Transcript
Speaker: There's going to be a way to be a parent. It may not look exactly like what you imagined upfront, but there's a way to get there. Many people know they want to build their family, but they don't know where to start.
Speaker: And when you're navigating fertility treatment, egg donation, surrogacy, or even donor sperm, the options can feel overwhelming fast. That's why I'm so excited to bring you today's guest, Justine Winski, PhD, MPH, and founder and CEO of Alineage Fertility.
Speaker: After years leading clinical operations at Cornell Center for Reproductive Medicine, Justine recognized a gap in the industry and founded a lineage to create a more personalized, human-centered approach to sperm banking and fertility care. We really need to think holistically about the person, right? It is not just as simple as, okay, come today and free sperm. At a lineage care goes beyond simply following a lab order.
Speaker: Justine helps us understand what a semen analysis can tell you, how male fertility and male fertility preservation can help shape family building decisions and how the right information can help you move forward with confidence.
Speaker: Enjoy. I think one thing that we've talked about is many people know where they want to go when it comes to family building, but they don't necessarily know where to start. And Google can be incredibly overwhelming.
Speaker: What role can a semen analysis play in helping someone just understand their starting point? It's crucial. Among the services that we offer are baseline semen analysis. Like somebody, you know, maybe there's a just a person who's considering trying to start conceiving soon, or maybe they've been trying to conceive for a few months and not having success just yet. It's a super simple appointment. um We get some information, schedule, you come in, provide the specimen. And then we have a report with 14 different parameters the same day. And we're looking at the volume, the count, like how many sperm there are. the percentage of those sperm that are moving.
Speaker: Among the sperm that are moving, are they sort of swimming the way that we imagine them to be? Or are they twitching? Are they doing something else that we you know is movement, but maybe isn't ideal for fertility? And we also look at the morphology, the shapes of the sperm. So if you can imagine from a cartoon or a textbook, the head and the neck and the tail. and This is like just a trivia, fun fact, but the percentage, sort of optimal percentage of normally shaped sperm is only 4%.
Speaker: So we're expecting a single digit number of sperm or single digit percentage of sperm to be normally shaped. So that's always, people are always like totally shocked at that.
Speaker: And at our lab, every lab is going to be a little bit different with this, but our lab, we have the report later the same day. So this is not something that you do the appointment and then you have to. you know, be bent out of shape for three weeks waiting for the result. Like we have the result that day, our team calls, goes through the report. If you're working with a doctor, we can send it. You know, it's something that we want to make it super accessible, really easy. And if it looks great, carry on trying to conceive. If it doesn't look great, then Maybe you work with a reproductive urologist. Maybe your partner sees a reproductive endocrinologist. you know, we just, depending on the plan and what the overall goal is, what the family structure is, are we doing fertility treatment no matter what? Are we hoping to avoid fertility treatment, et cetera? It can really kind of point us in the right directions. um And the beauty of fertility treatment of IVF is super forgiving of the semen parameters. Ultimately, you need one nice looking sperm per egg for fertilization. So it doesn't have to be perfect to still result in a baby and a totally healthy, wonderful baby.
Speaker: I love that. i think i think one thing that is also so great about this is when you think of fertility and just all of the testing that is involved, you know, I know I immediately jumped to like hysteroscopies and, you know, just all kinds of things that are taking place. But a semen analysis, like you said, it's pretty simple and pretty cost effective of all the things that you're going to do.
Speaker: For us, he even here in New York City, under $300 to do the test. A lot of people can even seek reimbursement from their insurance companies. So it's something that's pretty accessible to people and can really like give you a lot of either a lot of confidence that the path you're on is really the right path and just be persistent and carry on, or get you to the people who can be helpful and start building that team of family building professionals that might be useful in getting you to the overall goal. yeah
Speaker: Yeah. what What would you say are maybe some of the most common misconceptions when people like that people may have about fertility before they even start seeking testing? um You know, it's funny, like even on the semen analysis, like people often have no concept of like,
Speaker: what order of magnitude these numbers might even be, right? We're hoping um for millions of sperm per milliliter of the specimen. And the normal range is anything 16 million or more. But in some people, that's like 150 million sperm per milliliter.
Speaker: And these are numbers that like, we can't really fathom. We've never seen 150 million of anything in our lives. So it's really hard to imagine these things. um But there's attrition at all of this. It's a math equation. We're multiplying the volume. Maybe it's two milliliters times the count. Maybe it's 50 million sperm per milliliter times the motility. Hopefully it's something like 40, 50% of the sperm are motile.
Speaker: And then we're multiplying by that 2, 3, 4% normal shape. So you do, you drop it down pretty well there by multiplying by these, you know, numbers, but you're still left with millions of normally shaped progressively motile sperm in a pretty normal semen analysis. Now, are there some cases where we do this and we see no sperm on the initial analysis? Yes, there are. And there can be lots of different causes for that. We could probably spend an entire hour of podcast on all the different causes of these things, but there are ways of processing and further analyzing to determine are there rare sperm in the specimen or there truly no sperm in the specimen. And that's helpful in knowing, can we just use this specimen for, you know, or a similar specimen for IVF?
Speaker: Or do we definitely need urology to weigh in and maybe there are procedures or maybe there are things that we can do to try to reinitiate spermatogenesis?
Speaker: And I think one of the other, you know, maybe it's not a misconception, but something that we discuss a lot with people is um how spermatogenesis works. So the body is constantly making new sperm. It's something like 75-day cycle. So you'll hear people talk about it as like a three-month cycle.
Speaker: And the sperm that you're somebody's giving today, their body started making about three months ago. So if they had COVID, if they had the flu, if they had some sort of like acute illness in that window, we might see fewer sperm. We might see that the motility has declined. oh If they're a daily cannabis user, if they're a cigarette smoker, we might see impacts of those environmental exposures.
Speaker: There are also some medications, certain hair loss medications, things like that, that people may not even know could impact their future fertility that do.
Speaker: The beauty of this though, is that it is modifiable. So if somebody comes to us and they're a daily cannabis user, but they want to improve the semen parameters, if they can,
Speaker: you know, stop using the cannabis or at least really cut it down three, four months from now, we would expect that we see some improvement in the parameters, which is so different than when we think of, you know, assessing eggs, right? But we're all born with all of the eggs that we will ever have. There is no improving those eggs necessarily. Certainly not, you know, in the same ways that we think about improving semen parameters. So there's, it's very forgiving, which is really nice. Yeah.
Speaker: No, I mean, that's so nice. And it's especially for, you know, infertility where everyone is trying to kind of seek control in some things that feel pretty uncontrollable to be able to be like, Hey, just, you know, do X, Y, Z for three months and right to probably see an improvement.
Speaker: You certainly can. Now, does that mean that like, If you eat a perfect diet and are those things going to necessarily do it? Probably not. Right. sure Probably we not making some like noticeable improvement. Might you feel better? Sure. Right. That's always that's always a good thing. um But some of these things that we know have impact on the semen parameters are modifiable and can, you know, can certainly allow for improvement over time.
Speaker: yeah Yeah. Why do you think that this is such an important first step? Well, think it's like, i think there are some still even, and I've been doing this work almost 20 years now, just shy of 20 years, and the taboos and the stigmas and things have improved so much over that time. People are so much more open and willing to share their fertility experience or their infertility experience than they used to be. But I think there are still some fears and some stigmas associated with male fertility and people being like nervous to do the test. um You know, one of the things that we, you know, sort of set out to do when we open this practice is make this more approachable, make it feel, make you feel taken care of when you're here. The office is like, nice and bright and pleasant. And it's not yucky, right? You'll hear people talk about it sometimes. And they're like, I don't know what to expect. It's actually like pretty pleasant here, right? I don't want to sit in a yucky place all day. So we have, you know, we have like a nice professional office, the staff are great that everybody's like, we do this all day, right? So even if for the patient, it is the first time they've ever done a semen analysis and the idea of doing a semen sample in an clinical setting is really like kind of an overwhelming thought.
Speaker: It's something that we're doing constantly. And I hope that we're making it um much more approachable, much more accessible and making people feel like they can be empowered to get this information and, you know, carry on however they see fit after that.
Speaker: Yeah, no, absolutely. I think when it does when it does come to that, the semen analysis and just that the testing in general, I think a lot of people might actually assume that the testing is being done on the sperm itself. Can you help us understand what's actually being tested? Sure. Yeah. So with a, just with a regular semen analysis, we are basically observing the semen sample. We're observing the volume, how many sperm we count.
Speaker: Are those sperm moving? Um, what shapes they are? but also like the color and how quickly it liquefies and a variety of other parameters. When we think about donor testing and screening, so if, you know, to give a little bit of an overview of what we do here Alineage, we do baseline semen analysis, like as we've been talking about, we do fertility preservation for either medical indications, maybe somebody has cancer treatment upcoming or gender affirming care upcoming, something that might impair their future fertility. Or we see patients who are sometimes concerned about their own age and want to preserve sperm at a younger age so that they could use it for fertility treatment in the future.
Speaker: But the bulk of the work that we really do is directed donor testing and screening. And this gets into really like some niche fertility stuff here. But ultimately, the FDA and the Department of Health have specific regulations and requirements designed to reduce the risk of transmitting infectious diseases between people who are not sexually intimate partners. So among that group are a variety of different types of patients. Maybe someone's working with a friend or a family member to be a sperm donor. Maybe someone's making embryos that ultimately will be transferred to a gestational surrogate. Maybe they're working with an agency to recruit a directed sperm donor.
Speaker: And all of those people, even though sort of their, how they got to doing mistesting and screening, need the same type of testing and screening. With anybody sort of pursuing one of those paths to parenthood or to fertility treatment, We still are going to do that baseline semen analysis as we've been talking about, but we're also going to do a variety of other testing and screening to make sure we're meeting those regulations and that we're reducing that risk, right? It is designed to make it as safe as possible for everybody involved.
Speaker: And so let's say we're working with someone who is going to make embryos for transfer to a gestational surrogate. That's maybe and a nice example to use. That gentleman will come to us and we'll do a sperm sample for semen analysis and freezing of that sperm.
Speaker: We do blood and urine testing for infectious diseases, for genetic carrier status. um We do physical exam and we do a whole host of paperwork on personal and family health history and risk assessment. So things like travel, drug use, sex partners, things that put people at risk of having been exposed to an infectious disease. And all of this gets combined to make what we call a donor eligibility determination. And that's a term that the FDA designed more than 20 years ago, 2005, these regulations came out and
Speaker: It's all designed for us to essentially compare the testing and screening of the individual to the regulations and say, this donor is eligible or this donor is ineligible. Now, there are lots of causes for ineligibility that we're not necessarily clinically concerned about that in a case of gestational surrogacy or known sperm donation that we can still proceed. So as an example, if someone spent more than five years living in Europe, they will be ineligible per the FDA regulations as a donor because of a geographic risk for exposure to mad cow disease.
Speaker: Now individuals are not walking into our office with mad cow disease, right? So what does this actually mean in real life? If it's an example like that, what it means is we collect all of this information. We counsel the recipient. We explain this theoretical risk to them.
Speaker: We document it. They sign consent forms and everybody carries on. Right. um So I'll give you a different example that maybe even further you know shows how okay we feel about that that type of ineligibility. If someone, if I, let's say I am from France and my sister is also from France and she's going to be my egg donor.
Speaker: if they come to the United States to be my egg donor, she's going to be ineligible because of mad cow disease. Obviously I'm not concerned that my sister as my egg donor has mad cow disease. So I'm going to sign the forms and i'm going to carry on.
Speaker: Right. um But there are, other things that can be more concerning to people, right? Somebody who has a history of specific exposure to specific in sexually transmitted infections, things like that. That, you know, there are pathways through depending on exactly what the goal is and what the history is, but it does require you know, a team like ours to do that assessment, that counseling, sometimes communicate with the FDA or the Department of Health about their particular case and make sure that we are mitigating that risk of transmission of infectious disease.
Speaker: So um and to get all of that to say that testing and screening is done on the person who's providing the gametes, right? Whether they're providing eggs or providing sperm, it's not actually done on the semen sample.
Speaker: Mm hmm. very long answer to your simple question there. But no, no, no, no I love it. Because I think, you know, i think of the scenario of a person and you you even mentioned, you know, you'll you will have people that come to you who need to free sperm because they're about to undergo cancer treatment. And I think a lot of people, I know for me, it was like, okay, you go like freezing sperm is freezing sperm. And, and then that's that, but there's a whole host of questions. And like you said, thought behind a lot of that, can you, I mean, what are people missing whenever say that it is, Hey,
Speaker: you're about to, you have this diagnosis. This is what we need to do. If they're thinking about, you know, future family building, why is something like this so important? If we were, if we're working with someone who calls us up and says, I'm supposed to start chemotherapy in three days, what do I do?
Speaker: Right. um It really depends on a lot of different things, what the plan would be. Sometimes it depends on what their cancer treatment plan is. Sometimes it depends on their family building plan. Sometimes it depends on their age or their medical history. whole We really need to think holistically about the person, right? It is not just as simple as, okay, come today and free sperm. Sometimes it is that simple and we always hope that it's that simple. But what we do, and I think this is something that we've put a tremendous amount of effort into here at this practice, is we want people to feel like
Speaker: we're helping in this process, not that we're just blindly doing whatever they call and ask about, right? Because especially in a case like this, they've probably never considered fertility treatments, sperm freezing, anything about this and now have been given maybe the worst news they've ever received. And everything's a rush and everything costs some money and every like, there's just so many layers to this. So that conversation, usually what we're trying to find out is what's the treatment timeline?
Speaker: Do we have three days? Do we have three weeks? Like what what are we working with here in terms of the timeline? um Do they have kids already? Do they have a partner that they is their family building partner? right We'd love to know sort of what what we're working with.
Speaker: And we also want to know what are they who's the intended recipient of this sperm in the future? And that gets back to that regulatory question we were talking about before.
Speaker: If the intent is that this sperm would be used with a partner who can carry a pregnancy in the future, it is quite simple. They come in, freeze sperm, and we either get records of infectious disease testing that was done recently, or we do it, right? Pretty simple. And we try to fit in one to four appointments for fertility preservation prior to their treatment starting if feasible.
Speaker: Sometimes we only have time for one, right? Maybe treatment starting tomorrow and we can do one. And that's you know that's what we work with. And that goes back again to that, the beauty of IVF of not needing that many sperm in the future, right? There are labs that have protocols for partially thawing a vial if there's a really limited amount of sperm available, things like that. So really this thinking about the patient as a whole person and sort of what their overall goal is, is critical at this stage, but also when you go to actually use the sperm in the future, because it may be right a very limited resource. But at that same time, we want to find out, is does this person know that they are going to work with a gestational surrogate in the future? Maybe they
Speaker: need to free sperm and they only have male partners. Well, certainly they need to work with a gestational surrogate in the future. So let's do that testing and screening, meet the FDA requirements, meet the Department of Health requirements right now, not have them ever have to worry about it in the future. And then they go have their treatment, recover and build their family.
Speaker: Right. And that's what we would, you know, it's really important to me that we've are able to counsel and, you know, really discuss these things in a way that is effective and considerate of the overall plan.
Speaker: We'll get right back to the show, but real quick, if you're dreaming of growing your family through egg donation or surrogacy, we'd love to help. At egg donor and surrogate solutions, we've spent 18 years guiding hopeful parents with compassion expertise, and personal experience.
Speaker: Our team includes people who have been intended parents, surrogates, egg donors, and even nurses. So when we say we understand, we truly do. You can schedule a free 15 minute call with our team at create a happy family.com to get your questions answered and explore your next steps.
Speaker: You don't have to navigate this journey alone. We're here to walk it with you. All right, let's get back to the show. I worked at a really large IVF program. Really, really reputable, wonderful program for many, many years before starting this practice. And one of maybe some of the best work I ever got to do was I got to formalize the fertility preservation program there. This was like in 2011, 2012. And back then we would do an egg freezing case here and there because the patient was having cancer treatment soon. But a patient who's seeking fertility preservation for a medical indication, is so different from a patient who has been experiencing infertility and now is seeking fertility treatment. They haven't had time to look this up. They haven't had time to think about this. They're often young. They often really have not contemplated their future family building. So what I did in that role now almost 15 years ago was build patient education materials, build a workflow that works for these patients that were considerate of the timeline And we're providing the amount of medical information they need now to decide how to make this decision. You don't need to decide how many kids you're having. You don't need to decide what fertility treatment you're doing 10 years from now. You need to decide, like does this feel aligned with my overall goal? Does this give me the flexibility that I'm looking for in the future? And we've, you know, I've kind of carried that on to what we do here.
Speaker: and you know, often this is the case, and I think maybe the the media has sort of shown this too, that sperm has become like a pretty hot topic lately. We're just on like a 15 year delay from, you know, fertility preservation for um egg providers. Now we're you talking a lot more about it with sperm providers. So just, you know, we're getting around to it.
Speaker: I love that. Well, and again, i mean, Yes, you're so right. Because I do think when you hear fertility preservation, i think a lot of people automatically, yes, they think they think about the woman they think about, you know, oh, the biological clock is ticking. And, you know, and like you said, it it is.
Speaker: it's a different approach for, for each, but I love the fact that it could be, yes, a medical diagnosis that is having you, you know, is the catalyst for you to go forward with sperm freezing, or it could be, I'm 35 and i don't know. think it could be a while before I'm ready. Yeah. Yeah. Yeah. And there are more and more data coming out that the impacts of advanced paternal age seem to start a little younger than we historically thought they did. Now, maybe not as early as this sort of 35 number that has always existed for egg providers, but probably it's around 45 instead of around 55 that maybe 20 years ago we would have thought that was more like it. Now, are men always going to be creating sperm? Yes. Right. You hear these cases of, you know,
Speaker: high profile people who have a baby at 80 years old. Sure. Yes, sure. That does exist. Are those sperm the same as if they had that baby at 35 years old? No, they're not. They're not the same. They're probably not are not as many. The volume of the sample is probably lower. The motility is probably lower.
Speaker: We don't know that for any one individual case, but if we look, you know, across the population, that's, those are sort of the trends that we see. Yeah, yeah. And again, i love this, this thought, this holistic thought that you are having about each of these individuals in terms of, you know, you may not know what your partnership is going to look like in the future or what your family building goals are. And so, yes, you, you know, if you are potentially, you know, you've only had male partners and you will need a gestational carrier, you do have to have that FDA testing at the time because you can't do it later when you decide. Well, let's, you know, really understand what
Speaker: what the requirements are. And that's where like, we feel really privileged to be able to do this work. I talk about that all the time, like that people will let us into this part of their lives continues to feel like a privilege even 20 years into doing it.
Speaker: And i think I can always get to that no matter how many emails are coming in, I can always get back to wow, these people trust us to do this. And we really want to do it in a way that is aligned with the regulations, of course, is a reasonable way to run a practice that the staff are well, you know, well-trained, well-taken care of, that they're on board, and that we're thinking about every single patient and what their plan is. And I think, you know, our practice has been open about three years i think we've proven that principle. Like it can be done that way. And that's such an exciting, cool thing to be able to do. um I don't spend a tremendous amount of time thinking about how cool it is, but when I do, I'm like, oh, look at that. Like,
Speaker: This works, right? And it's really well received by the patients. And all of these things are a new language for the patients to be learning. You know, almost always our patients are calling us and they don't really even know what type of appointment to ask for. and That's not their, that's no one's fault. That is just like, there is no way to have learned this language. One thing that um you have already kind of touched on in some of your you know examples is this idea of sperm donation because, you know and and that may be, you know,
Speaker: many people might encounter a lineage because they're interested in but donor sperm, whether that be directed or you know, or maybe you're thinking about a kind of the word sperm bank. And I know whenever I hear the words sperm bank, I definitely have kind of this thought in my head. What do you think people get wrong about this idea of a sperm bank and like what a lineage actually does?
Speaker: Sure. So um I'm going to, again, like try to paint a picture of like, you know, categories here, because I think that's yeah the easiest way to think about it. So within sperm donation, there historically was anonymous sperm donation. right now that has been renamed as non-identified sperm donation. But the idea being that you don't know the person who's being the donor. And now there's often um identity release, right? So information for a child at the point that they turn 18, that they might be able to seek out information about the donor, whether they are, whether that's very actionable is I think
Speaker: hard to determine because maybe it's old information, maybe who knows, right? What that, what that looks like. But for many patients still today, working with a commercial sperm bank is their choice of finding a sperm donor that they go on the website, they read profiles, they kind of can narrow it down based on characteristics or components of the profile that are interesting to them. They can choose those vials and send them to their clinic and work with those. um Those donors have gone through the FDA, the Department of Health testing and screening, they've gone through a quarantine period, all before the vials become available. um
Speaker: There's been a lot of conversation and sort of movement in the sperm donation field over the last several years of a movement toward more transparency, toward knowing the sperm donor at the time of donation. And we always have seen friend and family sperm donors. Maybe it's a same-sex female couple and one person's providing the eggs and the other person's brother is the sperm donor, something like that. That's existed for as long as, you know, people have been doing this type of work, right? But what we're seeing now is a large increase in what I call facilitated known donation. I'm not sure anyone else has come up with that term, but I've i've made it up. And I think it i think it describes what we're explaining here, that there are agencies and programs that are recruiting individuals interested in being sperm donors and matching them with recipients who are looking for a sperm donor.
Speaker: And every program has a slightly different model. But what this allows for is really the recipient and the donor to build the level of relationship that they want to build. It allows them to know each other.
Speaker: Some of them we hear are, you know, having weekly meetings with each other, weekly get-togethers. Some of them are having a little bit more of a professional relationship as they go through this. but it allows for um more information for the family, for the future child to have access to the donor. And um one of the beauties of a lot of these programs is there's really pretty tight control on the number of families that will be built from any one particular donor. Maybe it's three families, maybe it's six families. whatever the number might be, but that's much more knowable because these people do all know each other. It's what the donors are seeking out, which is really, really nice.
Speaker: And it's what the recipients are seeking out. So there's this like collective um interest in the same process. And we see that the donors who are participating in these facilitated known donations, they they take it very seriously and they're very responsible to the process and they're very engaged in the process. Like they they wanted to do this and they wanted to do it in this way where they get to have a personal relationship with the recipients, with the future children. um Now there aren't,
Speaker: generations of data on what those relationships look like in the future. That's one of the limitations, but there are limitations to every treatment modality that we've ever had. right And I think we're seeing a lot of excitement from recipients who go down this path, that they really feel like this is aligned with their you know what they envisioned for being able to build their family. So it's been really exciting to see that. So I sort of think of it as like,
Speaker: three categories, right? That you're working with a commercial sperm bank, that you might work with a friend or a family member, or that there's facilitated known donation. And that's really the bulk of the work that we do here is, you know, this directed sperm donation.
Speaker: Yeah. what What would you say are maybe, and again, i just i I love that so much. One, because I mean, it basically sounds like the sperm version of what we do in our egg donor program or what you know one of the things that we offer in our egg donor program. And I love just this idea of...
Speaker: all parties being just aware at least of everybody. Because again, yeah when I, when I think sperm bank, I do think of the commercial it's,
Speaker: somebody on a profile and you don't necessarily know how many families are are out there or things like that. it It's sort of like an Amazon shopping experience, right? Like it's a very different experience.
Speaker: Yeah. Sure. Sure. And not one good or bad over the other, just a different route. What would you say are maybe some of the just...
Speaker: important things that intended parents should think about or maybe just something that they should understand before they're choosing maybe one path over the other? So I think it's interesting and I, I,
Speaker: joke with patients all the time about this. So like friend and family, that's the easiest to rule in or out. Either you're going to come to us and say, this is how we're building our family. We can consider, we can contemplate nothing else. Or I want nothing to do with my family member being my sperm donor, right? Like people are either all in or all out on that.
Speaker: and um And I think that that makes sense, right? Like this is a very specific relationship that you would be introducing into the existing dynamic. And for some people that feels exactly like what they're looking for. And other people are like, I don't even know how I would like go about doing that. Like that's not for sure, right? Then the, you know, commercials firm bank model,
Speaker: for many years was all that existed for decades, right? That was kind of all that existed. And for many, many people, that was how they built their families and they have wonderful children from it. Are there, of course, reports coming out now that there are many, many children from particular sperm donors or, you know, that we don't necessarily know?
Speaker: Yes, that is the case. um For a lot of people now seeking sperm donation, that does not feel aligned with what they're looking for. For other people, they're still very comfortable with it and it's a very appropriate way to build their family. um But what we're seeing with, you know, kind of seeking facilitated known donation is that they do get a lot of autonomy and it's it's a match thing like surrogacy, like egg donation, right? That what level of relationship you want is one of the layers to that match, right? Do you want to talk to the donor every week? Or do you want to be able to reach out to him when your child starts to ask about his family? do you want to be able to reach out to him and send him a holiday card? You know, that kind of thing. um But one of the things that is meaningfully different, I would say, is for directed donation, so either friend or family or facilitated donation, um
Speaker: It is within the regulations to be able to work with a donor who is ineligible per the that all of that testing and screening that we talked about earlier. So the donors who donate through a commercial sperm bank must be eligible after you do all of that testing and screening.
Speaker: If they go back to our example of like we grew up in France, though somebody who grew up in France cannot be a donor through a commercial sperm bank. but they could be a donor through an agency that facilitates known donations because the recipients can be notified, counseled, and consented about this cause for ineligibility.
Speaker: So what we see is that there is a newly tapped into pool of prospective donors who would not have met criteria to be donors at a commercial sperm bank that now can be. So men who have male partners are not able to be anonymous sperm donors or non-identified sperm donors, but they can be known sperm donors.
Speaker: The um geographic risk of mad cow disease from living in Europe. Some of these things are super common. They are not things that we consider to be safety risks. We're doing multiple sets of infectious disease testing. We're doing genetic testing. We're doing toxicology testing. We're doing all these things to make sure that at the time that the person provides the sperm, that everything is good to go. um So we see that there's like a a new kind of novel patient population who are available as sperm donors.
Speaker: That is so cool because again, it's, i mean, going back to you know I think wait what you were saying earlier and you know what a lineage is so known for is just that idea of you're looking at that patient as a whole. You're looking at that situation as a whole. And yes, there are guidelines and you know all of those those checkboxes that are just as important. But like you said, if you're educating the person and if you are counseling them, then they have
Speaker: autonomy and they're able to make the decisions that make sense for their family. And there are certainly, you know, certain donors with whatever, you know, specific medical history that one recipient might feel really comfortable moving forward with. And one recipient may not feel comfortable moving forward with. And that's completely fine. And that is the point of these agencies. That's the point of us doing this work in the way that we do it is that, you know, i joke with the patients all the time, like,
Speaker: There are a lot of right answers to the same questions. Ask two doctors, get three answers. Like you're, there are just a lot of ways to do this that are good and correct and work for somebody, but may not work for you or may work for your sister and not for you. And we want we want people to have kind of the full breadth of these options available to them. So we feel really lucky to be able to provide that to people and help you know work with work with some of these programs and these agencies that are doing more of that work too, because you know as
Speaker: The regulations are very similar for egg donation and sperm donation, but they're not identical. And so we, you know, we get to work with our peers in the field. We get to work with patients, with clinics to make sure that we're all moving in the same direction, you know, getting people to the goal that they are striving for.
Speaker: Yeah, no, I love that because I mean, again, right? Like anytime anybody is going on a family building journey, you are not operating with any of these you know people in isolation, right? And there is something to be said for you know a lineage being part of that care team and all of these providers working you know together. Can you kind of dive in a little bit more into like, what does that actually look like in practice for you?
Speaker: Yeah, so we, you know, we get patients at different stages of this, right? Sometimes we're the first call. and No one's ever sought out fertility treatment, fertility information before. I love when that is the case because we get to like start from scratch and go through the vocabulary and all the different paths to parenthood. I know that's like such a saying, but there are so many paths. Yeah,
Speaker: help point people to practices, help point people to lawyers, to psychologists, to agencies, to all of these other professionals in our field. um But it starts with like, what is the family building goal? Do you want to have four kids? Do you both partners want to get pregnant? Are you working with a surrogate? you already know who the surrogate is? Like there any number of possible answers of where are we starting? And then we figure out what options exist. But also we frequently work with fertility practices that, you know, they're
Speaker: talking to ah maybe a recipient couple, intended parent couple, who knows that they are working with a family sperm donor. So kate the group will come to us, we'll do all of this testing and screening, we'll coordinate the care with the team. Okay, they're doing IVF yeah or they're using frozen eggs,
Speaker: or they want to do IUI and the semen parameters aren't perfect. So we're going to use two vials of sperm with every iui We need very different numbers of donations, numbers of vials of sperm, like all of these things play into what the goal is and what the test results are play into how do we plan out the donation visits? How do we plan out how we're preparing the samples, those kinds of things. Um, so we love to, you know, I came, as like I said, I came from a large practice. I was a patient coordinator as one of like my first jobs in this field. And I still love the fact that I got to do that. I think it really informs how I think about
Speaker: this stuff even today because making that calendar and thinking about the timeline and working back from oh you're doing a testy procedure on this day let's work backwards from that to figure out what else we have to do um i think that really is fundamental to how we approach this and it has been you know I'm very proud to say, like well received by the clinics that were able to be a complimentary service to what they're doing, allow them to really focus on the stimulation, on the pieces of it that they're doing in house and you know utilize us for this piece that we are specializing in and it's it's been really like very effective. What I thought was possible is possible, which is always a yeah always a good outcome. um But I think it really, that that feeling of doing it in a connected way is palpable to the patients. And I think that that's something that, um
Speaker: you know, maybe puts it over the edge of it being useful, you know, and our patients being happy with this. And, you know as you know, the fertility world is quite small, right? So we're probably one degree of separation from any provider that you're working with. Yeah. we can call them up and say, this is what we saw on the semen parameters. This is what we saw today.
Speaker: what do you want us to tomorrow? Right. And we're iterating in the midst of, know, the process, which is such the nature of IVF. And I think those of us who've worked in this field a long time love that. I love that gray area piece of it that like we might have made a plan for three months, but today's result tells us we should do something a little bit differently two days from now. And maybe that isn't for everyone. But for me, I really love that like ability to do that and to educate the patient and counsel the patient and make sure they're on board with how we how we do think we should move forward. um So it it really does feel like a privilege to be allowed to do this type of thing.
Speaker: 100%. is such a collaborative field. I use the phrase, you know, the team that you build on your your path to parenthood or as you're helping someone create their family, you have to have a team around you. and But that team has to collaborate with each other to provide, like you said, education and accepts.
Speaker: you know We've referenced it with matching with a sperm donor or matching with a surrogate, but that match matters. right I often talk about with surrogacy with our patients, like if you want to text a surrogate every day, you want a surrogate who wants to text you every day.
Speaker: And vice versa, right? And that isn't that any one of you are wanting something that's incorrect. You just need a good match. And the same thing happens with providers, right? You need a practice that you can feel like you can communicate with them in the way that works for you and that they can communicate with you in a way that works for their process and their program. And i think all of those things matter, right? If it doesn't feel quite right,
Speaker: Reconsider, you know, think, have a consultation somewhere else, talk to somebody, see, you know, if you really love this one provider, they probably then have a team of everybody else that they love working with. Right. And that is often the quickest way and simplest way to build your team is like, Oh, I, I feel really connected to my REI, or I feel really connected to my reproductive attorney.
Speaker: Ask them. They're going to know, they're going to feel like, Oh yeah, this person's going be able to do that part for you. This person is going to be able to do that part for you. And we all know how to work together already. You're not recreating that. And yeah that, you know, can feel, make the whole thing feel a little bit easier, right? um It's a massive dedication of time and money and energy to pursue fertility treatment, to pursue family building through assisted reproductive technology. And that shouldn't be lost in this, right? Like we we want to be really conscious of that.
Speaker: Even like as a silly example, often we'll schedule a directed sperm donor for three visits over the course of one week so that we get, you know, kind of a nice number of vials that the recipient can work with in the future. But if this recipient knows that they're doing one IVF cycle and thawing their frozen eggs, they probably don't need that many visits. Now, from a business perspective, could I say, well, we scheduled three appointments, let's do three appointments. We're not going to do that. We're going to say,
Speaker: you have now eight vials of frozen sperm. Even if you are end up doing more IVF than you initially hope to, you still have tons of flexibility. i don't think he needs that third visit or I don't, you know, and We want patients to make the decision that feels good for them.
Speaker: That being said, often lot of effort that goes into getting the donor in the door, don't shortchange yourself, right? Sure. want you to have more flexibility. We don't want the sperm to be the limiting factor in your decision-making down the line. So we yes, we encourage people to err on the side of caution, have more vials than you think you hope to need, but you know, you don't need a million vials. You're not doing a million IVF cycles. Like that's just right ultimately the case. So, hey um so I think it, it matters how we think about it. And we don't function as like a reference laboratory. That's just going to do the thing on the piece of paper without talking to you and without incorporating it into the overall plan.
Speaker: Right. Right. And again, i love that. I love that you, you are asking the questions. You want to get a full understanding of the goals and where are we? And, you know, just like you said, and we keep saying it, but just that holistic idea of the person that you're working with.
Speaker: Yeah. Yeah. um You know, everybody's, everybody's little different. And yet there are so many parallels to our learned experiences and it crosses across geographies and religions and ages and life histories that a lot of people want to be parents. And there's going to be a way to be a parent. It may not look exactly like what you imagined upfront. Things may not go exactly as you planned, but if you have that care team that you trust,
Speaker: there's a way to get there and they will help you get there. And we, you know, I, I think every Instagram post I've ever made is like, what a privilege to do. And like, it is, it really feels like that. And I think try to work with people who feel like that, because that's that it works.
Speaker: For, for someone listening who, you know, they, they know they want to build their family, but they don't know where to start. What would you tell them? So, I mean, we actually offer a service for this. The website is like, I'm not sure where to start.
Speaker: Let's do a consultation. So let's do a service that they can you know meet with us in person or virtually. And we'll go we'll have this conversation and we'll make the referrals and we'll make the recommendations. And we may they may leave with more questions than they started with, but at least a framework of where to go, what to look into, what to think about. as they're making new decisions. um But the other piece of it is i wouldn't spend 100 years Googling and on Reddit and all the things. Are those dumb things helpful feel sometimes? Yes, they're sometimes helpful. Not sure what the definition of this is? Look it up, right? That's always helpful.
Speaker: but And actually, we heard recently that lots of our directed donor patients are finding us from a Reddit thread. So we're pro-Reddit at the moment. But that's great that being said, that is not the you know the fundamental data source that anybody should be relying on, right? So you know i think doing a semen analysis, if that's relevant for your case, if it's doing an AMH test or doing a antral follicle count, like get some baseline information. And that way you can feel like everything's kind of looking okay. And this is my overall plan. And that seems reasonable, or I should really think about taking some action sooner rather than later and how, what action is that?
Speaker: Right. But we're happy to meet with people. They do not need to be in New York. They don't have to, you know, it's not something that is geographically restricted in any way. It's really, we want to educate, we want to help people do this. um And I think it often is a very useful way to learn some of the terminology, learn some of the options, and then go and figure out, you know, which exact path feels right.
Speaker: After working with patients and families in on all of their different paths to parenthood from just even before a lineage, a lineage what have these experiences taught you about family building?
Speaker: Oh my gosh. um What a sweet question. I think there are cases parents the first year I did this work that I can picture the patient. I can remember their name. I can remember everything about them. um there are probably also phone calls I had yesterday that I don't know what happened on them, but sure there are, you know, I think there's, I, I maybe referenced it a moment ago, but there's this universality to it. And I think in New York, we get a really beautiful glimpse of this, of people,
Speaker: traveling from all over the world, people from every background, from every part of our community with a shared goal of being a parent and of building a family. And you look around the waiting room at a large fertility center in New York, and you're going to find multiple languages, multiple religions, multiple ages, multiple family structures, all represented in one room waiting for their blood to be drawn and their ultrasound to be done and all of that. And I think it's really like, it reminds you of how
Speaker: base how much of a base human goal this is for so many people. And the idea, you know, it isn't for everyone. you know, being a parent is not for everyone. And it doesn't need to be. It needs to be for the people who want it. um But there is there is a path to getting there. And as I said earlier, it may not look exactly like what you imagined when you were 17, but sure there's a way to get there. And it's really...
Speaker: it really is like, can still give me goosebumps to think about like what we've been able to do. And every now and then on the street, you see somebody who was our patient 15 years ago and like, we help make that baby, right? We get baby pictures, all those things. It's so silly, but it really like, it matters so much. I joke with the patients whenever they leave, I'm like, you're, you're done with us until you send us a baby picture. Like that's actually, we would like you to do that. Um, because it is like, it it's is such a unique position that we're so intimately involved in this. And then we like send them on their way and hope, cross our fingers, hope it works. Right. I had a a physician colleague, um, at my old, um
Speaker: in my old role who said, you know, it's one of the only types of medicine where the doctor says, good luck, you know, at the end of the procedure, right? sure just It's inherent to the work that we do here is that we are, you know, we can do all the things we can do all the testing, be very elaborate, and they're still going to transfer an embryo and we hope it implants.
Speaker: And, you know, that is just, you know, very unique to this type of work. um And I think that shouldn't be lost on us. It shouldn't be lost on the patients that like, that is as a special type of medicine and a special type of relationship that we all get to have.
Speaker: Yeah. Yeah, for sure. For sure. And you're so right. It is. It's so... I feel like it is one of those, the novelty doesn't wear off.
Speaker: It is still every time someone is like, okay, my transfers today. i mean, i could not be more excited or whenever you're waiting for that, you know, pregnancy test or just, I mean, the novelty never wears off.
Speaker: But also just like how, you know, new the field is in total, right? That like the oldest people born from IVF are in their forties and,
Speaker: This is, you know, in the grand scheme of types of medicine, this is all very new. And what we know today compared to what we knew five years ago is different. What we told people five years ago is different. And that pace of, you know, the information changing, the data, more and more data becoming available, um i think is...
Speaker: something that maybe keeps a lot of us in the field, right? We love that part of it and it is always different. And what a family looks like is different than it was 20 years ago. And all of these things that like, make it, yes, we're doing the same work, but it isn't really the same. But I think it does add to the challenge for patients because they are getting told one thing today and then they go back for baby number two, three years later and they're getting told something else. And like, yeah How can that be the case?
Speaker: But it is. And that's where like back to sort of the beginning of all of this, the relationship you can build with the patient, the education, the counseling, that is matters so much because we they have to trust us in a way that they probably never wanted to trust anybody.
Speaker: And that's, you know, that's really what it comes down to. Yeah, yeah, you're not wrong. And again, right? Like not only do the do the patients have to trust us, but again, that collaboration as a team where everybody is on the same page and there is that understanding of what changes or, you know, are we doing here or what are the circumstances that are different or right? Like you said, the medical advancements or, you know, just things like that. Yeah, it' absolutely.
Speaker: It really feels like, um, ah now I'm a broken record, but it really feels like a privilege that we get to do this. And um I am happy to continue it on. I hope we can be more and more accessible to patients that we can serve, you know, as time goes on. And as we continue to build this practice, um we're certainly seeing that a lot more people are interested in directed sperm donation, a lot more people are seeking gestational surrogacy to build their families. um And, you know, we feel like we fill a nice little gap in that and can be really an asset for for our patients as they go through these, you know, sometimes complicated journeys. You know, I could
Speaker: I could belabor all of this all day, but, you know, I think often, especially with directed sperm donation patients, you know, five years ago, if you called a fertility center and said, oh, I want to use my friend as a sperm donor, like someone might grumble at you on the phone and say, it's complicated. And that was about the amount of information that people would convey. And we get those phone calls and I'm like, okay, great.
Speaker: but this is how it works. And that's really how it is, right? And we're we're still a really small practice. like Often I'm the one answering the phone. I guess I won't get to do that for my entire career, but i do love doing it because we get to start building that relationship from minute one. And that's pretty fun.
Speaker: Yeah. Well, again, that should be the experience in this. It should be a, you know, hi, this is what I want to do. And great, here's the education. let's let's go Let's go from there. And I think that is something that is, i know, something that we are passionate about at Aged, Owner, and Surrogate Solutions. And then obviously you are passionate about, because this is such an individual experience.
Speaker: Yes, it's an industry, but it is an individual experience. Well, Justine, again, thank you so much. It has been such a Just you are a wealth of information and knowledge, and I am so grateful for your time and everything that you're doing in the industry. I have one last question for you. Sure. It's a fun one.
Speaker: um So for anyone who knows me, they know that coffee and i are never far from one another. um And so with cup in hand, always, I love to ask the question, what has filled your cup lately, literally or figuratively?
Speaker: Oh, well, I think I'll give you a couple of answers. How about that? um Professionally, as I mentioned earlier, we love getting baby pictures. And as a practice, you know, as a relatively new practice that, you know, it takes time before that starts. So we love that that is happening. We have some young staff members here who started over the last six months that are amazing. And I was trying to explain this to someone the other day, like it isn't, I can't say it's a dream because I could not have actually dreamt it to be this good and how lucky we are, how lucky our patients are, hopefully how lucky the future of our field is that we have these young people like really getting engaged in it. Um, and then as you and I were discussing the next one, uh,
Speaker: championship this week. and the New York City is just a love fest of pride in our our city, in our sports and all of those things. So, I love it. I'll give you three things. I guess I need three coffee cups here, but um I condone that. oh Sometimes I have that actually sitting here. so oh, absolutely. Absolutely. Yes. Yes. I love that so much. Thank you so much for having me. It's been really a pleasure and you're so kind to invite me and to facilitate the conversation. so thank you.
Speaker: Yeah, absolutely. No, thank you. um Really, this is just, everything that you're doing is just so amazing. and And I could not be more grateful for just your passion and love for just everything, the industry as a whole, and then just everything that you do within it. So really, thank you. so so very
