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Infertility - Frequently Unasked Questions

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Michelle Ottey, Medical Director of Fairfax Cryobank gave the following answer: Anonymous donors are just what they sound like. These men agree to participate in the donor program to provide semen but remain anonymous (unknown) to you, the recipients and your resulting child(ren). The sperm bank will not release any of their identifying information for any reason.

ID Option donors agree to provide semen and to be identified to your child(ren) when they are of age. Though all births should be reported to the Cryobank, if a recipient wants their child to have the option to contact the donor, the ID Option birth Registration must be completed. This allows an 18 year old ID Option donor conceived person to contact the Cryobank and request the donor’s information. You, the recipient, cannot request this, only your child(ren).

Some people will consider a known donor/directed donor, someone they personally know who they would be comfortable asking to donate sperm; a relative of a male partner, a close friend, etc. If choosing this option it is crucial to work with a legal professional to draw up the necessary paper work to clarify the relationship of the donor to your future child. It is also important to know the laws in your state and how they affect parentage. Know donors are required by the FDA, to be screened in the same way that a sperm bank sperm donor is screened because they are non-sexually intimate with you, the recipient. Some sperm banks and clinics have Directed Donor Programs that will assist you in making this option work for you.

Dr. Ken Doka, Senior Consultant to the Hospice Foundation of America, and author of many books on grief, including Disenfranchised Grief, does not like the term "resolving grief" because it implies dealing with it as a one time event, wrapping it up, and being done with it. That is not the nature of grief. It is always with you, but you can come to terms with it in such a way to live a joyful productive life. For more suggestions on how to healing from the pain of infertility when the rest of society does not understand, listen to these Creating a Family shows on phone, tablet, iPod, computer: Coming To Terms with Infertility Grief and Coping with Infertility Grief After Adopting.

Catherine Tucker, a reproductive law attorney at Tucker Legal, says the following:

While it may sound counterintuitive, anonymity and future contact both can be a part of your egg donation arrangement. The important thing is to select a program that is willing to facilitate the contact. While most programs in the U.S., and this includes agencies, IVF clinics and egg banks, are willing to facilitate future contact for medical reasons, policies differ greatly on future contact for social reasons. In general, the most flexibility is available with agencies and the least flexibility with egg banks. However, it’s important to ask the program you are thinking of working with for information as to their specific policies. If the program is agreeable to such future contact, the next step is to see if your potential donor is open to future contact—most donors are agreeable to contact for medical reasons, but not all donors will agree to social contact. Once you have located a donor who meets your needs, you will want to make sure that you have a plan in place for locating your donor many years down the road, when your child is older. One of the many benefits of having a written agreement with your donor is that you can set out your mutual expectations about both anonymity and future contact, as well as lay out a plan for reaching your donor in the future should she relocate, as young women are prone to do.

Stephanie Caballero, a reproductive law attorney in California, provided the following answer:

First, work in a state where the surrogate has no parental rights at birth, like California, where I practice. There is a statue, as well as case law, to protect your parental rights and if you comply with the statue, you are the presumed parents. The surrogate will not be given any parental rights at all to your child.

I have to say that it is very, very rare that your surrogate will even want any parental rights. I know there are some cases where that has happened, but, for the most part, the surrogate doesn't want your child. She wants to help you realize your dream of having a child. She has her own children and her own family and after she gives birth she wants to say hello to the baby (or babies), take a nice nap and watch you hold and love your child.

But, you do need to ensure that your surrogate has been properly screened by a mental health professional who specializes in this field. That is key to a successful surrogacy and something that should not be waived by anyone.

For more information, check out the Creating a Family radio show on Legal Issues You MUST Consider when Using Egg Donation, Sperm Donation or Surrogacy.

Yes, some clinics can biopsy the embryo for preimplantation genetic screening (PGS) or comprehensive chromosomal screening (CSS) on Day 5 and complete the screening in time for a fresh transfer on the morning of Day 6. This is true in 2013 and will only become more available in the coming years. Also keep in mind that there may be advantages to freezing the embryo and transferring in a frozen embryo transfer. We talked about all of this in the Creating a Family show on Increasing Success with IVF.
I always suggest that you start from a position of assuming no ill intent or bad motives; therefore, I suggest that you begin by educating the family member of the distinction between a donor and a mother. One contributes genetic material, the other raises a child. I would also discuss your understanding of the relative importance of nature and nurture in human development. (If you need some help, read this blog on Nature vs. Nurture. Then politely, and without anger, ask then to refer to the donor as the "donor" and you as the "mother". If after educating your family member on the distinction and your preferences, they continue to disrespect your wishes, I would have a very frank and pointed conversation, saying some variation on the following: " Regardless whether you agree or disagree with me, I feel hurt when you call the donor the mother, and I need you to stop immediately." If they don't, then you have the choice to distance yourself from this person because they are choosing to hurt you. I would also recommend that you listen the following Creating a Family show on Overcoming Reluctance to Donor Egg, Sperm, or Embryo in Your Extended Family where a therapist the specializes in infertility discussed this question at length.
Check out the "Ask Our Expert" breastfeeding FAQ page for more information, questions, and answers from our expert, Lenore Goldfarb, Ph.D.
Natalie, I think there are a couple of issues. John Travolta is 56 and Kelly is 47. You actually asked about conception. With donor eggs it is entirely possible for a 47 year old to conceive. Ease of conception is mostly dependent on age of the eggs. I have asked doctors on various Creating the Family shows about the safety of carrying a child in your late 40s or early 50s. Although not necessarily recommending it, most say that if the woman is healthy it is not all that risky. I believe the pregnancy is usually treated as a "high risk" pregnancy. I think the more interesting question is the how old is too old to raise a child. By the way, we did a show on How Old is Too Old on April 8, 2009. We also have a page on our website with lots of resources for those considering parenthood at a more "advanced age", including a link to that radio show. http://www.creatingafamily.org/adoption-resources/olderparents.html
Hannah, it is absolutely normal to feel defective. I would almost say it is universal, although there are probably a few people out there that have been able to escape this. People feel like their body has let them down, that they can't do the one uniquely feminine thing--produce a baby. It helps to wrap your head around the concept that infertility is a disease. You didn't do anything to deserve this. It happened to you, and your job now is to deal with it the best that you can. Some days the best you can do is feel sorry for yourself, and that's OK too. It is so unfair, and I'm sorry it is happening to you.
Boy, parenting is hard and it doesn't necessarily get easier as our kids age, does it?!? Everyone deals with a diagnosis of premature ovarian failure (POF) or premature ovarian insufficiency (POI) in a different way. Our dreams and thoughts for our future, as well as our basic temperament and coping styles affects how we react. And for some people, who envision a child free life or are totally open to adoption, this diagnosis in simply not that devastating. (There are other health consequences other than infertility, I should mention.)

I have no idea where your daughter is at on the coping continuum. Truthfully, you probably don't either. It is entirely possible that she is slowly and surely gathering information in her own way and processing what it means for her, but isn't ready to share it with you.

The hard part is that you too are affected by this diagnosis since it will have an impact on your grandmotherhood. If you are like me, I have spent some time dreaming about being a grandmother. Oh, I'm certainly not in any hurry considering the age of my children, but I have every intention of being a kick-butt granny in the future. I would be very sad if that dream was taken away from me. Perhaps your coping technique for your grief is to take action. (Again, that is my go-to technique as well, so perhaps I'm projecting here.) The problem is that it isn't yours to fix. And the fix you might want, may not be the best fix for your daughter. 

I can only guess that you daughter knows about some of the wonderful resources available for POF. I almost hate to post them because I truly don't think you should mention them to her. You can check them out, in case she comes to you and asks. Two of the best are:
International Premature Ovarian Failure Association http://www.pofsupport.org/ Rachel's Well http://www.rachelswell.org/poi-101/
General anesthesia is not mandatory. Different doctors use different types of anesthesia. I strongly recommend that you talk with your Reproductive Endocrinologist about this specific concern. I imagine she/he will be able to work with you to work out a solution you would feel comfortable with. You might also find that once you become more educated on what is involved, you will feel more comfortable with a sedation/anesthesia option that you feared. If this concern has kept you from scheduling an appointment with a RE, then by all means schedule one and be completely honest about your concerns.
  I asked this question of Dr. Cappy Rothman on the September 10, 2008 Creating a Family radio show. He recommends Male Fertility Supplement by Coast Reproductive. I have done no independent research on the efficacy of this supplement and would also caution you to discuss this with your husbands urologist, and if he decides to take it, make sure to tell your RE and embryologist.
I posed this question to Dr. Cappy Rothman on the Sept. 10, 2008 Creating A Family radio show. He responded that vasectomy reversals are quite successful, and although success does depend on time, you could expect a good result after eight years. However, vasectomy reversals are not a quick fix and given your wife’s age, time is not on your side. Dr. Rothman recommended that you consider a sperm aspiration followed by IVF. A sperm aspiration can be done under local and you should get enough sperm for several IVF attempts. To hear his response and not rely on my paraphrase, listen to the Sept. 10, 2008 show on the radio page.
Dr. Marcelle Cedars answered this question on the Aug. 13, 2008 Creating a Family internet radio show. She said that with treatment, PCOS patients have about the same chance of getting pregnant as someone without PCOS. You can listen to this show by going to the radio page of this website.
The list of clinics I referred to is the CDC list that tracks success rates for IVF. (Go to my Infertility resource page and click on success rates.) Unfortunately, they don’t track success rates of egg freezing, probably because it is still considered experimental.

I don’t know of an independent source for the success rates or how many egg freezing cycles a clinic does, but this is how I would approach it. First, I assume if you listened to the April 30, 2008 Creating a Family show, you understand that the odds are not necessarily in your favor, and you shouldn’t postpone a pregnancy with the expectation of sure success. Second, if it were me, I’d be interested in going to a clinic whose clinicians are publishing in the peer reviewed journals on egg freezing. I list a couple of these articles under “egg freezing” on my infertility resources page. The hard part is getting access to these journals. You can probably rely on just the abstract, which are more readily available on the internet through a simple google search. If you can access a university library e-journal collection, that is your best bet to get the full articles. If not, most public libraries have access to a some medical journals for free. Ask them to do a search for you. Make sure to look for the most recent research. Then call the clinics the authors are associated with and ask how many cycles they did in the past two years and what their success rate is. The problem you will run into is that most people who freeze eggs don’t want to thaw and use them within just a few years, so pregnancy rates may be hard to come by.
According to Dr. David Hoffman, board certified reproductive endocrinologist and past-president of the Society for Assisted Reproductive Technology, on the Sept. 17, 2008 Creating a Family radio show, other than missing your period there really are no reliable physical sign of pregnancy that come up that early. A few woman may have an implantation bleed, but that is not a reliable predictor. I include a rating of the sensitivity of OTC pregnancy tests under Infertility Resources on this website. You can listen to the Sept. 17 show at the radio page.
I’ve posed this question to two experts on the radio show Creating a Family: Dr. Cappy Rothman, board certified urologist and specialist in male infertility, on the September 10, 2008 show on male infertility and to Dr. David Hoffman, board certified reproductive endocrinologist and past-president of the Society for Assisted Reproductive Technology, on the Sept. 17, 2008 Infertility 101 show. Dr. Rothman recommended relying only on your own lubrication since it is the perfect environment for sperm. If a lubricant is needed, Dr. Hoffman suggested either Pre-seed, Astroglide, or the liquid base form of KY Jelly. Do not use any lubricant with a petroleum base. Both doctors recommended against using egg whites.
According to Dr. David Hoffman, board certified reproductive endocrinologist and past-president of the Society for Assisted Reproductive Technology, on the Sept. 17, 2008 Creating a Family radio show, studies have shown that being overweight reduces fertility, but only when your Body Mass Index exceeds 34. You can listen to this show at the radio page.
According to Dr. David Hoffman, board certified reproductive endocrinologist and past-president of the Society for Assisted Reproductive Technology, on the Sept. 17, 2008 Creating a Family radio show, the OTC ovulation predictor kits are all about the same. The kits available by prescription are able to predict ovulation within a narrower range of time, but for most people, this is not necessary. You can listen to this show at the radio page.
According to Dr. David Hoffman, board certified reproductive endocrinologist and past-president of the Society for Assisted Reproductive Technology, on the Sept. 17, 2008 Creating a Family radio show, raising your hips will not increase your odds of conception. Just lying down after sex is enough since the vagina is tipped already and cervical mucus around ovulation acts like a wick to draw the sperm up into the cervix. You can listen to this show at the radio page.
According to Dr. David Hoffman, board certified reproductive endocrinologist and past-president of the Society for Assisted Reproductive Technology, on the Sept. 17, 2008 Creating a Family radio show, it is best to make love every other day during the woman’s fertile time of the month. Sperm count is optimal with between 2 and 5 days of abstinence. I list resources for tracking the time of ovulation under infertility resources of this website. You can listen to this show at the radio page.
According to Dr. Robert Stillman, Medical Director of Shady Grove Fertility Center and Professor of Medicine at Georgetown Medical School, the answer is no. You can of course monitor through ultrasound and cancel a cycle if too many eggs mature, but many women are hesitant to go forward knowing that they may well have to cancel the cycle. IUI with injectable ovulation stimulating drugs are the primary source for higher order multiple births (triplets and up). Dr. Stillman said that the ASRM and SART have not issued guidelines for how to safely do this procedure because they don’t exist. There are too many variables to accurately predict how many eggs will mature the first time. Dr. Stillman recommends being prepared to either cancel the cycle if more than a few eggs are produced, or convert the cycle to an IVF cycle. Of course, this answer does not take into account the very real possibility that the reason a couple is doing IUI with injectables in the first place is that they either can’t afford an IVF cycle or have ethical objections to IVF. In many ways, these couples are between a rock and a hard place. To hear Dr. Stillman’s full response, listen to the Jan. 14, 2009 Creating a Family show.
Good question. In the past, transferring at 3 days was the standard. Now that culturing medium and embryologist skill are advancing, it is possible to grow the embryos to the blastocyst stage at day 5. The problem is that many embryos don’t survive the 5 days in the Petri dish, so some reproductive endocrinologists are now recommending transferring more embryos, but doing it at the 3 day mark. Other embryologist, think that the natural selection that takes place in the Petri dish from day 4 and 5 makes for stronger embryos more likely to implant and grow into a baby. I have heard both views on the Creating a Family show. To hear an articulate assessment of the transfer at day 3 argument, listen to the September 17, 2008 Creating a Family show where I interviewed Dr. David Hoffman, Board Certified Reproductive Endocrinologist with IVF Florida and past president of the Society for Assisted Reproductive Technology (SART), about the most common myths surrounding infertility and IVF. The argument in favor of day 5 transfer is expressed by Dr. Robert Stillman, Medical Director of Shady Grove Fertility Center and Professor of Medicine at Georgetown Medical School on the Jan. 14, 2009 Creating a Family show.
As a general rule, it should cost you nothing as the donating couple. The receiving couple picks up all testing and shipping costs, and often your past cryopreservation (frozen storage) costs. It is not possible to recoup any of your infertility costs. Listen to the Jan. 28, 2009 Creating a Family show on embryo adoption. We addressed the costs for the donating couple at length. Also, the May 28, 2008 Creating a Family show was devoted entirely to the topic of couples deciding to donated their unused embryos.

We did a Creating a Family show on male infertility on September 10, 2008 where we covered some of this information. (You can find the show link on The Big List .) I would assume that your RE is suggesting IVF combined with Intracytoplasmic Sperm Injection (ICSI). This procedure, where a single sperm is injected into the egg, has revolutionized the treatment of male infertility since very few sperm are needed. Most REs still recommend that men refrain from smoking, drinking, hot tubs and other activities that can increase the temperature of the testes such as wearing tight bike shorts or long bike rides.

 

I’m sure that I’ll get into trouble with the manufacturers of male fertility supplements, but if you are right about the cost, I would save my money since very few sperm will actually be needed for ICSI. That is, however, just my opinion.

Each clinic has their own rules, but I can tell you that most clinics would not exclude you. Let me suggest a couple of Creating a Family radio shows that I think would be helpful. The May 20, 2009 show on fertility tourism and the July 8, 2009 show on surrogacy. You might also want to watch the Creating a Family video on Surrogacy and our surrogacy page at this website.
 
 
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