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The most important woman in my life is a woman I only met for a couple of minutes.

My sweet daughter Olivia is 14 now, and I’m still so madly in love with her that several times each day I wish I could inhale her. I often think about the young woman known in my household as Angel Cate, whose egg made this child possible, and I send up little agnostic prayers of gratitude to whatever force in the universe brought her life to sit forever next to ours.

I went off birth control when I was 24 and gave birth when I was 33. They never did diagnose why my body didn’t work, but I spent that decade of my life building to a crescendo of desperation in trying to figure it out and fix it and have it be over, so I could meet my baby. I wasn’t then, nor am I now, a woman who’s naturally drawn to children. But I always knew I wanted a shot at living out the clean love I fantasized a mother might feel toward her child.

When we began sliding into infertility treatment, the science was new and labor intensive. Every stage of it, as it unfolded in my body and my marriage, demanded a physical diligence and a consuming emotional preoccupation that I thought at times would take me down. It strung together mercilessly, making us not believe we were in our third year of trying, then our fourth … well surely it’ll happen this cycle … yet there we were in our eighth year, then approaching our tenth. I stopped counting surgeries and procedures after the seventh in vitro. And still, 104 times, my period came. Each month, more hope rinsing out of my body.

As my chances of conceiving continued to fade, I spent a couple of those years reluctantly contemplating the idea of donor eggs, and weighing my ambivalence about carrying another woman’s baby against never having the chance to carry one at all. I’d grown up in a family in which there were always stop orders being placed on what was thought of as love, so I’d learned early on that genetic connections guarantee nothing, but that understanding wasn’t enough to disconnect me from wondering if I could love a baby that wasn’t my own.

When my last in vitro failed, we decided we would try one more time with a donor, if we could find one we agreed on. Through a friend I found a psychologist who advertised for, and screened potential donors. She mailed us a chart of available women, each of them accompanied by the standard descriptive terms: height, ethnicity, eye color, IQ and so on. We selected three from that list and requested the full packet on each of those women, which would include a lengthy questionnaire, completed in the donor’s own handwriting, and Xeroxed photographs.

The afternoon the three packets arrived in the mail, I was home alone. I was scared to open the white 8 1/2 x 11 envelope they came in, because I felt like it contained the prognosis for my future, so I laid it on the table and sat next to it for a little while. When I was as ready as I was capable of being, I opened the first one. Before I could even engage in reading the woman’s questionnaire I was overcome by the fact that it was peppered with bubble exclamation points and “i”s dotted with smiley faces, and I became immediately uncomfortable. People from that stratosphere of perkiness make me edgy. I feel badly about this, but it’s true. The second packet stirred almost no reaction in me, and then I started to feel flat and numb — a sign my emotional rheostat was dimming off to protect me from the pain of what it would mean if I didn’t connect with the last donor profile laying on the table.

But when I opened Angel Cate’s packet and saw the warmth in her eyes, all my ambivalence fell away. I read her thoughtful responses to the questions about being an egg donor, and said to myself: I can do this with this woman.

My husband felt exactly the same.

I didn’t want to meet Angel Cate when the three of us were trying to conceive my daughter. We were in the same hospital at the same time, but after so many years of what felt to me like the loss of baby after baby, I was irrationally afraid that if we met her, and I did get pregnant, she would somehow be more inclined to take the infant back. I also felt protective of the positive reaction I’d had to seeing her on paper, and didn’t want anything to mess that up.

Instead, we passed along to her a gift, with a note containing feelings drawn all the way up from my toes. I knew if I were to get pregnant, I wasn’t opposed to having our child meet Angel Cate, if that’s what the child wanted, but I was certain I didn’t want to start out on that foot. When we learned the pregnancy had taken hold, we asked the psychologist to please share this miraculous news and our profound appreciation with Angel Cate, who then sent her congratulations back to us.

The pregnancy was a joy. A joy. But by noon on the day Olivia was due to be born, not having had any symptoms of labor yet, a part of me couldn’t help but go back to that dark psychological place we’d been living in for so long, and I asked my husband, “What if she’s not coming? What if all of this has been a dream, and we wake up and never meet her?”

Olivia was born a week later, and it didn’t at all feel like I was meeting her. It felt like I had known her my whole life.

When Olivia was 16 months old, we contacted the psychologist to see if Angel Cate, who had said she’d be open to a second donation, was willing to try again. She was. Once again we took drugs to coordinate our menstrual cycles, and once again we were in the same hospital in separate rooms.

During the surgery to have her eggs harvested, there was a glitch. The HCG injection that causes the release of the eggs had apparently shot blanks; the eggs weren’t retrievable, and the procedure was stopped. Afterward, the doctor gave her the choice to consider this the end, or to take a second injection of HCG and return in 36 hours to undergo another surgery. The chances of the eggs being viable had dropped significantly due to the inability to retrieve them at their ripest point, but she chose to do it again anyway, and this second time, I could not leave the hospital without meeting her.

While Angel Cate was in recovery, lying on a gurney and coming out from under the anesthesia, she’d given her permission for me to come in. I had no idea how to begin to tell her what she meant to us, and as I was hoping to say something to her to do her justice, she looked up at me with a calm smile and asked, “How’s your baby?”

My eyes had been full of tears before I’d even walked into the room, and the generosity she held out to me in her choice of those three words, and all that they revealed about this young woman, made them crest and fall. I told her she had given us an amazing little person and I handed her the silver box I’d gotten her with a lock of Olivia’s hair inside its velvet lining.

She thanked me and said she’d been happy to do it, and told me how sorry she was that the HCG hadn’t worked. I told her we had worked as hard to have a life as we would have to save a life, and that she had given us life. Then I kissed her on the cheek and said what you say to someone who has given you a gift you can never possibly repay: Thank you.

The three of us did conceive again, but I lost the baby. Shortly after the miscarriage, I wrote Olivia a fairy tale about Angel Cate, and my husband illustrated it. I wanted her to know that in this world such dimensions of humanity exist. They are out there; and they are in her. We read it to her at bedtime as often as we read Goodnight Moon.

Once upon a time,
in a kingdom deep, deep in the center of two hearts,
there lived a King and a Queen.

The kingdom was safe and warm,
with soft cool breezes,
and the King and Queen were quite happy there.

The only problem was that this kingdom was dimly lighted,
and the King and Queen longed for a brightness
to illuminate the land.

Each morning
and each night
they dreamt of brightness,
but it did not come.

Now it just so happened
that there was a distant star
way,
way above the kingdom.

And this star
was governed by a third heart,
the heart of Angel Cate.

One magical night,
after nine years of dreaming,
the synchronized pulsing
of the King and Queen’s hearts
propelled the dream
up
up
up into the sky.

As the beating of their hearts
rose higher,
Angel Cate’s heart
began to beat in exactly the same rhythm,
and it pulled their dream
all the way up to her star.

The sound of the hearts beating together
was so powerful
that the star began to sparkle.

Angel Cate reached into the
sparkling stardust
and sprinkled it onto the dream,
and floated it gently back down
to the King and Queen.

As soon as the stardust was
absorbed by the King and Queen,
the kingdom began to glow.

And from the love
in each of the three hearts,
of the King, the Queen, and Angel Cate,
a fourth heart
brighter than the King and Queen
imagined possible
began to beat.

This was the heart of
Baby Olivia,
The Baby of Light.

And from that day forward,
the tempo of Olivia’s heart
set the sun
to wash golden over the day,
and the moon
to wash white over the night.

What began as my ambivalence about having another woman’s baby has alchemized into a purity of love for both Olivia and Angel Cate, and I realize the longer I love Olivia, the more indebted to Angel Cate I become.

My daughter has a capacity for empathy that blows me away. She is smart and true to herself, and she has a wicked sense of humor. The privilege of loving her has been my resurrection.

To this day, she will occasionally take her fairy tale off the book shelf and we’ll snuggle together and read it, just as we will occasionally go to the desk drawer and carefully take out Angel Cate’s packet and read her words, and touch the picture of her face.

This is our love story

Infertile couples in Quebec will now be able to access government-funded in vitro fertilization treatments (IVF), a first in North America.

Couples who have not been able to conceive naturally will be eligible for three free rounds of treatment as of Aug. 5, said Quebec Health Minister Yves Bolduc.

The province becomes the first jurisdiction on the continent to offer subsidized IVF treatments, which are a costly and last-ditch option for couples with problems conceiving.

There is no age limit for treatment, although the program will show priority preference for women near the end of their childbearing years, Bolduc said. It’s not clear how the province will handle any waiting lists.

Quebec’s government hopes to see the number of IVF pregnancies double in coming years as a result of the policy, Bolduc said at a news conference on Tuesday at Montreal’s Royal Victoria Hospital.

An average of 3,500 IVF pregnancies are recorded in the province every year.

Treatments covered by the Quebec government include:

• Egg harvesting.
• In vitro fertilization.
• Pre-implant genetic testing.
• Embryo transfer.
• Sperm sample collection.

A single IVF treatment in a private clinic can cost up to $15,000.

The Quebec fertility program will cost an estimated $35 million per year, with expenses rising to about $63 million in four years.

Services will be offered across the province, split evenly between public and private clinics. Specialized treatments will be limited to major university hospitals.

About 10,000 Quebec couples are considered infertile.

Doctor federations in Quebec are opposed to the program, saying there are more pressing needs within the health-care system.

By Jodi

I was recently the proud surrogate of two wonderful intended parents who happen to be gay. For me it wasn’t a decision of whether I should carry for a gay couple or not. They are both marvelously Caring and compassionate people, and I know they will be great fathers to their twins.

I feel very strongly about equal rights, and I hate that it’s so hard for gay parents to adopt. When I decided to become a surrogate, both my husband and I had stated that we were open to carrying for a gay couple. When we were almost immediately matched with one, I was excited but also nervous. I wanted to like them, but I wanted them to like me too.

The moment my intended parents walked into the room at Alternative Reproductive Resources, one of them cracked a joke and I knew we were going to get along. They were both very respectful of me and told me that because it was my body, they would let me make any decisions regarding my health and pregnancy. We knew right away that this was the right couple for us. The fact that they were two men

instead of a traditional couple wasn’t even a factor.

A son, a daughter and a year later, I have to say that my surrogacy was perfect. Every step was easy and I couldn’t have asked for better intended parents or friends. The hardest part about leaving the hospital after giving birth was leaving the guys. I can’t say that I will ever be a surrogate again, but thanks to these men, I would do it for them all over again.

Jodi is The Surrogacy Spotlight’s featured surrogate of the month! Visit http://www.facebook.com/surrogacyspotlight to ask her questions or find out more about her journey.

Last week, two surrogates won their battle with their insurance companies when the Wisconsin Supreme Court unanimously ruled that insurers cannot deny benefits to pregnant women based on their reasons or methods of becoming pregnant.

It’s an important step forward for surrogates in Wisconsin, but women in other states aren’t so lucky. Most surrogates are still denied benefits during their pregnancies.

Most insurance policies have an exclusionary clause regarding reproduction or maternity, which denies any benefits related to a surrogate pregnancy. Most policies also include a one-year waiting period from the time coverage begins before a woman can get pregnant and receive benefits.

It’s an issue. More than 90 percent of the surrogates we at Alternative Reproductive Resources work with are not covered by their own policies. And we’re seeing more and more exclusionary language in insurance policies, regardless of the state.

Ideally, we’d like for gestational surrogates to be able to use their own insurance policies during their pregnancies. More often, the policy excludes any treatments related to surrogacy. The intended parents become responsible for medical costs when a surrogate isn’t covered and usually have to purchase an individual policy for her. Several companies offer policies specifically for surrogates, including New Life Insurance, but the policies are extremely expensive and can cost anywhere between $35,900 and $47,900.

It seems insurers still have a long way to go when it comes to covering surrogates. Our attorney, Nidhi Desai, who specializes in fertility law, understands that insurers feel they can exclude surrogates because they receive financial compensation. From a legal standpoint, however, she thinks it’s unfair. “I think it is very important to focus on the principle of the matter, that pregnancy is a health condition, period,” she said.

The ruling in Wisconsin leaves us with some questions. What does this mean for other states? Will others follow suit, and when? There’s no way to know for sure but it’s certainly encouraging to see changes taking place. Federal healthcare reform has also been heading in the right direction with the Affordable Care Act that guarantees coverage to those who have been denied because of pre-existing conditions. The act hasn’t had an effect on surrogates yet, but nationwide changes could be on the way as well.

Wow, what a relief to know that what we have been saying for years is now finally officially stated. Any sperm morphology over 3% is considered normal.

How did this change come about? The World Health Organization (WHO) determines the normal parameters for semen including volume, count, motility, forward progression and morphology. The WHO published their guidelines in 1987, with updates in 1992 and 1999. The original “normal” cutoffs were based on estimates from old data, some of it dating back to the 1950’s. There were inconsistencies in the way data was collected, ie the sperm studied was collected and analyzed in many centers, but there was little regulation of how the tests were being performed. Plus there was not clear data on the history of the men.

This time the semen tests were performed using similar protocols in all of the testing centers. Plus, some history was obtained from the men, mostly related to fertility status.

4500 men in 14 countries on 4 continents were tested. Australia, China, Denmark, Germany, Chile, Singapore, France, the UK, and the USA were some of the countries included.

Men were placed into one of 4 groups.
Fertile men. All men in this group had initiated a pregnancy sometime in the 12 months preceding testing. This was the most important group because the researchers could establish normal values based on men know to have fertile sperm.
There were 3 other groups evaluated. To save a little confusion, I’ll summarize and say 2 groups were a little more random in nature and the fertility status of the men was mostly unknown. The 4th group was also fertile, but the time since last pregnancy was unknown and may have been longer than 12 months.

The results.
The normal fertile men’s sperm had the following results.
Volume: The median (midway between the lowest and highest results) was 3.7 cc, but anything over 1.5 cc was considered normal
Concentration: the median was 73 million but anything over 15 million was considered normal
Motility: the median was 61%, anything over 40% being normal
Morphology: the median was 15%, anything over 3% was deemed normal.

Some important points.
You may have noticed that morphology is not the only parameter with a new normal value. Volume was at 2.0 cc, now it is at 1.5cc. A normal count was 20 million, this changed to 15 million. Motility was 50%, now it’s 40%. The normal morphology had the biggest change, as it went from 15% to 4%.

Keep in mind that in this group, all of these men were fertile, so even men with levels lower than the new definition of normal had working sperm. The normal values were established mathematically. If you were in the upper 95% of the fertile people you were deemed normal. The bottom 5% of the fertile people was deemed abnormal. This 95%/5% cutoff is the system used to define cut offs for other tests such as TSH, Prolactin and many others.

When comparing the different groups of men there were very slight differences in volume, count, etc, but hardly worth mentioning. Fertile men did have slightly higher volume and counts then men whose fertility status was unknown. Morphology was mostly similar in the different groups. Remember, there was no group of men who had established infertility, so in this study there is no way to compare normal fertile men to known infertile men.

And even though we have no details on the women, knowing that they became pregnant in the past year is probably all the information we need.

So now you know. Any morphology over 3% is considered normal. If your doctor tells you otherwise, ask him if he has seen the new WHO guidelines.

To take it one step farther, can there really be difference between 4% and 2%? I doubt that there is a difference between having 96% abnormally shaped sperm and 98% abnormally shaped sperm. So as I have said before, at our practice here at NYU, morphology is not considered with much respect, except in some rare cases where the sperm is unusually abnormal.

I hope this helps.

For those of you who want more details, here is the link.

www.who.int/reproductivehealth/topics/infertility/cooper_et_al_hru.pdf

Dr. Licciardi

Go to Infertility Blog

By Dr. Joe Massey, Reproductive Endocrinologist, Batzofin Fertility Services, New York, NY

The treatments available for treatment of cancer in young men are highly successful. Leukemias, lymphomas, and malignant tumors often are treated with chemotherapy which is toxic to the testicle and sperm production. One of the most devastating consequences of anticancer therapy is the loss of fertility. Semen cryopreservation prior to therapy has been a strategy utilized for over 20 years in these situations.  After early attempts at IUI had low success rates, the advent of IVF, especially with ICSI, raised the level of successful outcomes.

In the Netherlands a large series of patients over 600 collected semen since 1983. Among the subjects, 14% of the population died, most of them very early. In 9% of the men there were no motile sperm at the time of collection of the sample. In follow-up, some of the men regained sperm function and achieved pregnacies. Many still have sperm waiting for usage.

Of those who did not recover, and wished to conceive at the reporting center, there were only 37 men.

In the cases in which  IVF was performed with ICSI usually, success rates for achieving parenthood, including multiple attempts, was 54% (Van Casteren,  2008). The age of the females was an adverse factor in some of the cases in this study.

Another report involved over 100 cases of men who had sperm thawed and their wives underwent IVF treatment. The average age of the women was 35 suggesting again that the circumstances did not induce these men to push initiation of their family forward aggressively. Pregnancy rates were in the30% range per cycle and enough patients repeated therapy to reach cumulative results of nearly two thirds of couples  succeeding (Hourvitz 2008). Other research has found success rates from 33-73%.

It must be remembered that, though offering hope, there are limits to the success of this method. Sperm quality from men who are ill may be poor. Preserving multiple samples prior to therapy is a good concept to keep in mind.  There is always some urgency to begin chemotherapy and the referral for semen cryopreservation should not be a last minute recommendation. This study points out the need for awareness of the option among all men facing cancer treatment who may wish to preserve their reproductive options.

Increasingly, the same availability of the option to preserve fertility is being offered to young women thanks to the advent of successful egg cryopreservation.

References:

Hourvitz A et al. ICSI with cryopreserved sperm from men with malignant neoplasm.  Fertil Steril 2008; 90:  557-563.

Van Casternen NJ et al.  Use rate and assisted reproduction technologies; outcome of cryopreserved semen from 629 cancer patients. Fertil Steril 2008;90:2245-50.

by Mary Ellen McLaughlin

Fox’s wildly popular “Glee” tackles many controversial topics, most recently, surrogacy. One of the main characters, Rachel Berry, is an aspiring Broadway star and the daughter of two gay men. Her birth was made possible via a surrogate named Shelby Corcoran. The storyline is that Shelby was not just the surrogate but also the egg donor for Rachel’s gay parents, making Rachel her biological daughter. Sixteen years after giving birth to Rachel, Shelby regrets the contractual agreement that prevents her from meeting or speaking to her daughter. Meanwhile, Rachel has been longing to find and meet her biological mother as well.

While this complicated tale makes for great TV, it is far from the reality of a typical gestational surrogacy journey. Gestational surrogates are not biologically related to the child they carry.

Shelby’s surrogacy would be considered a traditional surrogacy, where the surrogate uses her own egg and artificial insemination to become pregnant. However, with as in vitro fertilization has become a standard in fertility treatment, so has gestational surrogacy.

Gestational surrogacy ensures that the surrogate is not related to the child through the use of unrelated egg and sperm, either from the intended parents or other donors. If a traditional surrogacy is used and the surrogate is biologically related to the child, she has legal parental rights if she changes her mind about surrogacy.

Stephanie Eckard was a traditional surrogate in Florida, where her verbal surrogacy agreement with the Lamitina family was viewed as an adoption, where Stephanie could decide to keep the baby until 48 hours after the birth. She changed her mind about the surrogacy a few months into her pregnancy, and the Lamitinas had no claim to the child they’d asked Stephanie to carry for them.

ASRM guidelines for surrogacy also state that surrogates should have already given birth to a child. Shelby doesn’t seem to have any other children on the show, making her a highly unlikely candidate for surrogacy in real life.

Another discrepancy between the “Glee” take on surrogacy and real surrogacies is Shelby’s motivation for becoming a surrogate. A desperate young Shelby, who needed money to fund her dream of becoming a Broadway star, decided the pay for nine months of pregnancy was too good to pass up. In reality, most women who become surrogates don’t do it for the money. They are already mothers of their own children, have stable family support systems, and often know someone who had problems with infertility. They are typically motivated by the idea of helping someone realize their dream of becoming a parent, or simply enjoy pregnancy and don’t mind carrying an unrelated child for another parent.

The moral of the story is, of course, that you can’t always believe what you see on TV. Surrogates are far more often mothers who want to help others create a family than aspiring Broadway singers looking for cash.