How Do Fertility Patients Feel About Donor Anonymity?

I work in a medical field that is ripe with controversy at times. There's nothing casual about helping people try to create life. But I try to avoid bringing a sense of alarm to my patients, even when the news headlines are worrisome. I do think there's a place for staying updated, though, when the news is about laws that may find their way into how I practice reproductive endocrinology and how my patients' treatments will be impacted.

The most recent such item is a state law that's about to bump up against the way things are often done for patients who need third-party reproductive treatment. Later this month, the state of Washington will enact a law that chips away at the anonymity of egg and sperm donors.

Now, most fertility specialists and their patients have been sharing medical history from their egg and sperm donors. It makes good common sense in light of what we know about genetic transmission of many things. If you have a baby using an anonymous donor's sperm or eggs, you likely at least want to know if there are potential medical conditions that may show up in your child. But the sharing of identifying information about donors has long been handled case-by-case, depending on the needs and comfort level of the donors and the fertility patients.

The Washington state law requires that anyone who donates eggs or sperm must provide both medical history and identifying information. Also, children born from third-party reproductive techniques will now be allowed to obtain the donor's information from the fertility clinic once the child becomes 18 years old. However, donors can file a disclosure veto with the clinic that prevents the identifying info from being revealed to the offspring; only the medical history is mandated to be disclosed on request.

This is a first in the United States, but it's not a surprise. Adult donor offspring over the past few years have been gathering to make their needs known. In some countries, donor anonymity is already a thing of the past. America has been slow to legislate these unique and intimate relationships. Those of us impacted by such laws -- fertility specialists, patients, and their families -- will be watching with interest to see if Washington state encounters some of the challenges that have resulted in other nations, most notably a serious decline in the number of available sperm and egg donors. In the meantime, I will continue serving my patients' best interests by providing access to the highest quality fertility care available, including third-party reproductive technology.

~ Dr. Sonja Kristiansen MD

Here's what Huffington Post blogger Naomi Cahn had to say about the new law and its potential repercussions: The Biological Clock -- for Donor-Conceived Offspring?

Disney and I Both Hope You Won't Need My Services

The other day I saw a headline that really pulled me in -- "Disney/ABC Television Group Sponsors The American Fertility Association's Infertility Prevention Program".

The combined images of Disney and infertility were curious, indeed. When was the last time you thought about Mickey Mouse and fertility problems at the same time? But that odd juxtaposition is actually the result of positive progress in terms of fertility education.

Truth is, as a mother and physician, I hope you don't need the services of a fertility specialist, now or later. But another truth is explained in this recent blogpost on EmpowHer, "STDs and Infertility", where the author, Stacy Lloyd, explains how some young women are destined for infertility down the road. And it's those facts that make me smile when I read about Disney/ABC TV granting funds to the American Fertility Association (AFA).

The AFA works hard to not just support men and women who are struggling with infertility, but also to educate everyone about the realities of normal fertility. When young people arrive at the point in their lives when having a baby feels like the right thing to do, some are shocked to find that, all along and without their knowledge, their bodies have built up roadblocks against conception. Programs like the AFA's "Infertility Prevention Handbook" and their outreach gatherings at a broad variety of venues (even manicure salons!) can spread the message that steps can be taken before infertility is a fact in someone's life.

Since Disney definitely brings to mind "family", I think it's fitting that the corporation supports efforts at keeping couples from having to consult fertility specialists in the future.

You can find out more about the AFA at their website.

IVF Works for Hispanic Women, Too

Many of my patients may be relieved to hear this piece of research news from a colleague in San Antonio: Hispanic women are just as successful with IVF as are non-Hispanic anglo women.

There's no particular reason to believe otherwise, but a previous nationwide study that compared IVF success rates among women of multiple ethnicities showed that Hispanics were 13 percent less likely to have a baby following the procedure. They were, however, just as likely to get pregnant via IVF as anglo women.

The newer study is smaller and included only patients at one clinic. Also, nearly all the Hispanic study subjects were Mexican-American, unlike the larger, national study. It also showed that while getting pregnant is comparable in terms of percentages, Hispanic women were more likely to miscarry, although the researcher, Dr. Robert Brzyski, says that's likely a chance occurrence.

Of particular interest is the clear difference in cause of infertility between whites and Hispanics. White women had more endometriosis and Hispanic women were more often diagnosed with tubal factor infertility.

Tubal blockages and resulting infertility were the original reason for IVF being invented. As long as other factors aren't impacting a woman's chances for pregnancy success, using IVF to work around tubal factor infertility is very effective.

Like Dr. Brzyski's practice, Houston Fertility Center is in the middle of a richly diverse metropolitan area. With Spanish-speaking staff and educational efforts within the Hispanic community, we provide every opportunity possible to bring home the message to women that infertility is treatable. I'm happy to be able to add this piece of good news to our message.

~Sonja Kristiansen, M.D.

There's Something Special About Fathers-To-Be

I've worked for many years to help couples finally achieve their dreams of parenthood. As Father's Day approaches this year, I'd like to tell you what I think about the men who come into Houston Fertility Center. They arrive, nearly always with the other half of their team (wives or other partners), sometimes with great anticipation, but more often hesitantly.

I just can't say enough about how important it is that they are there, in my consultation office, sometimes in the exam room (depending on the couple's circumstances), learning how to give injections to their loved ones, sticking their own arms out for blood draws, enduring rather embarassing semen analysis, and just being a part of the team in general.

Hopefully by now everyone knows that infertility isn't "a woman's problem," that it's a situation resulting from many different conditions, statistically dispersed equally between men and women. There's virtually no good reason for a woman to go through infertility testing alone.

And no matter how forward-thinking and sophisticated and educated we are, it's still more difficult for men to discuss infertility -- especially with someone other than their partner -- than it is for women.

So here's to you, guys. Thanks for being part of the process and an active team player. We truly couldn't do what we do for the women you love without you.

If you're into social media, here's a treat for you guys: On Friday, June 17th at 2pm ET, RESOLVE is hosting a special Twitterview (sort of like a Q&A session by tweet) with Alec Ross, blogger at I Want To Be a Daddy.

Here's where you can get all the details on the Father's FriDay Twitterview -- http://www.mydestinationfamily.org/fathers-day-twitterview/

Happy Father's To Be Day,
~Sonja Kristiansen M.D.

Celebrate Fertility Freedom

The Memorial Day weekend brings to mind time off from work and fun in the sun. It's also a time to remember those who sacrificed so we could enjoy that freedom. If infertility's a part of your life, it might be tough to conjure up this feeling of freedom -- but if you look closer, you'll see it.

Did you know that in some countries, egg and sperm donors are required to reveal their identity throughout the process? Since anonymity is what many prefer, the result of such laws is far fewer donors and fertility patients who must travel internationally just to get pregnant.

Even tighter restrictions exist in other nations where donor eggs are simply not allowed to be used for fertility treatment. Just imagine -- the only options available for these women is adoption, unless they travel to access IVF.

Just as incredible: freezing excess embryos is of questionable legality in some places. Imagine being lucky enough to create many embryos in an IVF cycle, but the law requires you transfer them all, increasing your already upped chances for multiples to dangerous proportions.

The United States continues to demonstrate leadership in the championing of individual rights, and this includes the health care arena. Fertility treatment is a highly personal choice and, so far, it's still very much up to the patient and her physician to decide which treatments to use and when. You can find out about the services we're free to offer at Houston Fertility Center's website, http://CallDrK.com.

Have a great weekend, knowing you're free to choose fertility treatment and make other decisions that are right for your life.

~Sonja Kristiansen, M.D.

15 Is Magic Number?

Last February, I wrote that there's no magic to getting pregnant. That post was specific to "miraculous" fertility supplements. Well, now the news is full of "magic" again. This time, it's a Magic Number.

It's 15.

What kind of magic does the number 15 do for infertile couples?

A study that looked at 17 years worth of data concluded that 15 eggs retrieved in one IVF cycle renders the best chance of a live birth. Retrieving more eggs than that was linked to higher incidence of ovarian hyperstimulation syndrome.

The study authors failed to clarify that they were looking at conventional IVF cycles, not at cycles using very minimal or no ovulation stimulation medication. They did, however, tease out and present their findings related to the different ages within the study subjects. Specifically, the number 15 (eggs) did not make the live birth chances for women over 40 much better than otherwise. But as this article in the Globe and Mail suggests, a chance of live birth boosted by 4 percent might be inspiring to fertility patients older than 40.

I would remind patients that this is statistics, although well done. I worry about patients hearing these sorts of numbers and feeling stressed because theirs haven't "hit". As with so many aspects to treating infertility, your mileage may vary. We do everything possible to make each cycle safe *and* effective, and always, the outcome -- a healthy baby -- is our focus.

Tis the Season For Donor Eggs: Fresh or Frozen Work

In our minds, the concepts of fertility and eggs go hand-in-hand -- especially this time of year. Now, there's some very good news for those who want to either preserve their fertility for the future or otherwise have a Plan B in the freezer for subsequent treatment cycles.

Research performed in the nation of Cyprus has concluded that frozen donor eggs are just as likely as fresh to have a pregnant outcome.

Freezing sperm for later use is almost fool-proof, it's been done for so many years. Likewise, freezing embryos has become a far smoother process that ends in success more often than not. Freezing eggs, on the other hand, has been a challenge.

I've spoken often about the use of egg cryopreservation technology -- the tricky nature of the egg cell that makes the freeze-thaw processes so tenuous, and the hope that comes with improvements on the technique. In 2008, I was interviewed by Houston Business Journal about the intersection of related advanced reproductive technology and society. The ASRM has long been pleased to hear of frozen eggs being used for women prior to cancer treatment, but they've been slow to agree on the technique's use for women who aren't preserving fertility in the face of life-threatening illness.

Now, a new subset of patients are given hope by frozen eggs -- women who must use a donor's eggs to conceive a child.

Arriving at "Honey, I think we need to use donor egg to get pregnant" comes only after some serious thought about very tough topics. Women who've gone through menopause prematurely in life -- a huge psychological burden itself -- and older women who've deferred pregnancy find themselves giving thought to what most people don't have to: "I can either have a child who isn't genetically related to me, or not at all."

Using donor egg to get pregnant also adds to the financial burden of these patients, since they are required to meet the donor's compensation needs.

Among other benefits, documentation of frozen donor egg success increases the possibility of egg banks, similar to long-standing sperm banks, which might then make the entire process cost less. More directly for patients, knowing that subsequent cycles using their donor's frozen eggs can be just as likely to help them get pregnant as that first fresh cycle -- that's a huge load of stress taken from the patients' shoulders.


Any bit of hope we can offer to donor egg recipients is a good thing in my book. The news that frozen donor eggs can be just as successful in rendering a pregnancy is very good.