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Embryo donation — the process by which a family donates their "extra" embryos to a couple or individual — is a viable path to parenthood. In a previous blog post, I addressed some of the reasons why people who consider their families complete after in vitro fertilization (IVF) might choose to donate embryos.

Who, then, is on the receiving end? Often, this option interests people considering adoption, and individuals or couples who need donated eggs or sperm, or both, to achieve pregnancy. If you find yourself in one of these groups, here are some initial questions and issues you might consider as you make your decision.

Embryo donation or adoption: A few points to compare

Pregnancy. The opportunity to experience pregnancy draws some prospective adoptive parents to seek embryo donation. This may be important to you. It may be a life experience you always looked forward to, or hoped to share with a spouse or partner. Or perhaps you are concerned about having someone else carry your baby. For example, prospective adoptive parents often worry that their future child could be affected before birth by a birth mother's choices around drugs and alcohol, or exposures to unavoidable stresses.

Time frame and cost. The pandemic fueled already significant declines in the number of babies placed for adoption. If you are seeking to adopt a newborn, you are likely to face a wait of two years or more. By contrast, embryos are available, and an embryo transfer often occurs within six months of making the decision to seek donated embryos.

The cost of embryo donation is considerably less than adoption. If you go through an agency there will be a fee, as well as costs related to moving embryos from one clinic to another and (depending on your medical insurance) costs associated with medications and with the embryo transfer. While costs are substantial and vary across the US, fees are much higher for infant adoption than for embryo donation.

Although the short wait and lower costs are attractive when comparing embryo donation to adoption, it is important to know that embryo donation does not always result in a live birth, while adoption — with a reputable agency — will bring a baby into your home.

Your child's story. All of us want our children to feel good about their origin stories. Adoptive families have long recognized that some adoptees have enduring feelings of loss because their birth parents chose to make an adoption plan. Some people believe embryo donation mitigates these losses because the child is born into the family they will be raised in. However, others see it differently: they feel that embryo donation brings with it a more complicated origin story. How will a child make sense of the fact that they began as an embryo created by people longing for a baby, but an embryologist chose another embryo for transfer, making them "extra"? Might this lead to a greater sense of displacement, and perhaps to feeling like a bit of a science experiment?

Choosing family backgrounds. If you pursue adoption, you'll weigh in on the race of your child. You may be able to request birth parents who avoided drugs or alcohol during the pregnancy and/or have family histories free of serious physical or mental health problems. You will not be able to narrow your match to people you like or feel are compatible, people who feel familiar, and whose interests and values align with yours.

If you pursue embryo donation, you and the donor family get to choose each other. Before anyone makes a commitment, you can confirm with the donor family that you have a shared perspective of how much contact you want to have, and what each of you believes is in the best interest of the children involved. Decisions tend to feel more collaborative than in adoption, where it may feel like "birth parents get to make all the decisions."

Embryo donation or egg or sperm donation: A few points to compare

If you are in a position to need sperm or egg donation, or both, you might be comparing this with embryo donation as a path to pregnancy. Below are key points to consider, and some questions that may arise as you sort through your options.

Since pregnancy is your primary goal here, you are probably thinking about which option is likely to work best. With embryo donation, one might say you get a head start, since you begin with healthy embryos. However, the number of embryos you receive will be limited.

You could decide to seek a second donor family if you don't achieve pregnancy with embryos from the first donor, although this would be a long, discouraging path. By contrast, if you seek donated sperm and eggs separately and begin with a large number of eggs, you may have a larger number of embryos to work with.

Time frame and cost. The good news is that each of these options can be available to you without delay. You can obtain donor sperm from a donor known to you, or from major cryobanks within days of choosing a donor. If you choose frozen eggs, these can be secured quickly also. Donated embryos take longer to locate and arrange for their transfer from one family to another.

Your medical insurance will play a big role in determining the expenses associated with each option. Sperm from a known donor usually is free. With egg and sperm donation from a cryobank, you will owe a fee to the donors. In the case of egg donors, fees can be high. With embryo donation, no fee is paid to the donating family.

Your child's story. If you opt for embryo donation, your child's story began with another family planning to have a baby. You may wonder if your child will have feelings of displacement similar to what some adoptees report. Or, carrying and giving birth to your baby may make embryo donation feel fundamentally different from adoption. Double donation — conceiving a child with both donated eggs and sperm — also offers the connection that comes with pregnancy, although you may wonder how your child will make sense of being conceived by two people who never knew each other. A single donation of either egg or sperm offers a genetic connection to one parent, which some feel helps root a child in the family. Yet each of these origin stories is complicated, making it essential that you feel comfortable with the story before you move forward. Long before being able to understand the story, your child can sense that you feel secure in the rightness of your decision.

Decisions like these abound worldwide

If you are taking a serious look at embryo donation and comparing it to other parenthood options available to you, you are not alone. The arrival of IVF in 1978 has led to a series of new paths to parenthood. Each one drew pioneers who took a careful look before moving forward into new and unfamiliar territory. Making the decision with patience, thoughtfulness, and information has enabled them to embrace and celebrate the families that they have built.

For more information

Regulations, rules, and costs of different paths to parenthood vary by state and other factors. These resources may help you track down information you need to make a decision.

Resolve

Source: Harvard Health Publishing

Editor's note: Health inequities have long been an issue for people in the LGBTQ+ community. We're pleased to share a post from our colleagues in Corporate Learning at Harvard Medical School focusing on solutions that health care leaders can champion.

Health care business professionals can improve patient outcomes and reduce health inequities by championing the health care needs of the lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, asexual, and two-spirit (LGBTQIA2+) community. These issues are an important priority for health care professionals year-round, not just during Pride Month.

Research shows that the LGBTQIA2+ community faces disproportionate adverse health conditions due to health inequities. It's important for those working in the health care industry to be aware of the challenges the LGBTQIA2+ community faces to help make systemic changes and improve health outcomes.

The LGBTQIA2+ community — which is less likely to trust the health care system — is a rising part of the population. The 2022 national Gallup survey shows that at least 20% of Gen Z identifies as LGBTQIA2+. This includes our coworkers, customers, and clients, says Dr. Alex Keuroghlian, a psychiatrist at Massachusetts General Hospital and faculty advisor for LGBT and Allies at Harvard Medical School (LAHMS).

"LGBTQIA2+ people experience pervasive stigma and discrimination, as well as numerous adverse social determinants of health, all of which negatively impact health outcomes," says Dr. Keuroghlian. "Health care professionals, organizations, and governmental agencies need to intentionally provide clinical care and design health systems and policies, in a manner that is culturally responsive and improves health outcomes for LGBTQIA2+ people."

Due to the politicized nature of these issues, health care providers around the world, including in several U.S. states, face limitations and backlash when providing gender-affirming care. In some places, Dr. Keuroghlian says, "legal restrictions on access to gender-affirming care create challenges for clinicians to deliver this care and for transgender and gender diverse people to safely receive it."

Everyone in health care — including health care business professionals — can work to improve health outcomes and decrease inequities. "It is critical for all businesses to offer welcoming, inclusive, and affirming work environments and service delivery for LGBTQIA2+ people," Dr. Keuroghlian says.

Supporting LGBTQIA2+ health begins in the workplace

With thoughtful action, health care business professionals can contribute to greater health equity for these underserved individuals. Some ways to do so include:

1. Take an active interest in better understanding the needs and perspectives of the LGBTQIA2+ community.

Conducting research, including surveys and consumer focus groups, is a good way to help better understand specific health needs and priorities. "This community has historically been excluded from studies and research that would be very helpful in understanding their needs and their challenges," says Dr. Enrique Caballero, an endocrinologist at Brigham and Women's Hospital and the faculty director of International Innovation Programs in the HMS Office for External Education. "We need to get to know the population better."

2. Prioritize inclusive language.

Whether you are involved directly in care delivery or other aspects of health care, pay attention to the words you use — for both customers and employees. Gendered language in job postings, informational or marketing materials, and even casual conversation can be off-putting. That means lost opportunities for organizations and LGBTQIA2+ individuals. Slight shifts in language and conscious efforts like adding pronouns to your email signature speak volumes.

3. Train staff to be community allies.

Gaining awareness of our unconscious biases and making shifts in our everyday language doesn't happen overnight. Health care industry businesses can help their staff be better allies to the LGBTQIA2+ community by providing access to workshops delivered by community members.

"No one becomes fully competent after one conversation, lecture, or video," Dr. Caballero says. "It's a lifelong process in which we all learn how to be more respectful, inclusive, and to embrace diversity."

4. Support companies and community organizations that focus on LGBTQIA2+ health.

Show, don't tell. Making financial contributions to organizations already on the ground and working with this population demonstrates that you aren't just concerned about the bottom line. You are truly dedicated to helping the LGBTQ+ population access good health care.

5. Hire LGBTQIA2+ staff.

The best way to ensure your company is prioritizing health equity is by having a diverse group at the decision-making table. It is crucial to have employees that represent the diversity of your customer base — not only diversity in gender expression and sexuality, but also diversity in race, ethnicity, age, ability, and beyond.

"Part of our obligation is to really open the doors for everybody," Dr. Caballero says. "Talent is not exclusive to a particular group, and I think that is important to embrace as an organization."

6. Include LGBTQIA2+ representation in all communications.

Diverse representation is key. Make a pointed effort to include same-sex couples, non-traditional family units, and transgender and non-binary individuals in all kinds of communications, participating in everyday activities.

7. Acknowledge any missteps.

On an institutional level, company acknowledgments can go a long way in rebuilding trust with the LGBTQIA2+ community. Within the organization, it's valuable to encourage ongoing communication about company culture.

"All organizations should have a system in place for people to provide feedback on how things are going and to report anything that they want to call the leadership team's attention to," Dr. Caballero says. "Having a system that truly listens to members of the organization — and being sure that follow-up action is taken — is very important."

8. Make action consistent beyond Pride Month.

Embracing the LGBTQIA2+ community consistently and with commitment all year long "is truly an opportunity for everyone," Dr. Caballero says. "This is not good just for the members of the community, but for everybody that works in a place that embraces diversity, equity, and inclusion."

Industry professionals turn to HMS for custom corporate learning programs, including on topics like LGBTQIA2+ health, that leave a lasting impact on participants. To provide these programs, HMS leverages faculty expertise from throughout the School and the entire Harvard University community to share with health care teams. To learn about HMS Corporate Learning custom programs, read about the approach or hear from clients themselves.

Source: Harvard Health Publishing

Are you finding yourself with itchy, irritated skin that you can't stop scratching? Or have you wondered why your child's eczema is suddenly worse and so hard to control? Mounting evidence suggests that wildfires, which are increasing in intensity and frequency, contribute to skin problems, including eczema flares.

What is eczema?

Eczema is a common chronic skin condition that affects about one in 10 people in the US. Its hallmarks are inflamed and dry, itchy patches of skin.

Atopic dermatitis is the most common type of eczema. It can run in families, often beginning in childhood. Typically, in the northern hemisphere, it grows worse during the winter season when the weather is cold and drying. Now some experts are seeing that pattern change. At Massachusetts General Hospital, for example, one dermatologist noted an unusual spike last summer in patients with flare-ups of eczema.

Why is eczema getting worse during summer?

In 2023, Canada experienced more than 6,000 wildfires that burned over 16 million hectares of land — an area larger than the entire state of Georgia. While far away from the devastation, the smoke reached across the US and more than 2,000 miles to Europe. Poor air quality from these distant wildfires caused eye and throat irritation and difficulty breathing.

In Boston, Dr. Arianne Shadi Kourosh, a dermatologist at Massachusetts General Hospital, also began to notice skin symptoms. Normally the dermatology clinics would see fewer than 20 people during a summer month for eczema, including atopic dermatitis. Suddenly that jumped to 160.

Looking back at summer month records from the last four years, her research showed that the number of visits for these skin complaints tracked with the severity of air pollution. These findings are consistent with other research noting an uptick in eczema flares and psoriasis flares associated with wildfire pollution. But why?

Researchers theorize that airborne pollutants might set off a cascade of effects within the body by activating an oxidative stress pathway. This damages the skin barrier and prompts an inflammatory response. This cascade also may play a role in the development of eczema.

What can you do to protect your skin?

Air pollutants in wildfire smoke may harm multiple organs — not just your heart and lungs, but also our skin, it seems. So, when outdoor air quality is bad due to wildfires, limiting your exposure can help reduce health risks. While we can say the same for industrial air pollution, wildfire pollution is likely worse due to its additional toxic particles.

Source: Harvard Health Publishing

You may have heard recent news reports about a company that knowingly sold defective lead testing machines that tested tens of thousands of children between 2013 and 2017. Or wondered about lead in tap water after the widely reported problems with lead-contaminated water in Flint, Michigan. Reports like these are reminders that parents need to be aware of lead — and do everything they can to keep their children safe.

How is lead a danger to health?

Lead is poisonous to the brain and nervous system, even in small amounts. There really is no safe level of lead in the blood. We particularly worry about children under the age of 6. Not only are their brains actively developing, but young children commonly touch lots of things — and put their hands in their mouths. Children who are exposed to lead can have problems with learning, understanding, and behavior that may be permanent.

How do children get exposed to lead?

In the US, lead used to be far more ubiquitous than it is now, particularly in paint and gas. Yet children can be exposed to lead in many ways.

What can parents do to protect children from lead?

First, know about possible exposures.

Second, talk to your pediatrician about whether your child should have a blood test to check for lead poisoning. The American Academy of Pediatrics recommends:

How is childhood lead exposure treated?

If your child is found to have lead in their blood, the most important next step is to figure out the exposure — and get rid of it. Once the child is no longer exposed, the lead level will go down, although it does so slowly.

Iron deficiency makes the body more vulnerable to lead poisoning. If your child has an iron deficiency it should be treated, but usually medications aren't used unless lead levels are very high. In those cases, special medications called chelators are used to help pull the lead out of the blood.

For more information, visit the Centers for Disease Control and Prevention website on lead poisoning prevention.

Source: Harvard Health Publishing