- Dr. Amato opens up about her personal experience with embryo donation, discussing the emotional and ethical factors that guided her decision.
- We dive into the advancements in embryo freezing, including the process of vitrification and how the technology has evolved over the last 15 years.
- Dr. Amato shares why she chose not to use her own frozen embryos and highlights the role of genetic testing in embryo donation decisions.
- We discuss the ‘fertile window’ and how it relates to a woman’s reproductive lifespan and planning for parenthood.
- Dr. Amato offers valuable insights into the challenges of freezing and donating embryos, stressing the need for empathy and greater awareness in reproductive medicine
Dr. Aimee: I am so delighted to have Dr. Paula Amato on today’s show. Welcome, Paula.
Dr. Paula Amato: Thank you, Aimee. Thank you for inviting me. Glad to be here.
Dr. Aimee: I read your article about donating your embryos and I said, “Wow. I have to have you talk about this on the show.” That’s what we’re going to talk about.
I love learning about how people got interested in the field of fertility. What drew you to be an REI (reproductive endocrinology and infertility) doctor?
Dr. Paula Amato: I think initially I was attracted to being an OBGYN because of the obstetrics piece. But during my OBGYN training, I became very interested in REI. I think I was just fascinated by the science. I was really interested in the endocrinology piece, actually. I found it fascinating. I just loved the patients. I thought it would be a really rewarding career, and 30+ years later I’m happy to say I think we have the best job in the world.
Dr. Aimee: You look like you’re 30 years old, so I’m not sure how it’s 30+ years later. You’ll have to tell us your secret later.
You froze embryos in your 30s using sperm from an anonymous sperm donor. What led you to that decision?
Dr. Paula Amato: I found myself in my 30s, single after a brief marriage. I was working as a fertility specialist, I was a junior faculty member at Baylor College of Medicine in Houston. I always thought that I wanted to have children, but I wanted to have children in the context of a relationship. As a fertility specialist, I was very well aware that age-related fertility declined. Of course, I was in a very privileged position because I was working as an infertility specialist. So, I thought I’m just going to take advantage of this option of fertility preservation just in case, as a backup, my insurance plan if it didn’t work out.
Dr. Aimee: Why did you just choose embryos versus eggs?
Dr. Paula Amato: This was about 15 years ago now, so this was before vitrification. For your listeners, vitrification is a newer freezing technology, which is a lot more successful than the slow freezing method we had at the time. Freezing eggs wasn’t that successful at the time, so that was one reason.
The other reason was at the time, and now, I’m primarily in a relationship with women, so it wasn’t like I was waiting for Mr. Right. I was going to be using donor sperm anyway, so I went ahead and chose an anonymous sperm donor and decided to freeze embryos.
Dr. Aimee: What made you decide to forgo using your own frozen embryos?
Dr. Paula Amato: I was never, unfortunately, in a position in a relationship that was stable enough with someone who really wanted children, until my late 40s. Then when we were together enough that we started that conversation, we decided that at that point we were really kind of too old to parent. I realize that’s a very individual decision, and maybe somebody else might have made a different decision. But my partner is a few years older than I am, we talked about it, and we thought we’re just too old at this point to initiate our family building. We have a very rewarding life with lots of nieces and nephews. We made that decision together.
Dr. Aimee: Once that decision was made, what made you consider donating your embryos?
Dr. Paula Amato: As you know, if you have embryos stored, you have a few options in terms of disposition. You could keep them frozen indefinitely, you could discard them, or you could donate them to research, or you could donate them to another patient. Of those options, donating to research, there was nothing special about my embryos, so I didn’t think it would add that much to scientific research and I didn’t feel great about discarding them.
I see patients every day who obviously aren’t sometimes successful using their own gametes, or sometimes can’t access donor gametes because of financial barriers, and I thought this is a good thing to do. I thought it would be a way to pay it forward. I thought about it a lot, and then decided ultimately that’s what I wanted to do.
Dr. Aimee: You talk about the fertile window. Can you teach us a little bit more about that?
Dr. Paula Amato: Fertile window has a few different meanings. We can think of it as that part in the cycle, for example, that’s the most fertile around ovulation. You can also think of it in the course of a woman’s lifespan, those reproductive years that are the most fertile, usually 20s and 30s. But there is also a parenting window, as I came to realize. There’s a window of time in your life when it might be optimal to parent. Again, I know it’s a very individual decision. For me, all those windows started to come into focus a bit.
Dr. Aimee: I imagine the parenting window is a very personal thing.
Dr. Paula Amato: Yes.
Dr. Aimee: What led you to dig into your own genetics and the genetics of your embryos?
Dr. Paula Amato: When I finally made that decision to donate my embryos, I started looking for a recipient. There’s a few different avenues that you can use. There’s a site that I used called Miracle Waiting, there’s a company called Embryo Connections, there’s a variety of different embryo donation companies. I started looking into it. I found a recipient, actually the first person I contacted. We had a few email exchanges. I thought this would be a good fit.
At the time, again this was 15 years ago, it was before the time of expanded carrier screening, so I hadn’t done any expanded carrier screening at the time, and the donor had really only had maybe cystic fibrosis testing and that was about it. He was a Jewish donor, so I know that certain diseases are more prevalent in the Ashkenazi Jewish population, and the last thing I wanted was to donate embryos that were affected with some kind of disease. So, I first did carrier screening on myself, and was surprised to learn that I’m a carrier for this really rare but very serious metabolic disease that causes really serious neurological problems.
I really was motivated to find out that the donor wasn’t a carrier for the same mutation, because obviously if we both were carriers then a potential child would be at risk, so I had to find this anonymous sperm donor, which is not easy. First, I contacted the sperm bank and said, “I used sperm from your bank 15 years ago. Would you mind reaching out to the donor to see if he would agree to testing?” They’re like, “Sure, we’ll do that,” but I’m not sure that they ever did. I never heard back from them, so I doubt that they actually tried very hard.
Then I contacted some patients through the Donor Sibling Registry, which you may be familiar with. This is a website that includes people who have used donor sperm, or donor eggs, or donor embryos to create their families. It’s a way for half-siblings to match with each other and parents to match with each other. I found some people on that site that had used the same donor that I had used. There were about maybe six children from that particular donor. I contacted one of the moms and found out that she knew some of the other patients that had used this particular donor, and as far as she knew all of the children were happy and healthy, nobody had any serious diseases. That was reassuring, but I still wanted the proof.
I had the profile from this donor that I saved from 15 years ago, and there was enough information on there, believe it or not, with the internet of course, that I was actually able to locate this man that I was 99.9% sure was the donor. I found out that he was married and had his own children. I was able to find an email address for him. I was a little bit hesitant to contact him. I didn’t want him to think I was stalking him or something. I can imagine it would be very disconcerting to get an email like that. But ultimately, I did, and he was very gracious, actually, and I’m very grateful to him.
I explained the whole situation and he said, “Sure, no problem. I’ll agree to get tested.” Great. We got him tested, and he’s not a carrier for the same thing that I’m a carrier for. He’s a carrier of a few other things, but it wasn’t an issue because I was negative for those mutations.
Dr. Aimee: Great. What did you discover about your nine embryos?
Dr. Paula Amato: I had nine embryos frozen. Six were frozen at day three stage, which is what we used to do back then. Three were blastocysts, so day five and six.
The person I had agreed to donate to had a history, she had undergone multiple cycles of IVF and failed, and then actually had two miscarriages of euploid embryos, so she was very interested in having euploid embryos donated to her. I could totally understand that. I think if I was using my embryos for myself, I probably wouldn’t have undergone PGT. I would have probably just transferred them. But given that I was very motivated to donate to this particular recipient and I understood her history, I decided that I’m just going to test these embryos before I donate them to make sure that they’re chromosomally normal.
They were thawed at the fertility clinic where I work now. The blastocysts, predictably, didn’t survive very well, but the day threes did. We cultured those to blastocysts, and two made it. Two were biopsied, and they both came back chromosomally abnormal. That was the end of my embryos.
Dr. Aimee: Wow. How did that make you feel?
Dr. Paula Amato: There was definitely a sense of loss. I don’t want to say that it’s equivalent to what people go through who are undergoing infertility, because it really isn’t. I never tried to get pregnant, I never underwent infertility treatment per se. I learned, especially because I was feeling quite sad at that moment, that I was very attached to these embryos, or the idea of having a biological child, if not myself then somebody else.
So, it was very sad. Which is not to say that I had any regrets, really. The decisions were the right decisions for me at the time. But I was sad. I was also sad about the potential relationship with this recipient who I had grown close to. I thought this would be a very unique relationship. I was sad to lose that, but we’re still friends, so I am grateful for that.
Dr. Aimee: What did you learn about the process of freezing and donating embryos through this?
Dr. Paula Amato: I learned quite a bit. As a doctor, I think I became more empathetic about what my patients go through. I realized that there is a lot of waiting involved. There’s this feeling of lack of control because lots of things are out of our control. There’s an emotional roller coaster that happens.
I think ultimately it made me a better doctor. I think it also helped me counsel patients better in terms of options for fertility preservation and embryo donation as a family building option.
Dr. Aimee: What do you wish patients knew about this process?
Dr. Paula Amato: That more patients and doctors were aware of this option. I think people are, but maybe don’t suggest it as often as perhaps we should.
There’s something like over 1.5 billion frozen embryos in the United States. I understand again that it’s a very personal decision, not everybody is going to want to donate their embryos. I think if we introduce the subject earlier in the fertility journey more people would be receptive, both recipients and donors. I think it’s a great way to build a family. As you know and I know, infertility treatment is not accessible to everyone because it’s not always covered by insurance and there are financial barriers. This is a much more affordable option.
For patients that have surplus embryos, often they’re conflicted about what to do with them. It’s a wonderful thing to be able to donate your embryos, it’s a way to pay it forward. I wish people just had more awareness about that.
On the fertility preservation side, when I talk to my young patients in their 20s and 30s, and some of my medical trainees, and they’re in a similar position that I was perhaps in their 30s where they might be single or still pursuing education and career and not at a place in their life where they can start their family, we counsel them about egg freezing. I know you do a great job of counseling patients out there about that potential option. I want people to realize that it’s not a guarantee. Having said that, there is a psychological benefit to doing it. Even if it doesn’t work out in the end, I think you feel like you did something proactive, you thought about it, etcetera. It’s a great option for someone who is not quite ready to have a child, thinks they want to have a child, but it’s not a guarantee.
I just want people to understand what the options are and what the limitations are. I think when I counsel patients now, I tell them they absolutely should consider doing preimplantation genetic testing on their embryos if they’re freezing embryos, because you want to know if you’re freezing something and you’re not planning to use them for many years later that they were actually normal, because if not, then you’re going to do another cycle if you can. That wouldn’t apply necessarily to everybody. Not people in their 20s, but certainly people like me in their mid to late 30s, I think I would definitely recommend it.
Dr. Aimee: What do you wish doctors knew as they lead patients through this process?
Dr. Paula Amato: Again, I wish there was more awareness about embryo donation as an option, both for recipients and for donors. Also, when counseling patients about fertility preservation, I think we need to be very frank with our patients and tell them, yes, this is an option and there are benefits to doing it, but it is expensive and there are no guarantees. As long as a patient is counseled and they still decide to pursue it, I think it’s definitely something people should avail themselves of.
The other thing that I learned, I have more sympathy now for donor-conceived children who want to know their genetic origins. I kind of know how frustrating it can be to know that some sperm bank out there or some fertility clinic knows the identity of your sperm donor, egg donor, or embryo donor, but is not allowed to release it to you or doesn’t want to release it to you. So, I have much more sympathy for those people and how strong that motivation can be. I’ve become kind of a proponent of open donation. I think donor’s rights should be respected as well, so I don’t think it should be applied retrospectively unless donors agree at a later date to reveal their identifying information. But moving forward, I think we should definitely encourage more open donation.
Dr. Aimee: I agree. There is such a gender gap between sperm donors and egg donors, too.
Thank you for sharing your story today. There are so many lessons to be learned. It’s just so wonderful as a fertility doctor that you can share everything so openly with us. Thank you for that. Is there anything else that you would like to add today?
Dr. Paula Amato: I would like to say that this is my first personal essay. As you mentioned, I’ve written very many scientific articles. This is the first time that I shared something so personal. I think when I first wrote this essay it was for me, it was very therapeutic for myself. Then I realized that sharing stories is actually a wonderful way to help our patients. I hope that it’s helpful to both potential donors and recipients and patients out there.
The other thing is I think it’s very important that we as a field and as a society continue our advocacy efforts to try to increase access to infertility insurance coverage at the employer level and at the state level. I think there are so many disparities amongst who can access infertility treatment that we should do our best to try and reduce those and eliminate those, hopefully. Also, I think it’s really important that we advocate for policies that help women have children during their peak reproductive years because that really is the best time to have children. Again, it’s kind of a personal decision, but I think things like paid parental leave, flexible work schedules, subsidized child care, and all of those things are very important if as a society we think it’s important to support women in particular but also men to have children during their peak reproductive years and not at the expense of pursuing their career and education.
Dr. Aimee: I agree with that so much. Where can people find you and your article?
Dr. Paula Amato: You can Google my name and the fertile window, and it should come up. I’m hoping it’s open access, but if anybody has trouble downloading it, please contact me or Dr. Aimee, and hopefully we can share a link without violating any copyright rules.
I am, as you mentioned, a fertility specialist here in Portland, Oregon. If any of your listeners are in that area, please feel free to look me up at Oregon Health and Science University. I’m also vice president of The American Society for Reproductive Medicine, so that’s another way, too.
Dr. Aimee: Amazing. Thank you, Paula. Thank you for joining us today. I really appreciate you sharing your story again.
Dr. Paula Amato: Thank you, Aimee. Thanks for having me. Keep up the good work.
