Have you been told you need donor eggs? Many women are encouraged to consider donor eggs by fertility clinics. First, let me say that I personally know three women who had babies using donor eggs,
and they collectively have five beautiful children. However, using donor eggs is a big decision which requires much thought.
I was given the option of using donor eggs when I went through fertility treatments, however, aside from the exorbitant cost
of paying for the donor and all the associated expenses,
I couldn't get used to the idea of having a third party involved.
Here are some things to think about when using donor eggs:
1. Many fertility clinics have age cut-offs for women in their 40's unless they're using donor eggs.
If you have unexplained infertility in your 40's, donor eggs are probably going to work as well
in a year or two from now as they will if you used them today (assuming you are in good health).
TTC naturally may be worth a try first.
2. Before you embark on fertility treatment with donor eggs,
you may want to think about what you are going to tell relatives and friends about your child. Your
child may not want everyone knowing that they were conceived with a donor egg.
3. Is the donor going to remain anonymous?
I know one couple who found their donor through an ad in the paper and they have a
lengthy legal contract with the woman who donated the eggs.
They all met and know each others names, etc.
4. What about the egg donor?
Many of these women are young college-age students, who may be lured
in with the money and they don't really understand the risks of taking fertility
drugs...knowing what I know now about fertility drugs and the complications I suffered,
I would never put myself through that for any amount of money. I wouldn't want to put anyone else through it either.
5. I know at least two women from when I ran an infertility support group who were told to consider donor eggs. Both of these women ended
up getting pregnant naturally. One was in the process of saving up for the procedure when she got pregnant on her own and the other had a similar
situation. Using a donor is a big step, be sure you've exhausted all other possibilities first.
When undergoing IVF whether through a donor or with your own eggs,
many couples have extra embryos which are frozen. Some actually have quite a few.
You have a number of options. You could have them destroyed (basically, they thaw them out,
then discard them). You could implant them to see if they “take”.
If you’ve completed your family, you could donate them.
All of these things are hard decisions to make.
I know one couple that did
an IVF cycle with donor eggs from a 21 year old woman. They harvested quite a
few eggs and they ultimately got pregnant with twins. There were four extra embryos
left over that were frozen. There were quite a few complications during the twin pregnancy but fortunately, the twins were born healthy. The mother was advised not to get pregnant again because of some damage to her uterus. The couple had a major dilemma on their hands because they had four extra embryos and they could not undergo another procedure. They absolutely did not want to have the embryos discarded. Last I heard, the couple was saving up their money to implant the 4 frozen embryos but this time they were looking at using a surrogate. They may even need to do two cycles with a surrogate depending on whether or not their RE was willing to implant all four embryos at once or only a couple at a time. You can see how complicated this situation has become. In addition, if you donate your embryos to another couple and a pregnancy results, you will have to decide and agree upon whether or not you will stay anonymous, whether the child may contact you, etc. Additionally, you have a different biological “mother” of the egg.
If you can’t make up your mind about what to do with your frozen embryos, you can continue to have them stored, however this can be quite expensive and can amount to hundreds of dollars in ongoing storage fees.
See also this article on how donated eggs may lead
to a higher rate of miscarriage:
(If you are entering this site on this page, please click on the "Home" button to the left for my story,
my articles, my blogs on fertility over 40, pregnancy over 40, miscarriage/recurrent miscarriage
and how to order "You Can Get Pregnant Over 40 Naturally" book, DVD and CD.)
For many women, disease and/or diminished ovarian reserve precludes achieving a pregnancy with their own eggs. Since the vast majority of such women are otherwise quite healthy and physically capable of bearing a child, egg donation (ED) provides them with a realistic opportunity of going from infertility to parenthood.
Egg donation is associated with definite benefits. Firstly, in many instances, more eggs are retrieved from a young donor than would ordinarily be needed to complete a single IVF cycle. As a result, there are often supernumerary (leftover) embryos for cryopreservation and storage. Secondly, since eggs derived from a young woman are less likely than their older counterparts to produce aneuploid (chromosomally abnormal) embryos, the risk of miscarriage and birth defects such as Down's syndrome is considerably reduced.
Egg Donation-related, fresh and frozen embryo transfer cycles account for 10%-15% of IVF performed in the United States. The vast majority of egg donation procedures performed in the U.S involve women with declining ovarian reserve. While some of these are done for premature ovarian failure, the majority are undertaken in women over 40 years of age. Recurrent IVF failure due to "poor quality" eggs or embryos is also a relatively common indication for ED in the U.S. A growing indication for ED is in cases of same-sex relationships (predominantly female) where both partners wish to share in the parenting experience by one serving as egg provider and the other, as the recipient.
Ninety percent of egg donation in the U.S is done through the solicitation of anonymous donors who are recruited through a state-licensed egg donor agency. It is less common for recipients to solicit known donors through the services of a donor agency, although this does happen on occasion. It is also not easy to find donors who are willing to enter into such an open arrangement. Accordingly, in the vast majority of cases where the services of a known donor is solicited, it is by virtue of a private arrangement. While the services of non-family members are sometimes sought, it is much more common for recipients to approach close family members to serve as their egg donor.
Some recipients feel the compulsion to know or at least to have met their egg donor, so as to gain first hand familiarity with her physical characteristics, intellect, and character. This having been said, in the U.S. it is much more common to seek the services of anonymous donors. In terms of disclosure to their family, friends and child(ren), recipients using anonymous donors tend to be far more open than those of known donors about the nature of the child's conception. Most, if not all, egg donor agencies provide a detailed profile, photos, medical and family history of each prospective donor for the benefit and information of the recipient. Agencies generally have a website through which recipients can access donor profiles in the privacy of their own homes in order to select the ideal donor.
Interaction between the recipient and the egg donor program may be conducted in-person, by telephone or online in the initial stages. Once the choice of a donor has been narrowed down to two or three, the recipient is asked to forward all relevant medical records to their chosen IVF physician. Upon receipt of her records, a detailed medical consultation will subsequently held and a physical examination by the treating physician or by a designated alternative qualified counterpart is scheduled. This entire process is usually overseen, facilitated and orchestrated by one of the donor program's nurse coordinators who, in concert with the treating physician, will address all clinical, financial and logistical issues, as well as answering any questions. At the same time, the final process of donor selection and donor-recipient matching is completed.
Egg donor agencies usually limit the age of egg donors to women under 35 years with normal ovarian reserve in an attempt to minimize the risk of ovarian resistance and negate adverse influence of the "biological clock" (donor age) on egg quality.
No single factor instills more confidence regarding the reproductive potential of a prospective egg donor than a history of her having previously achieved a pregnancy on her own, or that one or more recipients of her eggs having achieved a live birth. Moreover, such a track record makes it far more likely that such an ED will have "good quality eggs". Furthermore, the fact that an ED readily conceived on her own lessens the likelihood that she herself has tubal or organic infertility. This having been said, the current shortage in the supply of egg donors makes it both impractical and unfeasible, to confine donor recruitment to those women who could fulfill such stringent criteria for qualification.
It is not unheard of for a donor who, at some point after donating eggs, finds herself unable to conceive on her own due to pelvic adhesions or tubal disease, to blame her infertility on complications caused by the prior surgical egg retrieval process. She may even embark upon legal proceedings against the IVF physician and program. It should therefore come as no surprise that it provides a measurable degree of comfort to ED program when a prospective donor is able to provide evidence of having experienced a relatively recent, trouble free spontaneous pregnancy.
Screening of Donors
Genetic Screening: The vast majority of IVF programs in the U.S. follow the recommendations and guidelines of the American Society of Reproductive Medicine (ASRM) for selectively genetic screening of prospective egg donors for conditions such as sickle cell trait or disease, thallasemia, cystic fibrosis and Tay Sachs disease, when medically indicated. Consultation with a geneticist is available through about 90% of programs.
Most recipient couples place a great deal of importance on emotional, physical, ethnic, cultural and religious compatibility with their chosen egg donor. In fact they often will insist that the egg donor be heterosexual.
Psychological Screening: Americans tend to place great emphasis on psychological screening of egg donors. Since most donors are "anonymous," it is incumbent upon the ED agency or the IVF program to determine the donor's degree of commitment as well as her motivation for deciding to provide this service. I have on occasions encountered donors who have buckled under the stress and defaulted mid-stream during their cycle of stimulation with gonadotropins. In one case, a donor knowingly stopped administering gonadotropins without informing anyone. She simply awaited cancellation, which was effected when follicles stopped growing and her plasma E2 concentration failed to rise.
Such concerns mandate that assessment of donor motivation and commitment be given appropriate priority. Most recipients in the U.S. tend to be very much influenced by the "character" of the prospective egg donor, believing that a flawed character is likely to be carried over genetically to the offspring. In reality, unlike certain psychoses such as schizophrenia or bipolar disorders, character flaws are usually neuroses and are most likely to be determined by environmental factors associated with upbringing. They are unlikely to be genetically transmitted. Nevertheless, egg donors should be subjected to counseling and screening and should be selectively tested by a qualified psychologists. When in doubt, they should be referred to a psychiatrist for more definitive testing. Selective use of tests such as the MMPI, Meyers-Briggs and NEO-Personality Indicator are used to assess for personality disorders. Significant abnormalities, once detected, should lead to the automatic disqualification of such prospective donors.
When it comes to choosing a known egg donor, it is equally important to make sure that she was not coerced into participating. We try to caution recipients who are considering having a close friend or family member serve as their designated egg donor, that in doing so, the potential always exists that the donor might become a permanent and an unwanted participant in the lives of their new family.
Drug Screening: Because of the prevalence of substance abuse in our society, we selectively call for urine and/or serum drug testing of our egg donors.
Screening for STDs: FDA and ASRM guidelines recommend that all egg donors be tested for sexually transmittable diseases before entering into a cycle of IVF. While it is highly improbable that DNA and RNA viruses could be transmitted to an egg or an embryo through sexual intercourse or IVF, women infected with viruses such as hepatitis B, C, HTLV, HIV etc, must be disqualified from participating in IVF with egg donation due to the (abeit remote) possibility of transmission, as well as the potential legal consequences of the egg donation process being blamed for their occurrence.
In addition, evidence of prior or existing infection with Chlamydia or Gonococcus introduces the possibility that the egg donor might have pelvic adhesions or even irreparably damaged fallopian tubes that might have rendered her infertile. As previously stated, such infertility, subsequently detected might be blamed on infection that occurred during the process of egg retrieval, exposing the caregivers to litigation. Even if an egg donor or a recipient who carries a sexually transmittable viral or bacterial agent is willing to waive all rights of legal recourse, a potential risk still exists that a subsequently affected offspring might in later in life sue for wrongful birth.
Screening of the Recipient
Medical Evaluation: while advancing age, beyond 40 years, is indeed associated with an escalating incidence of
pregnancy complications, such risks are largely predicable through careful medical assessment prior to pregnancy. The fundamental question "Is the woman capable of safely engaging a pregnancy that would culminate in the safe birth of a healthy baby?" must be answered in the affirmative before any infertility treatment is initiated. For this reason, a thorough cardiovascular, hepatorenal, metabolic and anatomical reproductive evaluation must be done prior to initiating IVF in all cases.
Infectious Screening: the need for careful infectious screening for embryo recipients cannot be overemphasized. Aside from tests for debilitating sexually transmittable diseases, there is the important requirement that cervical mucous and semen be free of infection with ureaplasma urealyticum. This organism which rarely causes symptoms frequents the cervical glands of 15-20% of women in the U.S. The introduction of an embryo transfer catheter via a so infected cervix might transmit the organism into an otherwise sterile uterine cavity leading to early implantation failure and/or first trimester miscarriage.
Immunologic Screening: Certain autoimmune and alloimmune disorders (see elsewhere) can be associated with immunologic implantation dysfunction (IID). In order to prevent otherwise avoidable treatment failure, it is advisable to evaluate the recipient for autoimmune IDD and also to test both the recipient and the sperm provider for alloimmune similarities that could compromise implantation.
Disclosure and Consent Preparation for egg donation requires full disclosure to all participants regarding what each step of the process involves from start
to finish, as well as potential medical and psychological risks. This necessitates that significant time be devoted to this task and that
there be a willingness to painstakingly address all questions and concerns posed by all parties involved in the process. An important component
of full disclosure involves clear interpretation of the medical and psychological components assessed during the evaluation process.
All parties should be advised to seek independent legal counsel so as to avoid conflicts of interest that might arise from legal advice
given by the same attorney. Appropriate consent forms are then reviewed and signed independently by the donor and the recipient couple.
Most embryo recipients fully expect their chosen donor to yield a large number of mature, good quality eggs, sufficient to provide enough
embryos to afford a good chance of pregnancy as well as several for cryopreservation (freezing) and storage. While such expectations ore often
met, this is not always the case. Accordingly, to minimize the trauma of unexpected and usually unavoidable disappointment, it is essential that
in the process of counseling and of consummating agreements, the respective parties be fully informed that by making best efforts to provide
the highest standards of care, the caregivers can only assure optimal intent and performance in keeping with accepted standards of care. No
one can ever promise an optimal outcome. All parties should be made aware that no definitive representation can or will be made as to the
number or quality of ova and embryos that will or are likely to become available, the number of supernumerary embryos that will be available
for cryopreservation or the subsequent outcome of the IVF donor process.
Geoffrey Sher, MD is an infertility specialist with more than
27 years' experience in the field. He founded the first private In Vitro Fertilization clinic in the United States in 1982. He is currently the
Executive Medical Director of the Sher Institutes for Reproductive Medicine, a network of infertility clinics with 10 locations across the
United States. He is in active practice in Las Vegas, Nevada and treats patients from around the world. He has been at the forefront of research
and development in the field of infertility and reproductive technologies throughout his career.