Egg donation is often so successful that some can potentially build an entire family from one egg donation cycle. Of course not every egg donation results in a pregnancy, but more often than not a carefully selected egg donor not only leads to the birth of a child, but will provide a family with extra embryos to freeze for future family building.

Such was the case for my former client Nancy. Her experience with egg donation provides a great example of the types of things someone considering using egg donation might want to take into account as they move forward on their journey to “Mama” (or “Dada”).  Nancy, at the time her journey into egg donation began, was in her early forties.  Like many women today, Nancy had waited to marry until she found the “right guy” and had established her career.  After graduating from law school, Nancy decided that she wanted to put off starting a family until she had paid off her student loans, and had made partner in her law firm.  She felt very strongly that it was important her career and financial life be stable before she became a mother.  When she was 35 she met Daniel, and after dating for a few years they married when she was 38.  Well aware of fertility landmines related to age, she and Daniel  had discussed her desire to become a mother before they got married and agreed to start trying for a baby immediately after the wedding (Nancy, just like me, hoped for a honeymoon baby!).  She was such a planner that before they got married Nancy went to her OB to see if she was facing any age-related infertility issues.  Much to her surprise and relief, after her OB examined her, Nancy found out that it seemed like all systems were good-to-go; she appeared to have a healthy body, good ovarian reserve, and nothing standing in the way of her becoming a mother.  Nancy’s OB recommended that the newlyweds try having unprotected sex for six months and if nothing happened to go see a reproductive endocrinologist (sounds like a good plan to me!).  However, after six months of unprotected intercourse, Nancy and Daniel had not gotten pregnant. Proactive Nancy immediately contacted the reproductive endocrinologist her OB recommended.

The RE Nancy and Daniel saw recommended that they try assisted-reproductive technologies.  Unfortunately after several failed IUI and IVF cycles, Nancy’s doctors told her that her best chances for becoming a mother were through egg donation or adoption.  Although there seemed to be no medical explanation for Nancy’s failure to conceive, their RE didn’t think further attempts using Nancy’s eggs made sense.  Despite her remarkably low FSH and good AMH results, her RE nevertheless attributed Nancy’s IVF failures to issues related to ovarian reserve and her age.  Ironically, after all her efforts to detect infertility, especially age-related infertility, Nancy discovered that she was dealing with the dreaded NOvary™.  (Just as side note, my definition of NOvary™ extends beyond ovaries that refuse to produce eggs because we are too old.  However, in this case Nancy’s confrontation with the NOvary™ did seem to be related to the fact that she was in her early forties and her ovaries were headed into retirement.)

The RE suggested they consider using an egg donor or adopting.

Nancy was at first — like all of us — somewhat devastated by this diagnosis.  She had done everything correctly, ate a healthy diet, exercised her entire life (in fact Nancy had almost become a professional dancer before going to college), she didn’t smoke, took yoga classes, and yet her body still seemed to be failing her.  After discussing the situation with Daniel, Nancy realized that she really, really wanted to experience pregnancy (I can relate to that!), and so they chose to first pursue egg donation.  N&D agreed that they would try egg donation one or two times and if they didn’t conceive a baby through egg donation, they would move on to adoption.

Nancy, however, was not prepared for the overwhelming information and advice she received once she had settled on using an egg donor.  People told her different things:  don’t use an agency, use an agency, don’t use an inexperienced donor, use an inexperienced donor.  Everything Nancy heard seemed to be conflicting and confusing.  Even worse was how overwhelmed she felt when she logged onto various egg donation agency’s databases.  How on earth could she ever select a donor out of the hundreds that seemed to be available?

Her gut reaction was to work with her RE’s “in-house” egg donor program as they would select the donor for her, thus ensuring that she had a fertile donor and, more importantly, Nancy wouldn’t feel she had to cull through profile after profile.  Nancy just wanted someone to make the decision for her so that she and Daniel could move past infertility and onto pregnancy!

After doing her research (if we haven’t already established it, I want to remind you that Nancy is quite the type A person and she is proud of it!  I can relate, as I too am rather Type A) Nancy, however, decided instead to work with an egg donation agency.  Although many “in-house” programs are flexible, Nancy felt that she had more options when working with an egg donation agency.  While Nancy felt that she was giving herself more legwork to locate her own donor and dealing with the accompanying stress, Nancy felt that by working with an agency she had greater flexibility in choosing her donor.  What had first seemed so attractive — having someone present her with an “egg donation goddess” (her words not mine) — in reality turned out to concern Nancy.  By relinquishing control to her RE and his staff, she lost the flexibility to request a donor who had an athletic background (not only a former dancer, both Nancy and Daniel are self-professed exercise junkies, and Daniel had played some serious basketball in college), or to use an egg donor who has an “artistic” personality (the dancing thing turned out to be really important).  She also seemed to have a harder time finding a college educated egg donor through her RE and in the end having a “smart” donor also turned out to be very important to both Nancy and Daniel.  Their RE’s in-house program would be able to provide them with a donor who already had been screened for fertility (a huge plus by many standards) and who physically resembled Nancy and Daniel (another huge plus for most people), but with the in-house program she couldn’t request an “athletic, artsy, super-smart” donor.  Using an egg donation agency gave her the freedom to be more selective than she initially thought she would need or want to be.

Nancy also didn’t have to share eggs with another infertile family which was a requirement at her particular RE’s in-house egg donation program (off topic for a moment:  shared egg donation cycles are a common effort by clinics to help reduce the cost of an egg donation cycle but being “required” to share a cycle isn’t common).  Nancy also realized that working more independently meant she would have greater control over their finances.

With a limited budget because they were also considering the possibility of adoption, most of the agencies she spoke with recommended that N&D select a donor who lived near the clinic she would be using, thus avoiding substantial travel expenses. Using an agency, Nancy also had a greater selection of donors with compensation rates to fit her budget, compared with the fixed rates offered by Nancy’s and many in-house egg donation programs.  By selecting a “local” donor with a lower compensation than that which her RE’s in-house program requested on behalf of its donors, Nancy was able to save a couple of thousand dollars and put it in what she called their “adoption bank.”  It did take more time finding that “artsy, athletic, super-smart donor” than she had anticipated but Nancy felt the time was worth it given that she didn’t think she would know “enough” about her egg donor’s background had she chosen the egg donor recommended by her RE.

One donor Nancy considered, I am going to call her Lucy, was twenty-seven years old, single, had been a dancer in high school and had attended a Seven Sister’s college (rock on to all women’s colleges!!).  Lucy had graduated at the top of her class and was attending graduate school in journalism (did I mention that Daniel is a news columnist?!). Despite Lucy’s outstanding academic credentials, which often result in a higher requested compensation, Lucy’s “requested comp”  (egg donor industry lingo) was on the low side.   Side Note:  The Society for Assisted Reproductive Technologies’ (SART) has guidelines that recommend egg donors receive between $4,OOO-$7,000 per donation.

With Lucy’s dancer’s background and desire to be a journalist like Daniel, Lucy seemed like the perfect donor.  Lucy, however, had no track record donating eggs.  With their tight budget and limited time factors — N&D were also concerned that if they waited much longer their age might preclude them from working with certain adoption programs and they very much wanted to preserve this as a family-building option — Nancy and Daniel instead decided to match with ”Lauren.”  While Lauren also was twenty-seven and had attended college where she played soccer, Lauren had a three year old daughter and had conducted one prior egg donation cycle that had produced a lot of eggs.  Although they didn’t know whether that egg donation cycle resulted in a live birth, Lauren was clearly fertile and was likely to respond well to medication.  To Nancy and Daniel, this made her a better candidate.

Both Lauren and Lucy were requesting $5,000 as compensation for their cycle and lived relatively close to Nancy’s and Daniel’s clinic (no overnight travel was involved).

Once N&D selected Lauren as their donor, the egg donation agency presented them with a list of attorneys to help prepare their egg donation agreement, and it arranged for Lauren to be represented by an attorney as well.  I am working on a blog on egg donation agreements and why you MUST have one so I am not going to go into it in depth here.  I actually had already met with N&D before they got the list of attorneys from the egg donation agency (and my name was NOT on it grrrr), but I did help them prepare their anonymous egg donation agreement with the woman we are calling Lauren.

Once the egg donation agreement was signed, their egg donation cycle got underway. Lauren didn’t produce as many eggs as N&D had hoped; Lauren “only” produced eleven eggs but all eleven fertilized (Side Note: 100% fert rates are not something you should expect, it doesn’t always happen that all of a donor’s eggs will fertilize.  Nancy and Daniel got lucky). Nancy conceived twins from the first embryo transfer (now that is something you should expect and should discuss with your RE if you don’t feel prepared to parent two at once).  After watching the remaining pre-embryos which were not transferred to Nancy’s uterus, the clinic froze five blastocysts.  Off topic again: Nancy’s RE performed a day-3 pre-embryo transfer which, for reasons that exceed the scope of this blog, I am at a loss to explain.  Despite Nancy’s disappointment with the number of eggs retrieved, I would have thought the clinic would have done a day-5 or blastocyst transfer??

Nancy and Daniel are very happy and currently are considering whether or not to use their frozen pre-embryos.

If you have any thoughts or comments to add about your experience, please feel free to share them.  This blog is designed to help people achieve success in egg donation and if there’s something you think might help someone, go for it!

p.s. I don’t know whether any of this sounded familiar to you, but I did think that Nancy’s and Daniel’s decision-making process and the issues they faced, particularly those Nancy faced, were typical and helpful enough that I wanted to share them.  Nancy and Daniel’s story is discussed in much greater detail in my next book if you want to learn more about what they went through when finding their donor and negotiating their egg donation agreement.  More details about pub date to follow (I am under an editorial deadline which is a good thing because it means this thing will finally be finished!!!  I’ve only been working on the book for three years.  Enuf is enuf!).

The book is “Baby Proof” by Emily Giffin (author of Something Borrowed, recently made into a movie with Kate Hudson).

Written in the first person, the author is struggling through marital problems and decisions about whether or not to have a child.  As she is trying to sort out her own issues, her sister is going through treatment for infertility.  Author Emily Giffin does an amazing job of both describing the issues a person faces when contemplating living a life without having children (and the condemnation that may come with that decision).  And she does an even better job describing what her sister is going through and issues involved with egg donation and the dreaded NOvary, fears about birth mothers, open adoption — heck she even accurately addresses the differences between embryo donation and embryo adoption and the misuse of terminology . . . .  Seriously, you cover that one accurately (as did Ms. Giffin) and I HAVE to put you on the Stork Lawyer’s recommended reading list!!

Baby Proof is a great read and one that very clearly articulates the very complex landscape of third party assisted reproduction and adoption.  I tend to be really harsh and judgmental when it comes to reading other people’s — especially fertile people’s — interpretation of my world (both the part I live on a day-to-day basis and the part I work in) and my hat’s off to Ms. Giffin!  Baby Proof is politically and legally correct down to its core and it is still a fascinating read.

Baby Proof gives us a multi-faceted view of  the myriad of complicated emotional and legal issues faced by infertile couples and singles.  If you are going through infertility don’t be afraid to read this book.  It’s not preachy, critical, judgmental, hurtful, or voyeuristic.  Baby Proof looks at the issues infertile women face every day and with the precision of a plastic surgeon and her scalpel, the author manages to peel apart the very delicate skin (issues) involved when you’re dealing with ovarian reserve issues, third-party assisted reproduction, adoption, as well as the concerns women face as their biological clock ticks away and they lack a partner to help make a baby.

It’s a fun read and manages to be educational at the same time.  I totally was caught off guard.  I thought this was going to be some light chic lit for summer vaca.  Was I ever wrong!  For the first time in a very long time, I wound up thinking and marveling at the ability of someone who doesn’t live my life to totally understand my life.

I may know that she interviewed a reproductive lawyer but I still have to believe that she knows more about this topic than what one can learn from spending an afternoon being educated by someone like me.  I can’t help but think she must have more insight into infertility than just an interview would bring.  I mean she really GETS IT.  I tend to think that you can only understand this pain if you’ve lived it.  Granted the character in the book is going through a life crisis and is incredibly intellectual and so these issues are discussed through a filter of self-analysis . . . but even that, the self-analysis part of it, leads me to wonder if there isn’t some personal connection to infertility that I am unaware of.  Maybe I will re-read the acknowledgment section?  Maybe I missed a thank you to someone who shared their heart.  But if I didn’t miss it, then this is one book that understands the infertile woman (and maybe will help people find their way through their infertility to consider an option of family building that without this book they might not have understood or considered).

It’s been a long week and I am brain dead.  I hope I made the point I wanted to . . . I don’t typically think that it’s possible to understand what we go through and I don’t typically find that people get the legal issues involved in what I do everyday.  You know I analyze every movie and magazine article looking and hoping to find an accurate portrayal of the path to parenthood when you’re not a fertile person.  Did I finally just find one??

I think so.  Maybe I won’t just re-read the acknowledgments. Maybe I will re-read this book.  This might be a first.

Thanks Emily.  You done us proud.

I have to say I have a little bug up my arse today.  I just finished writing an article for the American Bar Association’s Family Advocate magazine, talking about why you need to draft egg donation agreements and what you need to include in them.  I also have been working on the same issue in my e-book.  But what’s really got me peeved is the amount of explaining I have to do with potential clients, or just people calling for a consult, about why egg donation agreements are so important.

In two words: parental rights.

I don’t know whether it is agencies trying to save their clients’ money or whether its clinics trying to make things easier but let me tell you that the consent forms you sign at your clinic doesn’t provide you and your soon to be larger family in the event your child gets sick and you need medical information from you donor (just one of the many benefits that can be addressed in an egg donation agreement).  And any representation that anyone makes to you about someone living in a “donor friendly” state thus you don’t have to be worried about parental rights, is only 1/4 correct.  If you are lucky enough to live in a state with an egg donation statute that is a huge plus, but I bet you anything that statute says something about the fact the someone, preferably you and your donor, sign some document stating that this statute is going to apply to your relationship and your donor isn’t going to have any rights or responsibilities with respect to any child conceived from your donation.

And even if the statute doesn’t require a legal document, egg donation agreements state the parties’ intent throughout the agreement and the law in the United States pretty much consistently relies on the parties’ intent as they enter into third party assisted reproductive arrangements, so statute or no statute, having a legal document that addresses your intent is critical.

There are ten key points on which you want to express your intent.  Other than parental rights, can you guess what the other nine might be?

This is your baby folks — or this is a baby you don’t want to have responsibility for if you are an egg donor.  This is a family and this is the rest of your life.  Why wouldn’t you take the time to at least speak with a reproductive lawyer in your area about whether the steps you are taking are sufficient to protect you and your family, or you from having an unwanted family?  One of my clients and I had this discussion one day.  Their agency was telling them that they didn’t need an egg donation agreement and that it was a waste of money and time.  Once I explained my top ten reasons to have an egg donation agreement, my former client was speechless for a few minutes.  And then he responded with:  ”when you put it that way, it seems like it’s kind of a no-brainer. . . . ”

I understand — all reproductive lawyers understand how expensive this process is and how overwhelming it is.  We all want the same thing for you.  A protected family or lack thereof.  If you can’t afford our fees, most of us will try and work with you but in the grand scheme of things what you spend on your egg donation agreement is pennies compared to what you are spending on the rest of the process and if you look at its value over time, well in the words of my former client, I think it’s a no brainer.

So anyone want to take a shot at the other 9 things on my top ten list?  Egg donation agreements run about 30 pages.  What the heck do we put in the agreement that could possibly make it so long?

Thanks for listening to me vent.  I look forward to posting a link to the article I wrote for the Family Advocate and I look forward to the publication of my e-book where I answer all these questions.  But in the meantime, feel free to ask me about it.  It’s your family or someone else’s . . . you should know what you might be missing.

p.s. this post wasn’t proofed so please forgive typos.

To think about everything that I should be doing in the office but can’t.  To think about everything that I need to be writing:  my e-book on egg donation is pretty much finished but I haven’t had time to input the final edits or to speak with my design and production team about getting it ready for the marketplace; I have an article on egg donation and surrogacy contracts that is due to the American Bar Association in a matter of days; I have to talk to my publisher about revising The Infertility Survival Handbook; I want to write a blog about a RESOLVE event I co-hosted on March 24th at Bis.Co.Latte Cafe in NYC regarding the legal issues egg and embryo donation; and oh yeah I am supposed to be teaching a class on third-party assisted reproduction at a law school and I have to prepare the syllabus (that one may not happen).

To think about all the contracts that I need to draft and edit for clients.

To think about the new series of blogs I am working on (perhaps it too will become an e-book?) on the mind-body connection in dealing with and resolving infertility.  Thanks to a Facebook friend, I discovered a wealth of information on something called “Conscious Conception.”  I have a ton of research to do on Conscious Conception, it is a seed germinating in my mind and something I very much want to talk about.   Just this morning I was staffing out work in the office and we got into a long conversation about how much I believe faith plays in people’s ability to deal with and overcome fertility.

And yet, all I am capable of on this gorgeous sunny day is to THINK about the overwhelming amount of things that are filling my proverbial plate.  I am utterly and completely without the ability to deal with any of it today.  For today my goal is to be able to breathe.  One of the fundamental things in life which I must attend to if I am going to get back to these things, yes?  Yet, instead of recognizing the very important need to take care of my own health, I have been beating myself up for my inability to do my work.  I feel like I am drowning, literally and figuratively.

It was only upon stumbling across an issue of the Wellesley Alumnae Magazine and its cover article about “When Life Doesn’t Measure Up” and reading about how, when and why so many of my fellow Wellesley sisters feel like failures, that I realized that I feel like a failure for having pneumonia and not being able to do my work.  And with that thought, I was off and running on a journey of self-analysis that of course brought me right back to the world of fertility and the feelings of failure that come with it.

Apparently, my college magazine conducted some kind of a poll asking graduates to discuss their feelings about their satisfaction with their life and feelings of inadequacy, failure, or success in a variety of different contexts.  I don’t recall receiving a questionnaire in the mail or an email like this — must have missed out on contributing my own thoughts to this very profound poll.  The reasons women gave for feeling like a failure were incredibly diverse.  And yet, despite the very diverse reasons or situations my Wellesley sisters gave when describing their own issues with failure, including dealing with chronic illness, the article did not mention infertility or an inability to have children (or the choice not to have children) as raising issues of failure.  Certainly, someone among the thousands of Wellesley graduates has experienced difficulties conceiving and must have felt like a failure.  I did.  I do.  Why didn’t someone else talk about it?  The Dixie Chicks talk about it in their song “So Hard” . . . a ballad that haunts me every time I hear it.  It’s all about the feelings of failure and loss we have when we can’t conceive.  One out of every 8 Americans is dealing with infertility.  Why didn’t the Wellesley College Alumnae Magazine talk about it?  Especially at an all women’s college, you would think that a topic like infertility and failure related to something so integral to being a woman would be recognized and not continue to be shrouded in secrecy. The article talked about the shame my sisters felt about their various failures, the secrecy that surrounded them but infertility was not among them.  What gives?

The secrecy and shame surrounding infertility is pervasive.  Just as for my sisters who are wrestling with their own failures of a different nature, the article pointed out that all of them felt better by talking openly in the article about failure and its impact on their self-perception.

Indeed, the magazine itself was often a cause for Wellesley alumnae to feel failure.  By hearing about the success stories profiled in the magazine many women admitted that they felt that they had let down the school or that they failed to measure up to the “Wellesley standard” of being or becoming another Hillary Clinton.  The article concluded with the following statement:

“But maybe what we don’t know is what failures happened to those women before they became household names that eventually brought them to the point of celebration.  And until we hear those stories, too, we can’t begin to make new templates for success that acknowledge the inclusion of failure as part of a life well-lived.”

And this leads me to the following conclusions:

Until we hear stories about our feelings of failure and inadequacy arising from our infertility, and our subsequent success at overcoming them, we cannot begin to make those new templates for success that acknowledge how much stronger or sensitive we have become as a result of our infertility.

Until we hear stories about our feelings of failure and inadequacy arising from our infertility, we cannot begin to find faith that our own journey will end in success.  We need to be inspired by the success of our sisters (and brothers) who have gone before us and achieved that which we long for — a baby — even if that success means embracing an alternate route to parenthood such as surrogacy, egg or embryo donation, or adoption.

It is, as my Wellesley sisters say, in embracing the loss in which we gain the faith to succeed.  I wish there was no stigma to being infertile but I must confess that the lack of mention of infertility in this article really drove home for me the sense of the overwhelming stigma with which we live.  I have a serious issue with the Wellesley Alumnae Magazine for not bringing to light a discussion of how failing at something as intrinsic as becoming a mother can be so devastating to our sense of self-esteem, to our marriages, and to our sense of failure as a woman.  (I cannot fathom that not one woman responded to that poll and didn’t mention infertility and if that was the case, I am even more troubled by the statement that makes regarding how much we hide about our infertility).

Learning from others who share their own shame or other sense of failure about something with which we are all supposed to be able to do — conceive, carry and give birth to our children — is what will carry us through.  For others it is not necessarily biological or medical failure but a sense of frustration at being unable to conceive because we lack the essential components — we are socially infertile.  And learning from others who find ways beyond our social infertility will give us ideas and strength for achieving that which our sexual orientation precludes us from obtaining.

And as the wheels started turning and hit overdrive as I considered the article and my own sense of failure because I have pneumonia and am unable to work (and am thus letting down my clients to whom I truly want nothing more than to help have a child), and considered once again the stigma with which we live, I couldn’t stay silent.  I pulled out my laptop and curled up in bed to “think through” this article and my situation and put together the pieces of this puzzle.  My blog will now not only be devoted to discussing the concepts behind Conscious Conception, but it will be devoted to de-stigmatizing this disease.  I know there is a Wellesley sister out there somewhere who is struggling to defeat the NOvary™ or endometriosis, to locate a birth mother, to navigate the increasingly complicated red tape of Ethiopian adoption, or to find a way to establish the fact that she and her partner are both the legal mothers of the child one of them delivered and which they intend to parent together.

So in my failure of having pneumonia, new ideas and inspiration have been born for my blog and thus my day has turned into one of celebration.  And I ask you to please not be silent.  I took the pledge with RESOLVE not to remain silent and today my failure in being human and having pneumonia has given me an idea of how I can fulfill my pledge to RESOLVE.  My blog is a safe place where I hope to support people walking with me on this path, and to provide the occasional nugget of legal or medical information to move us another step forward on the path to parenthood.  And thus I ask you to talk about your shame.  Talk about your sense of failure.  Talk about your frustration, your anger or confusion. (And if you are a Wellesley alumnae, help me convince them to let me write an article about infertility).  Share your story here wherever you may be in your journey.  And I will try and find people to share with you how they conquered the NOvary, endometriosis, found birth mothers, survived the red tape of Ethiopian adoptions, or proven their joint parentage.

Because I know that if we continue to be silent and give in to this crazy stigma, we will never know what failures happened to those women (and men) among us before they became mothers (and fathers), and that eventually brought them to the point of celebration.  And until we hear those stories we can’t begin to make new templates for success that acknowledge the inclusion of infertility as part of a life with children.

And now for some random FAQ’s and reminders:

Yes, you can establish your parentage if you are a same-sex couple and one of you has a baby.  Depending on where you live the mechanisms for doing this will vary.  In some states you can file a legal action to have your parental rights established, in other states you may need or want to adopt (even if you are not married).  In some States and in some circumstances you may need or want to do both.

If you have a functioning uterus, egg donation is perhaps the most successful route to pregnancy for women who have issues with the NOvary™.  At many clinics, with a properly screened egg donor, live birth rates per egg donation are in the 60% range.  Yes, you read that correctly, you could have a 60% chance of conceiving a baby using an egg donor.  And among those that conceive using an egg donor, the rate of twin conceptions is in the 40% range (making a strong case for single embryo transfer).

If you are considering adoption but have financial concerns or are worried about wait times, relinquishment risks, or red tape, embryo donation is a rapidly growing path to parenthood.  Using embryos donated from another family who has cryopreserved embryos which they no longer wish to use to build their own family, you may have a 40% chance of conceiving a child.  In addition to the affordability of embryo donation and the high success rates, you have the opportunity to carry the child, control the uterine environment, and may have the ability to conceive more than one child (this will depend on the type of embryo donation you enter into, as well as the number and quality of the embryos donated to you).

If you don’t have a functioning uterus, gestational surrogacy is another option for becoming a parent.  Using either your own gametes (genetic material), or an embryo created from egg or sperm donation (or sometimes both), another woman can carry a child for you and you will have all legal and parental rights upon that child’s birth.  Surrogacy laws vary by State, and it’s far from inexpensive, but when done correctly, surrogacy is a wonderful means of building a family.

And let’s not forget what is now almost considered boring: IVF.  If you have a viable uterus, eggs and/or sperm but for other reasons have difficulty conceiving on your own, with the assistance of In Vitro Fertilization, your chances of conceiving get better every day.  With the improvement of the culture medium used to nourish embryos, together with advances in reproductive medicine, some families will have as high as a 70% chance of conceiving.  Although the vast majority of families using IVF will need more than one attempt before conceiving, this is a technology that should not be ignored.

Other things to consider are:

PGD, (Preimplantation Genetic Diagnosis).  This enables you to select only those embryos that appear chromosomally normal for embryo transfer in an IVF cycle.  For older infertility patients, those with a family history of hereditary illness, or those with recurrent pregnancy loss, PGD can increase your chances of conceiving a healthy baby.

ICSI, (Intracytoplasmic sperm injection).  This is where doctors inject the sperm into the egg to help facilitate fertilization.  For families with male factor infertility this can help side-step problems with sperm that might prevent it from fertilizing an egg.

DNA Fragmentation Assay.  This is a test performed on sperm to determine whether the sperm are chromosomally normal.  Although there is a large range of “grey area” where it is unclear whether the sperm are going to cause problems with conception or pregnancy loss, this is proving to be a very important aspect in solving cases of recurrent pregnancy loss, IVF failure, or otherwise diagnosing “hidden” infertility issues.

Blood Clotting Disorders and other immune issues.  Do you have unexplained pregnancy loss or IVF failure (with an egg donor)?  Go get a work-up from a hematologist or other doctor specializing in diagnosing harder to find infertility issues.  Sadly many physicians routinely overlook or discredit the influence or impact of blood clotting and/or immune issues on the ability of an embryo to implant in the uterus, or to the ongoing development of a baby.

Are you going to stay silent, or are you going to talk with me here about what you are feeling, what you are trying to do to overcome your infertility, or what you did that helped you overcome it?  Speak.  If not here, then find somewhere.  Please.

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.

There is a lot more fun to be had and work to be accomplished, praise to be garnished and shopping for hot “Jeggings” (well maybe not for me) to be done in one’s 40’s.  The “not your mom’s kind of jeans” have given way to a new look for those of us who are fabulous and 40: long hair and tight jeans are acceptable on a 40 year old woman’s body. No longer are these considered unacceptable for a woman of a “certain age”!  No longer does turning 40 qualify you as a “woman of a certain age” and for that matter, neither does turning 50!!  As a dear friend of mine recently turned 40 and all her friends gave her a shout-out on Facebook (and yes, someone not yet 40 begged my friend to confirm that 40 is the new 30), it was generally considered among her already 40 friends that turning 40 was a cause for celebration.   So yes, my friends, your 40’s are a decade to be embraced and not dreaded.

Except for one small, “eensy weensy” factor of which no woman should ignore and most women to my surprise are unaware of . . . have you met

The NOvary?

Who or What is the NOvary?  Well, let me fill you in!  The NOvary is the any-woman’s ovary who has decided not to cooperate with her plans to become a mother.  The NOvary does not care if you’re 30, 35 or 40.  She can and does reside in all women of all ages.  However, she tends to emerge with more Attitude at or around the time you turn 35.  And by the time you turn 40, the NOvary has almost universally decided to take over your reproductive system and your Plan.  The NOvary defies what medical science and a good cosmetic dermatologist have allowed us to enjoy — another decade of productivity and passion for all things, most especially those career, clothing or relationship related.  Because let’s face it, not every woman is ready to, or wants to have a child, in her 30’s.  Indeed, we have been taught to wait and enjoy, and to relish life!  And we should!!  But then as we turn 40 and we’ve lined all our nice little ducks in a row, or decided we don’t need our ducks to be in a row, and we consider parenting, we come face to face with the not-so-new but seemingly unknown nemesis to pregnancy and motherhood:

The NOvary.

The NOvary is the Ovary that says NO to all your carefully defined and created plans.  In the world of fertility, or rather infertility, 40 is from the reproductive endocrinologist’s standpoint, the death of your childbearing years.  The NOvary has not run a slick social media champagne – in fact it’s quite the opposite – she has been enjoying our ride along with us all the while knowing her little secret, and enjoying her secret power.  The NOvary is the Ovary that no longer makes healthy eggs and she is so stealthy and sophisticated that you can actually conceive on your own for a few years as she gains her power and comes into her prime.  But even though she hasn’t hit her full capabilities to destroy your dreams (or so you think) her influence over the eggs she releases on your behalf will cause you to miscarry, and miscarry again.  Lulled into a false sense of security that your eggs are working because you are getting pregnant, she continues to work her evil spell, pushing you farther and farther into her control.

So powerful is the NOvary that she can continue to elude you into believing that you are still fertile even though you’re 40.  So powerful is the NOvary that she can fool even the smartest of reproductive endocrinologists who will look at all your Day-3 data, manage to retrieve some very “healthy” looking eggs from your ovaries, only to find that those fertilized eggs and “beautiful” preembryos don’t turn into the baby you are longing for.  The NOvary can place the cleverest of masks on eggs that are on the verge of retiring, and making them look as fabulous as you do in your 40 something glory.  But the NOvary knows: your eggs have long since passed their expiration date.

How do I know this?  How did I meet the dreaded and feared NOvary?  Over hundreds (and I unfortunately mean hundreds) of my clients have battled her, failed to defeat her, and then faced the reality that (whether they are Thirty-Somethings or Forty-Somethings, married, career in place, or otherwise just determined to become a mom), if they want to realize their dreams of becoming pregnant and having a baby that they would need to bypass the NOvary altogether.

Yes, we can defeat the NOvary.  You still have options and a powerful weapon to defeat the NOvary; one of those options is donor eggs and your success rate using donor eggs is about 50 to 60 times higher (perhaps more than that) than your chances are of defeating the NOvary. Yes, you read that correctly, success rates for using donor eggs are (at some fertility clinics) close to a 60% live birth rate!

Just as medical science has preserved your beauty and created a body that does not look, act or feel anywhere near 40, it has created a technology that can put the NOvary out of business!  But be warned, while 40 is truly the new 30 . . . the NOvary has no intention of catching up with the rest of us, and if you want to have a baby and you haven’t yet decided to TTC or the TTCing isn’t going anywhere, consider the fact that she may be up to her devilish deeds.

Celebrate your age and enjoy your life . . . but please don’t forget she’s out there . . . looming in the shadows and finding new ways to avoid detection by physicians and scientists alike . . . and her name is the NOvary!

Liz

p.s. up next, another option for defeating the NOvary . . . stay tuned!

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.

In the story, the prosecutor decided to use the fact that one of the defendants (who was a daughter of the guy who died and who was supposed to inherit ten million dollars) had conceived a child with her lesbian partner using an egg donor (at least I think it was an egg donor, it could have been that the defendant female partner had donated her eggs to her lesbian partner so that her partner could carry the baby for them to raise together . . . however, the prosecutor kept using the term “egg donor” so I assumed that the couple had used an egg donor and were planning on raising the baby together).  To further complicate matters, the lesbian couple had entered into an adoption whereby one partner had adopted the other so that they could obtain insurance together etc. and more relevant to the Law and Order story line, to inherit money together.

The prosecutor wanted to use the fact that the baby, because it was conceived via an egg donor, was not really their child (biological or otherwise) to cut off any inheritance rights the baby might have to the ten million dollars, and thus deny the defendant her right to benefit from the baby inheriting the money.

This had to be  a recent episode of Law and Order as the prosecutor is someone new, and Sam Waterston (sp?) is now the District Attorney or is in a more senior role and not trying cases.  The law as it pertains to same sex couples in NY has been pretty well established for several years.  Adopting an adult for purposes of a establishing a legal relationship between same sex partners is extremely difficult to do, and I believe there are and have been enough other laws that protect or recognize same sex marriages in NY that the adoption aspect of the story line was just plain stupid and offensive (if not legally wrong)!  I don’t believe that one adult can adopt another adult.  But . . .

Second and more to the point.  Law and Order got the law wrong on egg donation!!!!!!!!!!!

Let’s assume first that it was a true egg donation whereby this couple used an egg donor to conceive a child they would parent together (and not that one partner was donating her egg to the other for purposes of conception).  In NY, although there is no statute, there is a case that specifically states that woman who gives birth to a child or children conceived via egg donation is the legal and natural mother of that child or children.  McDonald v. McDonald, 196 A.D.2d 7, 12, 608 N.Y.S.2d 477 (App. Div. 2d Dep’t 1994) (finding woman who gave birth to child conceived through egg donation to be “the natural mother of the children. . . .”).  Indeed, this case and a long line of other cases in NY deal with the presumption that a woman who gives birth to a child in NY is the legal and natural mother of that child.

Law and Order usually has lawyers that check the facts and the law on its episodes.  I am absolutely dumbfounded that they got this so wrong.  Regardless of whether one member of this partnership donated an egg to her partner or whether they used an egg donor, that baby was the legal child of the woman who was going to give birth to it.  Assuming the two members of this partnership had a legal relationship that could be recognized in NY (and maybe I am wrong on the adoption thing, but it seems that in 2010 it is easier to go to MA or Canada and get married than to try and adopt an adult (???) to create a legal union), that baby was a baby of their partnership and their love for one another, and if the baby was delivered in New York City or any of the five boroughs and they were legally married, then both of their names would go on the birth certificate.

This manipulative and legally inaccurate representation of same sex partnership laws, same sex parentage laws, and egg donation is staggeringly offensive and WRONG.  Where were Law and Order’s lawyers in this?  Do they no longer check that their story lines are factually and legally correct?  And if they have lawyers, may I take a guess that their lawyers are 80 year old homophobic men and that the show’s writers must have been on acid when they wrote this episode.

I am anxious to watch a re-run of this show and figure out what the facts were, and to determine just how wrong Law and Order got the law and order of reproductive law.

Here’s How One Woman Made Egg Donation Work:

Through the gift(s) provided by an egg donor, many infertile women are now able to experience pregnancy; sharing their thoughts, feelings, blood supply and the sound of their voice with their baby; and to deliver their child into the world.  The success rates offered by many egg donation programs are staggering (nearing the 70% mark at most clinics), making this one of the more popular options in modern family building for women with diminished ovarian reserve or other issues of egg quality.

Egg donation is often so successful that you can potentially build your entire family from one egg donation cycle.  Of course not every egg donation results in a pregnancy; but more often than not a carefully selected donor not only gets the recipient mother pregnant but there are extra embryos frozen for future family building.

Let us consider Janet[1], and her experience with egg donation.  Janet is in her late thirties and after several failed IVF cycles, Janet’s doctors told her that her best chances for becoming a mother were through egg donation or adoption.  Janet wanted to experience pregnancy, and so chose to pursue egg donation.

After doing research, Janet decided to work with an egg donation agency, rather than using her clinic’s in-house program. While some clinics are very flexible, Janet found she had more options when using an egg donation agency.  By working with an agency Janet had greater flexibility in choosing her donor, didn’t have to share eggs with another infertile family, and would have greater control over her finances.  Because she was on a tight budget, most of the agencies she spoke with encouraged Janet to select a donor who lived near the clinic she would be using, thus avoiding substantial travel expenses.  Using an agency, Janet also had a greater selection of donors with compensation rates to fit her budget, compared with the fixed rates offered by most clinics.

One donor Janet considered (we’ll call her Leslie[2]), was twenty-six years old, single, had near perfect SAT scores, attended an Ivy League college, graduated at the top of her class and was attending medical school.  Despite Leslie’s outstanding academic credentials (which sometimes result in higher compensation rates) Leslie’s requested compensation was within the middle range of both ASRM’s and the Society for Assisted Reproductive Technologies’ (SART)[3] guidelines for egg donor compensation: $3,000-$7,000 per donation.  Leslie also visibly resembled Janet and lived near their fertility clinic thus helping to make the cycle more affordable for Janet and her partner.  Leslie seemed like the perfect donor.

Leslie, however, had no “track record” donating eggs.  She had never been an egg donor before and didn’t have any children of her own.  Although statistically, carefully screened first-time (or “unproven”) donors have the same success rates in helping infertile women/couples achieve pregnancy, Janet was concerned that she would spend money to have Leslie donor undergo the first part of the necessary screening process, only to find out that Leslie was not sufficiently fertile and had been disqualified from being an egg donor.

Janet and her partner were also considering matching with a donor named “Julie”.   Julie also was twenty-six, had high SAT scores, had attended college, and had never been an egg donor before.  Julie was requesting the same compensation as had Leslie ($5,000) and lived near Janet’s clinic.  However, Julie was married, and had two-and-half-year old twins and a one-year old baby.  Julie was clearly fertile (she had children) and thus would be more likely to produce healthy eggs, which to Janet and her partner meant she presented a lower risk of being “screened out” by their fertility clinic.

Once Janet and her partner selected Julie as their donor, Janet’s egg donation agency presented them with a list of attorneys to help prepare their egg donation agreement, and it arranged for Julie to be represented by separate counsel in connection with the negotiation and drafting of their agreement. The egg donation agreement is a critical aspect of the egg donation process and all parties should be represented by independent counsel.  The egg donation agreement will protect your rights as parents and govern your relationship with your donor for years to come.  You should have the right to select your own attorney, one who is an experienced reproductive lawyer.

Each egg donation agreement is unique; some agreements provide for complete disclosure of names and addresses and others are completely anonymous.  Whatever your comfort level or that of your donor may be regarding future contact, please consider that your agreement should ensure that you can contact your donor in case of a future medical emergency.  Among other things, your egg donation agreement should specify your rights to utilize and/or dispose of the eggs/embryos created from the cycle, require that your donor follow medical directions, address what happens if your donor breaches your agreement or if the cycle needs to be rescheduled for some reason (like a death in the donor’s family), and/or how medical bills are handled if she experiences a complication like ovarian hyper-stimulation.

Within four months of the time Janet initially contacted their egg donation agency, Janet, Julie and their respective partners had negotiated their agreement and their cycle got underway.  Julie produced seventeen eggs of which fifteen fertilized.  Janet conceived a beautiful baby girl on the first embryo transfer and when Janet’s daughter was about a year-old, Janet and her partner went back and did a frozen embryo transfer; this time conceiving twin girls (it is admittedly rare for a frozen cycle to result in a twin pregnancy but in this case it did)!

[2] Names have been changed to protect people’s privacy.

[3] ASRM (The American Society for Reproductive Medicine) and SART are related organizations which, among other things, establish ethical and regulatory guidelines that many clinics and agencies agree to comply with.  For more information, visit their websites:  #www.ASRM.org# and #www.sart.org#

But it also isn’t the end of the world.  I am all for getting into bed and having a big cry when you find out you’re infertile for any reason, but technology has moved us to a point where aging doesn’t matter as much as it once did.  Thanks to egg donation and surrogacy women have options they never had before.  So we can choose to put off child bearing, as long as we are prepared for the possibility that we may not have a genetic link with our child or be able to carry that pregnancy.  Tough call no doubt.  I just find it surprising that suddenly newspapers are onto our ovaries.  Like this was some massive conspiracy and women didn’t know about it?  I guess a lot of women don’t realize just how serious an issue it is and the article did point out just how drastically our fertility drops off at age 30 (I admit I was taken aback by the new statistics quoted) and age 35 . . . but the vast majority of women are not ready to be mothers at 30 or 35 . . . so what are we to do?  Read all these scary articles and rush to freeze our eggs (a technology that I do not believe has gotten to the point where it is a viable option for most women)?  I’m sorry to rant, but I am tired of people acting like science just discovered this!  Egg donation has been around for about 10 years (maybe a little less but not much).  PULEASE give me a break and give women some credit!

I am about to open an egg donation agency and all of my donor candidates are well aware of what happens to their ovaries.  These are “20 something” prospective egg donors that understand they are helping women who are sometimes not even ten years older than the donor is . . . .  and more to the point, ovaries don’t just age out.  Sometimes they never work properly.  So, journalists, let’s move on!

Let’s talk about something else in the world of infertility.  Why don’t you talk about what a devastating disease infertility is and why health insurance doesn’t cover most if any of the costs?  Now there’s a conspiracy for you!