Third Party Reproduction Explained

February 17, 2005 - Thursday
2:16 PM to 3:16 PM (EST)
Guest Speakers: I. Lane Wong, MD FACOG, Huntington Reproductive Center in California

Categories
Donor Egg • Gestational Carrier • IUI • IVF • Surrogacy • Third Party Reproduction

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Lisa_Rosenthal	Welcome everyone! Thanks for joining us this evening.
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LADV	Where did everyone go--and why?
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Dr._Lane_Wong	Hello my name is Dr. Lane Wong. By way of background, I went to medical school at UCLA, did an OB GYN residency at University of Utah and then Infertility fellowship at USC. I am a board certified reproductive endocrinologist and have been in full time infertility practice since 1994. Third party reproduction refers to many things but for most people it means the use of Donor Eggs, Surrogacy or Donor Sperm. I will be happy to answer any questions regarding this or other REI topics. PS I am new to online chat – so please bear with me.
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Lisa_Rosenthal	Welcome Dr. Wong, thanks for joining us this evening!
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Lisa_Rosenthal	Could you give us a basic run-down on what Third Party Reproduction means?
frshlilly	Dr Wong, how much does BMI affect implantation?
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Lisa_Rosenthal	Thanks to everyone here for joining us this evening!
Dr._Lane_Wong	Dear frshlilly:
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chloe	i am curious about donor screening and ethical considerations. what is the number one stated reason donors donate?
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Lisa_Rosenthal	Please feel free to post questions for Dr. Wong. Consider saving them so that if you need to repost your question, you do not need to retype.
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Dr._Lane_Wong	The effect of weight (body mass index) on implantation has not been well studied. There is data that being extremely overweight has lower implantation rate. There are alot of papers about PCOS especially elevated LH being associated with higher miscarriage rate. However, in general I think these issues are overstated. Statistical significance does not mean clinical significance. Bottom line: the effect of BMI on implantation is not well studied and not a simple linear matter.
Dr._Lane_Wong	Dear Chloe:
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Lisa_Rosenthal	Ladies and Gentlemen, please keep in mind that The AFA has message boards that are moderated by physicians every day, (including Dr. Wong, on Sundays!) visit them and get more answers!
Dr._Lane_Wong	When I was a fellow at USC with Dr. Mark Sauer in the early 90's most donors were not paid and were doing it because of high minded ideals and altruism. Many were graduate students and professors. However, the field has moved to the point that most donor now are college students and realistically monetary issues probably do play a role. However ASRM has held the position that the fee should not be so high as to be the only motivation
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Lisa_Rosenthal	Fertility Dream 2005 is a great way to get fit. Please check out our home site and join us.... one foot at a time.
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Lisa_Rosenthal	Welcome Grebena, thanks for joining us this evening!
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wannababy	Dr. Wong, how high is too high for fsh and should donor egg be considered?
Dr._Lane_Wong	Dear wannababy:
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Dr._Lane_Wong	There are several factors to consider your age, if you are still ovulating and how high your FSH is. Women can still conceive with an elevated FSH but the chances are lower if it is high. The most fertile group of women ever studied in the history of the world were the Hutterites, they had 11 kids each, however 33% were infertile by age 40, 87% were infertile by age 45.
Fran	What do you mean by infertile? Unable to have a baby or needing treatment?
Dr._Lane_Wong	For this group - Unable to have further children even though they continued to have sex and were of proven fertility.
Susan	If a 35 year old woman has had four children and her last child was born 3 years ago, is this a good indication that she would be a successful surrogate?
goupil	At what point would you consider that a woman has problem with implantation(and how do you find out) and when can surrogate mother be taken in consideration
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Dr._Lane_Wong	Dear Susan: If this women's uterus was still the same, ie has not developed fibroids, etc, she would be an excellent surrogate.
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Dr._Lane_Wong	Dear Goupil: Your question is extrememly complicated. Implantation may not happen because of embryo quality (a factor of egg quality - and sometimes sperm quality), issues of the uterus e.g. fibroids, adenomyosis, and finally issues of the person e.g. autoimmunity and the controversial topic of alloimmunity.
Susan	How many embroys is typically implanted?
Kate	Hi, I'm tired of my program pushing donor ovum. I'm 38, my fsh is 14, and I think this is all about their pregnancy statistics. Should I get a second opinion?'
Lisa_Rosenthal	Thank you Dr. Wong for joining us in our online session this evening! We appreciate your time and knowledge.
Dr._Lane_Wong	Dear Susan: It depends on the age of the person providing the eggs and the embryo quality. Usually if less than 35 and good embryos 2 or less; 35-38 3; over 38 4 -
Susan	Can you recommend a IVF clinic in Central Florida that also does embroy adoption?
Lisa_Rosenthal	Susan, please call our toll free number for a physician referral.
Susan	Sure, what is the number?
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Lisa_Rosenthal	The number is (888)917-3777. Lori Masi is our patient advocate, she is just wonderful and helpful.
Lisa_Rosenthal	How did you all hear about tonight's online session?
frshlilly	serch through the site on gestational carriers
Dr._Lane_Wong	Dear Kate: I assume the lab has a normal level to 10. Your level is barely elevated. More information is almost never harmful. Other factors should be considered such as if there are other factors, how long you have been trying, what treatments you have had.
Grebena	Dr. Wong, I will be 46 in April. After 3 IVF cycles and 3 IUI cycles, (my husband and I were blessed with the miracle of a baby boy ...who is now 2 1/2 years healthy! We conceived him during the last IUI cycle) My husband and I have gone through 7 IUI's since with no luck. Our hopes are dwindling for a biological sibling for our son. Do you think we should not try anymore on our own and go with donor egg? What willl my chances be for carrying full term?
Lisa_Rosenthal	A second opinion is not seen as a betrayal to your physician. It is a reasonable way to gather the additional information that Dr. Wong was suggesting.
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Barb99	How do you go about selecting donor sperm?
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Dr._Lane_Wong	I got disconnected.
Lisa_Rosenthal	Thanks for rejoining us Dr. Wong, it happens!
Dr._Lane_Wong	Re Q on how to pick Donor Sperm:
Lisa_Rosenthal	Please repost questions for Dr. Wong, he won't be able to see what he has missed.
Dr._Lane_Wong	One should go to an accredited sperm bank. One needs to have an order from a doctor.
kinn6	Who gets to decide when it's hopeless to try without donor egg?
Grebena	Dr. Wong -- My husband and I will be 46 in April. After 3 IVF cycles and 3 IUI cycles, were were blessed with the miracle of a baby boy--it occured during the last IUI cycle-- I was producing 20 follicles on 8 vials of Rep/Gonal F. He is now a healthy 2 1/2 year old! We have gone through 7 IUI cycles since, getting pregnant once last February for 12 weeks--no heartbeat--Anyways our hopes are dwindling for a biological sibling for our son. Do you think it is not possible to conceive with my own eggs at this point? Should I be able to carry full-term with a donor egg?Help:)
Dr._Lane_Wong	Dear Kinn6: Like all medical decisions, it should be a decision that you make with your doctor. Your doctor should provide you with realistic expectations and you should decide what is the best route for you. There are alot of factors involved. Certainly many failed treatments, age greater than 42, high FSH would all be negative factors. However, I like most fertility doctors have successfully had women conceive with their own eggs after being told they need donor eggs by another doctor. So it is usually not an absolute thing however factors like I listed above are significant
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Lisa_Rosenthal	Thank you to everyone for joining us this evening. Please check out our message boards, which are moderated by physicians, (including Dr. Wong, on Sundays!) every day.
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Lisa_Rosenthal	Dr. Wong, you have done a wonderful job here this evening. Thank you for joining us.
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frshlilly	Why does a gestational carrier need to go on hormones to prepare her body? Why not follow her natural cycle with blood tests and ultrasounds and then put the embryos in when the time is right?
Lisa_Rosenthal	The way that I get wonderful speakers, like Dr. Wong, is by promising them that they will be off by 9, sharp. That leaves us about 8 minutes with Dr. Wong. Keep in mind that our online sessions are weekly. Please check the schedule.
Lisa_Rosenthal	Save the date, April 17, the National Fertility and Adoption Conference 2005 is being held at the Grand Hyatt in NYC. There will be over 100 speakers, 8 sets of keynotes and 60 workshops, as well as a great exhibit hall.
Grebena	Did Dr. Wong see my questions? I posted them twice Thank you
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Dr._Lane_Wong	Dear Grebena: I don't know all the details in your case but it sounds like the main factor for you is your age - egg quality. It is not your pelvis or your husband's sperm. So you can hope to get lucky and ovulate a good egg or move to donor eggs. Obviously as time goes on it is less likely you will be lucky. One of the reasons is the higher chance of chromosomal abnormalities with age, that could have happened with your last conception. If you are healthy especially your kidneys, cardiovascular system you should have a good chance of a good pregnancy. After the age of 45 I usually request women have medical screening and speak with a perinatologist
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Dr._Lane_Wong	Dear frshlilly: What you describe can be done but practically speaking it is difficult because it is difficult to time a surrogates ovulation with the timing of anothers egg collection. There is a "window of implantation" e.g. it would not be good to put in a day 3 embryo in someone who has not ovulated yet.
Lisa_Rosenthal	Ladies and Gentlemen, if you have any other questions after this session, please come to our message boards and post them there. We so appreciate you joining us this evening!
Grebena	Thank you!!!
Lisa_Rosenthal	Dr. Wong, you were teriffic, thanks so much for joining us, I hope you will do it again!
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erailso	Thank-you!
kinn6	Good night
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Dr._Lane_Wong	Thank you. I hope I was able to help.
Barb99	Lisa, and dr. thanks
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Orly	Thanks Doctor, you were great....
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Lisa_Rosenthal	Dr. Wong, you were just great, thanks again.
Fran	I agree!
Fran	thanks nite
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wannababy	I appreciate all the help in these sessions, thanks
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Maddie	good night
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Stephen	Any last comments about gestational carriers?
Kate	bye, next week.
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Lisa_Rosenthal	Thanks to all of you for joining us this evening. Great questions.
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Third Party Reproduction Explained

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