Embryo Donation – Option for Infertile Couples & Waiting Lives

I recently had the opportunity to be on Theresa Erickson's Internet radio show, Voice America. Known as the Surrogacy Lawyer, Theresa is renowned for her work on behalf of many patients faced with infertility looking for third party options. During my interview, we discussed the option of embryo donation  from the physician, recipient and donor perspectives.

One of our donors, Tori, discussed her infertility experience as well as her and her husband's  decision to donate their remaining embryos following a  successful IVF procedure culminating in the delivery of her twins. You can see a picture of her twins and information regarding her amazing embryos by visiting our website.

Tori's Twins!

Tori and her husband decided that they wanted to “pay it forward” to other infertile couples. Here is a combination of her own words during the interview and some other comments she told me separately:

“Donating the embryos brought on a wide range of emotions; some expected such as the happiness to help another infertile couple, peace in setting the embryos ‘free’ by finally making a decision on their fate and others were a bit of a surprise  such as a brief feeling of sheer panic that I ‘forgot’ something after leaving the clinic. The donation experience to me is like paying it forward to other infertile couples. I did not see any reason to leave the embryos suspended in time, did not want to see them destroyed and there was no reason to donate them to stem cell research when there are so many infertile couples in the world going through the same anguish I went through.

That feeling of anguish kept coming back, that longing and yearning for something that was so easy for others to have, yet so very difficult for me to obtain. I wanted to help someone relieve that awful feeling and by donating my embryos, I had a very good chance of doing just that.”

To listen to the show, please visit our Audio Gallery and click the play button to the right.

I am so thankful for people like Tori and other donors who consider giving their frozen embryos life while helping other people building their families at the same time. If you'd like more information on the process, please visit our embryo donation page on our Website, contact us at (239) 275-8118 or e-mail us at Fertility@DreamABaby.com.

Also, for additional details on surrogacy or fertility via third party assistance, I encourage you to read Theresa's book: Surrogacy and Embryo, Sperm and Egg Donation: What were you thinking?

Please stay tuned for the launching of our expanded embryo donation program called Embryo Donation International! I hope that many couples will consider to “pay it forward” just as Tori and her husband did.

Your thoughts and comments are always welcome.


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The Fertility Chase, Episode 4, WE TV, 5/22/2010

I was in a meeting starting Friday night, all day Saturday and then went to yet another one on Saturday evening, so I was a bit delayed on my post regarding the 4th episode of The Fertility Chase (TFC). I hope you will find that it was worth the wait.

A Woman’s Reproductive Age:
Maria Bustillo, Kimberly Thompson and Juergen Eisermann were the Reproductive Endocrinologists from the South Florida Institute of Reproductive Medicine in the first segment. I know all of these physicians and they do a very good job.

Angelique was the infertility patient. She went through six intra-uterine inseminations (IUI’s). I couldn’t tell if oral or injectable medications were used. Laparoscopy was the next step wherein “unexpected” problems were discovered. In vitro fertilization (IVF) was used next and she conceived and delivered her son, a “mini-me” of her husband. Really, the likeness was quite striking.

The theme was the influence of a women’s age in their quest for parenthood, a topic that has resounded through nearly all the episodes of TFC. It is the single most difficult issue for us to deal with as we cannot make ovaries younger or increase the production of healthy eggs when few exist.

Angelique did highlight a couple of interesting points. All of us have been caught by doing IUI procedures followed by a laparoscopy (out-patient belly button surgery) only to discover that the IUI procedures were unlikely to work because of problems found at the time of surgery. My feeling is that if surgery is to be contemplated, that one not perform too many IUI procedures before doing it. Understand, however, that laparoscopies do not always significantly improve the natural pregnancy rates, it is a “catch-22”. Even so, laparoscopies do often give us a diagnosis and provide us with enough information and confidence to continue the IUI’s procedures or to quickly move to other alternatives. As they say, hindsight is “20/20”, and it is always easier to look back and think of treatments that we would have modified and a bit tougher to do it from the get go.

My last comment has to do with fact that Angelique had infertility insurance coverage. I have seen numerous cases where the treatment plan was different compared to someone without coverage. For example, where a non-covered patient may only try 3-4 IUI procedures, a covered patient may try 6. While not a tremendous difference, each failed month takes it toll on the patients and it so easy to let the insurance coverage influence the treatment plan. I call this the “insurance trap”.

Polycystic Ovarian Syndrome (PCOS):
Edward J. Ramirez, M.D., from The Fertility and Gynecology Center, Monerey Bay IVF, was the Reproductive Endocrinologist in the second segment. Brandi and Monique were the patients featured.

For the readers, the diagnosis of Polycystic Ovarian Syndrome (PCOS) requires that at least two out of three of the following are true:

  1. The woman doesn’t release her eggs on a regular basis.
  2. Male hormone levels are increased in the blood or there is an excess of facial or body hair in such locations as the chin, neck, back, abdomen and chest. Acne can sometimes also present.
  3. That each of the ovaries have more than 12 small cystic structures, which we call antral follicles.

PCOS is the most common endocrine disease in reproductive age women affecting about 6% of the population. It is a very common cause of infertility.

Dr. Ramirez stated that 80% of the patients didn’t ovulate (release their eggs) on either clomiphene citrate (Clomid) or letrazole (Femara). I believe that number is a bit high. In fact, there is ample evidence that it is more likely that 80% will ovulate on the medications, although not all of these will conceive. Nevertheless, these oral medications are a good starting point in addition to treating the other issues that are commonly present including pre-diabetes and even diabetes itself. Problems with weight are also found in about 80% of the PCOS patients so diet and exercise are an essential, although difficult, component of the treatment plan.

I was struck by the words and phrases these young women used to describe their diagnosis of PCOS and infertility including “alone”, “not female”, “jealousy”, “shame” and “depression”. I was very concerned about Monique’s comment that she didn’t have “the will to live”. This level of depression must be treated seriously and be carefully followed by the clinician. Fortunately, Monique conceived and delivered. I hope Brandi soon does the same. Perhaps TFC can follow up on Brandi in the near future.

Male Factor Infertility, Spinal Cord Injuries:
Dr. Randall B. Beacham from the University of Colorado School of Medicine was in the next segment discussing spinal cord injuries inmen. Jasmin was the injured male patient who apparently was unable to ejaculate naturally. Dr. Beacham is well respected and well published.

This couple told a story of being seen by four doctors being told different things before finding Dr. Beacham. Male factor infertility really requires the assistance of a highly trained Reproductive Endocrinologist who also sees male patients and/or a Urologic Infertility Specialist such as Dr. Beacham. Both of these types of physicians are a bit rare so infertility patients have to seek them out.

Jasmin entered an experimental study where clomiphene citrate (Clomid), a medication usually reserved for women, was given to him in the hope of stimulating sperm production. This medication has been studied in the past and was not shown to be useful in the vast majority of men suffering from male factor infertility. I had to laugh when Jasmin said he bought six pairs of shoes and had an urge to shop while on the medication. In reality, Clomid hopefully increases the male hormone in men and the female hormone minimally, if at all. I think he just wanted an excuse to go out shopping.

It appeared that Dr. Beacham was able to stimulate ejaculation through a technique called “electro-ejaculation” wherein a probe is placed into the rectum and electrical current is released resulting in a type of spasm that produces an ejaculate. His wife underwent hormone stimulation of her ovaries to increase the number of targets for the limited quality and quantity of sperm. Presumably, she had an IUI procedure and conceived a little girl. The macho Jasmin clearly wanted a boy but I’m sure he will treat his little girl as a princess.

My only concern in this piece was that it needed to be emphasized that Clomid has not been found to be useful in the previous randomized and controlled studies and had fallen out of favor. I did a search to see if there were any prospective studies published on the subject over the past 10 years and found none. Dr. Beacham made it quite clear that there were no magic medications for male infertility but he apparently feels that this medication may be of some use in this particular kind of patient. If it is to be used, I urge that it be done in a study setting, as it was with Dr. Beacham, so as to not give false hope, waste time or result in unrealistic expectations.

The last segment was a collection of past segments, including ours from last week about embryo donation. The show ended with the comments that infertility patients were misinformed, misled, suffered in silence and felt powerless. Clearly, TFC is trying to change that and more power to them. I’ll certainly support their effort.

As always, if you agree to disagree with whatever I write, please do not be shy and leave a comment or two. Questions will also be answered when possible. Until then, go forth and try to multiply.

The Fertility Chase, Episode 3, WE TV, 5/15/2010

The Fertility Chase (TFC) show today covered numerous concepts including genetic testing of the embryo, embryo donation (embryo adoption), egg donation and affordable infertility coverage.

Pre-Implantation Genetic Diagnosis:
Edward L. Marut, M.D., from the The Fertility Centers of Illinois was featured in the first segment. The infertility couple, Kelly and Tom, was unable to conceive over a three years. Basic treatments were performed without success wherein they underwent In Vitro Fertilization (IVF) twice and failed. The final and successful outcome occurred when they did a third IVF procedure combining it with Pre-implantation Genetic Diagnosis (PGD). In PGD, a single cell from each of the embryos is screened for chromosomal defects such as Down’s syndrome. Nine out of the possible 24 chromosomes were examined. PGD is commonly done for genetic disease, gender selection, to transfer a single embryo, recurrent miscarriage and when there is a history of failed implantation such as this couple. Apparently only two out of twelve sampled embryos were probed as normal. A male child was eventually delivered.

As women age, the quality and quantity of their eggs decrease. In this case, quality seemed to be the issue. While not every one agrees, it is thought that PGD may decrease miscarriage rates and decrease the delivery rates of genetically abnormal offspring such as Down’s syndrome. I too have used PGD to decipherer the reason why embryos have failed to implant and will frequently find that nearly all of the embryos are indeed genetically abnormal. PGD has its strengths and weaknesses, however, in this particular instance, it may truly have saved some time and heartbreak. I thought the piece was well done.

Embryo Donation:
OK, this is going to be hard to review as this was my own segment In the making for over a year, I thought Exodus Productions did a wonderful job with it. To view, please visit: http://www.vimeo.com/11762266.

Kerry (commissioning parent) and Christiana (surrogate) did an amazing job opening up their lives to the media to tell this important story.

Christiana (below) is the surrogate carrying Kerry's donated embryo.

Walt and Amy’s side of the story was that they would much rather donate their embryos than other alternatives should they never use them themselves. Amy is set to deliver very soon and I hope they use their own beautiful embryos for themselves but, in case their first child is a little hellion and they decide not to have any more (which I doubt), I would be more than happy to find a wonderful home for them.

Walter and Amy with baby in between.

None of this entire story would have been possible without the generosity of the couple that donated the embryos to Kerry. In addition, they did not stipulate that we couldn’t give their embryos to a single woman. This was an amazing gift from undoubtedly an amazing couple. Since these embryos came from a distant facility and not our own, I will probably never have the privilege of thanking them directly.

We will be covering the topic of embryo donation in great detail in the months to come. Right now, we have over 140 abandoned embryos and we are trying to get these designated to either personal use or embryo donation. I feel we are both patient and embryo advocates.

All kidding aside, I surely hope you enjoyed the segment as much as I did.

Egg Donation:
The third segment had many players from Long Island IVF, one of the busiest IVF facilities in the country. Reproductive Endocrinologists Dr. Daniel Kenigsbert and Steven Brenner and Embryologist Glenn Moodie, Ph.D. were the experts. Carolyn and Nicholas were a infertility couple and Donna was also a patient who sought treatment. The theme had to do with egg donation. As stated a few paragraphs above, as a woman ages, the quality and quantity of eggs decreased. At times, we also see young women who surprise us in that they seem to be very close or have actually entered menopause. When there aren’t enough healthy eggs around, an excellent option is egg donation.

I was struck by Donna’s story of four IVF cycles with one physician and another four with a different one. New York is a mandated state, which means that a certain amount of infertility has to be covered by insurance companies. I have unfortunately found that insurance coverage often leads to poor decisions. I had one patient recently that was told she was had to undergo six intra-uterine insemination procedures before doing IVF. The problem was that her Fallopian tubes were very damaged and severe pelvic adhesions were present. I recommended moving forward with adoption or IVF but IUI procedures were not on my radar screen. Doing IUI procedures was a very foolish and expensive (i.e., wasteful) step before IVF in this instance. Getting back to The Fertility Chase, Donna probably needed to move to egg or embryo donation long before the eighth IVF procedure. If none of them had been covered, she surely would have made the decision sooner and with less heartbreak.

Lastly, the egg donor stated it took weeks for her to complete the pages of needed information. Our patients have told us that it took less than 30 minutes to do it on our website (http://www.dreamababy.com/eggdonation.htm) . These are young patients and their medical histories should be pretty simple. Perhaps the donor was just being overly cautious but the TFC viewers or my readers should know that it isn’t that difficult or time consuming to do.

Cost of Infertility:
This was a great segment featuring the Gunderson Lutheran Fertility Center. Dr. Kathy Trumbull was the Reproductive Endocrinologist. Two couples were highlighted, Crystal and Larry as well as Bobbi Jo and Marty. Both of the men apparently had male-factor infertility, Crystal had polycystic ovarian syndrome and Bobbi Jo, stage I endometrioisis.

I couldn’t tell what treatments were used for which couple. Dr. Trumbull’s discussion regarding infertility patients seeing a general physician for the simple stuff but to find a Reproductive Endocrinologist when too much time passes or the issues are growing in their complexity. This is actually a statement that needed to be stated long before now so hats off to Dr. Trumbull. Infertility, especially the issues as presented by TFC, are well beyond anyone’s care besides a Reproductive Endocrinologist.

The issues of cost of infertility care will probably come up again in a future TFC program. It is a difficult issue but few areas of medicine require such a tremendous amount of physician and nursing training, continuous equipment upgrades and an extraordinary amount of time committed to our patients. Hats off to Gundersen Lutheran if they are truly able to make it more affordable in my home state of Wisconsin. I truly wish I could give it away free.

Well that is it for now. It was wonderful to be part of The Fertility Chase. Even though my show has aired, my commitment is to continue to watch each program and report back to my readers my thoughts and comments. If you agree or disagree with whatever I say, please do not be shy and leave a comment or two. In the mean time, be fertile.