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In the past three years, my husband and I have suffered four miscarriages. We've also had 28 embryos genetically tested, only to find out that they were not viable. Why? Because I have a translocation, a genetic mutation which causes the vast majority of my eggs to be genetically unsound. This means that if my husband and I want to expand our family, the only options we have left are egg donation, embryo donation and adoption
I recently spoke with Dr. Michael Blotner, Medical Director of Westchester Fertility, about egg donation. Egg donation is a viable option for women like myself, who can carry a baby to term, but cannot provide quality eggs. Four years ago, Dr. Blotner and his caring staff helped me get pregnant with my daughter. Last week, he was gracious enough to answer ten questions I had about the process.
What types of fertility issues would cause a woman to consider using donor eggs?
The primary reason for a woman to seek an egg donor would be infertility caused by a very low egg reserve, which also implies a decreased egg quality. This would be reflected in an elevated FSH (follicle stimulating hormone) or a low AMH (anti-mullerian hormone). Eggs from a donor may also be appropriate in the cases where in vitro fertilization has failed multiple times.
What is a snapshot of a “typical” egg donor?
The typical egg donor is a woman over 21 years of age, often in graduate school or pursuing a career. While financial compensation can be a central motivation, there is also usually an altruistic desire to help other women conceive.
How much of the process is covered by health insurance?
Unfortunately, health insurance can only be used for tests and procedures that involve the recipient, not the donor. The costs not covered by insurance may include mandatory laboratory screening; intake appointment and physical exam; medications involved in stimulation of the donor; monitoring hormone levels and ultrasound development of the follicles; the actual egg retrieval with anesthesia and donor compensation for going through the process.
How extensive is the screening for egg donors? Are they checked for genetic abnormalities that could cause miscarriage or life threatening illnesses in the baby?
The donors are screened for sexually transmitted diseases (such as HIV, Hepatitis B and C, etc.) and they undergo genetic testing for chromosome analysis, cystic fibrosis, and hemoglobin abnormalities. Other genetic tests may be obtained when applicable, for example, if a donor is of Ashkenazi Jewish descent, they may undergo Tay-Sachs screening.
How are donor eggs retrieved?
The egg donor is stimulated with injectable hormones (FSH and LH) on a daily basis from the early phase of her menstrual cycle and she is monitored every few days by serum estrogen levels and ultrasound evaluation of the ovaries. At the same time, the recipient’s uterus is being prepared to receive the embryos using hormone supplements. When the eggs are deemed mature, the donor undergoes general anesthesia for 15-20 minutes while the eggs are retrieved by transvaginal ultrasound and a needle aspiration of the eggs from each ovary.
What happens to the donor eggs after they are retrieved?
The donor eggs are isolated in the laboratory and injected with the sperm of the recipient’s male partner (or sperm donor, as indicated). The resultant embryos are monitored and allowed to develop to an appropriate stage for transfer into the recipient’s uterus. Often extra embryos may be cryopreserved (frozen) as a back-up for additional attempts or future pregnancies.
Can the egg donor donate multiple times? Do the couple receiving the eggs know if others babies have been born from the same donor's eggs?
Egg donors are allowed to cycle several times. Information regarding prior successes is available, but the specific information regarding other patients and their offspring is protected under HIPAA.
How does you choose an egg donor?
Egg donors are recruited by agencies specifically for this purpose and are generally selected by the recipients based on shared physical characteristics, desired educational or ethnic backgrounds. Extensive family history screens are also presented for review.
What challenges do people face when using donor eggs? (Monetary, physical, emotional.)
Donors may be local, which makes monitoring easier, or they may need to commute or even fly from their place of origin. This requires coordination with a fertility center in their locale. This also requires lodging and accommodations for the donor during the time of the egg retrieval. All of this can add to the financial burden of the entire process. The recipient and her partner must also be emotionally ready to abandon the idea of conceiving with her own eggs.
What are the benefits of the egg donation process?
While adoption is an option for many couples, the use of an egg donor provides the opportunity for the male partner to contribute to the genetics of the offspring. The recipient is also able to experience pregnancy and childbirth, and bond with the baby in that time. For many women with fertility issues, the chance of conceiving through donor eggs is approximately 50-60% per transfer, as opposed to less than 5% using their own eggs.
At the end of the day, egg donation is a viable option for couples in our situation. But as Dr. Blotner mentioned, there are many challenges to this option. The most obvious is the financial obstacles: the expense of using an egg donor is huge, costing anywhere from $25,000 to $30,000. But the intended parents also have to deal with the loss of their dream to have a child with their same genetic makeup. This can be difficult for the egg donor recipient to come to terms with.
Stay tuned! In the coming weeks, I'll explore the process of embryo donation and adoption.
Michael Blotner, MD, is board certified in obstetrics and gynecology and reproductive endocrinology. For over 15 years, he has been helping patients in his care achieve their goal of having a child through state-of-the-art infertility treatment. Dr. Blotner has dedicated himself to providing personalized professional care in a relaxed environment. You can find more information at www.westchesterfertility.com.