There is no one ‘right way’ to start a family. While we are oftentimes only exposed to the ‘traditional’ path of becoming a parent, this is far from the only way to bring a child into the world.
There are many life circumstances and experiences that can lead to individuals seeking out alternative ways to become parents. But we live in a culture that does not openly acknowledge and oftentimes places stigma around these experiences. So individuals that struggle with things like infertility, which affects roughly 1 in 6 people worldwide btw, feel like they are alone when in reality they are far from it. This also applies to same sex couples who, in our heteronomative society, are oftentimes discriminated against and completely left out of the family planning conversation. And then there are individuals who, for a myriad of reasons, choose to start a family on their own. Which is 100% okay!
So let’s FINALLY start to speak openly about and validate these alternative paths to family planning.
And the first step to open up these conversations is to learn about them. Keep reading to learn about all things IVF and surrogacy from Dr Rachel B. Danis, reproductive endocrinologist and infertility specialist and board certified OB GYN at RMA of New York.
When in the conception journey should you begin to consider IVF as a solution to pregnancy?
The WHO considers a diagnosis of infertility when a heterosexual couple has been trying to conceive for 12 months. However, the decision to consider IVF treatment to conceive depends on a variety of factors, aside from the time interval the person/couple has been trying to conceive. Particularly in older women who are above the age of 35, they may want to proceed to IVF treatment sooner rather than later, given the facts that egg quantity and quality are declining at faster rates in the late 30s and early 40s age-range. Other reasons for considering/proceeding with IVF include those who are using a third party to conceive, such as a same-sex couple creating embryos with donor sperm, donor egg, and/or using a gestational carrier to carry the pregnancy.
Similarly, a person choosing to be a single parent by choice will need a third-party to build his/her/their family, and may consider IVF to assist with family-building. In addition to cases requiring a third-party to conceive, people who are interested in having more than one biological child may consider IVF. In this case, the goal would be to freeze/bank more than one embryo. One embryo can be transferred to conceive in the immediate future, while the remaining embryos can be frozen, or what we call “cryopreserved,” for future use. An additional case for considering IVF would be if both intended parents, or both egg and sperm sources are carriers for the same recessive disease, or if one party is a carrier for an autosomal dominant disease. In these situations, one may want to screen an embryo before conceiving to prevent passing on the gene to his/her/their offspring. This screening is called preimplantation genetic testing (PGT), which involves the creation of an embryo in vitro, then biopsy of the embryo for PGT. 2.
Who should consider IVF?
A heterosexual couple who has been trying to conceive for 12 or more ovulatory cycles, a heterosexual couple who has completed 3-6 intrauterine insemination (IUI) cycles after struggling with infertility, a person or people who require third-parties to conceive. This may not include a same-sex female couple who uses donor sperm to conceive via IUI, but if this couple would like to proceed with reciprocal IVF, then they would require IVF as the mode of fertility treatment. Reciprocal IVF is when one female partner stimulates her ovaries, proceeds with an egg retrieval and fertilization with sperm, anonymous or directed donor sperm, and then transfers the developed embryo into the female partner’s uterus.
What does the process of IVF entail?
IVF involves controlled ovarian hyperstimulation (COH), which is when a female patient injects recombinant gonadotropin hormones subcutaneously (below the skin) daily with the goal of causing multi-follicular development, or growth of multiple follicles, which contain eggs. In place of ovulation, where a follicle ruptures to release an egg, the person receives an egg extraction. This procedure involves light sedation, where a needle is guided via a transvaginal ultrasound, to aspirate follicular fluid from each follicle, with the hope that an egg would be retrieved. After this point, embryologists, who specialize in handling gametes in a laboratory, will examine the follicular fluid under a microscope. Embryologists will then carefully fertilize the mature/viable eggs, then incubate these zygotes (which is what we name fertilized eggs that now have two nuclei, one from the egg and one from the sperm) for about a week until the embryo reaches a blastocyst stage of development. (Historically, younger, cleavage-stage embryos were transferred.) The latter part of IVF involves preparing the uterus for embryo implantation. Implanting the embryo is timed carefully over about a 3-week time period where the patient is given first estrogen and then added progesterone therapy. An embryo transfer does not typically require anesthesia and is quite similar to an IUI procedure, where a speculum is used and a tiny catheter is used to transfer the microscopic blastocyst embryo.
What effects does IVF have on the body?
Physical side effects from the stimulation of the ovaries include bloating, abdominal pressure, and constipation. Sometimes, people report nausea, fatigue/feeling tired. Physical side effects from injections themselves may cause bruising and scant bleeding at the injection site. Risks associated with the supraphysiologic (above typical baseline) levels of estrogen include thromboembolism and ovarian hyperstimulation syndrome (OHSS). We do not believe IVF increases risks of GYN, such as breast, or non-GYN cancers, such as thyroid or colon cancer.
What are the advantages and disadvantages of doing IVF?
Advantages include being a more efficacious form of fertility treatment, compared to IUI. Each euploid embryo has about a 65% chance of implanting. Another advantage is being able to perform preimplantation genetic testing (PGT) for aneuploidy, which is an abnormal number of chromosomes, or PGT screening for a monogenic disease. IVF may also generate multiple embryos, where ones not transferred can be banked/cryopreserved/stored for a later time- either if this first embryo transfer does not implant successfully, or for future offspring. Given that we advise transferring a single euploid, or genetically normal, embryo at a time, IVF also allows us to conceive singleton pregnancies instead of the historical multiple gestational pregnancies.
Disadvantages of proceeding w/ IVF are related to the risks associated with COS, such as thromboembolism and OHSS, as well as the risks associated with the retrieval surgery. Every procedure, no matter how minor, carries risks, including risk of bleeding, infection, and causing harm/damage.
What are potential costs associated with IVF?
This depends on a person’s insurance coverage, if they perform intracytoplasmic sperm injection (ICSI) versus conventional insemination, PGT, and the number of embryos being biopsied for PGT.
How can one best prepare for successful IVF treatments?
I’d recommend not asking friends/family for their fertility outcomes, such as their ovarian reserve parameters (Antral follicle counts, anti mullerian hormone values), their egg yield, fertilization rates, etc. I find that this exacerbates the anxiety felt by patients. As for lifestyle behaviors, I’d advise smoking cessation and a healthy lifestyle to promote a healthy body in preparation for pregnancy.
Any other important need to know info?
Dr. Danis: Scheduling a consultation will increase awareness, provide education on fertility and what is right for the person, and help alleviate anxiety around fertility and IVF.
Who should consider Surrogacy?
Surrogacy may be required in cases of a same-sex male couple or in cases where a person has had poor pregnancy outcomes, such as in cases of placental abruption, history of multiple cesarean deliveries, second trimester losses etc.
What does the process of Surrogacy entail?
This involved legal teams, psychologists, fertility clinics, and surrogacy agencies. Learn more about the surrogacy process here
How does one pick a surrogate and what is the relationship between mother and surrogate?
There are many variables that can determine surrogacy selection, such as geography and cost. The relationship should be cordial, supportive, and trusting.
How does a parent best prepare for a surrogacy journey?
Support groups, counseling services, and open discussions with friends and family
5. What are the advantages and disadvantages of using a Surrogate?
This is a tough one to answer and can vary based on situations. Using a surrogate is a way to create a family for those who cannot on their own for various reasons like health of the mother, both partners are biologically male etc. Surrogacy can be expensive and there is a shortage of surrogates so it can be difficult to find one. 6. What are potential costs associated with Surrogacy? This can really vary from state to state and situation. Typically, anywhere from 50 to 100k depending on the circumstances and situation.
This interview only scratches the surface of what these nontraditional family planning paths entail, so we encourage everyone to continue learning about these topics because all forms of parenthood deserve to be supported and validated, and you never if you or someone close to you will be the one to seek them out.
Meet the Author:
Dr Rachel B. Danis, reproductive endocrinologist and infertility specialist and board certified OB GYN at RMA of New York.
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Momotaro Apotheca and its materials are not intended to treat, diagnose, cure or prevent any disease. All material on Momotaro Apotheca is provided for educational purposes only. Always seek the advice of your physician or other qualified healthcare provider for any questions you have regarding a medical condition.