Deborah Howell (Host): Planning a family in the year
2023, comes with numerous options. So how best to plan yours. Today we'll be
talking with Dr. Jane Nani, a Reproductive Endocrinologist and Medical Director
of Fertility Centers of Illinois Third Party Program, as we examine family
building options using an egg or sperm. This is the Time to Talk Fertility
Podcast. I'm your host, Deborah Howell. Dr. Nani, it is so nice to have you
with us today.

Jane Nani, MD: Well, I'm very happy to be here. Thank
you for having me.

Host: Just lovely. Okay. First of all, who is a good
candidate for using a sperm or egg donor?

Jane Nani, MD: Well, generally we require sperm donation
for couples where the male partner has very poor sperm counts. You know, we
always judge the sperm in terms of the overall number of sperm, and also what
we refer to as the motility or progressive movement of the sperm, you know, and
something called morphology.

And sometimes we have gentlemen who have almost no sperm in the
ejaculate. Now often, you know, we consider sperm donation in these cases
unless they are a candidate for having their sperm extracted. And those are
sometimes the situations where they might have an obstruction, let, let's say
in the what we call the vas deferens.

They might make sperm that can be retrieved. But otherwise if,
if there's a what we call a no sperm and there's no obstruction, then we're
almost always inclined to use a sperm donor. So that's very common with men
with very poor sperm samples. We have to resort to sperm donation. There are
some men that have what we call congenital absence of the vas deferens, and
those people also are candidates for sperm donation.

And of course we have same sex female couples, that are unable
to conceive without sperm donations. So these are the two major categories for
sperm. Men who have very, very poor sperm and are not candidates for sperm
retrieval or have no vas deferens. And also same sex female couples that are
just missing male partners, they, they resort to sperm donation.

Host: Now can using a donor increase the success rates
of getting pregnant for those struggling to conceive using their own eggs or
sperm?

Jane Nani, MD: Yes. You know, in, in particular, you
know, when we talk about sperm donation, and this is also true of egg donation,
these are of course human products, not all together on unlike blood products.
We talk about that's human tissue, you know, from the blood, you know, eggs and
sperm, are what we call gamates from the human.

And of course, because it's human tissue, we do have to comply
with what we refer to as the FDA standards regarding transfer of human tissue.
So that is something that happens in you know, general, with fertility clinics.
We have to comply to the standards from the FDA, the Food and Drug
Administration that requires that on particularly with sperm donation, that
these sperm donors be screened. And of course they definitely get screened for
infectious diseases, but they also get screened for various genetic carrier
diseases and they get screened in part for their fertility as well. So one of
the, one of the ways that we can utilize sperm donation is by going to these
FDA compliant sperm banks, and they're, you know, they've been doing this for
many, many years.

We've been freezing sperm. So again, when you know, couples go
to choosing a sperm donor, often it's overwhelming because there's such a
variety of donors out there, you know, across the country. Some of the bigger
banks on the West Coast and on the East Coast, et cetera, et cetera. So again,
sperm banks are very common, and the ones that really do comply are only the
ones that we tend to work with. You know, they have to comply to these FDA
standards.

Host: Sure. Now, what's the difference between using
fresh or frozen and does it vary for eggs versus sperm?

Jane Nani, MD: Uh, it does a great deal. You know, we
think about particularly with sperm donation, the overwhelming majority are
using frozen sperm because these are readily available from sperm banks. Now we
have the ability also to do, what we think of as fresh donations, but these are
normally what we call known cases. In fact, the terms, I should clarify, we
always traditionally used anonymous and known, you know, when it came to donor
sperm or donor egg anonymous versus known. But now we think of it as directed
if it's a known case, a known donor or identified versus unidentified.
Identified links to what we think of as anonymous tissue donation.

You don't know that individual, but again, with the fresh
samples, almost always those are identified donors. And again, they do some of
the same screening that we do with the traditional sperm donation. But there
are some rules that are more lax because these are known cases.

Host: Got it. Now, you've mentioned these sperm banks,
so what's the process for choosing an egg or a sperm donor?

Jane Nani, MD: Well there are two different banks
generally, although sometimes they can concur, but usually the sperm banks and
the egg banks have websites. And the easiest thing to start deciphering who you
might choose as either a sperm or an egg donor, is to get on the website. They
have the most recent updates on the list of potential donors, and that's the
first thing to do, to start looking at the whole variety of donors that might
be present. And almost always there are these sort tabs. You can, you know,
screen and filter for certain ethnicities, races and things like this. And so
that's the thing that we usually recommend people do, get onto these websites
and start to take a look because as I say, it can be quite overwhelming; all
the variety of people that are out there that you might be able to choose from
in terms of donation donated eggs or sperm.

Host: Okay, got it. Now can you tell us about Fertility
Centers of Illinois Egg Donor Database and what makes it unique?

Jane Nani, MD: Yeah. You know, because we do in-house
donation, and this is also very interesting. Traditionally we, we've only been
able to do fresh, even though we have sperm donors that are frozen. We've only
been able to do up until quite recently, we've been able to use fresh donors
that go through retrieval and then, you know, we use the couples, what we call
the intended parent, that that's sperm to fertilize the eggs.

Now, that has traditionally always been fresh, fresh eggs.
However, since 2013, we no longer call it experimental to use frozen eggs. So
now not only do we have sperm banking, but we now have egg banking. And that's
been since around, it started to come alive back in 2013 when it came off the
experimental list for doing egg freezing.

So now we have egg banking as well as we have sperm banking.
And particularly in FCI, what I think what is unique about our particular
donors, and these are all fresh donors that go on our website. And often some
of these donors will contribute to the egg banks as well. But the idea again,
is that these are particular donors that go through a very rigorous review of
records.

We call it a summary of records, particularly looking at their
family history. We are very, very particular about our donors. We carefully
screen the history of the person, including their family history. They
definitely go through the same idea as in blood products, the FDA risk factor
questionnaire.

We look at them again in terms of infectious diseases, in terms
of their genetic carrier risks and we very much have standards for who we think
are going to be good donors based on their fertility potential. So they get a
very rigorous screening. They get a psychological screening as well. So these
donors, they go through a lot of testing even before they get up on our
website.

And again, we also look at them carefully as they go through
donation cycles. In other words, we have a standard, if we see that one cycle
might fail, an individual, we might do one more time. And if that, you know,
and usually we get a success or a live birth, and if they had two in a row,
then we take them off the list, you know, so we're very discerning with who we
accept onto the program, the donor program. And we carefully look at them as
they go through treatment as well.

Host: I just love your passion and your enthusiasm, and
congratulations on being able to offer both fresh and frozen now. That's
wonderful.

Jane Nani, MD: Thank you.

Host: Now, if someone wants a friend or family member to
be their donor, do they still need to go through a screening process?

Jane Nani, MD: Well, that's a very good question,
Deborah, and, and again, as I mentioned, when we talk about these particular
cases, these are what we think of as known or identified directed, known,
identified donors, so, that's not uncommon. We do quite a bit of that. Often
couples will pick a relative, you know, relative let's say as an egg donor.

And I think there's a lot of reasons for that. But again, we do
that quite commonly and they do get screened in addition for like particularly
the infectious diseases. But if someone is not looking like somebody might be a
carrier for a genetic disorder, if it's an, you know, a recessive genetic
disorder, we just have to, we can be more lax and screen the intended parent,
the sperm source, and make sure that they're not a carrier. And you know, so we
have things that like that, that we can do to make sure it's still safe, but
there is a little more leeway with these because an individual recipient couple
could say, well, even though we usually have our donors up to age 32, the couple
might want to choose a relative that's 34. Yes, we can proceed with that if, if
that's their choice. So we do have a lot more leeway with directed donors for
sure.

Host: Now you spoke to this a little bit earlier, but
let's revisit. Can you search for donors with specific traits?

Jane Nani, MD: Now that's a very, very good question. We
generally think of things like eye color and hair color as sort of
multifactorial, but as you know, there are traits in families. So again, when
couples are choosing donors, as I mentioned, they can discern, you know, on the
website for egg donor or sperm donor.

They can choose couples that have a certain ethnic background
or racial background or hair color, eye color, so they can choose these. Now,
even though they might, they get pictures of course, so they can see and many
of them will try and choose a donor that kind of looks like people in their
family I would say. That's the most common thing. People that are similar in
skin or hair or eye color. And even though they choose this individual, it's
not always a hundred percent, by the way, that they get this child perhaps that
has blue eyes, for example. Because that is, it can be multifactorial, but I
think a lot of the couples will go ahead and choose someone, they try to pick
specific traits.

It's not a hundred percent because again, there's some
variability when it comes to the actual, what we think multifactorial when it
comes to eye color, hair color,

Host: Some is passed down, some is not. Some skips a
generation, et cetera. Okay. Now, if someone wants two or more children born
from the same donor or donors, is that possible?

Jane Nani, MD: Absolutely. We often have couples
particularly I think of it very common with same-sex women who might have used
a sperm donor and have a live birth. We tell them at the beginning, you might
want to order several more vials of that particular donor because if they have
success and have a live birth, they'd often want to have a sibling.

So again, so they, it depends on the actual sperm donor, but
usually we suggest they take or look for a donor who might have several vials
and maybe even to purchase them right out front cause they can stay in the
freezer until they want to use them. And the same is true with the donor egg.
Now I would say when it comes to donor egg, most of the donors have a very nice
yield when it comes to retrieval, and many, many embryos can get created.

And so we maybe only transfer one embryo and they have a live
birth, and they'll have embryos in the freezer, and often they come back and
choose a sibling, you know, to transfer. So that's very common.

Host: Right. And what are the legal considerations for
using a donor?

Jane Nani, MD: We are in a state, in Illinois where we,
it is legal to use sperm donation, egg donation, and gestational surrogacy.
Now, of course, when we are talking about, again, the unidentified or anonymous
donors, particularly with egg donation; the egg donor herself will have legal
counsel and also the recipient couple has a legal counsel.

In other words, there's a, they're what we call reproductive
attorneys with who, whom we work that will definitely take care of these cases.
And they're very adept and have lots of experience with these, what we call the
reproductive endocrine cases where people are using donor gametes and they do
have to come to a legal agreement that the particular donor will not come back
and try and perhaps manipulate the situation in any way.

So there is a legal thing that they do, especially again, with
these unidentified or anonymous donors now, with the, with the known, no they
don't have to, they just don't have legal recourse as much because they know
the individual.

Host: I'm imagining that emotional support services would
be very, very, wonderful for some of these couples, women, men. Are those
support services available for those looking to use a donor?

Jane Nani, MD: Absolutely. In fact, we mandate it really
that they should be counseled with our psychology team, and we have several
people that work with us that are clinical psychologists. All the donors, by
the way, our in-house egg donors go through a personality test and personality
screening, and speak with a what we call a psychologist who is adept in this
field.

So again, they're specific, I would say psychologists who work
with these sorts of cases, and I think it, it helps them to understand. I think
one of the things, it's not a medical thing that the psychologists talk to them
about, but from talking with them, I think it's nice for the couple who's using
either donor egg or even donor sperm to entertain these questions that the
psychologist brings up.

Often it comes down to when the child is born, let's say, and
the child is of sufficient age; what do you tell your child about the way they,
or how they became, how they were created? You know? So these are the kind of
questions I think that the psychologists do bring up with these individual
couples. And yeah, they're readily available here for sure.

So,

Host: And, then of course for the family and maybe for
the child who is born this way, are there counseling services for them?

Jane Nani, MD: Well, I, I would say that we don't have a
call for that here. We know, cause we don't take care of, we're not a pediatric
clinic, but for the couple, we could continue to talk with them, but we don't
see individual children here.

Host: This is all fascinating. I have one last question.
How long can these frozen eggs and sperm remain in the freezer before they
become not viable?

Jane Nani, MD: Well, it's interesting that you bring
that up. We have now do what we call no longer this what we think of as the
slow freezing method, and there was problems with that. But on more recent
years and over the last 12, 15 years now, we don't do that. We do what's called
embryo vitrification, egg vitrification. And it's a way that these can stay
frozen for many, many, many years. So I would say a minimum 10 years. But you
normally, people are using their frozen, not always, but normally they're using
them prior to keeping them in the freezer for 10 years. If they do keep them in
the freezer long term that there's long term storage that's available. But it,
could be costly too.

Host: Understood. Is there anything else you'd like to
add for our listeners to know?

Jane Nani, MD: Well, I would just say that I think we're
in a certain age, 2023, where we have so many resources for couples who are
struggling with infertility. And of course, some of the time it does require
either a sperm donor or an egg donor. And even so, we have many, many more
options than we ever had before because only since around 2013, 10 years or so
have we been able to offer frozen oocytes or eggs, for example. So I think it's
nice to have all of this technology that has advanced to the point where we
have not only sperm banks, but egg banks. So it's very exciting.

Host: Absolutely. Wonderful information Dr. Nani. Thanks
so much for being with us today to share your expertise.

Jane Nani, MD: Well, thank you, Deborah. It's been a
pleasure.

Host: Thanks for all the work you do. That was Dr. Jane
Nani, a Reproductive Endocrinologist and Medical Director of Fertility Centers
of Illinois Third Party Program.

You could 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.