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Making an Egg Donation Cycle Work. A brief look at what you might need to know to increase your chances of success!

January 19, 2012 | By: | Filed under: adoption, Age and Infertility, Announcements, Egg Donation, In-House Egg Donation Programs, IVF, Personal Musings, The Journey to Parenthood, Third-Party Assisted Reproduction, Thoughts on Choosing an Egg Donor, Thoughts on Donor Egg Recruitment

Through egg donation, many infertile women are now able to experience pregnancy: sharing their thoughts, feelings, blood supply and the sound of their voice with their baby, and delivering their child into the world. The success rates offered by many egg donation programs are somewhat staggering, making this a very popular option in family building, especially for women dealing with the NOvary™.

Egg donation is often so successful that some can potentially build an entire family from one egg donation cycle. Of course not every egg donation results in a pregnancy, but more often than not a carefully selected egg donor not only leads to the birth of a child, but will provide a family with extra embryos to freeze for future family building.

Such was the case for my former client Nancy. Her experience with egg donation provides a great example of the types of things someone considering using egg donation might want to take into account as they move forward on their journey to “Mama” (or “Dada”).  Nancy, at the time her journey into egg donation began, was in her early forties.  Like many women today, Nancy had waited to marry until she found the “right guy” and had established her career.  After graduating from law school, Nancy decided that she wanted to put off starting a family until she had paid off her student loans, and had made partner in her law firm.  She felt very strongly that it was important her career and financial life be stable before she became a mother.  When she was 35 she met Daniel, and after dating for a few years they married when she was 38.  Well aware of fertility landmines related to age, she and Daniel  had discussed her desire to become a mother before they got married and agreed to start trying for a baby immediately after the wedding (Nancy, just like me, hoped for a honeymoon baby!).  She was such a planner that before they got married Nancy went to her OB to see if she was facing any age-related infertility issues.  Much to her surprise and relief, after her OB examined her, Nancy found out that it seemed like all systems were good-to-go; she appeared to have a healthy body, good ovarian reserve, and nothing standing in the way of her becoming a mother.  Nancy’s OB recommended that the newlyweds try having unprotected sex for six months and if nothing happened to go see a reproductive endocrinologist (sounds like a good plan to me!).  However, after six months of unprotected intercourse, Nancy and Daniel had not gotten pregnant. Proactive Nancy immediately contacted the reproductive endocrinologist her OB recommended.

The RE Nancy and Daniel saw recommended that they try assisted-reproductive technologies.  Unfortunately after several failed IUI and IVF cycles, Nancy’s doctors told her that her best chances for becoming a mother were through egg donation or adoption.  Although there seemed to be no medical explanation for Nancy’s failure to conceive, their RE didn’t think further attempts using Nancy’s eggs made sense.  Despite her remarkably low FSH and good AMH results, her RE nevertheless attributed Nancy’s IVF failures to issues related to ovarian reserve and her age.  Ironically, after all her efforts to detect infertility, especially age-related infertility, Nancy discovered that she was dealing with the dreaded NOvary™.  (Just as side note, my definition of NOvary™ extends beyond ovaries that refuse to produce eggs because we are too old.  However, in this case Nancy’s confrontation with the NOvary™ did seem to be related to the fact that she was in her early forties and her ovaries were headed into retirement.)

The RE suggested they consider using an egg donor or adopting.

Nancy was at first — like all of us — somewhat devastated by this diagnosis.  She had done everything correctly, ate a healthy diet, exercised her entire life (in fact Nancy had almost become a professional dancer before going to college), she didn’t smoke, took yoga classes, and yet her body still seemed to be failing her.  After discussing the situation with Daniel, Nancy realized that she really, really wanted to experience pregnancy (I can relate to that!), and so they chose to first pursue egg donation.  N&D agreed that they would try egg donation one or two times and if they didn’t conceive a baby through egg donation, they would move on to adoption.

Nancy, however, was not prepared for the overwhelming information and advice she received once she had settled on using an egg donor.  People told her different things:  don’t use an agency, use an agency, don’t use an inexperienced donor, use an inexperienced donor.  Everything Nancy heard seemed to be conflicting and confusing.  Even worse was how overwhelmed she felt when she logged onto various egg donation agency’s databases.  How on earth could she ever select a donor out of the hundreds that seemed to be available?

Her gut reaction was to work with her RE’s “in-house” egg donor program as they would select the donor for her, thus ensuring that she had a fertile donor and, more importantly, Nancy wouldn’t feel she had to cull through profile after profile.  Nancy just wanted someone to make the decision for her so that she and Daniel could move past infertility and onto pregnancy!

After doing her research (if we haven’t already established it, I want to remind you that Nancy is quite the type A person and she is proud of it!  I can relate, as I too am rather Type A) Nancy, however, decided instead to work with an egg donation agency.  Although many “in-house” programs are flexible, Nancy felt that she had more options when working with an egg donation agency.  While Nancy felt that she was giving herself more legwork to locate her own donor and dealing with the accompanying stress, Nancy felt that by working with an agency she had greater flexibility in choosing her donor.  What had first seemed so attractive — having someone present her with an “egg donation goddess” (her words not mine) — in reality turned out to concern Nancy.  By relinquishing control to her RE and his staff, she lost the flexibility to request a donor who had an athletic background (not only a former dancer, both Nancy and Daniel are self-professed exercise junkies, and Daniel had played some serious basketball in college), or to use an egg donor who has an “artistic” personality (the dancing thing turned out to be really important).  She also seemed to have a harder time finding a college educated egg donor through her RE and in the end having a “smart” donor also turned out to be very important to both Nancy and Daniel.  Their RE’s in-house program would be able to provide them with a donor who already had been screened for fertility (a huge plus by many standards) and who physically resembled Nancy and Daniel (another huge plus for most people), but with the in-house program she couldn’t request an “athletic, artsy, super-smart” donor.  Using an egg donation agency gave her the freedom to be more selective than she initially thought she would need or want to be.

Nancy also didn’t have to share eggs with another infertile family which was a requirement at her particular RE’s in-house egg donation program (off topic for a moment:  shared egg donation cycles are a common effort by clinics to help reduce the cost of an egg donation cycle but being “required” to share a cycle isn’t common).  Nancy also realized that working more independently meant she would have greater control over their finances.

With a limited budget because they were also considering the possibility of adoption, most of the agencies she spoke with recommended that N&D select a donor who lived near the clinic she would be using, thus avoiding substantial travel expenses. Using an agency, Nancy also had a greater selection of donors with compensation rates to fit her budget, compared with the fixed rates offered by Nancy’s and many in-house egg donation programs.  By selecting a “local” donor with a lower compensation than that which her RE’s in-house program requested on behalf of its donors, Nancy was able to save a couple of thousand dollars and put it in what she called their “adoption bank.”  It did take more time finding that “artsy, athletic, super-smart donor” than she had anticipated but Nancy felt the time was worth it given that she didn’t think she would know “enough” about her egg donor’s background had she chosen the egg donor recommended by her RE.

One donor Nancy considered, I am going to call her Lucy, was twenty-seven years old, single, had been a dancer in high school and had attended a Seven Sister’s college (rock on to all women’s colleges!!).  Lucy had graduated at the top of her class and was attending graduate school in journalism (did I mention that Daniel is a news columnist?!). Despite Lucy’s outstanding academic credentials, which often result in a higher requested compensation, Lucy’s “requested comp”  (egg donor industry lingo) was on the low side.   Side Note:  The Society for Assisted Reproductive Technologies’ (SART) has guidelines that recommend egg donors receive between $4,OOO-$7,000 per donation.

With Lucy’s dancer’s background and desire to be a journalist like Daniel, Lucy seemed like the perfect donor.  Lucy, however, had no track record donating eggs.  With their tight budget and limited time factors — N&D were also concerned that if they waited much longer their age might preclude them from working with certain adoption programs and they very much wanted to preserve this as a family-building option — Nancy and Daniel instead decided to match with ”Lauren.”  While Lauren also was twenty-seven and had attended college where she played soccer, Lauren had a three year old daughter and had conducted one prior egg donation cycle that had produced a lot of eggs.  Although they didn’t know whether that egg donation cycle resulted in a live birth, Lauren was clearly fertile and was likely to respond well to medication.  To Nancy and Daniel, this made her a better candidate.

Both Lauren and Lucy were requesting $5,000 as compensation for their cycle and lived relatively close to Nancy’s and Daniel’s clinic (no overnight travel was involved).

Once N&D selected Lauren as their donor, the egg donation agency presented them with a list of attorneys to help prepare their egg donation agreement, and it arranged for Lauren to be represented by an attorney as well.  I am working on a blog on egg donation agreements and why you MUST have one so I am not going to go into it in depth here.  I actually had already met with N&D before they got the list of attorneys from the egg donation agency (and my name was NOT on it grrrr), but I did help them prepare their anonymous egg donation agreement with the woman we are calling Lauren.

Once the egg donation agreement was signed, their egg donation cycle got underway. Lauren didn’t produce as many eggs as N&D had hoped; Lauren “only” produced eleven eggs but all eleven fertilized (Side Note: 100% fert rates are not something you should expect, it doesn’t always happen that all of a donor’s eggs will fertilize.  Nancy and Daniel got lucky). Nancy conceived twins from the first embryo transfer (now that is something you should expect and should discuss with your RE if you don’t feel prepared to parent two at once).  After watching the remaining pre-embryos which were not transferred to Nancy’s uterus, the clinic froze five blastocysts.  Off topic again: Nancy’s RE performed a day-3 pre-embryo transfer which, for reasons that exceed the scope of this blog, I am at a loss to explain.  Despite Nancy’s disappointment with the number of eggs retrieved, I would have thought the clinic would have done a day-5 or blastocyst transfer??

Nancy and Daniel are very happy and currently are considering whether or not to use their frozen pre-embryos.

If you have any thoughts or comments to add about your experience, please feel free to share them.  This blog is designed to help people achieve success in egg donation and if there’s something you think might help someone, go for it!

p.s. I don’t know whether any of this sounded familiar to you, but I did think that Nancy’s and Daniel’s decision-making process and the issues they faced, particularly those Nancy faced, were typical and helpful enough that I wanted to share them.  Nancy and Daniel’s story is discussed in much greater detail in my next book if you want to learn more about what they went through when finding their donor and negotiating their egg donation agreement.  More details about pub date to follow (I am under an editorial deadline which is a good thing because it means this thing will finally be finished!!!  I’ve only been working on the book for three years.  Enuf is enuf!).

 

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Some thoughts on making egg donation work

May 13, 2010 | By: | Filed under: Egg Donation, Thoughts on Choosing an Egg Donor

As I get closer to finishing my E-Book on egg donation, I seem to have more and more clients asking me some of the essential nuts and bolts questions about egg donation.  It is urging me to write faster and get the first of the three book series finished.  In the meantime, I have taken an old article I wrote for the then Hartford Chapter of RESOLVE on egg donation, and modified it for this blog post.

Here’s How One Woman Made Egg Donation Work:

Through the gift(s) provided by an egg donor, many infertile women are now able to experience pregnancy; sharing their thoughts, feelings, blood supply and the sound of their voice with their baby; and to deliver their child into the world.  The success rates offered by many egg donation programs are staggering (nearing the 70% mark at most clinics), making this one of the more popular options in modern family building for women with diminished ovarian reserve or other issues of egg quality.

Egg donation is often so successful that you can potentially build your entire family from one egg donation cycle.  Of course not every egg donation results in a pregnancy; but more often than not a carefully selected donor not only gets the recipient mother pregnant but there are extra embryos frozen for future family building.

Let us consider Janet[1], and her experience with egg donation.  Janet is in her late thirties and after several failed IVF cycles, Janet’s doctors told her that her best chances for becoming a mother were through egg donation or adoption.  Janet wanted to experience pregnancy, and so chose to pursue egg donation.

After doing research, Janet decided to work with an egg donation agency, rather than using her clinic’s in-house program. While some clinics are very flexible, Janet found she had more options when using an egg donation agency.  By working with an agency Janet had greater flexibility in choosing her donor, didn’t have to share eggs with another infertile family, and would have greater control over her finances.  Because she was on a tight budget, most of the agencies she spoke with encouraged Janet to select a donor who lived near the clinic she would be using, thus avoiding substantial travel expenses.  Using an agency, Janet also had a greater selection of donors with compensation rates to fit her budget, compared with the fixed rates offered by most clinics.

One donor Janet considered (we’ll call her Leslie[2]), was twenty-six years old, single, had near perfect SAT scores, attended an Ivy League college, graduated at the top of her class and was attending medical school.  Despite Leslie’s outstanding academic credentials (which sometimes result in higher compensation rates) Leslie’s requested compensation was within the middle range of both ASRM’s and the Society for Assisted Reproductive Technologies’ (SART)[3] guidelines for egg donor compensation: $3,000-$7,000 per donation.  Leslie also visibly resembled Janet and lived near their fertility clinic thus helping to make the cycle more affordable for Janet and her partner.  Leslie seemed like the perfect donor.

Leslie, however, had no “track record” donating eggs.  She had never been an egg donor before and didn’t have any children of her own.  Although statistically, carefully screened first-time (or “unproven”) donors have the same success rates in helping infertile women/couples achieve pregnancy, Janet was concerned that she would spend money to have Leslie donor undergo the first part of the necessary screening process, only to find out that Leslie was not sufficiently fertile and had been disqualified from being an egg donor.

Janet and her partner were also considering matching with a donor named “Julie”.   Julie also was twenty-six, had high SAT scores, had attended college, and had never been an egg donor before.  Julie was requesting the same compensation as had Leslie ($5,000) and lived near Janet’s clinic.  However, Julie was married, and had two-and-half-year old twins and a one-year old baby.  Julie was clearly fertile (she had children) and thus would be more likely to produce healthy eggs, which to Janet and her partner meant she presented a lower risk of being “screened out” by their fertility clinic.

Once Janet and her partner selected Julie as their donor, Janet’s egg donation agency presented them with a list of attorneys to help prepare their egg donation agreement, and it arranged for Julie to be represented by separate counsel in connection with the negotiation and drafting of their agreement. The egg donation agreement is a critical aspect of the egg donation process and all parties should be represented by independent counsel.  The egg donation agreement will protect your rights as parents and govern your relationship with your donor for years to come.  You should have the right to select your own attorney, one who is an experienced reproductive lawyer.

Each egg donation agreement is unique; some agreements provide for complete disclosure of names and addresses and others are completely anonymous.  Whatever your comfort level or that of your donor may be regarding future contact, please consider that your agreement should ensure that you can contact your donor in case of a future medical emergency.  Among other things, your egg donation agreement should specify your rights to utilize and/or dispose of the eggs/embryos created from the cycle, require that your donor follow medical directions, address what happens if your donor breaches your agreement or if the cycle needs to be rescheduled for some reason (like a death in the donor’s family), and/or how medical bills are handled if she experiences a complication like ovarian hyper-stimulation.

Within four months of the time Janet initially contacted their egg donation agency, Janet, Julie and their respective partners had negotiated their agreement and their cycle got underway.  Julie produced seventeen eggs of which fifteen fertilized.  Janet conceived a beautiful baby girl on the first embryo transfer and when Janet’s daughter was about a year-old, Janet and her partner went back and did a frozen embryo transfer; this time conceiving twin girls (it is admittedly rare for a frozen cycle to result in a twin pregnancy but in this case it did)!


[1] Janet is a combination of several of my clients, a fictitious character created for purposes of this blog to help demonstrate a typical egg donation process from a more “real life” perspective.

[2] Names have been changed to protect people’s privacy.

[3] ASRM (The American Society for Reproductive Medicine) and SART are related organizations which, among other things, establish ethical and regulatory guidelines that many clinics and agencies agree to comply with.  For more information, visit their websites:  #www.ASRM.org# and #www.sart.org#

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Donor Compensation

January 7, 2009 | By: | Filed under: Egg Donation

there should be no question about this! I have twice been a donor and it is indeed an extremely taxing, invasive, time-consuming process. the money I see as necessary compensation for pain, time, and traveling, for there is plenty! for the gift of my eggs, the responsibility I proudly shoulder, I would never take money. it is a wonderful, powerful feeling to know you are absolutely helping a woman who might otherwise be helpless.

D.S.

(This post was made on 1/4/08 and brought over from our old blog on typepad)

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