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The Parents Via Egg Donation Organization: January 2012

Monday, January 30, 2012

Journey of a Donor Gamete Mom

I just put my kids to bed.  I can hear the twins playing instead of sleeping and our daughter is reading the book we gave her for her birthday.  She turned eight years old today.  I can’t believe the time has gone this quickly.  I can’t believe all three of those little miracles are mine.  I can’t believe the journey that got us here.  And most importantly, I wouldn’t trade any of it for anything in the world.
I remember the near panic with each failed month when trying to conceive our daughter.  I look back at the audacity of being deeply depressed because it took seven whole months to conceive her.  Afterall, we were using ovulation sticks and I was only 31.  But an unsubstantiated fear of infertility had plagued me since my mid-twenties, so each unsuccessful month seemed to confirm that fear.  Yet seven months was all it took and the following nine months were pure bliss.  The only thing nauseating about that pregnancy was how unbelievably perfect it was.  I was the kind of pregnant woman that all other women hate: healthy, radiant, never felt better.  My husband and I relished every minute of it and the end result was, and continues to be, equally as perfect.  My fear had been banished and replaced with a new arrogance; I believed myself to be a gestational goddess.
One year passed and we celebrated the first birthday of our beautiful child.  Dizzy with joy, we began family expansion efforts.  This time it only took one month to get pregnant.  Of course this seemed entirely natural.  And why shouldn’t it?  I had recently proven that I was good at pregnancy, that I enjoyed hosting a human in my womb, that my belly is a good place to grow people.  So I didn’t take it too seriously when the spotting started a few weeks later.  The subsequent bleeding, however, caught my attention.
An early sonogram revealed an empty yolk sac, a molar pregnancy.  But there was some optimism that a fetus may yet develop as it was still quite early in the pregnancy.  However, serial labs confirmed a failing gestation and a surgical D&C was scheduled.  Strike one to my inflated fertility ego and empty womb.  One year and several ovulation kits later, the entire scenario repeated with the exception that the bleeding started sooner and the structures of pregnancy were even more disorganized.  The pain of a second surgery to evacuate my uterus was matched only by the pain of that second blow to my child bearing dreams.  My medical chart was stamped “recurrent miscarriage” and I was forever relegated to the other side of the waiting room, the side for reproductive medicine patients.  Oh, how the tides had turned with no room for audacity, arrogance, or assumption.  All that remained was sorrow, emptiness, and a little bit of hope.    
And so began the litany of tests and frantic research.  It would be weeks before we received all the labs results, providing me ample opportunity to scour the net.  I became a home-grown expert on recurrent miscarriage and infertility.  I learned about Factor V Leiden, MTHFR, X-linked recessive disorders, and various treatments such as heparin and IVIG therapies.  Some labs such as thyroid and prolactin hormone levels provided immediate results: negative for any deviation.  Some others, responsible for diagnoses that are typically more difficult to treat, took considerably longer: also negative.  The tests that required DNA analysis of both me and my husband, precursors to the most difficult and sometimes untreatable diagnoses, came back last: positive.  It seems that my husband and I both carry a particular immune marker known as DQ alpha allele 1.2.  Throughout my weeks of research this was the only diagnosis that made sense given my reproductive history and types of miscarriages I endured.  I knew in my heart, in my soul, in my womb that this was going to be our diagnosis.  But it still didn’t prepare me for the emotional devastation of hearing it from our infertility doctor.  Every part of me ached; every part of me wailed.
There are zero, yes I said zero, reported cases of second live births for couples like us.  Although I carried our daughter successfully, that gestation served as the initial exposure which triggered my immune system to produce antibodies against any subsequent children bearing our troublesome allele.  Since we both carry this dominant marker, there is no chance of conceiving a child without it.  Each pregnancy that followed prompted and actually strengthened my immune response, further guaranteeing the failure of the next.  The good news: I apparently have a killer immune system.  The bad news: those were our children and dreams that it killed.
Again, there is yet to be a single successful treatment that would allow me to carry another child genetically linked to us.  Thus, our options were few and complex: enlist a friend or family member to be a host uterus to our genetic offspring, carry a pregnancy myself with a genetically unrelated child, conventional adoption, or resign ourselves to the idea of not having any more children.  Knowing immediately that the latter was not an option we would even begin to consider, we began to examine the other three. 
Our belief that a family is created by love and  shared experiences, not genetics, coupled with our desire to enjoy another pregnancy made the option to carry a child genetically unrelated to us the obvious choice.  However, we did not start with donor gametes.  Rather, we tried adopting donor frozen embryos.  Despite greatly reduced success rates in comparison to fresh embryos, this was our initial chosen route.  Finally, our optimism returned and we were once again excited about our family planning options.  Sadly, three unsuccessful transfers over the course of six months shattered our hopes.  Once again, we were down---way down, but not completely out.
Our determination remained strong, but our emotional stability was waning.  There are a finite number of times a couple can sustain this type of heartbreak.  Maybe we didn’t fully deserve to feel such despair since we were among the minority of infertility patients with the good fortune of already having a child.  But watching our one child mope around the backyard all alone, wanting to give her the gift of a sibling, wanting to give another child the gift of knowing her only served to heighten our sorrow and desperation.  It was time to get off this roller coaster, to better our odds, to lay it all on the line.  We decided to progress to IVF with fresh embryos using both donor sperm and donor eggs.
We selected our sperm donor from a bank immediately and waited patiently for nine months until an anonymous egg donor became available.  A few weeks after signing the appropriate consent forms, things started moving forward.  Our egg donor and I both began our hormone injections and frequent monitoring to sync our cycles.  Egg harvest day was met with cautious optimism on high alert, as the egg count was unusually low.  But they were lovely eggs, so we pressed on.  Fertilization results in the lab were 100%.  Embryo progression results in the lab were at 75%.  All three surviving embryos were transferred into me three days after harvest and we began our twelve day wait to check for the first clinical indications of successful implantation---again, cautious optimism on high alert.
It had been two and a half years since our first miscarriage by the time our perseverance was finally rewarded.  I was pregnant, very pregnant with twins.  I wish I could say that my second viable pregnancy went as smoothly as the first, but neither the pregnancy nor the delivery were without serious complications.  All of that is irrelevant though, as our sons finally arrived healthy, happy, and ready to receive the love that mother, father, and sister had been waiting so long to share.      
So that is the story of our family, a family of which I am tremendously proud.  Our particular story may be uncommon, but family development in which members do not share a common genetic history is not.  Families of differing genetic backgrounds are created every day through varied means: adoption, foster care, second marriages/relationships, donor gametes, and surrogacy.  And each and every one of these families is valid.  We have one child who shares our DNA and two who do not; but make no mistake, they are all our children.    
Although our family expansion endeavors are complete, our journey is not.  To quote Carole Lieber Wilkins, M.F.T., we have an obligation to be “fierce protectors and advocates for the family we created and how we created it.”  I have authored a children’s book to help other genetically diverse families begin discussions with their children.  Birds of a Different Feather is designed to foster self-esteem by illustrating the joy children impart on their families while encouraging them to embrace their personal identities and means of family inclusion.  This book is featured, endorsed, and distributed by PVED.  To learn more, please visit:  www.kelleywendel.tateauthor.com   
-----  Kelley Wendel, RN, BSN, & most importantly, MOM

Saturday, January 28, 2012

My Response to the Dr. Oz Show: Is 40 Too Old To Have A Baby?

I have been asked over and over again to weigh in on this topic and so here I am. This is going to be a long rant of sorts so please hang in there with me.

Please realize I am not a doctor. Nor am I a nurse. I am just a mom via egg donation who's followed literally thousands of women over 40 who have had children via third party reproduction over the past 15+ years.

First of all while I love Dr. Oz, and he's a doctor he's a cardiac surgeon, a personal friend of Oprah, and cardiac medicine is his specialty and expertise. Secondly, I spoke to the producers of their show as they contacted me for information about third party reproduction and namely what my opinions were about women over 40 having children, and they didn't get the sensationalism from me as they wanted. While they were kind and gracious it was clear I wasn't going to help them with ratings because I don't think there's anything wrong with having a child via egg donation, OR being over 40.

Thirdly, Dr. Oz is not a fetal maternal medicine specialist, a GYN, OR a Perinatologist. These guys aside from being medical doctors undergo about 3 years of additional specialized training. Much like Dr. Oz did when he became a cardiac surgeon. Perinatologists train in learning to assess and manage of higher risk pregnancies that may or may not have to do with age of the mother. Women who have special medical issues like heart disease, kidney disease, diabetes, blood clotting disorders, previous miscarriages, still births, preterm labor, multiple pregnancies, high blood pressure and yes being over 40.

I wouldn't for instance take the advice of my RE about a cardiac issue I might have, nor would I go to a Neurologist if I had a toothache - nuff said about that.

Last but not least -- Any of your talk shows are going to sensationalize issues. Today it's being pregnant over 40, tomorrow it's going to be the latest diet or botox treatment. I think last year it was all about being obese, weightloss, and gastric bypass. The year before it was sexual abuse, and drug addiction. Oprah was famous for those kinds of topics. While I think it's great to have information out there, it annoys me to no end when they make everything scary.

Pregnancy regardless of your age is not easy -- people under the age of 40 have complications every single day. Before the age of 35 I had experienced 9 miscarriages, with my first occurring at the tender age of 22. Labor and delivery is the equivalent of a 1/2 marathon or running about 13 miles. It's hard for a reason -- pushing a bowling ball out of your vagina can't be easy for anyone -- and we all know if men had children, each family would have one child - right?

Are women more apt to have more complications after the age of 40 regarding pregnancy. Sometimes yes, and sometimes no.

Centuries ago we didn't live much longer than our 40s and 50s and we haven't changed the basic biology of how our ovaries and uterus work. That's why third party options are helpful for those of us who are choosing to have children after the age of 40. However, we are living longer now, much longer, with the help of science.

Over 40 you are at higher risk of developing certain complications during pregnancy – like gestational diabetes, preeclampsia, placental abruption (in which the placenta prematurely separates from the uterine wall), and placenta previa (in which the placenta lies low in the uterus, partly or completely covering the cervix). These things are supported by hard data, it's just the way it is. We also know that studies some that older mom's sometimes may need pitocin during labor and we have a higher rate of C-sections. Research shows as well that we sometimes have smaller babies than those under 35.

Now while I get that all of this can sound super scary but what the studies don't know and haven't taken into account is if those mom's took good care of themselves, if they received the right kind of prenatal care, etc.. And my guess is (again I am NO DOCTOR) if you take care of yourself and get the right kinds of care having a baby should be like those women who are under 35.

Please do not get me started on Jennifer Lahl. Jennifer Lahl is not a doctor. She was a pediatric critical care nurse in California. She feels passionate about those who don't have a voice. She is very critical of ART - she even made a documentary called "Eggsploitation" to support her argument that egg donors face health risks and are not told about those risks by the infertility professionals. Some say she has a religious bias against ART and many disagree with her about the idea that egg donors are exploited.

The bottom line -- regardless of how old you are when you conceive and have a baby proper prenatal care is a no brainer. We all know that. We don't live in the pioneer days when there was no prenatal care to be had. And for goodness sakes if you create your child through IVF or ART -- you can bet your bippy you are going to be seeing more than one doctor.

Don't let talk shows like this or society for that matter dictate to you what's right for your body or your family. At the end of the day these are personal decisions that are to be made by you and your doctor.

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Sunday, January 15, 2012

The Role Of A Therapist During A Donor Egg Cycle

This essay was written by Carole Lieber Wilkins, Licensed Marriage and Family Therapist in private practice in West Los Angeles. A specialist in the field of reproductive medicine, adoption and family building options since 1986, she became a founding member of Resolve of Greater Los Angeles in 1987 and served on the Board of Directors in various positions for the next 14 years.

Carole is first and foremost a mother via egg donation and adoption. Carole is also an active member of The Mental Health Professional Group (MHPG) which is a part of ASRM. This group is a multidisciplinary group that formed in 1985 with the full support of the American Society for Reproductive Medicine (ASRM). Its mission is to promote scientific understanding of the psychological, social, and emotional perspectives of infertility patients

During a discussion about the roles therapists fulfill with intended parents during DE cycles Carole took the time to write an essay talking about what exactly that role is.
- Marna Gatlin

I have been meeting with patients pursuing gamete donation, embryo donation, and surrogacy for many, many years. I don't call them, nor do I consider them to be evaluations or assessments, despite the fact that the clinics do tell patients they need a “psychological evaluation” before proceeding. My attempt to educate clinic staff has not been successful in changing their language, thus, patients often come in defensive and angry. I attempt to put them at ease immediately by telling them the meeting is not an evaluation and it is not my job to decide whether or not they are worthy of becoming parents. Their response is visceral. Shoulders drop, faces relax, and they breathe. Then we can proceed.

I tell patients I see my role as educative in two ways: to talk about the ways in which building a family thru gamete donation is DIFFERENT from having a family the easy and inexpensive way; and to play the role of child advocate.

I tell patients that I try to represent the only person in the family building equation who has no vote, but is the sole reason for the endeavor—the unborn child. The children resulting from all the procedures have no voice in how it all happens, (as no children have a vote in how they are conceived.)

I try to put a spin on what we DO know about how individuals feel who come into families thru donor conception, surrogacy, etc., regardless of the single/married, gay/straight constellation of the family.

We DO know some things that make healthy families and we DO know now from studies of DE and DS offspring how people feel about their means of conception and all that goes with it.

We DO know that it is normal and common for people to grieve the loss of a genetic link to an offspring.

We DO know how most infertility patients feel after being in treatment for a period of time.

Many have recently written about “the brave new world” we are involved in, but I wonder when it will stop being a brave new world. Yes, the stakes keep getting higher as technology tests our ethical boundaries of what can be done, but should it be done. However, surrogacy is now 30 years old. Donor sperm has been around forever and the first child born thru egg donation is now 27. Many people now have “children” through gamete donation who haven’t been children in a long time. In fact, some parents through gamete donation are now grandparents. It’s not that new and we DO know many things to be true.

With some exceptions, the report I send to a doctor reflects the discussion of the many complex issues that accompany complicated family building. Gamete donation families are special needs families, as are adoptive families, and many other kinds of families. This requires unique preparation and knowledge. Special needs are not bad; they’re just special, aka “a little extra.” I call it parenting plus. These families have all the stuff “regular” families have, with a healthy dose of EXTRA.

Even in a brief consultation, we can get a rough idea of whether there is psychopathology (vs. neurosis, thank goodness, or surely most of us would have never become parents), substance or spousal abuse or other issues that would make us significantly concerned about bringing a child into the household. In those cases, I recommend further counseling or whatever is needed. But most of the time, I think, our patients are as unqualified to parent as anyone off the street, only now, because they have been required to see us, they are much better educated about certain aspects of family building and parenting.

When patients leave my office, I hope they have more questions than when they walked in.

I hope they are thinking about gamete donation differently than when they resentfully made the appt. (if required by physician).

I hope they no longer think gamete donation is no big deal.

I hope they are thinking about what it would be like to grow up in a home where your parents didn’t have enough respect to tell the truth about who you are, or where parents were too scared to tell the truth.

I hope they think about the fact that it won’t matter what other people say about gamete donation as long as they as parents are fierce protectors and advocates for the family they created and how they created it, thereby claiming children as one’s own.

I hope my patients leave my office knowing that infertility is a lifelong disease that goes into remission for long periods of time, and then springs up again at the least expected moments.

I hope my patients leave my office armed with the response to the dreaded exclamation:
“I don’t have to listen to you because you’re not my real mother!!”

I want them to leave my office having shifted from being terrified their kid will someday say that to them, to looking forward to it because they are prepared and ready to help guide their child through the muddy waters of trying to figure out who they actually are.

All that in an hour? We do what we can with what little we are given.

Carole LieberWilkins, M.F.T.
Los Angeles, CA
(310) 470-9049

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