Knocked Up Podcast - Big Miracles and Fertility for Singles with Dr Daniel Lantsberg
With Big Miracles back on TV for 2025, we speak to Dr Daniel Lantsberg, featured in the channel 9 show "Big Miracles" with his patient, Anna.
With Big Miracles back on TV for 2025, we speak with one of the Doctors featured in the series, Dr. Daniel Lantsberg.
Dr. Daniel Lantsberg is a Fertility Specialist at Melbourne IVF. After graduating with honors from Israel's Ben Gurion University in 2008, he completed extensive training at world-class Israeli hospitals before relocating to Australia for an additional three-year subspecialty fellowship at the Royal Women's Hospital and Melbourne IVF. With special interests in elective egg freezing, age-related and unexplained infertility, male infertility, PCOS, endometriosis, and fibroids, Dr. Lantsberg maintains private practice in East Melbourne while holding public appointments at the Royal Women's Hospital where he trains junior doctors.
Anna is a 39-year-old woman pursuing life as a Single Mother by Choice (SMBC). Her journey highlights the unique medical and emotional considerations involved, from selecting fertility treatments appropriate for solo parents to navigating Victoria's specific regulations regarding donor sperm access, which differ from other Australian states. The show documents how Daniel guides patients like Anna through critical decisions about known versus clinic recruited donors while addressing common concerns about single parenthood.
Hosted by Dr Raelia Lew and Jordi Morrison
Dr Raelia Lew is a RANZCOG Board Certified CREI Fertility specialist, Gynaecologist and the Director of Women’s Health Melbourne.
Find us on Instagram - @knockeduppodcast
Have a question about women's health? Is there a specific topic you'd like us to cover? Email podcast@womenshealthmelbourne.com.au. We keep all requests anonymous.
TRANSCRIPT
Jordi Morrison:
Hello, and welcome to Knocked Up, the podcast about fertility and women's health. You are joined as always by me, Jordi Morrison, and Doctor Raelia Lew, CREI fertility specialist. Welcome, Raelia.
Dr Raelia Lew:
Hi, Jordi.
Jordi Morrison:
And we are joined today by a very special guest, Doctor Daniel Lantsberg. Hi, Daniel.
Dr. Daniel Lantsberg:
Hi, Raelia. Hi, Jordi. It's good to be here.
Jordi Morrison:
So great to have you, Daniel. Before we tell our listeners why you're joining us, do you wanna tell us a little bit about yourself?
Dr. Daniel Lantsberg:
My name is Daniel. I'm married to Einat, the love of my life, who I met in med school. I've got three beautiful children. We are originally from Israel, where I also did my general obstetric and gynecology training, and we also practiced as a fertility specialist before relocating to Melbourne almost six years ago.
Dr Raelia Lew:
And that's where I met you, Daniel, when you came to work at the Royal Women's Hospital.
Dr. Daniel Lantsberg:
Yes. And I still remember our first encounter and how welcoming you were. It’s been an amazing experience, and I still work at the Royal Women's as a specialist there. And I also work at Melbourne IVF where I've been practicing for several years, helping couples and single women become parents.
Jordi Morrison:
And that leads into why we're talking to you today, Daniel—helping single women become parents, but a bit of a special case.
Dr. Daniel Lantsberg:
Yeah. Absolutely. Today, we're going to be talking about Anna, who's featured in the TV show Big Miracles airing on Channel Nine. And Anna is a woman who was almost 40 when she came to see me, and she really wanted to take charge of her own journey to motherhood.
There's a bit more to her story than what we can see on TV because she had a marriage breakdown. And after the relationship ended, she wanted to have options to have children in the future. So she actually, at the age of 36, decided to freeze her eggs, and she managed to freeze nine eggs at the age of 36. And she came to see me actually a few years later, almost turning 40, and she said she was ready to become a single parent by choice.
Anna wanted to maintain an option for a second child. So whether it's with a future partner or whether it's on her own, she decided to keep her frozen eggs and basically embark on attempts at conception with her 39-year-old eggs. Her journey is a great example how many women reassess their plans after a major life change and take proactive steps to keep the future family options. And it's not necessarily about just having a child, but planning her future family.
Dr Raelia Lew:
I think that's a great point to make, and it's a discussion that fertility specialists like Daniel and myself have on a regular basis when a patient who has frozen their eggs comes back to try and conceive. We have to think about the context of their circumstance and their desired family size over time.
Sometimes it's the right thing to do to go straight for the frozen eggs, and sometimes we like to retain them to keep more options on the table for the future. Particularly, when a patient is at an age where trying with her own eggs now is reasonable, but also at an age where with the passage of time, trying with her own eggs for a second child might be implausible, and having those frozen eggs from when she was younger might be her best chance of a second baby.
Dr. Daniel Lantsberg:
Absolutely, Raelia. And that's the kind of discussion we had at our first appointment. We talked about her very specific circumstances where at the age of 39, she had a lower ovarian reserve, and we knew that would be a challenge in itself.
Her AMH was three, and as we know with the AMH being this low, this may pose quite significant challenge for stimulation in the process of IVF. But at the same time, we didn't really know what her fertility capacity was. We didn't know if she was infertile, and she wanted to give her eggs a try before resorting to a backup plan, which is to use her frozen eggs.
And we had to have a holistic approach to her family goals because if we wanted to focus just on success and just on getting her pregnant as quickly as possible, using her frozen eggs would have given her a much better chance. But if we were to look at her family goals, keeping her frozen eggs will give her a lot of options for the future.
Dr Raelia Lew:
I think that's a really great point. When we talk to our patients in IVF, it's not just about illness, wellness, biology, and science. It's also strategy in terms of what we do, and we can play our cards in different ways to help our patients achieve the outcomes that they want.
Dr. Daniel Lantsberg:
Yeah. Absolutely. And in our clinic, we often see women at different crossroads in their life, whether it's after a long-term relationship ended or unexpected life change. And I think it's important that during that initial consultation to spend time to discuss person's hopes, values, challenges they face. And I'm glad to say that with Anna, it was a very straightforward and honest conversation that made it very clear. She's ready to move forward to single parenthood, but she wants to keep her future options open.
Jordi Morrison:
I wanna ask about becoming a single mother by choice and the process around sperm, because there's a few options available—known donor or anonymous donor. How is this explored, and how do the options work?
Dr. Daniel Lantsberg:
Here in Victoria and specifically at Melbourne IVF, we offer a couple of ways to access donor sperm. As you mentioned, option one would be a clinic-recruited sperm donor. These are donors that are prescreened through our program. And I'm happy to say that currently at Melbourne IVF, the waiting times are just a few weeks.
Dr Raelia Lew:
That’s incredible.
Dr. Daniel Lantsberg:
That's incredible recovery because COVID really impacted that.
Dr Raelia Lew:
Correct.
Dr. Daniel Lantsberg:
So in the past, waiting times were very significant, and that impacted a lot of women and also couples requiring donor sperm and opted them to choose different alternatives, whether that's going overseas, accessing different donor banks. And now I'm happy to say that we are in a very fortunate position to be able to offer clinic-recruited sperm donors at a very short period of time.
And it's no secret that in Australia, recruiting donors can be quite challenging, mainly due to the fact that donors in Australia are required to be altruistic in nature, meaning that they do not get paid or funded in any way, shape, or form, and they're only donating out of the kindness of their heart. And we are very, very fortunate to have a bank where we continuously recruit more and more donors here in Victoria from males who are looking for their own way to give back to society and help single women and same-sex relationships, also heterosexual couples requiring sperm donors. This would be one pathway.
There is an alternative pathway, and some come to us already with a known donor that they have chosen. It might be somebody they know or somebody they met or within the family circle, but they already know who they want their donor to be. And we would guide them and help them in processing this medically, but also in other aspects of going through this important yet very nuanced challenging time in the family-building process.
Dr Raelia Lew:
And we have lots of different episodes of Knocked Up. One of them was with Diana Elsner, family lawyer, and she went through some of the legalities around sperm donation and including private donation.
I guess it's important to mention for anybody considering sperm donation as a single person, that when you do go through an IVF unit, like Melbourne IVF, the process of preparing a sperm donor is very robust. We would expect that an IVF unit would organize a whole gamut of medical tests, as well as the genetic assessment of the donor and also screen the donor for all manner of infectious diseases that it's possible theoretically to pass on through sperm.
Sperm is also quarantined for at least three months. And by that, I mean, it's frozen and kept in storage and then donors are retested after that time for infectious diseases that can very occasionally fly under the radar due to a delay in what we call seroconversion. An example is HIV virus, which can sometimes have a delayed appearance in the bloodstream. So it's very, very cautious for the protection of the person receiving the sperm.
And we also, during that time at IVF units, ensure that donors are counseled extensively so that they're very aware of their rights and obligations. And also, they've had the time to explore emotional impacts of becoming a donor so that they're very comfortable with their decision. And what that means is that they can give true informed consent.
Another important aspect of sperm donation through an IVF unit is the fact that we can very carefully these days control the number of families that are created from a single donor’s altruistic donation. And we take that responsibility very seriously. And you may have heard through different documentary series about how things may have gone wrong in the past, where a single donor has fathered many, many children. And we take that responsibility very seriously these days. And that does not happen in modern practice.
Dr Raelia Lew:
It takes quite a while to prepare a clinic donor. It takes several months to go through the process — somewhere between three and six months is quite normal. And that's the same time that it takes to prepare a known donor. But when we prepare a known donor, it's upfront and a priority so that if a single person comes to see a doctor like Daniel or I, and they have a donor in mind, when they consider their timeline to pregnancy, it's important to keep that in mind also — that it may take three at the minimum to six months, usually at the maximum, to prepare a donor.
Depending on how complicated results of tests may be and whether secondary investigations may be required. And also just in terms of the reality of medical practice — attending appointments, organizing mutually convenient times — these things can drag out a little bit.
Dr. Daniel Lantsberg:
And this is also where quarantine of sperm comes into play. And that's quite a rate-limiting step because what we require is for the sperm to be in quarantine for three months prior to using it. And what I mean by quarantine is that we collect the sperm, and at the time of sperm collection, we also assess for infectious disease. Some of these infectious diseases can manifest in the bloodstream only a few months later. So to ensure that the recipient is not at risk of contracting an infectious disease from the sperm, we reassess these infectious diseases after three months, at which time if the donor is cleared, we can release the sperm from its quarantine and actually use it in a safe manner.
And this is one practice that is really important and key to ensuring the safety of everyone involved. There have been cases before these guidelines were in place where women or also pregnancy itself with a fetus can contract an infectious disease as a result of the donation process. And this, unfortunately, type of practice can also happen when at-home donation is done not using a clinic that has strict guidelines and rules that we have to follow to ensure the safety of our patients.
Dr Raelia Lew:
Daniel, let's talk a bit more about that just for our listeners because I think it might not be widely appreciated that some people do try to get pregnant with a, quote unquote, sperm donor outside of a clinic setting. What from your perspective would be the pros and the cons of that approach compared to having treatment under the care of an IVF doctor?
Dr. Daniel Lantsberg:
I think primarily first, you talk about the legal framework of going outside of clinic, and you talked about that in your previous episodes. And I think that's really key because donation, as smooth as it may appear doing it in your own space with somebody who you may consider a friend or a colleague or even a distant family member or partner or whatever that may be, may pose quite significant legal challenges later on as things may get more complicated.
Having a framework where everything is well-defined and guided throughout this process in an IVF clinic is key to ensure everyone's favorable outcome.
From a medical perspective — and this is the area where I feel more comfortable speaking about — we ensure many aspects of conception are optimized. And we talked just a minute ago about infectious disease, and Raelia, you mentioned genetic screening, which is really, really important and key because we can have cases where this has not been discussed. And we know that in one in fifty cases of a donor and a random one trying to conceive, there would be a risk of having a child affected by a recessive genetic condition — something that could have been picked up by routine genetic carrier screening — and a risk could have been avoided by doing genetic testing on embryos or by addressing this during the pregnancy itself to test the baby.
Dr Raelia Lew:
Or by just choosing a different donor. Because when you're in a relationship and you're committed to putting sperm and egg together with a certain person, you know, we might go down that road of genetic testing of embryos or testing a pregnancy and having to make serious considerations about continuing or discontinuing a pregnancy.
But if you're a single woman choosing a donor, you could alternatively just choose a different donor who wasn't a clash genetically with your DNA.
Dr. Daniel Lantsberg:
Absolutely. And this is just another key aspect. We talked about safety — whether that's genetic safety or infectious safety. We talked about legal ramifications of this, but there's also outcome differences between home insemination and optimizing fertility treatment. It's not always safe to assume that there are no barriers to conception.
Dr Raelia Lew:
I would also think that in this case with Anna, as she's approaching 40, even more so IVF would be the better option.
Dr. Daniel Lantsberg:
The success rates of insemination, whether they're done at home or through a clinic at the age of 40, unfortunately, drop quite significantly to below ten percent per attempt. And sometimes this would be discussed. Anna was 39 when she came to the clinic, and we discussed success rates from inseminations.
And there are some advantages to attempting inseminations at such an age. Our approach has to be individualized. For many women, the first step would suggest IUI or intrauterine inseminations. It's a more affordable option compared to IVF. There are less medications involved, and if gonadotropins — so stimulating hormones — are used, they're usually used at much lower doses, reducing the side effects.
But there are also risks to doing this, and these also need to be discussed. Success rates from IVF are obviously significantly higher but are also more expensive. They're more invasive. They require a procedure to collect eggs.
But as I said, it's all about personalizing the intervention to optimize success rates. And at the same time, looking at a person's own goals and approach to this process. Some are really reluctant from an invasive intervention. And some are looking to conceive as quickly as possible and possibly even having a chance to have more than one child. This all has to be personalized to the patient's circumstances.
Dr Raelia Lew:
Daniel, you and I, due to the fact that medical training is long, have been working in this area for a long time now. How do you think from your perspective society's perception of single parents by choice has changed from when we started to where we're at today?
Dr. Daniel Lantsberg:
I'm very, very glad that we're seeing this societal change in perspective on what a family needs to look like. What in the past was perceived like a heterosexual couple having children — nowadays, there is a lot more acceptance and a lot more openness to families that come in all shapes and sizes. And the whole spectrum is a lot more acceptable, and people take charge of their own destiny and make choices to build the family they want to have.
This coincides with my own personal values — that everybody deserves the opportunity to have the family they want to have. And I think we're very, very fortunate to live in a country where this is not only accepted, but also very accessible. It's accessible to all, and there are no legislative barriers that deprive any sector from achieving or striving for the family they want to have.
Dr Raelia Lew:
Yeah. So I guess shout out to any listeners who are thinking about exploring the option of having a baby in whichever way that could happen for you. Don’t feel like there’s a barrier to you achieving your goals that is based on your sexuality, your relationship status, or your age necessarily. We do know fertility declines with age and there’s a particular window if we want to have a family that’s biologically plausible — and there’s no reason if you’re in that window and you’d like to explore those options that you absolutely have to do so with a partner.
And I feel like this is a time where we need to shout out to one of our teachers — both Raelia’s and myself — Professor John McBain, who was one of the pioneers of IVF in Australia. I had the huge fortune to get to work a little bit with him towards the end of his IVF career, but he's been a huge influence and impact on our ability to say everything that we just said — about all people having access to fertility treatments, all forms of family creation, and irrespective of sexuality or relationship status.
Dr. Daniel Lantsberg:
And I think a huge thank you to him for taking on this huge landmark Supreme Court case.
Dr Raelia Lew:
Yeah. It was John McBain versus the State of Victoria. And what that was, was the, I guess, demolition of the law that prohibited IVF use outside of a heteronormative circumstance.
Dr. Daniel Lantsberg:
Yes. Incredible.
Jordi Morrison:
I'd like to ask — and maybe this is for both of you — what are the common questions or concerns that you hear from patients who come to you who are pursuing solo parenthood?
Dr. Daniel Lantsberg:
The biggest concern that I see from most people accessing donor sperm is not knowing all the information they would have preferred to know about their donor. When accessing donor sperm in Victoria, the information provided includes general physical features like weight, height, hair and eye color, skin tone, and also some information about their personality, hobbies, profession, and age. But this doesn’t always truly depict a person's personality, and there is always some concern around that.
I'm happy to say that at Melbourne IVF, we do attempt to think of every potential donor as somebody that we would have felt comfortable had we needed to receive a donor ourselves. And we respect the wide spectrum of personalities and appearance and physical features. But at the same time, we want to feel that we are comfortable with this particular donor to create babies for people who are seeking to use donor sperm.
Dr Raelia Lew:
There is some level of reassurance there, I think. And there are some criteria, Daniel, that maybe you can elaborate on — for someone who might be rejected as a potential sperm donor.
Dr. Daniel Lantsberg:
Yeah. So the first is for medical reasons. So anyone with a genetic diagnosis or illness that is associated with hereditary passing to an offspring — even if it's not a single specific single gene — those would be excluded straight away.
Also, the donors go through a counselling session and other aspects of their personality are assessed, and there could be criteria where a donor would seem to be donating for the wrong reasons, or we feel that it is unsafe for that donor to become a donor because of their motives or because of other aspects that could potentially impact the future offspring.
Dr Raelia Lew:
What about psychological diseases like schizophrenia or severe depression?
Dr. Daniel Lantsberg:
These have to be disclosed. And in cases where we feel there is no clear linkage between father and offspring, but rather an increased risk to an offspring, these donors could either be discussed in a donor committee for assessment whether they would be approved to become a donor. And if they are, this information is disclosed to the recipient, and they may choose to select that donor, or they may decide that they would rather use a different donor because of the risk associated.
For example, you mentioned schizophrenia. We know there's an association in families, but definitely not a causality. A recipient may choose to still select a donor that has schizophrenia or ADHD or spectrum disorders or depression. From our experience, we know that these donors are most of the time not selected often by potential recipients because I think we all want to imagine giving the pregnancy the best chance of having a healthy child.
But circumstances may change for different people, and priorities may change for different people. And people sometimes come themselves struggling with such conditions and say that they're having a healthy, valuable life that is worth living, and they would be okay having a child that is struggling with a similar condition. It is a choice.
Dr Raelia Lew:
I think the key point here is transparency. When the donor has any issues raised in their psychological assessment or physical, medical assessment, this is disclosed to the recipients and they get to choose.
Dr Raelia Lew:
I think another thing that recipients of donor sperm worry about is that they might end up being many siblings or half-siblings in the community that share 50% of their DNA with their children because the donor has donated in other contexts to other families. How do you counsel women regarding that concern?
Dr. Daniel Lantsberg:
I think it's a valid concern, but more so in the past when we had no regulation around this. Nowadays, a donor is limited to 10 families. In the context of Victoria, which has a huge, wide population, the chance of encountering a sibling or half-sibling is considered to be quite low.
And that is also why at the age of 18, they could also access the national registry, and they can see who the donor is and have some reassurance in case of any suspected situation where they might encounter a half-sibling — whether that's in a romantic relationship or any other. So I think that puts some relief on women accessing donor sperm in that context.
Dr Raelia Lew:
Daniel, we’ve been so excited to cheer for you on the show Big Miracles. What has your favourite part been?
Dr. Daniel Lantsberg:
I think watching the show, I get to see a side of Anna that I don’t get to see in my clinic or in theatre or in the procedure room. Although we've come to know each other across the time she has been my patient — and if you want to see how this ends for her, you'll need to tune in — but there are very interesting things to come ahead, and it has been a journey for Anna.
But to get to see the other side of how she experiences her journey with her family and friends, what she looks like when she gets a call, and with the results — that's something I don't get to experience.
Dr Raelia Lew:
Yes. That's so exciting. You’d have no idea.
Dr. Daniel Lantsberg:
Absolutely right. And it’s a constant reminder for myself doing what I do and with the great passion that I have for my job is that every person coming into my office has a story, and everything that happens here in this space has a continuous echo that goes far beyond what I can see.
And I always try to engage in a conversation that goes beyond just the fertility treatments because I get, I think, a lot of reward understanding what my patients go through, and I get to relate to that, and I establish a relationship with them. And when something good happens, I don't really feel my own success, but I rather have the joy together with them for their success.
Jordi Morrison:
Thank you, Daniel. We can't wait to watch Anna's story play out on Channel Nine, Wednesday night. And you can find Daniel on his social media channels or at Melbourne IVF.
To support Knocked Up, leave us a review or recommend to a friend. Join us on Instagram at @knockeduppodcast, and join Raelia at@drraelialew, and email us your questions to podcast@womenshealthmelbourne.com.au.