Being a single gay dad certainly suggests that I didn’t get pregnant accidentally; my journey into parenting has been a long and deliberate one. Having my 6 month old son and daughter staring up at me all day reminds me that I really did want to do this 25 years ago, but being 50 still does not feel too late. They say it takes a village to raise a child. In my case it took a village to create a child. Thanks to a loving gestational surrogate, and longtime friends as both egg and sperm donors, my dream of parenting has come true.

A difficult pregnancy with many complications somehow made it to 36 weeks and 5 days with Ella weighing 5 lbs 12 ounces and Armstrong (Ari) weighing 5 lbs 11 ounces. Amazingly, at 6 months, they are 19 lbs each and have been sleeping 11 hours a night since week 13. For those of you who are soon to be parents, you will find that’s pretty remarkable. Having hardy and healthy babies is such a blessing. I am forever indebted to Pacific Fertility Center, and Dr. Isabelle Ryan, for their essential roles in helping me achieve parenthood and having a healthy family.

Choosing PFC was not initially an easy decision. It took accessing the CDC nationwide fertility clinic website and comparing the data from clinic to clinic to make me feel confident about picking up the phone and scheduling a first meeting. I really analyzed the data from the clinics carefully, as I was interested in high success rates achieved with high total numbers of embryo transplants.

I had also heard about specific experiences that gay men had had with other local clinics that were less than heartwarming. As an HIV-positive individual, even though I was opting to not undergo sperm-washing to utilize my own genetic material, I did want a compassionate and professional environment in which to pursue my parenting dream.

To be perfectly honest, I had been told by other parents that PFC took a “conservative” approach to achieving pregnancy. Conservative is a term that can be interpreted in many ways. For leftist liberals, like myself, it can somehow seem like a dirty word. However, I have a newfound appreciation for the term. My first surrogate was a lovely married woman with 2 children. She had been a gestational surrogate for a San Francisco couple 2 years prior. They had worked with another local fertility clinic and she got pregnant, rather quickly, with twins. She carried to week 28 and the babies were each under 3 lbs and fortunately survived. I was excited to proceed with her, as we got along splendidly and my priority was finding someone who had her own family and had previous surrogacy experience. PFC screened her and immediately determined that she had an “incompetent cervix”. I had no idea what that meant, though it seemed like the two most incongruous words to ever be placed back to back. Well, an incompetent cervix is a serious matter! I’m supposing that this was not previously diagnosed and was likely the cause of her prior preterm labor and delivery. PFC’s screening saved me a lot of heartache, money and time. I should say that 3 times in a row, to really give it the weight it deserves. I don’t think many people arrive at fertility clinics devoid of heartache, so having a clinician save you from avoidable disaster is an enormous gift.

Having now gone through a twin pregnancy, I more fully understand the roller-coaster process of which I was forewarned. Proceeding with a less than perfect surrogate would have been a tragedy. The second surrogate I found had actually conceived via PFC twice before and would have been a great surromom; but her insurance no longer covered surrogacy. I’m still in constant touch with her and she has nothing but great things to say about her experiences with PFC.

It would be easy for me to find the heart-space to simply rave about PFC. After all, I have the reward of two healthy babies to serve as living proof. For others considering parenting through assisted reproductive technology, there is so much more about my process that is crucial to know. I was insistent, from the get-go, about wanting twins. I had several discussions with Dr. Ryan about the risks that came with carrying multiples. Yes, I’d heard from many people that being a single dad with twins was going to be a “handful”, but the potential clinical complications and risks were not something I’d widely considered. I was 48 years old and didn’t want to go through the process over the course of several years and really wanted at least 2 kids.

Again, if a “conservative” approach is what I got from PFC, the counsel was so very right. My surrogate had previously carried twins and we were both confident that all would go well. We never imagined the complications that did arise during each trimester. It was a very difficult pregnancy. Even with a vaginal delivery, the recovery was tougher than I wish to describe herein. Everything I’d been told by PFC was absolutely accurate. Knowing what I know now, I would say that I, while not at all cavalier, was filled with excitement and anticipation that had me driving full speed through a string of yellow lights. Trust me; I drive now more carefully with twins on board.

Not a day goes by without my being awestruck by the wonder of my children. I have to say that, so far, this has not been a daunting experience. Maybe I have easy babies. Maybe being highly organized has provided them with the structure and consistency that I was told was essential to parental sanity. I’m not sure what it takes to be a great dad, but certainly the desire to parent was a good start towards just being a good dad. Certainly, being 50 has made me a bit more patient and knowledgeable than I might have been as a 20 or 25 year old dad. Being 50 also makes me appreciate having gotten pregnant on the first embryo transfer. At the time, every passing month was just another month of living without the children I knew I was going to have. It seemed like lost time. I heard the clock ticking; I felt the pangs of desire growing.

As crazy as it may sound, hardly a day goes by without my thinking about going back to PFC, thawing my remaining embryos and giving it another go. Through all the obstacles, PFC gave me a sense of direction, a grasp of the reality that I faced and clear information with which to proceed. Perhaps the confidence that I felt in PFC’s expertise has given me a residual optimism that makes me feel willing to try again. For the moment, Armstrong and Ella find each other in sufficient and good company; but I’d be willing to consider a special unanimous request from the two of them for another sibling. But, maybe just an old-fashioned singleton next time!

—Submitted by Gedalia (G’dali) Braverman,
Dad to Armstrong and Ella who were born November 19, 2008

In January, Dr. Carolyn Givens and I attended a meeting in Hawaii organized by the American Board of Bioanalysts (ABB). This organization board certifies and licenses embryologists, andrologists, and a number of other laboratory specialists in the United States. Our meeting was under the direction of the College of Reproductive Biology, a special interest group within the ABB and for which I am the immediate past Chair.

The meeting was small and intimate, a situation always welcomed among reproductive biology professionals. The location allowed for good interaction with embryologists from Japan who have always been a great source of ideas and innovation within our specialty.

In fact, the highlight of the meeting was a series of videos shown by Dr. Yasuyuki Mio from the Mio Fertility Clinic in Yonago, Japan. He was able to take time-lapse cinematography of human embryos in culture, and as a result reported some novel observations on how oocytes fertilize and how embryos develop. The actual moment of sperm entry into the oocyte was recorded and it was possible to see that human oocytes form a fertilization cone (a membrane that helps bring the sperm into the oocyte), shortly after sperm entry. The events that follow (2nd polar body extrusion, which is the egg extruding a set of chromosomes, and pronuclear formation, alignment of the nuclei from the egg and sperm) occurred as expected, but for the first time the male and the female nuclei could be distinguished from each other.

After fertilization, the embryos were seen to change dramatically as they developed. In particular, they appeared more disorganized and untidy immediately after a cell division event and more symmetrical and organized several hours later. This discovery has implications for those embryos that sometimes may appear poorly. It suggests that they may look better later in the day when they are clear of the cell division process. Another important observation regarding blastocysts, is that those that develop 2 inner cell masses (ICM: the precursor cells of the fetus) do so in a predictable way. At PFC, we avoid using embryos with two ICMs whenever possible, as they are likely to lead to the formation of identical twins. A normal embryo should have only a single ICM. Currently, it is possible that one of the ICMs may be small enough to avoid detection. The observation was made that the fine cellular bridges within the embryo cavity appear to correlate to the presence of an extra ICM.

Another notable presentation was that of Dr. Tetsunori Mukaida, of Hiroshima HART Clinic, on sperm morphology. He demonstrated that observing sperm under ultra-high magnification can show structural defects that are not always visible when using standard microscopes. While magnifying sperm thousands of times has its difficulties, Dr. Mukaida reported that sperm with subtle physical defects have a much lower chance of making an embryo that can become a baby. Sperm that are close to perfect in size, shape and structure are difficult to find in any sperm sample and it can take hours just to find a few ideal sperm. However, the extra effort may be worthwhile, especially in patients that have had a previous IVF cycle where the embryos did not develop well or implant after transfer. PFC is currently looking into this technology and we will report more details in a future issue of Fertility Flash.

Attending meetings like this and keeping up with the latest developments in our field is an important part of the culture at PFC. We share the load of traveling to educational events and are always excited to bring home ideas and thoughts to share with our colleagues. PFC is committed to implementing the latest technology and innovations to maximize pregnancy rates for our patients. We will continue to stay updated with all of the research and development in our specialty.

Both Dr. Givens and Dr. Conaghan contributed to this article.

	Joe Conaghan, Ph.D., HCLD is PFC’s laboratory director. Dr. Conaghan is internationally recognized for his work on improving embryo culture conditions. His interests include developing programs for the treatment of severe male factor infertility; diagnosis of genetic disease in embryos; and improved embryo culture. See more posts
	Carolyn Givens, M.D. was the first in San Francisco to successfully initiate a pregnancy using intracytoplasmic sperm injection (ICSI). She currently co-directs the Bay Area Pre-Implantation Genetic Diagnosis Program (PGD) and is director of PFC’s PGD program. See more posts