So you're thinking that just because your a guy and you have a , well you know,  there is no way you can be the source of the infertility problem.  Can't be me, your brain screams out in narcissistic denial.  I hate to break the news.  It may be you. 

Fertility expert Dr. Mark Perloe of Georgia Reproductive Specialists has something to tell you.  Infertility affects 1 in 8 couples of child-bearing age. Of those 7.4 million cases of infertility, 30 percent are attributed to the male.

 "If you're thinking about becoming a father for the first time," he states, "there are three primary considerations you need to make. Think of these broadly as mind, body and sprit. All need to be positive and healthy.

"First, your mind needs to focus on whether this is a good time for you and your partner, whether you are ready to accept the responsibility of parenthood." Dr. Perloe noted.   Next, the potential father should be sure he is physically ready to start a family by knowing know his sperm count.  Finally, a potential father should enjoy the journey of having children.

The lesson here is that we males do not have a "get out of jail free card".  Our participation in the infertility process requires us to do just that, participate.  We have to support our partner, undergo testing, and work toward a resolution in a non-judgmental fashion. 

For more information on the male factor: http://http://infertilityanswers.org/what_are_the_fertility_tests_for_men__

Clients are, by necessity, concerned about their financial health when they start discussing ART.  As you know, there are only about 13 American States and fewer other Countries that offer insurance coverage for infertility.  So, for better or for worse, treatment options are driven by the thickness of the wallet.

Those who have kept up, know that PGS or preimplantation genetic screening is offered to older patient having a history of miscarriage.   A new study will be published in the June issue of Human Fertility which will effectively remove PGS as a testing option.  The British Fertility Society will suggest that PGS only be offered to patients who are participating in randomized clinical trials.

Why the change?  It seems, so say the authors of the publication, that there is no difference in live birth rates for those that use PGS and those that do not.  If there is no difference, why not save money and direct it toward a treatment modality which is more likely to help increase your odds of having a child. 

As the saying goes, the jury is still out on this issue.  You will never know if PGS will help or not until you ask your Reproductive Endocrinologist to explain why your situation is different than those persons who were included in the "Human Fertility" study.  At the very least, you owe it to yourself and your future child the respect of being a good patient and an educated consumer.

This is from the "just when you thought Egg Donation was complicated" department. 

When I represent egg donors in third party reproductive cases, I always suggest, strongly, that they prohibit Intended Parents from a "secondary donation" to another set of intended parents.  I want my client to have a clear understanding of where the donation starts and where their genetic contribution ends.      

One of the newest breakthroughs within the Egg Donation community is the ability for a Reproductive Endocrinologist to freeze unfertilized eggs for future use.  Now, women with questionable reproductive futures i.e. ovarian cancer, will be able to bank eggs for their later use.

Of course, the Egg Donor agencies are concerned that their business lifespan has been appreciatively shortened by these new techniques.  I am not convinced.  I suspect that the greatest marketshare for agencies comes from those women who need eggs because of their age, not because of ovarian loss. 

But what of those frozen eggs?  How does that change things beyond the obvious? 

We may see the technology only used by those women who anticipate illness.  They bank eggs for themselves and use them.  This homologous donation will be viewed no different that a pre-surgery blood donation to yourself.

If however, the percentage of live births as between fresh transfer and frozen gets closer, unfertilized egg banking may become popular in third party donation.  And, if the Clinics or the Agencies or the Attorneys do not limit how far the donation can go, the Donor will lose control over her genetic contribution. 

Thus, we have the possibility that a Donor would discover, ten or even twenty years from the date of donation that a child was recently born from her eggs.  I just don't know how I would respond to a frantic, emotional call from that Donor, now aged 43 with her own family. 

It is fairly common for me to provide help in the ED area of ART.  Even when the participants include IM, IF, ED and a GS, the whole process can be fairly simple from a legal perspective.  Easy peasy as the Brits would say.

Just when you get complacent a fact pattern comes out of left field.  So we have an IM in her second marriage, an IF in his first with no children and the ED is IM's adult daughter. 

Obviously then, any child of this donation will be genetically related to the ED.  Not so obvious, however, is that the child and ED are also seen as sisters while being mother and daughter. 

Confused?  It is just getting interesting! 

You see, ART, especially ED, is new and there are very few ED children of adult age.  All of the possible reproductive variables have not yet been studied over time.  Thus, we have no way to predict the effect that such a donation will have on the participants.

Did the IM discuss this donation with the ED's father?  How will the IP's disclose the donation to the child and to what extent?  How will the ED or the child disclose their relationship to their respective life partners?   Finally, how do we practitioners protect our clients and patients today, for the potential issues which will arise tomorrow? 

I am always happy to speak with Intended Parents who have done their homework, whether they know it or not. 

Confused?  Well, I spend my days speaking with Intended Parents.  As you might imagine our conversations range from legal to medical to ethical, sometimes of the present, eventually toward the future. 

When Intended Parents are matching with independent carriers, there is always one question.  How does the fact that she had a c-section affect our chances of having a baby?  These Parents suspected a connection between the c-section scar and pregnancy.  As you can see from the following article, they knew more than they gave themselves credit for!

Article Date: 28 May 2008 - 0:00 PDT

Cesarean sections account for nearly all of the increase in U.S. singleton preterm births, according to an analysis of nine years of national birth data.

Between 1996 and 2004 there was an increase of nearly 60,000 singleton preterm births and 92 percent of those infants were delivered by a cesarean section, (c-section), according to research by investigators from the March of Dimes and the U.S. Centers for Disease Control and Prevention (CDC) that will be published in the June issue of Clinics in Perinatology. While singleton preterm births increased by about 10 percent during this time, the c-section rate for this group increased by 36 percent.

Preterm birth is a serious and costly health concern and is the leading cause of death in the first month of life. More than 520,000 babies -- one out of every eight -- are born too soon each year in the United States.

Late preterm babies, those born 34-36 weeks gestation, account for most of the increase in the US singleton preterm birth rate. These infants have a greater risk of breathing problems, feeding difficulties, temperature instability (hypothermia), jaundice, delayed brain development and death than babies born at term. This new analysis shows that that these late preterm infants had the largest increase in c-section deliveries.

"While maternal and fetal complications during pregnancy may result in the need for a c-section, we're concerned that some early c-section deliveries may be occurring for non-medically indicated reasons," said Alan R. Fleischman, M.D., the March of Dimes medical director and senior vice president. "We need research to determine how many c-sections that result in preterm babies are not medically indicated and may place both mother and baby at risk for little or no medical benefit."

C-sections are the most common major surgical procedure for women. More than 30 percent of the 4.1 million U.S. live births are delivered via c-section and the rate has increased dramatically since 1996. A c-section delivery can be lifesaving when there are complications during pregnancy, but it is a major operation with potential risks to the mother from the surgery and anesthesia and to the baby, if the delivery occurs too soon. The March of Dimes is concerned that some early deliveries may occur without good medical justification and may be done at the request of the mother or based on an inappropriate recommendation from the doctor.

"The Relationship Between Cesarean Delivery and Gestational Age Among US Singleton Births," by Bettegowda VR. et al. will be published in Clinics in Perinatology, Vol. 35.

The March of Dimes is the leading nonprofit organization for pregnancy and baby health. With chapters nationwide and its premier event, March for Babies(SM), the March of Dimes works to improve the health of babies by preventing birth defects, premature birth and infant mortality. For the latest resources and information, visit http://www.marchofdimes.com/ or http://www.nacersano.org/. For detailed national, state and local perinatal statistics, visit PeriStats at http://www.marchofdimes.com/peristats.