Speaker 1

You're listening to the fertility docs, uncensored podcast, featuring insight on all things, fertility from some of the top rated doctors around America, whether you're struggling to conceive or just planning for your future family, we're here to guide you every step of the way.

Speaker 2

Hello, and welcome to another episode of fertility docs. Uncensored. This is Dr. Carrie BDN from the fertility center of Las Vegas here with Dr. Abby , Evelyn of the Nashville fertility center and Dr. Susan Hudson of Texas fertility center and our lovely special guest today, Dr. Lisa Hansard, also of Texas fertility center. Now Lisa is based in Austin and Susan you're based in San Antonio, new Braunfels area. So you guys don't get to work with each other super often, but , um, but get to hang out on all the meetings and fun stuff like that. And so , um, Dr. Hansard has been at Texas fertility center for better part of 24 years, what you were saying. And, and I, so the first time I met you, Lisa, we were at , um, we were at a , uh , physician meeting for our lab. And I remember looking over and thinking, holy crap, this woman has her together because you were, first of all, you looked stunning because you had this. It was like a Brock hade type jacket. That was just so smooth and so polished and your hair is perfect. And then that was my

Speaker 3

Thing. I was going to say the first time I saw Lisa,

Speaker 2

I thought, golly, I love her hair. I wish I had her hair pretty in Shawnee . And , and then you opened your mouth and you took no prisoners. And I was like, all right, let's do this.

Speaker 3

Yeah . Not the first time I've been accused of that. And my motto has always been fake it till you make it. So,

Speaker 2

Absolutely. Absolutely. So , um, so whenever we have guests on, we always want to know what are the random tidbits of your life? And we have found out about things like , uh, welders people who raised her.

Speaker 3

Here's a pole vaulter let's go back

Speaker 2

Kind of will , and a world war two and a welder. And did you know that Amy Joni , Amy Jones raises turkeys?

Speaker 3

I am. So I'm not surprised by that, like a Turkey. She looks like a Turkey riser to me.

Speaker 2

She has done us a really great picture of it afterwards . Beautiful. Yeah. It was a really,

Speaker 3

And do that. I can do that.

Speaker 2

Factoid is I'm anxious to hear what your what's your interesting factoid is that we weren't expecting .

Speaker 3

So in Austin where I've been for a parallel million years or 30 or 24, the thing that people say when they meet me, they're like, oh, you're the one that racist Supercars . Ooh . And

Speaker 4

Now that is a fact toy

Speaker 3

Supercars. So we had this thing called circuit at the America here. It's a formula one track down. They even know what that is. So formula one is mostly a European sport. It says my wheel racing. It's pretty cool. It's at one point maybe still these people were the highest paid athletes in the athletes. We'll use that word loosely in the world. So the

Speaker 4

Little cars that they raised around European

Speaker 3

Towns, these are not no girlfriend . These are like tracks. Okay . Um,

Speaker 2

So the formula one race cars, or the open wheel race car ,

Speaker 3

And then the big ones. There's a, like a Ferrari red bull. [inaudible]

Speaker 2

What do you see in the rain? The movie I have the book. I didn't see the movie, but I read the book. Does that count?

Speaker 3

Y'all, you know, literally a book seriously. It's like , you're in your , let me go ahead and say, I'm in my super car and I'm on the backstretch . I hit 1 65 and I'm like, and then I'm like going , why didn't I get 1 75 before I throw on the brakes ?

Speaker 4

Oh, one of these, I actually looked up with a formula, one car looks like, so I could , and it it's ,

Speaker 3

That's done on a formula one car, but is that silly? They're not straight legal, but , um, I do , um , cars that race on the tracks, real a hundred Ferrari on a Lamborghini. I got a Ford GT one. Um , I really, I have a need

Speaker 2

For speed .

Speaker 4

Um , like, so when you do this or do you do this for fun? Do you do it to race? I mean, do you race your car or you could

Speaker 2

Have ,

Speaker 3

Um , non-professional Rachel is getting it off . No , it's that ? It's fun. And it's like, everyone needs a release. Some people run. Some people like knit, some people, whatever, whatever, whatever, get behind the wheel of a really great car and go as fast as I can. And, you know, basically compete against myself,

Speaker 2

Getting pulled over and getting a ticket. It's on the

Speaker 3

Track . It's on a race track,

Speaker 2

High 35.

Speaker 3

Sometimes it is on I 35, by the way. But in general, no, it's not in general. It's on the race track. That's designed for that purpose for like

Speaker 4

A time. Like if you're going shooting range, you go to for a time, do you, do you sign up for time to race your car? How do you do that?

Speaker 3

Mostly you racing groups and teams for fun. Um , but you said that like the shooting range. So that's my other hobby. I like weapons.

Speaker 4

You are from Texas, right?

Speaker 3

Rural . I have a raging judge Magnum if anybody really like this is funny story. So also let the rodeo, we're going to talk about medicine at some point.

Speaker 4

Can we just talk about this? I don't want to talk about [inaudible] ,

Speaker 3

But it didn't know about me. So I love, I love, love, love, love, love country and Western music. I love the radio. I'm from Lubbock, Texas. And so I was at this rodeo auction fundraisers thing, and there was a raffle. And so , um, I won the raffle and the prize was this like semiautomatic weapon. And I was like, I'm sorry, I already had that one. What else can we do? And they were like, are you kidding me? I'm not kidding. So I got a , you know , credit gift certificate, whatever. And I wish I had a picture of it. And , um, I could run downstairs and get it. And so I go to the store, the gun store, the store, I go to the gun store and I'm like, what don't I have ? That would be really cool to have. So I got this thing called a raging judge Magnum . It's a 50 caliber handgun with a long nose. It's it's really cool.

Speaker 4

Yeah. I want a bad-ass . Nobody would bother us if I was traveling with you. Wow.

Speaker 3

No , no one would buy and you know, everyone should have their concealed handgun license, or maybe we shouldn't , maybe we should talk about politics or religion or weapons, maybe in a , this kind of

Speaker 4

Scared of guns. I was never raised with guns. So I just don't know anything about it . And that scares me. I don't know anything about it makes me nervous. I mean, but I'm fine with you having your concealed handgun. You can , you can protect me next time. Instead of us meeting in Vegas, you come to Texas,

Speaker 3

Megan , right ? Bring all my guns. We will have, we'll go out and race cars and we will shoot guns and then we'll come back and we will drink wine. Hey, there you

Speaker 4

Go. It's like a weekend.

Speaker 3

I think I've just told you all my hobbies. 1, 2, 3 .

Speaker 4

I think that it has to say and a welding

Speaker 3

Cause places to say guns and ammo, like being sold at the same place. I always think is like hilarious and true. The only thing that makes guns and ammo, I mean , wait , I'm sorry. Whining , guns, ammo, and beer on a combination of weaponry and alcohol. The only thing that makes it better is if you got there and got home in a road car ,

Speaker 2

Wow.

Speaker 3

I'm very shallow. That's all there is to me. Talk is give me guns and wine . I'm like, thank you very much.

Speaker 2

This is really fascinating. So on that note,

Speaker 3

Can you make a boring

Speaker 2

Subject of medicine now? I mean, I know that , uh , I mean, vaginas can compete with guns and ammo. I mean, that is, that is ,

Speaker 3

It did or lesbian. They can totally can be with guns. Are alcohol

Speaker 2

Fair, fair. Um, okay. Susan, what's her question of the day. So our question of the day , um, it was, let me see. Okay. You're blown away by what [inaudible]

Speaker 3

Been part of my practice for. I keep it on the deal.

Speaker 2

Oh , wow. But it's so fun listening to you. Talk about it.

Speaker 3

You can tell,

Speaker 2

Cause you get really animated when you start talking about it. She you're like I have this big gun and I had everything. This is great for me to say , ask the question of the day, Lisa , we're just going to have you keep talking. Um, so our , our topic of the day was , is to talk not was still is, but we're going to, what interesting tidbits. You're going to put into this because , um, so we're going to talk about egg donation and, and screening egg donors. So when you have somebody who comes in, who you've got, however many patients who know, who, you know, need egg donors, where do those eggs come from? Like, do you just drive around in your fast car and take a girl at gunpoint? So you really look smart.

Speaker 3

I don't do that, but I'm going to start doing that as of tomorrow. That is such a good idea. [inaudible] get my car.

Speaker 2

So where did these women come from? Like if you're not abducting them, how do they know to come find you?

Speaker 3

And you were , you're really good at this care . You should , you should host podcasts frequently. Um , so that's a really good question. And in certain markets recruiting egg, donors is a real challenge. Now I live in Austin, Texas, where everyone wants to hug the trees and, you know, feed the homeless and make the world a better place. And I a hundred percent agree with that. Um, but it's a very like empathic, altruistic community. And so you get the word out and you say, you know, this is a need, there are people out here who will never be to have a family without the generous services or donation of someone like you and, and women here respond to that. And to be honest with you, most of our new egg donors, I'm going to , I'm going to regress here in a second. But most of the donors that come to us come from word of mouth. They either know someone who's had a fertility issue or they know someone has been an egg donor and they think, you know, that's something that I could do to, you know, help my fellow human being. And I want to look into that a little bit more.

Speaker 4

I get surprised as people when you tell them, because I find that as well, that most women that do this. Yeah. I mean, you make money doing it, but I really do find that most women that really do this really feel like they're giving a gift that no one else can give. And so I think that's interesting that you pointed out

Speaker 3

Yeah. A hundred percent. So , um, we, we market for donors in various , um, different platforms, but it's, it's easy as like Facebook , um, Google Craigslist, believe it or not. We're lucky because we're in a , uh , very, very , um, what's the word I'm looking for? I don't want to say liberal, but a very open-minded community where we have a lot of young women who are wanting to get back to humanity. And so we try to recruit these women with an understanding of what they're doing is extremely serious. It's it is a, like literally like a heartbreaking experience that day's recipients are going through. And they're the ones who basically have the whole , the key to these folks, happiness. So besides that, who were the people and why did they do that? Let's go ahead and talk about what does it take to be an egg donor? What are the,

Speaker 4

Can be a dinner, right?

Speaker 3

Correct. So we've had people call us and they're like 43 years old. They're like, I want her to, and I mix and we're like, you know, we appreciate, we appreciate your willingness to give, but you're not going to be , um , an appropriate candidate for intonation. So , um, couples here , couples and individuals who needed donation the majority of the time they needed an egg donor because they quality or quantity or both of the eggs for the female partner are not buyable , not adequate to achieve , um , a pregnancy. And so these women have to look outside for these women or couples have to look outside of the female partner to say, you know, we've got a healthy uterus, we've got normals from what we're lacking is a healthy egg. So if we can replace that one component with a younger, you know , healthy made younger egg, then that is the answer to our fertility conundrum. So to be an egg donor, you have to be between the ages of eight. And this is an anonymous donation. This is someone who's just coming off the street saying, how can I help? You have to be between the ages of 18 and 32. You have to have normal ovarian reserve. That's the term that refers to typically quantity at the eggs that you have, which should be high. If you're young and you have to be free of significant , um , genetic diseases, you have to have a pretty normal family history and you have to be a non-smoker and not use drugs. And you have to have a psychological evaluation that says that, you know, you are going into this for the right reasons. There's no , um, sub-clinical pathology, doesn't cure

Speaker 5

Exterior motive

Speaker 3

Essentially . Correct? There's not a , you know what , none of us could have ever been egg donors because you have to be perfect to be an egg donor. And I, I for sure would never have qualified. Okay . So there's a basic screening , um, like a primary screen of the 12 or 14 parameters. And if you pass that, then the next thing is you have a one-on-one interview with the , um, donor nurse donor coordinator. And then there is a long application, 14, 15 pages of questions that look at family history, look at your social history, look at your pregnancy history, et cetera, family history, all those things are very important. Okay. When I see those that in and of itself, I think tells me that somebody is really in it for the wrong reasons. If they fill out that he

Speaker 5

It's a 20 page application,

Speaker 3

It's long it's long. So

Speaker 5

Lisa who, who develops that really long application, is there any type of governing body that that oversees?

Speaker 3

Yes and no. So there's two different organizations that are pro preliminary are primarily responsible for this one is the FDA. So you're like, what does this have to do with dude or drugs? That's weird. But the FDA is the organization in the government that is , um, tasked with any kind of donation of human fluid organs, et cetera. And the main focus of the FDA is to reduce the trans the risk of transmission of communicable diseases. So there are FDA criteria for infectious disease screening , but all of these women have to meet the second organization is this association, I'm sorry, the American society of reproductive medicine, which is basically our governing board, that's our professional organization. And they have guidelines. So the difference between regulations is this is a law you have to follow these rules and guidelines is we think this is a really good idea, and this is the standard of care. This is what you should do. So the ASR am American society of reproductive medicine has come up with guidelines that encompass the family history, psychosocial component, you know, drug screening, in fact cetera, the rest of it that like touchy feeling part of it. That's not just the FDA looking for , um, disease transmission. So go ahead

Speaker 2

To interrupt real quick. One of the biggest questions that my patients have is I need an egg donor. How do I know that, that her family history, isn't terrible? You know, how do you, how do you, how do you know what's true? How do you really assess that? And how, like, how does any individual clinic take that on ?

Speaker 3

That's a good question. So the bottom line is you can't 100% know, but these women are coming to this, coming into this process generally with a very open , um, approach. And they don't really know when we're asking these screening questions, what will eliminate them and what won't. And at least for Texas fertility center and our donor pool, we are completely transparent. So, you know, you don't have to have a perfect family history. You know, your uncle may have had schizophrenia, your grandmother may have had breast cancer. These things don't eliminate you as a candidate, but they're , they're disclosed. So a recipient couple or recipient female coming into this has the opportunity to look at the profile and do her own risk assessment of, is this something that I think is okay, in addition, we screen these women for a very expanded genetic carrier status. So we look at almost 300 unique single gene abnormalities to see if this woman is a carrier of any of those. If she is, then we require that the male partner be screened to make sure he's not a carrier of the same disorder. Abby , you have a question. So Lisa,

Speaker 4

Tell me how people know that their particular fertility clinic is really following the rules. How can you describe a little bit about what goes on every year and a half in each of our offices and kind of what the, what the FDA has to really make sure we're following the rules?

Speaker 3

Um, so remember I talked about the FDA and they're the regulators, they're the law enforcers. Um, they audit us randomly. So I'll be, this has happened more than once out of the country. I'm the director of third party services of Texas fertility center. And it always happens. I'm in another country and my nurse will call and

Speaker 5

She'll ,

Speaker 3

She'll say , call us. And they'll say , um, the FDA is here and I'm like, okay, that's cool. That's cool. We don't have, I mean, I've been doing this for 16 years, so I'm not worried when the FDA shows up. I know that when they show up, they're going to look at our charts and they're going to say, and this is actually happens with my , um, donor coordinator nurse. They said, is there any way you can like go on the road and show all these other programs, how to do this? I'm like, absolutely not, but it's true. Like, you know, we've never been, we've never, ever been sanctioned or reprimanded or had like, like a demerit or the way they do things. Because when I set this program up, I absolutely did it knowing the rules and knowing that we were always going to completely follow the rules

Speaker 5

From the patients . Perspectively said , how, how can you know , we have, we have people listening to us, you know, all over the nation and actually all over the world. How, how does somebody who knows they need an egg donor know that they're, they're looking at a clinic that may follow the, the rules and guidelines and, and do everything as wonderfully as, as what we are able to do.

Speaker 3

They may not. And I think that is what has led to the , um, really explosion of frozen egg banks, because it's easy to, easier to , um, screen a donor, do everything correctly, stimulate her, retrieve her eggs, put them in the freezer. You don't have to think about it again. You've done it all in real time. It's done. Now the problem there is that you may not have frozen eggs that , um, meet the particular parameters that you're looking for. You may say, you know what? I don't want just one child. I want two or three children, and I want them to all be genetic siblings. So I'd rather have a donor go up, rather have a single donor go through a cycle. I get all of her eggs and I build my whole family from that one cycle. So there's a lot of different options. Um, particularly with anonymous donors, there's egg banks, there's age what we call agency donors, where it's basically a middleman and it's a business for them where they recruit these women to meet certain criteria. And you may be in Los Angeles and your donor may be in Minneapolis and she's being monitored remotely. And that's a lot harder and actually a lot more expensive. The problem is to have your own donor pool. It's a very expensive and time consuming to keep an active donor pool going. Um, it all really depends on the , the fertility center that you're working with. This is a passion of mine. It's incredibly important to me. So I convinced my partners, thanks, Susan , um , to support this. So this, this has been a , um, a viable dynamic program since we started it. And we're probably one of the largest active, fresh donor egg pools in the country. So for everybody,

Speaker 2

It's true. It's definitely , uh , quite a bit of , uh , a process as you're going through it. So if you have somebody who has been through and they are just frustrated and at their limit, because they did a bunch of IVF cycles themselves, they didn't work. They're now at the point of, of donor eggs. And they're like, I need to do this. I need to do it once. And I need to be over this part of our journey. Right? What kind of tips can you give them for looking for an egg donor?

Speaker 3

So the most important thing is find a clinic that you can trust and ask questions. Um, oftentimes when I have a patient or a couple who have gotten to the point where they need to consider a donation, it'll say, where do we even start? And I said, you know, talk amongst yourselves and figuring out what your, your main priorities are. What are you really, really looking here? And we're lucky enough to have a large enough pool where we can say, you know, give me your top two or give, give me your top three. And then I can always go back and look, and is this a proven donor? Is this someone who's been through before? Did she have success? What was the outcome? Um, a lot of times couples want to maybe move away from a donor who's unproven, meaning a donor who's in the process for the first time, and you don't know how she's going to do. And my response to that is everyone had to be a first time donor at some time.

Speaker 5

And sometimes donors respond better their first time.

Speaker 3

They may be. So these donors who are fabulous, they were all first-time donors sometime . So we've screened them as well as we can to try to , um, choose the ones that are going to give us the highest chance of success with the most desirable characteristics. So like ,

Speaker 4

Is there a rule about limiting the number of times that a patient donates or a donor donates? Cause I think that's one of the concerns for my patients sometimes are, you know, are there going to be children all over the United States that have the same, you know, lineage as macho ?

Speaker 3

Yeah. So with egg donation, it's, it's much less of an issue than it was from donation. We've all seen those, you know , movies, documentaries, children from this one, person's like, that's a little creepy, but , um , with egg donation, the American society of reproductive medicine and in their guidelines states that a donor can go through six cycles for different recipients. And that's just based on actuarial charts of what's the probability in a certain community that you would end up running into, you know , progeny from those eggs , um, with, you know , someone who's also progeny from those same eggs. I think that that is a little bit , um, random because when you really look at the statistics, especially in such a mobile mobile world that we live in, these donors come here, they donate and they like, you know, cruise to wherever. So we're a very, very transient population. So I think that six cycles is a little bit arbitrary. Um, it's always sad for us when we have to retire a donor because she's been through so many cycles and she's done so incredibly well and dependent on so many families. Um, we can always pull these women out of retirement is a couple that they've helped achieve a pregnancy with now desires the subsequent child that can come out of retirement to , um , donate again for the same family.

Speaker 5

So one thing that's , um , a relatively hot topic sometimes when people are talking about donors is anonymity. What, what exactly is anonymity and how real is it? Wow,

Speaker 3

Greg question. So , um, anonymity is important and I'm going to go ahead and talk about this, not just in terms of egg donors, but sperm donors also, because it really applies to that . So sperm banks have been doing this for a long time and they've kind of got it down. I mean, I think that we can learn a lot about egg donation from sperm banks. So they've been subject to the FDA regulations for literally decades and , um, act donates is a little bit new to that. But what we do the difference is we treat everybody the way we treat all of our patients with HIPAA compliance. We're not going to share their private , um, you know, private health information with anyone. The difference is that there are photographs , um, to help our recipients choose their donors. So we have photographs from, you know , toddlerhood to late teens or early adulthood with the way technology is advancing with , um , facial recognition software with social media. We tell these donors, we can't guarantee we can not guarantee that their recipient will not, at some point in the future, find them. We do say that we will treat them with the same , um, regard as we do any of our patients in protecting their personal health information. Did that answer the question?

Speaker 5

Yeah. I th I think that's a very realistic answer, cause it, it is a world that this isn't even the same world. It was 10 or 15 years ago.

Speaker 2

One of the things that I always tell my donors, cause I, I do most of the donor and gestational carrier coordination for our clinic is that, and we do a fair amount as well, both for local domestic patients and our international patients is that assume at some point that between facial recognition software. And the other thing that we've found is the 23. And me assume that between those two things, there is a reasonable chance that a child could reach out to you one day wanting more information about their genetic heritage. And it's not really a , I want you to be my mommy kind of situation. Um, because typically they're older and they're just more interested in their own, right? It's just ,

Speaker 5

And they're winning information. There's that curiosity. I mean, my mom just did the ancestry in me and she's like, here's your box? And I'm like, that's not quite right .

Speaker 3

So this is again, when I say we can learn a lot from sperm banks , um, sperm banks have evolved because it used to be completely anonymous. No pictures you just kind of got , or you've got a catalog. Y'all remember those days every year, remember that we get a catalog like you like the Sears catalog. You write off.

Speaker 5

No think how far people even know what the Sears catalog are .

Speaker 2

Well, now I tell patients it is online shopping at his mind, says ,

Speaker 3

Um , the difference is that banks are ahead of the game and they , um, they have an opt in ID option. Okay. So what that means is the donor can say, once the offspring ratio reached the age of consent, 18 years of age, that they are willing to have some more of a contact, whatever that means with their genetic offspring. So I think that from an egg donation perspective, we should look at the same thing. And if a recipient couple feels like that may be important for their children in the future, that they should choose an egg donor who has opted in for identification. Otherwise it really is a respecting privacy situation. You know, this is a gift. This is a huge gift. And to be coerced or forced into only doing this, if you're willing to disclose your identity, that really defeats the purpose of why women are doing this.

Speaker 5

It's a good point . I think we also have to think about the future there, that these children growing up, you know, we we've seen generational changes in the last 20, 40 years that that I think have been surprising to a lot of people. Um, but not even people who it's like, oh, I'm not even when I'm thinking of intended parents looking for information, but those kids later looking for information, just like children who are given for adoption, sometimes search for that information that they , they have curiosity about. So

Speaker 2

Looking at egg donation as a whole, if you were going to give one piece of advice to a couple that is seeking egg donation, as we're kind of wrapping all this up, what would it be?

Speaker 3

The advice would be , um, to the couples who need to consider a donation, not the ones who've already made the decision, but the ones that are seeking it is to my advice would be like really evaluate your priorities is at the end of the day, what matters the most to you is we have a baby in this house to expand our family. Let's look at what the most successful most efficient route is to get there. If on the other hand, the priority is we only want to do this. If it's your genetics and your genetics together, then, then this is not going to work for you. So the major, major, major obstacle for couples electing to pursue , um, egg donation is the fact that they can't relinquish this dream of a genetic can tell them. I said, you know, I have three kids. They are all genetically linked to me. They can not be more different from each other or with the exception of one of them or to me. So that's not what this is about. This is not about replicating yourself in your own genetics. This is about bringing a baby into the world, is going to expand your family and let you be as steward of their, you know, upbringing. That's really the joy in this. The genetics is a component of it, but if you think that that's all there is to being a parent, you're missing the big picture. That's a

Speaker 2

Wonderful,

Speaker 4

Excellent point. I agree. A hundred percent. Yay .

Speaker 2

All right, well, thank you so much, Lisa, for being with us again, Lisa Hanser from the Texas fertility center and Dr. Abby , Evelyn , Dr. Susan Hudson, and I'm Dr. Carrie obedient . So to our audience. Thanks for listening, please, to , to please be sure to tune in next week for more and be sure to subscribe and leave us a review on iTunes. We would love to hear from you

Speaker 4

Also visit us on fertility dot, send sensor.com to schedule an appointment with one of us or to submit specific questions. The more embarrassing, the better

Speaker 3

We'll see .

Speaker 2

And we love sharing these stories with you. Thanks for having me .

Speaker 3

Thanks,

Speaker 2

Lisa. Thank you so much. Thanks Lisa.

Speaker 6

[inaudible] .