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Is Egg Donation the Right Choice for You?

by David Tourgeman, M.D., HRC Fertility, February 24, 2011
Perhaps the most difficult and emotional decision a person or couple can make when trying to have a child is choosing whether or not egg donation is the correct route for them. For some people, the decision may be relatively straightforward. Perhaps the adoption process has been met with failure, or the woman has premature ovarian failure or another medical conditions in which the ovaries will not produce eggs.

But in most cases, the parents have attempted artificial inseminations (IUIs) and/or in vitro fertilization (IVF) procedures without success, and have been burdened with the bad news of negative pregnancy tests. The decision to move forward with an egg donor was not how they had envisioned becoming parents.

The Issues of Egg Donation
The biggest issue intended parent considering egg donation must confront is deciding if their genetics must play a part or if having a baby (despite the maternal genetic origin) is most important.

Indeed, there have been attempts at using a donor egg for the shell and transferring the genetic material of the intended mother into the donor egg. Unfortunately, this has not been scientifically successful so we are left with the preceding dilemma.

Known Egg Donors
An option that may be considered is a non-anonymous (known) egg donor. Typically, a sibling or relative is chosen, and ideally that family member is less than 35 years of age and has children of her own. This provides a “bridge” in which there is some genetic input, although it is somewhat removed.

There are many patients who choose not to have a known donor because they do not feel comfortable asking, do not have an age-appropriate relative, or simply do not want anyone to know. In this case, we are left with an anonymous (unknown) egg donor.

Anonymous Egg Donors
Choosing an anonymous egg donor is indeed a challenge. There are certainly many things that parents may want to address. Physical attributes and similarities are often paramount. However, intelligence, nationality, and family health issues are also significant.

From a medical standpoint there are also many desired qualities to optimize the likelihood of success. I typically recommend that the donor be less than 30 years old and that she have had testing for ovarian reserve that returned normal. She should have had all appropriate genetic screening tests and have been evaluated by a mental health professional to make sure that there are no ulterior motives. When counseling a couple, I will tell them that in the best scenario an anonymous donor is “proven,” meaning that she has done a cycle of egg donation in the past, produced 15 eggs or more, and the donation resulted in successful pregnancy.

Being Fulfilled as Parents
The most important thing for the person or couple to consider is whether they will be fulfilled as parents when they decide to use a donor egg. The parents will be able to nurture and nourish the baby the way that had been envisioned. There is also an extraordinary bonding that occurs as the mother feels the growing baby.

The pregnancy experience and birthing process is the beginning of parents understanding that, despite the genetic contribution from the egg donor, this baby is their own.

David Tourgeman, M.D. graduated medical school from the University of Southern California in 1994. He completed his residency in Obstetrics and Gynecology in 1998 and his fellowship in the Division of Reproductive Endocrinology and Infertility in 2001 at the University of Southern California, Los Angeles County Women’s and Children’s Hospital. After his fellowship, Dr. Tourgeman became an assistant professor of Obstetrics and Gynecology in USC's Division of Reproductive Endocrinology and Infertility. He began working with HRC Fertility (then Huntington Reproductive Center) in 2005 and currently sees patients in HRC’s Encino and West Los Angeles offices. His areas of interest and studies include assisted reproductive technologies and oocyte donation in women of advanced reproductive age, alternatives for enhancing embryo implantation, advanced reproductive fertility surgery, evaluation of ovulation induction agents, and vaginal hormone administration.

Three Day vs Five Day Embryo Transfer

We know that the primary reasons embryos don't make it to blast is they don't have the genetic instructions to continue -- and we can't change or improve the genetics or egg quality of an embryo. If you have faith in your lab there really is no risk with continuing to culture those embryos to blast stage.

Some say that embryos are better in the uterus at day 3 while others say they are not because if you were having a baby the old fashioned way the embryo remains in the fallopian tube until day five or blast stage. And really if we think about it (Ask your RE I bet he agrees with me) the uterine environment on day 3 isn't the same as your fallopian tubes. And on top of that with what labs do regarding sequential culture systems that help grow embryos to blast -- those kinds of conditions in the lab are as close to the fallopian tubes as you are going to get. So with all that being said maybe embryos are better off in the lab until blast.

Now -- the reason we grow embryos to the blast stage in the lab is to weed out those embryos on purpose that don't have the genetic potential to grow into babies. So the risk folks talk about I think doesn't really exist. I mean think about it -- if they make it they make it -- if they don't they don't. Now I know there is always the risk that zero embryos make it to blast in the lab but I bet my bottom dollar that the issue is genetically related and not something to do with the lab. ie egg quality or sperm quality issues.

There's also lots of reasons that labs do three day transfers - first of all it's less expensive and cheaper. It's less work for the lab and I think there less liability (i.e. the lab has the embryos for a shorter period of time, the patient always makes it to transfer, and last but not least if the cycle doesn't result in a positive pregnancy test the program still looks fine) So with all that being said I am thinking that day three embryo transfers are done for a myriad of reasons.

So I have to say this about blast transfers -- just because you have a blast transfer doesn't mean you are automatically going to have a baby. Now when your embryo reaches blast stage it's okay to think that these embryos are capable if implanting right where they are supposed to and go on to develop into a baby. There are still a few potential obstacles to overcome -- the embryos are transferred into the uterus and they have to attach to the wall of the uterus and then go on for the next ten days completing the implantation process. That process is out of the control or the hands of the clinic, and like I have always said it's really a crap shoot at that point.

What we do know is at the blast stage embryos are capable of implanting, whereas day three embryos we don't know for sure if they even going to make it to blast -- what we do know however is lots of 3 day transfer result in babies.

My son is the result of a three day transfer.

Lots to think about. Yes?