Better fertility treatments can mean much older parents. But how does this affect their offspring?

Older parents

For nearly 40 years, fertility treatment has grown ever more advanced and so entrenched that it’s not uncommon for couples to begin their families in their late 30s, 40s or even 50s, producing much older parents.

Much older parents…  But even as questions about the technology to extend fertility have been answered — yes, children born through in vitro fertilization are healthy; yes, freezing embryos appears to be safe; yes, mothers can generally deliver babies safely well beyond the classic childbearing years — another important question is emerging: How old is too old for their offspring?

Offspring like Hayley, the 10-year-old daughter of a 58-year-old, Ann Skye.

“I knew that she was going to really need to build her own support system in life, or potentially would need to,” said Skye, who lives in North Carolina and works in public health. “I think that has really impacted the way we parented her. We were strong proponents of letting her cry [herself] to sleep for that same reason: She needs to be able to self-soothe.”

In December, two prominent psychologists and two reproductive endocrinologists published an opinion paper in the Journal of Assisted Reproduction and Genetics questioning whether it was time to establish age restrictions in the field. They wrote that research has shown that children often experience social awkwardness if their parents are a half-century older than them and face greater risk of autism and psychopathologies. These children are also more likely to serve in a caregiving role and experience bereavement as adolescents or teens compared with their peers whose parents gave birth in their 20s and 30s, they wrote.

Do those risks constitute the potential for “great harm” to the child and outweigh a person’s right to “reproduce without limitation or interference” at any age, the authors asked.

“It is a self-perpetuating issue; the more older patients that seek [fertility] treatment, the more people feel that it is reasonable to seek treatment, especially in an age where sensational births are widely celebrated as positive events in the media,” they wrote.

In the United States, the number of live births to mothers ages 45 to 49 increased from 3,045 in 1996 to 8,257 in 2016, and the number to mothers ages 50 to 54 increased from 144 births to 786 births over the same time period, according to the National Center for Health Statistics. The average age of women becoming mothers in the United States is now 26, up from 23 in 1994, according to the Pew Research Center.

WashingtonPost.com, May 30, 2020 by Eric Berger

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How Coronavirus Is Affecting Surrogacy, Foster Care and Adoption

How Coronavirus Is Affecting Surrogacy

How Coronavirus Is Affecting Surrogacy – The pandemic is not just impacting parents and pregnant people — all prospective parents are facing new challenges.

How Coronavirus Is Affecting Surrogacy – Covid-19, the disease caused by the novel coronavirus, has upended life for those who are or hope to become pregnant in the United States. Fertility doctors have indefinitely postponed all advanced fertility treatments, and some major hospitals in hard-hit areas are trying to ban partners and doulas from delivery rooms.

But the pandemic is affecting expectant parents forming families through surrogacy, foster care and adoption as well.

Global travel restrictions have left surrogacy agencies in the United States scrambling for exemptions for their international clients — particularly for those whose surrogates are scheduled to give birth in the next month or two.How Coronavirus Is Affecting Surrogacy

Circle Surrogacy, an agency based in Boston, has 15 international clients with due dates before May 1. “We’ve had our legal team prepare letters for each of these families, which has gotten many of them into the country despite travel bans,” said Sam Hyde, the agency’s president. Still, he said, his foreign clients were at the mercy of individual immigration officials. “Some have been sympathetic to the plight of our clients, others have not — it’s really been a case-by-case basis.”

 

Some intended parents, as clients of surrogacy agencies are known, who are currently struggling to gain entry into the United States are hoping to do so after completing a 14-day quarantine in a country with less severe travel restrictions.

Last week, for instance, Johnny and Patty — a Chinese couple working with a surrogate living in South Carolina — traveled from Shanghai to Phnom Penh, Cambodia, to begin two weeks in isolation at a local hotel. The couple, who work for an international company and use these westernized names, asked that their last name be withheld since surrogacy is still relatively uncommon in China. They hope to complete their quarantine in time to witness the birth of their daughter, who is due in mid-April, and claim guardianship over her.

But with travel restrictions tightening seemingly daily, they worry their effort may still be in vain. “First we bought plane tickets to travel through Thailand, but now travel is restricted there,” Johnny said in an interview from their hotel on the second day of his quarantine. “Then we tried Dubai, but that is now also restricted.” Traveling via Cambodia, he said, was the couple’s “last hope” to reach the United States in time for their daughter’s birth.

Though they would be disappointed to miss the delivery, the couple said they were even more concerned, in that scenario, about the baby’s well-being in the ensuing days before they are allowed to travel. “Who will take care of our baby if we can’t arrive before she’s born?” Patty said.

Will Halm, a managing partner at International Reproductive Law Group, said surrogacy agencies were creating contingency plans for clients living abroad who may be prohibited from entering the United States over the next few months. “Plan A is absolutely to have parents in the U.S., joyfully watching their child being born,” he said. “If they can’t get into the country in time, that’s when we look to plans B, C and D.”

 

In one of the better scenarios, agencies hope friends or family members living in the United States can temporarily assume guardianship of the baby until the intended parents are granted entry into the country. As a backup, however, caseworkers are also preparing strangers — health care professionals, child care providers and even surrogates themselves — to care for the newborns until travel restrictions are eased.

“These babies will not be abandoned,” said Dr. Kim Bergman, founder of Growing Generations, a surrogacy agency with dozens of international clients who may be impacted by travel bans in the coming months. “We have an army of former surrogates who are ready and eager to act as helpers and guardians for as long as necessary.”

The ongoing crisis has created an uncertain environment for foster care parents and children as well. “Basically, everything is on pause until things are back to normal,” said Trey Rabun, who works as a services supervisor at Amara, a foster care agency based in Seattle, Wash. — one of a growing number of states ordering its citizens to work from home.

Amara, whose staff members are included in the state’s proclamation, has been able to continue some aspects of the licensing process for foster parents online, such as initial interviews. But other critical components, like home inspections, need to be done in person, Rabun said.

As a result, the number of foster homes, already all too scarce in Washington before the crisis hit, will remain static for the state’s over 10,000 foster care children until the pandemic subsides and business returns to normal, Rabun said. Of bigger concern to him, and other foster care professionals throughout the country, is the impact that “stay at home” orders may have on children not yet accounted for in the system.

“We know abuse and neglect happen more in high-stress situations,” Rabun said. But the people who would normally notice and report these sorts of problem, like teachers and doctors, will be unable to do so in the days and weeks ahead. “No one has eyes on them,” he said.

With courts and other government offices closed in many states, parents who had hoped to finalize adoptions within the next couple of months are also now navigating a drastically changed landscape — particularly for parents completing adoptions abroad.

 

Early in the year, when the coronavirus was barely registering as a news story outside of Asia, Holt International — an agency that facilitates adoption placements between Chinese orphanages and adoptive parents in the United States — was already closely monitoring and responding to the outbreak.

NYTimes.com, by David Dodge, April 1, 2020

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Shielding the Fetus From the Coronavirus

coronavirus fetus

New studies suggest the Coronavirus can cross the placenta to the fetus, but newborns have been mildly affected if at all.

Newborns and babies have so far seemed to be largely unaffected by the coronavirus, but three new studies suggest that the virus may reach the fetus in utero.coronavirus fetus

Even in these studies, the newborns seemed only mildly affected, if at all — which is reassuring, experts said. And the studies are small and inconclusive on whether the virus does truly breach the placenta.

“I don’t look at this and think coronaviruses must cross across the placenta,” said Dr. Carolyn Coyne of the University of Pittsburgh, who studies the placenta as a barrier to viruses. She was not involved in the new work.

Still, the studies merit concern, she said, because if the virus does get through the placental barrier, it may pose a risk to the fetus earlier in gestation, when the fetal brain is most vulnerable.

Pregnant women are often more susceptible to respiratory infections such as influenza and to having more complications for themselves and their babies as a result. It’s still unclear whether pregnant women are more likely to contract the new coronavirus, said Dr. Christina Chambers, a perinatal epidemiologist at the University of California in San Diego.

“We don’t have any knowledge of that at all — that is a complete open question at this point,” she said. It’s also unclear what effect the virus has on the fetus, she added.

The placenta usually blocks harmful viruses and bacteria from reaching the fetus. And it allows in helpful antibodies from the mother that can keep the fetus safe from any germs, before and after birth.

Still, a few viruses do get through to the fetus and can wreak havoc. The most recent example is Zika, which can cause microcephaly and profound neurological damage, especially if contracted in the first and second trimesters.

Neither the new coronavirus, nor its more familiar cousins, has seemed to belong to this more dangerous category. If so, “we would be seeing higher levels of miscarriage and preterm delivery,” Dr. Coyne said.

NYTimes.com by Apoorva MAndavilli, March 27, 2020
 
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Effect of COVID-19 on LGBTQ Family Planning

Effect of COVID-19 on LGBTQ family planning

The Effect of COVID-19 on LGBTQ Family Planning is evolving and far reaching.  It is also temporary.

Effect of COVID-19 on LGBTQ Family Planning – The COVID-19 pandemic has affected us all in ways more numerous to describe.  Those of us with families have had to learn about home schooling, some the hard way (me).  Everyone has had to adjust to what essentially has become a home quarantine situation and the emotional effects of social isolation.  And we are all witness to the world going through a major change which will create a new reality for everyone when we emerge on the other side.  But we will emerge on the other side. effect of COVID-19 0n LGBTQ family planning

While I myself have experienced the loss of a friend due to the virus, as well as the infection of a family member, I know that we all are doing our best to maintain a sense of normalcy and peace within.  Practicing this type of self-care will help mitigate the effects of COVID-19 on LGBTQ family planning.

The effects of COVID-19 on LGBTQ family planning are very real.  I have said in the past that there are no accidental pregnancies in the LGBTQ community.  Everything is carefully thought out and planned in advance.  However, the COVID-19 virus has created specific and real-world disruptions to our ability to create families.

For example, those were using, or planning to use, an IVF clinic for either surrogacy, artificial insemination (AI), intrauterine insemination (IUI) or in vitro fertilization (IVF) procedures have experienced an actual shut down of normal operations.  The clinic administrators that I have spoken with are optimistic that once the virus is contained, or at least the infection curve has flattened, that they will resume normal operations.  For the time being, they are following ASRM guidelines.  But they will also be dealing with backlogs of patients and procedures that may cause further delay in your family building timeline. 

effect of COVID-19 0n LGBTQ family planningFor lesbian couples who have thoughtfully chosen to use a clinic to assist in insemination, this delay is not only frustrating, it can also change the projected timeline of their families.  Even those couples who choose anonymous sperm donors will most likely have to wait an indefinite period of time to undergo AI or IUI procedures.  For those who choose known sperm donors, the essential DNA testing that is a prerequisite for clinic inseminations will also be on a delayed time schedule.

Gay male couples who are considering surrogacy are facing an even more complicated challenge.  First, there will inevitably be a delay in the embryo creation aspect of the beginning of their journey due to IVF clinic shutdowns.  If an intended parent already has embryos created, perhaps from a previous surrogacy journey, they may be in a better position.  However, they will also experience a delay in embryo transfer until restrictions on IVF clinic activities are lifted.  A silver lining is that they will be able to match with surrogates sooner, thereby shortening the time to pregnancy once those IVF restrictions are lifted.

Lesbian couples who choose a known sperm donor and home insemination may be the only group in our community who might not experience the delays discussed above.  However, these types of inseminations will not have the benefit of genetic testing and, for the safety and security of all parties, must have carefully prepared legal agreements in place and a second or stepparent adoption plan incorporated into that agreement.

For those in the midst of a surrogacy journey, perhaps awaiting their carrier to give birth, the effects of COVID-19 on LGBT family planning can be particularly frustrating due to travel and hospital restrictions.  Many hospitals are restricting the number of people who can be in a delivery room, particularly if they have traveled from an area that has been severely affected by COVID-19, like New York, Washington or California.  Be prepared for snags in the road and lots of patience.  You will go home with your child!  You may have to be flexible in your travel plans, i.e. be prepared for long drives instead of air travel.

For lesbian couples and gay men with surrogates who are pregnant, there is a limited study from Wuhan China showing that babies of mothers with the virus were not effected, meaning that there was no vertical transmission.

Couples considering adoptions are also at a bit of a standstill depending on where they live in the US.  Most state court systems have closed to all but “essential” proceedings.  While I would argue that adoptions are essential, the courts have determined that they are not.  I have several cases now awaiting the scheduling of finalization hearings that are simply on hold until the pandemic subsides.  This includes private placement adoptions and step or second parent adoptions.  This does not mean that making connections with birth parents must be put on hold, but the legal work that is required to effectuate the adoption may be delayed, causing additional anxiety.Effect of COIVD-19 on LGBTQ family planning

You may be asking what you can do to mitigate the effects of COVID-19 on LGBTQ family planning.  I know that I am.  Here are a few options that you can consider now.

  1. Make sure that your Estate Plan is in place and up to date. Ask yourself, “Do I need a Will?”  If you have named guardians for children in your Wills, please review to make sure that they are current and correct.  If you have not created an Estate Plan, now is a good time to do the work to ensure that you have prepared for the unexpected.  Here is a list of the documents you should be considering for your estate plan.  We have also seen a relaxation of Notary laws allowing for online notarizations.  This can make the execution of documents much easier in certain states.
  2. If you have been thinking about creating your family, now is a great time to do more research. Men Having Babies is a great resource for surrogacy.  “If These Ovaries Could Talk” is a wonderful podcast for all LGBTQ family planning.  This should include speaking with your friends who have had children to get their perspectives on the process.  It is also a really good time also to start thinking about the financial implications of having a family.  Many of us will be irreparably financially harmed by the COVID-19 pandemic.  Many of us will have to rethink the timelines we had anticipated would apply to our family planning journeys.  You may want to meet with a financial professional to discuss the best way to get your family plan back on track.
  3. Practice self-care! Whether you have children or not, staying calm and finding peace in your heart will help you get through this.  While you might feel alone, you are not alone.  Reach out and find solace in your friends and family if you can.  Take walks if you can and get outside.  Remind yourself of what will be on the other side of this experience.

If you have specific questions about how to address the effects of COVID-19 on LGBTQ family planning and estate planning, and you think I can be of help, please do not hesitate to reach out to me.  Thank you for taking the time to read this and remember to breathe.

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ASRM Guidelines on Fertility Care During COVID-19 Pandemic

ASRM guidelines COVID-19

ASRM Guidelines on Fertility Care During COVID-19 Pandemic: Calls for Suspension of Most Treatments

ASRM Guidelines on COVID-19: The American Society for Reproductive Medicine (ASRM), the global leader in reproductive medicine, today issues new guidance for its members as they manage patients in the midst of the COVID-19 pandemic.  Developed by an expert Task Force, of physicians, embryologists, and mental health professionals, the new document recommends suspension of new, non-urgent treatments.ASRM guidelines COVID -19

Specifically, the recommendations include:

  1. Suspension of initiation of new treatment cycles, including ovulation induction, intrauterine inseminations (IUIs), in vitro fertilization (IVF) including retrievals and frozen embryo transfers, as well as non-urgent gamete cryopreservation.
  2. Strongly consider cancellation of all embryo transfers, whether fresh or frozen. 
  3. Continue to care for patients who are currently ‘in-cycle’ or who require urgent stimulation and cryopreservation.
  4. Suspend elective surgeries and non-urgent diagnostic procedures.
  5. Minimize in-person interactions and increase utilization of telehealth.

The above recommendations will be revisited periodically as the pandemic evolves, but no later than March 30, 2020, with the aim of resuming usual patient care as soon and as safely as possible.  ASRM has been closely monitoring developments around COVID-19 since its emergence. Data on its impact on pregnancy and reproduction remains limited. However, the task force used best available data, and the expertise and experience of the members to develop the recommendations. Until more is known about the virus, and while we remain in the midst of a public health emergency, it is best to avoid initiation of new treatment cycles for infertility patients. Similarly, non-medically urgent gamete preservation treatments, such as egg freezing, should be suspended for the time being as well. Clinics who have patients under treatment mid-cycle should ensure they have adequate staff to complete the patient’s treatment and should strongly encourage postponing, the embryo transfer.

Ricardo Azziz, CEO of the ASRM stated, “This is not going to be easy for infertility patients and reproductive care practices. We know the sacrifices patients have to make under the best of circumstances, and we are loath to in add, in any way. to that burden. And it will not be easy for our members. The disruption to routines, the stress on staff members and the very real prospect of economic hardship loom large for ASRM members all over the world.  But the fact is that given what we know, as well as what we don’t, suspending non-urgent fertility care is really the most prudent course of action at this time.”

Dr. Racowsky added, “We should recognize that the situation on the ground is fluid, and as such we will continue to revisit and review our recommendations at least every two weeks, to provide providers and their patients with the best information and support we possibly can.”

ASRM Press Release – May 17, 2020

Click here to read the entire release

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Fertility Fraud: The U.S. Is Experiencing An Explosion Of Legislation. And That’s A Good Thing

More and more cases of fertility fraud have been uncovered. And more and more lawsuits have been filed. However, each prosecution or lawsuit has faced an uphill battle.

Direct-to-consumer DNA kits have changed our reality. The wall of secrecy that was once behind conception and parenting — including adoptions, affairs, and the use of donor eggs, sperm, and embryos — is crumbling. One major facet of this reckoning with the truth has been the stark realization that many, many doctors were using their own sperm, a form of fertility fraud, to “treat” their unknowing patients.fertility fraud

Sometimes this practice was in place of “anonymous donor” sperm; sometimes, it was actually in place of the spouse or partner’s sperm. It’s pretty gross to think about. But even grosser is the complete lack of accountability for the doctors who must have known of the ethical and moral shortcomings of their actions.

The Justice System Has Been Failing Us

A doctor using his own sperm to impregnate a patient, without her knowledge or consent as to the source of the sperm, must be a crime, right? Or at least a pretty solid tort – fertility fraud? For many states, you guessed wrong. More and more cases of those doctors’ egregious practices have been uncovered. And more and more lawsuits have been filed. However, each prosecution or lawsuit has faced an uphill battle.

Take, for example, the case of Donald Cline, formerly a licensed medical doctor in Indiana. In one of the most notorious cases of fertility fraud in the United States, DNA tests have shown Cline to have used his sperm in unknowing patients, resulting in at least sixty children. When the betrayed patients and offspring sought legal remedies against Cline, they were unsuccessful. After all, the patients had consented to Cline inseminating them with sperm. Cline did plead guilty to two charges of obstruction of justice, after lying to officials about using his own sperm with patients. But that, to most victims, was not sufficient.

Time To Change The Law

Since current law has been failing the victims, many have sought, and are currently seeking, to change the law. State by state, if necessary. Last year, two successful bills were passed. One was in Indiana, unsurprisingly, as ground zero of the Cline fiasco. Another was in Texas, where Eve Wiley led the charge. (Listen to this podcast where Wiley and her believed-donor tell the twisting and fascinating tale of uncovering the truth of Wiley’s genetic history.) In Texas, without a civil cause of action due to the state’s recent tort reforms, and without a viable criminal cause of action to charge him, Wiley’s “doctor daddy” is still actively practicing medicine even today. That’s crazytown.

Now other states are following suit, and closing the legal loopholes that existed for doctors to take advantage of their patients in this most intimate of areas. And while I doubt that as many doctors are so casually using their own sperm these days, there are certainly modern horror stories involving assisted reproduction, including that of a staff member at a Utah clinic swapping out countless sperm samples with his own.

The states currently making progress in this area include my own home state of Colorado with HB20-1014 (Go, Representative Kerry Tipper!), Nebraska with LB 748, Ohio with HB 486, and Florida with SB 698. Other states, as well, appear poised to introduce their own fertility fraud legislation. While the proposed laws vary, they are consistent in their goals of ensuring or clarifying that this type of behavior by trusted medical professionals is not acceptable and not legal, and providing a path forward for justice.

AboveTheLaw.com, by Ellen Trachman, February 12, 2020

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Fresh Eggs For IVF Offer Slightly Better Birth Outcomes

fresh eggs

Using fresh donor eggs for in-vitro fertilization (IVF) provides a small but statistically significant advantage in birth outcomes compared to frozen donated eggs, research finds.

The national study in the journal Obstetrics & Gynecology was the largest head-to-head comparison of the two IVF approaches, measuring the likelihood of a good perinatal outcome, defined as a single baby without prematurity and with a healthy birth weight.fresh eggs

“Our study found that the odds of a good birth outcome were less with frozen than with fresh, but it was a small difference,” says lead author Jennifer L. Eaton, medical director of assisted reproductive technology and director of the Oocyte Donation Program at the Duke Fertility Center.

“From a clinical standpoint, given that frozen eggs have many benefits such as ease, cost, and speed, the decision to use fresh or frozen donor eggs should be made on an individual basis after consultation with a physician,” Eaton says.

Eaton and colleagues, including senior author Alex Polotsky of the University of Colorado Advanced Reproductive Medicine, studied three years of data from the Society for Assisted Reproductive Technology. Nearly 37,000 IVF attempts were analyzed, including 8,381 (22.7%) that used frozen eggs and 28,544 (77.3%) using fresh.

Controlling for factors such as the quality of fertilized eggs and the age of both mother and donor, the researchers found that fresh eggs resulted in a good perinatal outcome in 24% of fertility attempts compared to 22% of the attempts with frozen eggs. Implantation, clinical pregnancy, and live birth rates were all significantly higher among the women using fresh eggs vs. frozen.

“As IVF with donor oocytes has become standard treatment for women with decreased egg supply or advanced reproductive age, there has been an increased demand for donor oocytes, making frozen eggs an attractive option,” Eaton says. “In general, IVF with frozen donor eggs is cheaper and faster than with fresh donor eggs.

Fututiry.org by Sarah Avery-Duke, February 7, 2020

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How Men’s Bodies Change When They Become Fathers

Men's bodies change

Hint: They don’t just get ‘dad bods’ but men’s bodies change.

Men’s bodies change when they become fathers.  As an anthropologist who studies human fatherhood at the University of Oxford, I’ve run up against a widespread and deeply ingrained belief among fathers: that because their bodies haven’t undergone the myriad biological changes associated with pregnancy, birth and breastfeeding, they’re not as biologically and psychologically “primed” for caretaking as women are.men's bodies change

As a result, they feel less confident and question their abilities to parent: Will they be “good” parents? Will they bond with their babies? How will they know what to do?

As my own personal and professional experiences dictate, the idea that fathers are biologically “less prepared” for parenthood is unlikely to be true. Much of the role of parenting is not instinctual for anyone. (I remember the steep learning curve of those first days of motherhood — learning what each of my baby’s cries meant, mastering the quick diaper change and juggling the enormous amount of equipment necessary just to make it out the door.)

And while the biological changes fathers undergo are not as well understood (nor as outwardly dramatic) as those of mothers, scientists are just beginning to find that both men and women undergo hormonal and brain changes that herald this key transition in a parent’s life.

In essence, being a dad is as biological a phenomenon as being a mom.

Testosterone seems to dip

Take testosterone, the stereotypically “male” hormone that plays important roles in male fetal development and puberty. Testosterone is largely responsible for motivating men to find partners and, studies suggest, men with higher levels of testosterone tend to be more attractive to potential mates. But being a successful human father means focusing inward on the family and resisting the drive to seek out another partner. So, experts believe, men have evolved for some of that testosterone to go.

In a pioneering five-year study published in 2011, for instance, Dr. Lee Gettler, Ph.D., an American anthropologist, followed a group of 624 single, childless men in the Philippines from age 21 to 26. Dr. Gettler found that while all men in the study experienced normal, age-related dips in testosterone, the 465 men who became dads during that five-year period experienced a more significant drop — an average 34 percent (when measured at night) — than those who remained single or married.

Globally, study after study — including my own unpublished findings in the United Kingdom — have found similar results, noting that this reduction in testosterone can happen just before and just after the birth of a man’s first child. And while it isn’t clear exactly what prompts this drop, Dr. Gettler said that his own preliminary results suggest that the more dramatic the drop, the bigger effect it seems to have on a man’s caregiving behavior. “We found that if brand new fathers had lower testosterone the day after their babies were born,” said Dr. Gettler, “they did more caregiving and baby-related household tasks months later.”

While news of this drop in testosterone is often greeted with groans of resignation from men — choose fatherhood and choose the road to emasculation, they think — some studies have suggested that the lower a man’s testosterone, the more likely he is to release key reward and bonding hormones, namely oxytocin and dopamine, when interacting with his child. Caring for your child, therefore, produces not only a strong bond but a neurochemical reward, inducing feelings of happiness, contentment and warmth — a welcome trade-off.

Brains seem to change

The brain also appears to undergo structural changes to ensure that fathers exhibit the key skills of parenting. In 2014, Dr. Pilyoung Kim, Ph.D., a developmental neuroscientist at The University of Denver, put 16 new dads into an M.R.I. machine: once between the first two to four weeks of their baby’s life, and again between 12 and 16 weeks. Dr. Kim found brain changes that mirrored those previously seen in new moms: Certain areas within parts of the brain linked to attachment, nurturing, empathy and the ability to interpret and react appropriately to a baby’s behavior had more gray and white matter between 12 and 16 weeks than they did between two and four weeks.

NYTimes.com, By Anna Machin, June 13, 2019

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Opinion – What Happened to All Those Frozen Eggs?

Frozen Eggs was supposed to be as revolutionary as birth control. It hasn’t lived up to the hype — but it has still changed women’s lives.

Frozen eggs – The potential for egg freezing to allow women to pause their biological clocks is one of the most astonishing developments of recent fertility science. The promise was thrilling: Women could enjoy more time to find the right partners, break up with the wrong ones and become emotionally and financially ready to become mothers.Egg Donations

Enthusiasts even fantasized the technology would promote gender equality by giving women control over their fertility so that they wouldn’t have to scale back their career ambitions during their 20s and 30s. “Freeze Your Eggs. Free Your Career” blared a 2014 cover of Bloomberg Businessweek.

When Facebook and Apple announced that same year that they would pay for egg freezing for employees in a “game-changing perk,” Apple said in a statement, “We want to empower women at Apple to do the best work of their lives as they care for loved ones and raise their families.”

Egg freezing was an act of self-care — and professional advancement — for the modern woman.

“All the talk in the beginning was about how egg freezing would be as big as the birth control pill and liberate women,” said Janet Takefman, a reproductive health psychologist at McGill University in Montreal, who has counseled more than 200 women considering egg freezing.

And women responded to this promise. In 2009, the first year the Society for Assisted Reproductive Technology started collecting egg freezing data, 475 women went through the procedure, in which an average of 10 eggs are surgically removed and preserved in liquid nitrogen after 10 days of hormonal stimulation. In 2017, more than 9,000 women froze their eggs.

Now we have a chance to look back and ask: Did egg freezing live up to its hype?

The most obvious question is whether egg freezing worked by allowing women to have children later. Although SART collects data on pregnancy rates using frozen eggs, it doesn’t break out whether women had frozen them as part of in vitro fertilization treatment or fertility preservation during illness, or to delay childbearing. So I contacted four fertility clinics that have been in the field the longest to find out. (I froze my eggs at two of them and haven’t yet thawed.)

nytimes.com, by Sarah Elizabeth Roberts, December 21, 2019
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Opinion – The Big IVF Add-On Racket

PGS, PGD

IVF Add Ons – This is no way to treat patients desperate for a baby.

There are few things as unsettling as sitting in an in vitro fertilization clinic hearing you need a team of experts — embryologists, lab techs and nurses along with a reproductive endocrinologist — to help you become pregnant.embryo

What comes next can be a blur. First, you meet with the clinic’s financial counselor to assess whether you have enough money for a complex, invasive $15,000-$20,000 IVF cycle. What follows are drug injections, blood tests, invasive ultrasounds, surgical egg retrieval, and fertilization ahead of an embryo transfer. Before your first hormone shot, you’re well into head-spinning, unfamiliar territory.

Then the doctor tells you there are “add-ons” you might want to consider.

Might you have interest in endometrial scratching? What about vasodilation, human growth hormones, intralipids, assisted hatching, oocyte activation, physiological intracytoplasmic sperm injection, or embryo glue? Post-fertilization, there is also embryo pre-implantation genetic testing to consider. Interested?

These extras come with price tags ranging from hundreds to thousands of dollars. All are presented as ways to increase your chances of a pregnancy. What are you willing to try? What can you afford? The ball is in your court.

This is no way to treat patients at their most vulnerable.

That’s the conclusion my colleagues and I arrive at in a new paper on the ethics and regulation of IVF add-ons.

An add-on is anything that is not essential to carry out an IVF cycle. Such measures, patients are told, will improve the likelihood of a live birth — and yet our examination revealed a startling absence of robust research into the effectiveness and the safety of these add-ons. Despite this, their use is widespread, and regulation of them is minimal.

The most expensive add-on category is pre-implantation genetic testing. These tests were originally developed to identify embryos at risk for genetic diseases. Today, however, they are primarily sold, at a cost of $6,000 to $12,000, as a way to screen for chromosomal abnormalities that could lead to failed implantation or miscarriages.

In October, however, a large study found that a single abnormal cell does not doom an embryo and determined that one of the tests, PGT-A, made no difference to rates of live births. Worse still, patients who opted not to transfer embryos based on the test’s results may have lost potentially viable ones.

There is also endometrial scratching, a procedure, sometimes costing as much as $500, that purposely irritates the endometrium, the innermost lining of the uterus, before IVF While it’s promoted as increasing the chance of an embryo implanting, a recent large randomized trial found no benefit. Beyond significant patient discomfort, risks include bleeding, infection and uterine perforation.

Then there are intralipids, an emulsion of soybean oil, egg phospholipids and glycerin administered intravenously and described as a way to decrease natural killer cell activation in the immune system and ostensibly aid in embryo implantation. This emulsion is priced around $400 per infusion; typically several are recommended. Side effects include headache, dizziness, flushing, nausea and the possibility of clotting or infection. A meta-analysis last year found that intralipids and other forms of immunotherapy should not be used in routine clinical practice.

Such procedures are often presented to patients in the form of a stack of papers, written in legalese or medical jargon. Resourceful patients might take to the internet to learn more, where searches might deliver densely written scientific articles, and ads might direct them to companies or clinics eager to promote their own brands of add-ons.

Why is all this happening? It’s because IVF remains an under-regulated arena, and entrepreneurial doctors and pharmaceutical and life science companies are eager to find new ways to cash in on a growing global market that is projected to be as large as $40 billion by 2024.

NYTimes.com, December 12, 2019 by Pamela Mahoney Tsigdinos

Click here to read the entire article.

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Source: Time for Families