Q from U: When should you consider donor eggs?

August 13, 2014Carole 4 Comments »

I received this question from a reader today:

When a woman (very close to 40 ) has her first IVF cycle and responds great to medication, they retrieve 13 eggs – and only 1 fertilizes (with great sperm) and some of the eggs appear to have abnormalities, does she chalk it up to bad eggs or bad luck with that cycle? Even If she conceived naturally 3 years ago, with 2 miscarriages in between. How common is this in the ivf world and is it realistic that changes to protocol DHEA etc. make a difference, Or does this often signal a time that doctors recommend Donor Eggs.

This patient’s situation is not unusual. Having an average number of eggs retrieved and having successful fertilization, while an encouraging and necessary step in treatment does not  guarantee that the embryos produced have a normal number of chromosomes- especially in a patient approaching or past 40. The past history of recurrent miscarriages can be explained if the embryos in those pregnancies had an abnormal number of chromosomes.

As we age, we produce more eggs that didn’t segregate their chromosomes properly in the last stages of egg production and the resulting mature egg has more or less chromosomes than what is normal. You can read more about the link between chromosomal number abnormalities  (aneuploidy) and miscarriage here.

DHEA which is a male hormone or androgen, has been  used with IVF stimulation  in an attempt to improve parameters of the IVF success (eggs retrieved, eggs fertilized, embryos available for transfer, and pregnancy rate).  Some studies support the use of DHEA but it is still controversial, with many opposed to its routine use for all patients, due to its effect on increasing androgen levels. DHEA is used in menopausal women to relieve some menopausal symptoms– bone loss and sexual function issues. DHEA is also used for lupus patients to reduce the effective dose of steroids they need to take. DHEA may be helpful for certain patients but side effects are not understood and DHEA should only be used under doctor’s supervision.

Doctors vary in when they decide it is time to suggest donor eggs. If they believe in DHEA, they may offer that first. If they have good results with aneuploidy testing of embryos, they might suggest another round of IVF in which every embryo is tested for chromosomal number and abnormals are not transferred. This approach also has its detractors because to have anything left after testing, you need a goodly number of eggs (and embryos) to start with–a situation which is precisely lacking in the older patient. Donor eggs is usually suggested sooner rather than later at most clinics because this is the fastest, most reliable method, to get older patients pregnant and on their way as a pregnancy success.

Hopefully the doctor who suggests donor egg as a treatment also takes same time to explain why donor eggs are not just a technical fix and require a little more consideration than most other interventions. If you use donor eggs, you will be able to experience pregnancy first hand (in most cases) but your child will not be genetically related to you. We live in a society composed of individuals with wide religious and cultural attitudes toward the use of donor eggs (or sperm or embryos) . But almost every culture has a great reverence for genetic relatedness and genetic family – whether it is overt or subtle. We relish finding evidence of that genetic link- “You have your father’s eyes, etc”.

You need to ask yourself:

  • Will I ever regret that this child is genetically unrelated to me?
  • Will the people that are closest to me accept this child?
  • Will I have to keep the origin of the child a secret from my closest friends and family or from the child?
  • What will I do if my child wants to know who the egg donor is at some future date? Does the clinic offer a means to connect with this donor in the future? (Often, donor eggs are 100% anonymous and the child has no way to access their egg donor information- ever. Records are not required to be kept past 10 years – at the longest- so the records are often long gone when the child is 18. That is why some groups have formed to find donor siblings if they know the donor code and the ART clinic but this is a hit or miss method to find donors).

These social and emotional issues are difficult for many patients. Egg donor is an easy technical fix- you are much more likely to get pregnant if you use a donor’s eggs- but make sure that you are comfortable with the  long term implications for you and your family.  Most good programs can refer patients to therapists who specialize in this third party reproduction issues so that patients have a chance to think about and speak with their partner about as many implications of the procedure as they can before they agree to use donor eggs.

© 2014, Carole. All rights reserved.

4 Responses to this entry

  • DB Says:

    Thank you so much for your very informative posts! I have been struggling with my next steps in my IVF journey. I am a 40 year old childless woman with infertility from a pituitary tumor, which although was resected in 2011, left me anovulatory. In fact, I was most likely anovulatory for a number of years prior to the tumor diagnosis. I have partial hypopituitism now and have to take hydrocortisone daily to support my adrenal function. I have no other structural reproductive problems, and husband’s sperm is fine.

    I did a round of IVF last February, which produced 24 (!) eggs. Of those, we were left with 2 embryos on day 5 and another 6 to freeze on day 6. My first fresh transfer immediately following that egg harvest was successful, but I had a miscarriage at 7 weeks. I have since done two frozen cycles and used all of the remaining 6 embryos (2 failed implantation on the first transfer, then we thawed the last 4 but only 2 lived and those failed implantation).

    So although I still have a lot of eggs, they seem to be of poor quality due to my age…?? Despite the hypopituitism, I am well-managed and my RE thinks the cause of the miscarriage and failed implantations/nonrobust embryos is aneuploidy. ‘m wondering where to go from here. I am leaning toward doing another egg harvest and sending the embryos for PGS. I read your PGS posts and understand the limitations, but I’m hoping I produce a good amount of eggs again like last time in order to up the odds of having at least one chromosomally normal embryo to implant. I know this is not a guarantee. However, I could just move to using an egg donor now. I have some philosophical reservations about this but am trying to wrap my head around it. The idea of epigenetics, that my womb gives the growing fetus instructions for what to do with the donor DNA, helps me to be more comfortable with it. Wondering your thoughts about my particular situation and your thoughts on epigenetics. THank you so much.

  • Carole Says:

    Dear DB,
    One reason it might make sense to do aneuploidy testing at this stage is to give you some more information to help with the decision to move on to donor eggs–or donor embryo transfer or adoption–something that is more likely to help you build your family. Another reason it might make sense to havePGS done on the embryos in a fresh cycle is that you could be really lucky and have a few normal euploid embryos to transfer and at least you won’t waste time and $$ on transfers that can not succeed). If you are considering donor egg- the best next step might be to discuss these issues with a therapist who specializes in third party reproduction so that you and your partner can explore all the possible issues that arise with using donor gametes or donor embryos. Many IVF programs actually require it before proceeding. This is a great way to explore your feelings. It is not trivial for most people to give up the biological link to their children that has been part of their expectation (and often also expected by their own extended family- mother father- siblings-) of having children. Regarding epigenetics, certainly there are many maternal influences that impact how the genetic code is expressed, but this is not the same as actually passing on your genes. This may be acceptable to you. It might not be. There is no wrong response to this. But it is important to try to anticipate some of the downside (as well as upside) to this approach. I wish you all the best going forward with your family building !!!

  • DB Says:

    Carole, Thank you so much. I especially appreciate the suggestion to go see a therapist. Great idea!

  • baby2mom Says:

    Woman close to and over aged 40 are encouraged to consider donor eggs to conceive in South Africa.

Join the discussion