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The Parents Via Egg Donation Organization: July 2008

Thursday, July 31, 2008

The Donor Egg Process - Step by Step

Although there might be a slight variance from clinic to clinic, in general, the donor egg process is as follows:

1. Locate a donor see ( How To Select an Egg Donor )


2. Complete medical screening for the recipient, the spouse of the recipient, and the donor: psychological (includes MMPI for donor, counseling for the donor and the recipient couple, individually and jointly, if the donor is a known donor) and physical (includes semen analysis, blood work to test the donor and the recipient for infection and sexually transmitted diseases, hysterosalpinogram for the recipient to allow the doctor to view the uterine lining to detect uterine polyps or other defects which could affect implantation or pregnancy, "mock transfer" to determine the best type and size of catheter for the embryo transfer, etc.).


3. Some clinics require a "mock cycle" for the recipient, where the recipient takes medications (generally Lupron, followed by Estrace and then progesterone) and has ultrasounds and bloodworm to ensure that the medication is effective and the uterine lining is appropriate to support a pregnancy.


4. Coordinate cycles of donor and recipient. For pre-menopausal recipients, this is accomplished by both the recipient and the donor taking medications such as Lupron (shots), Synarel (nasal spray), and/or birth control pills. For recipients past menopause, only the donor will be down-regulated using Lupron or Synarel.


5. Some clinics prescribe antibiotics for the donor, recipient, and recipient's spouse early in the cycle (often a 10-day treatment) in order to treat any undiagnosed infections that may exist.


6. Once both the donor and the recipient are down-regulated, the recipient begins to take estrogen supplements in some form - oral, patches, or shots. The dosage may be adjusted based on blood tests (measuring E2 levels) and ultrasounds to measure the uterine lining.


7. While the recipient is taking estrogen supplements to build a thick uterine lining, the donor begins her fertility medications. These medications are often taken for 8-10 days. Her progress is measured through bloodworm and ultrasounds.


8. The date of the egg retrieval will be determined based on the size of the donor's follicles, as measured by ultrasounds. At an appropriate time, she will be given a shot of hCG and the retrieval is generally performed approximately 33-35 hours thereafter.


9. On the date of the retrieval, the recipient's partner will provide a semen sample. The semen is processed and sperm are added to the eggs that same day. In some cases, ICSI will be performed. This is a process where a single sperm is injected into each egg.


10. The day after retrieval the lab will provide a fertilization report. The embryos remain in the laboratory until the date of the transfer, which can be between two and five days after the retrieval date. Periodic progress reports are provided to the recipient to keep her informed about number, size, and quality of embryos.


11. On or just before the date of the donor's egg retrieval, the recipient will begin taking progesterone supplements, available as injections, vaginal gel, vaginal or rectal suppositories, or in oral form.


12. Based on embryo quality and other factors, the recipient couple determines how many embryos to transfer to the recipient's uterus. The rest may be frozen at that time or kept in the laboratory for several more days before freezing. Often clinics will freeze only high quality embryos.


13. Some clinics will prescribe a steroid (often Medrol or prednisone) and another round of antibiotics for the recipient to take for several days preceding the embryo transfer.


14. The embryo transfer is performed either at a hospital or in the clinic's office. The embryos are placed into a catheter and transferred through the cervix into the uterus of the recipient under ultrasound guidance. Some clinics prescribe valium for the recipient to take prior to embryo transfer, although the procedure is generally not any more painful than a pap smear or insemination.


15. Following the embryo transfer, the recipient will remain in the hospital clinic for 30 minutes to several hours, depending on the clinic's protocol. Then the recipient remains on bed rest for several hours to several days, depending on the clinic's protocol.


16. Several restrictions may be imposed for the period between transfer and the pregnancy test: limitations on exercise, heavy lifting (over ten pounds), sex, caffeine, etc. Again, this varies from clinic to clinic.


17. A blood pregnancy test may be performed 9-14 days from a day 3 embryo transfer (or sooner for a day 5 transfer). The hCG level in the blood is measured; if the test is positive, it is repeated two days later. hCG levels should double every 48-72 hours.


18. If the test is positive, the recipient continues to take progesterone and estrogen supplements as directed by her physician - often until the end of week 10 or 12 of pregnancy.

Friday, July 18, 2008

It's Not Only About Women -- Biological Clocks Tick for Men, Too

Men's Fertility Plummets in Late 30s, Early 40s
By ELIZA BROWNING
July 7, 2008

A new study shows that a man's fertility starts to fall in his mid 30s, providing more evidence that like women, men, too, have a kind of biological clock that can play a big role in a women's chances of getting pregnant.

New research suggests that men may become less fertile as they reach their late 30s.
(Getty)
Researchers in France found that a male's fertility starts to decline as he enters his mid-30s and is significantly lower if he is over 40.

The study included more than 12,200 couples being treated for infertility at the Eylau Center for Assisted Reproduction in Paris. The women were given intrauterine inseminations, or IUIs, also known as artificial inseminations, where sperm is inserted into the uterus when the woman is ovulating. This type of treatment is typically given to couples if the woman has no fertility problems.

Scientists monitored more than 21,000 of these procedures between January 2002 and December 2006 and recorded rates of pregnancy, miscarriage and births.

If a woman was over 35, the rate of pregnancy was lower. This was expected: maternal age has been long been linked to a couple's rate of pregnancy and chances of miscarriage.

But the study also found that if the father was in his late 30s, the chances of a successful pregnancy went down. Ten percent of treatments led to pregnancy in fathers over 40.

The father's age also affected rates of miscarriage. If a father was over 34, the miscarriage rate was 16.7 percent. Between the ages of 35 and 39, it went up to 19.5 percent. And if the father was older than 44, it jumped to 32.4 percent -- which means nearly one-third of the pregnancies ended in miscarriages.

Researchers said the problems were likely the result of DNA damage and fragmentation in sperm, which can lead to pregnancy failure and miscarriage.

Dr. Peter Schlegel, chairman of urology at the Weill Cornell Medical Center in New York, works at the Male Center for Reproductive Medicine. He told ABC News it is possible that there is a link between DNA damage and age.

"As men get older, there is an increase in the risk of having that fragmented DNA," Schlegel explained.

The findings were presented today at the European Society of Human Reproduction and Embryology conference in Barcelona, Spain, and represent the strongest evidence to date that age can affect male fertility.

Dr. Stephanie Belloc, who presented the study, said, "This research has important implications for couples wanting to start a family."

Belloc went on to report that although gynecologists have always placed emphasis on maternal age, now paternal age will increasingly become a factor in reproductive medicine.

"The message was to get pregnant before the age of 35 or 38, because afterward it would be difficult. But now the gynecologists must also focus on paternal age and give this information to the couple," she said in her presentation.
The U.S. Census Bureau, which compiles national health statistics, does not publish data on the age of first-time fathers, according to Andy Hait of the Census Bureau, but a handful of reproductive studies show that the average ages of men having children is going up.

In 2003, the number of fathers between the ages of 35 and 39 went up 18.7 percent from a decade earlier, according to a report released on births for the Centers for Disease Control and Prevention. Information on the age of the father is not recorded as much as the age of mother, as it's often not entered on birth certificates for unmarried women or women less than 25 years old.

Schlegel told ABC News it is becoming increasingly common for males to be treated for infertility.

"Couples are older when they try to have children than they were in the past, so it's a more common situation for us to encounter," he said. Schlegel also said there is more research to be done on how male age affects embryos and birth defects.

Schlegel went on to say the relationship between age and male fertility is not a new concept but has been masked by the focus on the connection between female fertility and age.

"The changes in male fertility rates, as they relate to age, are not as dramatic as in female fertility rates -- which are massive and marked," said Schlegel, "but there is a clear link between age and male fertility."

Friday, July 11, 2008

Donor kids 'psychologically well

Paris - Children born to a gestational carrier or conceived through donated sperm or a donated egg do just as well psychologically as counterparts who are naturally conceived, a study unveiled on Sunday said.

The probe is the widest yet into concerns that the rising numbers of children born through assisted reproduction may suffer lower self-esteem or be treated less positively by parents, siblings and schoolmates.

Scientists led by Polly Casey from the Centre for Family Research at Britain's Cambridge University carried out interviews and psychology tests among 39 surrogacy families, 43 donor insemination families and 46 egg donation families. The children are now seven years old.

For comparison, they made the same investigation among 70 families where the children had been conceived naturally. They also asked the children's teachers, in order to get an independent assessment of the child's wellbeing.

The children were all given a blank "map" with concentric circles, and were told that they were at the centre of it. They were asked to complete the map by placing family members and friends in the circle that represented the emotional closeness of each relationship.

They were also given a picture test, designed as a measure of self-esteem, to assess where they felt they stood among their peers.

"We found that the family types did not differ in the overall quality of the relationship between mothers and their children and fathers and their children," Casey said.

Mothers who had had their child through surrogacy and egg donation tended to be more sensitive to their child's worries and anxieties compared with donor insemination mothers and natural conception mothers, but the difference was minor, she added.

Self-esteem

As for the child's view of family relationships, children of all backgrounds placed their mother or father in the closest circle with the same frequency.

There was no significant difference between family types when it came to self-esteem.

An overview of the research, based on data from approximately half of the families, was to be presented on Sunday at the annual conference, taking place in Barcelona, Spain, of the European Society of Human Reproduction and Embryology (ESHRE).

In a press release, Casey added that she found a majority of parents of children born through assisted reproduction delayed telling the child about how he or she was conceived.

"At the time of the child's seventh birthday, only 39% of egg-donation parents, 29% of donor-insemination parents and 89% of surrogacy parents had told their children about the nature of their conception."

These figures contrast markedly with what the parents said they would do when they were questioned at the child's first birthday.

At this point, 56% of egg-donation parents, 46% of donor-insemination parents and 100% of surrogacy parents declared they would disclose this information to the child.

The reasons for not informing the children "are numerous and complex", including a desire to protect an infertile father and the fear that a child may feel less love for the non-genetic parent, she said.

Tuesday, July 8, 2008

Frozen embryos 'better for IVF'

By Caroline Parkinson
Health reporter, BBC News, Barcelona

Frozen is better than fresh when it comes to transplanting embryos in IVF treatment, a study shows.

Danish scientists found babies born after a frozen embryo was thawed and implanted had higher birth weights than those born from fresh embryos.

The study of over 19,000 babies also found no added risk of birth defects.

A European fertility conference heard frozen embryo babies did better because only the most robust embryos survived the freezing and thawing process.

Freezing embryos allows couples to have several cycles of treatment from one egg collection.

That means it cuts the amount of times women have to take ovarian stimulation drugs.

Single embryos

As doctors want to avoid multiple pregnancies, it is common for just one embryo - which has been fertilised in the lab - to be transferred into the womb, and the rest frozen.

In later cycles, a frozen embryo is thawed and implanted three to five days after ovulation, exactly the same way as fresh embryos are used.

While single embryo transfers are becoming increasingly common, the researchers said there was little data on the results of using frozen embryos.

But earlier mouse studies had shown a higher rate of behavioural and development problems in animals born from frozen embryos.

In this study, presented to the European Society for Human Reproduction and Embryology meeting in Barcelona, all 1,200 babies who had been born from frozen embryos between 1995 and 2006 in Denmark were compared to the 17,800 babies born from fresh embryos.

The data showed no increase in the rate of congenital malformations - which include conditions such as spina bifida and cleft palate.

Fewer frozen embryo babies were admitted to neonatal care units, but the researchers said this was probably because there was a higher rate of multiple births in the fresh embryo group.

In addition, pregnancies lasted slightly longer in the frozen embryo group, and babies were an average around 200 grams bigger.

There was also a lower proportion of low-birth weight babies weighing under 2,500 grams (5.5lbs) and fewer premature births, before 37 weeks.

Survivors

Dr Anja Pinborg, who led the research, said: "We think the reason for the differences is probably positive selection of the embryos for frozen embryo replacement.

"Only the very top quality embryos survive the freezing and thawing process.

"And you only get pregnancies in patients with lots of good embryos to freeze."

She added that by the ovarian stimulation patients have to go through in order to get fresh embryos could negatively influence a consequent pregnancy - something women using frozen embryos would not be affected by.

Dr Pinborg said: "The findings are reassuring.

"If our results continue to be positive, it can be accepted as a completely safe procedure, which can be used more frequently than it is currently."

Monday, July 7, 2008

Haywire brain chemical linked to sudden baby death

By LAURAN NEERGAARD
AP Medical Writer


WASHINGTON (AP) -- Scientists have new evidence that the brain chemical best known for regulating mood also plays a role in the mystifying killer of seemingly healthy babies - sudden infant death syndrome.

Autopsied brain tissue from SIDS babies first raised suspicion that an imbalance in serotonin might be behind what once was called crib death.

But specialists couldn't figure out how that defect could kill. Now researchers in Italy have engineered mice born with serotonin that goes haywire - and found the brain abnormality is enough to spur sudden death, in ways that mesh with other clues from human babies.

Moreover, the work suggests it might one day be possible to test newborns for their risk of SIDS.

For now, even an animal experiment can offer a message for devastated families:

"It should provide them with some sense of comfort that there was nothing they could have done to prevent it," said Dr. Marian Willinger, a SIDS specialist at the National Institute of Child Health and Human Development, who wasn't part of the study. "It is a real disease."

The work was published in Friday's edition of the journal Science.

SIDS is the sudden death of an otherwise healthy infant - anywhere between ages 1 month and 1 year - that can't be attributed to any other cause. It kills more than 2,000 U.S. infants each year, and is the leading killer of babies after the newborn period.

Babies should always be placed to sleep on their backs, as the risk of SIDS increases greatly when babies sleep on their stomachs. And parents are urged not to allow anyone to smoke around their babies, or to let their babies get too warm while sleeping.

But beyond those risk factors, doctors have little advice.

In 2006, Dr. Hannah Kinney of Children's Hospital Boston compared brain tissue from 31 SIDS babies and 10 infants who died of other causes. The SIDS babies had abnormalities in their brain stem that led to imbalances in serotonin, a neurotransmitter or chemical that helps brain cells communicate.

Low serotonin famously plays a role in depression. Less known to laymen is that it also helps regulate some of the body's most basic functions - breathing, heart rate, body temperature, arousal from sleep.

Dr. Cornelius Gross and colleagues at the European Molecular Biology Laboratory in Italy were studying how the serotonin system turns itself on and off when they stumbled onto the SIDS connection.

They genetically engineered mice to have an overactive serotonin-regulating receptor, which in turn reduced the amount of serotonin in the brains of otherwise normal baby mice.

More than half of the mice abruptly died before they were 3 months old. More intriguing, they had erratic episodes where their heart rate would drop and, five to 10 minutes later, so would their body temperature, Gross reported. Sometimes they died in the midst of what Gross calls those crises, other times afterward.

The exact cellular defects in the mice and the human babies studied so far aren't identical, researchers caution.

But heart and temperature problems are consistent with what little human data is available, Willinger noted.

Here's another key: Gross could switch on and off the genetic defect that controlled serotonin levels in the mice. By doing so, he showed that older baby animals were less likely to die from haywire serotonin than younger ones.

"This is a very exciting part of the research," says Willinger - because doctors have long suspected that if at-risk babies just get through a developmental period, they'll be OK. That's impossible to test in humans, however.


On the Net:

Science: http://www.sciencemag.org

Government SIDS info: http://www.nichd.nih.gov/sids

Saturday, July 5, 2008

Surrogate, egg donor, or sperm donor children are psychologically well

PARIS (AFP) - Children born to a surrogate mother or conceived through donated sperm or a donated egg do just as well psychologically as counterparts who are naturally conceived, a study unveiled on Sunday said.

The probe is the widest yet into concerns that the rising numbers of children born through assisted reproduction may suffer lower self-esteem or be treated less positively by parents, siblings and schoolmates.

Scientists led by Polly Casey from the Centre for Family Research at Britain's Cambridge University carried out interviews and psychology tests among 39 surrogacy families, 43 donor insemination families and 46 egg donation families. The children are now seven years old.

For comparison, they made the same investigation among 70 families where the children had been conceived naturally. They also asked the children's teachers, in order to get an independent assessment of the child's wellbeing.

The children were all given a blank "map" with concentric circles, and were told that they were at the centre of it. They were asked to complete the map by placing family members and friends in the circle that represented the emotional closeness of each relationship.

They were also given a picture test, designed as a measure of self-esteem, to assess where they felt they stood among their peers.

"We found that the family types did not differ in the overall quality of the relationship between mothers and their children and fathers and their children," Casey said.

Mothers who had had their child through surrogacy and egg donation tended to be more sensitive to their child's worries and anxieties compared with donor insemination mothers and natural conception mothers, but the difference was minor, she added.
As for the child's view of family relationships, children of all backgrounds placed their mother or father in the closest circle with the same frequency.

There was no significant difference between family types when it came to self-esteem.
An overview of the research, based on data from approximately half of the families, was to be presented on Sunday at the annual conference, taking place in Barcelona, Spain, of the European Society of Human Reproduction and Embryology (ESHRE).

In a press release, Casey added that she found a majority of parents of children born through assisted reproduction delayed telling the child about how he or she was conceived.

"At the time of the child's seventh birthday, only 39 percent of egg-donation parents, 29 percent of donor-insemination parents and 89 percent of surrogacy parents had told their children about the nature of their conception."

These figures contrast markedly with what the parents said they would do when they were questioned at the child's first birthday.

At this point, 56 percent of egg-donation parents, 46 percent of donor-insemination parents and 100 percent of surrogacy parents declared they would disclose this information to the child.

The reasons for not informing the children "are numerous and complex," including a desire to protect an infertile father and the fear that a child may feel less love for the non-genetic parent, she said.

Thursday, July 3, 2008

ASRM BULLETIN

California Department of Public Health Posts Updated Information on Treating Research Egg Donors


The California Department of Public Health has issued updated information for physicians working with research egg donors. See below for links to the Human Stem Cell Research Program (HCSR) website.

Note that, while these requirements were developed in the context of regulating stem cell research, other medical research utilizing donor oocytes conducted in California is also subject to the California Department of Public Health’s reporting requirements and informed consent requirements. These requirements apply to all egg donation procedures for research that is conducted in California, whether the egg donation procedure takes place in California or in another jurisdiction. When the regulations were being developed, we were told they were not intended to affect clinical practice—egg donation for infertility treatment.

REPORTING FORMS
The HSCR Program has finalized the reporting forms for Stem Cell Research Oversight Committees overseeing human embryonic stem cell (hESC) research and for research projects involving human oocyte retrieval. Annual reporting is required on research involving hESCs and/or human oocyte retrieval that is not fully funded by the California Institute for Regenerative Medicine (CIRM). The reporting forms are now available for download at: http://www.cdph.ca.gov/programs/HSCR/Pages/HumanStemCell
ResearchReportingForms.aspx.

INFORMED CONSENT CHECKLIST
To assist in the informed consent process for research involving human oocyte retrieval, an informed consent checklist is available under “Resources” at: http://www.cdph.ca.gov/programs/HSCR/Pages/HumanStemCell
ResearchReportingForms.aspx.

GUIDELINES
To assist in assessing the type of review and approval needed for various types of stem cell research based on the CDPH Guidelines for Human Stem Cell Research, a reference table is available under “Guidelines” at: http://www.cdph.ca.gov/programs/HSCR/Pages/default.aspx.

STATUTES
Applicable California statutes and legislation can be found under “Legislation” at: http://www.cdph.ca.gov/programs/HSCR/Pages/default.aspx.

The HSCR Program will also be mailing an informational letter to universities, review committees, and biomedical companies regarding reporting requirements and resources available on its website.

Washington Wire (What's Happening Regarding ART in DC)

Presidential election years often see federal policy making slow to a crawl. At the same time, however, the pace seems to increase in state capitals throughout the country. This issue of Washington Wire will not deal with Washington at all, but will share some of the developments from the states.

There are efforts in a number of states to codify some form of "life begins at conception/embryo rights" measures into state constitutions. The most pressing efforts seem to be in Colorado and Montana. In both of these states, the proamendment forces are gathering signatures in an effort to get the amendment on the ballot for the November elections.

In Montana, ASRM is participating in the opposition effort. The coalition there is working actively to discourage people from signing the petition in hopes of keeping the measure off the ballot. There are similar efforts at various stages in Mississippi, Michigan, Illinois, and South Carolina as well. At present, this movement does not appear to have the support of the most prominent of the anti-choice groups, which may make it more difficult for them to gather the resources they need to be successful, but they are still an important concern. Clearly, such amendments could constitute a serious threat to some practices in reproductive medicine. ASRM will pay close attention to these efforts and will keep you informed.

Georgia's legislature has tabled a proposed embryo rights amendment and is instead pursuing a bill titled, "The Human Embryo Protection Act" that 1) would make procedures other than straight egg/sperm combination IVF illegal, 2) would give "personhood" status to embryos 3) declares that embryos are not property and provides that if/when patients give up their parental rights to the embryos, the embryos must be made available for “adoption”, 4) sets standards for physicians and labs, 5) allows courts to appoint guardians for frozen embryos - at the request of doctors or progenitors, 6) and prohibits the intentional destruction of embryos. Despite providing all of these "rights" for embryos, the bill also makes it clear that they do not have inheritance rights until birth. More bills to control embryo disposition have been introduced in West Virginia, Indiana, and New Jersey.

West Virginia's bill prohibiting the destruction of embryos states plainly that the goal of the legislation is to enable an embryo to "live out its full life." The bill does not allow embryos to be moved out of state for destruction, but allows them to be moved to other facilities for preservation or transferred to married couples for "adoption." Indiana has a bill that would prohibit the destruction of an abandoned human embryo and would permit its "adoption." Other bills to control embryo disposition have been introduced in West Virginia, Indiana, and New Jersey.

New Jersey has also seen a bill introduced that would severely restrict ART services. It requires that the motivation for using IVF to create an embryo be the intention to implant it in a married woman's body. It prohibits the creation of more embryos than are reasonably expected to be transferred and prohibits the deliberate destruction of embryos. No research may be conducted on IVF embryos. If a couple with embryos decides not to use them (in the case of divorce or family completion), the embryos become wards of the state to be "adopted" out.

There have been various kinds of insurance mandate bills in Maryland, Minnesota, Rhode Island, Iowa, Tennessee and Virginia.

Minnesota is also again attempting to update its sperm donor law by substituting the word "partner" for "husband" and adding provisions to recognize the recipient of a donated egg as a parent. This measure has made some progress in previous years but never obtained final passage. As you can see, there are state legislators who would like to make it difficult for physicians to help patients build their families. The good news is that most of these bills will not move forward at all, let alone obtain final passage and become law. ASRM makes every effort to monitor and, when appropriate, weigh in on these measures. However, it is very difficult to do so with our limited resources. We urge all of you to stay involved in your states.

State Infertility Insurance Laws

If a state is not listed here, or if you have questions about insurance laws in your state, please call your state's Insurance Commissioner's office.

To learn about pending legislation in your state, please contact your State Representatives.

The Employment Retirement Income and Security Act of 1974 exempts companies that self-insure from state regulation.


Arkansas

This law requires all health insurers that cover maternity benefits to cover the cost of in vitro fertilization (IVF) Health maintenance organizations, commonly called HMOs, are exempt from the law. Patients need to meet the following conditions in order to get their IVF covered:
The patient must be the policyholder or the spouse of the policyholder and be covered by the policy;

The patient's eggs must be fertilized with her spouse's sperm;

The patient and her spouse must have at least a two-year history of unexplained infertility, OR the infertility must be associated with one or more of the following conditions:
Endometriosis;
Fetal exposure to diethylstilbestrol, also known as DES;
Blocked or surgically removed fallopian tubes that are not a result of voluntary sterilization; or
Abnormal male factors contributing to the infertility.

The patient has not been able to achieve a successful pregnancy through any other less costly infertility treatment for which coverage is available under the policy.

IVF procedure must be performed at a medical facility licensed or certified by the Arkansas Department of Health. Those facilities certified by the Department of Health must conform to the American College of Obstetricians and Gynecologists guidelines for in vitro fertilization clinics or meet the American Fertility Society's (sic) minimal standards for programs of in vitro fertilization.
The IVF benefits are subject to the same deductibles and co-insurance payments as maternity benefits. The law also permits insurers to limit coverage to a lifetime maximum of $15,000. (Arkansas Statutes Annotated, Sections 23-85-137 and 23-86-118).

California

The California law requires certain insurers to offer coverage for infertility diagnosis and treatment. That means group health insurers covering hospital, medical or surgical expenses must let employers know infertility coverage is available. However, the law does not require those insurers to provide the coverage; nor does it force employers to include it in their employee insurance plans.

The law defines infertility as:

The presence of a demonstrated condition recognized by a licensed physician and surgeon as a cause of infertility; or
The inability to conceive a pregnancy or carry a pregnancy to a live birth after a year or more of sexual relations without contraception.
The law defines treatment as including, but not limited to:
Diagnosis and diagnostic tests;
Medication;
Surgery; and
Gamete Intrafallopian Transfer, also known as GIFT.
The law specifically exempts insurers from having to offer in vitro fertilization coverage. Also, the law does not require employers that are religious organizations to offer coverage for treatment that conflicts with the organization's religious and ethical purposes. (California Health and Safety Code, Section 1374.55).
Connecticut
Individual and group health insurance policies are required to cover medically necessary expenses for infertility diagnosis and treatment. Infertility is defined as the inability to conceive or sustain a successful pregnancy during a one-year period.

Covered treatments include ovulation induction, interuterine insemination, IVF, uterine embryo lavage, embryo transfer, GIFT, ZIFT, and low tubal embryo transfer. Coverage is limited to individuals who have maintained coverage under the policy for at least a year.

Some additional limitations apply:

The covered individual must be under 40 years of age;

There is a life-time coverage maximum of four cycles of ovulation induction, three cycles of IUI, and two cycles of IVF, GIFT, ZIFT, or low tubal embryo transfer (with not more than two embryo transfers per cycle);

Covered treatments must be performed at facilities that conform to standards and guidelines developed by ASRM or SREI.

Individuals seeking coverage must disclose to their insurance carrier any prior infertility treatments for which they received coverage under a different insurance policy. Religious employers are permitted to exclude coverage for treatments that are contrary to their bona fide religious tenets. (Public Act No.05-196)

Hawaii
The Hawaii law requires certain insurance plans to provide a one-time only benefit for outpatient costs resulting from in vitro fertilization. Those plans include individual and group health insurance plans, hospital contracts or medical service plan contracts that provide pregnancy-related benefits. Patients need to meet the following conditions in order to get their IVF covered:

The patient's eggs must be fertilized with her spouse's sperm;
The patient or the patient's spouse must have at least a five-year history of infertility;
The patient has been unable to get and stay pregnant through other infertility treatments covered by insurance;
The IVF is performed at medical facilities that conform to standards set by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists; and
The infertility must be associated with one or more of the following conditions:
Endometriosis;
Fetal exposure to diethylstilbestrol, also known as DES;
Blocked or surgically removed fallopian tubes; or
Abnormal male factors contributing to the infertility.
(Hawaii Revised Statutes, Sections 431-lOA-116.5 and 432.1-604).

Illinois
This law requires insurance policies that cover more than 25 people and provide pregnancy-related benefits to cover costs of the diagnosis and treatment of infertility. The law defines infertility as the inability to get pregnant after one year of unprotected sex or the inability to carry a pregnancy to term.

Coverage includes, but is not limited to:

In vitro fertilization (IVF);
Uterine embryo lavage;
Embryo transfer;
Artificial insemination;
Gamete intrafallopian transfer (GIFT);
Zygote intrafallopian transfer (ZIFT);
Intracytoplasmic Sperm Injection (ICSI);
Four completed egg retrievals per lifetime; and
Low tubal egg transfer.
Coverage for IVF, GIFT and ZIFT is required only if:
The patient has used all reasonable, less expensive and medically appropriate treatments and is still unable to get pregnant or carry a pregnancy;
The patient has not reached the maximum number of allowed egg retrievals;
The procedures are performed at facilities that conform to standards set by the America Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists.
The law exempts religious organizations which believe the covered procedures violate their teachings and beliefs. (Illinois Compiled Statutes Annotated, Chapter 215, Sections 5/356m and 125/5-3).

Maryland
The Maryland law requires health and hospital insurance policies that provide pregnancy-related benefits to also cover the outpatient costs of in-vitro fertilization. Policies that must provide the coverage include those covering people who live and work in the state, regardless of whether the policy is issued inside or outside the state. HMO's must provide IVF benefits to the same extent as the benefits provided for other infertility services.

Patients need to meet the following conditions in order to get their IVF covered:

The patient's eggs must be fertilized with her spouse's sperm;
The patient is unable to get pregnant through less expensive covered treatments;
The IVF is performed at facilities that conform to standards set by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists.
The patient and his or her spouse must have at least a two-year history of infertility; OR their infertility must be associated with one or more of the following conditions:
Endometriosis;
Fetal exposure to diethylstilbestrol, also known as DES;
Blocked or surgically removed fallopian tubes; or
Abnormal male factors, including oligozoospermia.
Coverage may be limited to three in vitro fertilization attempts per live birth and a maximum lifetime benefit of $100,000.
A religious organization may, by request have this coverage excluded from its policies and contracts if the required coverage conflicts with its bona fide religious beliefs and practices.

Regulations that took effect in 1994 exempt businesses with 50 or fewer employees from having to provide the IVF coverage. (Maryland Insurance Article §15-810, Health General Article §19-706).


Massachusetts
This state's law requires health maintenance organizations and insurance companies that cover pregnancy-related benefits to cover medically necessary expenses of infertility diagnosis and treatment. The law defines infertility as "the condition of a presumably healthy individual who is unable to conceive or produce conception during a one-year period."

Benefits covered include:

Artificial insemination;
In vitro fertilization;
Gamete Intrafallopian Transfer;
Sperm, egg and/or inseminated egg retrieval, to the extent that those costs are not covered by the donor's insurer;
Intracytoplasmic Sperm Injection (ICSI) for the treatment of male infertility; and
Zygote Intrafallopian Transfer (ZIFT).
Insurers may, but are not required, to cover experimental procedures, surrogacy, reversal of voluntary sterilization or cryopreservation of eggs. (Annotated Laws of Massachusetts, Chapters 175,§ 47H; 176A,§8K;176B,§4J; and l76G,§4, 211 CMR 37.00).
Montana
This state's law requires health maintenance organizations to cover infertility services as part of basic preventive health care services. The law does not define infertility or the scope of services covered; nor did the state ever draft regulations explaining what infertility services entail.

As for health insurers other than HMOs, the law specifically excludes infertility coverage from the required scope of health benefits those insurers must provide. (Montana Code Annotated, Sections 33-22-1521 and 33-31-102).

New Jersey
The Family Building Act requires insurance policies that cover more than 50 people and provide pregnancy-related benefits to cover the cost of the diagnosis and treatment of infertility. The law defines infertility as the disease or condition that results in the inability to get pregnant after two years of unprotected sex (female partner under the age of 35) or one year of unprotected sex (female partner over the age of 35) or the inability to carry a pregnancy to term.

Coverage includes, but is not limited to:

Diagnosis & diagnostic tests

Medications

Surgery

In vitro fertilization (IVF)

Embryo transfer

Artificial insemination

Gamete intra fallopian transfer (GIFT)

Zygote intra fallopian transfer (ZIFT)

Intracytoplasmic Sperm Injection (ICSI)

Four completed egg retrievals per lifetime

Coverage for IVF, GIFT and ZIFT is required only if:

The patient has used all reasonable, less expensive and medically appropriate treatments and is still unable to get pregnant or carry a pregnancy;

The patient has not reached the maximum number of allowed egg retrievals and the patient is 45 years of age or younger.

The procedures are performed at facilities that conform to standards set by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists.

The law allows religious organizations to request an exclusion of this coverage if it is contrary to the religious employer's bona fide religious tenets. (New Jersey Permanent Statutes: 17B:27-46.1X Group Health Insurance Policies; 17:48A-7W Medical Service Corporations; 17:48-6X Hospital Service Corporations; 17:48E-35.22 Health Service Corporations; 26:2J-4.23 Health Maintenance Organizations)

New York
Insurers are required to cover the diagnosis and treatment of correctable medical conditions and shall not exclude coverage of a condition solely because the medical condition results in infertility. Private, group health insurance plans, issued or delivered in the state of New York providing coverage for hospital care or surgical and medical care are required to provide coverage for the diagnosis and treatment of infertility for patients between the ages of 21 and 44, who have been covered under the policy for at least 12 months. Certain procedures are excluded from this requirement, including IVF, GIFT, ZIFT, reversal of elective sterilization, sex change procedures, cloning, and experimental procedures. Plans that include coverage for prescription drugs must include coverage of drugs approved by FDA for use in diagnosis and treatment of infertility. (New York Consolidated Laws, Insurance, Section 3221(k)(6), Section 4303(s).)

Ohio
Ohio's law requires health maintenance organizations to cover basic preventive health services, including infertility The Ohio Insurance Department has no written definition of infertility services, but states that the procedure must be medically necessary. Experimental procedures are not covered. (Ohio Revised Code Annotated §1751)

1742 was repealed and replaced and the $2,000 General Interpretation no longer applies.

Rhode Island
The Rhode Island law requires insurers and HMO's that cover pregnancy services to cover the cost of medically necessary expenses of diagnosis and treatment of infertility. The law defines infertility as "the condition of an otherwise healthy married individual who is unable to conceive or produce conception during a period of one year." The patient's co-payment cannot exceed 20 percent. (Rhode Island General Laws (§ 27-18-30, 27-19-23, 27-20-20 and 27-41-33).

Texas
This state's law requires certain insurers that cover pregnancy services to offer coverage for in vitro fertilization. That means insurers must let employers know this coverage is available. However, the law does not require those insurers to provide the coverage; nor does it force employers to include it in their health plans. Patients need to meet the following conditions in order to get their IVF covered:

The patient must be the policyholder or the spouse of the policyholder and be covered by the policy;
The patient's eggs must be fertilized with her spouse's sperm;
The patient has been unable to get and stay pregnant through other infertility treatments covered by insurance;
The IVF is performed at medical facilities that conform to standards set by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists; and
The patient and her spouse must have at least a continuous five-year history of unexplained infertility, OR the infertility must be associated with one or more of the following conditions:
Endometriosis.
Fetal exposure to diethylstilbestrol (DES);
Blocked or surgical removal of one or both fallopian tubes; or
Oligospermia
The law does not require organizations that are affiliated with religious groups to cover treatment that conflicts with the organization's religious and ethical beliefs. (Texas Insurance Code, Article 3.51-6).

West Virginia
West Virginia's law requires health maintenance organizations to cover basic health care services, including infertility services, when medically necessary. The West Virginia Insurance Commissioner does not define infertility services. (West Virginia Code §33-25A-2)

Disclosure can be tricky for Egg Donor and Sperm Donor Parents

Original post by: Theresa M. Erickson

By Patricia Wen | The Boston Globe March 12, 2008 MEDFIELD, Mass. - Cara Birrittieri is set to have a talk with her 3-year-old daughter soon, something that has been on her mind since Victoria was just a fetal ultrasound image.

“Part of me wishes I didn’t have to tell her,” Birrittieri said. “The love is so intense for this kid — I mean, she is mine.”

Yet in the months to come, Birrittieri plans to explicitly tell Victoria the way in which she also is part of another woman, a graduate student in her 20s who donated the egg that helped create the preschooler. This particular version of a child’s origins is so complicated, and sometimes so painful, that some parents never try to explain it.

“It’s easier not to tell,” said Birrittieri, a 48-year-old former television health reporter. “Most women go through hell with infertility, and this was their last chance. Rather than grieve the loss of the child they didn’t have, they make this child that child.”

44% don’t plan to tell

Research shows that as many as 44 percent of parents who used egg donors have no plans to tell their children the truth about their origins, a figure that surprises psychologists and fertility specialists who had expected a higher rate of disclosure at a time when openness is encouraged about such matters.

“The technology is so far ahead of the psychology,” said Alice Domar, a psychologist and director of the Mind-Body Center for Women’s Health at Boston IVF, the state’s biggest fertility clinic.

Therapists surprised

Therapists say they know these talks with children are never easy, and must be done slowly in age-appropriate ways, but they had assumed parents using egg donation would want to be open, embracing the latest psychological wisdom as easily as the newest technologies.

The most current thinking about disclosure comes from vast research done on adoption and sperm donation, two of the most common options used to address infertility. Researchers found children kept in the dark about their origins often felt betrayed when they later learned the truth, and more so, if they discovered accidentally through a relative or family friend.

Also, given the mounting evidence about the powerful role of genetics in health, many psychologists say children have a right to know their medical history.

Still, even as psychologists advise openness, many parents who used the latest in egg-donation technology have no plans to tell their children, citing the complexity of the narrative, a desire to protect the child from being seen as a “science fiction” curiosity, or a belief that it remains a deeply private family issue.

Some mothers who gave birth and nursed the child are reluctant to tell their child anything that diminishes their role as the mother.

A 2005 study of 148 couples who used a West Coast infertility clinic for egg donation found that 27 percent had already told their children; 53 percent had not yet disclosed but said they would at some point in the future; 12 percent did not plan to tell; and 8 percent remained undecided.

A 2004 study of British parents who used egg donors found that 56 percent planned to tell their children, while 44 percent had decided against telling or were undecided. Researchers say there is a shortage of reliable data because many parents using egg donation decline to participate in studies.

A 52-year-old former Waltham resident said he and his wife have no plans to tell their 7-year-old son that he was conceived with his father’s sperm and a donor egg, largely because they don’t want to upset him with a hard-to-understand story.

No second mother

The father, who asked that his name not be used to protect his family’s privacy, also said his wife does not want to introduce the image of a potential second mother.

“She wants to keep the status,” he said. “She’s worried that talking about the egg donation will change her status.”

Explaining egg donation to a child is not easy. In talking to Victoria, for instance, Birrittieri will have to explain that her womb nourished another woman’s egg, which had been fertilized with Birrittieri’s husband’s sperm.

Additionally, she will have to explain to Victoria that her 8-year-old brother has a simpler story: He is the product of both of his parents’ genes.

Birrittieri, who has written a book about a woman’s biological clock, couldn’t conceive a second time.

Other factors may also discourage disclosure, including religious considerations. The Catholic Church, for instance, opposes high-tech fertility procedures, including egg donation.

Several fertility organizations are trying to coax prospective parents into confronting the issue earlier in their child-raising years.

Advice available

Two years ago, the Society for Assisted Reproductive Technology put out an ethics paper encouraging parents using egg donors to tell their children. In the last five years, nearly a dozen books have been published helping parents to explain egg donation to their children, or to better understand their own post-birth emotions.

Last summer, Resolve of the Bay State, a fertility group, held a seminar, “Talking with Children about Their Origins,” for prospective parents, and similar events are planned, said Rebecca Lubens, head of the group.

A 51-year-old Cambridge woman, who gave birth to twins through egg donation, has used a Dr. Seuss book, called “Horton Hatches the Egg,” to explain their entry into the world. When asked how they came to be, she tells her twins, “Mom had a helper.”

July Dates For New York Egg Donor Support

July 8-Contact JGalst@aol.com to participate in AFA-sponsored phone conference on parenting children conceived with donor gametes. Patricia Mendell co-moderating, 9-10pm. I am signed up and as of this morning there is still room to join.

July 14-Womerns midtown dinner, 5:30-7:30pm.

July 17-Long Island Resolve Peer Support Group Meeting-6-8pm in Westbury with Therapist Janet Mueller moderating and Coffee at Panera afterward.

Please contact Sara via email at saxel95@aol.com or 516-967-7430 for more info.