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How do you prepare your patients for donor IVF in a way that provides the personalized care they need while setting the right expectations for their future?
Dr. Mark Leondires, REI and co-founder of Illume Fertility, tackles this question with Lisa Schuman, licensed clinical social worker and co-author of Building Your Family: The Complete Guide to Donor Conception.
Tune in as Dr. Leondires & Ms. Schuman discuss:
The criteria intended parents should focus on more when searching for donors (And focus on less)
What’s reasonable for intended parents to expect from their donors
What’s reasonable for donor-conceived children to expect from their donors
The commodification of donor sperm and donor egg
Speculation on how to solve the issue of 3rd Party IVF demand far outstripping the supply of carriers & donors
Transcript
[00:00:00] Dr. Mark Leondires: I think that most people go on a donor website and they start with what this person looks like and that biases them down the pathway to accept some things. It's a, it's a complete loss of control to choose a donor. It's nothing that anybody wants to do, but there are things you can control and understand that, you know, you can make sure.
Your donor has had mental health screening and passed. There's a whole generation of sperm donors that never had mental health screening. And there are many hundreds of families that suffered the consequences of young men with mental illness who went ahead and transmitted that, some of these heritable risks onto their children.
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Announcer: Today's advertiser helped make the production and delivery of this episode possible for free to you. But the themes expressed by the guests do not necessarily reflect the views of Inside Reproductive Health nor of the advertiser. The advertiser does not have editorial control over the content of this episode and the guest's appearance is not an endorsement of the advertiser.
[00:01:40] Griffin Jones: How do you prepare patients for third party IVF? Preparing them in a way that grows your third party IVF program, that provides patients with the personalized care that they need, and that sets them and their children with the right expectations for their future. My guests have a new book called Building Your Family, The Complete Guide to Donor Conception.
We talk about donor egg and donor sperm. We also talk about gestational carriers. Because my guests each have deep expertise in in different areas in this realm. Dr. Mark Leondires is an REI. He's one of the founding partners of what is now Ellume Fertility and the organization Gay Parents to Be. Mark does a much higher share of third party IVF than average, and over the years he's shared many cases with Lisa Schuman, who's a licensed clinical social worker who has a lot of experience with screening candidates for mental health and properly preparing intended parents and donors so that they have true informed consent.
Mark and Lisa talk about what criteria they need to get intended parents focused on more, and what criteria they need to focus on less when they're searching for donors. With 25, 000 donor conceived siblings connected to each other in online registries, what's reasonable for intended parents to expect from donors?
and to expect from their practices and what's reasonable for donor conceived children to expect from donors and practices. Dr. Leondires talks about monetization of donor sperm and donor egg, and we speculate on what's coming in the future that might be necessary to solve for the issue of the demand for third party IVF, greatly outstripping the supply of gestational carriers, sperm donors, and egg donors.
Again, the book is called Building Your Family, The Complete Guide to Donor Conception. It's available on Amazon and other places books are sold. Enjoy this conversation with Lisa Schuman and Dr. Mark Leanderis. Ms. Schuman, Lisa, welcome to the Inside Reproductive Health podcast. Dr. Leanderis, Mark, welcome back to the Inside Reproductive Health podcast.
Thank you, Chris. Thank you. I'm. I'm interested to explore what's happening with third party IVF in the U. S. in the world. And then I'm interested to explore the book that you've written on the topic called building your family that the two of you coauthored. Let's start with just what's happening in the marketplace.
What are the numbers in terms of how much donor egg donor sperm? Gestational carrier IVF has grown in the U. S. in the last decade or, or, or some years.
[00:04:04] Dr. Mark Leondires: Yes, Griffin, I can certainly address that. So, you know, for myself, I'll tell you that I see very few regular infertility patients anymore. My practice is almost wholly, um, donor conception.
Everything from cisgender female couples looking to conceive, to same sex male couples, to talking about people want to receive donated embryos, to people, you know, moving forward with gestational carrier cycles with donated gametes. So third party reproduction nowadays is both You know, donated sperm, donated eggs, donated embryos, and the utilization of gestational carriers.
And what we can clearly see in the SART data, and anybody can do this themselves, if you just pull the increase in the past 10 years of embryo transfers from donated eggs. That's increased by 40%. And if you also just dig into start yourself and you can watch the slope of the line of the utilization of gestational carriers go up year over year over year.
Obviously, as with most things in our field, there was a dip in during COVID, but the utilization of donated gametes has increased. And then. You know, we're not even aware of what's happening on the sperm donor world in that we've passed two of the major sources of donor sperm, and they state that demand is, is outstripping supply.
There may be some other reasons for that as well as that we talked about in the book, as far as anonymity. The other part of the story is that people are going out and finding their own donors, whether it be on Facebook, Craigslist, or a lot of these other third party sites that are trying to match people with sperm sources.
Uh, so, uh, so there's a, there's a, an openness to using donated gametes that I think is, is relatively, you know, um, new in the past 10 to 15 years. And, and there's still, and there's people who want to be parents sometimes who either biologically can't be parents because there are members of the LGBTQ plus community, or perhaps they're single.
They want to be a parent and they don't want to be. Um, held back because they, they haven't found that person or don't want to find it or last but not least, you know, there's other reasons, whether it be low sperm male factor or female factor that they're using donated gametes, but they want to be parents and, and there's lots of different ways for them to get there.
And the demand for that is increasing.
[00:06:32] Griffin Jones: So was that, was the demand outstripping the supply? Is that part of the reason for writing the book? Tell me about why the book was written because normally when someone writes a book, it's that some monkey that they want to get off. They're back. It's either some subject matter expertise that they've developed such a unique point of view on that they want to share that unique point of view, or they find such a misconception or lack of total comprehension around a certain subject that they want to address that for you all.
What were, what was the primary reason for writing the book?
[00:07:10] Lisa Schuman: You are right on point, Griffin. Exactly. Correct. I felt. Day after day, week after week, year after year, people would talk to me about their donor conception journey and the things that they wanted to do, whether it's how to talk to their children, how to choose a donor.
And I would share what I knew. And people would say over and over again, how come nobody's telling me these things? I can't believe this information that you're sharing. How come nobody says it? And in part I was informed by my own experience in the field and partially just watching the adoption field move over time from a place where people You know, in the fifties, there was a large number of children adopted in the U.
S. And over decades, we can see how those adopted children felt. And those agencies used to tell people, don't tell your children. And we saw the effects of those children and learned that we had to tell early and often. And I saw a very similar trend happening in donor conception. And yet no one really seemed to kind of learn from the adoption world, even though adoption is very different than donor conception.
That particular piece is. Was very similar. So both of those things were annoying at me.
[00:08:28] Dr. Mark Leondires: We are actively kind of almost trained, my generation of reproductive endocrinologists, to tell people that, you know, you never have to tell the story to your child, because nobody's ever going to find out.
[00:08:43] Griffin Jones: Is that really the case, Mark?
Were you told that when you were training?
[00:08:47] Dr. Mark Leondires: When I was training for donor conception, um, in the military, it happened very, very rarely. And it was something that was kind of back to my military days. Don't ask, don't tell. We're just not going to talk about it. You're a heterosexual couple. You need to use donated sperm or egg and, and you'll never have to talk about it again.
Because back in the nineties, nobody knew that Direct to consumer marketing of DNA testing was going to allow us to find these relationships. And they thought the parent child bond was going to be negatively affected by the truth, which it's the reverse.
[00:09:28] Griffin Jones: Maybe you're starting to answer my next question that I've been thinking about is one version of this book could have been written by a fertility specialist.
Another version of this book could have been written by a social worker. Why did this book need to be written by both a fertility specialist and a social worker? And a social worker or or vice versa. I'm not putting one in front of the why a social worker and a fertility specialist.
[00:09:54] Lisa Schuman: Well, I think we shared Mark and I shared a lot of cases over the last decade.
And we both really saw eye to eye on so many cases that we would struggle with. And so it really made sense for us to collaborate.
[00:10:06] Dr. Mark Leondires: So Lisa came to our practice 2017 and At that point in time, you know, I still had a, a young family. I have a donor conceived family myself, just processing what, how to speak to my children.
And Lisa has spoken to children of donor conception and processing how. You know, meeting somebody's donor might be important to choosing a donor, right? And then, you know, transitioning our anonymous program to a known program and realizing that the donors want to know where their gametes are going. At least the young women that we spoke to from our, you know, local area.
Um, so the, the impetus to write the book, you know, comes from Lisa's experience. And then. I was I lived this life, right? And then for us both together to be working closely together and appreciating what we were hearing from the parents to be and the parents after we changed our program a little bit was transformational and it and it just wasn't out there.
There's not. This type of content out there, and I think we're ready for it.
[00:11:22] Griffin Jones: How did you each approach what you contributed? Do you did you like Mark writes a chapter? Lisa writes a chapter. Or did you sit down at a coffee shop and jam out each chapter together? How did you each contribute your different perspectives?
[00:11:39] Lisa Schuman: Well, I think it's, you know, pretty clearly you can see which parts are the social work parts, which parts are the medical parts you can see in the book and we will send you one Griffin for sure. So you'll see.
[00:11:50] Dr. Mark Leondires: So you know, as far as the storyboards for the book, you know, it was pretty clear, you know, how does this all work, right?
And what, what, how do we need to educate our patients, our donors, and a lot of third party reproduction. is not about the medicine. It's about the people. So the, the, the book, most of the content in the book is from a mental health interpersonal relationship point of view. And, you know, I chime in with personal stories and things like that throughout the book.
The book is not a textbook. It is not a self help book. It's, it's basically an exploration of kind of a new part of our humanity. And so, The melding of like the medical plus the personal psychosocial and so on is how it happened. So, you know, chapters of the book that are medical are mostly written by me, but Lisa chimed in of like, well, people aren't going to grasp that.
You need to take that down. And I did the same thing to, to, with her. This exercise of re reading your book three, four, or five times is really quite remarkable about how to fine tune this message to intended parents, to donors, and to children, and taking care of yourself through this process, because this is art.
[00:13:17] Lisa Schuman: It's really like a how to guide. We have a very, very clear steps on how to choose a donor, which are very different than I think a lot of people would imagine, and we think it works better for most people to use this paradigm. And there are very clear ways to understand how the medical process works, there's very clear ways to hear, to understand how to talk to your children.
Really wanted to be like a how to guide. We, we both went through our own fertility journeys and we felt it was very difficult to learn everything. Even if you're in this business, it's very difficult to know what to do and to deal with the emotions involved. And so we really felt that it would be helpful for people to have a guide to shepherd them down this journey.
[00:14:03] Griffin Jones: And part of the shepherding that you're doing, as I understand, has to do with the way people choose donors. What do you hope to change about the way people are choosing donors right now?
[00:14:15] Lisa Schuman: Well, we hope to kind of flip the script in a way. People usually find that choosing a donor naturally, even if you Have already always known that you needed a donor.
Maybe you're a single person or maybe you're a queer couple and you feel like we are accepting of it, even then it can be very dysregulating to choose the genetics for your child. This is one of the most intimate relationships of your life from a stranger. And so. People reflexively will very often choose somebody who feels familiar to them, somebody who feels comfortable, somebody who reminds them of their, you know, their brother or has the same sort of bushy eyebrows or whatever it might be.
And that's nice. And you can see that the sperm and egg banks kind of play into that. They give you celebrity lookalikes and tell you how nice this person is or show you their, you know, their, their, Profile and maybe a voice message, but those things are not heritable. And as we know in our culture, we see lots of examples of people who don't look anything like their parents or don't have anything to do with, you know, their siblings, musical talent, or their other siblings, athleticism.
So, we know that these are not heritable, so perhaps that's not the best place to start. It's nice to like your donor. You want to like your donor because you want your child to, to maybe be able to meet that person one day. You want to feel good about talking about them, but it's not the best place to start.
Best place to start is to try to be practical and start with the more practical aspects first. And then, once that's settled and you. can decide on the practical aspects to give you the best health possible for your child, then everything else is gravy.
[00:16:00] Dr. Mark Leondires: I think that most people go on a donor website and they start with what this person looks like.
And that biases them down the pathway to accept some things. But when you, it's a, it's a complete loss of control to choose a donor. It's nothing that anybody wants to do, but there are things you can control, right? And understand that, you know, you can make sure. Your donor has had mental health screening and there's a whole generation of sperm donors that never had mental health screening.
And there are many hundreds of families that suffered the consequences of young men with mental illness who went ahead and transmitted that some of these heritable risks onto their children. I mean, it was on the cover of the New York Times, right? Somebody with schizophrenia who's generated, you know, more than 50, 50 offspring, right?
They're they're so mental health screening for sperm donors is actually relatively new in the past five years, right? mental health screening for egg donors is has always been recommended for the asrm and it needs to continue to be done and so you can control the whether your donors passes mental screening and presents as a At a clinical interview that they're they are of sound mind and know what they're getting into and understand That they have There's a strong likelihood somebody's going to contact them in the future, that anonymity is gone and they have an ongoing responsibility to the, the, the child to be, the family and so on.
I mean, The 2019, you know, past term ethics committee on, you know, donors and donor conceptions. Their comment reads like this, and I have it up because I think it's important and really well written. Donors, recipients, and programs must recognize that they have a unique and ongoing moral relationship with each other.
And this obligation does not end. and with the procurement of gametes or the donation of embryos. Evolving medical technology, laws, and social standards will likely require re evaluation of these relationships throughout the lifetimes of the parties involved. So we'll unpack that a little bit more a little bit, maybe a little bit later on, but this is an ongoing relationship.
And I think that donors didn't always understand that or wasn't always driven home and maybe not always driven home by the medical providers that were interviewing them. So mental health screening, clinical interview and family history. Listen, when you're choosing a donor, you're not getting them.
You're not getting their picture, who they are. You're getting their family tree, probably their past three to five generations, understanding that when somebody sees a donor that they like. They should pass that to the side and go right to their family tree and then genetics. Like we all know there's recessive genes that cause disease, right?
So that needs to, that's something you can control and make sure it was done that you did it yourself. And then also think about the things that in your own family tree that you don't want to. replicate or increase risk off because we all have things in our, our genetic closet. So if you start basically with those four issues that the donor's looks and her there, because it's a male sperm and egg donors, right there, what you see becomes less important.
So one of the goals of the book is to, to, for intended parents to give them a sense of what they can control. And to, to reframe how people go about choosing donors. And I think it's also a message out there for. Providers for mental health professionals, for nurses, for everybody out there in this industry.
So we're in this industry of, of basically procuring gametes. So people could have babies, but we're, these gametes eventually become people, people with lives who have questions and so on. So we want to make sure that, that the intended parents are really thoughtful about how they choose a donor. And And of course, everybody's going to say, well, I didn't just choose a donor because of what they looked like, understanding that if you exercise as much control over the first four things I mentioned, you're going to have a really nice story to tell your child about why you chose that.
So I think that, you know, that's a big part of the book, changing the conversation on it. How people find their donors and the other parts of the book that I think are really powerful are, you know, how to talk to your children as well.
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[00:22:07] Griffin Jones: So you're steering people away from first looking at, uh, attributes of appearance and you're steering them to more practical criteria such as, uh, their, their mental health screening, their clinical interviews, their family history. As a marketer over the years, I have learned that the market gets what the market wants.
And uh, that's not always a great thing, uh, because people don't always want things that are the best for them. They don't want. They don't always want things that are ethical. They don't always want things that are sustainable. And so if one is going to try to go against the market, they got to find a niche that's receptive enough to it.
They, and they have to find a way of leveraging that message to where people start to see something else that they want more. So how are you doing this in this chapter, in this part of the book, where you're, where you're trying to get people like, no, no, I want, you know, I want, you know, six feet tall. I want Harvard educated.
I want blue eyes and red hair. You know, how are you, how are you getting people to think differently?
[00:23:16] Lisa Schuman: Well, a couple of things. First of all, I mean, if you give examples, I mean, even in our culture, right? The two princes of England look very different from each other. Our ex president Bill Clinton was a Rhodes scholar, president of United States and his brother is an alcoholic, right?
So people are not like their siblings, but also if you think about it. Our paradigm, instead of just the way that we reflexively think about things because we're anxious, really that's where it's coming from. We're anxious about choosing somebody we don't know, right? So we want something familiar. And I think when people understand that, they can be a little bit more reasonable about their decision.
Also, it narrows their choices. Patients often come to Mark and I saying, I feel completely overwhelmed. I'm looking at this sea of like Match. com people. I don't even know where to start, right? So if you start with, did they have mental health screening? Right away, you're narrowing the pool. Do we have replicated risks?
You're narrowing the pool. All of a sudden, you're narrowing the pool and it makes the whole process so much easier. Also, I think that, you know, we do make the point of, Why all of these things are important, we were, Mark and I were just talking before this podcast, that someone suggested to me that one of these people who's pushing for legislation that clinics should investigate all donors and do thorough background checks on them in order to prevent mental health problems of one of the families who unfortunately lost their son.
Sun through suicide is one of the people who's doing this. Unfortunately, that, I think, is, is sadly unreasonable. First of all, no clinic has the ability to do that. Secondly, it's not feasible. You can't find every single person's, every doctor appointment, every time they went to mental health counseling, every time they were prescribed everything.
And last, No one is, has a record unless they're convicted in this country. So you could have people who are mentally ill, who are, who are doing all kinds of things, and if they don't, if they're not convicted, there's no record. So what's really the point in doing all of that, when you can just do mental health screening and get a much better picture of that person?
So we, we try to make reasonable arguments for all of our suggestions.
[00:25:25] Dr. Mark Leondires: And specifically addressing your question, how we hope to change hearts and minds is by thinking about the fact that as a parent, someday, you're going to do all these other things that are uncomfortable that you don't want to do. So your, your parenting is going to start by trying to find the best family tree, genetics, story, mental health screen donor.
Of course, they're going to be appealing to your eye. That is not what your kid's going to care about. And what do we want for our children? We want them to be healthy first, have good emotional well being, to find happiness and love and live their lives, and to be smart enough to leave your house, right?
So, so, and that's, none of that's how we traditionally find donors. So changing hearts and minds is like, Also thinking about, you know, how, why did you choose your donor conversation with your child? And it's a, it's a, it's a conversation that's developed over years. And I mean, I will tell us, I tell a story that just happened recently to me.
So we're driving back from a family event with my two kids and I have a 12 year old and a 10 year old and we're talking about the donor because I always called, um, her the donor and, and discussing that she might have her own children right now. And, and my 12 year old said, well, that means I might have a sister.
I said, yeah. And he said, that could be cool. And. My nine year old who's usually a little bit thoughtful is just hanging out back there. And so I asked, you know, what do you, what do you think about this special lady who gave us some of her cells? And then I said, you know, what should we call her? I think she needs a better name than the donor.
And he paused and said, our fairy godmother, which for me, that's kind of what these people are. They're giving us this human magic that allows us to have families. So being really thoughtful in choosing the donor is also going to be make for very strong relationship and bond and ability to talk about with your children why they chose their donor.
And that hopefully means that they're launched into adulthood with a good sense of self. That they were very much wanted and loved before they even came into existence. I mean, right now there's in the New York times this week, there was a story about donor conception. There's a popular book right now that talks about finding out, you know, my genetics are not my genetics.
At most recently at the SREI conference, which some of the listeners went to, there was a very heartfelt video about somebody who found out that, that later in life, Who they thought they were the whole time is not who they were. So how to change hearts and minds is that you're going to do this for your child to be, because you already look so like within the book, you know, changing the paradigm, getting that message out that anonymity is gone, doesn't exist anymore.
And with more openness. hopefully comes to a better place for all these families to be. And it is something that our field, I think culturally needs to change. I mean, at this same SREI conference in the 1950s, people were like the donor there, it did not matter. It wasn't something that was going to be revealed about choosing if you use donor conception.
And, and now, you know, there's a whole bunch of donor conceived people. We have a voiced, there's 25, 000 donor conceived siblings that have been connected on donor signaling registry. And these taking care of taking what we know now and, and moving it forward for the thousands of people, hundreds of thousands of people in the future who will proceed with donor conception is one of the reasons we wrote the book.
[00:29:51] Griffin Jones: Do you talk about what's reasonable to expect from donors from the part of I guess donors and providers from the part of the intended parents and from the part of the the Children of the donor of donor assisted reproductive technology. I think you were talking a little bit about that, Lisa, but I members at ASRM this year, there was a small crowd, 10, 20 people at most outside.
I don't know what their grievances were, so I don't want to misrepresent what their grievances were. I've also had Igor Brussel on this program who is an embryologist turned reproductive health attorney. And he said, Some of what is being asked for by some people from the donor conceived community in certain legislation is things that we would never be able to get from our biological parents.
And, and so it's, it isn't reasonable to ask for, for those, those things. It isn't tenable to ask for them. So do you talk about that all in the book? What, what's the limits that intended parents and children can expect from donors and providers?
[00:30:59] Lisa Schuman: There are a lot of limits and that's a whole other conversation because there is some division, I think, between people who are donor conceived and what we find is either found out about their origins accidentally or found out late.
And those adults are usually very distraught over that. So there's, there seems to be a division between those people and then the younger donor conceived people who seem to feel a little bit better adjusted. And so there's a lot of difficulties, I think, as time goes on, as there was similarly in the adoption community until things change.
So, and we don't really go into that in the book, but we're really talking about is when you're going through fertility treatment, you have to make all of these big decisions and you're really focused on getting pregnant naturally, right? That's what everybody's focused on. Let me make a lot of embryos because I want to have as many embryos as possible.
I need to build my family. I need to get pregnant. And understandably, The patients, the doctors, everybody's kind of focused on that. And yet now we really have to think into the future. We really need to talk to the donors about what the implications are for their future. These people will reach out to them.
What's it going to mean for them? What's it going to mean for their family? What's it going to mean for their future partners? What's it going to mean for the children and for the recipients? Do they, do they really understand what they're getting into? And. it's really important for them to think wisely about all of these pieces of the puzzle before they do.
So we're really helping the people who are just beginning this process.
[00:32:33] Griffin Jones: So what, what is it that fertility practices need to know about the changes in donor conception?
[00:32:39] Lisa Schuman: Well, the fertility practices really need to start to think a little bit differently, right? We're, we're all kind of conditioned to think about pregnancy.
That's what we're thinking about, a happy pregnancy, and that's wonderful, but we now have to think into the future, right? Just like the ASRM, ASRM statement says, we're, we're all part of making this happen, and so we all have a responsibility to really think about What, what we're doing, how are we talking to the donors?
Do they really, are they really well informed? Do they have true informed consent in a way that's different than what we were trained to do decades ago? Are the recipients really educated about how to talk to their children? And do they really understand what that means? And, you know, as we move forward, There are a lot of donor related siblings.
You know, last year there was an, you know, a live birth from a 31-year-old embryo. So we have many, many generations of donor related siblings that are going to be coming around decade after decade, and that's not going to stop anytime soon. So we really need to be thoughtful about all of these things and prepare for the future, not just for getting pregnant.
[00:33:50] Dr. Mark Leondires: Yeah. I mean, I think that fertility clinics need to know that anybody who's thinking of donor conception needs to understand that there's, there's no way to keep things anonymous. I think that if you're speaking to any donor, whether it be a sperm donor or egg donor, that They need to be aware of that.
The other part of the story is that moving towards openness, whether it be an open egg source or open or a familial or family member or friend, the legal aspects of this are, are, are important. So, you know, in all, in, in this whole third party reproduction field, it's clinicians, doctors, nurses, embryologists, It's mental health professionals and it's reproductive attorneys that all need to work together to protect the donor's rights, the parent's rights, and the children's rights.
And it's, and it, it's just a lot more complicated than just getting somebody pregnant. It's thinking of the, the, the longterm implications. Of what we do. And so I think, you know, changing the way fertility practice thinks about, well, we're just going to help her get, help them get pregnant. It needs to needs to go to, well, we need to be really thoughtful about making sure everybody's properly educated and that they have, they understand all aspects of, you know, how donor conception through a fertility practice affects these families to be.
[00:35:26] Griffin Jones: The first time I had you on the show, Mark, was because I have so many people in the audience that want to do more third party IVF. They want to attract more gay male couples. They, they want to do more donor IVF and more GC IVF, but it's, it's not just as simple as just saying, Hey, we do this too. There's an infrastructure, there's an investment that needs to be made.
And you've invested a lot in this. And so talk to me more about the specifics of when you say, Hey, That it's, it's the docs, the nurses, embryologists and the mental health professionals working together. What does that look like specifically?
[00:36:05] Dr. Mark Leondires: You know, I think that the third party team at every fertility practice needs to really have a very strong kind of interdisciplinary band, meaning that, you know, it's easy for you to speak to your, a reproductive attorney or Mental health professional and, and I think that, you know, our, our field is a lot of aspects of our field are being commoditized sperm and egg included and, and understanding that, that the third party team is, it's so much more than you just need a donor.
It's, you need, you need to think forwards and backwards and, and try to guide people to make their, their best decision. So as people go, want to do more and more third party, I think it's really important that there, there's a separate part of a practice or a dedicated team. That, that, that moves under stays up to date and understands what's happening in the field.
I mean, there's a beautiful conference that it's the donor egg conference that happens every year. That's, uh, it's basically all dedicated to the legal, medical, mental health aspects of donor conception. Right. And, and I think that if people want to. You know, grow this aspect of their practice, understand that it's, it's, there's a lot to it and they need to be able to pick up the phone and ask questions and, and stay up to date with what's changed because a lot has changed.
[00:37:34] Lisa Schuman: And you also, we also need to understand And, you know, Mark and I spend a lot of time talking about difficult situations with known donors. As time goes forward, more and more people are going to use their friends or family members as donors. And certainly you have people in the trans community who are going to have more and more children.
We've had people who are in throuples. And so, you know, it's only going to get more complicated and there are, you know, educational pieces that really need to be part of this practice. To help the patients understand and work through all the potential difficulties and implications for these these situations and There are a lot of ethical issues that that arise in each one of them and we have to really be thoughtful about that
[00:38:22] Griffin Jones: You mentioned mark that we're starting to see a bit of commoditization Happening sperm and egg included that brings me back to a thread you pulled at in the beginning of this conversation about the supply and demand and that You The demand is outweighing the supply of available donors, gestational carriers.
So would commoditization possibly be a good thing that you have more of a scale to provide the supply for the demand, or is it a bad thing?
[00:38:52] Dr. Mark Leondires: I actually think that with driving home to donors, the loss of anonymity, There, they, there may be fewer sperm donors, probably not fewer egg donors, right? There's much more greater demand for sperm donors than egg donors because the young men who were donating sperm.
I think, you know, 10, 15 years ago, didn't think that they, there was any future implications for them. And I think that, so what we've seen over the years is the compensation for donors has gone up and up and up, and the cost for donor sperm has gone up and up and up. Compensation for surrogates has gone up and up and up.
So I think that, you know, what's, I think commoditization is not going to, is not going to increase availability because the, the humans involved are, are getting a, getting a better understanding of what the, the commitment and they're not just donating, they're just donating their sperm. You know, if we're doing our job right, they understand that they're, they're helping a family come to life at, and you know, there's, there's, you know, a future child that may come knocking on their door.
And, you know, for the, for the, the, the sperm donors who were doing, you know, had the best intentions, most likely who ended up having a hundred children out there, you know, that's not, that's not something I think, you know, was done well. I can't imagine being that young person who realizes that, you know, I have, you know, 99 half siblings, nevermind the.
The, you know, 40 year old man who realizes that he has all those, you know, genetically linked children out there. So thank things are changing.
[00:40:38] Griffin Jones: So and some of that probably some of that absolutely needs to happen because we consider us as a species. If I, if I have my statistics right, we have twice as many.
female ancestors as we do male ancestors, meaning that some men were reproducing a lot. Some men weren't reproducing at all, which tends to be common among species. And so you might have people a few decades ago that there was a Prado's distribution where you had some sperm donors donating too much, but you also might now have just because you are more properly informing donors.
Of what the involvement in the commitment is, is, as you stated earlier in the conversation, I think it is, you called it an ongoing ethical relationship between donors, recipients and the program. And so as you start to give people the proper informed consent, it becomes harder to recruit than if there's no strings attached, which is necessary.
But then how do you amplify Recruitment.
[00:41:45] Lisa Schuman: I think they're more known donors now as a result of it. I think that's just going to happen. What do you think, Mark?
[00:41:53] Dr. Mark Leondires: Yeah, I think that I think no donation is going to come into the forefront. And then and you know, as long as it's done well and With full disclosure and the right legal documentations, it's, it should limit the amount of families that are made from any particular sperm source.
And we already advise egg donors not to donate more than six times, but it, it, it likely will limit that. So. You know the the governor so to speak on on donor conception is likely going to be the donors themselves I don't know lisa. What do you think about that?
[00:42:30] Lisa Schuman: Yeah, I mean, I think it's it's very important, you know decades ago I don't know if you remember but decades ago there was a an article written by a mental health professional in fertility and sterility about Uh, clinic where they had this ethical dilemma where they cycled two, two families who use the same sperm donor and the same egg donor by sheer coincidence in a very small town in Westchester in New York.
So these two little kids were born around the same time in the small town, probably, you know, went to kindergarten together and hopefully they won't go to prom together. This is, you know, a problem. So people really need to understand even the, the, you know, the limits that we have are very large.
[00:43:13] Dr. Mark Leondires: And I just want to dial back.
It's not that, that Mark had that statement. It's the American society for reproductive medicine ethics committee that has, we have this ongoing relationship or a commitment and moral obligation. So. But I think that,
[00:43:29] Griffin Jones: so what do we do to get more donors though? Because it sounds like that's the, that seems to be pretty common across the board, not enough gestational carriers, not enough sperm donors, not enough egg donors, and the U S is sitting in a lot better of a position than a lot of. There's there's none or very few in their countries. So what are we, what needs to happen in order to have more donors and more gestational carriers?
[00:43:56] Dr. Mark Leondires: Well, first of all, a lot of the reasons why there's no donors in other countries is not considered legal, for those things.
[00:44:03] Griffin Jones: And they can't compensate, and even in the countries like Australia and New Zealand, where Canada, where, where it is legal there, there's You know, there's, there's rules and limits on compensation.
So is the answer only more compensation? Is it, is it more, is it public awareness? Is it some, some change in the messaging? And if so, what does the message need to be?
[00:44:25] Dr. Mark Leondires: I don't have a clear answer to how to solve that, that equation of supply and demand. My, my impression is that there's not going to be as much supply because of the donors.
And practices and intended parents understanding, you know, this process better, you know, the future of this may be the future of science where we're able to take stem cells and make them into sperm and egg. And then nobody needs a donor anymore. Right. Right. And so, so that will solve that problem. Uh, and then, you know, this whole industry goes, which is kind of an interesting comment for your show, right?
[00:45:10] Griffin Jones: They're, they're, they're working on it. I saw, I saw the CEO of one such company speak on that earlier this year. And, uh, maybe we'll have to have that person on the show because maybe that is ultimately the only solution. Maybe there isn't enough supply from. From from what we currently have right now, but I think that also points to the importance of what you're discussing earlier in the show in terms of preparing intended parents to look for the right things that at least they're not wasting their potential supply source by looking at things that are either superficial or just simply not as important as the practical criteria that is.
[00:45:53] Lisa Schuman: Yeah. And one other thing, Griffin, that that might might also be in the interim happening in the interim. Mark and I talk about this as part of a talk that we give. There are all of these new small companies. You're probably familiar with them like Modemily and a lot of other groups that are developing.
And I think there is this ongoing need for more transparency. And as the The donors, and I spoke about this at the egg donor conference as a donor, start to feel a greater sense of agency, maybe more power in the relationship, more interest in choosing maybe their recipients. There'll be more matchmaking companies perhaps where people will decide, maybe I want to donate.
And I have actually on my podcast, a couple of donors like this who decided they wanted to donate to specific people where they could have an open relationship and they meet people they like and they, and that. that's really the end of the story for them. So there may be more of those sorts of relationships that will develop over time.
Of course, that's a smaller number than the large sperm banks provide, but there may be a rise in that over time until we come up with the science to, to make children from stem cells.
[00:47:03] Griffin Jones: I think it's useful for providers to pick up a copy of your book and not just providers, we also have nurses, we have practice owners, we have business suite folks that listen, we have reproductive health attorneys, we have mental health professionals that listen, people that work in our field, anyone that touches third party IVF, I think could benefit from reading your book.
Each of you have a concluding thought of what you would like. Folks that work in the fertility field to take away from your book.
[00:47:35] Dr. Mark Leondires: So more for myself, you know, I think that understanding moving forward with recommending your patient pursued donor conception needs to then. Be followed through with making sure they understand, you know, how to choose a donor, maybe reasons to think about an open donation and what is the best and how to talk to their child and their feet in the future.
So they are, they fully know. That their parents did everything they could to bring them to life as a happy, healthy, well adjusted person. And that will not only bring these parents to be joy, but it also will bring that child to adulthood and, and hopefully as a committed, helpful member of society.
[00:48:31] Lisa Schuman: Yes, I echo that completely and I hope that patients don't feel discouraged.
We know how stressful fertility treatment can be even when you don't have infertility and we want patients to feel like this is all possible. There are paths to parenthood that can work and you can learn these things and you should be armed with this knowledge and feel confident that you can move forward and create the family that you want to create.
[00:48:55] Griffin Jones: The book is called building your family the complete guide to donor conceptions
The authors are dr. Markley and dearest and lisa schuman We will link to links that people can pick up the book But if they're driving in the car right now and for them to remember later on where can they pick up the book?
[00:49:15] Dr. Mark Leondires: The book is available at Amazon, Barnes and Noble and Macmillan Press. And it's also as an audio book. And, and I, I really want to thank you for having us on and, and appreciate your podcast and the work you do. And this is a very multidisciplinary podcast. So there's, there's a lot that you do for our industry.
So thank you so much.
[00:49:36] Lisa Schuman: We really appreciate it, Griffin.
[00:49:37] Dr. Mark Leondires: Thank you.
[00:49:37] Griffin Jones: Thank you both for coming on.
[00:49:39] Sponsor: This episode was brought to you by BUNDL Fertility. Fertility clinics, ready to boost your online reviews? Our survey of over 2, 500 online patient reviews showed that 30 percent of the negative experiences were focused on billing or finance frustrations.
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