The term Assisted Reproductive Technology (ART) is traditionally associated with a range of services and treatments meant to aid couples who are experiencing infertility. However, in recent years the same techniques are being increasingly used by single individuals and same sex couples to start their own families, regardless of whether they have been diagnosed with an infertility problem.
The Centers for Disease Control and Prevention define ART as all fertility treatments in which both eggs and sperm are handled. This would exclude procedures in which only sperm are handled, such as the case of Intrauterine Insemination (IUI), also known as the turkey baster method, where the sperm is deposited directly into the uterine cavity, without the extraction of the woman's eggs. Another fertility procedure that is excluded from the ART definition is the case of a woman receiving only medication to stimulate egg production in order to increase chances of pregnancy, but without the intention of extracting the eggs.
The menu of fertility treatment procedures is extensive, and depending on the specific needs of prospective parents, a particular combination of services is prescribed.
In the case of single individuals or same sex couples, the most obvious need is that of a donation of genetic material in the form of either eggs or sperm. Assuming there are no fertility problems, a single woman or a lesbian couple, healthy and capable of carrying out a pregnancy, would only need a sperm donor in order to achieve conception.
To start a family, single men or gay male couples can provide their own sperm assuming no fertility problems exist. However, they need not only an egg donor, but also a gestational carrier, also known as a surrogate, a woman willing to carry the pregnancy to term.
In Braverman's case, his HIV positive status complicated things, as using his own sperm presents a risk of infection to the surrogate and the children.
There is a procedure called sperm washing, which many fertility clinics practice routinely prior to starting an IUI in order to increase chances of pregnancy.
Sperm washing consists of separating the sperm from the seminal fluid in order to produce a concentrated sperm sample, and the procedure can be accomplished through a variety of methods. Besides its benefits in increasing chances of pregnancy, special sperm washing techniques have been used to help HIV positive men use their own sperm in order to conceive.
The process rests on the assumption that HIV resides mainly in the seminal fluid of the HIV positive male, rather than in the sperm, and that by eliminating the infectious seminal fluid, the risk of infection to the woman and child is greatly reduced.
A majority of pregnancies achieved in this way have been successful, without infecting the woman carrying out the pregnancy or the child. However, because sperm washing was originally developed as part of a fertility treatment, it has only been practiced for the purpose of avoiding HIV infection since the mid 90s.
Sperm washing is not yet a widely used practice as not all HIV positive males qualify for the procedure and it is not 100% safe, having resulted in a few instances of mother and child becoming infected. The scientific community still debates its efficacy, making it a controversial procedure, and still a challenge to find a clinic that will perform it.
Braverman's choices for parenting were narrow. Fostering was not a good long term option. Adoption was unlikely due to his HIV status, and while being single did not automatically exclude him, it wouldn't make things easier.
And so he decided he would have to assemble all of the elements needed to create his family. He would need an egg donor, a sperm donor, a surrogate to carry the pregnancy, and a clinic that would put all of the elements together.
In most cases, ART procedures involving the donation of genetic material are done under conditions of strict anonymity. Prospective parents contact either a sperm bank or an egg donation clinic. They select their donor from a catalog, and in most cases, the parents and donor will never meet each other in person.
This separation through anonymity, along with contracts signed by all parties, is done with the intention of protecting the legal parents from potential custody battles in the future, if a donor were to try to claim parental rights.
However, to start out his family, Braverman wanted everything to be out in the open. "I didn't necessarily need someone who was going to be involved after the kids were born ... but I wanted someone who was going to be (there), if my children wanted to meet that person, talk to that person, hear about how they were conceived," he said.
So while Braverman has put the appropriate contracts in place that secure his position as the legal parent, the donors continue to be part of his and the children's lives.
Many parents would be uncomfortable with the idea of having the donor be a part of their child's life. But in Braverman's case, he wouldn't have it any other way. "More love for my children is better than less love ... if I have to be that overprotective and that concerned that I'm choosing the wrong people in my process, that scare me, then these are not the people I want to have biologically related to my children," he said.
And so, to welcome his children into the world with the proper support structure, he chose two good friends as his donors. Health and intelligence were his top priorities.
When looking for a sperm donor, Braverman wanted someone who had already gone through the experience of donating, and who would remain in contact afterwards. He approached a friend who had just done a donation for a lesbian couple. There had been leftover sperm which was stored and frozen, which his friend was willing to donate.
As he searched for an egg donor, Braverman began to spread the word. And then, she "just came to me," he said. "When I told her I was starting this project...she just immediately volunteered."
She was in her 20s, the time in a woman's life when the largest number of best quality eggs can be harvested. She also met Braverman's criteria for health and intelligence.
And best of all, she was already a friend, in fact, she was a niece to Braverman's best friend from college. "I knew her from the time she was born. And that whole family is a second family for me, it's as though I married into that family."
Having found the right donors, now remained the challenge of finding a gestational carrier. In the end, he was not able to find a friend who would volunteer. "Nobody was able, or emotionally willing, which is totally understandable, I think that's the biggest job," said Braverman.
Besides the obvious challenges of carrying a pregnancy, surrogacy involves a commitment for an extended period of time. In addition to expecting for nine months, the pregnancy is preceded by a few months of screening and the surrogate meeting with the parent.
So not only is it hard work and wearing on the body, it is also inherently risky and the time commitment of continuing a relationship with the parents can span to about a year and a half.
Braverman had a long list of priorities in mind when he embarked on the search for the woman who would give birth to his children. Of course, there is health.
But Braverman was also very aware of the deep attachment that can occur when a woman carries a child in her womb, even when the child is not her biological offspring. With this in mind, one of his top criteria was a woman with prior surrogacy experience, someone who knew what she was getting into.
In addition, he wanted her to had already been pregnant with her own children, and who had her own children, as opposed to having her own children and later giving them up for adoption. All this in order to ensure that "she already had her own familial attachment. That was important to me, I wasn't going to start the process with someone who is going to become emotionally involved in the pregnancy, feeling like it was her child when it wasn't," said Braverman.
He also wanted a surrogate who was in a relationship. "Married or unmarried, lesbian or straight, it didn't matter, but I wanted somebody who had the support structure in their life of a significant other," said Braverman.
After finding someone that satisfied all of the above criteria, he just needed to make sure they could get along well for the next year or so, so a match in personalities is also important. Braverman didn't want anyone who would be "racist, homophobic, prejudiced or have religious affiliations that would make them a bad match for me." He knew personal conflicts can result in bad pregnancies.
But he found the right match, and he was ready to get started.
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