Third-party reproduction is now easier, more accessible, and more successful than ever before, yet it is still a complex process. Before you start down this path to parenthood, there are important questions to consider such as, “How are sperm, eggs, and embryos screened?”, “How do I find a donor?”, or “What are the legal issues surrounding surrogacy?” Here, psychologist Kim Bergman—an expert in the field and a mother herself through assisted reproduction—provides the answers you need and more.
Your Future Family provides a roadmap for navigating the journey of building a family through assisted reproduction. It outlines the very first steps you should take, the options available to you at each turn, and includes essential advice and tips to help set you up for success. Filled with personal anecdotes from Bergman’s own life, as well as the lives of her clients, this book brings the human element of creating a family this way to life.
The definitive primer on assistant reproduction,Your Future Family provides a foundational knowledge of the entire process, includes essential facts, as well as a list of resources to help you along the way. Kim Bergman’s expertise and her open, honest approach will inspire confidence to fulfill your dreams of creating a family.
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About the Author
Read an Excerpt
MARCY AND ERIC had been trying to have a baby for several years with no luck. They'd been to many specialists and they'd tried everything their doctor suggested, without success. When their doctor finally suggested they explore surrogacy, rather than feeling excitement, they felt sad, ashamed, and hopeless. It was another six months before they called me and asked to talk about surrogacy. I met with them on and off for another six months while we explored their feelings of sadness and loss. Marcy especially needed to dig deep to uncover how she was feeling and to grapple with her excitement about being a mom in the context of what she would have to give up to get there. They eventually decided to proceed, and their surrogate, Annie, got pregnant on the first try. The pregnancy and delivery went smoothly, and Annie delivered a healthy baby girl. Still, every step of their process was fraught with sadness, loss, and regret. Until their baby was in their arms. From that moment on, they focused completely on the joy of raising their daughter. In an instant, the sorrow of their past was a distant memory.
Like Marcy and Eric, you may have some big emotional hurdles to overcome before you begin the process. But with the support of professionals, family, and friends, and by staying focused on the outcome — your future family — you will get there.
Sometimes couples embrace the idea of getting help from the start, once they realize it is the only viable option, and even enjoy the process. For others, picking up this book is exciting and joyful, because you are setting a plan in motion to realize your dream of becoming a parent. Regardless of where you are emotionally, there is no shame about needing assistance, no sense of failing at something, but rather a sense of hope and possibility.
Assisted reproductive technology (ART) is by definition assisted. That means other people are involved in the process of conceiving a child. Before delving into the particulars of the medical options and procedures, and the various pieces you will need to put in place, it's important to determine if building a family this way is the right path for you.
Different readers of this book will be in very different places emotionally and psychologically. If you've tried to conceive a child naturally and haven't had success, it's likely you're feeling some grief about that fact. For you, exploring assisted reproduction may feel as if you've failed at something everyone else can do without much trouble. You may feel as if something is deeply and inherently wrong with you, and now you must take this unusual path to become a parent. When you understand that to realize your dream of parenthood you might have to give something up — one or even both of your genetic contributions, and/or the ability to carry and give birth to your baby — the emotional and psychological impact is undeniable. Why me? You might ask. While I can't answer that question, I can tell you that your feelings are totally valid. And after twenty years of experience helping prospective parents through third-party assisted reproduction, I know that if you truly want to become a parent and you choose assisted reproduction, you will eventually come to embrace it.
There are many, many people who have a child in a nontraditional way, but if you think there is something wrong with or shameful about having a child through assisted reproduction, then you shouldn't do it. A shred of doubt or uneasiness can grow. You are using exceptional means to bring a life into the world, and you need to be completely sure where you stand. Otherwise your choices can affect your ability to parent, your relationship with your child, and your relationship with your partner if you have one. If you feel embarrassed, or if you have moral or ethical concerns, then it is important to sort those out before you begin. Sometimes just a few conversations with a mental health professional can really help. Often, just talking through all of your feelings, understanding where they come from and having the opportunity to express and process your grief, can help you work through your feelings and then make a powerful choice. If after all of these conversations and research you are still uncomfortable with enlisting the help of others to have your family, you should choose a different option. There are many children in the world in need of loving parents, and fostering and adoption are wonderful ways to build a family. Being aware of where you're at emotionally, spiritually, and financially is an important first step in the process, and I encourage you to take a moment to check in with yourself and your partner if you have one. This is one of the most important decisions one can make, and the more facts you have about the process, and the more in tune you are with how you feel about your options, the easier it will be to make the decision that's right for you and your family.
The (Potential) Puzzle Pieces
There are four key players in your assisted reproduction journey:
A medical specialist, your reproductive endocrinologist
A reproductive attorney
A mental health professional specializing in fertility and ART
A fertility insurance expert
While some hopeful parents choose to go it alone, or go it partially alone (enlisting the help of a few but not all of these people), I would advise against that. For a life decision as major as this one, you'll want all the support you can get. And it's very likely that at some point you will need — yes, need — these experts to guide you through the legal, medical, and psychological aspects of third-party assisted reproduction. With that strongly worded advice out there, let's dive into how these four professionals can help you on your journey.
A Medical Specialist
Assisted reproduction can help you conceive a baby using your own sperm, eggs, and womb, with the fertilization process managed and guided by a reproductive endocrinologist, a highly specialized medical doctor. Reproductive endocrinologists are trained and certified as an obstetrician/gynecologist (OB/GYN) and then as a specialist in reproductive endocrinology, which is the science of reproduction. These are the doctors that help people get pregnant.
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Fact: The American Society for Reproductive Medicine (ASRM) is a hub for reproductive endocrinologists and all other professionals in the field of ART and is a great resource for hopeful parents. An especially helpful tool is their collection of statistics online about how likely each reproductive endocrinologist is to help their patient get pregnant.
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Reproductive endocrinologists are highly trained medical professionals. That said, just like any doctor, they have different personalities, different bedside manners, and different ways of working with patients. It's imperative that you find one you're comfortable with because this is a very intimate and emotional process. To this end, most are willing to have an initial consultation to go over their protocols, to talk about their statistics, and to discuss their overall approach. Before you commit to working with a specific doctor, it is wise to take advantage of this. If you can talk to a few former patients as well, even better.
When you visit a reproductive endocrinologist, you should expect a head-to-toe analysis of you and your partner. One important element of this will be blood work with the intended mother to look at hormone levels and similar issues that may be preventing pregnancy, and sperm analysis with the intended father to check for problems there. Often, after this assessment, the doctor will offer advice about timing sexual intercourse to maximize the potential for pregnancy and may suggest lifestyle changes to increase the odds of pregnancy, such as eating better, reducing stress, etc. If the intended mother's lab work indicates a need, she may be put on some type of fertility drug.
Often, this is enough to help a couple to get pregnant. When it's not, the likely next steps are insemination or IVF, or in vitro fertilization. With insemination, the doctor puts the intended father's sperm into the intended mother via catheter, in the ideal spot at the ideal time, to see if nature will take it from there. With IVF, eggs are removed from the intended mother, fertilized in a lab using the intended father's sperm, and nurtured to the embryo stage. Then the embryo is transferred back into the intended mother. I will discuss these processes in detail a bit later.
A reproductive endocrinologist can help you figure out why you can't get pregnant and what to do about it. Most of the time, some combination of timing, lifestyle, fertility drugs, insemination, and IVF results in pregnancy. If these options fail repeatedly, the doctor may suggest third-party assisted reproduction, which involves contributions from one or more third parties, like a sperm donor, an egg donor, or a gestational surrogate. The more people involved in your process of conceiving, carrying, and having your baby, the more complicated that process becomes. This is when other pieces — a lawyer, a mental health professional, insurance, financing, sperm donor, egg donor, and/or a surrogate — are essential to complete the puzzle. In these cases, you need to enlist the services of a lawyer and a psychologist, or an assisted reproduction agency, which will provide you with the legal, psychological, and medical expertise you need.
A Reproductive Attorney
If you need an egg donor or a surrogate, you need the services of a lawyer who specializes in reproductive law.
With egg donors and surrogates, there are specialized, incredibly detailed contracts. These contracts are designed to cover every aspect and potential aspect of the process, and to protect your rights as the intended parent. You need a good lawyer to make sure the contracts are meticulous and handled correctly. And that attorney needs to be a highly trained and experienced expert — so kindly decline your tax attorney uncle's offers to save you money and do the legal work for you for free.
If you're using a surrogate, your lawyer will help you make sure your surrogate lives in a surrogacy-friendly state — a state where surrogacy is legal and your rights as an intended parent are protected by statutes and case law. There are states where surrogacy is not legalized and your rights are not protected, and the consequences of attempting surrogacy in one of those states can be dire. This issue is discussed more fully later in the book, but it's worth mentioning here, too.
Your lawyer will also help you do whatever is necessary to establish your parental rights. If you're a same-sex couple, for instance, you may need to jump through a few extra hoops to make sure that both of you are the legal parents of your child. (This can be true even in some surrogacy-friendly states.) And, once again, different states have different laws and requirements, so you need a specialist lawyer to guide you and make sure that everything is planned ahead of time and done by the book.
Do not skimp on this part of the process. You will not be able to navigate this nuanced legal process on your own, and failing to get everything done correctly right from the start can be disastrous. I've listed useful information about lawyers who do this work in the Resources section.
A Mental Health Professional
Having the support of a mental health professional specializing in fertility and ART to help you through the process is not just a luxury; it is essential. As I mentioned earlier, you may be grieving the loss of the picture you had in your mind of how your family would come to be. A qualified mental health professional can help you work through your feelings and make the best choice for moving forward. He or she can help you navigate the unique relationship and feelings that may come up throughout the process of assisted reproduction, especially when third parties are involved.
Should you use a surrogate, your relationship with her will be unlike any you have ever had — it will involve a very strange intimacy with someone who may start out as a total stranger, or may be someone you already have a very different kind of relationship with. A psychologist will help you know what to anticipate as the relationship unfolds. A mental health professional will also screen all the parties involved to ensure transparency and lay the groundwork so that the process is set up for success. He or she will help educate all parties and set realistic expectations.
An agency that specializes in assisted reproduction will provide you with this service, but if you think you might go about it on your own, be sure to seek a qualified, experienced mental health provider. The ASRM can help you find an expert in this field.
A Fertility Insurance Expert
Assisted reproduction requires many types of insurance as you move through the process. If you're using your own sperm, eggs, and womb, your insurance may or may not help you get pregnant. If you're serious about beginning the process, one of the first phone calls you make should be to your insurance company to find out exactly what your coverage is. Some insurance companies will cover only part of your fertility treatments. Once you get pregnant, your insurance should cover you because it's your own pregnancy, but it's good to find out ahead of time just what your insurance covers.
If you need a third-party participant, especially if you need a surrogate, insurance gets considerably more complicated and expensive. First and foremost, you need specialized insurance that covers a surrogate pregnancy, or, at the very least, you need to make sure your surrogate has insurance that covers a surrogate pregnancy. Sometimes it will, but usually not. You also need special insurance that covers both the egg donor and the surrogate in the event of medical complications they might experience as they are going through the process. There are insurance agencies that specialize in this type of work, and I have listed them in the Resources section. Insurance costs can vary greatly. For example, cycle insurance, which covers egg donors and surrogates, is just a few hundred dollars, while pregnancy care insurance can range from $15,000 (if you are able to use the surrogate's own insurance, as you will pay her premium, deductible, and copays) to $30,000 if you need to buy the specialized surrogacy insurance.
Fact: Make sure your cycle and prenatal care insurance is in place before your surrogate becomes pregnant, as pregnancy is considered a preexisting condition, and the pregnancy and delivery can be very expensive without insurance.
Assisted reproduction, with or without third-party involvement, is very expensive. If you're working with a reproductive endocrinologist and attempting IVF, you can expect to spend upwards of $15,000 to $20,000 per cycle. If you need an egg donor as part of that process, the cost rises by around $50,000. If you need a surrogate, you're looking at another $120,000. Looking at the most expensive option — assisted reproduction with an egg donor and surrogate — it's likely that your total bill could be between $150,000 and $250,000 for one child. And most of that is out of pocket.
One of the variables that accounts for the range in cost is how many pregnancy attempts you need. Each additional embryo transfer costs around $20,000 — for the medical bill, medication, and surrogate's travel to the clinic. When using an embryo created with an egg donor (so they have been tested and are healthy), surrogates are pregnant on the first try about 70 percent of the time, with the other 30 percent needing one or two more tries. Ninety-nine percent of surrogates will be pregnant within three tries. So most of the time intended parents will not have to pay for more than one embryo transfer. Still, the process is very expensive.
This should not be surprising when you think about everyone involved in the process. First, you've got a group of highly specialized professionals, and they get paid accordingly. Then you have people who contribute the biological requirements, and they too must be compensated. All the pieces of the puzzle come with a cost, and those costs are significant. It's also important to weigh the emotional cost of spending so much money on something that is not a sure thing. Is it worth going into debt to attempt to have a baby this way with no guarantee? Luckily, some surrogacy agencies are now offering guaranteed programs — there is no avoiding that you'll spend a lot of money, but they will stick with you until you have a baby. Still, the stress and pressure of the expense are worth exploring before you begin.
There are a few companies that will help you with the expenses by financing parts of the process, and there are also organizations that provide grants and scholarships. Lastly, almost every professional I know working in this field does at least a small amount of pro bono or sliding scale work, so you can always inquire about that. There are some options to help you manage the financial costs, but there is no denying that they are significant.(Continues…)
Excerpted from "Your Future Family"
Copyright © 2019 Kim Bergman.
Excerpted by permission of Red Wheel/Weiser, LLC.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Foreword Mark Leondires, MD xiii
Chapter 1 Getting Started 1
Chapter 2 Sperm 13
Chapter 3 Eggs 29
Chapter 4 Embryos and Conception 47
Chapter 5 The Womb and Surrogacy 65
Chapter 6 Pregnancy and Birth 85
Chapter 7 Telling Your Story 105