The AFA thanks Google, a premiere sponsor, for their online advertising grant.

The American Fertility Association Blog

Georgia House Bill 388, The ‘Option for Adoption’ Act.

June 3, 2009 - Wednesday
Posted by admin

By: Daniel Shapiro, M.D.

Georgia recently enacted Georgia House Bill 388, the ‘option for adoption’ act. The bill provides legal basis for patients using donated embryos to ‘adopt’ them under the Georgia family law code. This bill is the first of its kind to be enacted and represents one of many attempts by right to life groups to establish ‘personhood’ of embryos. By all prior legal standards and in all reproductive medicine clinics practicing embryo donation, embryos are considered property, not people.

The moral standard implied by this bill is likely to be unconstitutional because it violates the 1st amendment’s establishment clause (separation of church and state). Though reasonable people can certainly argue for the ensoulment of a pro-nuclear embryo, the civil pacts by which we live in this country prevent the supremacy of one religious view over any other or over any irreligious view. Since the concept of personhood is inherently a religious question, this law violates our nation’s constitution. The law also probably violates the 14th amendment (equal protection under the law) since it establishes a special class of human being with rights that supersede the rights of others in the class. Why should an IVF embryo have the right to be adopted and treated as an ‘individual’ while a naturally conceived embryo has no similar protection?

I had the privilege to testify before the Georgia committee hearing this bill before it passed. First let me say that what was originally written was so egregious and foolish that had the original language passed Georgia’s legislature would have looked plain stupid. An attorney with extensive experience in Georgia family law and third party reproduction rewrote much of the bill and eliminated the expressed intent to make all IVF embryos into full grown people. She also crafted the language in a way that makes the bill superfluous in that it only created the option for an expedited adoption process but does not require it. In effect the law does nothing except answer to the rantings of the religious right.

Because the law is vague as to how it is we are supposed to actually proceed with these cases, we in the REI community in Georgia do not foresee any change in our practice. Our consents and contracts with patients have provided for rescission of parental rights in the case of embryo donation from time immemorial. Unless a recipient patient actually tells outside parties how she achieved pregnancy, all anyone would see is a pregnant woman anticipating delivery. Since the overwhelming majority of embryo donations are anonymous, the donor would not know if a) her embryos became pregnancies or b) who actually got pregnant. It is hard to imagine a case where a willing embryo donor would come back and sue for parental rights since said donor wouldn’t know if or when a donation took place. Even if she could discern the above from the unavailability of her former property, she would not know if the procedure actually worked. Someone would have to show a compelling reason for us to violate someone else’s right to privacy and reveal their identity and the circumstances of their embryo recipiency. Ain’t gonna happen. I defy anyone who claims to believe in freedom and autonomy (many are in the same party as the religious right) to explain why the state of Georgia has a compelling interest in unmasking HIPPA protected patients.

Dr Shapiro is board certified in Reproductive Endocrinology and is the former medical director of Reproductive Biology Associates (RBA). He is currently the clinical director of RBA’s egg donor program and the RBA egg bank.

In cases where the embryo donor is not anonymous (a rarity) the bill allows for expedited adoption. Though this may afford a greater level of protection for the recipient’s claim to parentage, the physical reality of labor and delivery is probably a good enough standard under which a couple may establish their claim. To the best of my knowledge, there are no cases of willing embryo donors coming back to claim parental rights. It is equally hard to imagine what would happen if they did. For this law to be applicable at all, the donation, gestation and residence of all the parties would probably have to be in Georgia. If any of the parties, especially the recipient lived out of state, the existing property laws and family statutes of the resident state would likely apply.

From a medical perspective, we could limit our donations only to embryos that came from egg donation and then offer them only to out-of state recipients. This is likely to be unnecessary as again the bill only provides for the adoption option. After the law is enacted on July 1st it would be prudent of us to be sure to document that we informed recipients of the adoption option. Beyond that we see no change to medical practice standards under this bill.

Categories
Adoption • Embryo Donation • Family Building • IVF • Pregnancy

(0) Comments • (0) Trackbacks • Permalink

Pretty Woman

June 1, 2009 - Monday
Posted by admin

By: David Kreiner, M.D.

“We at The AFA have received a large number of emails from women who are confused by Kate Gosselin’s diagnosis of PCOS because, in their eyes, she is simply too pretty to have it. Many people seem to have the misconception that a woman with PCO is doomed to a lifetime of unattractiveness. AFA blogger, David Kreiner, M.D., has written about PCOS today in an effort to further educate women about this disorder” - The AFA staff

Polycystic Ovary Syndrome (PCOS) is a condition in which a woman’s hormones are out of balance. It can cause problems with your periods and make it difficult to get pregnant. PCOS may affect the way you look and can be associated with a variety of health problems including diabetes, hyperlipidemia and hypertension.

PCOS is the most common hormonal disorder of reproductive age women, occurring in over 7% of women at some point in their lifetime. It usually develops during the teen years. Treatment can assist women attempting to conceive, help control the symptoms and prevent long term health problems.

The most common cause of PCOS is glucose intolerance resulting in abnormally high insulin levels. If a woman does not respond normally to insulin, her blood sugar levels rise triggering the body to produce more insulin. The insulin stimulates your ovaries to produce male sex hormones called androgens. Testosterone is a common androgen and is often elevated in women with PCOS. These androgens block the development and maturation of a woman’s ovarian follicles preventing ovulation resulting in irregular menses and infertility. Androgens may also trigger development of acne and extra facial and body hair. It will increase lipids in the blood. The elevated blood sugar from insulin resistance can develop into diabetes.

Symptoms may vary but the most common are acne, weight gain, extra hair on the face and body, thinning of hair on the scalp, irregular periods and infertility.

Ovaries develop numerous small follicles that look like cysts hence the name polycystic ovary syndrome. These cysts themselves are not harmful but in response to fertility treatment can result in a condition known as Hyperstimulation syndrome. Hyperstimulation syndrome involves ovarian swelling, fluid accumulating in the belly and occasionally around the lungs. A woman with Hyperstimulation syndrome may become dehydrated increasing her risk of developing blood clots. Becoming pregnant adds to the stimulation and exacerbates the condition leading many specialists to cancel cycles in which a woman is at high risk of developing Hyperstimulation. They may also prescribe aspirin to prevent clot formation.

These cysts may lead to many eggs maturing in response to fertility treatment also placing patients at a high risk of developing a high order multiple pregnancy. Due to this unique risk it may be advantageous to avoid aggressive stimulation of the ovaries unless the eggs are removed as part of an in vitro fertilization procedure.

A diagnosis of PCOS may be made by history and physical examination including an ultrasound of the ovaries. A glucose tolerance test is most useful to determine the presence of glucose intolerance and diabetes. Hormone assays will also be helpful in making a differential diagnosis.

Treatment starts with regular exercise and a diet including healthy foods with a controlled carbohydrate intake. This can help lower blood pressure and cholesterol and reduce the risk of diabetes. It can also help you lose weight if you need to.

Quitting smoking will help reduce androgen levels and reduce the risk for heart disease. Birth control pills help regulate periods and reduce excess facial hair and acne. Laser hair removal has also been used successfully to reduce excess hair.

A diabetes medicine called metformin can help control insulin and blood sugar levels. This can help lower androgen levels, regulate menstrual cycles and improve fertility. Fertility medications, in particular clomiphene are often needed in addition to metformin to get a woman to ovulate and will assist many women to conceive. The use of gonadotropin hormone injections without egg removal as performed as part of an IVF procedure may result in Hyperstimulation syndrome and/or multiple pregnancies and therefore one must be extremely cautious in its use. In vitro fertilization has been very successful and offers a means for a woman with PCOS to conceive without a significant risk for developing a multiple pregnancy especially when associated with a single embryo transfer. Since IVF is much more successful than insemination or intercourse with gonadotropin stimulation, IVF will reduce the number of potential exposures a patient must have to Hyperstimulation syndrome before conceiving.

It can be hard to deal with having PCOS. If you are feeling sad or depressed, it may help to talk to a counselor or to others who have the condition. Ask your doctor about support groups and for treatment that can help you with your symptoms. Remember, PCOS can be annoying, aggravating even depressing but it is fortunately a very treatable disorder.

Sincerely,

David Kreiner, M.D.

Do Live in California?

To learn more about PCOS and how to control it, along with other steps you can take to prevent infertility, be sure to attend The AFA’s FREE Manicures & Martinis Infertility Prevention Series, which is coming to San Francisco and Laguna Niguel. Enjoy complimentary manicures and martinis and learn about the reality of the biological clock, how STD’s can compromise your fertility, and how certain environmental toxins can jeopardize your ability to conceive a child.

Manicures & Martinis San Francisco
Nova Nail Spa
811 Mission Street in San Francisco
Tuesday, June 9th, 6:00-7:30 PM
RSVP with Vivian: [email protected] or 646-861-3226
More Details

Manicures & Martinis Laguna Niguel
Accent On Nails
28121 Crown Valley Parkway in Laguna Niguel
Tuesday, June 16th, 6:00-7:30 PM
RSVP with Vivian: [email protected] or 646-861-3226
More Details

Categories
Fertility Drugs • Infertility • IVF • Ovulation • PCOS • Pregnancy

(0) Comments • (0) Trackbacks • Permalink

Welcoming Jesse

May 27, 2009 - Wednesday
Posted by admin

By: Sierra Hansen

When my partner announced 7 years ago she wanted to start a family, I was speechless. We never really talked about getting pregnant because we knew it would require money and effort and we simply weren’t ready to initiate the whole process. She was 37 and I was 31, so it was obvious she would go first. We announced our plans to get pregnant to all of our friends, asked for tons of advice, found a friend willing to be our donor, and tried to get pregnant.

And tried, and tried, and tried. We adopted a laissez faire attitude because like many women our ages, we thought as soon as we decided to get pregnant, it would be a snap. It wasn’t. After 7 years, we used 6 different sperm donors (known and unknown), underwent ~30 IUIs, 18 which were medically assisted with drugs, and finally one IVF procedure which culminated in a happy 9 month old boy.

At first, we were giddy with excitement every time we tried to inseminate, and we held our collective breath for the two weeks between trying and the first pregnancy test. After a year, we began to wonder if we shouldn’t talk to a specialist. We did, and it was eye-opening. We thought we were well-informed and educated about our fertility. Boy, were we wrong. So, we initiated a much more strategic, medically-assisted plan with a great physician who shared the startling truth about reproductive health. He brought up concerns about my partner’s age, and suggested we only try 6 IUI’s before we consider IVF or switching to me. We began to dread the two week wait, especially when our friends were constantly enquiring how the baby-making was coming along. We finally told people that no news was bad news, and most got the hint.

Meanwhile, we watched a number of our straight and gay friends have one and two babies. We rubbed pregnant bellies and babysat as much as possible hoping some good luck would rub off on us. After the 6 IUI’s with our doctor wrapped up the second year of trying, my partner had given up and it was my turn. She tried to keep her chin up, but I knew she was devastated. I did my best to support her, and we turned our hopes to my getting pregnant quickly. We took a few months off to recoup our energy and spirits and started again.

When I started, we didn’t tell anybody except for our closest friends. We just couldn’t handle the monthly barrage of questions, and the seemingly inevitable “No news is bad news” response. Our best friends tried to be supportive, but after 11 cycles of drug-assisted IUI’s, we began to isolate ourselves from them. One day, about 2 months before we knew we would have to make the decision to go forward with IVF or remain childless, we invited our neighbors who were walking by in for a glass of wine. She announced no wine for her because she was expecting, patting her belly to reinforce the announcement. A month earlier they were not even sure they wanted kids and all of a sudden they were pregnant. I wanted to yell at them, slam the door, crumple into a ball and cry. I didn’t. Somehow, I found the courage to invite them in, offer her a glass of water, and toast their good fortune. We did pull back from them, and our close friends, after letting them know we were really struggling with the inability to get pregnant. Our friends understood when we crawled into our shells.

When we initiated the IVF, our physician was incredibly optimistic. The most optimistic he had been in a long time. While my inability to get pregnant via IUI stumped him, he thought I would be a good candidate for IVF success. He was right. After all the shots, pills, ultrasounds, and blood tests, my doctor harvested 21 eggs, fertilized 14, and eventually 5 made it to blastocyst. We froze three, and two were transferred. One took, and when a beautiful 8lb, 6oz baby boy was born 9 months later, we named him Jesse. I had the easiest pregnancy in the world and Jesse is an amazing baby. Today we feel very lucky and grateful that we have a child with big blue eyes who sleeps through the night. However, we try to educate our friends who seek information about getting pregnant at every opportunity. If our experience can help shorten the time it takes another couple, we’ll consider it a bonus.

Best,

Sierra Hansen

To read more about Gay Moms Doing Well Despite Prop 8, click here

http://www.huffingtonpost.com/elizabeth-gregory/gay-moms-doing-well_b_207455.html

Sierra Hansen and her partner, Barbara, have been together for 14 years, and last August she gave birth to a baby boy. She is currently a graduate student at the University of Washington researching on infertility genetics, policy, and law.

Categories
Donor Sperm • Family Building • Fertility • Fertility Drugs • Frozen Sperm • Gay and Lesbian Family Building • IUI • IVF • LGBT • Pregnancy • Sperm Donation

(1) Comments • (0) Trackbacks • Permalink

Manicures & Martinis & MDs

May 14, 2009 - Thursday
Posted by admin

By Lori Holden

One of these things is not like the others.
One of these things just doesn’t belong
Can you guess which thing is not like the others...?

The Sesame Street song was in my head as the nail tech pushed back my cuticles at the American Fertility Association‘s Manicures & Martinis event in Denver.

I was in a room full of beautiful 20-somethings. Tanned legs, cute sun dresses, fresh skin. We were all guests of the AFA to begin thinking about our fertility and to listen to three doctors from Conceptions Reproductive Associates of Colorado.

I ONCE had tanned legs. I ONCE wore cute sundresses that didn’t have spaghetti sauce in some not-so-hidden crease. I ONCE had fresh skin.

But I never, in my 20s, worried about my fertility. Back then, we were trying hard NOT to get pregnant. And, we were told, “people have babies well into their 40s—you have plenty of time.”

So when I didn’t meet my husband until I was 31, I was not concerned. When we married at 32, I was not concerned. When, after a year of not exactly trying to become pregnant but not really trying not to, I began to grow concerned.

I could have used a night like this back then. Or even before then.

After welcoming remarks by AFA Executive Director Ken Mosesian, Drs. Swanson, Bush and Albrecht told about substances and activities that can decrease fertility in both men and women. They shared results of studies on everything from egg health to treatment success rates to timing of intercourse. They entertained questions about an alphabet-soup of issues: PCOS, POF, MFI, OHSS, IVF, IUI and the rest of the infertility lexicon.

(I am now reading The Land of IF: Understanding Infertility and Exploring your Options, so I was able to follow the technical parts. Mostly.)

The good doctors were informative and charming, and I could see trusting them with my fertility hopes, if I had been like the others instead of being a tired mom having a rare night out with an organization I’m now blogging for.

How did my story turn out? Well, we never did get the better of our fertility. Our one shot at IVF was a failure, and we faced it alone and isolated in the days before online support groups, blogs, forums and the AFA.

But we did become parents, nonetheless. In 2001, we were at our daughter’s birth, and remain in contact with her first parents in a fully open adoption. Two years later, her brother joined us as an infant, and our family was complete.

Lest you think I’m blowing the age gap out of proportion, check out the local news clip. You’ll see my back (I’m talking with the doctors) at 1:12 where the voice over says, “Most importantly, know about the AGE FACTOR.”

Even though I was not like the others—wanting to know the ways to preserve my fertility—I did somehow manage to enjoy my manicure and martini.

Some things are universal.

Lori Holden blogs about open adoption and mindful living amid chaos at Weebles Wobblog, and she dishes up sassy reviews at All Thumbs Reviews. Lori has recently joined the AFA as a contributing blogger.
--
http://WeeblesWobblog.blogspot.com ...mindful living amid chaos

http://AllThumbsReviews.blogspot.com ...sassy reviews by sassy chicks

@BestLight ...follow me on Twitter
http://twitter.com/BestLight

Categories
Adoption • Fertility Preservation • IUI • IVF • PCOS • Pregnancy • Reproductive Health

(2) Comments • (0) Trackbacks • Permalink