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Archive for June, 2008

Choosing an Egg Donor

June 12, 2008 | By: | Filed under: Thoughts on Choosing an Egg Donor

So, I just took an interesting call from a client. She was very confused about the benefits of using an experienced or “proven” egg donor versus using a first time donor. A proven donor is one who has either been pregnant and/or had a baby herself or gotten recipient parents pregnant (or both!). A first time donor has never cycled before so her egg quality and recruitment is an unknown.

I tried, and Danielle tried, to explain to her that it doesn’t really matter either way. In fact, I just learned at that amazing conference in Charleston that first time, “unproven,” donors have the same success rates as proven donors. Donors are so carefully screened these days for their fertility that approximately 70% of donors will get the recipient parents pregnant; regardless of whether they have cycled before or not with another recipient family.

But, alas my client couldn’t be persuaded. Much to my surprise as most of clients will only work with a proven donor. This woman was terribly afraid that working with an experienced donor meant she had a greater likelihood of having the “bad” cycle happen during her match with this donor, and that she’d get a crappy bunch of eggs. Statistics don’t bear this fear out at all . . . but since she’s just as likely to get pregnant either way (proven or unproven donor); I suppose it doesn’t really matter?



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Next Steps: Is it Okay to Pursue ART and Adoption?

June 12, 2008 | By: | Filed under: The Journey to Parenthood

For those of you who are confused about what your next step is on your frustrating, convoluted and phenomenally expensive journey to parenthood, I’d like to share something with you that an increasing number of our clients are doing. They’re “dual tracking”. That is, while they finish up one final attempt at IVF or IVF-ED, they are simultaneously starting their adoption paperwork. It can take months to get an adoption to the place where you are waiting for an international referral or you are certified and home study ready and can begin to look for a baby. You can be finishing up your IVF stuff while you’re doing all that paperwork (just please make sure to tell your home study social worker that you’re pursuing IVF and what your plan is re: adoption if you get pregnant).

I did it myself when my husband and I were going through infertility and adoption stuff. It gave me the peace of mind of knowing I was going to be a mom no matter what! It totally took the pressure off of my last IVF cycle and when I miscarried with that cycle (and it was the earliest miscarriage of them all, thus reaffirming my decision to pursue an adoption . . . it seemed like a sign from the Universe that we had made the right decision to pursue adoption!), well I didn’t dwell on it as much. I still had a lot of grieving to do but I didn’t have that anxiety about “what if the next cycle doesn’t work?” or “am I ever going to become a mom?” I knew that because we had started a domestic adoption plan and had our paperwork started that I was steps closer to finding a birth family. In fact, I was so relieved that we had started the adoption process and I didn’t have to start something new from scratch!

We were up front with our adoption case workers and we knew that if I got pregnant and carried to the second trimester that we would put our adoption on hold and see whether I delivered a baby. Having that plan, knowing what we would do if I did get pregnant was important for our adoption professionals; and as an adoption professional now it is a question I make sure to ask. I want to know that my clients have thought through the process completely and they aren’t going to bail on a birth mother if they get pregnant. Or at least, I get assurances from them that they will be honest with any birth mother with whom they might be working and let her know they are pregnant and give her the choice about whether she will still work with them toward a successful adoption (and yes, some birth mothers will keep working with you). But then I have to ask my client if they are prepared to parent two children born very closely together? It’s a lot of work!

I know not all adoption professionals agree with me, but as a former infertility patient I think you need to pursue all avenues to parenthood that may be available to you and right for you. As long as you know where your priorities lie, you don’t lie or misrepresent your intentions, and what you will do if you get pregnant while working toward an adoption, who should judge you for trying to move things along as quickly as possible?



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Egg Donors

June 10, 2008 | By: | Filed under: Thoughts on Choosing an Egg Donor

So I just got back from attending the 10th annual Oocyte Donation Conference in Charleston, SC (man was it hot and humid!!) and I must say I not only had a fantastic time but I learned a ton! One of the things that caught my attention were tips and suggestion for how to choose and screen an egg donor for a clinic or agency’s donor program (as opposed to a recipient parent choosing an egg donor), and statistics about success rates for egg donations.

I have always advised my clients that it is better to choose a “proven” donor than one who has never been pregnant, had a baby, or donated to a couple that got pregnant. Guess what? Turns out, I was wrong! Statistics clearly showed me – and let’s face it, I am swayed by stats – that a properly screened first time donor has the same success rate as a “proven” donor. So I guess I need to start advising people that they can choose just about any donor that feels right to them, and not worry so much about whether she’s got a proven track record. Because according to the gurus in Charleston, that first time donor is just as likely to get a recipient mom pregnant as the donor who has cycled two or three times and gotten the recipients pregnant on at least one or more of those cycles! Go figure!!



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Donor Eggs

June 10, 2008 | By: | Filed under: Thoughts on Donor Egg Recruitment

So question of the day: how many eggs do you need your donor to make? Sounds like one of those jokes, “how many [fill in the blank] does it take to screw in a lightbulb?” Right? Well it’s not a joke. It happens to be one of the most frequent conversations I have with my clients, both before and during their cycle. Recipient/intended parents are justifiably obsessed with the issue and question of how many eggs their donor ideally should recruit. The general sentiment I hear from my clients is you can never be too skinny and you can never have too few eggs or embryos. I can understand. I remember back in the days of my own IVF cycles, I was always disappointed when I “only” produced 7 or 8 eggs. Even if we had 100% fertilization results I was still disappointed . . . and let’s be honest it’s way more intense when you’re using an egg donor and investing so much time, energy and money in your egg donation cycle. You want a ton of eggs. But the reality, as I was just reminded, is that you really don’t. All it takes is one!

I mentioned in another blog about the conference I just attended in Charleston SC, on egg donation. I heard a lot about donor egg recruitment and how many eggs are ideal, not ideal, and even how to rescue a failed cycle. I really wish all my intended parent clients could have been sitting there with me because it was so reassuring (although the information was spread throughout several different lectures and you basically would have had to sit through about 6 hours of medical lectures and Q&A). It was enlightening too.

I think that intended parents and me as their advocate well, we tend to get caught up in wanting to see the donor produce a bazillion eggs. My clients are sometimes disappointed when their donor’s “only” produce 12-15 eggs. Boy, I would have been so stoked to produce that many in one of my IVF cycles, how bizarre that it is a disappointing result when it’s a donor! Everyone seems to want an egg recruitment in the 20-30 range even though that puts the donor at very high risk for hyperstimulation and usually leads to excess number of stored, frozen embryos which create issues and problems for intended parents and clinics later on down the road after the intended parents have had their babies. (There are hundreds of thousands of frozen embryos in storage now and no one quite knows what to do with them—but let’s leave that for another blog and another day shall we?) While I certainly recognize and sympathize with my client’s desire to have tremendous numbers of eggs recruited from their donor (and I cheer along with them when it happens), what was of much greater impact for me was what I learned about just how many eggs it takes to get a recipient/intended mom pregnant and how I can comfort or reassure my clients when a cycle doesn’t yield 50 gazillion eggs.

First of all, according to the doctors at the conference, the ideal number of eggs to be recruited from an egg donor is no different from that for any woman going through IVF. Docs like to see a donor produce around 10-12 eggs. It’s the same argument I discussed in The Infertility Survival Handbook: we’re going for quality not quantity. Although far lower recruitment numbers than what my clients are hoping for, 10-12 eggs gives them a great shot at the important aspects of ART, things like blastocyst transfer, single embryo transfer and having frozen embryos. Although higher egg recruitment does usually mean more eggs to freeze, the statistics and information presented at the conference clearly indicate that higher numbers do not yield higher pregnancy rates and in fact only increase the risk that the donor will experience OHSS (not a good outcome for anyone, most especially the donor!).

And, in fact, surprising to me were the statistics that donors who produce far less than the “ideal 10-12 eggs” show the same pregnancy rates (which are very high across the board these days) as for a donor with a much higher number of eggs recruited. I have seen that several times, so just from an anecdotal standpoint and watching from the sidelines, I know that my clients who’s donors have had “dismal” or “horrific” (my clients’ words, not mine) results, only a few eggs and embryos produced, have gone on to get pregnant and sometimes even with twins!

But even more impressive was the lecture I attended on rescuing a failed donor cycle. The doctor who presented this lecture blew me away and taught me a very important lesson (or maybe I already knew it and just needed to be reminded?): NEVER GIVE UP. The point of this lecture was about donor cycles that go wrong, either because of a mix-up and the donor not doing her injections correctly, or because the donor just wasn’t responding to the medication. The doctor used one cycle as an example in which the donor had virtually no follicles after 10 or more days on stim meds. For whatever reason (and I truly cannot remember why), the cycle seemed to be completely failing. But instead of giving up, this very inventive doctor (well he seemed inventive to me, but I have to say several other doctors in the conference were chiming in with their suggestions on how they have saved similar cycles so maybe I am just underestimating the ability of a reproductive endocrinologist to make lemonade out of lemons) was able to use meds to get this donor to produce two eggs take her to retrieval despite the apparent failure of the cycle earlier on, and get recipient mom pregnant with twins (well she should take credit for that part, yes? I mean he only put the embryos in her uterus so let’s give some credit where credit is due to the recipient/intended mom and her awesome uterus). I was amazed that zero follicles at day 10 or so of stims still wound up producing a twin pregnancy . . . I mean okay this was an egg donor and not your average infertile 30-something patient, but still, I think that is pretty cool! And I am never going to tell a client to give up . . . in fact, just the opposite. My new mantra is: Never Give Up on A Donor Cycle!



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