When Surrogacy Can Become a Real Choice

December 15, 2004 - Wednesday
2:24 PM to 3:24 PM (EST)
Guest Speakers: Jeffrey R. Nelson, MD, Huntington Reproductive Center in California

Categories
Embryo Donation • Gestational Carrier • Miscarriage • Pregnancy • Surrogacy

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Lisa_Rosenthal	Hi Dr. Nelson, thanks for joining us this evening!
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Dr._Jeffrey_Nelson	Type hereHi Lisa, I'm ready when ever you are.
Allie	Hi Lisa and Dr. Nelson!
Lisa_Rosenthal	Dr. Nelson, can you go over the different ways that surrogacy can work?
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Dr._Jeffrey_Nelson	Gestational surrogacy is a treatment that we use in the event that someone is unable to carry a pregnancy using their own uterus, for whatever the reason.
Stephen	Good evening everyone
Dr._Jeffrey_Nelson	Hi Stephen.
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Jen	hi
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Orly	Sorry to be blunt, but how many miscarriages does one have to have before looking at surrogacy?
Dr._Jeffrey_Nelson	Just to further elaborate, patients using surrogates have had hysterectomies due to fibroids etc. Also patients with a history of recurrent pregnancy loss will consider the use of a surrogate.
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Dr._Jeffrey_Nelson	There is no particular number, it depends more on what the reason for the misscarriages is.
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Diane	Are you allowed to do surrogacy everywhere?
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Dr._Jeffrey_Nelson	No, the laws vary country by country and state by state. Please forgive my spelling.
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Lisa_Rosenthal	Your spelling is just fine, thank you, Dr. Nelson.
Dr._Jeffrey_Nelson	So far, just wait.
Art	Typically, does one use the surrogate's ovum as well?
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Lori_Masi_AFA_ Patient_Advocate	Welcome Dr Nelson - thank you for being with us tonight!
Dr._Jeffrey_Nelson	It depends on the status of your ovaries. If you have adequate ovulatory function than most patients would consider using their own eggs.
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Dr._Jeffrey_Nelson	Thank you Lori.
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Lisa_Rosenthal	With third party reproduction, would you recommend having a legal agreement? Is that usually done?
Lori_Masi_AFA_ Patient_Advocate	Welcome All! Please call the AFA Toll Free Support Line at 888-917-3777 for information, a referral in your area or just some good ol fashioned support. Looking forward to hearing from all of you! Lori Masi – AFA Patient Advocate
Blee8	My doctor told me that i should adopt, that it never works out well to have a surrogate
Dr._Jeffrey_Nelson	Lisa, having legal contracts is manditory.
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Art	Doctor, where do you practice?
Dr._Jeffrey_Nelson	Blee8, what reason did your physician give you to support his claim that surrogacy doesn't work out? We have found it to be a very successful form of therapy for the appropriate circumstances.
Allie	When you have a surrogate, using your own eggs, how does a cycle work?
Dr._Jeffrey_Nelson	Art, I practice at the Huntington Reproductive Center, at the Pasadena office, in Southern California.
Lori_Masi_AFA_ Patient_Advocate	Dr Nelson - aside from the fact that legal contracts are mandatory, I think eveyone should realize how important it is, even if you are using a family member or friend!
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Dr._Jeffrey_Nelson	Allie, we synchronize the growing of your eggs with the preparation of the surrogates uterine lining. We collect your eggs, create embryos in the lab, and then transfer them to the surrogate.
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Petra	Hi Doctor, I'm 50 years old. Have had many miscarriages. Is surrogacy still an option for me?
Jen	How do you synchronize the growing of the eggs and the preparation of the lining? who has to take what drugs, with what monitoring?
Dr._Jeffrey_Nelson	Lori, legal contracts are a critical aspect of surrogacy, and they should only be drawn up by someone with substantial experience. The genetic parents and the surrogate must anticipate all the possible senarios that may occur during the pregnancy and contractually agree on how all matters with be handled. Contracts should never be taken lightly.
localhost	[2009] touser Welcome to The American Fertility Association's online educational session. We are pleased to have Dr. Jeffrey R. Nelson, (Huntington Reproductive Center in California)joining us this evening. We will be discussing the topic "When Surrogacy Can Become a Real Choice". Thanks for joining us this evening! Lisa Rosenthal, Educational Coordinator for The AFA.
Dr._Jeffrey_Nelson	Jen, we usually synchronize the menstrual cycles of the surrogate and genetic mom through the use of birth control pills and lupron. Following the confirmation of the effectiveness of lupron, we then stimulate the genetic moms ovaries with gonadotropins like follistim or gonal-f, and we stimulate the growth of the surrogates endometrial lining with some form of estrogen, either pills, patch or injectible.
Diane	Are there specific pregnancy rates for surrogates? How do you find a surrogate, how are they screened and for what?
localhost	[2009] touser Please feel free to post questions for Dr. Nelson. Keep in mind that you may need to repost them as the room is quite busy. You may want to save your questions in a word document instead of having to retype them.
Dr._Jeffrey_Nelson	Petra, being 50 years of age, the most effective treatment for you would be the combined use of an egg donor and surrogate.
Petra	And, forgive me, but why not adopt at that point? There is no genetic connection, unless through the male?
Dr._Jeffrey_Nelson	Diane, the pregnancy rate for a surrogate depends primarily on the age of the woman supplying the egg. You can find a surrogate through one of the many agencies whos sole purpose is to recuit surrogates, or you can find one on your own, such as family of friend. All surrogates must be screened medically, psychologically, and have legal contracts as outline above.
Lori_Masi_AFA_ Patient_Advocate	Welcome All! Please call the AFA Toll Free Support Line at 888-917-3777 for information, a referral in your area or just some good ol fashioned support. Looking forward to hearing from all of you! Lori Masi – AFA Patient Advocate
Nancy5	so what would the cycle be like for me, not going through the transfer?
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Dr._Jeffrey_Nelson	Petra, you make a very good point. Adoption is an excellent alternative. However, it also depends on the reason for your miscarriages. Was it because of chromosomally abnormal embryos which increase in incidence with increasing age. or was it due to an abnormallity with your uterus. If your uterus is structurally fine, and you are in excellent healty, than you could consider using an egg donor and carrying the pregnancy yourself.
Dr._Jeffrey_Nelson	Nancy, I'm not sure what you mean. Would you be the genetic mom with the embryos being transferred to a surrogate?
Nancy5	Yes, I would be the genetic mom
Lori_Masi_AFA_ Patient_Advocate	Dr Nelson I know everyone would be interested in the approximate costs of a surrogate or gestatonal carrier cycle, including legal expenses and compensation for the carrier - is that something you could comment on?
Dr._Jeffrey_Nelson	Nancy, than after your eggs were collected, we would than just leave you alone, and you would start your menses in about 2 weeks, assuming that you have a uterus.
Dr._Jeffrey_Nelson	Lori, I am relatively ignorant regarding the cost, and that is a number that I don't want to guess at. If anyone is interested, they could call HRC at 626 440-9161and ask for Lizzette. She can give you accurate figures. Just tell her that Dr. Nelson had asked you to call.
Brandy	Where are you located Dr. Nelson? I live in southern CA.
Dr._Jeffrey_Nelson	Brandy, my office is in Pasadena CA. We are located at 333 S. Arroyo Parkway. Our web site is www.havingbabies.com. Our phone number in Pasadena is 626 440-9161.
Art	How long is the wait for an appointment?
Eliza88	Is surrogacy legal in Oregon? That's where I live, but flying down to southern california is a real option.
Dr._Jeffrey_Nelson	Art, usually you can get an appointment within the month. If you have some special circumstance and need to be seen quicker, just call the office and ask for Dr. Nelson and we will see what we can do to accomodate you.
Blee8	My doctor thinks that surrogacy has a very low success rate and is concerned about bonding with the child. I live in New York.
localhost	[2009] touser The American Fertility Association has free membership! Please go online and you will have access to all our publications at "No Barriers".
Lori_Masi_AFA_ Patient_Advocate	Don’t Forget to please call the AFA Toll Free Support Line at 888-917-3777 for information, a referral in your area or support. Looking forward to hearing from all of you! Lori Masi – AFA Patient Advocate
Art	Thanks Dr. Nelson
Dr._Jeffrey_Nelson	Eliza88, I do not know the laws in Oregon. Does anyone out there know the law in Oregon? Lisa and Lori, do you have a resource for Eliza88 to contact regarding her legal question?
Lori_Masi_AFA_ Patient_Advocate	Eliza pls call me on the support line at 888-917-3777
Lisa_Rosenthal	Dr. Nelson, you are doing a wonderful job keeping up with these questions. Eliza88, you can also check out our legal message board and an attorney can answer your questions.
localhost	[2009] touser Please call our toll free hotline to ask our patient advocate for doctor referrals in your area. That number is: 888-917-3777 and our patient advocate is Lori Masi.
Lori_Masi_AFA_ Patient_Advocate	Dr Nelson is it accurate to say that the success rates for a GC or surrogate depends on the age of whoever's eggs are used?
Melanie	What type of connection- genetically is there between a surrogate and a baby? The baby is being fed, nourished, and kept alive by the surrogate. doesn't blood, plasma, something pass so that there is a genetic connection?
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Lori_Masi_AFA_ Patient_Advocate	Dr Nelson do you ever use donated embryos with a GC?
Lori_Masi_AFA_ Patient_Advocate	Dr Nelson does HRC have embryos for donation available?
Lori_Masi_AFA_ Patient_Advocate	Don’t Forget to please call the AFA Toll Free Support Line at 888-917-3777 for information, a referral in your area or support. Looking forward to hearing from all of you! Lori Masi – AFA Patient Advocate
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Lisa_Rosenthal	Welcome Back Dr. Nelson.
Dr._Jeffrey_Nelson	Thank you Lisa
Dr._Jeffrey_Nelson	Where were we?
Dr._Jeffrey_Nelson	There is no genetic connection between the surrogate and baby. I think Melanie asked that question.
Lori_Masi_AFA_ Patient_Advocate	Dr Nelson does HRC have embryos available for donation?
Melanie	How is that possible, given that the surrogate is nourising and helping the baby grow?
Lori	Type here
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Dr._Jeffrey_Nelson	Lori, HRC does have embryos available for adoption, but there is a waiting list.
Lori_Masi_AFA_ Patient_Advocate	Can they be used with a GC? ALso how long is the wait time?
Dr._Jeffrey_Nelson	Melanie, the genetics come from the DNA transmitted from the sperm and the egg. That genetic make up off the embryo has been determined before transfer.
Eliza88	So what is the surrogate actually supplying and if not a genetic connecction, than what is the connection?
Lori_Masi_AFA_ Patient_Advocate	Dr Nelson am I correct in the assumption that a GC is similair to when a recipient is doing a donor egg cycle - there is no genetic connection - the surrogate is just a carrier?
Dr._Jeffrey_Nelson	Lori, the donated embryos can be used with a surrogate, and the wait time is variable. Patients who have cryopreserved embryos are asked to make a choice yearly as to what they would like to do with those embryos. They can dispose of them, use them, donate them for research, or to another couple. Therefore it depends on many factors. It will also depend on the ethnicity of the couple to be matched with the embryos.
Lori_Masi_AFA_ Patient_Advocate	Is a single woman eligible to receive donated embryos and if she has multiple miscarriages behind her can she use a GC?
Dr._Jeffrey_Nelson	Eliza88, the surrogate has a physiologic connection with the implanted embryo. There is a connection across the placenta through which nutrients are passed to the baby in order to nurture its development. There is no genetic connection.
Eliza88	Thanks for explaining it Doctor, my family has been wondering.
localhost	[2009] touser Please call our toll free hotline to ask our patient advocate for doctor referrals in your area. That number is: 888-917-3777 and our patient advocate is Lori Masi.
Dr._Jeffrey_Nelson	Lori, a single woman could possibly be a candidate for donated embryos, and a surrogate would be stronly considered if she has a history of multiple miscarriages.
Gloryxx	What type of psychological screening is actually done? How many hours? Can you see a psych analysis?
Lori_Masi_AFA_ Patient_Advocate	Thank you that is good information to have!
Dr._Jeffrey_Nelson	Gloryxx, the genetic parents and the surrogate should both be screened by a psycholoist who specializes in issues of infertility and reproduction.
Lori_Masi_AFA_ Patient_Advocate	Don’t Forget to please call the AFA Toll Free Support Line at 888-917-3777 for information, a referral in your area or support. Looking forward to hearing from all of you! Lori Masi – AFA Patient Advocate
Lori_Masi_AFA_ Patient_Advocate	Dr Nelson does the patient have a choice in the surrogate or GC that is used?
Wannababy	How much of your practice is surrogacy? And what does a stimulation cycle look like? How hard is it on my hormones to stimulate and not to transfer?
Dr._Jeffrey_Nelson	Lori, the patient typically will meet the surrogate, and must be very comfortable with her before moving forward. The same goes for the surrogate. She must meet and be comfortable working with the genetic parents. They are entering into a long term relationship and must be able to work well together.
Dr._Jeffrey_Nelson	Wannababy, we do more surrogacy treatment cycles than any clinic west of Chicago. It is a large part of our practice. Are you referring to the stimulation for the surrogate or the genetic mom? I
Dr._Jeffrey_Nelson	(cont) I'm not sure what you mean when you say "hard on your hormones" could you elaborate?
Lisa_Rosenthal	Ladies and Gentlemen, we are so lucky to have such wonderful speakers, because I promise them that they will be done by 9, sharp. That gives us 7-8 minutes left. Please remember that we have wonderful message boards that are moderated by physicians daily. And of course, we have Lori Masi, who is here this evening, who is available by toll free phone.
Wannababy	just all those hormones expecting to get pregnant and then nothing happening.
localhost	[2009] touser The American Fertility Association has a set of message boards, several which are moderated by a physician daily. Please feel free to stop by and ask questions there as well! Also, "Connections" will meet every week for an online educational session. Please check the schedule on our home page.
Lori_Masi_AFA_ Patient_Advocate	Don’t Forget to please call the AFA Toll Free Support Line at 888-917-3777 for information, a referral in your area or support. Looking forward to hearing from all of you! Lori Masi – AFA Patient Advocate
Dr._Jeffrey_Nelson	Wannababy, there will be no adverse consequence to your body. You will have a period typically within 14 days from your egg retrieval. Your period may be somewhat more heavy than typicall, and if so will be associated with greater cramping.
Lisa_Rosenthal	Dr. Nelson, you have done an outstanding job here this evening. We so appreciate your time, effort and information. Thank you for joining us, I hope you will consider doing it again sometime?
Jen	Thanks Dr. Nelson, for being here this evening.
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Lori_Masi_AFA_ Patient_Advocate	Dr Nelson - Thank you for being here and being so informative!
Dr._Jeffrey_Nelson	You are very welcome. I hope this information has been helpful.
Allie	I'm glad to hear that you are in my neck of the woods. I'll call and make an appointment.
Allie	good night
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Orly	You answered a lot of questions for me, thanks!
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Lisa_Rosenthal	Ladies and gentlemen, also keep in mind that the transcripts from our online sessions are kept up to read at your lesiure.
Dr._Jeffrey_Nelson	If anyone has any additional questions please feel free to call me at Huntington Reproductive Center in Pasadena, CA 626 440-9161or email me at lagoonatic@sbcglobal.net
Melanie	night
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Art	thanks
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Nancy5	see you next week....
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Diane	Dr. Nelson, what if anythign does insurance cover for surrogacy if you have insurance coverage?
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Brandy	nite
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Stephen	thanks
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Eliza88	thanks for your help this evening.
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Wannababy	bye
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Lisa_Rosenthal	Dr. Nelson, are you able to answer that last question about insurance?
Lisa_Rosenthal	otherwise, Diane, please feel free to post on our legal board and you will get help there.
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Dr._Jeffrey_Nelson	Diane, that is very individual based upon your particular insurance. I'm not much of an insurance guru, but if you have any questions about that someone here at our office could assist you.
Diane	Thanks Dr. Nelson, I will call.
Lisa_Rosenthal	Dr. Nelson, could you post your phone number one more time for Diane?
Lisa_Rosenthal	And then, we will really wrap this up!
Dr._Jeffrey_Nelson	Diane, if you want you could leave a message for me and I will have the appropriate person contact you.
Lisa_Rosenthal	Thanks so much for joining us this evening- Dr. Nelson- please join us again sometime?
Dr._Jeffrey_Nelson	My phone number is 626 440-9161.
Diane	Thanks Dr. Nelson, i appreicate all your help here tonightl
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Dr._Jeffrey_Nelson	Thankyou Lisa, it was fun, and I would love too.
Lisa_Rosenthal	Dr. Nelson, your spelling was great!!!!
Lisa_Rosenthal	and your answers!
Dr._Jeffrey_Nelson	Thanks.
Lisa_Rosenthal	I hope you have a wonderful holiday season.... Good night.
Dr._Jeffrey_Nelson	I wish you the same. If you ever need anything please call.
Lisa_Rosenthal	Thanks, can I ask a small favor?
Dr._Jeffrey_Nelson	Sure.
Dr._Jeffrey_Nelson	Lisa, are you there?
Lisa_Rosenthal	I do not have your direct email, and it's perfectly fine if you would prefer me to go through Jackie Sharpe. If you do not mind my contacting you directly, just send me an email to my address Lisa@theafa.org that way if I have an article that needs to be done, or a session, I can just ask you
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Dr._Jeffrey_Nelson	No problem. You can actually email me at my personal address because I can access it at home and the office: lagoonatic@sbcglobal.net
Lisa_Rosenthal	I appreciate it. Just makes it easier. Thanks
Dr._Jeffrey_Nelson	You bet. Good night.
Lisa_Rosenthal	Good night
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