Conceiving your own child is difficult. Innovative technologies in assisted reproduction explore new alternatives to traditional pregnancy, but legal matters and financial considerations complicate these choices. Educate yourself on the available options ...
Conceiving your own child is difficult. Innovative technologies in assisted reproduction explore new alternatives to traditional pregnancy, but legal matters and financial considerations complicate these choices. Educate yourself on the available options that are allowing families to bring a baby into their homes.
The Infertility Answer Book answers your questions regarding the advantages and disadvantages involved with all of the options available, including:
- How do find an egg donor?
- Will my insurance cover fertility treatments?
- What happens in cryopreservation if a parent dies?
- What are the risks with using a surrogate?
- Should I also be trying adoption?
- What laws are involved with insemination?
- How do I keep embryo donation private?
- When should I discuss my ART choice with my child?
The Infertility Answer Book is your complete guide to the family-building possibilities beyond traditional pregnancy.
Brette McWhorter Sember is a former New York state attorney and skilled mediator. She was on the Law Guardian panel in four counties and acted as a volunteer mediator for the Better Business Bureau. Sember is an expert at explaining and simplifying legal concepts. She has written more than 30 books, including File for Divorce in New York, Tenant's Rights in New York, Landlord's Rights in New York, The Complete Legal Guide to Senior Care, The Complete Credit Repair Kit, The Infertility Answer Book, The Adoption Answer Book, How to Parent with Your Ex, Gay & Lesbian Legal Rights, How to Form a Corporation in New York, Child Custody, Visitation, and Support in New York, Seniors' Rights and many more. Her web site is BretteSember.com.
Reproductive technology has reached a point where there are many options available to help you become parents. These options have given couples a lot of freedom, opened the doors to wonderful new possibilities, and created many families. When you are considering using reproductive technologies to help you become a family, there are a lot of points to weigh and a lot of information to gather.
Understanding Your Condition
If you are considering assisted reproduction, it is important that you come into the process with a good understanding of why natural conception is not working for you and what conditions or problems have brought you here. Understand what your doctor thinks is realistic for you and your partner and what the odds are for you with the different types of treatment. Many times, doctors cannot give you a complete answer as to why you cannot conceive without assistance, but it is important to arm yourself with whatever knowledge is available.
In general, it is best to try the least-invasive procedures first, if they provide real hope for you. This book talks mainly about fertility treatments that involve input from other people, but many couples are able to conceive using their own genetic material. There are many good treatments that are noninvasive, including drug therapies. Be sure to explore all of the options available to you and understand what could or could not work not before progressing to more invasive and complicated treatments.
What Technology Can Do for You
Technology can help you or your partner become pregnant; provide you with genetic material to create a baby if your body cannot do so itself; or, allow you to work with another woman to gestate your pregnancy. These options can seem staggering. Most people begin at the bottom of the totem pole with the least expensive and invasive options and work their way up to more expensive and complicated procedures.
What Technology Cannot Do for You
While technology can offer you new ways to become parents, it cannot change the basic facts of your circumstance. It cannot help you cope with the emotional effects of being unable to conceive on your own. Technology cannot erase basic biological facts. Technology can provide you with a baby, but it cannot always provide you with a baby that is genetically linked to both you and your partner. This can be a big stumbling block for many couples.
For many couples, it is possible to have a child that is a biological child of one of the parents, while using donor material for the other. This raises the issue of whether you and your partner are comfortable with all this implies-having a child who will resemble one of you but not the other; having a child who has an unknown or unidentified parent; and, the inevitable emotional fallout as you process these facts and live with them in the years to come.
The assisted reproductive field is filled with acronyms for different types of procedures. Following are some definitions of these terms that will be used throughout the book.
ART-assisted reproductive treatment. This is the medical assistance you receive as you try to conceive.
GIFT-gamete intrafallopian transfer. Eggs (either belonging to the intended mother or obtained through donations) are retrieved from the ovaries and placed in the fallopian tubes with sperm. Conception occurs in a natural location, but allows physicians to carefully choose the genetic material available.
ICSI-intracytoplasmic sperm injection. A single sperm is injected into an egg and the egg is then implanted into the intended mother.
IVF-in vitro fertilization. Eggs are fertilized with sperm outside of the mother and embryos are implanted into her uterus.
IUI-intrauterine insemination. Ovulation is induced in the woman and sperm is then inserted into the uterus.
ZIFT-zygote intrafallopian transfer. Eggs are retrieved from the mother or donor and inseminated. The zygote or young embryo is then implanted into the fallopian tube.
Other terms you may come across include the following:
gamete. This refers to sperm or eggs-the building blocks of a baby.
induced cycle. Ovulation that is induced by medication.
natural cycle. Ovulation that occurs without medication or medical intervention.
oocytes. An egg before maturation.
Finding Medical Professionals You are Comfortable With
As you begin your journey into the world of assisted reproduction, the most important thing you can do is select doctors and clinics that you are comfortable with. The process you are entering is very stressful and emotional. If you are working with providers who are not sensitive to your needs or who you just feel uncomfortable with, the entire process will be more difficult for you.
The first place to start is with your OB/GYN. Get a referral to a fertility specialist. If you are not happy with that referral, ask for another. If there is a medical school in your area, call them and ask if the school is involved in a clinic in your area. Talk to other couples you know who have used assisted reproduction about what doctors and facilities they have used.
Before visiting a specialist or clinic, call and ask if the providers are board certified or board eligible in gynecology and obstetrics as well as in reproductive endocrinology. Fertility specialists should be certified in both of these areas. If the clinic has an IVF lab, ask if it is accredited by the College of American Pathologists (whether or not you plan on using IVF). All labs of any kind must be accredited under the federal Clinical Laboratory Improvement Amendment (CLIA). Ask if the physicians are members of the American Society of Reproductive Medicine. Most reputable clinics also have the following specialists on staff:
When you interview clinics, it is important to ask about success rates. This will let you know how successful the clinic is at producing pregnancies. The most important success rates are the number of take-home babies per year and the number of live babies born per cycle. (The number of pregnancies can be a deceiving statistic because many may fail early in the pregnancy.)
Keep in mind that some clinics may not have high success rates because they focus on difficult-to-treat problems or because they use last ditch methods that may be a couple's only hope. Make sure you understand why a clinic's numbers are what they are.
Your Right to ART
Fertility clinics cannot turn you away because of a disability or discriminate against you because of your race or ethnic background. At the time this book was written, a case was being heard in Colorado about a blind woman who was required to show a clinic that she was able to care for a child before they would continue her IVF treatments. The court will consider whether the Americans with Disabilities Act prohibits this kind of discrimination. Clinics that receive federal funds may also violate the Rehabilitation Act if they treat those with disabilities differently than other patients.
Most couples enter the world of assisted reproduction slowly-first with fertility drugs and then gradually moving on to other procedures. When you first begin to work with medical assistance to get pregnant or have a child, it is important to have a frank discussion with your partner about what types of medical assistance you are comfortable with. This is not a topic that normally comes up in most marriages, but once you begin to work with fertility specialists, a whole world of possibilities opens before you. You may not know how your spouse feels about sperm donors, egg donors, and surrogates.
Realize that what you think you know about your feelings and preferences now may change. If you move through different procedures with no success, you may feel that that the desire to have a child is more urgent than any objections you might have had earlier to certain types of fertility assistance.
You and your partner will also have to make some choices about who you will tell about your ART procedures and what information you are willing to share with family, friends, and so on. You are not obligated to tell anyone, but most couples find they need the support that friends and family can provide.
Because ART procedures are medical procedures, they are protected by the Health Insurance Portability and Accountability Act (HIPAA). Your doctor or insurance company cannot give out any medical information (verbally or in writing) about you without your consent. Information can be shared without your consent to coordinate treatment between doctors (such as if you are working with an a reproductive endocrinologist and a reproductive surgeon) or to obtain payment from insurance. Your information cannot be given to your employer or used in a marketing or advertising campaign without your consent. In order for information to be released to your insurance
company, you need to sign a onetime waiver stating that you want your health insurance company to be billed and that you agree to have information released to them.
If you want your spouse or partner to be able to have access to your records (or even to be able to call in with a question on your behalf), tell the office staff you would like to give written permission for this. Although the law says that a family member involved in your care can have access to your records, doctors are very careful about this. If you
have an unmarried partner, it is essential that you give permission for him or her to access your records.
HIPAA also gives you the right to see your own medical records, obtain a copy of them, and get a report about when and with whom your health information was shared. You have the right to require doctors, clinics, and hospitals that treat you to make corrections to your records or to at least note that you disagree with information included in your record.
Your Rights as an ART Patient
This may be the first time in your life you have had to seek serious medical intervention. It is important to know what your rights are.
Who is the Patient
Most people enter ART with a partner or spouse. When you approach the treatment with a partner, it feels to you as if both of you are the patient, since you are trying to create a child together. While your doctors may talk to you both together and treat you the same way, only the person who is receiving medical treatment from the provider is the patient. Because of privacy laws, if a woman is the one receiving treatment and her husband calls the clinic to get a test result or ask a question, the clinic is not supposed to release the information to him.
The way around this is to sign a release form that will be kept in your file. This will authorize the clinic to speak to both of you about any treatment, test results, or procedures at any time. Your clinic will have a form they will want you to complete, but they may not offer it automatically-you will probably have to ask for it. Giving your partner access to your treatment will help make this a joint venture and will also allow you the convenience of not having to make every phone call yourself.
When you receive medical treatment, you must provide informed consent. This means that you must agree to the treatment after all the risks and benefits have been explained to you. Fortunately, in ART, your care providers will probably spend a lot of time talking with you about treatments, risks, and possible outcomes. If at any point you feel you do not have enough information to make a decision or if you feel confused about something, speak up and ask for more information. Always be sure to ask about risks and possible outcomes for you as well as for your child.
It is also important that you take the time to educate yourself about your condition and treatments. Spend some time doing Internet searches and reading articles so that when you see your provider, you are armed with some knowledge and are better able to ask questions.
You always have the right to a second opinion, and most insurance companies will pay for one. A second opinion is a good idea when you have been given bad news or when an invasive treatment is recommended. Do not ask your current doctor for a recommendation about who to see-he or she is likely to send you to someone with a similar viewpoint. Instead, contact your insurance company and ask for names of other specialists or contact the national organization for the type of specialist you are seeing.
You have the absolute right to refuse medical treatment and can walk out of any doctor's office, clinic, or hospital at any time. Refusing treatment is sometimes referred to as leaving against medical advice (AMA). You can change your mind about treatment, decide you want a second opinion, or feel that you need more time to think about something.
The one caveat that is involved with ART is that women are at the mercy of their cycles, so if you are scheduled for an IVF treatment but need time to think about it, you may miss your window of opportunity for that month. Additionally, if you have medical insurance that is paying for your care, and you refuse a recommended treatment, the insurance company may not pay for any complications or problems that result from your refusal of treatment.
Because the ART field is constantly evolving, there may be new treatments available to you that have not been fully tested, proven, or reviewed. If you are considering an experimental treatment, find out what other options you have and compare them and their success rates with the experimental treatment. Some couples go to experimental treatments when everything else has failed, while others are anxious to try new things that may have better or faster results than more traditional treatments.
Educate yourself about the treatment-its costs, its risks, and its benefits. Ask a lot of questions and get information about what kind of testing it has undergone and what bad results have occurred. Find out how experienced the practitioner is with the treatment. Get information about costs up front. Your insurance company is unlikely to pay for experimental treatments, but it cannot hurt to ask. Some experimental treatments are funded by universities or other groups that reduce or remove any cost to you.
Weighing Technology vs. Adoption
There comes a point, once you have not been successful with fertility drug treatment, that you must choose a path. You must decide whether you want to pursue becoming a family through adoption or becoming a family through assisted reproduction. It is important to understand that no decision you make at this crossroad has to be the final word. It is possible to pursue both options at the same time and then, if one works, give up on the other. It is also possible to begin down one path only to change your minds and pursue the other choice. In other words, you are not making a final, irrevocable decision no matter what you start to do.
Some couples simply know which path they will pursue. Others need to think about the possible outcomes, financial costs, and emotional costs of both choices. There is no right or wrong answer.
Weighing the Use of Donors
When you enter into ART, you probably do so planning to use your own genetic material to conceive a child. But some couples are unable to do so and must use donor material. Choosing to use donor material involves an acceptance of what you are giving up. You are giving up your dream of having a child that is genetically related to you and your partner.
Many couples are able to have a child that is genetically related to one of them, but not the other. In this instance, you and you partner must be able to live with this knowledge. Some couples experience real problems over this. Seeing your wife carry a child that another man's sperm helped to create or carrying a baby that was created with another woman's egg can be a difficult burden. Some people feel jealous of the parent who will be genetically related, resentful that they are unable to genetically participate, or worried that somehow the child will not be as much theirs.
It is very important to consult with a counselor when making these decisions. Conceiving via ART can be a long and arduous journey. You could be carrying this pain for a long time. It is important to resolve these feelings, because if you do successfully conceive, you want to be able to parent with a loving and open heart.
Dealing with Risks
Because you are considering cutting edge medical technology, it is important that you come to a clear understanding of the risks posed to you and your partner, as well as to your possible children. Medical risks should be discussed thoroughly and completely with your medical care providers. Do not allow your providers to assume you understand risks. Ask to have them spelled out. There are risks of infection and other problems from surgical procedures, as well as risks posed by fertility drugs used to stimulate ovulation, by pregnancy itself, and by other procedures you may encounter.
In addition to medical risks, you also face legal risks. When you are dealing with your own genetic material, the legal implications are not as great. However, when you begin to consider and use procedures that involve donated eggs, sperm, or zygotes (embryos), the legal risks become much larger.
It is imperative that you work closely with a reproductive rights attorney who has experience reviewing and drafting contracts for donations and surrogacy. Do not assume you can do this on your own. This book is designed to point out the important issues, considerations, and questions that should come up, but is not designed to allow you to do it yourself.
Because you are dealing with your legal rights as a parent, you want an expert on your side.
Chapter 1: Understanding & Evaluating Reproductive Technologies -
- Understanding Your Condition
- What Technology Can Do for You
- What Technology Cannot Do for You
- Understanding Terminology
- Finding Medical Professionals You are Comfortable With
- Success Rates
- Your Right to ART
- Initial Visit
- Setting Limits
- Your Rights as an ART Patient
- Weighing Technology vs. Adoption
- Weighing the Use of Donors
- Ethical Considerations
- HIV and Assisted Reproduction
- Dealing with Risks
- Fertility Specialist Questionnaire
Chapter 2: Coping with ART -
- Deal with Emotions
- Making Time for ART
- Keeping Your Relationship Stable
- Live Your Life
Chapter 9: Surrogacy -
- Laws Concerning Surrogacy
- The Legal Process of Surrogacy
- California Procedure
- Surrogacy Programs
- Finding a Surrogate on Your Own
- Surrogacy Agreements
- Payment Issues
- Insurance Coverage
- Problems with Surrogacy
- Other Steps to Protect Yourself
- Choosing a Surrogacy Program Questionnaire
Chapter 10: Emerging Technologies -
- Nuclear Transfer
- In Vitro Maturation
- Cytoplasmic Transfer
Chapter 11: Cryopreservation -
- Death of a Parent
Chapter 12: Raising an ART Child -
- Explaining Things to Your Child
- Coping with Other People
- Medical Information
- Helping Your Child Locate His or Her Donors or Surrogates
Chapter 13: Moving from Fertility to Adoption -
SECTION II: Adoption
Chapter 14: Understanding Adoption -
- Legal Effects
- Birth Parents' Rights and Roles
- Extended Birth Family
- Legal Process
- Making the Decision to Adopt
- Preparing for the Adoption Roller-coaster
- Preparing for the Future
Chapter 15: Adoption Decisions -
- Open vs. Closed Adoption
- Domestic vs. International Adoption
- Agency vs. Private Adoption
- Finding and Choosing an Agency
- Finding and Choosing an Attorney
- Affording Adoption
- Agency Evaluation Questionnaire
- Attorney Evaluation Questionnaire
Chapter 16: Adoption Procedures -
- Home Studies
- No Consent Needed
- Timing of Consent
- Consent Procedures
- Adoption Court Procedures
- Birth Certificates
- Adoption Financial Credits
- Family Leave
- Insurance and Planning for the Future
Chapter 17: Second-Parent Adoption -
- Deciding to Adopt a Stepchild
- Qualifications to Adopt
- Notice or Consent
- Preadoption Procedures
- Second-Parent Adoption Process
Chapter 19: International Adoption -
- Choosing an Agency
- Choosing a Country
- Choosing a Child
- Dealing with Paperwork
- The Process
- Dealing with Immigration
- Changes in Adoption Law
- Forms Checklist for International Adoption
- International Agency Questionnaire
Chapter 20: Parent-Initiated Adoption -
- Adopting Independently with an Agency
- How to Find a Birth Mother
- Choosing a Birth Mother
- Contact with Birth Mother
- Waiting for Your Child to be Born
- Adjustment Period
- Choosing a Facilitator Questionnaire
- Potential Birth Mother Questionnaire
Chapter 21: Single-Parent Adoption -
- Considerations for Single-Parent Adoption
- Bias Against Single Parents
- Home Studies
- Laws Governing Single-Parent Adoption
- Protecting Your Family
- Raising Your Child
Chapter 22: Gay and Lesbian Adoption -
- Single-Parent Adoption
- Second-Parent Adoption
- Couple Adoption
- International Adoption
- Finding Gay-Friendly Adoption Agencies
- Raising an Adoptive Child
Chapter 23: Coping with Adoption -
- Dealing with Reactions to Adoption
- Dealing with Others Involved in Your Case
- Dealing with the Waiting
- Dealing with Doubts
- Changing Your Mind
- Taking Time Off for Your Adoption
- Bonding with an Adopted Child
- Dealing with Adoption Disappointments
Chapter 24: Raising an Adopted Child -
- Celebrating Your Adoption
- Breastfeeding an Adopted Infant
- Talking to Your Biological Children about Adoption
- Raising Biological and Adopted Siblings
- Talking to Your Child about His or Her Adoption
- Keeping an Adoption a Secret
- Cultural Heritage
- Medical Issues
- Postadoption Support
- Finding Birth Parents
Appendix A: Resources -
Appendix B: Forms -
About the Author -