Rescripted _Ep10_Third Party Reproduction: Audio automatically transcribed by Sonix

Rescripted _Ep10_Third Party Reproduction: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Kristyn Hodgdon :
Hi, I'm Kristyn Hodgdon, an IVF mom, current IVF patient, and co-founder of Rescripted.

Ali Domar:
And I'm Dr, Ali Domar, a thirty-four-year fertility industry veteran, psychologist, and expert in the mind-body relationship between stress and infertility.

Kristyn Hodgdon :
Welcome to Dear Infertility, the first-ever podcast that doubles as an advice column for those dealing with the daily stressors related to infertility and pregnancy loss.

Ali Domar:
We're here to answer your real-life questions related to the mental and emotional toll of infertility, while providing research-backed tactics and strategies for overcoming these dilemmas.

Kristyn Hodgdon :
Now, let's dive in and help you find calm on this stressful journey.

Kristyn Hodgdon :
Hi, everyone, and welcome back to the Dear Infertility podcast, I'm your host, Kristyn, and I'm here with Dr. Ali Domar. Hi, Ali.

Ali Domar:
Hey, Kristyn, how are you?

Kristyn Hodgdon :
I'm OK. Thank you for asking. So I'm really excited about today's topic because I think it's not talked about nearly enough, and that's third-party reproduction. So donor egg, donor sperm, surrogacy, maybe we can even dabble into adoption a little bit. But you know, I think it's so hard for women and men, couples experiencing infertility to sort of wrap their head around these options when, when they're presented to them or forced to consider them. So yeah, I kind of wanted to just jump right in and ask you how you approach this typically with your patients.

Ali Domar:
You know, it's a hard time. I mean, it's not like someone uses birth control. I'm sorry, stop, someone stops using birth control for a month, the woman gets her period and they go, oh, goody! Now we get to do egg or sperm donation. And one of my patients who you know, I've mentioned in a previous podcast and in the 10-week in-person mind-body program, on the seventh session, we have someone come in and talk about egg donation and someone come in and talk about adoption. And I remember the adoption, actually, they were a couple and I remember them saying, and they had a really tough road, they had, I think, seven years of infertility and like five, five IVF cycles, and it just wasn't working and they ended up adopting. But when someone said, well, how do you feel about adoption? And I remember the wife said it was not our first choice, but it's not second best.

Kristyn Hodgdon :
Absolutely. I love that.

Ali Domar:
And I thought, you know, and I've, you know, obviously this is egg donation has sort of taken off in the last 30 years. You know, I would say I now counsel far fewer people who are pursuing adoption, although I actually have two patients right now who are pursuing adoptions. I've actually gotten them together, so they talk to each other, but I'd say most people that I see who have sort of hit the, at the end of treatment with their own eggs are moving on to donor egg. In terms of sperm donation that tends to be discovered a lot earlier during the initial workup, and so, you know, if someone has a, has such a severe male factor that IVF with eggs isn't going to be an option for them, then I often don't see them because that often even comes up in the gynecologist office. So I certainly have a ton more experience counseling people who are making the decision to move on to donor egg or adoption or surrogacy. I have a lot of patients doing gestational surrogacy.

Kristyn Hodgdon :
Yeah. So I think a lot of, of women who are told that donor egg might be their best option, it's hard not to feel grief over the fact that your child won't be biologically related to you. What are your recommendations for kind of coping with those feelings?

Ali Domar:
Well, I would stop and say, in fact, the child is biologically related to you because you are just getting the pregnancy, the child may not be genetically related to you. And so, you know, the first thing I say to if I have seen a couple or even just the woman, not just a woman, I'm seeing the woman or the couple, I'll say, if you actually think about it, pregnancy is kind of unfair, because in a typical pregnancy, the woman has a genetic connection because it's her egg and a biological connection, because she just, you know, the baby develops in her uterus and the male partner only has a genetic connection. So with donor egg, he has a genetic connection and she's a biological connection, so it's not like she's giving up. And there's this whole new, there's this whole new field of epigenetics, which is looking at the probability of the woman's body sort of turning genes on and off in the baby. And some of the animal research is incredible how the female's body can change the genes on and off to make that baby more like mom. And, you know, knock on wood, I have never had a patient go through donor egg say I wish I hadn't done this, because it can be such an extraordinary experience if the woman is ready to do it.

Kristyn Hodgdon :
Mmhmm.

Ali Domar:
And what you don't want to see and it has happened, what you don't want to see is, it has never happened to any of my patients, but it happens out there, is someone who, you know, goes through treatment, you know, either ... an IVF cycle which gets cancelled because she's just not responding to the meds or she's not producing normal eggs or whatever else, and the physician says, look, I just cannot sort of ethically recommend another IVF cycle for you, I think you need to consider donor egg and she's like, fine, I'll do it. And a month or two later, she does a donor egg cycle and gets pregnant and realizes she wasn't ready. And you know, you have the same fear with adoption or donor sperm or anything else is that, you know, being told you are not going to have a genetic child is excruciating.

Kristyn Hodgdon :
Yeah.

Ali Domar:
And you know, there's not much I can say other than it's a, it's a big shock, no one feels good. I mean, I, actually that's not true. I've had patients, for example, where both parents were alcoholics, you know, and my patient has a huge concern about passing that gene on, and so in fact, being told she had to move on to donor egg was somewhat of a relief because she realized she wasn't going to pass on the increased risk of alcoholism to her child, or if somebody has some genetic condition that they can't screen out for, there is a relief of using donor egg or donor sperm. But in general, if one has done treatment that has not been successful and one is told, you know, donor eggs are your next step, it hurts. But it's not going to hurt forever, it hurts at the beginning, it's like, it's sort of like when someone breaks up with you, you feel awful, and then a few weeks later, you feel a little bit better and then you feel a little bit better, and then all of a sudden you're thinking, you know, I could date again. And so I think that's the process is that, you know, I sometimes do screenings of individuals or couples who want to move on to donor egg. And, you know, if they've done the IVF cycle a month ago, there is no way that I'm going to feel comfortable. They have to mourn, and she specifically has to mourn and grieve that there's a good chance that her baby is not going to have her dad's nose or her mother's eyes or whatever else. I mean, I think now with epigenetics, we are seeing a lot more connection than we ever thought possible. But you can't assume that or count on that. But I will say that ninety-nine percent of the patients who are that I have seen who are considering donor egg, that's not true, I'd say seventy five percent move on to do it. I mean, some move on to adoption and some choose to be child free, but most of them mourn and recover and then get kind of excited.

Kristyn Hodgdon :
Yeah, I think that's such an important point. Like, give yourself the time you need to process it, do your research, ask the questions, go with an agency or, you know, just make sure the route you're taking makes you feel comfortable. And then and then press go.

Ali Domar:
Right. I mean, and then, you got to trust your gut feeling. If you start looking at donor egg profiles and you want to vomit, that's not a good excuse, it means you're not ready. But if you start looking at donor egg profiles and you're like, oh my god, I love her, I'm so excited, that's a really good sign.

Kristyn Hodgdon :
Yeah, for sure. So surrogacy, I think there's a similar feeling to, to being told that you cannot carry your pregnancy, and would you give similar recommendations for those sort of on the path to surrogacy?

Ali Domar:
Yeah. I mean, it's interesting because I don't know why I've suddenly had a lot of patients who are doing surrogacy or been advised to do surrogacy. I don't know if it's just that's because the luck of the draw of the patients I get, or if more uterine factors are being identified as causes of infertility or pregnancy loss, and I think it's a really hard. I talk to a patient yesterday who actually carried her first child and has been told she cannot carry again for medical reasons. And you know, that's going to be a number of conversations that we're going to have to have. You know, I have a cousin who had to do surrogacy, and I spent a ton of time talking to her about it and literally because my cousin lives overseas, I was the one that basically had daily conversations with the surrogate during the pregnancy because my cousin found it too painful to talk to her every day about how she was feeling in it. And it was twins and how the babies are moving and things like that. And so at some level, just like with donor egg, you're, I don't want to say sacrifice, but you're not having the genetic link to your child or children. With surrogacy, you're not having that pregnancy link. And again, one has to mourn that because a lot of women are like, you know, I can't wait to buy maternity clothes and I can't wait to breastfeed, and you know, and I want, I can't wait for people to tell me how fat I look, I mean, no women, don't want that, infertility patients want that. And so it's, it's a loss. And, you know, it's also staggeringly expensive. So, you know, I talk people through it all the time and that's where, you know, either you need to aggressively save or that's when you need to go to people who have resources because, you know, I have a, the brother of one of my best friends suggested a donor egg surrogacy cycle, and he saved for years and years and years to come up with the money that he needed to do it. So it's expensive, and that's, it's, it's way more expensive than just doing donor eggs. So I think that's something people have to factor in. But there's also an excitement when you know there's a pregnancy with a surrogate and, you know, ideally you live close by so that you can go to the OB appointments and everything else. But people have very mixed feelings. I had one patient a few years ago who actually now has two children via surrogacy, and with the first one, she was jealous. She was really envious that the surrogate was pregnant with her baby and that the surrogate got to have that experience. And I had to spend a lot of time with her saying, you know, it's not the surrogates fault that she's able to carry a pregnancy and you're not, you know, she's she's doing an enormously amazing thing for you. And I even had to sort of push my patient into like doing nice things for her, like buying her gifts and just, you know, bringing her fun food and things like that. And it was a completely different experience with the second one because, you know, at that point she realized, you know, once the baby is put in your arms, I mean, it is genetically your a baby and then you are a mom and you're treated like a mom by everybody. So I think for both of them, it's the getting to the pregnancy point, which often may be the hardest.

Kristyn Hodgdon :
Mmhmm.

Ali Domar:
And for some people, the pregnancy for surrogacy, the pregnancy itself can be, can be challenging. But there is also an excitement like there's a baby, you get to see an ultrasound and things like that. So it gets better. And then when there's a baby, it gets way better.

Kristyn Hodgdon :
So I'm curious, do you ever have patients who are sort of at a crossroads and they don't know which avenue to pursue? I mean, I've heard a lot of times it's just a gut feeling like I really want to experience pregnancy. So I'm going to do donor eggs over adoption because I really want to have that connection or they don't want to pursue donor eggs and and they decide that adoption is the best route or they really want a biological child, so surrogacy is something that they're willing to save up for. Like, how do they sort of, how do you sort of counsel them through those, like making that choice?

Ali Domar:
And honestly, I've had very few patients who didn't know. I mean, for example, surrogacy isn't really a choice, and I guess it could be surrogacy or adoption that would be the choice. But for a lot of people, it's donor egg versus adoption. And I think people often have just this gut feeling.

Kristyn Hodgdon :
Yeah.

Ali Domar:
Like I need to be pregnant and like, I, you know, this is something I need to be after infertility, I need to be treated like another, you know, pregnant lady and I want to breastfeed. And that's really important to me. And I have other patients that say, I, I don't want to have a baby that my husband's sperm and another person's egg made, and that just feels really yucky to me and I don't want to do it, so I think there's a real gut feeling. I think that the challenge comes in when the two partners of a couple don't agree.

Kristyn Hodgdon :
Oh, yeah.

Ali Domar:
And you know, men tend to be very pro donor egg because it's still their sperm. And for them, it feels like a no brainer, like it's, it's his sperm. And she's just stating the pregnancy, though, so they know that she'll be super careful and take your vitamins and eat well, and that sounds way better than adoption. And women might feel like, no, that feels kind of unfair that he has a genetic link, and I don't. And so that's when I come in with, well, but you have a biological link and you know, with epigenetics, there might be more of a genetic link than you might think. And that's a tough one. And I remember I saw a couple, and this is probably 15 years ago, and I've been seeing her for a while, and she was dead set against donor egg, she wanted to do adoption, I think someone in her family was adopted. And I mean, she was like super pro adoption and her husband was just as pro donor egg, and he just couldn't understand why she wouldn't see the fact that it was his sperm and she could be pregnant. It took us a year of counseling, with me counseling this couple, and finally, we reached a compromise that she agreed to do one donor egg cycle, and if it didn't work, he agreed to do adoption.

Kristyn Hodgdon :
Ok!

Ali Domar:
So which I thought, I think all three of us felt that was a comfortable compromise. So they did a donor egg cycle, she got pregnant, had a baby, and, you know, I've never in my life, no matter how a kid came apart, seen a kid look that much like their mother, like people, she said, stop them on the street.

Kristyn Hodgdon :
I've heard that so often in the community from donor egg mom.

Ali Domar:
Yeah, it's, I mean, she sends me Christmas cards every year and it's like, it's, it's, I mean, I'm sure they chose a donor that looked like her, but it's still crazy how much this little girl looks like her mom. And she she left me a voicemail, which I kept on my work phone until our offices moved after, 10 days after the baby was born, and she said if I had known how amazing this would feel, I would have done this five years ago, she goes, I have never been this happy in my life.

Kristyn Hodgdon :
I've heard that so often too. It's like once your baby is in your arms is sort of doesn't matter how they got there or who they're biologically linked to, or.

Ali Domar:
I've seen donor egg patients as soon as I see the embryo, the picture of the blastocyst, they're like, oh, that's my baby! I'm like, that's a very good sign.

Kristyn Hodgdon :
Yeah, absolutely.

Ali Domar:
But people need to be ready because what you don't want is for someone to rush into donor egg, donor sperm, donor embryo, surrogacy before they're ready and then realize they're pregnant and regret that decision, so you need counseling. I mean, people need to go to the ASRM website and look under mental health professional group and talk to somebody who has an expertise in this to get them to the point where they make the right decision for themselves and their families.

Kristyn Hodgdon :
Absolutely. So we did this in the beginning of the podcast and then kind of scrubbed it for the last couple of episodes because admittedly, I forgot. But I wanted to ask you to wrap up, our company name is Rescripted, how would you sort of rescript the way people understand the donor, sorry, third-party reproduction process?

Ali Domar:
Well, I think that patient of mine years ago, you know, to rescript the idea that, yeah, no one chooses to have to go third-party. I mean, again, unless there's some genetics, but in general, people don't choose to have to do third party, but it's not second best.

Kristyn Hodgdon :
I love that. Let's let's end right there and thank you, Ali, as always, until next time, everyone. Thank you for listening.

Ali Domar:
Bye!

Kristyn Hodgdon :
Thank you for tuning in to this episode of Dear Infertility. We hope it helps you find calm during this incredibly stressful time. Whatever you're currently struggling with, Rescripted is here to hold your hand every step of the way. If you like today's episode and want to stay up to date on our podcast, don't forget to click Subscribe. To find this episode, show notes, resources and more, head to Rescripted.com, and be sure to join our free fertility support community while you're there.

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