June 10, 2008 | By: Liz | 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!