Blog by Rhonda Levy - your fertility consultant

HIV Positive Gay Men Once Faced a Death Sentence – Now Fertility Clinics Are Helping Them Create Life

In 1995, AIDS was the leading cause of death among Americans of parenting age, ages 25 to 44. Gay men, in particular, were dying in droves. Once infected with HIV, that was the lens through which gay men saw their lives. Desperate to stay alive, building a family was the furthest thing from their thoughts.

sperm photoFast forward two decades from the peak of the HIV/AIDS epidemic and and it is truly remarkable how dramatically the world has changed for gay men, including those infected with HIV. With antiviral therapies, HIV infected gay men are now living long, normal lives with a manageable chronic disease. In many parts of the globe, same-sex couples have been granted the right to marry and with increasing frequency they are creating families of their own.

Gay men who desire a genetic link to their children have found themselves thrust into the world of fertility clinics and “gay surrogacy”. With the help of in vitro fertilization and the combination of a gestational carrier (often referred to as a surrogate) and an egg donor, they can now overcome the barriers presented by their lack of a female partner.

A genetic link to a baby is also within the reach of HIV positive gay men. A study published in 2014 retrospectively reviewed almost 10,000 cycles of intrauterine insemination and in vitro fertilization (combined) involving the sperm of men infected with HIV. These cycles did not involve a single reported transmission of HIV to the women who carried the babies or to the babies.

A number of American fertility clinics are particularly interested in helping gay men build their families and some have also taken a particular interest in helping HIV positive gay men. Most of these clinics collaborate with the Special Program of Assisted Reproduction (SPAR) Program at the Bedford Research Foundation in Boston, a not-for-profit public charity run by Ann Keissling, a Ph.D who is a renowned expert in semen transmission of HIV, and, until 2012, was a professor at Harvard Medical School. The SPAR program takes into consideration that more than 10% of semen specimens in men on antivirals with an undetectable viral load in their blood test positive for HIV. With this in mind, they ask men going through their program to produce two specimens and test half of each specimen for the virus. Only sperm extracted from specimens that did not reveal the presence of the HIV virus are then washed, frozen and shipped to a fertility clinic. There, donated eggs are fertilized with the sperm. One or two embryos are then transferred into a gestational carrier.

To date, there has been no transmission of HIV to women and babies with SPAR approved sperm. At May 2014, the SPAR Program had 193 babies born. It will only be once SPAR has been involved in the birth of 400 babies that statisticians will be able to calculate a risk factor with a 95% confidence interval. However, given that the SPAR program involves an extra layer of protection over the thousands of cycles in which only sperm washing was performed without transmission of HIV (SPAR only washes sperm extracted from specimens that it first confirms are not HIV infected), without a single case of transmission of HIV to the woman or baby, it is believed to be unlikely that SPAR approved sperm will cause transmission.

9 Tips for Choosing a Fertility Clinic


1. The fertility clinic landscape is highly complex. It is hard to recognize what you don’t know about this new and unfamiliar world, but you need to quickly learn everything you need to know.

2. Fertility clinics vary dramatically in quality. Although no fertility clinic can offer you a guarantee of success, some have the power to maximize your potential for success. Your journey will be made much easier if you identify and use only top-performing clinics from the outset.

3. If you put yourself in the hands of an inferior fertility clinic, you will be at risk of suffering unnecessarily from a financial, emotional and physical perspective. It can even mean the difference between whether you will or will not ultimately have a baby.

4. To avoid spinning your wheels on the wrong track, learn about all of the factors that should govern your fertility clinic choice so that you will be better equipped to choose one in an intelligent, thoughtful and fully informed manner.

5. Because of recent advances in in-vitro fertilization, fertility clinic success rates have never been more difficult to interpret than they are today. You must take the time to learn about the many subtleties and nuances that are not apparent on the surface of the numbers.

6. Fertility clinics do not provide treatment in one consistent manner. In fact, some clinics take an approach that is not in step with the most recent advances. Be sure to become informed about how (and why) treatment approaches vary clinic to clinic and about the approach that is most appropriate for your situation.

7. Many fertility clinics engage in aggressive marketing campaigns designed to seduce desperate and vulnerable patients. Avoid being lured in by these campaigns and make your fertility clinic choice based on deep knowledge and understanding.

8. A discerning fertility clinic choice requires intense research, strong critical analysis skills and an insightful comparative analysis of options. Researching fertility clinics in a thorough manner is a time consuming process. Turn to experts for help to avoid spending precious time within your reproductive window conducting research.

9. Reliable information needed to make a logical and well-reasoned fertility clinic choice is hard to come by for those who are not “insiders” in the world of reproductive medicine. Identify neutral “insiders” who you can safely rely on to provide high quality and reliable information.

Facebook, Apple & Egg Freezing: Self-serving Corporate Strategy or Supportive Gesture Toward Women?

Lab technicianThe recent announcements by Facebook and Apple that they would be offering their female employees financial support for egg freezing by way of a health benefit set off an odd response, in my opinion. Many people reacted with outrage and cynicism; it must be a self-serving corporate strategy designed to keep women focused on the demands of the workplace so they would not be distracted by the responsibilities of motherhood, they said.

I did not share that reaction, which felt to me like a “rush to judgment”. Before drawing any conclusion, I believe the public must view this new employee benefit through a wider lens, in the context of all of the benefits Facebook and Apple offer to their employees, with a particular focus on benefits that relate to reproduction, maternity, paternity, adoption and childcare. How could anyone reasonably conclude that these corporations have engaged in an evil conspiracy against women in the workplace, without first asking if they have a history of demonstrating, through their employee benefit policies, that they are supportive of their employees’ efforts to balance the demands of the workplace with the demands of family building? Before we react with outrage, don’t we have an obligation to determine whether, in addition to offering this new egg freezing benefit, they also offer benefits that provide financial assistance to employees who want children immediately or already have them? For example, do they provide health benefit plans that cover the significant cost of in-vitro fertilization for employees who are struggling with infertility or who are gay and require assisted reproduction to have children who are genetically related to them? Will their health benefit plans cover the cost of IVF for employees who have frozen their eggs with the company’s financial support? (I certainly hope so, since a woman’s frozen eggs will be of no use to her if the IVF procedure, which is required to use them, is beyond her financial reach.) Do Facebook and Apple provide drug plans that cover the cost of the expensive fertility drugs, which are required for IVF? Do they have policies in place to help employees with the cost of adopting? Do they offer paid maternity and parental leave to their employees upon the birth or adoption of a baby, more generous than the leaves they are required to provide by law? What kind of benefits do they offer to women who experience pre-birth complications? Do they offer an on-site childcare option?

I believe it is only once these questions are asked and answered that we can properly evaluate the motivation behind Facebook’s and Apple’s recent gestures relating to egg freezing. If we learn that their health benefits reflect a corporate culture that embraces family, I don’t see how anyone can justify the cynical reaction that exploded in the media and on the Internet. I, for one, will choose to view this new benefit as a supportive gesture toward women and an effort on the part of Facebook and Apple to ensure that their health benefits are in step with the rapidly developing world of reproductive technology in which the experimental label was only recently removed from egg freezing.

The AMH Test: A Simple Blood Test Can Help Women Understand If They Should Feel a Sense of Urgency About Becoming Pregnant Sooner Rather Than Later

Frozen EggsA simple blood test called the Anti-mullerian Hormone (AMH) Test can help women who want children understand if they should feel a sense of urgency about becoming pregnant sooner rather than later. Although the AMH Test is not invasive or expensive, it is rarely suggested by family doctors and OB/GYNs when women turn to them for counselling regarding their plans for reproduction. Most women first learn about the AMH Test only after they have experienced difficulty becoming pregnant and are a patient within a fertility clinic. A greater awareness among women of the utility of this test can help protect them from the heartache of infertility.

The AMH Test, which can be taken on any day of a woman’s menstrual cycle, provides information about the status of a woman’s ovarian reserve. A woman’s “ovarian reserve” refers to the quantity of eggs remaining in her ovaries. The diminishment of a woman’s ovarian reserve is an inescapable fact of reproductive biology. Women are born with a finite number of eggs in their ovaries and this number declines as they age, with a slight dip at age thirty, a significant decline at age thirty-five, and an accelerated attrition at age thirty-eight. When a woman’s ovarian reserve is diminished, many of the eggs that remain available in her ovaries are genetically abnormal and incapable of resulting in the birth of a healthy baby. Women with diminished ovarian reserve often struggle to become pregnant.

While diminished ovarian reserve is rare in young women, it does occur in some young women. The average age of menopause is 51.7, however ten percent (10%) of women reach menopause by age 45 and their ovarian reserve can be diminished approximately thirteen years prior, by age thirty-two (32). The beauty of the AMH Test is that it gives women insight into the status of their personal ovarian reserve based on the quantity of eggs in their own ovaries, rather than based on general guidelines focused on age. The AMH Test indicates whether a young woman’s ovarian reserve is as one would expect it to be at her age. If it is, she may have time to spare before attempting to become pregnant, and can test her AMH level over time to get a good sense of the rate at which her ovarian reserve is declining. However, if a young woman discovers that her AMH level is low for her age, she will be advised that she is likely to enter menopause early, that it would be wise not to postpone attempting to become pregnant, and that she might want to consider attempting to achieve pregnancy as aggressively as possible via in-vitro fertilization (IVF).

If attempting pregnancy is not an immediate option, the AMH Test can also help young women make decisions relating to fertility preservation. If a woman is in a committed relationship with a man and they have decided they would like to have children together but do not yet feel ready, and the woman’s AMH level is low for her age, this can alert the couple to consider freezing embryos now for future use. If a woman does not have a partner with whom she wishes to have a child, and her AMH level is low for her age, this can alert her to consider freezing her eggs now for future use.

Although it is a relatively new test, the AMH Test is now considered the most precise, informative and reliable method of assessing a woman’s ovarian reserve. Many clinics use this test exclusively to evaluate a woman’s ovarian reserve, however some fertility specialists use the AMH Test in combination with other tests, including a transvaginal ultrasound to count the number of antral follicles, the testing of other hormone levels such as the follicle stimulating hormone (FSH) level and the estradiol (estrogen) level on day 3 of the woman’s menstrual cycle, and the clomiphene citrate challenge test (CCCT).

If you are a woman in your early thirties or older who wants to have children but is considering delaying pregnancy, I urge you to make an appointment with a board certified reproductive endocrinologist without delay to request an AMH Test. The result of this simple blood test can inform your decision-making process and potentially protect you from the heartache that I witness daily in my efforts to help women overcome infertility.

It Is Important to Seek More Than One Fertility Doctor’s Opinion

My latest post on my blog Own the Process with Empowered IVF™ at Fertility Authority: “It Is Important to Seek More Than One Fertility Doctor’s Opinion”.

Why Those Contemplating Using Donated Eggs are Advised or Required to Meet With a Mental Health Professional

Touch of loveYour Initial Reaction

If you require the help of an egg donor to form your family, you may be surprised when your fertility clinic strongly suggests or even requires that you meet with a mental health professional. If the clinic refers to this meeting as a “psychological evaluation” or a “psychological assessment” your reaction may be more than surprise; you may become angry and defensive since fertile people are not “evaluated” or “assessed” when they decide to bring a child into the world.

The True Purposes of the Meeting

However, regardless of what may be an unfortunate choice of words by your fertility clinic, the true purpose of a meeting with a mental health professional is not to evaluate or assess whether you are fit to become a parent. The actual purpose of the meeting is to help you, educate you, and to advocate for your unborn child. Read More

Response to Emma Rosenblum’s Businessweek Article: “Later, Baby: Will Freezing Your Eggs Free Your Career?”

Frozen EggsBy now you may have read Emma Rosenblum’s cover story in Bloomberg’s Businessweek called, “Later, Baby: Will Freezing Your Eggs Free Your Career?” Despite its sensational but admittedly eye-catching title, Rosenblum’s article was excellent. However, I would like to emphasize three important points that were not mentioned:

1. Women who decide to freeze their eggs should be careful when choosing a fertility clinic in which to do so. Marketing efforts around egg freezing can be quite aggressive, especially in large urban centers where it is most common. Surprisingly, some fertility clinics are still using the “slow freeze” method of freezing eggs. And even in clinics that are using advanced vitrification techniques, many cannot point to a statistically significant track record of successfully thawing frozen eggs, creating embryos with them, and then conducting transfers that have resulted in the birth of a baby. Women considering freezing their eggs ought to think of themselves as “consumers” who have a right to ask physicians penetrating questions and who are entitled to receive meaningful answers. Read More

“Thoughts on Choosing a Fertility Doctor” New Blog Post on Own the Process with Empowered IVF™ at Fertility Authority

Check out the latest post on my blog Own the Process with Empowered IVF™ at Fertility Authority: “Thoughts on Choosing a Fertility Doctor”

Working With an Egg Donor Agency? 6 Things to Think About in Regard to Its Service Agreement

Asian couple with baby1. Confirm That the Agency Has a Service Agreement

If you need donated eggs to become a parent, one of your options is to work with an egg donor agency. If this is the option you decide to proceed with, it is highly recommended that you confirm that the agency has a Service Agreement, and that you avoid working with one that does not.

2. Understand Its Purpose

The purpose of the Service Agreement is to establish, in writing, the terms of your relationship with the agency, including the fees you will pay to the agency in return for its services. A well drafted Service Agreement should leave no doubt as to what services the agency has agreed to provide to you as recipient and your financial obligations in return for receiving the agency’s services. Read More

“Why Are Some Women Still Unaware of the Risk of Delaying Pregnancy?”: New Blog Post on Own the Process With Empowered IVF™ at Fertility Authority

Check out the latest post on my blog  Own the Process With Empowered IVF™ at Fertility Authority:Why Are Some Women Still Unaware of the Risk of Delaying Pregnancy?”

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