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Posts Tagged ‘premature ovarian failure’

When Infertility Professionals Get it Wrong.

September 18, 2012 | By: | Filed under: adoption, Current Affairs, Deadly Silence, Egg Donation, Faith and Infertility, I'm Just Another Angry Infertile Woman, In the News, infertility in the media, IVF, Personal Musings, The Journey to Parenthood, Thinking Out Loud, Thoughts on Choosing an Egg Donor, Thoughts on Donor Egg Recruitment

You know it’s not that often that I see glaringly offensive comments or information from professionals in the infertility world.  Most of us know to be very careful with the language we use so that we don’t inadvertently hurt someone’s feelings.  Today I was surfing Facebook and someone to whom I was connected (I am no longer “friends” with her) posted a comment about egg donation, adoption, and infertility.  I thought at first she was referring to a blog and was hoping she was quoting someone else.  Alas, I was very wrong and the link she posted was to an egg donation agency based outside of the United States (thank goodness for that — didn’t want to be running into her at any upcoming conferences lest I let her have it to her face) and the post was pretty much designed to bring attention to her agency.  I am not a big believer in the old adage that any attention is good attention or that negative publicity is still publicity.  In this industry, offending people is the kiss of death and well let’s just say I’ve been kissed.

I really don’t like the word “barren”.  It’s an ancient reference to women who were unable to conceive and it dates back to a time period when women had no rights and would sometimes be replaced by another woman if she was unable to conceive a child.  The Sixteenth Century this is not and I would have hoped that in the Twenty-First Century we would be a little bit more aware of appropriate terminology.  I guess not because this FB poster (who shall remain nameless even upon kiss of death) seemed to think that all women who are having difficulty conceiving should be considered BARREN.

I don’t think so.  Having difficulty conceiving does not mean we are barren.  The word barren actually has many definitions (http://www.merriam-webster.com/dictionary/barren ) including “lacking inspiration” or “lacking charm”.  For the record, I don’t consider any of my infertile clients, and certainly not my own bod, to be lacking in charm.  Some of my clients are downright amazingly gorgeous women with incredible resumes and great personalities.  In this case they are hardly barren are they?  They also usually go on to become mothers which would seem to indicate that they are in fact capable of producing offspring (please note Miriam-Webster dictionary says nothing about those offspring needing to be biological children — at least its editors “get it”).  But the word was used nonetheless in this FB post.  The fact that the post tried to be “neutral” and present all sides of debates as they pertain to third-party assisted reproduction was totally lost on me by virtue of the selection of this word to describe me.  Because that is who she is describing, me.  The last time I checked I am still considered to be infertile.

The other problem was that this poster and her choice of words — and barren was by far the least offensive of them — revealed her own underlying belief that women who have difficulty conceiving, women like me who are infertile, are somehow lacking, less than other women, and are desperate.  While she notes that “an element of respect” should be offered to these women, in and of itself that remark too is offensive.  I am only entitled to “an element of respect”.  7 IVF Cycles, 9+ miscarriages (I stopped counting but there were more), three adoptions, and I am only entitled to “an element of respect”.  Seriously?

Additional comments were made about whether decisions to use an egg donor were interfering with the “divine plan” for that woman’s life; and that what transpired to finally bring this barren woman to the point of actually considering using another’s genetic material could only be understood by the woman herself.  Here I do agree with the post.  However, I would prefer that she had not characterized the decision to choose egg donation as an act of finality, desperation, or somehow jumping off of the cliff of normalcy.  Families are built in countless ways and all of them are normal.  

Egg donors also were attacked for their decision to share themselves with other people.  Let’s be clear that egg donation does not involve any kind of “sharing”.  Egg donation agreements are clear that when a woman donates her eggs she relinquishes all rights to the resulting embryos and/or children.  Egg donors do not share in the day-to-day life of the intended parents’ pregnancy, or their life as they raise their child.  And let’s place the emphasis where it belongs, on “their” child, not the egg donor’s child.  If this woman is counseling egg donors — and I fear she may be — then she is sending the wrong message to these selfless and generous women who donate their genetic material, their ova, to an infertile couple.  They ain’t sharing those eggs or themselves with anyone.

Let’s not even discuss the offensive descriptions attributed to adoption.  I will have a stroke.

I understand that this woman was trying to raise a debate, trying to draw attention to her business and what she does.  But the choice of words she used as a professional in this industry was astonishingly rude and clearly revealed her own underlying biases.  She is entitled to those biases.  But as a professional she had a responsibility to keep them private and not mislead egg donors or intended parents.  I also think it was a poor decision to use such inflammatory language if she was trying to promote her business.  In all likelihood she sent potential clients running in the opposite direction.

I hope that the other people who read this post are wearing running shoes; they need to run as fast as possible.  Most likely the very charming, inspirational women who read this post pulled their flats or sneaks out of their gym bag and took off their Jimmy Choo’s, and headed in the direction of a more sensitive egg donation/surrogacy agency, a therapist (I may need a session), shopping (in which case maybe they should leave on the Jimmy Choo’s), or a glass of wine and some Oreos.  

For all those who read that post and felt in any way diminished as a human being because of their infertility, let’s get one thing straight:  anyone who can get through this stuff is one tough, rockin’ mama.  Emphasis on the word “mama” because that is what you will one day be called.

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Making an Egg Donation Cycle Work. A brief look at what you might need to know to increase your chances of success!

January 19, 2012 | By: | Filed under: adoption, Age and Infertility, Announcements, Egg Donation, In-House Egg Donation Programs, IVF, Personal Musings, The Journey to Parenthood, Third-Party Assisted Reproduction, Thoughts on Choosing an Egg Donor, Thoughts on Donor Egg Recruitment

Through egg donation, 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 delivering their child into the world. The success rates offered by many egg donation programs are somewhat staggering, making this a very popular option in family building, especially for women dealing with the NOvary™.

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!).

 

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It’s Confirmed: 40 Really is the New 30! Except . . . Wait . . . Watch Out For the NOvary

September 23, 2010 | By: | Filed under: Age and Infertility, Egg Donation, IVF, The Journey to Parenthood, Thinking Out Loud, Third-Party Assisted Reproduction, Treatment

Most people who know me, know that I am in my mid-early 40’s.  Turning 40 wasn’t a big deal for me.  I have such a baby face that sometimes I have a hard time getting people to take me seriously.  Turning 40 for me was a milestone of maturity I had long waited for.  You have to take a woman in her 40’s seriously.  If for no other reason than you’ve got the mileage to deserve it.  And yes, thanks to amazing strides in modern medicine (not to mention Botox® and Viagra®), people are living longer and are taking the time to enjoy their life; people are doing things later in life and enjoying them with the vigor and spirit of someone fifteen to twenties years younger.  No longer are we rushing ala “Mad Men” into marriage and childbearing in our 20’s.  Women are taking the time to establish themselves and find the right mate.   Forty has thus become to the former Twenty-Somethings, what 30 was to our parents’ generation.

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!

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NY Times article on premature ovarian failure

January 30, 2010 | By: | Filed under: Check This Out, Current Affairs, Egg Donation, Thinking Out Loud, Treatment

So I have only read part of this article.  It brought tears to my eyes and as I am mid-struggle with my own quest to have another baby I was too moved to continue reading it.  But I immediately recognized that this is an article to share and discuss.  What I want to discuss is how the news was imparted to the author . . . and what I felt was wrong with it.  Why don’t doctors, even OB/GYN’s and RE’s know how to tell someone they are infertile and why didn’t THIS woman’s doctors know she has many options for having a baby . . . why did she get immediately (and incorrectly) told:

“I’m sorry you can’t have a baby.”

WTF?  Read on:

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

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