SCIENCE PULSE    Donating Embryos to Research

Once patients have completed infertility treatment, a decision must be made about what to do with their excess embryos. Pacific Fertility Center offers three different forms of embryo disposition, and it is important for patients to know about the different options. Excess embryos can be discarded, donated to our Embryo Donation Program, or donated to research.

Creating embryos is a time-consuming, emotional, and expensive experience; sometimes patients do not want to simply discard their embryos. Instead, they anonymously donate them to our Embryo Donation Program, which provides a registry of embryos available for adoption. Patients are matched based on ethnic preference and length of time they’ve been on the embryo donation waiting list. Many couples on the embryo donation waiting list have been through failed cycles. It is comforting to know that they have other family-building options available. This is made possible through the generosity of fellow PFC patients, who have experienced the emotional roller coaster of infertility, and have donated their excess embryos to our Embryo Donation Program.

Sometimes patients do not feel comfortable donating embryos to the donation program. Another option for them to consider is offering their embryos to research, namely for embryonic stem (ES) cells. ES cells are important for the future of medical research, with many believing that some day ES cells will be able to treat cancer, spinal cord injury, and muscle damage, for example. Currently, the biggest challenge for researchers in this field is the availability of embryos. Should patients decide to donate to research, the embryos are transferred to UC San Francisco, where they are kept in a tissue bank until used.

There are three research options in which the embryos might be used:
Option 1 – allows the researcher to analyze proteins and copy genes from the embryos.
Option 2 – develops human ES cells from the embryos.
Option 3 – permits the investigator to contribute to the creation of immune-compatible human ES cells
                using somatic cell nuclear transfer.

Due to the important value of each embryo, there are scientific and ethical boards that review different protocols, ensuring that the embryos are used only in the most important investigations.

About Embryonic Stem (ES) Cells
Embryonic stem (ES) cells are derived from a group of inner cells within the inner cell mass within the 5 or 6 day old embryo. Naturally, ES cells are programmed to continuously divide without developing into specialized tissues, a process called differentiation. These cells are pluripotent - meaning that under the influence of certain physiological signals, they can differentiate to form the three primary germ layers: the ectoderm, mesoderm, and endoderm of the developing fetus. Ultimately, they can form any tissue in the body, excluding the placenta. Because they are so versatile, ES cells are extremely important for research in treating diseases that currently have no solutions.

As more and more embryos become available for research, investigators are able to better explore the current problems with ES cells and are able to develop techniques to maximize successful treatments. Like organ donation, immune rejection poses a threat to potential stem cell therapy patients. The current ES cell lines that are available have a very small window of genetic diversity. This is a problem because it means that the number of patients who will match the cells and be able to use them is also small. By providing a greater number of embryos for research, genetic variety will continue to increase, allowing more patients to avoid immune rejection and benefit from stem cell therapies.

In addition to therapy, ES cells are important in other aspects of research. Because of the complex interactions that occur during human development, different problems can lead to cancers or birth defects. ES cells can be used as a research model to test how the differentiation process occurs. A detailed understanding of how such molecular processes occur would help aid in creating new drugs and therapies for a greater number of diseases. ES cells pose a promising future and it is important to develop as many investigations as possible using these cells.

Whether it be to help a fellow patient conceive or to further medical research, embryo donation provides significant short-term and long-term benefits. We encourage patients to consider the different options for embryo disposition and consult their physician for more information.  Talia Mota

 Talia Mota, Laboratory Manager works with intended parents who are participating in Pacific Fertility Center’s Embryo Donation Program by matching them up with embryos and answering their questions. Her strong scientific background includes four years of laboratory research and a B.S. degree in Genetics from UC Davis.

CONCEPTION HEALTH    Therapy and Infertility

In last month’s issue we introduced our readers to Peggy Orlin, MFT, Pacific Fertility Center’s in-house therapist. This month we interviewed her about the key psychological issues affecting individuals and couples experiencing infertility.

What is the most common reason why someone comes to see you at PFC? At Pacific Fertility Center everyone who uses a known or unknown egg or sperm donor or a gestational carrier is required to meet with me. This is mainly an educational session designed to help people think through and discuss the issues involved with using a third party to assist them in building a family. Each meeting is custom tailored to meet the patient’(s) particular needs.

	Use of a third party for reproduction and its impact on a relationship.
	Attachment to a non-genetically related child.
	Disclosure of third party reproduction to family, friends and the child.
	Choice of meeting or not meeting with the donor.
	Use of a family member or friend as the donor.
	Multiple pregnancy (twins or triplets) and its impact on your lives.
	Support services during and after treatment.

What are some of the other reasons people seek your help?
Some patients have had a failed cycle and are having trouble coping with the losses. Other patients have experienced a miscarriage. Both of these scenarios can leave patients feeling bereft and not sure how to move forward. During a session, I can help them understand the grieving process and we can discuss ways that they might ritualize their loss in order to move forward.

The stress of infertility diagnosis and treatment often brings them to me either at the center or in my private practice. It is important to understand that no two people will have exactly the same experience and that infertility can strongly impact those within a committed relationship. A recent diagnosis of infertility, as well as the stress and/or disappointments of treatment, can lead to feelings of isolation and depression. Additionally, people may experience grief over the loss of fertility choices. It is not uncommon that I am the first person, other than their partner, with whom they discuss their feelings about their infertility challenges.

There are those who are at a critical decision point and are seeking help thinking through their reproductive alternatives. This may include deciding whether or not to do one last IVF, move on to egg donation, select an egg donor or complete their family through adoption or childfree living. In the therapy sessions, we discuss and explore the pros and cons of a decision from the unique perspective of their life beliefs and situation.

Others may need help with developing positive coping mechanisms and stress reduction techniques such as setting aside time each day to discuss infertility with their partner, rather than allowing it to be a constant topic of conversation. We may also discuss how they can reduce their isolation possibly by talking with others who are having similar experiences. We may even explore how to include moderate exercise in their schedule to reduce symptoms of depression.

What is your advice to those who are uncertain whether or not they should see a therapist?
For patients at the clinic, one exploratory visit can be helpful. Their doctor can refer them to me for one free session during which we can discuss any concerns they may have and talk together about whether or not seeing a private therapist might be useful for them. They are not signing on for long-term therapy by talking with me. As with stress reduction techniques-it can't hurt and it might help.

Could you discuss the Mind/Body@PFC Workshop and who might benefit from attending?
The jury is still out on the connection between stress and infertility. Recent studies indicate that there may be a stronger connection between depression and infertility than between anxiety and infertility. The Mind/Body classes not only teach people simple ways to relax, but the small group class gives them the experience of being in a safe environment with others who are all experiencing infertility and know just what it’s like to be going through infertility treatment. This group experience helps to reduce stress and may be helpful to ease mild depression. (Call 888-834-3095 to register or Click here for more information)

How does your private practice differ from your practice at Pacific Fertility Center?
Clients in my private practice tend to be those who are interested in more than one session. Some stay for a few sessions and some want longer-term therapy. Many are couples who are struggling with how differently they are approaching and/or moving toward resolution of their infertility journey. Sometimes clients are self-referred for infertility issues and then as we meet, they chose to move on to other issues in their relationship or their lives. Although I have a specialty with infertility patients, my private practice is with adults experiencing all types of distress.

Depression frequently accompanies infertility. When should someone seek a therapist?
The experience of symptoms of depression which last more than a couple of weeks is an important reason to set up an appointment with me or a therapist of your choosing. Remember, everyone will feel some of these symptoms, some of the time. They become a problem when the number and intensity of symptoms increase and/or don’t abate.

Symptoms of depression:
Feelings of emptiness or extreme sadness
Loss of interest and motivation to do regular activities
Increased level of anxiety
Decreased level of energy
Difficulty sleeping or sleeping more than usual
Difficulty concentrating
Abnormal weight loss or gain
Obsessive thinking about your infertility
Feelings of isolation from friends and family
Extreme and persistent feelings of anger
Persistent thoughts of death or suicidal thoughts or attempts
Persistent feelings of inadequacy, or worthlessness

What is the best way to make an appointment with you?
PFC patients phone the front desk at (415) 834-3000 and ask to set up an appointment. Those who prefer to see me outside PFC can make an appointment for a visit at either my San Francisco or Berkeley office by calling (510) 528-2750.

ASK THE EXPERTS    Allergic to Sperm?

Question: My wife and I have been trying to have a child for a while now. I have been told that she is “allergic” to my sperm. What are our best treatment options at his time?

Answer: Many people say that they are allergic to their partner’s sperm, and that can mean different things, depending on the testing done. True incompatibility with sperm is very uncommon. Some female patients may have had a blood test to see if they have “anti-sperm antibodies” circulating in their blood stream. A positive test result actually does not correlate well to a true problem of incompatibility and infertility, and therefore this blood test is no longer recommended as part of infertility testing. An uncommon, but more relevant problem would be if the MALE partner were making sperm antibodies against his OWN sperm. Men who are at risk of this are those who have had testicular injury (scrotal trauma) or testicular surgery (torsion, tumors, or other indications). Antibodies are also commonly found in men who have undergone vasectomy reversal, especially if the interval between vasectomy and vasectomy reversal is a long one.

The sperm has 3 parts: the head, midpiece and tail. If the male patient makes sperm antibodies against the sperm midpiece or tail, this is probably of no consequence. If he makes antibodies against the sperm head, then this can prevent the sperm head from fusing with the egg membrane, and progressing with the important steps of fertilization. The remedy for this condition is to proceed to IVF, and have the embryologist inject the sperm directly into the egg membrane and cytoplasm. This injection process is called ICSI (intracytoplasmic sperm injection), and will restore normal fertilization rates for that couple.

It therefore is important to be clear about the appropriate testing to be done, if one suspects a sperm incompatibility. The anti-sperm antibody test is done directly on the SPERM, and done in a laboratory which has the ability to do this specialized testing (usually an IVF or an Andrology laboratory). If you have a history that might place you at risk of making antibodies against your own sperm, please discuss this with your fertility physician.

• Isabelle Ryan, MD

DONOR ODYSSEY    Lucky to Be Chosen

 I can remember the day I decided to make the phone call to PFC to inquire about becoming an Egg Donor. I was so excited at the idea of “making some money”. Though, it took me about a month to work up the courage to complete the application and return it with my pictures. I kept thinking who would want to receive my eggs? Maybe I was too short or too blonde? I was also worried about who would see my pictures/profile and if they would recognize me or know someone in my family. It was not until I heard a story about a couple who was having a hard time trying to conceive their first child. Their story broke my heart, because I had always assumed that getting pregnant and carrying a child to term was supposed to be easy. After their story, I knew that I needed to do something besides “making some money.” Instantly I spoke with my family and asked for their support and then returned my completed application.

It was only a few weeks later that I heard from a PFC Egg Donor Coordinator, Bridgett. I thought how lucky I am to be “chosen” by this couple! Bridgett was so professional and took care of all the details for my initial process. I soon realized what a bigger issue this was when I met the first recipient couple. They were just as anxious as I was about the experience, but when they told me their story something bonded between us and by the end of the meeting, I knew there was a greater reason for why I was donating my eggs. I saw how much it meant to them and I was surprised by how much it affected me. I walked out of the meeting knowing something wonderful was going to happen and I was lucky to be apart of that process with them.

Before the first recipients selected me, I thought that PFC worked only for the benefit of the parties wanting to get pregnant. It was only after my first cycle donation, that I realized how much I received from the experience. The experience changed how I looked on life and how precious the gift of life is. All I could think about was how I “flushed” away my eggs every month because I was not ready to start a family of my own and how precious those eggs are for some people. Words cannot describe how amazing it felt to help others, with something that seemed so small and was ‘flushed’ away.

In the beginning, I was full of mixed emotions. I was very excited to meet the PFC staff and start my first cycle. Yet, I was nervous about the process and how it would affect my day-to-day life. But every member of PFC was kind and professional, and put me immediately at a sense of ease. Since I was apprehensive about needles, I had decided I would administer all of the shots, except the HCG shot, to myself and found that it was an easy experience. The medications were gentle on my body and the side effects were very minimal. There were no outward indications that I was going through the process, the worst side effect was minor bloating towards the end of the cycle.

At every appointment, the entire staff was amazing and so supportive. I had decided to take my mother with me for support for the last appointment and retrieval, when we left the procedure she turned to me and said she was so proud at what I was doing and wished that she had done something similar. It was then that I felt I was making a difference in the world. The actual retrieval was so easy; I think the worst part of the process was having an IV inserted in my hand. The best part was the Retrieval Nursing Staff, Ann, Olga and Carol; they made me feel like I was so special. The way they treated me made me feel like I was a part of a unique club. I knew that I wanted to do more after that first cycle. With each cycle, the process seemed easier. The staff began to remember me and always made a point to remind me how appreciative they were for my donations.

It was just a few months ago that I finished my last cycle (6th), and I was full of mixed emotions when I left the final retrieval. On one hand I was excited that I could help another couple. But on the other, I was sad because it would be the last time I donated and the last time I would see the staff at PFC. Throughout all six of my cycles, I had the privilege to get to know the staff and Doctors at PFC. I would recommend PFC to anyone in need of their services or wanting to become an egg donor. The staff is the most remarkable group of individuals. Their professionalism exceeds what you would expect to receive. They change lives and make dreams come true for everyone involved!

Donating your eggs requires you and your family to be selfless and unconditionally giving of yourself. You must not connect with the idea of a child in the world with your features, rather you must see it as a gift you have given a deserving couple. To be an egg donor was an honor that I will always hold in my heart. The feeling you get from helping others is more of a reward than you will ever realize. • Donor remains anonymous

FROM US TO YOU    New On-Line Egg Donor Registry

  We are pleased to announce that our egg donor registry is now available on-line to both current and prospective PFC patients. For many intended parents, having an on-line donor registry affords optimum privacy and convenience when it comes to the egg donor search—an intimate, private, and time-consuming experience. The on-line donor registry is valuable for intended parents living outside of the San Francisco-Bay Area as well. Those wanting to view our donor registry in-person can still do so by contacting our agency in order to schedule an appointment.

The on-line donor registry provides a wealth of information about the egg donor to both current and prospective PFC patients. Prospective patients are eligible to receive “Level 1” access, which allows you to view a donor’s photo along with basic information about the donor. “Level 2” access is available to current PFC patients only and allows you access to additional photos and the donor’s application. Both “Level 1” and “Level 2” access allow the intended parent to search for donors based on criteria such as eye and hair color, ethnicity, region, as well as by certain keywords. The interface is highly intuitive, providing a convenient drop-down menu allowing the intended parent to narrow down the search to meet their particular preferences. For instance, if the intended parent is looking for a blonde donor with blue eyes, the drop-down menu will narrow down the search accordingly. “Level 2” access, however, gives the intended parents the opportunity to review the donor’s entire application and multiple donor photos. Information on the application includes the donor’s personal and family medical history, educational background, and personality traits. The EDA works with PFC’s medical board to cautiously screen each of our donors to increase your chances of having a healthy baby.

In order to access our on-line registry, visit www.infertilitydoctor.com, then select the Egg Donor Agency link to the left, then select Search Egg Donor Registry. The intended parent will be prompted for a username and password. If the intended parent does not have this information, they should call our Egg Donor Agency at 1-800-734-2015. Given the private and personal nature of egg donation—for both intended parents and donors—we have gone to great lengths to ensure that our on-line donor registry has met our rigorous internet security standards.

If someone would like to learn more about our egg donation services and egg donor registry, the first step in the process is to call our Egg Donor Agency or visit our website. Egg donation can be an outstanding family building option for those wanting to conceive but are unable to use their own eggs. Our new on-line egg donor registry will streamline the process of selecting an egg donor, making it easier for intended parents while ensuring privacy for all parties involved.

CORRECTION: In the 2005 IVF statistics article featured in last month’s Fertility Flash, we indicated that PFC offers an egg freezing program. We meant our embryo freezing program, which has been strong for many years. We apologize for any confusion this might cause.

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-- Best regards from all of us at Pacific Fertility Center.