition of Newsweek, “You got your sperm where?”  The discussion in the article focused on how people are finding sperm donors (SD for short) through the internet (the “virtual” donor).  The article described one donor-recipient match and donation that was initiated through web contact and fulfilled via a donation made in a Starbucks bathroom in NYC.  Major yuck factor to that one.  Seriously, have you been in a Starbucks bathroom recently?  The line outside the bathroom will give you an indication of how actively they are used (hopefully not all for sperm donation purposes), and thus how potentially grimy they are.  I have a pretty high threshold for gross bathrooms and overall I think Starbucks does a good job keeping its bathrooms clean.  However, with the high traffic many of these bathrooms experience, you have to assume that they are crawling with germs.  And if you are trying to have a baby, at least to me, public bathrooms and sperm donation don’t make a great combination.  But to each his or her own, I suppose.

The thing that really got me, aside from the fact that this was taking place in Starbucks, was the lack of thought people were giving to what they are doing.  It’s one thing to go on a blind date with someone you met on an internet dating site.  To conceive a child from an online site — one that is not run by a sperm bank — seems a wee bit more frightening than agreeing to meet your average Tom, Dick or Harry for dinner or drinks.

One of the reasons people seem to be turning to online sources is to avoid the anonymity of sperm banks.  There is a sperm donor registry that is designed to help families created through anonymous donation, match the SD’s with the children conceived from the donations and to help children/adults conceived through sperm donation find their biological father.  The appeal of finding a random guy from whom you will receive donated sperm, and with whom you can establish some kind of non-anonymous but also non-parent-child relationship, is appealing to many people.  I get that.  No problem there.  Except, I don’t know, maybe some legal issues surrounding that lack of parent-child relationship. . . .

Known sperm donation agreements are some of the trickiest agreements a reproductive lawyer can draft.  I am always extremely careful when I draft them.  Why you ask?  Because, even though the goal of the agreement may be to avoid having the SD be liable for child support or retain any parental rights to the child conceived through the donation . . .  courts overturn them with surprising frequency.  All it takes are a couple of birthday cards signed “love Dad” and a court may well determine that, notwithstanding my carefully drafted known sperm donation agreement, the SD does indeed have parental rights, is liable for child support, and the child may even be able to inherit through “donor dad’s” estate.  Did any of us intend for that to happen when we sat down at the table to discuss what they wanted the agreement to accomplish?  No.  My clients usually want to have a friend donate sperm so that they can have a child (alone or with a partner), and have the comfort of knowing who the person is that is donating his genetic material.  All those “what-if” and “what is he like” questions can be answered later by the existence of a specific known SD.

If the SD and the recipient mom don’t want to have a parental relationship — for example two women in a relationship who intend to parent a child together but don’t want to use an anonymous sperm donor, and would like a close friend of theirs to donate his sperm (think along the lines of a well-known singer and her partner and another very well known male singer) — the sperm donation agreement becomes a critical component for recognition of the intended family unit.  The sperm donation agreement establishes what everyone intends to happen, and what everyone intends to be their respective rights and responsibilities in the future.  These intentions are set forth in writing prior to the conception of a child.  Most of the case law in the US that involves third-party assisted reproduction (including known sperm donation) looks to the parties’ intent at the time the child is conceived.  Provided that everyone sticks to the terms of the agreement, usually a good sperm donation agreement will be upheld if ever there are arguments, disagreements, or when and if someone suddenly wants something that was NOT intended when the agreement was drafted.  The thing is that just a few real-life events can cause that sperm donation agreement, and the parties’ intention, to come into question.  A court could decide that while the parties may have written down and signed an agreement that said one thing, their actions reveal a contrary intent.  Actions frequently speak louder than words when it comes to known sperm donation arrangements.

So let’s get back to the people who donated and received the sperm at Starbucks.  Do you think they took the time to consult a reproductive lawyer?  Did they consider what the consequences would be 10 years down the road if suddenly one person decided they wanted a different type of relationship or needed child support?  It didn’t sound like it from the article in Newsweek.  While their intent may have considered the prospective best interests of the child — having a person that the child could one day meet or speak to and thus avoid identity issues that plague many children conceived via anonymous sperm donation (thus giving rise to the donor registry I mentioned) — the reality of what they were doing and the lack of awareness of the long term ramifications are mind boggling.

According to the article, one man who is donating sperm through online forums, is asking the recipient to scream “make me pregnant!” or something like it during intercourse.  Let’s agree to not discuss the fact that they weren’t using medical professionals or a home insemination kit.  The statement the recipient is being asked to state in and of itself could be interpreted as an expression of their mutual agreement and intent to parent a child, TOGETHER.  Did the recipient of this sperm intend for this man to be the FATHER of her child?  I don’t believe she did.  Or did she?  Did the SD?

And hey, are we doing background medical checks of any kind?  Does anyone know if the people donating or receiving the sperm are healthy or otherwise able to parent a child?  What if the SD has an infectious disease?  What if the recipient is an ax-murderer?  Odds are they aren’t anything other than people with good and honorable intentions.  But if the law comes down to intent, don’t we owe it to the child to express that intent?

The internet is a wonderful place and it is a frightening place.  We all have heard horror stories stemming from internet match-making.  Let’s not add conception of a human being to those horror stories.  For anyone considering this type of sperm donation, and apparently there are plenty of people doing it, or even those seeking to enter into a known sperm donation with the assistance of medical professionals, do me a favor:  Find a reproductive lawyer or a family lawyer and talk about how you want to protect your family!

Maybe I am over-thinking this. Maybe it’s not different than someone who goes to a bar knowing she is ovulating, with the intent to hook-up with some guy and hope she gets pregnant.  At least the people going to Starbucks theoretically know each other’s real names and have some information about each other, and both know that a child is being conceived. Good intentions and lack of (legal) judgment aren’t a crime.  Then again, apparently Law & Order made an episode about this subject (maybe not involving a Starbucks sperm donor) and I would love to watch it.  I wonder what issues the writers of Law & Order found to address?

And really, I am just totally dumbfounded by this, someone donated his sperm in a Starbucks bathroom?  Wow.  What’s next? A mile-high  club for sperm donors?

Find out more at RESOLVE.org or watch this:

Take the Pledge!

Yesterday I read an article on some random website announcing that a celebrity had just announced she was pregnant. The article was extremely critical of the fact that she had waited until the 6th month to announce her pregnancy, and commented that it may have been due to the fact that she had suffered a prior miscarriage.  It then went on to discuss all sorts of celebrity pregnancy issues.  But it was about the third article I have seen recently commenting on a celebrity’s miscarriage.  None of the articles were supportive, not even for the one celebrity that was openly going through fertility treatment and then lost a baby.  Any miscarriage at any time in pregnancy is awful.  As many of you know my final infertility diagnosis was unexplained pregnancy loss (which has since been explained).  I had 5 IVF miscarriages (including a pregnancy that started as twins), and I don’t want to tell you how many more I have had on top of that because at some point you just have to stop counting and cope.  I have blogged about at least one of them.

I have always been open about my miscarriages and my pregnancies.  I am one of those “put it out there” kind of people.  But a lot of people choose not to share early pregnancies.  They instead choose to wait to make an announcement when they are sure that the pregnancy is viable or the fetus is otherwise healthy.  Everyone does it their own way.  And as this is a very personal subject, I was offended that this article “accused” this celebrity of failing to disclose her pregnancy earlier.  MYOB!

Miscarriage is poorly understood on so many levels.  I will blog about the medical aspects later, but for today let’s address the emotional component. I may have blogged about this before but someone recently commented to me that 20 years ago no one even talked about this.  My grandmother’s generation suffered in complete silence, often not even sharing the loss of a pregnancy with their spouse!!  The fact that we are beginning to talk openly about miscarriage is a huge leap forward.

Did you know that among the fertile population only 20% of all conceptions result in a live birth?  That number decreases with age.  With so many women choosing to build their families later in life, whether they conceive on their own or with some form of medical assistance, their chances of experiencing a pregnancy loss are much higher.  Doctor’s often warn patients who are over 35 not to get excited about a pregnancy until they see a heartbeat on ultrasound because the risk of miscarriage is so high.  NOvary™ or not, miscarriage is devastating.

If you ask me, all these women need support, information, and the ability to discuss their grief in whatever manner is most appropriate for them and to do so without criticism!  But the fact remains that most people still won’t even admit they had a miscarriage.  The entire first trimester of pregnancy is shrouded in secrecy and thus any resulting miscarriage is as well.  It is not a personal failure to lose a baby.  It is an overwhelming emotional experience whether you are six weeks or six months pregnant.  I think people should be able to talk about miscarriage — I think people need to be better educated about pregnancy loss but as noted that is a subject for a different blog post — and not have it be considered something shameful or even worse, “no skin off your nose dear, you were only 7 weeks pregnant, get over it”.

Is it the fear of being shamed that causes us to hide our miscarriages as was true for my grandmother and her generation?  Is it the need for privacy and the accompanying silence during the first trimester that causes the secrecy?  Or is it the fear of the “just get over it” response that people don’t discuss this topic?

Well, I am going to discuss this topic.  I think I have enough experience to have some insight into the emotional aspects of pregnancy loss and I’ve done a ton of research on the topic, both for The Infertility Survival Handbook, my own personal curiosity and now for the revised and updated version of my book.

My final comment of the day is this.  Whether we choose to grieve in silence or in public, please don’t attack us for our choice in so doing; you need to understand that it is a tremendous blow to every woman (not to mention her partner) who experiences a pregnancy loss.  If you know someone who has shared this information with you, BE SUPPORTIVE.

I was dropping my son off at school recently and there is church nearby where I had parked my car.  Alongside the church is a beautiful garden and in that garden there was a headstone that caught my attention.  It was a headstone with the picture of a baby in-utero and it was dedicated to all the unborn children in the world. The headstone had the name of a baby who died in utero at about 5 month’s gestation.  It wasn’t some pro-life stunt; this was a real headstone for a real fetus who died leaving a family devastated.

If I can do it, I will try and post a picture of the headstone (without the family’s name).  I would like to thank that family for putting that headstone there and for the church for allowing it, because I now have a place to go and lay flowers on my “bad” days.  Because frankly, my girlfriends don’t get it.  This headstone gives me an outlet, a place that recognizes what I and so many others have been through.

And for those of you who have experienced a pregnancy loss you have my empathy and a giant cyber hug. To that celebrity who just announced her pregnancy at 6 months, you have my congratulations.  To that cyber author, I can’t post what I think about you, but I do hope that you never have to endure what so many of us have been through.

I try and stay out of highly controversial discussions in my industry and to avoid taking sides unless I feel passionately about the issue.  Sometimes blogging backfires (ala Sarah Palin’s recent “hit list” and the resulting death of 15 people).  But I have come across another of those issues that MUST be discussed, so I am hereby entering into the foray and it’s along the lines of my “what was Brooke Shields thinking” blogs.

Let’s get real for a moment and turn to a movie reel about egg donation.

I today learned that the “documentary” Eggsploitation was announced to have been nominated as best documentary.  When I read this on FaceBook this morning I almost vomitted.  For those of you who haven’t seen it . . . and please don’t see it if you are considering either becoming an egg donor or using an egg donor to build a family . . . it is highly inaccurate and inflammatory.  Please understand that I am trying to be nice.

The movie is an attempt by right wing, pro-life. Christian conservatives to reveal the “real world of egg donation”.  And Honey, it doesn’t.  It serves one purpose only, to promote an anti-IVF anti-egg donation agenda.  And in my mind it isn’t a documentary unless you are basing your documentary on something with a substantial amount of truth or accuracy.  A documentary by one definition is the “creative treatment of actuality”.  I will agree to the creative part with respect to this film, but not the actuality part (with one caveat, I will agree that egg donation exists as a means to build a family).  Another definition says that a documentary presents the facts with little or no additions.  Isn’t it a failure to present the facts if you only present one side, or one statistically insignificant, rare and otherwise atypical aspect of something, i.e. ONE fact when there are many facts to be discussed?

This film is based on untruths, inaccuracies, mythical stories, and an agenda. It veils itself as a documentary in order to lend some false sense of “truth” to the movie’s topic, the exploitation of egg donors and recipient families all to the benefit of the massive money generating industry of reproductive medicine.

The reproductive industry has responded many times in opposition to the film, as have many of my colleagues (for example, here is another blog on the topic http://weblog.prospectivefamilies.com/2011/01/13/what-more-is-there-to-say-about-eggsploitation/ ).  I think it’s pretty much a universal sentiment in my world, both professional and personal, that this movie has nothing to do with reality and is serving to mislead the general public about a viable and very successful means of family building, egg donation.

I really think it has gotten to the point that the movie is now exploiting itself for its own financial benefit.   They are now twisting all the negative media attention into an argument that if they weren’t so “right” about the industry that there wouldn’t be so many defensive and anti-Eggsploitation blogs/articles/reviews.  It’s kind of like the old saying “you know you’ve done something right if they’re shooting at you!”  And they are using that to drive more people into movie theaters.

Well I don’t think they’ve done anything right, I am disgusted by the MOVIE, and I am disgusted that anyone would think it was worthy of the title “best” in anything.  I haven’t spoken out before because I didn’t want to further publicize this movie and thus encourage people to watch it — even if it is to see how wrong it is.

And for the love of all that is sacred about the word FAMILY, I respectfully request that the movie industry get a grip and get real.  Don’t endorse this movie.  Many a Hollywood family has been created through the gift of egg donation.  Do you really want to slap your egg donor in the face like that?  By promoting, endorsing, and casting something that she did to help you have a baby and a family, in such a negative, illicit and patronizing light?

I’m not saying the world of reproductive medicine is perfect.  I have some bones to pick with things that happen in the world in which work.  And I will cut the producers of this movie and Hollywood some slack and say that if you are going to focus on the very creative aspects of the use of truth to create a dialog (albeit the wrong dialog) then okay maybe this is a documentary.  But it’s a documentary that I refuse to endorse on any level.

Someone can, and should, do a better job at looking at the gifts that third party assisted reproduction are giving to infertile families.

Blech Blech Blech.

With all the recent emphasis on single embryo transfer, and avoidance of multiple pregnancy (a twin pregnancy is now considered a management failure at some IVF Clinics), should patients in consultation with their doctors be the ones to choose to how many embryos to transfer or should doctors face regulation or possible loss of their medical license for listening to their patient when she asks to have multiple embryos transferred when it might be advisable to limit the number transferred?

Here’s the link to the article for more info:#mce_temp_url#

(in case the link doesn’t work, cut and paste this URL  http://www.whittierdailynews.com/news/ci_16351124)

At 41, most of know that Jennifer is likely to be facing some fertility issues (although with her health conscious lifestyle and yoga-bod maybe she’s found the way to turn back time, she sure looks it anyway!).  While most of us would be doing a little freak-out dance now, and panicking about the ticking time bomb that are our ovaries, Ms. Aniston seems anything but panicked.  In fact, she seems rather Zen about it all.  And that is exactly my point and what inspires me.

First, the woman KNOWS she is going to be a mom.  One way or another the woman has total and complete faith that she will become a mom.  Rather than spiraling into depression (as I did and many of us do), Jennifer has seemed to have found a way to let go and TRUST.  This is, I think, the gateway to success.

I really truly believe that it is when you completely accept and embrace the concept that you will be a mother, no matter what and no matter how (IUI, IVF, IVF donor egg, gestational surrogacy, adoption, whatever is your path), that fertility treatments have the highest success rates.  Study after study shows that the mind-body connection cannot and should not be ignored.  Women who are able to be in the place that Jennifer Aniston seems to be in, are the women who are more likely to succeed with fertility treatments.  It’s fact not fiction.  I know — as does JA — that she’s got an edge on success that I wish more of my friends and clients had: The inner-knowingness of the inevitability of their impending state of motherhood.

Another thing that I think sets her apart from many of us (and I include myself in this group when I was in the first 4 or 5 years of treatment), is that by all media accounts, she seems fairly open to many different paths to parenthood.  I am not privy to her conversations with her BFF’s but I am guessing that there isn’t much she isn’t considering about how she’s going to become a mom.  That too puts her on the fast track to “mommydom”.  Not all of us can be as enlightened and confident as she is, and I am not saying that she doesn’t have her moments of . . . doubt  . . . but I really think that the confidence and openness that Jennifer Aniston is talking about whenever she is interviewed about becoming a mom is something that tells me it ain’t gonna be long before she’s announcing the arrival or the impending arrival of a little baby Aniston.

And for what its worth, I think she’s a fantastic role model for every woman, single or married, over the age of 35 who’s trying to become a mom.

ASSUME IT IS GOING TO HAPPEN, AND IT WILL.

p.s. and when you can’t totally assume it will happen, fake it, fake it until you make-it  . . . because that’s another sure fire way to get your mommy-Zen fire burning.

And I wish me all the success in the world too.  But that is the subject of another blog.  (would someone please tell me where the emoticons are in WordPress???).

“I’m sorry you can’t have a baby.”

WTF?  Read on:

http://www.nytimes.com/2010/01/31/fashion/31love.html

Anyone who has previously registered to be a user on this blog needs to register again.  As of today, we have only 4 registered users, down from over a hundred.  Please, please, please, take a minute and register again.  I am so sorry for the inconvenience.  But some mean person corrupted my blog.  Once you register again you shouldn’t have any problems.  You may not have even noticed . . . but we noticed and we miss you!

Once again, anyone who has previously a registered user on this blog is no longer registered due to a worm that corrupted the site.  Please re-register and join our discussions!

Thanks!

Liz