Archive for the ‘Advice From Our Colleagues’ Category
Thursday, April 18th, 2013
 Understandably, couples faced with the decision of choosing an egg donor typically have concerns about the donor’s genetic makeup. Fortunately, there are options available to help a couple identify any genetic disorders their donor might have and reduce the risk of passing these traits on to the child/children born from the donation.
There are two approaches when it comes to donor genetic screening, which are not mutually exclusive. The first and more traditional approach begins with genetic counseling. The genetic counselor will take a detailed family history from the donor and recommend specific genetic tests based on this history (and the ethnicity of the donor). Though this is still considered the standard approach in the industry, it has two potential flaws. First, the donor may be unaware of a specific genetic disease in her family or, worse, may choose not to disclose it. Also, single gene testing can be very expensive, especially when it comes to the “Jewish Panel” (performed on Ashkenazi Jewish donors), which can cost over $2,000!
A new alternative that has become more prevalent in recent years is Universal Genetic Testing (UGT). With UGT, a single saliva or blood sample can be analyzed for the presence of multiple recessive genes at a relatively low cost. Currently, the first such test available is called “Counsyl.” This test costs $350 and evaluates 100 recessive traits, including the Ashkenazi panel).
If a serious recessive trait is discovered, the intended father needs to be tested for that gene, or the donor should be excluded. Most doctors tend to encourage the latter choice.
Critics of UGT are uncomfortable with its “shotgun” approach. Detection rates for diseases not common in specific ethnic groups can be low, however, these women would not ordinarily be tested for these diseases so not much is really lost. In contrast, the cystic fibrosis screen in Counsyl contains more mutation than most of the traditional single gene tests currently available. Also several less-serious diseases (that do not have life-threatening affects) are included in Counsyl, and finding such a disease may unnecessarily create anxiety on the part of the recipient couple. Some doctors have started customizing the panel to exclude such conditions. One genetic disorder not included in the Counsyl panel is fragile-X. Women carrying this mutation can produce boys with severe mental retardation and autism. Fragile-X is the most common cause of mental retardation in boys and one of the few proven genetic causes of autism.
Both the traditional approach and UGT are appropriate options for screening egg donors. I personally recommend Counsyl and fragile-X testing on all new donors. If for some reason Counsyl is not desired, Caucasian non-Jewish donors are screened for cystic fibrosis, spinal muscular atrophy (SMA), fragile-X, and Tay-Sachs enzyme. I also recommend that a complete blood count be donor to screen for thalessemia. As always, your doctor and genetic counselor will be able to help in deciding which genetic tests are most appropriate for your donor.
- Michael Feinman, MD
Medical Director, HRC Fertility
Tags: Beverly Hills Egg Donation, BHED, Counsyl, Dr. Michael Feinman, egg donation, egg donor, egg donor agency, egg donor genetic screening, HRC, HRC Fertility, IVF, Jewish Panel egg donation, UGT, Universal Genetic Testing
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Monday, August 29th, 2011
Second in a series of posts for intended parents from HRC’s Dr. David Tourgeman…
Perhaps the most difficult and emotional decision a person or couple is confronted with when trying to have a child is choosing whether or not to use an egg donor. For some, the decision may be relatively straightforward. Perhaps the adoption process has reached a dead end, or the woman has premature ovarian failure or another medical condition in which the ovaries will not produce eggs.
In most cases, the intended parents have already attempted many rounds artificial insemination and/or in vitro fertilization without success by the time they come to consider egg donation, and have been burdened with the bad news of multiple negative pregnancy tests. For most, the decision to move forward with a donor comes at the end of a long road of struggle and disappointment.
 One biggest issue intended parents considering egg donation must confront is deciding whether they feel their genetics must play a part in conceiving a child, or if having a baby (despite the maternal genetic origin) is most important.
Intended parents are faced with two options: working with an anonymous donor, or choosing a donor who is willing to be “known” (non-anonymous). If the couple decides to move forward with known donor, typically a sibling or relative is chosen (although many egg donor agencies also have a list of donors who are willing to engage in an open cycle) and ideally that person is less than 35 years old and has children of her own. This provides a “bridge” in which (in the instance of choosing a family member) there can still be some genetic link to the intended mother. There are many patients who choose not to have a known donor because they either do not feel comfortable asking, do not have an age-appropriate relative, or simply do not want anyone to know that they’re using an egg donor.
On the other hand, choosing an anonymous egg donor can be a challenge. There are certainly many factors that the intended parents may want to address in their search. Physical attributes and similarities are often paramount, however, intelligence, ethnic origin, and family heath are also significant. From a medical standpoint, there are also many desired qualities to keep in mind that will help optimize the likelihood of success. I typically recommend that the donor be less than 30 years old, and that she have had testing for ovarian reserve that returned normal. She should have had all appropriate genetic screening tests and have been evaluated by a psychologist to make sure she is in a healthy state of mind and that her motives are genuine. Whenever possible I recommend choosing an anonymous donor who is “proven” (meaning she has done at least one successful donor cycle in the past – resulting in at least 15 eggs and a successful pregnancy).
Above all, the most important thing for the intended parents to consider is whether they will be fulfilled as parents if they decide to use a donor egg. As parents, you’ll have the opportunity to nurture and nourish your child in the way you have envisioned. The pregnancy and birth is the beginning of an amazing experience and, hopefully, the beginning of the intended parents understanding that, despite the egg donor’s genetic contribution, this baby is completely their own.
- David E. Tourgeman, MD, FACOG
HRC Fertility
Tags: assisted reproduction, Dr. David Tourgeman, egg donation, egg donation agency, egg donation los angeles, egg donor, egg donor agency, egg donor Southern California, HRC, IVF, Reproductive Endocrinologists
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Monday, August 22nd, 2011
 As a recipient preparing to embark on a donor IVF cycle, the most important initial step is identifying an egg donor that meets your “wish list.” In addition to physical and medical attributes, it is paramount to have the egg donor evaluated by a psychologist and genetic counselor. In general, the psychologist will administer a mental heath examination to verify that the egg donor is emotionally stable and that her motives are genuine. Additionally, a genetic counselor will review the donor’s personal and family history to assess whether there are any genetic predispositions or concerns.
Once the egg donor has received psychological and genetic clearance, she will be tested for infectious diseases according to the FDA guidelines. This is usually done by the intended parent’s physician, who will also evaluate the donor for any other medical issue. At this point, the only thing left to do is sign on the dotted lines. In addition to completing the contract wth the egg donor agency (typically done when the donor is reserved), an attorney is provided to protect both the egg donor and recipients.
Getting Ready
Before the process can begin, there will need to be an evaluation of the intended mother’s uterus. This is usually done by having a water-instilled ultrasound know as a hydrosonography or a dye-based X-ray called a hysterosalpingogram. In either case, the goal is to have a womb free of fibroids, polyps or other problems that may decrease the pregnancy rate
It is also common to perform a practice embryo transfer in which a small soft catheter is guided through the cervis into the uterus. This practice transfer is generally referred to as a “mock cycle,” during which the uterus is stimulated with hormones to test the response. Depending on the practice of your physician, the mock cycle may be followed by a uterine biopsy (although this is done much more rarely).
Ready, Set, Go
Believe it or not, at this point it’s time to begin the actual cycle synchronization. Typically both the egg donor and the recipient call the coordinating doctor’s office with their periods, and they are then started on birth control pills. Dependent on the stimulation protocol, the recipient and donor are then transitioned onto a daily injection of Lupron. This is done so that both the recipient and egg donor can begin at the same starting point in their menstrual cycles. Once the egg donor is started on the stimulation medication, the recipient will begin estrogen supplementation, which will thicken the uterine lining and continue the synchronization process. Estrogen is usually adminstered either orally, by patch, through injection, or via vaginal suppository.
The egg donor will typically stimulate her eggs to grow for about 10 to 12 days and will then take the last shot to “trigger” maturation of the eggs and prepare her for the retrieval.
Almost There
Based on the time of the trigger shot, the egg donor will be scheduled for her retrieval. In the cases where the egg donation is anonymous, the intended father will come at a different time (usually shortly after the egg extraction) to produce a sample. The intended mother will then stop the Lupron and begin progesterone supplementation. Progesterone is usually administered via either vaginal suppositor or injection. The progesterone and estrogen will continue through the end of the first trimester.
The embryologists will then combine the eggs and sperm, and the final steps begin. Your fertility doctor’s office will call you the next morning with a fertilization report. This will include the number of eggs extracted and the number of embryos that were achieved after fertillization. The embryos are then grown in a laboratory for three to five days. In most cases, there will be many embryos, and most fertility doctors will opt to grow them out to the fifth day (when the embryos reach the blastocyst stage in which they have 60 to 100 cells).
Final Steps
The time has come… the embryo transfer! Your doctor will review the number of embryos that are transferable and then make a recommendation as to the number that should be used, usually one or two. The embryos that are not transferred will be frozen for future use.
The embryos will be placed into the uterus with the same soft catheter that was used during the mock cycle. This is often done under ultrasound guidance, so that the embryos can be placed in the most desirable spot. The procedure is painless, other than the discomfort of the speculum. The embryologist will also double check to be sure the embryos did not stick to the catheter.
The process is done! In eight to twelve days your blood will be tested to see if pregnancy has occurred. About two weeks after the first blood test, you will have an ultrasound to confirm the viability of the pregnancy. Best of luck!!
- David E. Tourgeman, MD, FACOG
HRC Fertility
Tags: Beverly Hills Egg Donation, BHED, Dr. David Tourgeman, egg donation, egg donation advice, egg donation FAQ, egg donor, HRC Fertility, IVF, IVF clinic, IVF doctor
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Thursday, July 7th, 2011
All intended parents are confronted with the decision as to whether or not they should tell their child (and others) that they used a third-party to conceive their child. Parents usually come to a decision based on their own comfort level and feelings regarding using an egg donor or surrogate. Most experts agree that honesty is the best policy when it comes to informing your child. A good website that goes into more detail about how to talk to your children in developmentally appropriate ways is www.donor-conception-network.org. The website has a great series of booklets entitled “Telling and Talking” – they offer advice on how to talk to your child at every stage. Before telling your child you want to asses 1) the child’s emotional and intellectual capacity to process the information and 2) the extent to which your family, culture or religion may be able to accept a child born through egg donation or surrogacy.
The decision to tell your child may be an easy one or one fraught with decision. Most family therapists would agree that telling your child is the easier path to take because there’s no room for misconceptions or false information, which inevitably leads to feelings of betrayal or mistrust. It’s also recommended to start giving some information at a relatively early age, from three to five years old. Again, the website above goes into thorough detail in advising how to talk to children of all ages regarding their conception.
- Brenda Fahn-Hardt M.S., MFT
Beverly Hills Egg Donation Staff Psychotherapist
Tags: assisted roproduction, Beverly Hills Egg Donation, BHED, egg donation, egg donation agency, egg donor, egg donors, IVF, Southern California assisted reproduction
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Wednesday, June 1st, 2011
When choosing an egg donor, it is understandable that women will want to select a donor who is similar to themselves in appearance and ethnic background. As with many aspects of Jewish Law, what may seem obvious and desirable may not conform to rabbinical interpretations of the Law. Ironically, since it is sometimes difficult to find suitable Jewish donors, these legal twists can actually help some people “let go” of their desire to work only with Jewish donors.
While Reform Judaism recognizes that parentage can come from either parent, traditionally most, but not all, rabbis have agreed that if a Jewish woman gives birth to the baby, that child is fully Jewish. The Laws determining a child’s family and religion of origin were established thousands of years ago — long before genetic testing — and so Jewishness is passed from the mother who gives birth rather than from the genetic parents.
The following principles can guide most Jewish couples considering egg donation:
A Jewish donor is not legally required for a Jewish couple. Based on the concerns about accidental incest and the legal status of eggs, a non-Jewish donor may actually be preferable. Accepting this idea can alleviate much of the angst over trying to find a Jewish donor (which, again, can be difficult).
If a Jewish donor is chosen, she should be single or married to a non-Jewish man. If she is divorced, she needs a Jewish divorce, including a “Get.”
The process of choosing an egg donor is different for every family. There are an endless number of things to consider in making such an important decision. If observing Jewish Law is a priority for the Intended Parent(s), then finding a Jewish donor is not as necessary as one might think. Ideally, this will be helpful to some (as the pool of potential donors will be enlarged significantly).
- Michael Feinman, MD
Medical Director, HRC Fertility
Tags: Beverly Hills Egg Donation, BHED, do I need a Jewish egg donor, egg donation, egg donor, Jewish egg donation, Jewish egg donor
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Wednesday, May 26th, 2010
Below is our final topic in Brenda Fahn-Hardt’s series of discussions for Intended Parents. Thank you, Brenda, for all of your contributions over the past few weeks!
Will I Feel Bonded to My Child?
One fear that intended parents sometimes bring up is that they may not feel as connected or bonded to their child because they used an egg donor. I don’t think I have encountered any cases that substantiate this fear, but of course it is a valid concern. I tell intended parents that they may be more prepared to handle their child than parents who have biological children. Biological parents many times assume that they will understand their  child, yet each child is unique and may or many not resemble their biological parents either. The key to parenting is to be attuned to who your child is. When you enter the world of parenthood, it is a daily challenge to let go of who you think your child “should” be and accept them for who they are. A daily lesson as a parent is to listen and accept your child for who he/she is. If you can do that there is no doubt that you will feel connected to your child.
- Brenda Fahn-Hardt M.S., MFT
Beverly Hills Egg Donation Staff Psychotherapist
Tags: assisted reproduction, Beverly Hills Egg Donation, BHED, Brenda Fahn-Hardt, egg donation, egg donation southern california, egg donor, egg donor agencies, egg donor agency, egg donor psychologist, egg donors, intended parent, intended parents psychological issues, IVF, ivf cycle, resources for intended parents, Southern California egg donor, Southern California egg donor agency
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Thursday, May 20th, 2010
In the latest installment of our five-part series for Intended Parents, Brenda shares her advice for how/when to share with a child that they were conceived with the help of an egg donor.
Do We Tell Our Child They Were Conceived Through Egg Donation?
 All intended parents are confronted with the decision as to whether they should tell their child (and others) that they used a third-party to conceive their child. Parents usually come to a decision based on their own comfort level and feelings regarding using an egg donor or surrogate. Most experts agree that honesty is the best policy when it comes to informing your child. A good website that goes into more detail about how to talk to your children developmentally appropriate ways is www.donor-conception-network.org. The website has booklets entitled, “Telling and Talking”. These booklets offer informative advice on how to talk to your child at every stage. Before telling your child you want to assess 1) The child’s emotional and intellectual capacity to process the information and 2) The extent to which your family, culture or religion may be able to accept a child born through egg donation.
The decision to tell your child may be an easy one or one fraught with decision. Most experts agree that telling your child is the easier path to take. It is easier because there is no room for misconceptions or false information, which inevitably leads to feelings of betrayal or mistrust. It is also recommended to start giving some information at a relatively early age, from three to five years old. Again, the website mentioned above goes into thorough detail advising how to talk to children of all ages regarding their conception.
- Brenda Fahn-Hardt M.S., MFT
Beverly Hills Egg Donation Staff Psychotherapist
Tags: assisted reproduction, Beverly Hills Egg Donation, BHED, egg donation, egg donation agency, egg donor, egg donors, how to tell a child they were conceived with an egg donor, IVF, Southern California assisted reproduction
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Monday, May 17th, 2010
Part 3 in Brenda Fahn-Hardt’s informal discussion for Intended Parents.
Meeting the Donor? There is No Right Choice.
At some point during the egg donor process most parents consider whether or not they should meet their egg donor. There is no right or wrong answer to this question. Each case is different and depends on the intentions and expectations of the intended parents. If their expectations seem reasonable and realistic, then meeting the egg donor can turn into a very positive experience. Most of the time intended parents want to be able to meet their donor so that they have the option of telling their child at a later date. Statistically, only about 20% of intended parents choose to meet their donor. If you intend to tell your child that they were conceived with an egg donor and you want to tell your child something about the donor, then meeting would likely be a positive experience. Many times parents to not have an interest in, or feel comfortable, meeting their donor, which of course should always be respected. Each situation is different.
- Brenda Fahn-Hardt M.S., MFT
Beverly Hills Egg Donation Staff Psychotherapist
Tags: Beverly Hills Egg Donation, BHED, egg donation, egg donation agencies, egg donation agency, egg donation california, egg donation los angeles, egg donation process, egg donor, egg donor agency, egg donor blog, egg donor cycle, egg donor los angeles, egg donors, how to choose an egg donor, intended parent, IVF, ivf cycle, resources for intended parents, should I meet my egg donor
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Thursday, May 13th, 2010
Part two in our series of discussions on psychological issues for Intended Parents.
Choosing a Donor
 Once intended parents have made the decision to use an egg donor, anxiety can arise surrounding the donor choice. Every intended parent usually approaches the issue with ‘preconceived’ criteria for choosing their ‘perfect’ candidate – beyond the standard medical screening that is done, scholastics, personality, and appearance are usually at the top of their list. I empathize with individuals and couples as to how difficult it is to make such a big decision. It is important to remember that there is no rush in choosing a donor. It takes time to find the right match. Whatever the intended parents are looking for, I encourage them to get as much information as possible from their egg donation agency regarding their donor, while also trying not to ‘over-control’ the situation. Once one feels they have made the best decision, according to the information they have, then the challenge can be trying letting go. There are no guarantees in life, all of us who are parents usually begrudgingly learn that a lot more of life is out of our control than we would like. Parenting is about being able to handle all the imperfections that come with a child, whether you have your child through an egg donor or not. When couples do have difficulty containing their anxiety during this process therapy can help.
As the ‘screening’ psychotherapist, my process is analytical and involves assessing the donor for her maturity and ability to follow through with the process, as well as the presence of any major psycho-pathology (i.e. personality or mood disorders). An interview and psychological test are used to check for either of the two preceding elements.
- Brenda Fahn-Hardt M.S., MFT
Beverly Hills Egg Donation Staff Psychotherapist
Tags: Beverly Hills Egg Donation, BHED, egg donation agency, egg donation los angeles, egg donor, egg donor cycle, egg donor database, egg donor los angeles, egg donors, fertility clinic, how to choose an egg donor, ivf cycle, Oocyte Donation, Ova donation, Southern California egg donation agency, Southern California egg donor, Southern California egg donors
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Tuesday, May 11th, 2010
 The following is the first in a series of postings from Beverly Hills Egg Donation staff psychotherapist, Brenda Fahn-Hardt M.S., MFT. Brenda comes to us with years of experience working exclusively with egg donors and couples dealing with infertility issues. In this, and in posts to come, she will address some of the most common psychological and emotional issues that come up in her work with Intended Parents.
Intended parents usually come to infertility services after spending years on an emotional roller-coaster. There are several emotional and psychological issues that intended parents typically encounter during this process. The ones that I encounter most in my practice are 1) Dealing with the grief of not being able to conceive your own biological child 2) The anxiety associated with choosing a donor 3) Deciding whether to meet the donor during the process 4) Fears of not being bonded or connected to your child and 4) Deciding if, when and how to reveal to your child that an egg donor was used in their conception.
Grieving
The journey to the egg donor option can be arduous for most couples. The realization that you are unable to conceive without the assistance of a third party can be internalized in numerous ways – the most common emotions are feelings of failure, inadequacy, humility and anger. When couples arrive at an infertility office, frequently they have not dealt with the trauma and pain that usually exists. I always encourage couples to experience their unresolved grief before getting too far down the road in the process. However, in many instances, because couples have been waiting years to conceive a child, they often feel compelled to jump into the next stage without processing their feelings. It is common for couples to get caught up in the frenzy of doctor’s offices, tests, shots and drugs while neglecting to take a step back and let oneself absorb and process the grief.
 Elizabeth Kubler-Ross wrote the classic treatise on dealing with grief. In her seminal work, she identifies the five stages of grief – denial, anger, bargaining, depression and acceptance. In a perfect world, an individual would experience these stages sequentially. Yet, each of us approaches life’s complications in our own way. The process becomes inherently more complicated when dealing with two individuals simultaneously, given the complicated dynamics of relationships in general. It takes an enormous amount of patience and understanding to respect and understand your partner’s process. Therefor I encourage couples to attend support groups and couple’s therapy to assist them through the grieving process.
The goal in the last stage of the grief process is acceptance. Acceptance can take on different outcomes for different couples (or single parents). The one constant is the reality that one is unable to conceive his/her own biological child. When one comes to this acceptance, there are different paths from which to choose – using an egg donor agency and/or surrogate, adopting a child or choosing not to have a child. Whichever path is chosen, you want to be confident about your decision and optimistic about your future.
- Brenda Fahn-Hardt M.S., MFT
Tags: Beverly Hills Egg Donation, BHED, egg donation, egg donation california, egg donation southern california, egg donor, egg donor agencies, egg donor programs, egg donors, fertility clinic, fertility doctor, infertile, infertility, intended parent, IVF, ivf cycle, Reproductive Endocrinologists
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Understandably, couples faced with the decision of choosing an egg donor typically have concerns about the donor’s genetic makeup. Fortunately, there are options available to help a couple identify any genetic disorders their donor might have and reduce the risk of passing these traits on to the child/children born from the donation.
