Donor Egg IVF
Many of my patients come to me and never expect to have a conversation about donor eggs. This option, for most people, is something they never thought they’d have to discuss. I want to break down some of the barriers, talk about this honestly, and give you some things to consider. Most people going down this road are women of advanced maternal age or poor egg quality leading to failure to get pregnant.
Who needs donor eggs?
SAME SEX Couples WITHOUT EGG SOURCE
If you are in a same sex male relationship, donor eggs along with a gestational carrier is something you have to consider if you want children. It can be hard to make these decisions. Sometimes these are both anonymous sources and other times it’s someone they know.
Low Ovarian Reserve, PREMATURE OVARIAN FAILURE, Low Egg Quality, OR NO OVARIES
In most situations it is women who have waited until they are older to have kids or women who have premature ovarian failure. Some women don’t know that they are running out of eggs until they get off birth control and they don’t have period or other symptoms. They come in to see me and getting diagnosed while they are already in menopause. In this case you know right away that donor eggs are your only option. Other women may have been trying over and over and experiencing the inability to get pregnant. The issue here may be low egg quality. I know it really hurts to hear that. Our goal is to share with you the facts that we have in order to help you get pregnant.
Natural Fertility and egg freezing
One thing that often surprises women is the natural decline in fertility as we get older. Most people start too late and end up in this position. I’ll be very curious to see how my field changes over the next ten to twenty years. Currently most people using egg donation did not have the opportunity to freeze their eggs because this option was experimental until 2012. What about the younger generation of women who are now in their late twenties or early thirties? They may have the opportunity to use frozen eggs if they are waiting to get pregnant. That may change this aspect of our field, and I find it so fascinating. When we talk about natural fertility, you should know the facts. If you have never had a child and are younger than age 30- your chance of getting pregnant per month, also known as fecundability, is 20-25% each month.
This number changes once you enter your thirties, and if you’ve already had a child, the numbers look a bit different. These numbers are based on a large study done in the United States called “Time to Conceive.” My mentor while in fellowship, Anne Steiner, led this study.
Ages 30-33 17-19%
Ages 34-37 11-12%
Ages 38-39 5%
Over 40 3%
I share this because many people are shocked by the change that happens after you turn thirty-three and the profound drop that happens after age thirty-seven despite the fact that we have seen this in historical-based populations for a long time. If you are younger and planning to wait, you should consider getting your fertility evaluated and looking into the option of egg freezing.
What you should know
The decision of trying to switch to donor eggs when trying to conceive is hard. If you or somebody you know or love is in this position, please give yourself and them grace. It is hard to change paths, and it is not how we envisioned our family to look. Most of the time I find this journey to be very beautiful. I know that’s not how you feel at the beginning of the process. Here is something that validates the struggle, heartbreak, and questioning. When you hold a child that never would have existed without your struggle, you know that struggle was worth it. One of the top questions I get asked from women is, “Will I bond with the baby?” I understand and respect that question. You will bond with the baby and will believe that this is the child you were meant to have. This decision is hard and is made harder because every fertility clinic you go to will do something different. It’s a tough spot to be in as a patient. What you will get offered at our practice is not what they are offering at my previous practice. You need to understand your options. You need to understand what makes the most sense for you financially, emotionally and for your family.
Options When Using Donor Eggs
Fresh donor eggs
The donor goes through the egg retrieval cycle and the recipient is waiting on the timeline of the donor. You will get paired with somebody after you go through a catalog. They will go through an IVF cycle. While they are going through that cycle, you will get your uterus ready. She will go through an egg retrieval, you will start progesterone, and the transfer will happen a few days later if you do not go through genetic testing of embryos. You could have a fresh donor which will be a similar process except an embryo will be made. Then genetic testing will happen and you’ll do a frozen embryo transfer. The number one pro of doing it this way is that you typically get more eggs. However many eggs that donor had can all come to you in most scenarios. However, if she looks good on paper, but all of her eggs don’t make embryos, the process is over. You paid for the fresh donor to go through IVF, and they didn’t make it to embryos. That’s it. The con is that this is the most expensive option. Because they are going through IVF in real time and you are getting all of her eggs, you are paying for all of the cost. You also don’t get as much control in the timing of the process. If you match with a donor who is a medical student and can’t do a cycle until august, you have to wait. This can be very hard not to have control after investing so much. Fresh used to be the best option because egg freezing was still experimental.
Frozen donor eggs
Now we are seeing a shift in focus towards doing frozen donor eggs. You have a lot more control doing it this way. Sometimes you have more diversity and selection because they have already gone through the process, and the cost is shared between many people. Egg banks are similar to sperm banks. Every bank has different rules, requirements, and guarantees. Are they guaranteeing an embryo to transfer? Or a genetically normal embryo? How many batches of eggs do you get? What if you don’t get any embryos? Do you have to buy a different lot of eggs? What are the options? What does the process look like? All of these will vary depending on the egg bank and clinic. The first clinic I worked at did not use frozen eggs.
If you are being told you need donor eggs, I hope they explain very clearly how their clinic does it. At Fora I am in charge of collaborative reproduction. Anyone going through a process where an outside party is involved, I am in charge. The clinic side is complicated because there are a lot options, FDA requirements, and paperwork. So I understand why some clinics only offer donor eggs one way. However, as a consumer, you need to know why they are doing it this way. Asking your clinic is a way to understand and be on the same page. I don’t think one is better for everybody, but having an honest discussion is important.
DirectED Donation
In most of these situations it is a donation from a family member. This sounds like it should be easier. However, it is not. It can be done, but from the FDA requirement we have to make sure we screen that person appropriately. This usually involves psych evaluationS, blood work, a physical exam, a questionnaire, and legal agreements. It often costs more or about the same as the other options. Financial incentives are not the reason to choose this option. It should be because you feel more comfortable with the process or that person wants to be a part of your future child’s life.
Before You Start Donor Egg IVF
The uterus should be evaluated before considering donor egg IVF. This can be done with a saline sonogram or hysteroscopy. We need something that tells us everything looks good inside the uterus. We want to do preconception testing to check thyroid levels, vitamin D, your blood type, and infectious disease screening. You will want to make sure the sperm source and egg do not both carry the same genetic mutation that would require additional testing of embryos. We also want to make sure you understand the treatment protocol. Donor embryos should be transferred as a single embryo. Donor embryos have a very high success rate and genetic testing isn’t always necessary. Some clinics don’t recommend it, but I also understand wanting to control everything in the process that you can. However, you should never need to transfer more than one embryo at a time. This is increasing the chance that something bad could happen. Most clinics will have an age cut off for someone who can receive donor eggs. I believe this is is complex, but it is important to know what your clinic’s cut off age is. Clear expectations are important.
A few last words
Nobody has to know that you are using donor eggs if you don’t feel comfortable with it. Some people choose donors with similar characteristics so nobody would know. Many people are also sharing their stories and I think it is so powerful and helpful for others. Whether it is a public share on social media or with your inner circle, sharing your story will help others in the same position. That normalizes the process and breaks down the stigma. If you feel comfortable, I encourage you to share. Choosing not to share is also your own personal right. I have to tell your OBGYN and it will be part of your medical records. I will also say that your child will most likely find out even if you choose not to tell them. We are living in a modern world, and we are watching what happens in the reproductive world with direct to consumer genetic testing. That technology is only going to advance. My advice is to be open and honest, but ultimately that is your choice. Our patients see a therapist before making this decision. Some donors may allow contact in the future. So I say the more people you can get on your team and support you, the better.
My challenge is that each couple or person investigates all of the options presented and makes the choice that suits them the best. I want you to have peace with your decision.
