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Archive for September, 2010

Anonymous Egg Donation: A Leap of Faith

By Amy Demma

September 30th, 2010 at 12:00 am

Last week I wrote about the initial concerns often expressed to me by prospective parents when considering egg donation; I discussed costs, timing and likelihood of success. The next matter of concern for most donor egg recipients is, in my experience, donor compliance. When talking with clients about the good faith with which one must proceed through an anonymous donor cycle, the issue of donor reliability is something I spend a lot of time discussing.

Yes, anonymous egg donation requires trust, and an awful lot of it. But confidence in the due diligence and vetting processes in place at your clinic – your donor will meet with the egg donor coordinator, nurses, mental health professionals, your physician – as well as agency staff, if an agency has been engaged, should offer a good degree of comfort. Worthy of mention, too, is that fact that the donor is assessed by these professionals from different points of view, your physician is reviewing her profile, her screening results, her medical and gynecological records to determine her fitness to donate, the nurses and donor egg coordinators are not only looking at her records but likely assessing her reliability, the mental health professional is considering her demeanor. I look at a donor applicant to determine if she will be able to meet the legal standard of informed consent. Yes, there is a leap of faith that the recipient will take, but know that your risks are being minimized by the very team you have selected to guide both you and your donor through the process. You have a lot of folks invested in optimizing your chances for success.

Consider, too, that donors want a positive outcome. I’ve worked with hundreds of donors – when a cycle works out, they are thrilled, when a cycle does not result in a pregnancy, my staff and I often hear disappointment, regret and sometimes even guilt that perhaps there was something more she could have done to help the recipient reach the desired outcome.

When I first sat down to write this blog, I intended to talk about the language typically written into Egg Donor Agreements regarding breach and the remedies reserved for the recipient parent should the donor be non-compliant. As an attorney my job is to anticipate a worst-case scenario and to protect my clients accordingly. Considering though, that in my experience, donor non-compliance is a rare occurrence, I instead decided to remind prospective parents of the many folks, including the donor, who are working together, in a truly collaborative way to help you to build your family. The blog that would have been about crisis ended up, much more appropriately, about reasons to be positive and to have faith.

To learn more about Amy Demma, JD

Please Visit http://www.lawofficesofamydemma.com

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Should Doctors Talk About Money?

By David Kreiner, MD

September 29th, 2010 at 7:14 am

One of the most distressing things I face in practice is when I get negative feedback from a referring physician.  Fortunately, it happens rarely but recently I was shocked about the complaint.  Apparently, his patient was offended that I discussed the finances involved with her treatment.  Her Ob Gyn agreed with her that it was inappropriate for me to discuss the cost of her options.  He told me, “I like you and think East Coast Fertility is an excellent program but I never talk about money directly to patients!  It’s not – I don’t know…seemly!”   “Money issues are discussed with the business office, the doctor only discusses the medicine”.

Perhaps it’s unfortunate that fertility doctors have to be so concerned about their patient’s pocket books unlike other fields of medicine that are usually covered by some measure of insurance.  But in the case of infertility with only a handful of states having some kind of mandated coverage – not everybody in the United States -  mandate or no mandate for infertility  -even has health insurance!  Many fertility patients are in some form or another “cash pay” patients.  One of the most popular places that patients visit when they go to any fertility clinic’s website is the finance page.  This is simply a fact of life.

For this reason I have developed many programs that will create access to fertility care for as many people as possible.  But here is the catch! One program does not fit all. These are simply not over sized tee shirts – each of these programs represent a certain course of  medical care – and each individual and couple needs the assistance of a caring doctor to help them choose the right program that will fit their own particular medical history.  In addition to the NY State DOH Grant Program and our own East Coast Fertility Grant Program, we have the Micro-IVF Program, The Money Back Guarantee Program,  and The Single Embryo Transfer Program.  The most effective treatment and the most efficient is always a full stimulation IVF. However, if someone has insurance coverage for IUI and meds but not IVF then they may prefer to do IUI. If they do not have coverage for IUI either then it may be more cost effective to do the Micro-IVF Program or minimal stimulation IVF at 2-3 x the success of IUI with less risk than gonadotropin IUI and less cost per pregnancy. Yet at a price of $3900 it may be more attractive than a full stimulated IVF. There is also The Single Embryo Transfer Program where we reward patients transferring one embryo at a time by making their cryo, embryo storage and unlimited frozen embryo transfers for free.  Others prefer the insurance of The Money Back Guarantee Program where patients are offered six IVF retrievals and frozen embryo transfers for a fixed fee that is refunded if they do not result in a live birth.   In order to inform patients about our success and programs that make IVF more available to them we offer free consultations.

In today’s world of fertility care – a good doctor will help a patient find not only the right treatment but how to access that care.  In order to do that – a doctor may have to do what some may think is unseemly – and that is to talk about money.

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Understanding How Holistic Medicine Can Support Your Journey to Family

By East Coast Fertility

September 28th, 2010 at 8:50 am

The Berkley Center for Reproductive Wellness at East Coast Fertility invites
you to join us on October 13, 2010 at 7pm for our grand opening, light refreshments and a special presentation.

Featuring:

Dr. David Kreiner, Medical Director and Founder of East Coast Fertility

Mike Berkley – The first acupuncturist in the U.S. to devote his practice solely to the care of those faced with fertility challenges

With a welcome by: Pamela Madsen, Founder of The American Fertility Association and Patient Advocate for East Coast Fertility

East Coast Fertility provides state-of-the-art, high tech fertility care and
The Berkley Center for Reproductive Wellness provides holistic modalities including acupuncture, herbal medicine, and massage. With their proven track records, there is no doubt this team will improve your fertility outcomes,
helping to transform you from patient to parent.

Please join us for our grand opening presentation at our Plainview
office, 245 Newtown Road. After the presentation, we invite you to
take a brief tour of our new holistic center at 1074 Old Country Rd.
Come learn how we can make your dream of family a reality

To reserve your seat at this special presentation or to make an appointment please call (516) 204-7149

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When Will You Be in Menopause? Do You Even Want to Know?

By Pamela Madsen

September 27th, 2010 at 8:22 am

As a peri-menopausal woman – the answer is yes. In fact I would like to know in advance that the period I am getting is my last one – so I can celebrate it. But the way things stand now – I won’t know that I am getting my last period until a year passes.  Kind of takes a lot of the ritual possibilities out of it. My girlfriend has a "Goddess Party" for her daughters when each of the got their first period – why shouldn’t we celebrate the last?

Now a new study released during 26th annual meeting of the European Society of Human Reproduction and Embryology in Rome  states that researchers  have developed an  accurate way to predict the age when women will hit the menopause using a simple blood test.

The average difference between the predicted age and the actual age that the women in their study reached the menopause was only a third of a year, and the maximum margin of error was between three and four years.

The  implications of this test for women and their doctors; if the results of the research are supported by larger studies,  means that women will be able to discover early on in their reproductive life what their expected age at menopause will be, so that they can plan when to start a family.

Knowing you fertility life span – is huge for women. That’s why Dr. David Kreiner at East Coast Fertility and I have been trying to get the word out about "Fertility Evaluations". Right now we can’t predict when a woman will hit menopause but technology does exist right now for women to get a reading on where they are now in their own biological clock.

In this new study – they are taking blood samples from 266 women, aged 20-49, who had been enrolled in the much larger Tehran Lipid and Glucose Study, Dr Ramezani Tehrani and her colleagues were able to measure the concentrations of a hormone that is produced by cells in women’s ovaries – anti-Mullerian Hormone (AMH). AMH controls the development of follicles in the ovaries, from which oocytes (eggs) develop and it has been suggested that AMH could be used for measuring ovarian function. The researchers took two further blood samples at three yearly intervals, and they also collected information on the women’s socioeconomic background and reproductive history. In addition, the women had physical examinations every three years. The Tehran Lipid and Glucose Study is a prospective study that started in 1998 and is still continuing.

Dr Ramezani Tehrani, who is President of the Reproductive Endocrinology Department of the Endocrine Research Centre and a faculty member and Associate Professor of Shahid Beheshti University of Medical Sciences in Tehran, Iran, said: "We developed a statistical model for estimating the age at menopause from a single measurement of AMH concentration in serum from blood samples. Using this model, we estimated mean average ages at menopause for women at different time points in their reproductive life span from varying levels of serum AMH concentration. We were able to show that there was a good level of agreement between ages at menopause estimated by our model and the actual age at menopause for a subgroup of 63 women who reached menopause during the study. The average difference between the predicted age at menopause using our model and the women’s actual age was only a third of a year and the maximum margin of error for our model was only three to four years.

"The results from our study could enable us to make a more realistic assessment of women’s reproductive status many years before they reach menopause. For example, if a 20-year-old woman has a concentration of serum AMH of 2.8 ng/ml [nanograms per millilitre], we estimate that she will become menopausal between 35-38 years old. To the best of our knowledge this is the first prediction of age at menopause that has resulted from a population-based cohort study. We believe that our estimates of ages at menopause based on AMH levels are of sufficient validity to guide medical practitioners in their day-to-day practice, so that they can help women with their family planning."

Dr Ramezani Tehrani was able to use the statistical model to identify AMH levels at different ages that would predict if women were likely to have an early menopause (before the age of 45). She found that, for instance, AMH levels of 4.1 ng/ml or less predicted early menopause in 20-year-olds, AMH levels of 3.3 ng/ml predicted it in 25-year-olds, and AMH levels of 2.4 ng/ml predicted it in 30-year-olds.

In contrast, AMH levels of at least 4.5 ng/ml at the age of 20, 3.8 ngl/ml at 25 and 2.9 ng/ml at 30 all predicted an age at menopause of over 50 years old. The researchers found that the average age at menopause for the women in their study was approximately 52.

Dr Ramezani Tehrani concluded: "Our findings indicate that AMH is capable of specifying a woman’s reproductive status more realistically than chronological age per se. Considering that this is a small study that has looked at women over a period of time, larger studies starting with women in their twenties and following them for several years are needed to validate the accuracy of serum AMH concentration for the prediction of menopause in young women."
Who knows – maybe one day we will be able to celebrate our last period – just as some people celebrate the first.

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Are You Considering Egg Donation?

By Amy Demma, Jd

September 24th, 2010 at 12:20 pm

When a prospective parent contacts me for egg donor related discussion, typically, the three things I am most often asked about is how long, how much and how successful. Whether the client has had a long and exhausting fertility journey or is just embarking on family building, folks want to get pregnant, they want to get pregnant now and they want to do so while feeling that costs can be controlled.

With respect to time management, the variable in third-party reproduction is the length of time it takes for donor selection. I have worked with hundreds of recipient parents, some pick donors in a matter of weeks, others a couple of months and then there are the clients who elongate their donor search for years (yes, years!!) while they pursue the “perfect” donor. I have seen it all, from recipient parents who do not want to see photos of donor applicants to recipient parents who want to personally interview candidates before a selection is made (this is not something I have ever agreed to, by the way). Donor selection is complex, it is emotional, and it is so very personal. It can and will be as significant a factor in the timing of your cycle as you require. Once a donor is selected, if she is available to start a cycle immediately, the general timing then, from match to retrieval, is approximately 4 months.  This is good news!

The costs related to collaborative reproduction can, understandably  seem overwhelming. But there is more good news: the costs can be managed. If you are able, do proceed to donor selection through your clinic. Many clinics offer donor selection from a pool of pre-screened candidates, if you can find a donor who meets your preferences from within your clinical program, go for it….it is a best strategy!!!  If you choose to work with an agency, be a savvy consumer, compare fees and fee structures and if possible, choose a local donor. There are certain costs related to an egg donation cycle that are a given, the IVF cost, the meds, fees related to other clinical services, these are expenses related to your physician’s protocol and are likely firm costs. And then there are expenses that can be minimized if not avoided. Be smart about your donor plan and let the professionals with whom you are working know that cost is a factor in whether or not you will be able to proceed.

Donor compensation is a matter of particular concern for recipient parents. While the American Society of Reproductive Medicine has guidelines indicating that donors should be compensated between $5,000 and $10,000, regional and other factors will influence the compensation you will pay to a donor for undergoing the in-vitro fertilization process on your behalf. It is important that recipients not to view the compensation as payment for eggs. Not only is this not legally appropriate but it truly devalues the donor-parent relationship. Donors will endure much on behalf of the recipient parent, blood-draws, ultra-sounds, perhaps lost wages and maybe child-care costs. She will be evaluated by your physician, nurses, mental health professionals. She will put in much time, deal with inconveniences, alter her lifestyle and manage medications all to ensure a best possible chance for a successful outcome. I encourage my clients to view donor compensation as payment for all that the donor will do so that you can, if all goes well, achieve your family building goal.

And this brings us to the matter of success. While no program can guarantee the outcome you so desperately want, I say to my clients: be hopeful! Remember, when working with a donor, the objective is to take infertility out of the equation. If you compare the success rates of standard IVF with that of collaborative reproduction, reason for hope is not only implied it is obvious. Have confidence in the team you have selected to guide you through this process. You have selected your clinic for reasons that are both personal and well thought out, you donor selection will be driven by whatever it is that you feel is important and if you proceed carefully and thoughtfully you will have maximized your chances for the best possible outcome: the family you are so looking forward to celebrating! Good luck to each and every hopeful prospective parent!


Amy Demma, JD 
Founder, Prospective Families
781-235-0205 (p)     339-686-3031 (f)
Amy.demma@prospectivefamilies.com 
www.weblog.prospectivefamilies.com
www.prospectivefamilies.com

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East Coast Fertility to Open the First Holistic Fertility Center on Long Island

By East Coast Fertility

September 22nd, 2010 at 6:32 am

In association with The Berkley Center for Reproductive Wellness, the first complementary medicine Center in the U.S. to specialize in the care and treatment of those faced with fertility challenges, ECF will offer an “East meets West” approach to fertility treatment.  There is current research which shows that by combining holistic medicine with traditional Western medical approaches, outcomes for many may be improved.  The new Center is scheduled to open October 15th, 2010 in Plainview, New York.

ECF’s fertility clinics will continue to provide innovative assisted reproductive technologies, while The Berkley Center will focus on such holistic treatments as acupuncture, herbal medicine, massage, and clinical counseling.  Mike Berkley, the Director of Complementary Medicine Services, is the first acupuncturist in the U.S. to devote his practice solely to fertility care.  It is believed that combining these holistic treatments with advanced medical care can enhance the experience for many patients and help them achieve success.

 

The Center will be called The Berkley Center for Reproductive Wellness at East Coast Fertility, and will hold its grand opening presentation on October 13, 2010 at 7pm.  All are welcome to come and see the new facility and stay for a special presentation titled “Understanding How an East meets West Approach to Care Can Increase Your Odds!’.

Pamela Madsen, Founder of The American Fertility Association and Patient Advocate for East Coast Fertility will welcome you, your partner, and any friend you wish to bring. Mike Berkley will discuss his thoughts about the benefits of holistic fertility care, and  Dr. David Kreiner, Medical Director and Founder of East Coast Fertility, will share his insights.  

Reserve your seat at this special event by calling:  516.204.7149.

 
Dr. Kreiner is eager to offer patients holistic services to compliment their fertility treatments.  “Anything we can offer patients to enhance their experience or make them more comfortable during cycles can contribute to a successful outcome,” says Kreiner.  “It’s also about giving our patients options.  We want them to know they can come to ECF for comprehensive treatment, and holistic therapies are a part of that.”

Mike Berkley adds, “Many patients that use natural fertility techniques during IVF cycles have success.  It’s our job to offer them every possible resource to make their dreams of having a family a reality.”

East Coast Fertility has always focused on giving patients high quality care, and offering them holistic options along with their state-of-the-art medical care will surely be a benefit to all.

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Cross-Border Fertility Care – The Only Option for Some Hopeful Couples

By East Coast Fertility

September 21st, 2010 at 9:28 am

There has been a lot of negative press recently about cross-border fertility care – otherwise known as "reproductive tourism." However, the fact remains that couples struggling to start a family sometimes have no other option but to seek help away from their homes. This is the case for couples in the U.K. who must turn to egg donation as their only hope to conceive. For them, there is a three year wait for donor eggs. This is a huge obstacle for those anxious to start their families and for women already of an age where they can not afford to wait. In the U.S. the wait is much shorter, and one clinic is reaching out to provide donor egg services to these U.K. couples in need.

Dr. David Kreiner of East Coast Fertility reflects on the negative opinion that sometimes surrounds cross-border fertility care. "In an ideal world, patients wouldn’t have to leave their country and their local doctors to get the treatment they need in a timely fashion. But the reality in the UK is that many couples cannot afford to wait until a donor egg becomes available there. At ECF, it is with great sensitivity and care that we are trying to answer their needs, and we try to keep as much of the patient care in the home country as possible."

East Coast Fertility is the premier IVF/Donor Egg program located in New York and offers patients immediate access to hundreds of excellent eggs. Dr. Kreiner is the former director of the Donor Egg program at the Jones Institute, where he was involved with the first successful Donor Egg cases in the U.S from 1985-1988. He has also received awards from the American Society of Reproductive Medicine for his work with IVF-Donor Egg.

The team of professionals at ECF is always available to  answer all questions about the U.S. East Coast Fertility experience for using IVF with a donor egg. It doesn’t matter that we are across the pond with today’s communication technologies!

During a two-day visit to New York, ECF can perform your initial workup and help you select a donor. Their physicians and staff will coordinate your IVF cycle with your U.K. physician. You will revisit ECF for your embryo transfer and then return home to monitor your hormone levels and pregnancy results through your local physician. The average recipient only spends 2-7 days in New York.

The ECF program only requires two short trips to New York City, and since 2002, the clinic has a 75% pregnancy rate per donation cycle including fresh and frozen embryo transfers.

This is simply a trip couples cannot afford to miss.

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Have You Seen The New Offices in Plainview? We’ve Moved!

By East Coast Fertility

September 20th, 2010 at 7:58 am

In case you missed the announcement – East Coast Fertility has moved to a beautiful, bigger and even more comfortable space for our patients. You can now find our consultation, monitoring and administrative offices at 245 Newtown Road Suite 300, Plainview, New York.

All OR procedures will be performed at our Old Country Road Offices.

We look forward to seeing you soon!

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Agency, Independent or Clinic Matching: Using a donor? You need an attorney (or two or possibly three)

By Amy Demma, Jd

September 17th, 2010 at 8:40 am

By the time ART patients arrive at collaborative reproduction for  family building the cast of parties involved in the process has grown to include  physicians, nurses, clinical staff, lab professionals, mental health providers, the donor (or donors), perhaps agency representatives and to round it all off, attorneys who specializes in alternative family formation.

Reproductive Attorneys are legal professionals experienced in the area of clinically assisted family building. These highly-specialized attorneys can advise on donor selection but are typically brought in once a match between the recipient and the donor (or donors) has been confirmed. Primarily the role of the reproductive attorney is to draft and negotiate contracts between the parties (in embryo donation it is important that the “donor” actually be viewed as two parties: an egg donor and a sperm donor and that each of those folks have independent counsel) but the attorney may also be called upon to review other legal documents such as agency service contracts and clinic consents. Some attorneys will also oversee escrowed funds deposited by the recipients for the anticipated expenses of the cycle.

If you are anticipating family building with donor gametes (egg, sperm or embryo) going at it without legal counsel puts much at risk. Without a contract in place between the donor and recipient both parties are left vulnerable to parentage challenges, financial disputes and other possible conflicts around issues that can be addressed in a donor agreement. (Clinic consents should not be relied upon in place of independent contracts between the parties…remember, clinic consents were drafted on behalf of the clinic, they are documents of a different nature than an egg or embryo agreement). Rights, responsibilities and obligations owed and expected of each party to the other is detailed in the donor agreement and parentage, a particularly complex judicial matter will be explicitly addressed by clearly stating the intentions of the donor(s) to be recognized only as that, a donor and any other presumption or right of presumption of parentage will be explicitly and clearly relinquished. The recipient parents are acknowledged in the donor agreement as the legal parents.

Other matters that will also be negotiated and then documented by each party’s attorney may include matters of payment, breach, anonymity, future contact as well as control and disposition of excess embryos.

If prospective parents are applying for insurance coverage for clinical expenses, if coverage should be declined, reproductive attorneys may also be able to provide counsel and services related to appealing insurance denials.

It is a good idea to begin considering attorney selection at the time recipients have decided to pursue collaborative family building. Clinics and/or your agencies should be able to recommend attorneys. The American Fertility Association and RESOLVE: The National Infertility Association both have lists of reproductive attorneys available at their websites. The American Bar Association’s Assisted Reproductive Law Section has resources available, as well.

To learn more about Amy Demma, JD, Founder Prospective Families

Please visit http://www.prospectivefamilies.com

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Gamete Donation: The emotional decision to use Donor Egg or Donor Sperm

By Bina Benisch, M.s., R.n.

September 16th, 2010 at 8:46 am

How does one make the emotional leap from deeply desiring to conceive one’s own “genetic,” “biological” child to using donor egg or donor sperm?  A couple sits across from me already having journeyed through the minefields of infertility…. IUIs,  hormone injections, medications, IVF cycles, failed IVF cycles, no pregnancy, pregnancy followed by miscarriage… try again.  And again.  How does this particular “failure,” the failure to achieve what is often our life’s dream, not to mention a human right granted to seemingly everyone around us, affect our sense of self?  Are we betrayed by our own bodies, by God, or the spiritual universe?  As if the feelings of sadness, anxiety, and self-doubt are not painful enough, women and men must endure the emotional and physical side-effects of their hormonal medication, the gonadotropins.  Just as women are placed on these medications to enhance fertility, men are often treated by some of the same medications (Clomid, hCG) to enhance male fertility.  These hormones may have the distinct side effects of heightened emotionality, anxiety, or irritability.  How many fertility avenues has this couple traveled…how many road blocks have they hit… how many cycles of pain, grief, and loss can they tolerate?   And so they journey on after an extremely rough road and many dead ends. Perhaps this is a fork in the road.  They feel it is time to make a decision. They have been told that their best shot at conceiving is through egg or sperm donation. They sit here now having made that decision, whether with a resigned acceptance, or a kernel of hope.

As men and women begin this phase of fertility treatment, it is important to do two things.  While acknowledging that you have options, albeit, options you may not have been ready to consider previously, allow yourself to understand your loss.  Yes, you have suffered a great emotional loss.  That is the loss of your life as you had always perceived it.  Allow yourself to acknowledge and mourn this loss so that you may create new meaning and a new vision.  The fact is, if your goal and desire has always been to be a parent, you will be a parent – one way or another. Now this will require some flexibility on your part.  Bear in mind “the bigger picture.” This may be the picture of your lives in the future with your children.  Adoption, egg donation, surrogacy, sperm donation … do some soul searching.  Families are built in many ways.  In fact, it is the emotional and spiritual connections – not merely biological cells that create the relationships of family.  Initially, many couples feel repelled by the mention of gamete donation, and at best, are ambivalent. However, I encourage you to give yourself time to allow all the aspects of this concept to seep in. Speak to others who have gone this route. Read about their thoughts and feelings having given birth to their children who were conceived through gamete donation.  Some recipients are concerned about how, when, or if they will disclose this information to their children.  Every recipient is different, and it may be helpful to read or hear about how others dealt with this decision.  Most recipients who began this process with a great deal of ambivalence, end up expressing their extreme joy and gratitude at giving birth to their child.  Perhaps you are concerned with whether you will be able to love this baby.  Bonding with a newborn varies for different people.  Even mothers who give birth to their own genetic offspring may not feel initially bonded to their baby. Bonding can take time. This varies not only from woman to woman, but from one birth to another for the same mother, and therefore is not a function of gamete donation versus conceiving with one’s own eggs or sperm.

Shifting your vision to a different perspective does not happen automatically.  It requires honestly acknowledging your feelings and deep sense of loss.  From that loss, you may find a subtle emotional flexibility you hadn’t realized previously.  This flexibility fosters new visions and possibilities which open up for you.  You may begin to appreciate new and different ways of achieving your dream.  The gift of egg donation and sperm donation can help you realize your life dream of building your family. 

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