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Michael A. Feinman, MD, FACOG
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Friday, October 09 2015

 

For some patients, gestational surrogacy is an option, if repeat implantation failure is a problem.  This is particularly true if PGD normal embryos have been transferred, and the rest of the evaluation is negative.  I started working with surrogates in 1992.  Until recently, virtually all the agencies I worked with held to standard that surrogacy should only be considered when the intended mother really cannot safely carry a pregnancy to term.   Over the past couple of years, there appears to be a growing trend of women requesting surrogates for weak or non-existing medical reasons.  Some pundits call this “social surrogacy.”

A recent tragic death of a surrogate mother from a rare but well-know pregnancy complication known as abruption of the placenta, underscores the ethical problem with asking women to serve as surrogates for non-medical reasons.  To the family of this unfortunate woman, the reason she was surrogate does not matter right now.  However, for those of us who defend the practice of compensated surrogacy in the United States, it is an important reminder that the practice should only be allowed for legitimate medical purposes.  Dying from a pregnancy-related complication is so rare in the U.S., that many people take it for granted and feel it is acceptable to transfer the risks of pregnancy to another woman.  Somehow, a tragedy like this seems less egregious, if the surrogate mother was doing it for a woman who otherwise could not have a child.

Why the change in social attitude and acceptance of the looser standards?  One possible reason is the recent rise in the popularity of doing surrogacy in less developed countries like India, Nepal, and Mexico.  Most of these programs have a “no questions asked” policy, and financial reward for the surrogates is an important incentive.  Also, we have seen an increase in wealthy women from certain countries that can easily carry a baby, but see gestational surrogacy as a way to obtain a U.S. passport for their child.  Finally, there are some misconceptions about medical facts.  For instance, many women in their late reproductive years forties erroneously think that surrogates have a better chance for success than they do.  Ironically, many of these women are only in their late thirties or early forties, and we still work with healthy surrogate mothers in this age range!  

Critics of compensated surrogacy will point to the financial benefits as an inducement for women to take this risk.  In my experience, this may be true in poor countries.  However, in the U.S., the agencies I work with do not accept indigent women, and the compensation to these wonderful women, when amortized over the whole pregnancy amounts to less than minimum wage.

In conclusion, while the serious risks of pregnancy in the U.S. are small, they do exist.  The recent tragedy is a reminder of this and should make us all reflect on the importance of maintaining a high ethical standard in deciding which patients should benefit from surrogacy.   Along with the more common and less serious complications, combined with the major imposition of a surrogate mother and her family, appropriate compensation still seems reasonable.  However, the financial compensation should not induce women to take these risks.  Intended parents and health care professionals alike should keep these risks in mind when they consider moving forward with gestational surrogacy.

Posted by: Dr. Michael Feinman, MD. AT 02:40 pm   |  Permalink   |  0 Comments  |  Email
Wednesday, October 07 2015


Host: Dr. Michael Feinman, MD.
Ventura Beach Marriott
October 21, 2015
6pm-8pm
If you would like to attend you can register on the website or call
818-788-7288
FREE complimentary consultation voucher when you attend the seminar!
http://www.havingbabies.com/about-…/staff/michael-a-feinman/

Posted by: Dr. Michael Feinman, MD. AT 09:00 am   |  Permalink   |  0 Comments  |  Email
Monday, April 20 2015

Having babies

For over 25 years, our expert doctors have diagnosed and treated patients with the most advanced techniques and technology for a comprehensive range of infertility problems. Our team-created approach to delivering an exceptional patient experience allows us to offer an unparalleled level of fertility care and help couples bring dreams to life.

What makes HRC Fertility Encino the Best Choice for your Treatment?

HRC Encino is staffed with the highly qualified and experienced embryologists that use proprietary techniques for embryo growth development and transfer. Having an on-site, fully-credentialed IVF laboratory with the most advanced technologies provided a more controlled environment for patients and establishes a continuity of care that is beneficial to assisted reproductive technology procedures.

HRC-Encino is also one of very few centres in the United States that has the capability to perform a Day 5 pre-implantation genetic diagnosis (PGD) embryo biopsy and Day 6 fresh embryo transfer. A Day 5 biopsy allows our embryologist and physician to produce and transfer superior quality embryos with a higher chance of implantation and has a higher diagnostic accuracy than the Day 3 PGD biopsy that is performed at many other IVF centers. This unique ability is part of the reason HRC Encino has superior pregnancy success rates over many other fertility clinics.

HRC-Encino is conveniently located near two major freeways with easy access to all of Southern California’s world-famous attractions.  There is a Marriott Residence in within walking distance of the Center.

HRC is proud to report that as a result of these treatments, thousands of babies have been born to happy parents across the United States and around the world.

hrc-vs-sart

Go to: www.havingbabies.com

DOCTOR MICHAEL FEINMAN IS THE MEDICAL DIRECTOR AT HRC-FERTILITY

How long has HRC-Fertility been established and where are you located?

The original HRC was founded in 1988.  The company re-organised and the current partnership began in 1998.  My lab is located in Encino, California, with satellite offices in West Los Angeles and Westlake Village.  We have two other labs and several satellites located all over Southern California.  I have been working with surrogates, including those working with gay men, for over 20 years.

How long have you worked in the field of fertility and what attracted you to this area?

My career path in reproductive endocrinology began at the Albert Einstein College of Medicine in New York in 1986. When choosing my professional path, reproductive endocrinology was a developing field and I thought it would be exciting to be part on the ground floor of a new area of medicine.  Additionally, microsurgery was an important aspect of the field and I enjoyed performing these procedures.  Finally, I knew having children of my own would bring me complete happiness and I wanted to make it possible for others to share in my joy.

Which services do you offer to LGBT couples or individuals wishing to start a family?

We are a full-service practice that offers treatments ranging from donor inseminations to egg donor/surrogacy.  I also have a long experience at helping patients with previous IVF failures.  People can learn more about this at IVFImplantationFailureClinic.com

Many gay couples want to create embryos from both partners and transfer an embryo from each in the hopes of generating a twin pregnancy where each man is a father.  How do you feel about that?

I call this “shared embryo transfer,” and, for emotional and financial reasons, the desire to do it is understandable.  However, people need to be aware of the financial and health risks (to the children and surrogate mother) associated with twins.

What is the role of pre-implantation genetic screening (PGS), especially in egg donation?

With PGS, we can take a small sample of cells from an embryo and determine if it has normal chromosomes.  This is a useful tool to select embryos for single embryo transfer, thus reducing the risks of a multiple birth, which in turn increases the chance of a healthy outcome.

Do intended parents have to travel to the US for an initial consultation?  

No, initial consultations can be done over the phone or through Skype.

To undergo an IVF cycle, how long do patients need to be in Los Angeles?

For women, if they can get early monitoring locally, they are here for just under two weeks.  For men working with surrogates, they need to be here a bit less, it they intend to be present for the embryo transfer.  Sometimes, men will freeze semen here in advance, to alleviate the need to be here for the egg retrieval.

Feinmann (HRC) Image

Why not adoption?

This is an important question, especially when egg and sperm donors are used.  While adoption is an alternative to infertility treatment, the simple fact is adoption may not fulfil the human instinct of creating one’s own offspring.  Further, there are many legal and financial challenges with adoption that can make adoption expensive and difficult.  Potential parents should look at all the options to see what is best for them.

What does HRC-Fertility offer that other centres do not?

The doctors and staff of HRC-Fertility have incomparable experience with “third-party parenting”, and are especially adept at working with patients from abroad.  Personally, I organised one of the first anonymous egg donor programs in New York in 1987.  Having multiple locations in Southern California allows us to monitor donors and surrogates closer to where they live without adding costs.

Do you only perform American surrogacy?

No. While my strong preference is to work with American agencies and surrogates, I also work with a reputable agency that arranges surrogacy in Mexico.  Intended parents create the embryos in our lab and they are shipped to a state-of-the-art clinic in Cancun for ultimate transfer.  Thus, intended parents can work with me, regardless of where the surrogate mother is located.

How can the process be made more efficient?

When egg donors and surrogates are involved, there are occasions when the donor is ready before the surrogate mother.  Intended parents should feel comfortable freezing the embryos, so they can be ready when the surrogate is available.  The difference in success rates between fresh and frozen embryos is small.  Also, some people working with egg donors are interested in having future genetically similar siblings.  In these cases, it is also prudent to have a second cycle and freeze all the embryos for future use.  I call this “Advanced Family Planning”.

On a personal level, what is the greatest satisfaction you derive from your work?

The greatest source of happiness and satisfaction for me has been having a family.  I enjoy sharing  this blessing with other people and helping them have children in a safe and ethical manner.  As I said before, I have been involved with third-party-parenting  for many years, and feel it is important for anyone wanting to be a parent to have all options open to them, without unfair restrictions.   As a result of this experience, my focus has become the pregnancy outcome, not just the success rate.

 

Posted by: Michael Feinman AT 09:00 am   |  Permalink   |  0 Comments  |  Email
Monday, April 13 2015

Join me for a FREE Fertility Educational Seminar at Westlake Village! I would love to meet with you and answer your questions regarding the fertility treatments available to you at HRC. If you would like to attend you can register on the website or call 818.788.7288
Thursday April 30th from 6:30pm - 8pm
Location: Westlake Village

Posted by: Michael Feinman AT 09:00 am   |  Permalink   |  0 Comments  |  Email
Tuesday, April 07 2015

For many years, a common approach to implantation failure was to transfer larger numbers of embryos; regardless of embryo quality.  The result was that after many failed cycles, some women would end up with high-order multiple pregnancies (triplets or higher).  Clearly, this is not a good price to pay for success.

If the presumed cause of implantation failure is the embryos, this approach seems appropriate, although it can backfire.  Transferring more embryos will not overcome uterine or other implantation factors.  With improved diagnostic tools for implantation failure, along with PGS to screen out abnormal embryos, it no longer makes sense to transfer large numbers of embryos, even in the face of repeat IVF failures.

One could argue that once chromosomal abnormalities (aneuploidy) have been ruled out, there is little value to even a second embryo.  Certainly, it is not a good idea to transfer more than 2 at a time when PGS has been performed.  

Posted by: Michael Feinman AT 11:20 am   |  Permalink   |  0 Comments  |  Email
Wednesday, February 11 2015

It is interesting and even amusing to see how certain concepts come full-circle and even flip-flop, over time.  The debate over fresh vs. frozen transfers is one of these.

For the first 20 years of IVF history, it was a general given that fresh embryo transfers were superior to frozen ones.  Early attempts at freezing all the embryos and subsequently transferring them did not go well.  Two theories are used to support this approach.  The first is that freezing embryos would somehow sort out the better ones, as the less viable embryos would like not survive the thaw.  A sort of embryo “stress test.”  The second is that the uterine environment during a stimulated cycle is less conducive to implantation, so delaying the transfer may improve implantation.

Over the past few years, the belief in the superiority of frozen transfers has gained new interest.  A few papers have been published showing improved implantation rates with frozen embryo transfers.  Yet, not all clinics agree that this should be done on everyone.

There are some known variables that affect success rates with fresh and frozen embryos.  First of all, it is clear that embryo survival after freezing/thawing is related to the intrinsic quality of the embryo.  We see a very high survival rate and pregnancy rate with PGD normal embryos.  Secondly, it has been shown that during fresh cycles, subtle rises in progesterone levels prior to the administration of hcg, severely affect implantation rates.  This factor may not be addressed in some of the previously mentioned studies.

Given the above conflicting pieces of evidence, it is fair to say that frozen embryo transfers are probably comparable to fresh.  Frozen transfers should not be viewed as less successful anymore.  I use the Endometrial Receptor Assay (ERA) to see if a frozen transfer is likely to be better.  Although not intended to be used this way, it seems to a helpful guide in individual patient management.  If freezing all the embryos is recommended, the ERA should be strongly considered to help improve the outcome of the subsequent frozen transfers.  

Posted by: Dr. Michael Feinman AT 04:23 pm   |  Permalink   |  0 Comments  |  Email
Sunday, December 28 2014

 

Although each doctor has his or her own way of handling an initial consultation, there are few things that most of us would like to know at a first visit.  Many centers ask patients to fill out extensive questionnaires prior to the initial visit.  I will focus on the issues that are most important and universally desired.

Ages and length of infertility are two obvious pieces of information we need to know.  In particular, the age of the female is tremendously important in defining the level of urgency for proceeding with evaluation and treatment.  Six months of trying may be more significant to a 40 year-old, than to a 30 year-old woman.

Length of infertility many seem easy to define, but some couples get confused.  We define it as the length of time of having unprotected intercourse.  Frequently, couples tell me they stopped using contraception years ago, but they’ve only been “really trying” for 6 months.  The prior years count!

Copies of pertinent lab tests, including hormone measurements, semen analysis, and hysterosalpingograms are very helpful.  In general, most tests do not need to be repeated, unless certain hormone levels are over I year old.  The hysterosalpingogrmam (HSG or x-ray dye test) should not need repeating, unless there has been an event like an ectopic pregnancy or surgery since the last test.  Operative reports are also very helpful.

At the visit, the doctor will typically take a full medical history.  Prior fertility in either partner is important, as are a history of any STD’s or pelvic/genital surgery.  For women, specific details about menstruation may be asked, as well as other symptoms such as breast milk production or increased hair growth.  Current medication use is important as are any prior fertility evaluations or treatments.

A physical exam on the female, including weight and blood pressure measurements, is often performed.  We also perform an ultrasound to evaluate the uterus and ovaries.  Occasionally, ovarian cysts or uterine fibroids are found, and their presence may change the direction of the conversation.

While not yet part of the routine process in all centers, some discussion of genetic screening should be included.  The infertility experience gives patient a golden opportunity to look for possible unexpected genetic carrier states before conception.  In the unlikely event a couple carries a recessive trait like cystic fibrosis, they can consider IVF with pre-implantation genetic diagnosis (PGD) to prevent having a child with a life-threatening condition.

At the conclusion of the visit, the doctor will usually discuss what testing is needed and may begin discussing treatment options, based on what has already been done, or on what further tests might reveal.  Obviously, a treatment plan can be amended by new laboratory or imaging tests.  Frequently, a financial person will discuss the expected costs of the upcoming tests or treatments.

We believe that it is important to work with patients in a partnership spirit.  Make sure you are clear on what the doctor’s impressions are and what the plan is.  You should be able to explain to someone else why you are having a particular test, operation, or treatment.  If this is not clear, ask the doctor to explain it until you are comfortable with the plan.

Posted by: Dr. Michael Feinman AT 11:45 am   |  Permalink   |  0 Comments  |  Email

Fertility Treatments that Work

Here, failure is not an option! For those of you who have tried again and again but all treatments to this point have failed, the IVF Implantation Failure Clinic is here to change all that. Contact Dr. Michael Feinman and learn about how he can assist you with making your dream family come true. 

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IVF Implantation Failure Clinic
1220 La Venta Drive Suite 103
Westlake Village, CA 91361
feinmanivf@havingbabies.com
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IVF Implantation Failure Clinic-Hope is Here

Here, failure is not an option! For those of you who have tried again and again but all treatments to this point have failed, the IVF Implantation Failure Clinic is here to change all that. Contact Dr. Michael Feinman and learn about how he can assist you with making your dream family come true.