Dr. Samuel Pang is the medical director of the Third Party Reproduction Team at Reproductive Science Center of New England, one of the first clinics in New England to offer IVF to lesbian and gay male couples. Dr. Pang is responsible for the medical management of all IVF cycles involving Egg Donation and Gestational Surrogacy, as well as Reciprocal IVF cycles for lesbian couples.
Note: Part 1 of our interview deals with commonly asked questions about the IVF process for gay male couples and the gay surrogacy process. In Part 2 of our interview, Dr. Pang discusses Lesbian IVF.
You were one of the first doctors to help gay couples have a biological child through gestational surrogacy. Can you talk a little about that experience?
I believe that I was the first IVF doctor to treat a male couple on the East Coast – definitely in New England; however, I am aware that there were other doctors in California who had started treating gay male couples maybe 2 or 3 years before I did, so I may have not been the first in the country.
How did Third Party Reproduction for gay couples first come about?
I was first approached in 1998 by a gay male couple who wanted to conceive children through IVF. They had been to other IVF programs and none of the other programs would consider treating them, probably because it was not something they had done before. When the couple approached us, we said, ‘sure’ and so we started performing the procedure in 1998.
The numbers of gay male couples seeking services with egg donation and gestational surrogacy with IVF started increasing after an important Massachusetts Supreme Judicial Court (SJC) ruling in 2001 and after marriage equality became available in Massachusetts in 2004.
The 2001 SJC ruling established a differentiation between traditional surrogacy and gestational surrogacy. Up until then, most gay male couples who were conceiving biological children were conceiving through what’s known as “traditional surrogacy,” where their sperm would be inseminated into a surrogate, the surrogate would get pregnant and give birth, and then give the baby up for adoption, and then the intended fathers would adopt the baby. However, in a traditional surrogacy situation, if the surrogate changed her mind, she could keep the baby because the baby is biologically half hers, any contract notwithstanding, the courts would side with her.
The SJC ruling distinguished between traditional surrogacy and gestational surrogacy, and said that in a situation where there’s gestational surrogacy and the surrogate is not genetically related to the child, the surrogate would have no legal basis for changing her mind and keeping the baby. And with that ruling, the gay male couples who had previously been using traditional surrogacy decided that that was no longer a safe way to do it, so they turned to gestational surrogacy. I believe that was what changed the trend.
In 2004, when same-sex couples were becoming legally married, having children in their family was something that many wanted. That’s one of several impetuses for the increase in male couples seeking our services. We also saw an increase in female couples as well.
What services do you provide for gay and lesbian couples?
We provide the full spectrum of assisted reproductive services – so for female couples who want to perform insemination we will perform donor sperm insemination, and then there are a minority of female couples who have decided that they want to do IVF, in a process that I have come to call reciprocal IVF.
Editor’s Note: See Part 2 of our interview for more on Reciprical IVF for lesbian couples.
To your knowledge, is IVF for gay couples widely available now?
I wouldn’t say that it is generally or widely available. However I wouldn’t say that I’m the only practice. There are other practices out there who will treat gay couples or lesbian couples. However, especially with surrogacy, Massachusetts is one of the safest places to do surrogacy compared to other states because of surrogacy laws in those states. I always counsel people that they really have to be careful about where their surrogate lives and where they are going to deliver the baby because it can become a bit of a nightmare if the laws of the state are not friendly to surrogacy and they could have a hard time getting their baby.
Editor’s Note: Unlike Massachusetts, surrogacy is prohibited in New York. That means that a carrier must reside in a state where commercial surrogacy is not prohibited. This map is a good summary of Surrogacy Laws by State.
Do you recommend that the gestational surrogate, egg donor, and father(s) be in the same state?
It’s not necessary for all the components to be in the same state – egg donors can be from anywhere in the U.S. for example, but I think it’s more important where the surrogate lives and delivers the baby. We require that there are legal contracts both with the egg donor and the surrogate and that the intended parents have adequate and proper counseling with attorneys who specialize in this area of law. And that’s really, really important, because whether or not they get their baby depends on the proper legal paperwork and contracts that are done ahead of time. So we always counsel people that they need to see an attorney and make sure the contracts and paperwork are lined up before they proceed. We definitely recommend that they do not use, you know, “Uncle Bill who does real estate law” for these contracts, because Uncle Bill really doesn’t know anything about this area of law – it’s highly specialized.
When you counsel gay couples interested in IVF, what is the first step?
When I meet with gay couples, I tell them about the processes that we do here, I tell them that they need to have an egg donor and a surrogate, I tell them about the cost of the medical processes, and then I tell them that before they embark on this journey they need to have legal counsel from a professional who knows exactly what the legal steps are, what the implications are and that they have contracts with their egg donor and surrogate. Once all of those legal contracts are in place, then they come back to us and we will perform the medical, scientific and technical aspects of the IVF process.
Are there age restrictions for gestational surrogacy or egg donation?
Our general clinic policy is that people over the age of 50 are discouraged from doing IVF.
How is the IVF experience different for gay couples?
I think the biggest difference is that there may be some states where surrogacy is okay for straight couples, but not for gay couples. Again, I’m not a lawyer, but it’s a possible scenario.
Do you provide counseling or resources for gay couples after the baby is born?
We provide psychosocial counseling for couples who use donor eggs or gestational surrogates, gay or straight. We provide counseling ahead of time and during the process, but generally we do not provide counseling after. As far as breastfeeding is concerned, it’s something the intended parents can negotiate in their surrogate contract – the surrogate is willing to pump and provide breast milk. Some surrogates will do it and some will not , so that’s all part of the contract they negotiate ahead of time. I’m aware of people who have agreed to pump for a month or six weeks or three months, depending on what is agreed upon in the contract.
I’ve heard gay male couples can mix their sperm to have a chance at fathering two babies. Is this true?
Yes, it is possible to mix sperm from both intended fathers, but it is not something that we do. Typically what we do is inseminate half the eggs with sperm from one partner and the other half of the eggs with sperm from the other partner, so that we have embryos created from both men in separate cohorts. There are some couples who will choose to transfer embryos from both cohorts and others choose to transfer one embryo from one cohort and freeze the other cohort, so there are many different ways to do that. So yes, they can use sperm from both of the men. Generally we don’t mix the sperm; we keep it separate so that we can document which embryos come from which man.
Then, if you transfer one embryo from each of the two groups, and both of the embryos implant, you could have twins, one from each partner. But it doesn’t always result that way.
One of the most common strategies used here is to transfer two embryos as I just described. When we transfer two embryos, about half of the time only one of the two implants, and so the couple will have one baby. After the birth determine which is the genetic father with paternity testing. At birth, at least in Massachusetts, the courts require paternity testing be done so that the genetic father can be identified on the birth certificate. So the genetic father is identified and the couple can come back to try for a second baby, and at that time they can choose to transfer embryos created from the other man’s sperm. That’s typically the most common strategy, although it is not the only strategy, of course.
How long do you store frozen embryos?
We store the frozen embryos on site, for up to 5 years. Most people will come back within 2 to 3 years to use them.
How many embryos do you transfer per cycle?
We offer a choice to transfer either one or two embryos. It’s their decision whether it’s one or two.
What about cases like Nadya Suleman, where it was reported that many embryos were transferred – Is it common to transfer more than two embryos?
There are certainly physicians out there who I would consider unscrupulous by transferring a high number of embryos. We know that transferring more embryos will increase the likelihood that pregnancy will result, but it will also add the risk of a high order multiple gestation. At our program, we don’t have to transfer a high number of embryos to achieve a good success rate – we get a very good success rate transferring 1 or 2 embryos.
The physician who treated Nadya Suleman in California, transferred 12 embryos, 8 of which implanted to result in 8 babies. He has lost his license to practice medicine for what he did. While that sort of event draws a lot of publicity it certainly is very rare and not something that is done generally.
How many cycles does it take for a gay couple to get pregnant with a surrogate?
The likelihood of pregnancy is most highly correlated with the age of the egg donor. In our gay male couples who are doing a combination of egg donation and gestational surrogacy, the likelihood that they will be successful with their first cycle is a little over 70 percent, and the majority of them will be successful with their second attempt. So in our experience, close to 100 percent of gay male couples will have a successful pregnancy and baby by their second attempt. It’s unusual for them to require a third IVF cycle, although that’s very possible. Now, that’s very different from our general infertility patient, because they have different issues.
Editor’s Note: Because most egg donors and surrogates are offering their services when they are at an optimal age, with no fertility issues, most gay male couples tend to have higher success rates than straight couples being treated for infertility who may be trying to get pregnant with IVF.
Do you have a perspective on Indian Surrogacy for gay couples?
Aside from the fact that the success rates are pretty low, the major issues are legal entanglements. In terms of the success rates, I had patients (a straight couple) who went to India to do egg donation and gestational surrogacy because they thought it would be cheaper but after 4 unsuccessful attempts and spending over $100,000 they came back to the U.S. But to me, I think the most important thing is the legal entanglements because there are different laws in other countries. They can cause difficulties for some intended parents have in getting their babies out of the country.
The most recent case that I heard about was a Canadian gay couple who went to India to do gestational surrogacy with an egg donor there and after the baby was born the Canadian high commission in New Delhi required paternity testing to prove that the baby was genetically related to one of the men before they would issue a passport to the baby. However, when paternity testing was done, it was determined that neither of these two men were genetically the father of this baby, which the clinic claimed was their baby. And so, without that paternity documentation, the Canadian High Commission would not issue a passport to the baby, the intended parents said, gee this is not my baby, the surrogate said, well this is not my baby, so it was a huge mess. So it can become very complicated.
Do you recommend a specific amount that couples save before beginning the process?
For gay male couples, the cost can be very high. Not because of the medical costs, but because of the legal costs, and the compensation to the egg donor and the surrogate. The actual medical costs of the IVF procedure, and the testing here and the cost of the medication runs in the range of $15,000 – $20,000 . But the rest of the cost consists of compensation to the egg donor, surrogate, and lawyers. Those costs can go up to conservatively between $70,000 – $100,000 total. It could be less expensive for people who use a known egg donor and known surrogate. For example, I’ve had couples where one man’s sister provided the eggs, and the other man’s sister carried the pregnancy. In those situations, they saved a lot of money. I had another couple from Texas where they used a good friend as an egg donor and another good friend as a surrogate, and again they saved a lot of money.
Next: In Part 2 of our interview, Dr. Pang discusses Lesbian IVF.
Dr. Pang is subspecialty board-certified in Reproductive Endocrinology and Infertility by the American Board of Obstetrics and Gynecology. He received his medical degree from the University of British Columbia, completed his residency in Obstetrics and Gynecology at the University of Toronto, and his fellowship training in Reproductive Endocrinology and Infertility at the UCLA School of Medicine.
Dr. Pang’s non-professional interests include music and swimming. He sang with the Boston Gay Men’s Chorus for 6 years, until 2002. He swam with Boston LANES, a GLBT master’s swim team, and participated in swimming events at the Gay Games in Amsterdam in 1998 and again in Sydney, Australia, in 2002. He and his husband have two sons through IVF with donor eggs and gestational surrogacy.
The Reproductive Science Center of New England was founded in 1988 and provides comprehensive diagnostic testing, evaluation, consultation and treatment for infertility. RSC New England also specializes in providing assisted reproduction options for the GLT community.