Transcript
Speaker: Part of my job is to start off by every consultation by saying, give me a little bit of a story of your journey that brings you in today. Not, okay, I know you need an egg donor. I know you need a gestation carrier. all right, let's get going. No, it's tell me about yourselves. I want to know about them. I want to know everything about them. How do you know who to trust when building your family?
Speaker: For LGBTQ individuals and couples, choosing a fertility clinic is about more than finding a practice that's experienced in IVF, egg donation, or surrogacy. It's about finding a team that truly understands the journey and knows how to support you every step of the way.
Speaker: Today, I'm joined by fertility specialist, Dr. Michael Goranacha, who has spent more than three decades helping people build their families. Together, we discuss what LGBTQ individuals and couples should look for in a fertility clinic and how choosing the right professionals can shape your entire family building experience.
Speaker: been in this industry for 30 years. And i know over the past three decades, I am sure you've watched not only the science evolve, but society's definition of family to looking back, what changes do you feel like have been the most significant to witness?
Speaker: Well, I'll break it down into two buckets, so to speak. There have been the scientific advancements, scientific advancements, which I think globally have served to increase the pregnancy rates for patients going through fertility treatment. And we're fortunate now in this day and age to have very high probabilities of success in a patient going through IVF. So the bucket number one, the scientific advancements, which have- Sure. grown by leaps and bounds over the last obviously 30 years.
Speaker: But also there are these sort of changes in societal definitions. And I think um globally what I mean, from my perspective is what defines a family is whatever. the person building the family wants it to mean. So that's issue number one. And I think issue number two, that definition of family has now come into the fertility rain realm such that we can offer treatments for any patient to build the family that they are looking for, that they, you know, their chosen family.
Speaker: Yeah, absolutely. as As you've watched that unfold, what have your patients taught you about what they need from their fertility team beyond just excellent medical care?
Speaker: Well, I think first of all, it's a sensitivity in terms of understanding what they're going through. And I think for any person who has, who's either been trying to get pregnant within a couple or who is contemplating building a family outside of the sort of.
Speaker: standard norms of what that family is. It's first, I would say sensitivity towards each person's individual journey. And so I think, you know, everyone comes to this journey from a different perspective, just like medicine in general, patients come from share a different perspective, different anxieties about, especially coming to see somebody like myself. And what I find is that when a patient comes to me for an initial consultation, their biggest fear is that there's going to be something wrong that's not correctable. And they're going to be told that they there's no way they're going to be able to have failure. So that's issue number one. And then issue number two, I find a lot of patients will come to me saying at the very outset, I don't want to have to do aggressive
Speaker: therapy such as IVF. And I will say, wait a minute, let's start off by getting a history, treating each patient as an individual entity with a different background, with a different medical history, and potentially with different challenges to building a family. So as I tell patients, not all roads lead to IVF.
Speaker: generically There are some situations where IVF is the only option. We here at New England Fertility are fortunate enough to take care of a lot of same-sex male couples. And for those couples, they'll come to us already somewhat educated about, they know that they need to proceed in a certain fashion, which requires IVF and egg donors and surrogates, things like that. But for the average couple or patient who's been trying to get pregnant,
Speaker: I just say them, wait a minute, let's see what we need to do. Let's do the testing first. Not all roads necessarily lead to IVF. A lot of it's gonna be very dependent on that patient and her partner's unique characteristics and challenges.
Speaker: Yeah, for sure. Specifically for the LGBTQ community, I know you you said something so beautiful where there's there's a difference between a clinic that's willing to care for LGBTQ patients and ones that are intentionally built for them. Can you just go dive into that a little more? right So I would say what we've seen over the past 10 years, five years, especially here at New England Fertility, which even predates me coming to work here, is that this is a system that is designed to facilitate the journey for LGBTQ patients, couples, and so on and so forth. Simply because as I'll say to patients, and
Speaker: it's that It's a difference between if you're working with a general IVF unit, which isn't sort of catered to the unique needs of the LGBTQ community, you'll sort of be put in with the general pool of patients going through fertility treatment, which is fine. They'll probably get good care.
Speaker: But I think the uniqueness of the journey, especially for the LGBTQ community, which requires a different avenue of treatment, It's imperative, I think, that not only the physicians, but the nursing staff, the ancillary staff be facile at weaving through the hurdles potentially that patients in the LGBTQ community are going through.
Speaker: And in that way, we can deliver care, more catered care um in a more organic way to those couples. And it requires a practice that is that has become facile at weaving through the avenues. Because especially for, let's say, same-sex male couples, it's it can it can be a process. They need to identify an egg donor. That egg donor needs to go through treatment. Once they the couple has created embryos, then they have to use a gestational carrier or a surrogate. So these are a little bit more complex processes that require not only the physicians, but the staff be more facile and knowledgeable about getting through those processes, you know, simply because, especially for the LGBTQ community, the stressors
Speaker: may be different than a heterosexual couple or a single female going through this treatment. So I think once again, we want the journey to be both successful, but as minimally stressful as possible.
Speaker: Yeah, yeah. Tell me more about that, the stressors and maybe some of the, like what that looks like in practice. Here at New England Fertility, we have a system whereby once, ah I'll just talk about the same-sex male couples. yeah Once they have an initial consultation, they'll be immediately given a coordinator.
Speaker: Now that coordinator is going to follow them throughout their journey from start to finish. And I think it's imperative that it be done in this fashion because there are a lot of points of contact that need to be done in a correct, knowledgeable way so that their journey is as smooth and seamless as possible. So to for example, a lot of the couples will come to us and they'll say, well, we need an egg donor. We know we need an egg donor. Okay, so part of the process is helping them to choose an egg donor that for both men in the couple is something, you know, has the characteristics of what they're looking for. Right. So fortunately we here at new England fertility, either we have both our own donor egg pool, but we also work with, um, donor egg agencies as well. So as I say to couples, I'll say, listen, you know, we have our own donor pool, take a look, see if it's, you find somebody that you both would like to use, or if not, we have contacts and associations with other, agencies, which we try and make that process as seamless. So there shouldn't be any sort of artificial boundary, whether they use a New England fertility donor or an agency donor. And we try and facilitate that.
Speaker: Also the coordinators will assist them in getting their appointments done for the couple for the male couple coming in for semen analysis, genetic testing before they choose a donor.
Speaker: Also, because of the rules and regulations, we have to do FDA testing on right sperm sources. Right. So that's all done in a single appointment, which the coordinator will facilitate that appointment. So, you know, I think that in and of itself can be somewhat of a complex process, which theoretically, if you're at just a general IVF practice and you're dealing with.
Speaker: you know great staff and employees, they may not be facile at that process. So it may not go as seamlessly. So I think, right. And, and that's, I think that's a unique need in the LGBTQ community moving forward. Once embryos have been created for this couple,
Speaker: then they will work with a surrogacy agency along with us in sort of a tripartite manner, and they will identify a surrogate.
Speaker: Then we make arrangements to that surrogate to come in for testing and evaluation here. And, you know, once again, so then moving forward, getting all of her information, her paperwork, her chart. So there's a lot of data gathering and information gathering that needs to be done in order to facilitate the process. Yeah.
Speaker: It takes more than love to create a family. It takes compassion, courage, and connection. At egg donor and surrogate solutions, we've spent more than 18 years helping hopeful parents, surrogates, and egg donors create happy families through egg donation and surrogacy, one relationship at a time.
Speaker: Our team has been there. Many of us are former surrogates, egg donors, and intended parents. So we truly understand this journey. If you're ready to take the next step, visit create a happy family.com to apply today.
Speaker: All right, let's get back to the show. This sounds so similar to you know our process at Egg Donor and Surrogate Solutions where you are given a coordinator and you have the one person, but having that single person to guide you through the whole process to who already knows all of the nuances and next steps that maybe you're not you know thinking about. you You don't know what you don't know, right?
Speaker: Exactly. Exactly. yeah I think it also is helpful too, because like all of us, we have our own unique stressors. So the coordinators also get to know the patient's stress points. Everyone is unique. Everyone's relationship is unique. So really trying to work with them as well to minimize any stress points.
Speaker: And if there are identified stress points, bringing it to the attention of the doctors and the nurses to say, you know, this couple is having a difficult time finding an egg donor or having a difficult time getting this couple in for their semen analysis, for their FDA blood testing,
Speaker: or even with the gestational carrier, this couple would like to use a known gestational carrier, a sister, a friend. you know So once again, it's really understanding the nuances um of that unique couple. And I think that's where the coordinators really are on the ball in terms of doing that. And also they help the clinical staff you know, once again, balance the clinical care with the other processes that need to go smoothly in order to make this a fulfilling journey.
Speaker: Yeah, um again, I really love just the the relational focus of of this because yes, there is obviously the medical process and exactly like you said, you could go to you know a a any fertility clinic and you will probably be given great medical care. absolutely But there's something to be said that extra that extra step of like you said hey these are the stressors and i'm going to be your advocate and i'm going to make sure that you know nurse is aware of xyz doctor is aware of this this structure and when this journey goes smoothly it can take up to a year to a year and a half so i think yeah what happens is if the process isn't in place to facilitate all the other non-medical clinical stuff you don't want to extend that even longer like
Speaker: records aren't evaluated on time sure you know, miscommunication, because then that just adds more time to this couple's, ah you know, so family building journey. And you know, for a lot of men in the LGBTQ community, you know, they've come to a decision that they want to become parents, probably at a certain point in their life where, you know, they are like, listen, we're at a certain age, we want to now we are committed to doing this. So we want to get the process going. Sure. You know, and for a lot of our patients as well, we want to allow the journey to go smoothly. And then a lot of times we'll see them back in a year or two for what we call a sibling journey when they're ready to have a sibling once again. and it's sort of that coordinator will know them. We'll say, oh, they're coming back for a sibling journey. Let's facilitate that as well. Yeah, no, I love that. i love that. I think something that you know you shared that, i mean, it just broke my heart. You said that you know you witnessed many LGBTQ patients would come into an office almost expecting less. Well, I think once again, as any, you know, when a patient sees a doctor for any reason, there's a lot of anxiety. So once again,
Speaker: Part of my job is to start off by every consultation by saying, give me a little bit of a story of your journey that brings you in today. What brings you not? Okay. I know you need an egg donor. I know you need a gestation carrier. All right, let's get going. No, it's tell me about yourself. I want to know about them. I want to know, yeah you know, everything about them. And a lot of them will give me these great stories. Listen, we've been together for so many years. We finally got married. Now we're ready to build a family. So I think, I think it's,
Speaker: it's just first starting off with that the clinical care that they're going to get is is more consistent and more defined. And as I said before, there's a certain level of expertise. So it's most important for them to feel like they're being heard. And then, you know, fortunately here at new England fertility, we will take care of, um,
Speaker: We do take care of patients who have other medical conditions. We do take care of HIV positive male patients who have gone through treatment and are continuously, consistently undergoing treatment. We partner with the beacon Institute, um, in terms of working with their sperm specimens to make sure that it's the safest journey for both the.
Speaker: gestational carrier right and for the child so i think once again it's it's just the idea of creating a safe space for them to a talk about their journey if they'd like to um like everything else everyone is a little bit different sometimes i have patients like listen we've done the research we know what we need to do so let's so what are your success rates let's just get moving Sure, sure. You know, because there's a lot of information. Fortunately, we, as well as you probably participate in groups, advocacy groups that have meetings throughout the country and throughout the world where couples can go and get their information and yeah vet vet the different providers. So a lot of them, especially the LGBTQ community, come to us already very educated because they know their journey is going to be more complicated or more complex. So they're obviously facile enough to educate themselves about the process and also to parse out You know, if I were to tell you what, 30 years ago, 20 years ago, even 10 years ago, treatment for same-sex male couples was very uncommon. Now it's much more common, but I think you also have that treatment being offered maybe by clinical practices that do not have as much experience. So it's the type of thing where everyone is starting to offer it, which is great. but like everything else you have to you have to parse out where you're going to get the best clinical care and emotional support
Speaker: Yeah, for sure. along Along those lines, what should, you know, if someone is at the beginning and they are trying to choose their fertility clinic, what should someone be paying attention to as they decide who to trust with building their family, particularly in the LGBTQ community? Yeah, I mean, I think once again, word of mouth.
Speaker: research, going to these advocacy meetings, you know, uh, families out loud, men having babies, organizations like that. And just really listening to what other couples have to say, who've gone through the process.
Speaker: Um, you know, so I think educating yourself with how, how other couples have gone through the process and what they've experienced. I think, you know, one can get success rates for any practice. Those are publishable on the SART, Society of Assisted Reproductive Technology Database. So success rates are important. And I think also the organizations such as yours, other organizations will also be able to provide couples with information about practices. So I think it's just, and and once again, having consultations with,
Speaker: multiple practices. You know, you may, you know, and I think it's, this is a very personal journey. So a couple may gel with a doctor or a practice, one practice, and may not gel with another one, nothing to do with the quality of medical care. It's just the personality sort of situation that we all deal with. So I think there's no reason that a couple needs to do a consultation and then be wedded to that practice or stuck with that practice. Right. I mean, I think I have couples will even say to me, listen, we've talked to other practices. We're educated about what this practice office, what that practice offers. Tell us, tell us about New England fertility.
Speaker: So I think that's really, um i really think it's really very important that a couple feels like the decision they're making. It's a well-informed decision because there are going to be bumps in the road throughout this process, wherever they are. So they want to feel like they made a decision. They weren't pigeonholed into, well, my insurance says I have to use this practice or I won't have coverage, or we have to do this. Or we get a lot of couples who are not from the Connecticut area, not from the tri-state area. So, you know, sometimes couples will feel like, well, I live in Boston. So therefore I need to go to a Boston practice, or I live in Los Angeles or wherever. No, that nowadays for medicine, you know, there's telehealth and. Right.
Speaker: You know, we, as long along with our partnering agencies get patients from all over the country. So it it can be, they're not wedded to a certain geographic location and a certain practice.
Speaker: Yeah, no, absolutely. i think you know something that you've said, um you know yes, it is so important to educate yourself, but I think it is so easy to get overwhelmed of course by how much information is out there. And oh my gosh, there's a lot. And there's so much noise. and yeah.
Speaker: What for someone just starting out, what maybe, you know, misconceptions or assumptions do you find yourself helping people work through most often?
Speaker: So if we're talking about just couples trying to get pregnant on their own heterosexual couples, it's I'm going to need to do IVF. So that's issue number one. so For the LGBTQ community, I think really that yeah we can only use a donor with certain characteristics, or we want to use and a surrogate who maybe is a friend of ours or something, you know, some practices will say no, absolutely not. So I think the biggest concern that they have is, will there be a lack of flexibility within the practice that they're going to, or, you know, some, some,
Speaker: patients will say, listen, we're a couple, we're married, but we only wanna use the sperm from one of our partners, or we wanna split 50-50, or we also take care of a significant number of single men, by you know men who wanna go become parents and they're they're single, you know whatever their relationship status is, either part of the LGBTQ community or not. So I also think that a lot of single men are now starting to avail themselves of fertility treatment. um So I think once again, it's whatever preconceived notions a couple has, it's my job to bring them out in the open during the consultation and to dispel them. I'm also a big advocate that you know a lot of our patients are very well informed and they'll come with data and information. and things they've read on the blog or that quote background noise. Right. And part of my job is to have the, is to either agree with what they've vetted or read, especially clinical data or say, no, that's not quite true. This is, you know, the actual clinical
Speaker: reasoning behind certain decisions that a physician will make because there's a lot of noise on the blogs, especially for fertility care and what the best avenue of care is. And also, I think the other issue for any couple is there's not one avenue to proceed.
Speaker: um So I think that, and I think that's all part of the initial consultation is to just bring out into the open any preconceived notions they have, any data or information they have, which I will either agree with or refute, tell them why I agree or why I disagree. So I think it's always that they wanna feel like there's an there's an open dialogue. And I think also a concern nowadays, and obviously,
Speaker: with the sort of um there's a lot of concern among the LGBTQ community is what are their rights going to be in three years, five years and ten years? and And so I won't pretend to understand all the nuances, but fortunately, aligning themselves with an organization such as yours, where you have legal professionals who say, listen, you know,
Speaker: this is what needs to be done pre-birth order or once the baby is born, depending on the state the baby is born in, you know, things like that. Because sometimes they'll ask me those questions and I'll say, listen, I'm hearing the same information you're hearing, but that's really important to have a legal professional, either your own or through whatever organization you're using. And, you know, also here in New England Fertility, we have a significant number of men from Europe.
Speaker: who come and use an egg donor and a so a gestational carrier surrogate in the United States. So that's even a little bit more complicated because not only are you dealing with the rules and regs of the state that the carrier is going to deliver it, but also their own unique country's rules and regulations. So once again, so I think, I think it's important for them to know that They there are support systems throughout the whole process, you know, using attorneys who are facile at, you know, gestational surrogacy laws in each state or whatever state the carrier is going to deliver it. So I think it's um I think it's more just letting them know that there are.
Speaker: support at, there is support at every level and for them to get the right information. Right. Because, you know, we've all heard sort of stories when I go to these meetings, sometimes I'll hear stories of things that didn't go right, especially with the legal process, you know, also insurance.
Speaker: We will vet their insurance from the perspective of what we do clinically, but then obviously your organization will vet whether or not the carrier has insurance or insurance, plan things like that. sure You know, just all that information for them.
Speaker: Yeah. Yeah. Well, you're you're highlighting just again, all of those nuances and small things that I think, you know, you'll see somebody, okay, I i know i need to, i know I need an egg donor. I know I need to have a surrogate. And they haven't even thought about, right you know, what is a pre-birth order or, you know, what about insurance or all of those things. And I mean, again, this is why it is so important. to work with industry professionals that even if it's not your expertise. So obviously you are not an art attorney, but you know that an art attorney is important. And so you are counseling. You know, you're also you need an art attorney. And also sometimes patients will come to us and say, listen,
Speaker: you know, and it it might be a financial reason. I have a friend who wants to donate eggs for us and then I have a friend who wants to be the carrier. But what they need to understand is what risks are they taking by using, let's say, an egg donor who's a friend, you know, so once again, and what they sometimes and sometimes they'll go in that fashion and we'll work with them. sure So other times,
Speaker: you know, if you just if you discuss with them the risks and the benefits, they may say, oh, we didn't think about that. And oh, it may end up being a little more of a process than if we were to use an anonymous egg donor or a surrogate from an agency, so on and so forth. And so, and I also think, you know, as I say to the LGBTQ couples, I will say to them, listen,
Speaker: who else do you want to be involved in your family unit? So if you're using somebody who's a known egg donor or ah or ah a sister of one of the partners or a friend, that's somebody that with your family moving forward, you're comfortable with them being involved in some fashion. So, you know, once again, ah my job is to maybe have them think about If they come to us with a preconceived plan, okay, great.
Speaker: But what are the ups and downs of that possible ups downs of that plan? Sure. Yeah. You don't know what you don't know. and it's great to, you know, yeah, it's great to have those conversations. And it's certainly if you don't know what questions to ask, it's wonderful to have the industry professionals like yourself kind of read between and, you know, bring up exactly like you said, that perspective or, you know, have you thought about X, Y, Z. right when When you think about the families who walked through your doors 30 years ago and the families that are walking through today, what brings you the most joy?
Speaker: Well, I think basically it's, you know, it's just helping them build the family that they're looking for. And especially for LGBTQ couples, especially for male couples, you know, 20, 30, 10 years ago, you know, part of their journey,
Speaker: You know, I hear stories of, well, I never thought I'd be able to be a parent, you know, when I came out and things like that. And my parents were like, you know, these couples will say, well, their parents were like, oh, we're never going to be grandparents, you know, like most people. So I think it's more just knowing that they have this available to them. And some couples will say, you know what, with all due respect, this is not for us. We're gonna proceed with adoption. you know We're gonna look for other ways to build our family. But I think that's really, it's just this,
Speaker: family building within the LGBT community is, is really much more accessible to all. Hopefully it's more cost effective now that it's more widely available and insurance companies, some insurance companies and some corporate organizations are covering part or all of the process, which was unheard of. Um, yeah, ago. And even for, even for a woman who can't use her own eggs. And if she needs to use a donor egg, a lot of organizations now cover donor egg services, which in the past, it was all of pocket self-pay. So once again, corporate America has become smart enough to say that we want to offer these medical services to talented individuals as part of, you know, their employment.
Speaker: Yeah. Well, again, it's just it's wonderful that there's just a choice. And there, you know, whether it is adoption or IVF, egg donation, whatever your path to building your family, it's just amazing that the choice is just the choices are there. Exactly. Exactly.
Speaker: Yeah. If someone listening remembers just one thing from today's conversation as they begin building their family, what do you hope it is? Well, I mean, I hope it's that all options are available. And i think any questions that you may have, as opposed to just sort of wondering about it and doing your own deep dive, you can always talk to a a professional. And even sometimes patients will just call into the office. They've not had a consultation yet, but they'll say,
Speaker: Is it possible to do this? And do you guys do this? And is it available? And we'll say, yes, it's this is a service we offer. We're available. So I think it's just knowing that whatever your situation is and whatever your goals for family building are, there are options available for everyone.
Speaker: Yeah, yeah. And you don't have to be the expert and then come to your consultation. You can just be a blank slate. yeah Exactly, exactly, exactly.
Speaker: Yep. Yeah. Awesome. Well, perfect. Okay. So my last question for you, it's a fun one. And again, I'm so grateful for your time and for just your expertise. Thank you for having me. Yeah.
Speaker: Of course. So um one thing that everyone knows about me is coffee and i we are never far from each other. And so so, you know, sipping my coffee this whole time, but I love to ask the question, what has filled your cup lately?
Speaker: Literally or figuratively? my My cup in terms of my energy cup or my life cup? All the above. For me, the biggest, biggest, that filled my cup lately is being a grandparent. So my grandson just turned two years old yeah this past weekend. So it's sort of being able to relive, you know, being a grandparent and previously, being you know, because when you're a parent, you're busy and, you know, you're working. But now as a grandparent, it's, sort of yeah you can sort of enjoy and you can be you get to do all the fun stuff you get to do all the fun stuff and then at the end of the day you go home and you say wow i'm tired and i say to my wife how did we do this i don't remember it being
Speaker: these kids, mean, she's like, well, somehow we got through it. But, um, so that's what for me, and that, and for me, that also, it also reinforces my reasonings for going into this branch of medicine was building. I was fortunate enough to be able to build the kind of family that I wanted that my wife and I wanted, but also I want everyone else to feel that. And also for those people, you know, who want to be grandparents and they have, lgbt2 children and like anyone they want to know that they're going to be a grandparent one day if that's what their children choose as well so absolutely oh i love that that's beautiful and happy birthday to your grandbaby thank you thank you awesome well thank you again so much for your time and thank you for everything you're doing for you know your patients our shared patients um you know just all of the things most appreciated all right you have a good day thank you
