News broke earlier today about the death of a 69 year old mother who had undergone fertility treatment at age 66. She gave birth to twins in December 2006.

This is a very unfortunate incident and we express condolences to the loved ones, especially the children who are left behind. However, it is necessary to clarify that Pacific Fertility Center was not involved in the treatment of this patient. The AP article printed the name of the clinic as “Pacific Fertility Center”, which is an error of ambiguity since there are two fertility clinics with similar names. The fertility clinic where this woman received services was Pacific Fertility Center-Los Angeles. Our center, which is located in San Francisco, has no affiliation with the clinic in Los Angeles. While our names are similar, our standards of practicing medicine are much different. To begin, here at Pacific Fertility Center in San Francisco, it is standard procedure to verify the identity and age of the persons being treated at every visit.  Our physicians would not have treated a woman at the age of 66, since we believe this to be unethical. At Pacific Fertility Center in San Francisco, we believe it is our foremost and ethical responsibility to assure the children that are a result of our services are provided loving and caring families.

In southern California last month, a set of octuplets were born via Cesarean section. The mother, Ms. Nadya Suleman, recently divulged that this pregnancy resulted after undergoing in vitro fertilization (IVF) treatment. Most previous cases of high-order multiple births have occurred after treatment with injectable fertility drugs combined with intrauterine insemination (IUI). This case is unusual in that the treatment was IVF, where the number of embryos transferred back to the patient is a conscious decision on the part the patient and her physician. We are reassured to hear that Ms. Suleman and the octuplets are thus far doing well, but certainly the potential complications of premature birth may not present themselves until much later in each of these octuplets’ coming days, months, or even years.

We are very concerned that such an event of a high-order multiple pregnancy has occurred, and would like to reiterate that PFC takes the issue of multiple gestation very seriously. PFC has been taking steps to minimize the risk of multiple pregnancy for several years. Balancing high pregnancy rates with low pregnancy risk improves pregnancy outcomes. Achieving that balance and reducing the risk of multiple pregnancy is our goal. In all treatment cycles that we perform here at PFC, our ultimate aim, and any recommendations we provide, are with the hope of achieving a singleton pregnancy- the safest pregnancy.

Fertility physicians are very aware that one of the most important side effects of fertility treatment is multiple gestation. Our governing organization, the American Society of Reproductive Medicine (ASRM), as well as the Society for Assisted Reproductive Technology (SART) have worked steadily to formulate evidence-based guidelines for the number of embryos to be transferred in assisted reproductive technology (ART) cycles. These guidelines were first established in 1996 and were updated in 2006 to reflect improved success rates with ART. Over the past decade we have seen a significant decrease in the number of high-order multiples in the US.

We at PFC adhere to the ASRM and SART guidelines. These guidelines provide the flexibility to give each patient treatment individualized to her needs, and her best chance to become pregnant; while minimizing the risks of a high-order multiple pregnancy.

SART member clinics are committed to following these guidelines, although it would appear that the guidelines were not followed in Ms. Suleman’s case.

Cutting Edge Approaches to Sex and Relationship Therapy

Presented by: Dr. Naomi O’Keefe,
Licensed Clinical Psychologist

Thursday, March 26, 2009
Time: 4:00 – 5:00 p.m.

Program will be held at the
PFC Education Center
55 Francisco St., Fifth Floor
San Francisco, CA 94133
Parking in garage will be validated.

The Educational Series is a complimentary service provided by PFC to health care professionals specializing in the field of reproductive medicine, obstetrics and/or gynecology. Please watch for future talks on a variety of topics within the field.

Question:
Which insurance company has the most favorable coverage for infertility treatment?

Answer:
The package of insurance coverage for infertility treatment is not up to the insurance company, per se. It is typically up to an employer to determine the scope of coverage that is offered by its insurance company, and whether that package includes compensation simply for diagnosis of infertility, or whether it also covers treatment.

Moreover, one cannot assume that coverage will be the same from one employer to another even if that company uses the same insurer. For instance, an employee of Bank of America with Kaiser coverage might have a completely different insurance package for infertility as compared to an employee of Wells Fargo who also has Kaiser insurance. Through negotiation, an employer may choose an insurance plan with more or less infertility coverage than the average plan.

Another caveat has to do with state regulations. A total of 12 states in the United States have passed laws mandating infertility insurance coverage. However much of this regulation is considered a “soft mandate” meaning the insurers only have to offer it to employers who can choose to take it or leave it. California has a soft mandate so companies here are not legally obligated to purchase coverage for its employees.

A more forceful “hard mandate” requires a company to actually provide it, not just offer it. Massachusetts and Illinois are two states that have this hard mandate.

An exception to this is when a company is self-insured and is not legally required to follow state mandates. Because the majority of people with employer-sponsored health insurance policies are “self-insured”, the mandates do not apply to the majority of people, even in states with mandates.

Obviously, people who are self-employed and therefore pay for their own insurance might have a greater motivation to research those insurance companies that might have more comprehensive infertility coverage. Watch for subsequent articles in Fertility Flash that address this question for people who purchase insurance directly from insurance companies. In addition, the financial consultants at Pacific Fertility Center are available to work with our patients so they receive the benefits their insurance company provides. Click here for more Insurance Information.

– PFC Financial Consultants

We are proud to announce every one of our Pacific Fertility Center physicians have been recognized as best in their specialty by their physician peers in the 2005-2006 national survey “Best Doctors in America“. The list is complied through a survey of the nation’s leading physicians who are asked to nominate and evaluate the doctors they trust most. In the United States, Best Doctors surveying and research has identified 33,000 of the best physicians in a variety of specialties. Only those doctors who earn the consensus support of their peers are included. Congratulations to all our Best Doctors!

Left to right: Front Row: Carl Herbert, MD, Isabelle Ryan, MD
Back Row: Joe Conaghan, PhD, Eldon Schriock, MD, Carolyn Givens, MD, Philip Chenette, MD

The physicians at Pacific Fertility Center are internationally recognized specialists in reproductive endocrinology and infertility. They have completed top-level medical education, published groundbreaking professional papers, and held positions on the faculty of leading research universities. They continue to participate in reproductive research. All MDs are Board Certified by ABOG as Reproductive Endocrinology and Infertility Specialists. Our state-of-the-art laboratory has one of the most highly trained teams in the country with every embryologist board certified and licensed in their specialty.

Dr. Carl Herbert and
Kari Kawada of IFC

Living in California, with its open attitude, makes it difficult to imagine that some of the treatment choices we take for granted may not be available in other parts of the world. In Japan, IVF is available, and it is now accepted as one of the normal infertility treatments. Unfortunately, there are many restrictions. IVF is allowed only if the couple is legally married. Permission for PGD is determined on a case-by-case basis by the Japan Society of Obstetrics and Gynecology committee. So far, only one case has been approved. Egg donation programs are being considered, but the government and the Japan Society of Obstetrics and Gynecology’s unrealistic proposed guidelines would make it virtually impossible to establish a program. This same governing body has decided surrogacy is illegal in Japan. Through the world wide web, TV and other media, frustrated Japanese infertility patients have been learning of the more extensive services offered by IVF programs outside of Japan. Some fly over 9 hours from Tokyo to California, with hopes that their dreams of parenthood will come true.

This is where IFC, International Fertility Center, comes into the picture.

IFC has been working with PFC, Pacific Fertility Center, exclusively since 1997 to help Japanese couples become parents. IFC informs their clients about the services at PFC, prepares their medical history in English and provides transportation. IFC attends all patient appointments and provides translation and support throughout their entire IVF cycle with the ever-patient and efficient help of PFC’s Janet Debow, RN, IVF coordinator. IFC also works with donor/surrogate agencies, attorneys and Japanese-speaking infertility counselors to make the program happen even while the patients wait in Japan. Ever since we brought patients to Dr. Carl Herbert and his partner physicians, we have been impressed with their thoroughness of care, their generosity of time and understanding and their ability to deliver sometimes painful, but much needed, straightforward diagnoses. Unfortunately, we have discovered that many of our clients, prior to coming to IFC and Pacific Fertility Center, have undergone numerous IVF cycles- as many as 20 or more. Many of these patients would have benefited from egg donation, however egg donation does not exist in Japan. Using the only treatments available to them, these patients continue to hope that their next IVF cycle will be successful and do not have the heart to put an end to their infertility treatment. They stop only when their doctor tells them they are too old. The most wonderful thing about working with PFC is that the physicians, nurses, embryologists, and the rest of the support staff, are so understanding and hard-working. They bend over backwards to make the patients feel welcomed and relaxed, while providing the world’s top-level medical care. IFC had the option to select any infertility specialist’s practice in the Bay Area, and we have never regretted our choice to work with Pacific Fertility Center. The practice is state-of-the-art, ethical, honest, and warm. The PFC-IFC collaboration has been successful and is considered to be a good example when considering the future of reproductive medicine in Japan.

Kari Kawada speaking at the 6th Annual Japanese IVF Conference

As director of IFC, I have been invited to speak about our collaboration at various medical conferences in Japan, including the IVF Conference, Ethics Committee of Japan Fertilization and Implantation Society, Jichi-Medical School, and Tokyo Medical and Dental School. My work has been published in the Japanese OB/GYN periodicals and I have been interviewed for a variety of Japanese media. Our work with Pacific Fertility Center has resulted in many happy Japanese families that remember San Francisco as the place where they truly left their hearts. They all promise to come back with their children one day – to the place where their dreams came true and new life began.

– Kari Kawada, Director, International Fertility Center

•••

Infertility Care Outside the USA
Even though the United States continues to battle out issues related to abortion and stem cells, it would appear that advanced reproductive technologies are here to stay. Few other nations match the quality, number of clinics and the choice of treatment options that couples enjoy in the U.S. even with recent tightening of FDA regulations regarding donors and donated embryos. Without summarizing every nation’s policy, it is worth describing at least a handful to help put into perspective what American infertile couples may take for granted. Besides the Japanese regulations described in the article; New laws just passed by the government in Scotland have removed all donor anonymity. As a result, childless couples in Scotland needing either sperm or egg donation face a wait of up to five years because of a chronic shortage of both sperm and egg donors.

In general, European Union countries with egg donation programs do not allow the egg donors to be compensated for their oocytes – resulting in severe shortages of willing donors and delays in treatment of 2-5 years unless one has a friend/family willing to volunteer.

In Victoria, Australia, non-married people and same-sex couples are fighting to legally receive infertility treatment. Currently they must travel elsewhere.

This past June a voter referendum was unable to overturn one of the most prohibitive laws set in place by the Italian legislature in 2003. This law completely prohibits any donation of egg or sperm, as well as surrogacy arrangements. Only heterosexual couples that prove themselves to be in a stable relationship are eligible for infertility treatment. Also, only three embryos may be created at a time and all three must be implanted simultaneously. Freezing of embryos and sperm is prohibited and unused embryos must be kept until they perish.

In South Africa an organ smuggling scandal caused the country’s egg donor program to be shut down for 18 months even though the two were proven later to be unrelated.

Law Tries to Keep Up with ART: A spate of judicial decisions here in California has family law attorneys paying close attention to a handful of unique conflicts, or “gray zones” made in some way possible by Assisted Reproductive Technologies (ART). As the definition of “family” expands more broadly, thanks to ART, new laws are actually being forged. Couples that don’t fit the rubric of a traditional family (heterosexual man + woman = marriage) are being asked to make sure they have all of their legal ducks in a row.

A few California cases are summarized here, including at least one that may reach the state Supreme Court.

Lesbian Parents and Child Support: This complex case involves two lesbian partners, not registered as domestic partners, who jointly agreed to have children using the same sperm donor. Both women conceived, one year apart, and one of the infants was born with Down syndrome, prompting one of the women to remain at home as the care-giver. Two years later, the two women separated and the primary caregiver began receiving monthly child support payments from the woman who worked. When the child support provider halted payments after 18 months, county social workers attempted to tap her wages, a standard to which a biological father would have been held.

Although a Superior court judge agreed with the county that child support payments should continue because the woman showed initial “intent” to raise the children, this past May the Court of Appeal in Sacramento reversed that decision to the dismay of gay rights legal activists. This decision is particularly disturbing, asserts Deborah Wald, a San Francisco attorney who specializes in non-traditional family law. “Children of same-sex couples do not have the same rights compared to children that have two parents of opposite sex; this is a shocking ruling and one that we are confident that the state Supreme Court will overturn,” she said. Posthumous Conception: Many are anxiously watching a case that is pending final decision by the Los Angeles federal court. A wife had medical personnel extract her husband’s sperm for freezing after his unexpected death. This was not contested. Four years later, after she conceived a daughter with his sperm, the mother sought Social Security survivor benefits. Although she didn’t seek inheritance or life insurance claims, the outcome of this case is expected to have implications in these other areas.

The Social Security Administration denied the benefits, insisting that the deceased dad is not recognized as the father under California law. The SSA follows specific state guidelines in resolving such issues, and has granted posthumous benefits in other states. But California has no laws governing children conceived after the death of a parent. This case has simultaneously prompted the state Legislature to craft AB 1910, which is enjoying broad support. This bill establishes that a posthumously conceived child is entitled to inheritance rights and other benefits under the Uniform Parentage Act if the decedent intended his or her genetic material to be used for posthumous conception of the child and expressed it in writing. It is expected to be signed by the Governor in September. Copies can be found at www.assembly.ca.gov .

Lesbian Parents and Custody: A woman who provided the donor eggs for her female partner, enabling the partner to conceive twins, signed away her parental rights per a standard egg donor contract used by a Bay Area infertility clinic seven years ago. Nevertheless, the two women spent the next six years living together and raising the children. As the egg donor started pressuring the gestational mother about being identified as a legal co-parent, their relationship fell apart, and the gestational mother moved across country with the twins, eventually cutting off all contact between the children and the egg donor.

A California Court of Appeals ruling affirmed the gestational mother’s hold on primary custody, saying its decision is based on the “intent” contract signed by the egg donor, which absolved her of all parental rights and future claims. The biological mother has appealed, the case has received a flurry of press, and the case may end up at the First District Court of Appeal in 2005.