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Monday, July 27, 2015

Physician, breed thyself

Dallas fertility doctor helped many couples before he and his husband created their own family

As an obstetrician with a specialty in reproductive endocrinology and infertility, Julian Escobar has been helping others create families for years. Last year, he and his husband decided it was time to create their own family.

Since returning to Texas in 2008 for a fellowship at UT Southwestern, Escobar — the medical director of ReproMed Fertility Center in Dallas — has spent his days counseling couples about creating their families. Typically, straight couples will seek help of a fertility specialist when they’ve been trying to get pregnant for more than a year with no results. Couples older than 35 may seek his help after trying for just six months. Studies show couples undergoing fertility treatment exhibit the same level of stress as oncology patients.

Infertility issues can have several causes. For men, Escobar begins with a semen analysis; for women, he will make sure they are ovulating properly and that their tubes are normal. Solutions can include administering a pill or injection that promotes the ovulation of more than one egg to up the chances of conception; if the man is sterile, he’ll suggest use of a sperm donor. And if that doesn’t work, he might recommend in vitro fertilization — fertilize the egg in the lab and then transfer them back to the woman. (If the woman’s eggs are the problem, he may fertilize donated eggs from an anonymous donor and implant them in the woman.)

After discussing all these options — including their goals, deciding whether to buy eggs or freezing eggs for future conceptions so that the children will be biologically related — Escobar began to realize something: That he wanted to be a parent himself.

“I talked to couples about building families,” Escobar said. “I lived it everyday.”

He approached his husband, Pieter Verhoeven, about the possibility: “What about us?” he said.

Although he hadn’t worked with gay male couples before, Escobar knew it was being done — and all they needed was an egg and a uterus.

For legal reasons, they used an anonymous egg donor. Implanting someone else’s egg in a surrogate gives the surrogate less of a parental claim on the child, he said.

They decided to fertilize the donated eggs with semen from each of them, then did pre-genetic screening. Each fertilized egg was checked for a number of things, such as genes that predispose someone to certain types of cancers and for other abnormalities. A number of fertilized eggs remained.

“We each had normal male and female [fertilized egg] and wanted one of each,” he said.

The couple selected a male inseminated by one of them and a female by the other so they’d know when the children were born whose was biologically whose child. Through his practice, they found a surrogate and the two eggs were implanted successfully.

Now 7 months old, Escobar and Verhoeven are the proud daddies to fraternal twins — daughter Paloma and son Valentino. But even before they were born, the couple worked to secure their legal rights.

During the pregnancy, their attorney established parental rights for each biological parent. Then working with a judge who was amenable to the idea, they set up second-parent rights for each of them. Escobar called his surrogate “a little angel for us,” and said she’s remained a friend who said she’s carry another set of twins for them if they decided to have more children.

They’ve additional frozen embryos, but haven’t made a decision about more children. With two 7-month-olds, having more children isn’t on the agenda right now.

Since the birth of his own children, Escobar has been anxious to help other gays and lesbians who want to start their own families. He took his current position with ReproMed earlier this year in part because the clinic welcomes all prospective parents — couples or singles, gay or straight — seeking help with fertility. “There are fabulous clinics that will shut the door in your face,” he warned.

Don’t waste time and money and get disillusioned, he said. Find a doctor or a surrogacy or adoption agency eager to work with the community. He said lots of obstacles can be overcome.

Escobar has worked with HIV-positive and sero-discordant couples as well, and notes that if the HIV-positive member has an undetectable viral load count, his sperm can be inseminated in the woman without infecting her or the child with the virus. He’s also helped HIV-positive women become pregnant. When their viral load count remained undetectable throughout the pregnancy, the virus wasn’t transmitted to the child.

After years of helping others create families, Escobar believes that becoming a dad himself is “the best thing I’ve ever done.”


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