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Archive for the ‘gay IVF’ tag

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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Ethical, Moral and Legal IVF Factors

By David Kreiner MD, Tracey Minella

May 29th, 2012 at 9:35 pm

 

If you think that all fertility patients look like your average young urban professional neighbors with the SUV, think again. They are as diverse as the general population.

Actually, anyone can be infertile. There could be a reality show called “The Real Infertile Housewives of Long Island”. When the door swings open and a potential new patient walks in, infertility doctors never know what they’re gonna get. Often, it’s a so-called “traditional” married couple using their own eggs and sperm or those of a donor. It could also be an equally welcome gay couple or single woman using donor eggs and or sperm. But often enough… it’s not. And sometimes, it’s downright ugly and complicated.

Must he treat them? Should he treat them? Often, the legal system muddies the waters.

Dr. Kreiner of Long Island IVF gives us a glimpse of what it’s like to be on his side of the desk at a new patient appointment. Here’s a post he wrote prior to New York’s  legalization of same sex marriages:

Those of us who work in the infertility field are often presented with situations that make us ponder whether we should assist in endeavors that make us feel a bit, well, uncomfortable. I suppose it’s common to have these experiences in our field as family building is a cornerstone of our society. But manipulating a family affects not just the people directly involved, but all of us.

There are the straightforward illegal and unethical cases: The married woman who presents with a proposal to conceive with a man other than her husband (without the husband’s consent) or the married man “donating” his sperm to a “friend” other than his wife (without his wife’s knowledge). These are the easy ones that don’t even make me pause.

I come across more difficult questions, however, that require much more intense contemplation and research. On a daily basis, the way most of us professionals try to deal with ethical and legal dilemmas is to resort to an evaluation of the “yuk factor.” It’s an internal cliff notes version of societal morality and law that many of us professionals rely on to make daily decisions when we can’t read the whole book on an issue. Sure, there’s a potential downside of going down the slippery “yuk” slope, but when was the last time the approach “if you’d be ashamed to see it on the front page of the New York Times, then don’t do it” led you down the wrong path?

Yet, I still have difficulty understanding what’s ethically and/or legally right in some situations. The go-ahead is clear to me if an unmarried man and woman present as a couple, each using their own gametes, and both sign consent acknowledging their rights and responsibilities to the future child. Less obvious is the case of the unmarried lesbian couple who present with only one partner participating biologically. They live as a couple, but the law doesn’t necessarily recognize the partner who isn’t participating biologically as having parental rights. Should they be signing as a couple for use of donor sperm to create a baby and, if so, what –if any– are the ramifications? Is this situation different if the unmarried-yet-cohabiting partner who is not participating is a male? Does the unmarried lesbian partner have the right to adopt the baby? Does this change if the partner is a transsexual?

It would seem to me that if the couple decides that they will have a baby together, despite the fact that only one is contributing biologically, that there should be parity recognized legally based on the emotional and financial contributions the other partner makes, especially if she were willing to adopt the child and legally take on parental rights. For me the “yuk” factor becomes the legal system if that unmarried partner who is unable to contribute biologically is unable to retain parental rights in a split.

So now I’m off to the clinic to see what murky issues the day will present.

Every day is different.

* * * * * **  *  * * ** **

Do you think there are situations where a doctor can, should, or must refuse treatment? If so, when?

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=10714&picture=halloween-wedding

 

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Legal, Ethical, and Moral IVF Issues

By Tracey Minella and David Kreiner MD

December 2nd, 2011 at 4:33 pm

Question: What do you get when you cross a freak and a tramp? Or a slob and a deadbeat?

Answer: Potential fertility patients. (Of course, we’re not talking about YOU.)

When the door swings open and a potential new patient walks in, an infertility doctor never knows what he’s gonna get. Often, it’s a “traditional” married couple using their own eggs and sperm. But often enough… it’s not.  There’s non-married situations that can be sticky. And sometimes, it’s downright ugly and complicated. Liars and cheaters make appointments too.

Must he treat them? Should he treat them?

Dr. Kreiner gives us a glimpse of what it’s like to be behind the doctor’s desk at a new patient appointment:

Those of us who work in the infertility field are often presented with situations that make us ponder whether we should assist in endeavors that make us feel a bit, well, uncomfortable. I suppose it’s common to have these experiences in our field as family building is a cornerstone of our society. But manipulating a family affects not just the people directly involved, but all of us.

There are the straightforward illegal and unethical cases: The married woman who presents with a proposal to conceive with a man other than her husband (without the husband’s consent) or the married man “donating” his sperm to a “friend” other than his wife (without his wife’s knowledge). These are the easy ones that don’t even make me pause.

I come across more difficult questions, however, that require much more intense contemplation and research. On a daily basis, the way most of us professionals try to deal with ethical and legal dilemmas is to resort to an evaluation of the “yuk factor.” It’s an internal cliff notes version of societal morality and law that many of us professionals rely on to make daily decisions when we can’t read the whole book on an issue. Sure, there’s a potential downside of going down the slippery “yuk” slope, but when was the last time the approach “if you’d be ashamed to see it on the front page of the New York Times, then don’t do it” led you down the wrong path?

Yet, I still have difficulty understanding what’s ethically and/or legally right in some situations. The go-ahead is clear to me if an unmarried man and woman present as a couple, each using their own gametes, and both sign consent acknowledging their rights and responsibilities to the future child. Less obvious is the case of the unmarried lesbian couple who present with only one partner participating biologically. They live as a couple, but the law doesn’t necessarily recognize the partner who isn’t participating biologically as having parental rights. Should they be signing as a couple for use of donor sperm to create a baby and, if so, what –if any– are the ramifications? Is this situation different if the unmarried-yet-cohabiting partner who is not participating is a male? Does the unmarried lesbian partner have the right to adopt the baby? Does this change if the partner is a transsexual?

It would seem to me that if the couple decides that they will have a baby together, despite the fact that only one is contributing biologically, that there should be parity recognized legally based on the emotional and financial contributions the other partner makes, especially if she were willing to adopt the child and legally take on parental rights. For me the “yuk” factor becomes the legal system if that unmarried partner who is unable to contribute biologically is unable to retain parental rights in a split.

So now I’m off to the clinic to see what murky issues the day will present.

Every day is different.

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