Infertility patients face many decisions in the pursuit of building a family. One of those decisions frequently comes down to when to choose egg donation over another round of IVF. To help women understand more about when egg donation might be the right choice for them, we asked Dr. Joe Massey to share his expertise and experience.
Dr. Massey has been a friend to Creating a Family for many years – in fact, he was one of the founding board members when we launched our mission to support infertility patients and growing families with evidence-based education and resources. He is the President and Co-founder of the Egg Donor Collaborative, created to give more clinics access to fresh donor cycles. He is also the founder of Egg Donor Alliance, which seeks to make egg donation more affordable.
Here’s Dr. Massey introducing the three issues patients should consider when thinking about egg donation.
Many years ago it was difficult to explain certain cases of infertility. We knew, of course, that age was a factor, but sometimes young women had disappointing results, including low numbers of eggs retrieved when they did IVF. We could not predict when this would happen. Thankfully, now this is more predictable, using measures such as the AMH blood test and ultrasound observation of follicles, the basal antral follicle (BAF) count. If those are low, we know a woman, no matter what her age, has a lower chance of success. If these numbers are extremely low and are combined with advanced reproductive age, then the prognosis for success for IVF can be in the 5% range.
Faced with this knowledge, sometimes we advise patients to consider egg donation rather than IVF. Naturally, women want to try out their own eggs before they give up. However, most women do not choose this until they have tried IVF at least once. Even with low AMH and BAF, some women do get pregnant with only a small number of eggs and embryos. The only true test of ovarian reserve is a gonadotropin stimulation, ultrasound observation and finally, egg retrieval. The number and quality of embryos reveal the true answer to the question of ovarian reserve.
Balancing a Three-Legged Stool
However, the decision to do IVF comes at a cost. If a patient tries IVF once or more with her own eggs and still does not conceive, then the concern is that she depletes one of the elements of cost; time, money, or emotional energy before she chooses egg donation. What we do not want to happen is that our patient runs out of one of those before choosing egg donation. This is like a three-legged stool, and all three legs are equally important. We hope we have success but when we don’t, each “leg” suffers.
One leg of the “cost stool” is the loss of time; the biological clock is ticking. Going through a round of IVF can take months, and for older patients, this time is valuable. And the time required for the process itself is really more important.
The second leg of the cost stool, of course, is money. Even when working with a low-cost IVF center, there is no way to make IVF an inexpensive proposition if insurance does not cover it. Most of the time in the United States there is no mandated coverage as most employers are unenlightened.
The third component of cost is related to the stress during the process, which we could call emotional energy. Going through infertility treatments causes stress like nothing else – on the patient, her partner, and those closest to them. It can cause marital strain as each partner handles the stress and challenges differently.
Changing the Equation
Donor egg treatment is the next step and it changes the equation considerably. First of all, the cost financially is dramatically higher because we pay, evaluate and treat the donor separately, and she is compensated. A plan should be developed to avoid running out of money trying a patient’s own eggs so that they can try at least one donor cycle. It is important to know that while the percentages are significantly higher, there is no guarantee that one donor cycle will work. Some people even need two egg donor cycles. Once the decision to use an egg donor is made, the process is actually easier emotionally for the recipient’s stress level because the egg donor is doing all the “work.”
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Couples facing diminished ovarian reserve need to come up with a long-term plan as they enter the assisted reproduction journey. Professional counseling with a knowledgeable counselor can be very helpful to navigate all of this. Typically talking about this with family members is not helpful; they cannot really walk in your shoes. A lot of them do not understand.
A Good Backup Plan for Success
Knowing that egg donation is a good backup plan should brighten your day. Because egg donation is highly successful, you can go into assisted reproduction with the realization that the prognosis is excellent. We have high confidence that pregnancy will occur within a reasonable amount of time.
No one prefers egg donation from day one of the journey. It takes time for a woman to give up on her own eggs. Men can empathize by thinking how they would feel if they were asked to consider donor sperm. This journey can be long but, once again, a sunny day is on the horizon. A baby resulting from a donor egg is just as wonderful and loved as a baby from your own eggs. The hard part is making the decision.
Thank you, Dr. Massey, for sharing your expertise and giving this encouraging counsel on egg donation!
Image Credit: Rui Fernandes; Bai Win Collection Antiques Objets d'Art Images have been re-sized and cropped to fit parameters for size and publication.