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Archive for the ‘Male Infertility’ Category

Who Will Carry the Baby in LGBT Family-Building? (Part One): For Gay Men

By Tracey Minella

January 26th, 2018 at 3:58 pm

In family-building for heterosexual couples, this is not generally a question. But in LGBT family-building, single gay men or gay couples who want a baby that shares a genetic connection with them, the first question to answer is: Who will carry the baby?

Except in cases where a single gay man or both partners in a gay couple have male factor infertility, sperm is usually readily available for baby-making purposes. But the need for a woman’s egg– as well as a uterus in which the baby will grow– is obvious. Fortunately, there are donor programs at Long Island IVF.

In general, and depending on where they live, gay men can choose either a surrogate OR an egg donor and gestational carrier to carry the baby. Both of these options involve another woman carrying the pregnancy for the single gay man or gay couple as intended parent(s), so it helps to understand the difference, even though surrogacy is not legal in New York State.

In a surrogacy arrangement, the woman surrogate uses her own egg to become pregnant with the gay intended parent father’s sperm. Just to be clear –and to the relief of all involved –the pair does not have sexual relations to establish the pregnancy. Instead, a semen specimen is collected from the gay man who intends to be the biological father, and it’s processed and frozen in advance. The surrogate will be monitored for ovulation (when the egg is released from the ovary and the limited window for conception begins). At that time, in a fast and simple office visit, the father’s specimen is thawed and deposited into her uterus via a thin catheter– through a procedure called an intrauterine insemination, or (“IUI”).

If the IUI is successful, the surrogate carries the pregnancy to term, and gives the newborn to the gay father(s) upon birth, thereafter relinquishing her parental rights (in the manner dictated by that particular state’s laws). The newborn is genetically-linked to both the surrogate birth mother and the gay father. Again, this is not an option in New York.

Those of a certain age may remember the infamous New Jersey “Baby M” case of the mid-80s, which thrust the validity of surrogacy agreements into the national limelight. The birth mother, who was genetically-connected to the baby, changed her mind and wanted to keep the baby instead of turning her over to the biological father and his wife, who were the intended parents pursuant to a surrogacy contract.

A long legal battle ensued, and in a nutshell, the court ruled that the paid surrogacy agreement was invalid and against public policy, and that the birth mother and the biological father were the baby’s legal parents. Further, the case was remanded to Family Court for a judge to decide which parent would be awarded legal custody of the baby, using the “best interests of the child” standard that’s used in regular child custody cases. Custody was given to the father, but the mother was awarded visitation rights. *

Times have changed.

While surrogacy in some form is legal in some states, the advancements in reproductive medicine that followed in the decades since Baby M have now made the use of gestational carriers and donor eggs not only medically possible and popular, but also often the only legal way to have someone carry a baby for you.

Gestational carrier with donor egg is the alternative option to surrogacy for a gay man or gay couple to have a genetically-linked baby and it’s the only legal option in New York State. It involves finding two different women to help you– an egg donor and a gestational carrier. That’s how it’s different from surrogacy.

First, the egg donor only provides the eggs, not the uterus. She could be someone you know (like a sister or friend) or could be an anonymous donor who you select after reviewing an extensive profile of donor egg candidates. At Long Island IVF, we have pre-screened donor egg candidates ready to help you build your family.

Lady #2 is the gestational carrier. She only provides the uterus, not the eggs. She can be someone you know, or someone you don’t yet know but who you select through an agency. In most cases, you will get to know and develop a relationship with the gestational carrier.

With the gestational carrier and donor eggs option, the woman chosen to be the egg donor undergoes what is essentially an in vitro fertilization or (“IVF”) procedure up to the point of the egg retrieval. That means she will receive hormonal injections, bloodwork, and ultrasound monitoring of her ovaries (and the developing follicles/eggs inside them) over a period of a few weeks. The purpose of the treatment is for her to produce multiple egg-containing follicles rather than the one egg she would normally produce that month.

When the time is right, the eggs are retrieved prior to ovulation by a reproductive endocrinologist using a transvaginal needle aspiration procedure and injected with the sperm from the gay man (or men) intended parent(s) in the hope that fertilization occurs.

placed in a petri dish with sperm from the gay man (or men) intended parent(s) in the hope that fertilization occurs.

The resulting fertilized eggs, now known as embryos, will be frozen (a/k/a cryopreserved) until such time as they are ready to be thawed and transferred into the waiting uterus of the chosen gestational carrier. [Note that if pre-genetic screening (“PGS”) is elected, it is done prior to the freezing of the embryos.]

The thawed embryos—generally one or two– are placed into the gestational carrier’s uterus through a thin catheter in a fast and simple procedure performed by the reproductive endocrinologist, aptly called “the transfer”. The intention is for an embryo to implant in the uterine wall and a healthy pregnancy to result. If the gestational carrier gets pregnant, she turns the baby –who unlike in surrogacy has no genetic connection to her – –over to the gay man (or men) who is the intended parent(s).

In accordance with applicable state laws, these women are generally well-compensated for their time and effort. Because of the need for gay men to involve two different women in the process, costs are higher than what lesbians and straight couples using assisted reproductive technology typically incur. However, the good news is that a single egg donor cycle may produce enough eggs that gay male intended parents may be able to build their families through more than one pregnancy using just the eggs retrieved from that initial cycle. So, future pregnancy attempts would require the compensating the gestational carrier, but not the egg donor.

Here is how that could work: They might transfer 1-2 embryos into the gestational carrier on the first try (leaving the rest frozen), and if successful, they have a baby (or two). Then maybe a year or more later, they transfer another 1-2 embryos into the same (or another) gestational carrier, and if successful, they have another baby (or two). And so on, until all the embryos are used or they no longer want to use the embryos for additional children.

While there would be the expense of the gestational carrier for each birth (as well as for the medical treatment expenses for the gestational carrier to undergo a frozen cycle), there would be no additional egg donor costs– until you exhausted your supply of embryos from the first egg donor. As exciting and promising as this process is, each case is different and no program can guarantee a baby in the end for any couple. That said, we do have patients who have successfully used embryos retrieved from a single IVF cycle to build their multi-children families—a child at a time—in separate births spaced a few years apart.  So, there is reason to consider this wonderful family-building option that wasn’t available—especially to gay men—all that long ago.

[The second part on this topic on who will carry the baby—for lesbian singles and couples—will be posted next month.]

If you are a gay man or lesbian—single or married– interested in family building, Long Island IVF has decades of experience helping the community become parents.  Please contact us today for more information or to schedule an initial consultation. In addition, follow us on social media for info on our many free upcoming events.

We are proud to partner with the LGBT Network to provide the community with information, education, support, and access to the most advanced traditional and holistic assisted reproductive technologies. We also understand, respect, and are sensitive to the unique needs of the LGBT community when it comes to building its families.

This year, Long Island IVF is celebrating a milestone–our 30th anniversary. If you are ready for parenthood, we would love the opportunity to assist you with your own milestone.

 

*Source: https://en.wikipedia.org/wiki/Baby_M

 

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Why Being Voted the Best In-Vitro Fertility Practice on Long Island Matters to Us

By Tracey Minella

December 14th, 2017 at 10:47 pm

Long Island IVF has been fortunate enough to have won the “Best In-Vitro Fertility Practice” category of the Best of Long Island contest for the past several consecutive years.

It’s an honor we don’t take for granted.

Being nominated and then voted for by our patients and their families each year is humbling and we are thankful for your confidence in our program. We are especially touched that votes come not only from our patients who have had success already, but also from others who are still undergoing treatment and keeping the faith that their own little miracle is coming.

By voting for us—just like when you leave positive reviews for your personal LIIVF doctor on our Facebook page and medical review sites– you are helping others who are struggling with infertility make that tough decision as to what program they should trust with their own fertility care. (Not to mention that you make our day even brighter.)

If you are so inclined, you can still vote for Long Island IVF tonight and tomorrow before the contest closes on Dec 15th while you are supporting your other local favorite goods and services providers. We are listed in the HEALTH & WELLNESS section, under “In-Vitro Fertility Practice”. It only takes a moment. Vote here. You will also notice our own co-founder, Dr. David Kreiner is up for Best “Acupuncturist” in the same section for his fertility acupuncture services.

2018 will be our 30th anniversary of making babies on Long Island, and the thrill of family-building never gets old. In fact, some of our own IVF babies have already grown up and they vote for us, too! And what a concept and thrill THAT is!

Thanks again for trusting us with one of the most important health care decisions of your life and for your positive feedback and your vote.

Many blessing for a peaceful holiday season.

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Happy Birthday to the World’s First Test Tube Baby!

By Tracey Minella

July 25th, 2017 at 9:04 am

 

image: wpclipart.com

 

Happy Birthday to you. Happy Birthday to you. Happy birthday, dear Louise Brown. Happy Birthday to you. Are ya one, are ya two, are ya three…?

 

Do you remember where you were when you heard about the birth of the World’s first “test tube” baby? Probably not. But I do.

 

I was just learning about reproduction as a young teen, reading the newspaper in my parents’ brown, gold, orange and white classic 70’s kitchen, when I learned the sensational, seemingly sci-fi news. I remember thinking it was cool. Dad was intrigued. Mom was mortified.

 

Little did I know then how important that day in history would be in my own life. And how that very technology would be the answer to my own dream of becoming a mother some twenty plus years later.

 

Let’s celebrate Louise Brown’s birthday with a Q&A to honor the woman whose birth led us to our life’s work… and for some of us… to our own children.

 

So here are the questions:

  1. In what country was the World’s first IVF Baby, Louise Brown, born?
  2. Give the last names of Louise Brown’s mother’s two IVF doctors?
  3. In what year was Louise born?
  4. Was she an only child?
  5. Was Louise’s first child conceived naturally or through IVF?
  6. Louise is not the first IVF baby to have her own baby, but Louise is related to the first IVF baby to have her own baby. What is the woman’s name and what is their relationship?
  7. Who was America’s first IVF baby?

 

So…any smarty pants IVF historians out there? Let’s see what you’ve got!

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The Egg Donor and LGBT Family-Building

By Tracey Minella

July 20th, 2017 at 12:07 pm


Despite making decades of progress, obstacles, frustrations, and inequities are still part of daily life for the LGBT community. And for same-sex couples who want to build a family, having to seek medical attention to do so is an unwelcome but necessary reality. It’s particularly frustrating when simple biological necessity–rather than an infertility diagnosis–lands the couple in the fertility doctor’s office.

Depending on the particular couple’s situation, the “missing piece” they seek could be anything from the relatively inexpensive and easy intrauterine insemination (“IUI”) with donor sperm to the more involved and costly in vitro fertilization (“IVF”) using an egg donor and sometimes a gestational carrier. Very often, egg donation is needed in LGBT family-building.

What is egg donation?

In egg donation, a healthy young woman (the egg donor) agrees to undergo what is essentially an IVF procedure that ends at the egg retrieval stage when her eggs are turned over to a person/couple (the egg recipient/s) who uses them to create their family. The egg donor undergoes hormonal injection treatments over a couple of weeks designed to make her ovaries produce multiple mature eggs, rather than the single egg generally produced each monthly cycle.

As in IVF, the egg donor’s mature eggs will be retrieved, but instead of keeping the eggs for her own use, she donates them to another person/couple. Her role is done upon retrieval of the eggs. The donated eggs are then fertilized with the sperm of a male partner or a sperm donor and the resulting embryos are transferred to the uterus of the female partner or gestational carrier.

When is an egg donor needed?

The simple answer is: Anytime a single person or couple–heterosexual or homosexual–needs an egg to create a baby. That’s either because the woman trying to become pregnant can’t or doesn’t want to use her own eggs or because the single person or couple seeking parenthood is male. Gay men, lesbians with egg-related challenges, and some transgender people will need an egg donor.

How does it work for LGBT family-building?

A gay man or couple could have all the love in the world to give a child, but still needs an egg from a woman in order to make a baby. And a uterus, too. The embryo created from the egg donor’s egg and the sperm of the gay man/men or sperm donor needs to be transferred into the uterus of yet another woman –a gestational carrier – – who will carry the pregnancy to term. The gestational carrier, who has no biological tie to the baby, turns it over to the proud daddy or daddies at the time of birth.

Lesbian couples (or single women) using a sperm donor may be able to conceive with an IUI or through IVF using their own eggs. But sometimes, they may need an egg donor if there is an issue with egg-quality, genetic, or other concerns. (If there are uterine issues, a gestational carrier may also be needed to carry the baby.)

In certain situations, transgender people will need an egg donor. It is important to note that transgender people who transition from female-to-male can have their own eggs retrieved and frozen for future use (and male-to-female transgender people can their freeze sperm for future use) — if done prior to taking any medical or surgical steps on the transgender transition or sexual reassignment journey. Be sure to see a reproductive endocrinologist to discuss these options before it’s too late.

If you would like more information on LGBT parenting options  or would like to schedule an initial consultation with a reproductive endocrinologist, the doctors and staff at Long Island IVF have been helping build LGBT families for decades and would be happy to help you. With several offices throughout Long Island and one in Brooklyn, we’re conveniently located near you.

As a partner of the LGBT Network on Long Island, Long Island IVF is committed to continuing to build families for the LGBT community through cutting-edge medical technology, complementary holistic therapies, and sensitivity to all patients’ individual needs.

Long Island IVF, along with the LGBT Network, offers free LGBT family building seminars every June and periodically throughout the year.

Register here for our next free “Building Families in the LGBT Community” event, which will be held on October 26, 2017 at the LGBT Network at 34 Park Avenue, Bay Shore, NY. Follow our blog, Twitter, and Facebook for more information.

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Long Island IVF Seminar on Family-Building for the LGBT Community

By Tracey Minella

June 27th, 2017 at 11:36 am

Long Island IVF has been celebrating LGBT Pride all month long beginning with again sponsoring LI Pridefest. We’ve helped the LGBT community become parents for decades. So, what better way to close out Pride month than with an info-packed evening of everything you ever wanted to know about LGBT family-building options. If you’re thinking about having a baby and want to know all the ways we can help you pursue that dream, come down and meet us!

We’ve partnered up with the LGBT Network to bring you a quality LGBT family-building seminar on Thursday, June 29, 2017 from 6:30-8:30 pm at the Long Island IVF Melville office located at 8 Corporate Center Drive, Melville, New York.

In about two hours, the speakers at our seminar will answer everything you ever wanted to know about today’s many LGBT Family-Building options. One of our reproductive endocrinologists, Dr. Steven Brenner, along with other key Long Island IVF team members will introduce you to the fascinating world of assisted reproductive technology and specifically how it’s used to help the LGBT community become parents. In addition, Melissa Brisman, owner and founder of Reproductive Possibilities http://www.reproductivepossibilities.com/ will be there.

LGBT family-building is different in many ways from so-called “traditional” family-building. As a practice made up of both LGBT and non-LGBT employees, we truly understand the nuances that make your parenthood quest unique to you, whether you are gay, lesbian, transsexual, bi-sexual, or queer. Believing that everyone has the right to become a parent, LIIVF is committed to using the best available medical technologies to help you overcome or circumvent biological obstacles to parenthood.

Whether we met at LI Pridefest this month and you’d like to learn more about our LGBT Family Building program at Long Island IVF, or this is the first time you’ll be meeting us, we hope you’ll join us and the LGBT Network at our Melville office to learn about the many ways we can help you achieve your dream of parenthood.

For more information and to register for this free event, please click here.

Need to reach someone? You can email lmontello@liivf.com.

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Will you be attending the “Building Families in the LGBT Community” seminar? Do you have any specific questions or particular topics you want to see covered?

 

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Important Infertility Insurance Coverage Issues for the LGBT Community in New York

By Tracey Minella

June 22nd, 2017 at 8:31 am

From Stonewall to date, the LGBT community has always had to fight for rights equal to those of the heterosexual community, often in an atmosphere of “us against them”. Persistence has always paid off…eventually. As we’ve seen from winning battles on openly serving in the military with the repeal of “Don’t ask. Don’t tell” and the legalization of same-sex marriage (#LoveWins), we can move mountains as a community united.

 

The latest major gay rights fight involves insurance coverage for infertility treatment in New York.

 

The subject of mandated infertility insurance coverage in New York State has been in the news lately, but before addressing an important pending bill that could positively impact the infertility insurance rights of all New Yorkers– heterosexual and non-heterosexual– we must examine and understand the existing obstacles to LGBT infertility treatment coverage.

 

Currently, New York State has a mandate which requires coverage for infertility treatments. It’s one of only 15 states to do so, which sounds promising, but it’s not. With so many existing definitions, restrictions, qualifications, and loopholes, the mandate in its current form does very little to benefit New York’s infertile heterosexual couples– and does even less for non-heterosexual couples or single women who need advanced reproductive technologies in order to start their families.

 

Some of the major problems with the current New York State infertility coverage mandate include:

 

  • It does not cover in vitro fertilization (“IVF”), but only applies to intrauterine inseminations (“IUIs) and other low-level/less successful infertility treatments, which are also riskier in terms of causing a multiple pregnancy (twins, triplets, etc.);
  • Small group employers can opt out of having to provide this coverage;
  • Insurance carriers may impose certain restrictions and rules that impact the employees’ ability to access the benefits.

 

Some insurance carriers that do offer IVF require both heterosexual and non-heterosexual couples to undergo 6-12 unsuccessful IUI cycles before moving on to IVF treatment (6 IUIs if the woman is over 35, or 12 IUIs if under 35, though some require less).

 

In addition to the above multiple-failed-IUIs prerequisite for IVF coverage, the employee must satisfy the insurance carrier’s definition of “infertility”. “Insurance companies define ‘infertility’ as the inability to conceive after one year of frequent, unprotected heterosexual intercourse, or six months if patient is over the age of 35”.

 

Applying this definition to heterosexual couples merely costs them 6-12 months of time before moving onto IVF treatment—provided they can somehow prove they’re doing it often enough and without protection. And while up to a year of time wasted really is a big deal to all infertile folks, the impact on non-heterosexuals and single women is far worse.

 

When applying this definition to a same-sex couple or a single woman, they not only lose valuable time, but they also lose money that a heterosexual couple would not. Because for same-sex couples or single women to meet the current definition of “infertility”, they would have to undergo six or 12 months of IUI with donor sperm treatments — in many cases, at their own expense –just to prove their infertility so that they could qualify for covered infertility treatments.

 

This issue was thrust into public view when two lesbian couples in New Jersey filed a federal lawsuit alleging that the language of the New Jersey insurance mandate “discriminates based on sex and sexual orientation”.

 

There is also disparity among insurance companies with respect to requiring authorizations for IUIs, requiring IUIs with donor sperm prior to approving infertility treatment, and coverage for the cost of donor sperm or thawing the sperm. In addition, companies offer different levels of coverage, which may be dependent upon copayments, deductibles and other restrictions on certain services like embryo cryopreservation, embryo storage, Pre-implantation Genetic Diagnosis or Pre-implantation Genetic Screening (“PGD” or “PGS”) of embryos, and more. To further complicate matters, even within the same insurance company, there are different individual plans that are chosen by the employer which provide different benefits coverage and different qualifications or benefits structure.

 

That’s why Long Island IVF assigns each patient a personal financial counselor to help guide them through the complicated insurance process to maximize any benefits to which they may be entitled.

 

Despite the obstacles that currently exist, there is good news to report and even more promising change on the horizon.

 

As a result of New York Governor Cuomo’s mandate to New York State insurance companies, they may no longer exclude same-sex prospective parents or single prospective parents from infertility coverage. While this is a victory, the sticking point for true reform and open access to appropriate infertility coverage for both heterosexual and non-heterosexual patients requires a redefinition of “infertility” and direct access to IVF.

 

There have already been noticeable changes in policies and the provision of coverage for IUIs with donor sperm in same-sex couples, presumably collectively-driven by Gov. Cuomo’s mandate, along with the New Jersey lawsuit, and forward-thinking, large-scale employers like Facebook and Google now offering high-end infertility insurance coverage for egg-freezing services. But the bottom line is that until a patient meets the “infertility” definition, they still have to self-pay.

 

That’s why we need the definition of ‘infertility’ to change. And we need access to IVF, which is the more successful treatment in terms of a singleton birth outcome.

 

And it is within our grasp right now.

 

As this article is being written, a bill that would revolutionize the infertility insurance law in New York for the benefit of heterosexuals, same-sex couples, and single women is awaiting consideration by the Senate after having passed in the Assembly this week.

 

The Senate Bill S.3148A known as the “Fair Access to Fertility Treatment Act”, or (“FAFTA”), if enacted, would not only mandate coverage for IVF treatment, but it would change the application of the definition of “infertility” to:

 

“a disease or condition characterized by the incapacity to impregnate another person or to conceive, as diagnosed or determined (I) by a physician licensed to practice medicine in this state, or (II) by the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse in the case of a female 35 years of age or older.”

 

According to Long Island IVF co-founder and reproductive endocrinologist, Dr. Daniel Kenigsberg, who has been advocating for the passage of the FAFTA bill, “the current mandate’s specific exclusion of coverage for IVF has resulted in much emotional and financial cost spent on inferior or inappropriate treatments which ARE covered by the mandate when, for over 50% of infertile couples, IVF was the best or only treatment.” He further notes that “IVF is far safer in terms of reducing multiple pregnancy risk than less successful and often inferior treatments like ovulation induction and intrauterine insemination (IUI). There has been waste and needless sacrifice for insured couples denied IVF.”

 

It is time for both the heterosexual and the LGBT communities to get active and push our respective representatives to pass this legislation. You can find your local senator here or can access their phone number here. Armed with Senate Bill number S. 3148A, a simple phone call expressing your support of the bill may make all the difference. It takes less than one minute to help support this latest gay rights fight for fair access to appropriate infertility treatment and insurance coverage. Do it now.

 

There has never been a better time for non-heterosexuals to fulfill their dream of parenthood. If you would like more information on the many available LGBT family-building options, we encourage you to join Long Island IVF and our partner, The LGBT Network, on June 29, 2017 for a special free seminar entitled “Building Families in the LGBT Community”. Pre-register here.

 

This progressive legislation not only opens the door to IVF access for all, but it changes the definition of infertility to one that encompasses everyone, regardless of sex or sexual orientation. Instead of “us against them” it’s “one for all”. Its passage would put everybody suffering from the disease of infertility one giant step closer to our common dream of parenthood– and maybe, just maybe, a step closer to us all being one united community.

 

 

 

 

 

 

 

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How to Support an Infertile Man on Father’s Day

By Tracey Minella

June 17th, 2017 at 9:06 am

 

image: tminella


Infertile “dads-in-waiting” are no different when it comes to being infertile on Father’s Day than infertile wannabe moms are on Mother’s Day.

They want a baby.

A daddy’s little girl around whose little finger to be proverbially wrapped. A “mini-me” son to hang out with.

But society doesn’t seem to see his pain… because he is quiet. Maybe even to his wife or partner.

Women are more likely to chat with their sisters or closest girlfriends about their infertility—they cry on each other’s shoulders and talk about treatment—but men just don’t really do that. They don’t open up like that. Women talk. But guys’ group conversations tend to gravitate towards sports or politics—not how they injected their wife with a two-inch needle last night or held her as she cried over another negative pregnancy test.

Many men think they have to be the strong one– because if she sees him crumble, she may unravel herself. How unfair is that? Yet that’s how it is for so many guys and it’s completely understandable, and yes, a bit sexist, how they are willing to take all the pain on their shoulders if it’d shelter her.

Imagine that pressure to be strong and not cry? Imagine the totally unfounded but very real guilt he may feel if the diagnosis is male factor infertility? Or the stress he’s under if they can’t afford infertility treatment because his insurance or his salary doesn’t cover it? Or how he’s keeping the secret and hoping the guys don’t find out and rag on him about specimen collection or awkwardly joke about how they can help get her pregnant.

And don’t think for a minute he’s not aware of the children of other men at the gathering. Especially on Father’s Day. Kids playing catch with their dads. Dads showing pictures from the dance recital.

If his relationship with his own father is a good one, it may help to spend some one-on-one together on Father’s Day focusing on his role as the son. Maybe reflect on what kind of father he plans to be when the time comes for him—what he loved about his dad’s parenting style and what he might do differently.

Most importantly, let him do what he wants. See or be with who he wants and be sure to run interference for him with difficult people when you can. If he wants to be around the nieces or nephews, indulge his wish even if you feel differently. Or be alone together—or let him do his own thing–if that’s what he needs for that day.

And don’t ask him about starting a family. Just don’t. Ever. Especially on Father’s Day.

There is no substitution for a baby on Father’s Day, but you can give him hope for one next year. And if you think he’d benefit from talking it out with a caring infertility specialist, Long Island IVF offers group and individual counseling. Some couples have found a special connection to others who understand what they are going through and have even remained friends after their infertility journeys have resolved.

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What are your plans for Father’s Day?

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Everything You Always Wanted to Know About LGBT Family-Building Options at Long Island IVF

By Tracey Minella

June 16th, 2017 at 2:37 pm

 

Whether you are lesbian, gay, bisexual, transgender or queer/gender-fluid, you aren’t any different than heterosexuals who want to start a family but need medical intervention to do so.

You have the same dream of becoming a parent, the same longing in your heart for a baby of your own, the same frustrations and embarrassment about needing medical intervention for such a private matter, the same worries about affording and financing the treatment, and the same paralyzing fear of it not working.

And yet, you are different from the heterosexuals who are suffering from infertility. Your treatment needs are different. Your emotional needs are different. We understand that.

Long Island IVF pioneered IVF on Long Island, bringing Long Island its first IVF baby, first baby from a cryopreserved embryo and first donor egg baby. For almost 30 years, we’ve been serving both the heterosexual and LGBT communities on Long Island. Several of our staff are members of the LGBT community as well and many staff members were former patients—so we really do understand where you are coming from.

The easiest way to illustrate the differences between heterosexual and LGBT family-building is to begin with the similarities.

In heterosexual family-building, any number of factors may be causing the couple’s infertility. It could be female factors like poor egg quality, blocked fallopian tubes, uterine issues like fibroids, endometriosis, hormonal disorders like polycystic ovarian syndrome, recurrent miscarriage, and more. It could be male factor infertility due to poor quality sperm. Or it could be a combination of male and female factors—or simply be due to the frustrating diagnosis of “unexplained infertility”. When a couple is unable to get pregnant after 6-12 months of trying (the number of months differs based on age), they are considered to be infertile. Sometimes less aggressive medical approaches—such as intrauterine insemination (“IUI”) with or without ovulation induction do result in pregnancy. Oftentimes, more aggressive Assisted Reproductive Technologies (“ART”) like in-vitro fertilization (“IVF”) are in order.

Here’s a crash course in IVF 101.

In IVF, the goal is to have the woman develop more than the one mature egg she would normally produce in a typical monthly menstrual cycle. To accomplish this a woman’s ovaries are stimulated through the use of injectable hormone medications and careful monitoring by ultrasound and bloodwork so that at just the right time, the multiple eggs that have matured are retrieved from the ovaries transvaginally through needle aspiration under sedation. Then the eggs are either frozen or are combined with the partner’s sperm to produce embryos. The resulting embryos are then either transferred back into the woman’s uterus where they will hopefully implant and result in a pregnancy, or are frozen for future use, or a combination of the two options. Because the number of embryos transferred back into the uterus is both limited and controlled, IVF minimizes and virtually eliminates the risk of a multiple pregnancy, making it a safer treatment option.

Sometimes, a heterosexual couple needs help from a third party to build their family. They may need a sperm donor or an egg donor if the couple’s own sperm or eggs are not sufficient or of good quality. Or they may need a woman to act as a gestational carrier to carry their embryo(s) and resulting pregnancy if the uterus of the woman of the couple is either absent or not otherwise suitable.

Now let’s look at how LGBT family-building is different.

Well, for starters, virtually all LGBT couples need some kind of help from a third—or even a fourth—party in order to build their family. In fact, in virtually all cases, sex alone will never result in a pregnancy for the LGBT couple without outside intervention. So, while it does happen that a LGBT patient could have a medical factor making them infertile, in the vast majority of cases, LGBT couples seek out an infertility specialist to obtain the “missing contribution” that is required to make a baby. The exception is the transitioning individual who has not begun hormonal treatment to transition from male to female or from female to male.

Here are the general treatment options and the ways “missing contributions” for LGBT couples can be obtained. They are slightly more straightforward in the cases of lesbians and gay men than in transgender cases.

Lesbian couples:

Two women will need a sperm donor. Depending on their age and the health of their eggs and uterus, they can do IVF and may even be able to do an IUI. If doing IVF, some couples decide to use one woman’s egg and have the other woman carry the pregnancy in her uterus.

Gay couples:

Two men will need an egg donor. They will also need a gestational carrier who will carry the pregnancy in her uterus for them. Gay couples may decide to divide the number of eggs retrieved from the egg donor in half and then each partner may contribute a semen specimen to fertilize half of the eggs—thereby each being a biological father to the embryos that resulted from their contribution.

Transgender couples:

Transgender family-building is relatively new in comparison to lesbian and gay family-building which the LGBT community has been able to access for decades. There are varied options for transgender family-building, but they all require knowledge and proactive steps on the part of the transgender person.

The single most important takeaway from this article for transgender folks who do (or may in the future) want to have a biological child is this: See a reproductive endocrinologist BEFORE taking any medical or surgical steps on the transgender transition or sexual reassignment journey.

In “Woman to Man” reassignment, before the woman hormonally, medically, or surgically becomes a man, she should consider having her eggs retrieved and frozen for future use. Or if she has a male partner now, her eggs can be fertilized with his sperm and the embryos either implanted in her uterus now so she can carry the baby before she transitions, or if the woman does not want to carry the pregnancy and prefers to move ahead with the transition, then the embryos can be frozen and transferred into the uterus of a gestational carrier at any time.

However, if the woman who transitions prefers a female partner, then the couple has most of the same options as any lesbian couple. They could use either woman’s eggs with donor sperm and the resulting embryos could be implanted into the partner with the uterus or into the uterus of a gestational carrier if needed. Some couples choose his eggs and her uterus so both can be involved.

Now the opposite case.

In “Man to Woman” reassignment, before the man hormonally, medically, or surgically becomes a woman, he should consider having his sperm frozen for future use. Sperm freezing is so much cheaper and easier than egg freezing. If he has a female partner now and they want to become pregnant now, his sperm can be used to impregnate her through IUI or, if she undergoes IVF, then her retrieved eggs can be fertilized with his sperm and the resulting embryos either implanted in her uterus now or frozen for later use. Some couples choose his sperm and her eggs and/or uterus so both can be involved. If his female partner’s eggs or uterus are not optimal, they will need an egg donor and/or gestational carrier.

However, if the man who transitions prefers a male partner, then the couple has the same options as a gay couple. They could use either of their sperm with the egg donor’s eggs and transfer the resulting embryos into a (gestational carrier) woman’s uterus.

If you identify as queer or gender-fluid, you can utilize donor egg, donor sperm, a gestational carrier or any combination of the above options as they fit you and your partner.

Sadly, not all physicians realize or advise transgender individuals of their fertility-preservation and family-building options before the transition process has begun, so it is up to you to initiate the discussion or take action. It is absolutely critical that egg and sperm freezing be done before the hormonal, medical or surgical transition or reassignment begins. Or it will be too late.

Despite the current and uncertain political climate, there has never been a better time for LGBT members to pursue family-building. As a result of rapidly advancing ART, today’s LGBT community has choices beyond the noble but limited options of foster parenting and adoption—choices that allow for biological children. The lesbian and gay parents of recent decades have blazed a path of slow but ever-increasing acceptance that has not only benefitted today’s lesbian and gay parents, but has helped open the door for the transgender population to come out and claim their own fertility and parenting rights.

All people of reproductive age who are considering becoming parents at some point would benefit from a fertility screening by a reproductive endocrinologist—ideally sooner rather than later. At that exam, screening tests would be conducted to identify any actual or threatened obstacles to fertility, such as diminished ovarian function or premature ovarian failure or other factors in women, or sperm issues in men. Depending on what is found, proactive steps could be taken to preserve your fertility, including egg freezing for women who just want to preserve their young and healthy eggs for use at a future date.

Also file this important bit of information away and hope you will never need to remember it: If you or a loved one are ever faced with a cancer diagnosis and time allows for it, egg-freezing and sperm freezing done prior to starting certain chemotherapy or radiation protocols for certain cancers are options to preserve your fertility. That way, your healthy eggs and sperm are waiting for you when you’re ready to build your family after your cancer battle has been won. Be sure to call a reproductive endocrinologist to discuss fertility preservation before cancer treatment.

If you would like more information on LGBT parenting options  or would like to schedule an initial consultation with a reproductive endocrinologist, the doctors and staff at Long Island IVF have been helping build LGBT families for decades and would be happy to help you. With several offices throughout Long Island and one in Brooklyn, we’re conveniently located near you.

As a partner of the LGBT Network on Long Island, Long Island IVF is committed to continuing to build families for the LGBT community through cutting-edge medical technology and sensitivity to all patients’ individual needs.

Long Island IVF, along with the LGBT Network, offers free LGBT family building seminars every June and periodically throughout the year. Click here for information and to preregister for the June 29th event.

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One Year Later: Reflections on #OrlandoStrong and Hate Crimes against the LGBT Community

By Tracey Minella

June 12th, 2017 at 9:45 am

 

Image: Ryan McGuire/Gratisography.com


Today marks a somber day in LGBT history—one to reflect upon and remember.

Last June, from our sponsor table in the Family Services Pavilion at Long Island’s Pridefest 2016 celebration, the Long Island IVF team was able to witness and be a part of the pride and happiness of the LGBT community mingling peacefully and openly on a beautiful sunny afternoon.

Little did anyone know at that time that only hours after the event would end, the worst mass shooting in US history would happen in Orlando.  Fifty innocent lives would be taken and as many others would be injured. People just like those whose company we had just enjoyed. Regular people with their whole lives in front of them…targets of hatred in an increasingly ugly world. A world which in the months since then has become politically altered and alarmingly unstable for all—particularly the LGBT community.

It didn’t feel right to post Pridefest photos or talk of the positivity surrounding it in the wake of such a loss. But continued “radio silence” on Pridefest would be a disservice. It would be a lost opportunity to talk of and celebrate all that it was and, more importantly, all it must continue to be. There must be pride. There must be solidarity. In the face of hate, there must be love. And there must be real change.

There must be more than just a uniting of the LGBT community within itself –there must be support from those outside the LGBT community, too. Just as the world came together in vigils to support the LGBT community and to mourn those lost in Orlando, it must continue to look out for all people until the hatred is replaced by acceptance. Until there isn’t a need to designate “communities” anymore.

Prejudice and ignorance are frustratingly slow learners, so this change will require persistence. But despite the Orlando tragedy, we mustn’t lose sight of how far the gay rights movement has come, especially in recent years. And Pridefest is one of so many milestones of the movement. We mustn’t lose ground despite the political climate and a rising swell of previously-stifled but ever-brewing bigotry, hate, and violence.

Long Island IVF is proud to have supported the LGBT community and helped its members fulfill their dreams of parenthood for decades. None of us can undo these senseless deaths, but we can join together to create new life. If you’re ready to become parents, we can help you create your family. The next generation.

In the face of hate, there must be love.

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The Best Way to Survive Mother’s Day When Infertile

By Tracey Minella

May 11th, 2017 at 9:06 am

 

photo credit: ryanmcguire/gratisography


This might seem unconventional for an infertility blogger to suggest, but…

Stop looking for something online that will make you feel better this weekend. Chances are it isn’t out here. And even if there was one special nugget of wisdom that might somehow ease your pain, you’ll have to sift through so much useless and painful content that your heart will be in shreds before you find that elusive gem.

The worst place you can be when you’re infertile is on social media on Mother’s Day. The day photos of moms and babies posted are multiplied 10,000 times more than the already unbearable daily number you endure. Why subject yourself to millions of pictures of mothers and children or hundreds of blog posts like this one – – trying and failing to make you feel any better? Please hide. Resist the habit of Facebook. Protect your heart.

Yes, I’ve been in your shoes, but it was before the hell that is social media. I only had to endure real life pregnant people and babies in my actual face—not the flood of thousands of them in my virtual face 24/7. You have it so much worse in that respect—though IVF success rates have soared since I did it. Our experiences are the same, yet different. Only other infertile women could understand how you are feeling–currently infertile women.

Ten stressed-out Mother’s Days without a baby I suffered. I have walked that long and lonely path you are on now, and I do remember it like it was yesterday. Yet I know my well-meaning words of hopeful advice– that I so want you to find comfort in today– can’t help but somehow fall short because I finally became a mom while you are still waiting for your day. I walked before you, and it’s frustrating to know that I can’t comfort you the way someone walking beside you can. So while I do remember, speaking to you from where I am now instead of where I was then makes my words just one small step above those of others not currently walking in your shoes. Maybe the words of one who succeeded at IVF, even after many, many failures and losses are as unwelcome on such a difficult day as the words of those who conceived easily and effortlessly.

So on this hardest day of the year I won’t try further than to say that I know you can get through this day and I’m sorry for your pain. There is no magic answer in this post or any of the others you may read about Mother’s Day.

Despite constant advances in assisted reproductive technologies, no one can promise you a baby this cycle or in the future despite the technology advancing with lightning speed. For me, not knowing if it’d ever work was the hardest thing. Had I only known for certain that at some point– even years away– I’d definitely have a baby in my arms, it would’ve made all the difference in managing the highs and lows during those 10 long years. But there is no crystal ball. While many people might become parents if they just kept undergoing treatment, many people’s wallets are exhausted before their spirit is ready to stop treatment—or even before they can begin it. That fear kept me up at night.

You know what you need to get through this day– and only you know what you need. Time as a couple, alone time, or time with family and friends. Do what you need to do so it will pass.

For what it’s worth, know that I and the many women who walked before you will be looking backwards on Sunday with hope and strength for you as you walk on. Strength to get through this day– and hope that by this time next year you will be looking back on your journey as well.

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