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Deborah Howell: There are many paths to parenthood. And for some families, that includes collaborative reproduction. Using donor eggs or sperm and/or a surrogate is particularly essential for our LGBTQ+ friends. So in honor of pride month, Monica Nitschmann, the manager for the Center of Collaborative Reproduction here at FCI is with us to answer the most common questions we get about third-party reproduction.

This is the Time To Talk Fertility Podcast. I'm your host, Deborah Howell. Monica, so nice to have you with us today.

Monica Nitschmann: Hi, Deborah. Thanks for having me.

Deborah Howell: Let's jump right in. What is third-party reproduction?

Monica Nitschmann: Yeah. So third-party reproduction is a unique way that families can continue to grow their family. It really is a unique way for them to utilize a third party, hence the name third-party reproduction, to have the family that they've always wanted.

Deborah Howell: And who's a good candidate for third-party reproduction?

Monica Nitschmann: Anyone that may need assistance in growing their family is a good candidate for third-party reproduction. So at Fertility Centers of Illinois, we serve many different families that can use a help from a third-party. So someone that may need an egg donor or someone that may need someone to carry a pregnancy for them, also known as a surrogate, can be good candidates for it. So there's many reasons why families may need assistance in growing their families. And so really, anyone is a good candidate, as long as they need a little bit of assistance.

Deborah Howell: Sure. So what can couples and individuals expect at their first appointment?

Monica Nitschmann: Couples and individuals can expect to talk to their doctor about their options for treatment. So if there is a need for an egg donor or possibly a sperm donor or a surrogate to help them grow their families, the doctors will go through those options with them. And it may be a combination of any of those that I had mentioned. And the doctor's really going to work with the families to talk about what that looks like, how the treatment is completed and also how long that takes.

Deborah Howell: So what's the process for a known donor, such as a friend or family member?

Monica Nitschmann: I love this question, because I don't think many families know that this is an option to them. And so a known donor is somebody that a family can utilize to help grow their family and it's someone that they know in their lives, maybe a friend or a family member or someone that they know from school or church. And it's a great option for families to use an egg donor to grow their families. The known egg donor would go through a similar process of screening and preparation as an anonymous egg donor. But the big difference in this treatment is this person is known to the family. And so they may know their family history, they may know their personality and they may have the ability to communicate with a future child, which is really important to some families. And so, although the medical process, the screening process and the treatment for a known donor is really similar to an anonymous egg donor, it's really great for these families to have this different psychosocial aspect of the donation throughout their treatment.

Deborah Howell: I can imagine. But what if you haven't identified a donor yet? And what is the process for finding a donor?

Monica Nitschmann: That's a great question too. So when I started here at FCI, this was my job for almost 10 years. And so it's something that I'm really passionate about and love to help families start this process. So Fertility Centers of Illinois has our own egg donor program, that families that work with us, you know, select an egg donor that we have already pre-vetted and pre-screened and approved for treatment. These young women live locally, which is also really important when it comes to how time-intensive treatment can be and they can start there. If they're not able to find a donor with us, which we understand because each family is looking for something unique in an egg donor, whether it's their ethnic background, what their interests are, or even how they look, it's unique to each person.

And so when families are searching for an egg donor, we want them to have all options open to them. We encourage them to start with our in-house egg donor program, but we also encourage them to look at outside agencies. So there are companies that specifically work on recruiting egg donors and offering them to families in need. Now, these women can live all across the United States or they can live locally to the area. Our nurses do the hard work of all that coordination to make sure that we can serve anyone that lives almost anywhere.

There's also frozen egg banks as an option to families. This has been around for a while, but it's definitely increasing in popularity as time goes on. So women have already donated their eggs and they're frozen at various facilities that family can select these egg lots from, as they're called, and then have them shipped to our clinic to complete their treatment and grow their family.

Deborah Howell: This is very impressive. And for the donors, what's the screening process like for them?

Monica Nitschmann: The screening process is pretty intensive for egg donors. And the reason it's like this is because we want to make sure that our families are getting optimal egg donor candidates for their treatment. So there's genetic background screening. There's a lot of blood work and a lot of ovarian testing that we do, family history interviews. There's also a psychological component to egg donation and donors are screened through behavioral health specialists to ensure that they're optimal candidates for this.

The screening process can take anywhere from one to three months, with treatment also lasting three months. So anyone that's interested in becoming an egg donor should definitely know ahead of time that it's a very time-intensive process. And we let the families that we work with know this as well because often families are eager and excited to get their families growing as soon as possible. But at Fertility Centers of Illinois, we want to make sure that each donor is the best possible candidate for all of our family members, which is why the screening process is very intensive.

Deborah Howell: Sure. So Monica, how does a couple go about finding a gestational carrier?

Monica Nitschmann: Finding a gestational carrier can be similar to finding an egg donor, but it's definitely a much longer time commitment for the gestational carrier because they'll be carrying a pregnancy for a family. So at times, gestational carriers are known to family members prior to treatment. So it may be a friend, a family member or someone that a person knows from the workplace, or maybe at church.

There are also agencies that specialize in searching and recruiting and vetting gestational carriers as well. The benefit of finding a gestational carrier through an agency is a pretty big one. There's a lot of logistics and other items that need to be coordinated by a person. And so these agencies really specialize in this intensive coordination and communication between the gestational carrier, the clinic and the family. And so it's often very helpful for families to utilize these agencies when looking for and working with a gestational carrier.

When you're working with a known gestational carrier, that component is removed. So it can be a little bit more time-intensive for the families that are working towards these traveling coordination plans, treatment coordination plans. And so if someone has the time and ability to do that, we welcome them here and we're happy to help, but it is a little bit more time-intensive for the family if they're gonna work with a known gestational carrier.

Right now, it's been tough for families to find gestational carriers. We're not exactly sure why these waitlists for gestational carriers have increased in the recent one to two years, but they have. So a family looking to work with a gestational carrier through an agency is looking at this time to probably wait about a year to 18 months to even start that process. So if you're looking to work with a gestational carrier, we would really encourage you to start that process now and work with those agencies to let them know you're interested while you're fleshing out the other portion of your treatment with the clinic.

Deborah Howell: Sure. Totally understandable. How are the gestational carrier candidates evaluated?

Monica Nitschmann: So similar to donors, they're evaluated in a variety of ways. There's a psychological component that we want gestational carriers and any partner that they may have to make sure that they really understand the process that they're volunteering to do. And so there is a psychological component to the evaluation and also a clinical one where we're evaluating their uterine cavity to make sure that they can carry a healthy baby for these families and a variety of blood work as well, to make sure that they're really optimal candidates to carry these pregnancies for other families. We also look at their medical history and their delivery records to make sure that, again, we want these optimal candidates for our families for the best possible outcomes. And so it is a pretty intensive vetting process as well. And families may be disappointed when we don't recommend a certain gestational carrier or an egg donor, but it's really for their benefit in the long run to have these healthy candidates help them grow their families.

Deborah Howell: Absolutely. And what's the process like if a gestational carrier has already been identified?

Monica Nitschmann: So this would definitely fall into what we've touched on earlier, the known gestational carrier component. And so, we would treat that candidate as we do any other. We would have them come into our clinic. They would meet with the physician. They would meet with our behavioral health team and we would do those medical evaluations on them to ensure they're optimal candidates. Even if someone may come to the clinic with their sister or their best friend to carry their pregnancy, we want to support them in that, but in the same vein, we want them to have the best candidate. And so it's possible that we may deny this candidate for them. But again, it's in the best interest of the families to do so. But we would facilitate all the screening here at Fertility Centers of Illinois and help them through all the supportive measures that they need to make sure that the candidate is screened appropriately for their treatment.

Deborah Howell: Absolutely. And finally, let's talk about the legal side of the process. What legal components are involved with a gestational carrier?

Monica Nitschmann: I love this question, because I often think that when you think of a gestational carrier or even an egg donor, you don't think of legal components that are involved. You think of more the medical and clinical side of things. But legal is actually a huge component when it comes to treatment. There are even some states in the United States that don't allow surrogacy at all. With our families here at Fertility Centers of Illinois, they're very lucky because Illinois is a very friendly surrogate state. And so what that means is the laws are really in favor of families being able to use this option to grow their families.

And so I would encourage you to look up your state laws, contact a reproductive attorney if you're not sure if surrogacy is legal in your state, that's a good place to start. There's many attorneys across the US that are reproductive law experts and they can guide you on what implications your state may or may not have, as it relates to this.

Again, I want to emphasize that Illinois is a surrogacy-friendly state, which is such a great option for so many families. And so even if you don't live in Illinois, you can come to Fertility Centers of Illinois, see our doctors, and we can treat you in your gestational carrier here. So you don't have to be as apprehensive about some of the legal aspects of treatment.

Deborah Howell: That's beautiful. And finally, what legal components are involved with a known donor?

Monica Nitschmann: So there are legal aspects related to known and anonymous egg donation. And so I would, again, encourage families to contact reproductive attorneys in their state to really understand what those legal implications are and to support them through their journey.

Deborah Howell: I love it. Well, this is such great information, Monica. Thank you so much for being with us today to share your expertise.

Monica Nitschmann: Thank you so much. I really enjoyed it.

Deborah Howell: That was Monica Nitschmann, the Manager for the Center of Collaborative Reproduction at Fertility Centers of illinois. Schedule an appointment to talk to a fertility specialist at 877-324-4483 or visit fcionline.com for more information. And if you enjoyed this podcast, you can find more like it in our podcast library, and be sure to give us a like and a follow if you do.

This has been the Time To Talk Fertility Podcast. I'm your host, Deborah Howell. Have yourself a terrific day.