Transitioning to donor egg

By: Lawrence Grunfeld, MD, RMA of New York Co-Founder

There may be a point in the reproductive journey where a woman may improve her chance of having a healthy baby by choosing an egg source other than her own. It is challenging and frustrating when embryos do not implant. Most implantation failures are due to defects within the chromosomes of the embryos. The rate at which an embryo successfully implants drops linearly with age and approaches 0 around 46 years of age. Using a different woman to carry the pregnancy does not improve those odds. Fertility can, however, be restored when the egg of a younger woman is used.

There are several markers that we use to determine if an ovary is functioning properly. As women age, their supply of eggs gradually depletes. When the last 10% of the eggs remain, the woman is considered to have “poor ovarian reserve.” Eggs are mostly hidden away at the surface of the ovary. When a woman reaches menopause at around age 50 she has none left. Every month approximately 1,000 eggs leave the storage pool and enter a pool where they can be used for reproduction. Only one ovulates and the others die off. With fertility hormones we can salvage some of those eggs, but we do not influence the genetic health of those eggs. Markers of ovarian reserve include the size of the ovary as measured on sonogram called the BAFC (baseline antral follicle count), the AMH (Antimullerian Hormone), and the Day 3 FSH/E2. FSH is an indirect measure of ovary health as it determines the pituitary stress that is needed to drive the ovary. AMH is a better test as it measures the eggs directly. Neither test determines egg quality and both are measures of egg numbers. Egg quality does decline along with quantities, so there is value in knowing this information. Furthermore, these tests are good at predicting how many eggs will grow in response to fertility hormones.

The primary defect in the older egg is an abnormal number of chromosomes that carry the genetic code required for fetal development. Current IVF (in vitro fertilization) technology is able to determine the number of chromosomes in each embryo through a technique called PGS (pre-implantation genetic screening). When a couple has undergone IVF and all of the eggs are abnormal it may be time to consider using an egg from a donor.

Most couples feel a loss when their own genetic material cannot be used. Loss is a natural reaction to the transition to donor egg and we approach this emotional circumstance with guidance and care.. The stress of repeated IVF failure must be weighted against the greater success of a healthy child from a donor egg. Couples may express financial concerns about donor egg which may be more costly than IVF, but repeated IVF in poor prognosis situations can also carry a financial burden. I have often heard couples lament had they not spent their savings on IVF, they would have an easier transition to using donor eggs.

Trying to beat low odds of success is a natural human emotion. We are not naturally equipped to translate a success of under 5% into a decision about our own chance of being successful on an individual treatment. We certainly stay away from situations that carry a high risk of danger, but we also persist in tasks that carry low risk of success. It is often only after repeated failure that there is some comfort in making this transition. There is some reassurance in the knowledge that younger eggs carry fewer genetic disorders than pregnancies conceived with older eggs.

Oocyte donation is regulated by the FDA (Food and Drug Administration) and in New York, the DOH (Department of Health). All donors undergo a risk assessment, psychological screen, physical exam and blood work to assess health and ovarian reserve. Donors also undergo an expanded panel to test for gene mutations.

RMA of New York has two sources of oocyte donors. We screen donors at our New York practice and meet with them to assess their wellbeing. We also use frozen eggs from certified egg banks located outside of the New York region. Those eggs are already screened and are stored in a bank where they are immediately available to ship to RMA.

Chances of conception are substantially improved in IVF when using eggs from a younger donor source. The technology performs equally well whether the woman who receives the egg is ovulating naturally or is already past menopause. While the decision is a difficult one, it is our goal to help in the transition and complete the fertility journey.

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