http://www.facebook.com/pages/Wellesley-MA/Prospective-Families/27764169698?ref=ts

I returned yesterday from the RESOLVE of the Bay State Annual conference where approximately 200 folks participated, through-out the day, in 40 educational events and had the great fortune of a key-note speech by Ali Domar. I attend, exhibit at and in most years present, every year,  at this always successful conference. This year, as a result of RESOLVE again receiving a Federal Grant on Embryo Donation, attendees were offered 3 Embryo Donation sessions and then a Embryo Donor Focus group in which to participate. Admission to yesterday’s event was nominal. Several weeks ago the AFA held a similar event for those in the NY Metropolitan area. Both Resolve and the AFA hold regular 3rd party repro educational events through-out the year, admission is usually around $10.00

I know that here in Boston, Reproductive Science Center as well as Boston IVF hold weekend “educational seminars” on third-party reproduction. I imagine that Mass General, the Brigham and other fertility centers in New England do the same. Is it a regional thing??? Is my view narrow and limited?  Are we more committed to education than coulleagues in other parts of the country??

I offer every prospective client a one-hour gratis consultation (prior to and regardless of matching/cycling through our office) and take them through all of the steps of the practical aspects of collaborative reproduction. I certainly hope none of my clients feel the need to engage a third-party service provided for “education”….I would not be provding the level of service I intend if that were the case.

So, I am asking my medical and legal colleagues, nationwide, for their perspective….The contention is that physicians, nurses and other members of clinical donor egg teams, including mental health providers,  are either not qualified or not committed to offering “education” on infertility treatment options. I am asking patients and donors, too, who read my blog…..do you feel there is a void in the depth and quality of education that you are or have received from my office, my colleagues, the clinics in which you’ve chosen to cycle, the mental health providers you may have seen? ……

………….and then there is the issue of licensure!!!

As a long-term patient advocate (beginning my career in infertility working on complex legislative matters regarding insurance coverage for patients) and as a former Chair of Education for RESOLVE New York City, I believe that clinics, mental health providers and legal counsel have an obligation to “educate” on matters critical to the outcome of alternative family building efforts….and I value greatly the passion and commitment of  non-profits like RESOLVE and the American Fertility Assocation who consistently provide year-round educational events led by professionals who present pro-bono and where the attendance fee is nominal.

I am, frankly, curious, about this new level of service (and related fees) of these so-called “infertility consultants and educators” clients tell me they have been solicited to engage with when most, if not all of that “education” should be coming from licensed professionals. …what is the value added by these so-called independents and does the consumer really need another layer of service provider and another expense or is the call really to the clinics and attnys and MHPs to be meeting all of the “educational” needs of the IPs.

Alternative family building is a medical, legal, psychosocial and financial matter …professionals with education AND experience AND licensing/credentials in those fields are obligated (by nature of our credentials and licensure) to competently educate IPs and donors. If there is a void in education, the answer is not necessarily ”independents” (whatever that it) but rather a call to better education in the clinic, in the psychosocial practitioners office and in the attnys office…it is the reason we are required to be licensed to practice, b/c we have heightened standards of care.

I am and always will be a patient/donor advocate and on behalf of patients, I raise question of these “consultants”…it is just the way I was trained.

Several months ago, Prospective Families was contacted by a service that brings American egg donors to Bangalore and Hydrebad India along with American Intended Parents to work with Indian surrogates for family building. Having no idea as to the level of interest of any of the donors registered with Prospective Families, I polled our donor pool and was shocked to find an overwhelming and enthusiastic interest in travelling to India to do a cycle….okay, I had my charge: research, research, research and find out what Fertility Tourism in places like India is all about!

 At the AAAA meeting, not surprisingly, there was a good degree of cynicism and, I might opine, some rumbling hostility towards that gentleman who was speaking about his agency (travel agency, tourist agency???) that coordinates all of the logistics for American Intended Parents. It was a tough audience, 200 or so practicing attorneys licensed and doing business in the United States with American clients…what/who is this new player in our marketplace??

 Well, I am sorry to report…not much information to share. Questions were asked about success rates, questions were asked about the quality of care at the Indian clinics, questions were asked about pre-natal testing, questions were asked about choice of law issues and legal counsel regarding contracts…we were offered very broad, general statements that left the audience all the more skeptical.

One of the most significant questions is the issue of cost and cost savings. I have been involved, professionally, with infertility, for many years, starting with my early days at RESOLVE: National where the main focus was and is still today, solid legislation acknowledging infertility as a disease and mandating insurance coverage for treatment. I am also a parent of ART conceived kids; through both my personal and professional experiences I  have come to develop a deep empathy and sensitivity towards the financial burdens of assisted family building.

So, is fertility tourism really cost effective? If I take a narrow view of this question and look only at the fees related to doing a domestic cycle as compared to an international cycle…I do not see much that is compelling. Yes, in the States, the fees to the surrogate may be greater, but the costs related to int’l travel and the additional legal counsel needed to oversee that parentage is managed properly seemingly bring the comparative costs to a similar bottom-line. If a couple is working with an egg donor as well as an Indian surrogate, the costs of either doing the IVF here and then shipping the frozen embryos to India or bringing the donor to India add significantly to that scenario’s bottom-line.

If we take a broader look at cost comparison and consider risks associated with fertility tourism, I have come to the conclusion that, at least in the foreseeable future, family building outside of the United States, whether in India or elsewhere is, in fact, cost prohibitive. How do the success rates compare to that in the US? What is the pre-natal testing protocol? What are the legal loopholes of parentage? How are the surrogates screened? Any of these issues and so many more each have a real price-tag attached to them.

I believe the sessions on this issue at various professional meetings are important, critical, in fact. I expect we will see this matter discussed at ASRM. I have no doubt the Oprah show and others like it will continue to sensationalize and make sexy the option of fertility tourism but, as is the case with all matters we counsel clients on, let’s be sure we understand how a cycle abroad can play out both short-term, in terms of success with the cycle and long-term with respect to parentage issues before we allow this to become anywhere near a trend. 

 I think donors deserve the compensation they receive and I firmly support the practice of donors setting their own compensation because, I understand after interviewing hundred of donors, that matters such as time and effort are certainly of relative value to each donor.

 Prospective Families takes this issue of donor compensation into consideration for much of our practice and policy making and I am delighted to read Mr. McLoed’s most appopriate perspective on this issue.

But who are these women who so generously share their fertility? If you were in need of another woman’s eggs, who would you hope to be your donor? To many, the obvious response is a sister, a cousin or best friend…this is often a best case scenario, I am told by the mental health professionals with whom I often consult. It is also a tremendously complex and often burdensome dynamic to manage.

Donors, whether anonymous or “known” (that is, known to the infertile person or couple) will agree, through a legal document, to relinquish all parental rights to the child. That means the donor remains legally and socially….just a donor.

Despite then, or perhaps because of, the genetic connection, the passing of the sweet potatoes from the (sister/cousin/bff)/ donor to the child at the Thanksgiving Day table can often be, at the very least, awkward and sometimes, even painful. And so, for many folks who find this alternative family building option more appealing than adoption, embarking on a search for an anonymous egg donor seems their optimal path to parenthood.

Why? Why are their fewer donors than hopeful parents-to-be? Why are there Asian, Jewish, Russian, East Indian and yes, Caucasian couples scouring the internet for months in consideration of finding their ideal donor…..for good reason, I suggest….good reason and positive indication of where we are with this family building option.

 In the years that I have devoted to assisting infertile couples, I have seen the stastics shift, significantly, as couples and singles make their way through varied family building alternatives.  Child-free living and adoption were typically given equal consideration to third-party reproduction but in the past several years I’ve witnessed a huge shift in the direction of egg donation. The success rates of egg donation are sky-rocketing, so much so that it is the most compelling (in some ways even more compelling than trying to conceive with the Intended Mother’s own eggs) alternative family building option and more and more folks are jumping off the adoption track, coming back to pursuing pregnancy after choosing a child-free life and leaving IVF sooner just so that they, too, can benefit from the advances in donor conception. This is a good thing. More babies are being born. More families are coming to be.

Still though, there remains the issue of fewer donors than parents. Why is that? Again, I think for good reason. As the clinicians have achieved greater advancement in medicine and technology, so too have the standards for donor selection increased. The clinics with the highest success rates, in my experience, are the same conservative clinics that have the highest threshold for donor acceptance. Perhaps one of the reason success rates are on the rise is because we have learned much about what the profile of the ideal donor should look like. At Prospective Families we turn away a good number of applications submitted, clinics too have their screening processes and, if there is a good partnership between agency and clinic, together we are limiting, appropriately so, those women who qualify as fit for donation.

 Yes, for those who are searching their wait is frustrating. I hope that those who hear my counsel understand, though, that the the quality of the donor pool (however limited) is what will bring to them, eventually, the right young women for their family building success….and success is a wonderful thing!!!

On February 26th I, along with Prospective Families, got mention in a Chicago Tribune article entitled “Ethnic couples face difficulty finding egg donors”…an absolutely valid point and a real-life circumstance that I attribute to social, relegious and perhaps moral barriers. Why is it so difficult for Asian, Jewish or East Indian couples to find donors who share their ethnicity? Quite frankly, it is a matter of supply and demand, a condition that really applies to a broader group of hopeful parents-to-be and a condition that calls for more mainstream education about the process and the implication of egg donation.

I am hopeful that our website and it’s many donor pages is helpful, I welcome and seek out opportunities to speak to donor candidates, one-on-one or in groups. I have met with my staff and we talked about hosting a Donor Event. I think often about writing, not only a blog entry but a book on the considerations each young women, ethnic or not, should contemplate about egg donation.

So, is there a shortage of ethnic donors, certainly there is….should we really be talking about a general shortage of egg donors? I think so.