In the past three years my husband and I have suffered four miscarriages and have had 28 embryos genetically tested, only to find out they were not viable. This is because I have a translocation, a genetic mutation which causes the vast majority of my eggs to be genetically unsound. Egg donation, embryo donation and adoption are the only options left for my husband and I if we want to expand our family. This week I talked to Dr. Michael Blotner, Medical Director of Westchester Fertility, about egg donation. Dr. Blotner and his caring staff helped me get pregnant with my daughter four years ago. He was gracious enough to answer ten questions I had about the process. Egg donation is a viable option for women like myself, who can carry a baby to term, but cannot provide quality eggs.
What type of fertility issues would cause a woman to consider egg donation?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 will be reflected in an elevated FSH (follicle stimulating hormone) or a low AMH (anti-mullerian hormone). Also in the cases where in vitro fertilization has failed multiple times, eggs from a donor may be appropriate.
What is a snapshot of the “typical” egg donor like?
The typical egg donor is a woman over 21 years of age, commonly in graduate school or pursuing a career. While financial compensation is a central motivation, there is often an altruistic desire to help other women conceive.
Does health insurance cover any of the costs of retrieving eggs from the donor?Unfortunately, health insurance can only be used for tests and procedures that involve the recipient(not the donor). The costs include those for 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 donors checked for genetic abnormalities that could cause miscarriage or life threatening illnesses in the baby?The donors are screened for sexually transmitted diseases (HIV, Hepatitis B and C, etc) as well as genetic testing for chromosome analysis, cystic fibrosis, and hemoglobin abnormalities. Other genetic tests may be obtained when applicable(ie: Tay-Sachs screening for Ashkenazi Jewish descent).
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 the 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 with hormone supplements to ultimately receive the embryos. 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 donors’ 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 present to 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 about the other babies that have been born using the same donor?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 a person 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 are the challenges in using a donor’s egg? (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. This adds 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 their child in that time. The chance of conceiving through donor eggs is approximately 50-60% per transfer, as opposed to less than 5% using her 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 expense of using an egg donor is huge, costing anywhere from $25,000 to $30,000. Also dealing with the loss of the dream of having a child with your genetic makeup is something the egg donor recipient has to come to terms with. In the coming weeks, I will explore both 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. www.westchesterfertility.com