• Birth Certificate Fee: A certified copy of your child’s birth certificate must be submitted to the court. A certified New Hampshire birth certificate costs $15. This fee will vary if your child was born outside of New Hampshire, and there may be extra costs associated with rush processing.
• Notarization Fee: Your signatures on court paperwork need to be notarized. Most banks will provide this service to customers at no charge. If you decide to use a remote online notarization option, budget $100 for the notary’s fee.
• Court Filing Fee: A $150 court filing fee must be paid to the Probate Division of the Circuit Court. This fee is paid per child being adopted.
• Service Fee: This fee is paid to the sheriff or other process server to serve the paperwork on a birth parent whose rights are being terminated. Budget $50, but know that the actual cost can end up higher.
• GAL Fee: This fee is paid to the GAL who must investigate when a birth parent’s parental rights are being terminated. Budget $1000.
• Legal Fee: This is paid to your attorney for his/her services. Some attorneys charge an hourly rate, while other attorneys charge a flat fee for the entire case. Check out the firm’s costs section for current information on legal fees.
• Certified Copy Fee: One adoption decree is automatically issued. It’s good to get a few copies to have extras for your own files–each copy is $10.
• Birth Certificate Amendment Fee: This fee is paid if your child’s birth certificate is amended to reflect his/her new name or to list the stepparent’s name on the birth certificate.  For a New Hampshire birth certificate, the fee is $10. You will also need certified copies of the amended birth certificate. In New Hampshire, this fee is $15 for the first copy and $10 for additional copies.

Less common costs for a stepparent adoption include:

• If you are unable to serve the other birth parent, the judge may allow you to publish notice to him/her instead in a newspaper, which typically runs $100-200.
• Home Study Fee: If a home study is required (and it’s not required in every case), expect to pay around $2000-3000.
• Birth Parent’s Legal Fee: If the birth parent surrenders his/her rights, expect to pay his/her attorney’s fees also, which can could be $500+.
• Apostille Fee: If you need to use your adoption decree or new birth certificate in another country, you will need to have an apostille attached by the Secretary of State’s Office. The fee for this is $10 per document.

Ready to move forward on a stepparent adoption? Contact me to schedule a free consult.

The post Costs of Stepparent Adoption in New Hampshire appeared first on New Hampshire Fertility Law.

Ready to learn more about stepparent adoptions in New Hampshire? Contact me today for a free consult.

The post Stepparent Adoption in New Hampshire FAQs appeared first on New Hampshire Fertility Law.

Q:What are some of the issues that would be covered by a legal agreement with the recipients?

The legal agreement will typically establish the intentions and responsibilities of the parties and address their mutually agreed upon decisions regarding confidentiality, sharing of future medical information, future contact (if any), financial arrangements, and the disposition of any embryos remaining after treatment is concluded.

Q:I am donating my eggs to my best friend. I completely trust her and know that she wouldn’t try to take advantage of me. To save costs, can we all just share an attorney for the legal paperwork?

It’s not a good idea for both sides to be represented by the same attorney. The cost for you to have your own attorney is minimal, in the grand scheme of things, and provides extra protection for both you and the recipients.

Q:I am entering into an anonymous egg donation arrangement through a clinic. How can I be sure that my anonymity is maintained throughout the legal process?

The contracts can be signed using just your first names, pseudonyms or your donor identification number. There is no need for your name to be disclosed to the recipients as part of the legal process.

Q:Is there any possibility that my identity might be disclosed in the future?

It is possible that laws might change, stripping you of any desired anonymity.  In addition, while you might be able to prevent the recipient parents from doing DNA testing to identify you, the resulting child won’t be under any such restrictions.  When the child is old enough, he/she will be able to do DNA ancestry testing to possibly identify you and your family.  The reality is that there is no such thing as a guaranteed anonymous donation in today’s world.

Q:What will happen to any extra eggs that are not needed by the recipients?

In the majority of cases, fertilization of the eggs will be performed within minutes of the egg retrieval procedure, so the eggs will no longer exist in their original form. Since the resulting embryos can be frozen for many years, the recipients might have embryos remaining once their family building is complete. Any limits you wish to place on the use of these leftover embryos can be placed into your contract. For example, some donors have moral concerns about stem cell research and don’t wish leftover embryos to be used for such research; other donors don’t want leftover embryos donated to another couple for reproductive purposes.

Q:Do egg donors have any legal obligations or rights to the resulting children?

Your attorney will do his/her best to provide that you have no legal obligations or rights whatsoever to the resulting children. However, egg donation law is an evolving area of law and thus it is very important to discuss this issue with your attorney.

Q:How much will I get paid for my eggs?

Well, technically nothing. Payment is not provided for the eggs themselves; rather, compensation is typically provided for the time, effort, inconvenience and pain of undergoing an egg donation cycle. This means that your compensation should not be based on the number of eggs retrieved or whether a pregnancy results. Compensation is typically set by the clinic and/or matching agency, and may be negotiable between you and the recipients. Most agencies and clinics work within the $5000-15,000 range.  This may sound like a lot of money, but you have to consider that the average egg donor spends  whopping 56 hours participating in the donation cycle.

Q:Can I meet the recipients in an anonymous donation?

The level of contact can be whatever is mutually agreeable to all the parties. You should be aware that if a child is born, you may have an obligation to keep your address and certain medical information updated for a period of time, either through the clinic, the matching agency or the attorneys. Please talk with your own lawyer to determine what your specific obligations are with regard to this issue.

Q:What happens if the recipients fail to compensate me as we had agreed?

Many agreements specify that the donor will not begin any injectable medications until the recipients have deposited all of the funds that will be required to compensate the donor into an independent escrow account. Please discuss the specifics of your donation agreement with your attorney.

Q:Why does my husband/boyfriend need to be involved in the legal process?

It is beneficial for everyone if your partner is supportive of your decision to donate, as he is likely to be a support person for you throughout the process. He may also need to be screened for communicable diseases and agree to remain monogamous with you during the cycle. In addition, it is important to establish his legal obligations (such as the obligations regarding confidentiality and anonymity) and to ensure that he doesn’t inadvertently obtain legal rights or obligations to the resulting child.

Q:Once the legal agreement with the recipients is signed, will I need to be involved in any further legal process relative to the donation?

It is possible that your cooperation will be needed in the future for legal proceedings that are necessary to establish the parental rights of the recipients. This is more common when the recipients are also using a gestational carrier. Please talk to your attorney for specifics relative to your situation.

Ready to become an egg donor? Want to learn more about egg donation law? Get in touch for a free consult.

The post Becoming an Egg Donor FAQs appeared first on New Hampshire Fertility Law.

Want to learn more about second parent adoptions in New Hampshire. Contact me today to set up your free telephonic or video consult.

The post COVID-19 and Second Parent Adoption in New Hampshire appeared first on New Hampshire Fertility Law.

Interested in learning more about second parent adoptions? Contact me today for a free phone or video consult.

The post Second Parent Adoption in New Hampshire – More FAQs appeared first on New Hampshire Fertility Law.

Typical Second Parent Adoption Costs:

• Notarization Fee: Your signatures on court paperwork need to be notarized. Most banks will provide this service to customers at no charge. If you decide to use a remote online notarization option, budget $100 for the notary’s fee.
• Court Filing Fee: A $150 court filing fee must be paid to the Probate Division of the Circuit Court. This fee is paid per child being adopted.
• Birth Certificate Fee: A certified copy of your child’s birth certificate must be submitted to the court. A copy of a New Hampshire birth certificate costs $15. This fee will vary if your child was born outside of New Hampshire, and there may be extra costs associated with rush processing.
• Legal Fee: This is paid to your attorney for his/her services. Some attorneys charge an hourly rate, while other attorneys charge a flat fee for the entire case. Because most second parent adoptions are straightforward, I charge a flat fee for these cases. Check out the firm’s costs section for current information on legal fees.
• Certified Copy Fee: One adoption decree is automatically issued. It’s good to get a few copies to have extras for your own files–each copy is $10.

Less common costs for second parent adoptions:

• Home Study Fee: This fee is not typically applicable to second parent adoptions in New Hampshire because a home study is typically not required. FYI, a home study typically costs around $2000-3000, so I am always pleased when the judge agrees with me to skip this step.
• Apostille Fee: If you need to use your adoption decree in another country, you will need to have an apostille attached by the Secretary of State’s Office. The fee for this is $10 per document.

Ready to provide legal certainty to your family? Contact me today to learn more about the second parent adoption process.

The post Costs of Second Parent Adoption in New Hampshire appeared first on New Hampshire Fertility Law.

Infertility Insurance Basics:

What does this infertility insurance mandate cover?

This law, RSA 417-G, covers three separate segments of fertility care:

• Infertility diagnostics (to figure out why you are not getting pregnant)
• Fertility treatment (to get you pregnant)
• Fertility preservation (to preserve your eggs or sperm before you undergo chemotherapy or another fertility-impairing medical procedure)

When does this law go into effect

The law takes effect on January 1, 2020, on a rolling basis as insurance policies are renewed (although many renew effective January 1st).

Does this law apply to all types of insurance?

The law applies to group health insurance plans. Group health insurance plans are the kind you purchase through your employer. But, there’s an important caveat here: Some New Hampshire employers offer “self-funded” health plans for their employees. Self-funded health plans are not a type of insurance. Self-funded plans are not subject to the requirements of this law (there’s a federal law that prohibits the State of new Hampshire from imposing requirements upon self-funded plans, so that just simply wasn’t possible). Also exempt are two uncommon types of health plans: SHOP plans and Extended Transition to Affordable Care Act Compliant Policies.

What can I do if I have a self-funded plan through my employer?

You can ask that the company voluntarily match the fertility care benefits under the mandate. Please contact Fertility Within Reach for more information about advocating with your employer for benefits.

What about individual health insurance plans?

Individual health plans–such as those purchased on the ACA Marketplace–are not covered by this law. The individual insurance market is very fragile and legislators felt it was unworkable to impose the requirements of this law on individual health plans.

I live in Vermont but my employer is based out of New Hampshire. Am I covered under this law?

You may be. Check with Human Resources to see if the company has a New Hampshire insurance plans. Typically, a company will purchase insurance through the location of its headquarters.

Diagnosis of Infertility:

What do I need to do to qualify for infertility diagnostic care?

Coverage for the diagnosis of infertility is offered to both men and women who have been diagnosed with infertility.

How is infertility defined for diagnostic purposes?

Infertility is defined as a disease, caused by an illness, injury, underlying disease, or condition, where a woman’s ability to become pregnant or to carry a pregnancy to live birth is impaired, or where man’s ability to cause pregnancy and live birth in his partner is impaired. This definition covers both male and female infertility.

Are a certain number of attempts at trying to conceive required before insurance coverage kicks in? How many months do we have to try at home first? How does that work?

The definition of infertility does not require attempting to conceive on your own for a set period of time. The reason is that time limits are only appropriate in situations where there is no known cause of infertility. It’s pointless to make a woman born without a uterus have 12 cycles of unprotected intercourse with her husband before she can receive treatment, for example. In cases where there is no known cause of infertility, insurance companies may impose medically-based time frames before the diagnostic procedures will be covered by the law.

We are a married lesbian couple. Our insurance company is telling us we have to pay out-of-pocket for 12 “supervised” IUIs using donor sperm before we can receive insurance benefits. Is that right? The IUIs plus the costs of the donor sperm add up quickly. What can we do to challenge this?

The law provides that lesbian couples may not be subject to different requirements than opposite-sex couples. (Presumably, opposite-sex couples are not subject to this requirement of 12 supervised IUIs.) You should know that the law does not specify what kind of pre-qualification requirements would be appropriate to impose upon same-sex couples. It’s up to the insurance companies to appropriately figure out how to meet this legal standard. If you believe your insurance company is falling short of meeting this legal standard, please reach out to me so we can set up some time to talk about your options.

Are gay couples covered by the law?

Yes. Infertility is not just a female problem. Guys can be infertile too! Your fertility doctor will run some routine tests to assess whether your sperm’s ability to cause pregnancy and live birth in a woman is impaired. Check out these Surrogacy FAQs to learn more about how surrogacy works under this insurance mandate.

Are single women covered by the law?

Yes, if you are diagnosed with infertility. The insurance companies have leeway to impose pre-qualification requirements regarding your “exposure to sperm.” These requirements cannot be more onerous than the requirements imposed upon married women. If you believe your insurance company is failing to meet this legal standard, please reach out to me to set up some time to talk about your options.

Fertility Treatment:

What kinds of fertility treatment are covered under this new law?

The law provides coverage for all non-experimental fertility treatments. This includes treatments such as in vitro fertilization (IVF), IUI, ovulation induction, surgerical interventions, and medications. The medical expenses portion treatments for donor eggs, donor sperm, and donor embryos (“embryo adoption”) are all covered. Experimental fertility treatments are just that–experimental–and not yet ready for mainstream medicine. Experimental fertility treatments are not covered. An example of a currently experimental fertility treatment is uterus transplantation.

Is there a maximum age for IVF benefits under this new law?

There is no set age limit in the law, because that would arbitrarily determine who does and does not receive coverage. IVF coverage decisions are made based on medical factors only, which may include consideration of the woman’s FSH and AMH levels. Unfortunately, traditional IVF is not an appropriate treatment for many women in their 40s, as the likelihood of a live birth resulting is too low. These women should talk to their doctors about whether they are appropriate candidates for egg donation or embryo donation (“embryo adoption”), instead.

How many cycles of IVF are covered under this law?

There is no maximum limit on the number of cycles that must be covered. This does not mean that an unlimited number of IVF cycles must be paid for. Rather, it means that limits cannot be based on arbitrary factors, and must instead be based on medical criteria and the patient’s own medical history.

Are donor eggs covered?

Yes!! The medical expenses related to donor egg treatment are covered– this includes screening, medication, monitoring, egg retrieval. This applies both to known and anonymous arrangements.

Are there any donor egg expenses I will have to pay out of pocket?

Non-medical expenses are always your out-of-pocket responsibility. Examples would be: the donor’s compensation, the agency’s fee, travel expenses for the donor, legal fees. You may be able to deduct some of these out-of-pocket costs on your federal tax return–please discuss this with your tax professional.

Is sperm donation a covered treatment?

Yes, sperm donation is covered. This includes both anonymous sperm bank arrangements and known donor arrangements. Please be aware that only medical expenses related to donor sperm are covered.

Are lesbian couples using donor sperm covered?

Yes, provided that you have a diagnosis of infertility, meaning that your ability to become pregnant or to carry a pregnancy to live birth is impaired (see above for what that means in the context of a lesbian relationship).

Is gestational surrogacy covered under this law?

Yes. Intended Parents pursuing gestational surrogacy are able to receive certain insurance benefits such as making embryos. Embryo transfers to a gestational carrier are not mandated coverage. For more information, check out these FAQs geared specifically towards surrogacy and insurance coverage.

Fertility Preservation:

Help! I was just diagnosed with breast cancer and am having surgery tomorrow. I will start chemotherapy a few weeks later. I have the opportunity to undergo fertility preservation through egg freezing before I start chemo. Does this infertility insurance law apply to women who need to freeze eggs before starting chemo?

Yes. This is exactly the type of situation that was contemplated in creating this fertility preservation benefit.

What about a man who is about to start chemotherapy for cancer? Can a man freeze his sperm?

Yes. Many people think the sperm preservation process is easy, but there are actually a bunch of logistical steps involved. These steps are covered up through the initial storage period.

What about storage costs for cryopreserved eggs and sperm?

Insurance companies must, at a minimum, cover short-term storage costs until the insurance policy term ends. Beyond that, long-term storage is the responsibility of the patient. The good news is that there are grants out there to help with storage costs. Check out Fertility Within Reach and New England Surrogacy’s resource page.

I’m not quite ready to have kids yet, mostly because I haven’t yet met the right guy. But I’m 32 and I know my fertility will soon be taking a hit. So I’d like to freeze my eggs for later use. Will this be covered?

Fertility preservation, including egg freezing, for non-medical reasons is not covered. If you have a medical reason for needing to preserve your eggs, such as premature ovarian insufficiency (POI), then you might be able to receive insurance benefits.

I’m going to be transitioning from male to female gender. I’d like to freeze some of my sperm before I undergo the transition process. Is this covered under the new law?

As long as your transition involves a medical treatment with a risk of impairment of fertility (and most do!), you can qualify for insurance benefits under this law. These means the expenses associate with freezing your sperm are covered, except for long-term storage which you are responsible for on your own. The same applies for female to male transition.

Limitations on Coverage:

I’m 42 and my doctor is recommending that I pursue donor egg treatment, but my insurance company is refusing to pay because I’m over the age of 40. My insurance company says menopause is a natural female condition and thus I have no insurance benefits. Is my insurance company correct?

The law was written with the intention that donor egg treatment be covered at all ages, when medically appropriate. Please reach out to me so we can set up some time to talk more about this issue and what you can do.

I’m purchasing frozen eggs from a donor egg bank. My IVF clinic tells me that insurance won’t pay for any of my treatment because donor eggs are never covered. Is that right?

The law does not permit an arbitrary exclusion for frozen donor eggs. The problem you run into is that the cost for a batch of donor eggs lumps together both medical expenses related to the egg retrieval and non-medical expenses. The insurance company is only obligated to pay for medical expenses, so it’s unclear at this time how this will be sorted out. The medical expenses that occur post-thawing should be covered under the law. This would include the fertilization of the eggs and culturing the embryos in the laboratory.

I’m a cancer survivor. The treatment for my cancer was a partial hysterectomy–the removal of my cervix and uterus. I’m ready to pursue having a baby through surrogacy. Since I still have my ovaries, I’d like to proceed with egg retrieval. My insurance company is refusing to pay, claiming that I was “voluntarily sterilized.” I don’t consider my hysterectomy voluntary by any means–my options were to remove my uterus or die of cancer. Can my insurance company really get away with this?

Your type of situation is generally referred to as elective because, it was non-urgent. An urgent hysterectomy would be the kind performed on a woman who is hemorrhaging post-birth and needs immediate life-saving treatment. But your hysterectomy doesn’t feel elective, does it? The law was written with the intention that medically-necessary hysterectomies, such as yours, not be treated as “voluntary sterilization.” If your insurance company is giving you a hard time about this, then let’s talk–consults are always free.

My husband had a vasectomy during his first marriage. I always knew I wanted kids, so he had the vasectomy reversed after we got married. The reversal was successful but I still couldn’t get pregnant. I went for a fertility workup, and it turns out I have premature ovarian insufficiency at age 34. My doctor strongly recommended I pursue IVF as my best option to have a genetic baby of my own. But my insurance company refuses to approve the IVF cycle because my husband had a voluntary sterilization (before I even met him!!). Can the insurance company do this?

Nothing in the fertility insurance law authorizes an insurance company to limit an individual’s treatment coverage based on the fact that a spouse had a voluntary sterilization procedure. Please contact me so we can discuss this further.

My wife and I need to pursue IVF (with ICSI) because I have a very low sperm county. Our reproductive endocrinologist assures us that we have a very good chance at having a baby through IVF using ICSI. Our insurance company refuses to authorize IVF and ICSI because there is no evidence that my wife is infertile. The insurance company is requiring that we “prove” my wife’s infertility through 12 cycles of IUI using donor sperm before we can be approved for IVF with my sperm. I’m not necessarily opposed to using donor sperm, but I feel like that’s a decision for my wife and I to make for ourselves. I don’t think it’s the insurance company’s place to require us to use donor sperm. Is the insurance company out-of-line here?

The law specifically recognizes the fact that infertility can be diagnosed in a man when he is unable to cause pregnancy in his partner. The law does not require that the man’s female partner also be infertile in order for the man to receive medical care appropriate for his male factor infertility. Get in touch to schedule some time to talk so we can go over your options moving forward.

My boyfriend and I have been in a committed relationship for ten years. We have been unsuccessful at conceiving a baby together on our own. Our diagnosis is “unexplained” and my doctor recommends we try three cycles of medicated IUI before thinking about IVF. Medicated IUIs are not cheap, so we’d like to have insurance coverage. The problem is that insurance refuses to pay because my boyfriend and I are not married. Can they really exclude us for not being legally married?

The law does not allow different benefits to be provided to unmarried couples and married couples.

Insurance Denials & Appeals

What are my next steps if my insurance company denied coverage for my fertility care?

If your insurance claim is denied, you have the option of filing an appeal. You can also file an appeal if your insurance company refused to pre-authorize your treatment (this is something that often comes up with IUI and IVF cycles). The appeals process involves, at a minimum, two levels of appeal. If you are seeking coverage for fertility preservation prior to chemotherapy (or have other urgent circumstances), an expedited appeal process is available. Other options may also be available to you, depending on the nature of your issue.

I can assist you with navigating the appeal process, for a low fixed fee. I can also assist you by providing more comprehensive representation during the full appeal process, if you prefer.

If you want to set up a free consult to talk about insurance (or anything else fertility law related), get in touch.

The post New Hampshire’s Infertility Insurance Law FAQs appeared first on New Hampshire Fertility Law.

I’m proud to be a board member of RESOLVE New England (RNE), our local infertility support and advocacy organization. 

RNE has never been afraid to flip the script by challenging things that are wrong.  Whether it is legally wrong, morally wrong, or just unfair, RNE has been there to flip the script.  To turn bad legislation into good laws.  To stop unfounded insurance denials.  To expand infertility insurance coverage.  To create an even playing field for families being formed via egg and sperm donation. 

There are simply no roadblocks that will stand in RNE’s way to achieve equitable and affordable access to fertility treatment for all patients in New England.

At New Hampshire Surrogacy & Fertility Law, we are also always ready to “flip the script”.  Thanks to my advocacy efforts, we’ve changed New Hampshire from a “surrogacy no go” state to a “surrogacy friendly” state.  We were also, under my direction, the first New England state to adopt a comprehensive parentage law regarding the parentage of children conceived via egg donation, perm donation, and embryo donation. 

We look forward to connecting with you as we continue to “flip the script” with RESOLVE.      

The post Flip the Script for National Infertility Awareness Week! appeared first on New Hampshire Fertility Law.

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One of the things that a LGBTQ+ lawyer can do for you is to evaluate your legal risks based on the particulars of your situation.  We can then offer solutions for moving down the spectrum to a lower risk level.   Every situation is unique, so it really is impossible for us to create a blanket solution that applies to all LGBTQ+ families.

An example would be a female couple from New Hampshire who relied upon a family friend as their known donor.  A second parent adoption, in New Hampshire, can be used as a way to cut off whatever residual rights the sperm donor may still have.  A bonus is that the adoption would also strengthen the non-biological mom’s parent rights.  But, the right solution may well be different if the couple lives in another state.

These situations can be legally tricky so it’s important to work with an attorney who is highly familiar with LGBTQ+ parentage law.  Most general family law lawyers don’t have this expertise.

Attorney Catherine Tucker wrote the parentage laws currently on the books in New Hampshire.  She is also the only New Hampshire member of the Family Law Institute, a prestigious invitation-only collaboration between the National Center for Lesbian Rights and the National LGBT Bar Association.

Contact us today so that we can evaluate where you fall on the risk spectrum–initial phone consultations are always free.

The post LGBTQ+ Parental Rights: The Spectrum of Risk appeared first on New Hampshire Fertility Law.