Sarah, age 46, was almost happy with her life. She had a handsome and charming husband, whom she waited a long time to meet. She had a great career as a professor of English lit and had just made tenure. She had a beautiful home, good friends, and a weekend place in Nantucket. Now it was time to complete the picture with a baby.
Here is where the “almost” came in. The baby didn’t arrive. Susan, being a planner, and showing the drive that got her tenure and a place on the Cape, did not dilly-dally. She strode into my office to begin her fertility treatments and get on with her life. After a series of increasingly complex treatments with increasingly dismal results, she began to consider the unthinkable, donor egg.
Donor egg is the option that gives hope to women who find themselves in Susan’s position. Although it is becoming more commonplace, many couples find themselves stymied by worries that using another woman’s eggs is strange, But in reality approximately 16,000 donor egg cycles are performed in fertility centers each year in the U.S. With so many babies being born each year from egg donation, it’s time to clear up some myths.
What is donor egg? Egg donation is a process in which eggs are harvested from young healthy women by IVF, or in vitro fertilization. Once the eggs are retrieved from the donor, they can be fertilized with the partner’s sperm or donor sperm, and the fertilized eggs, now called embryos, are placed in the recipient’s uterus. Egg donors are rigorously screened for sexually transmitted and blood-borne diseases, and typically undergo physical and psychological examination by the fertility clinic. Egg donors can be known to the recipient, such as a younger or more fertile friend or relative, or they can be anonymous. Anonymous donors are either recruited by the clinic, or are found through donor agencies.
Once the donor is screened, she must take fertility drugs, given by injection, she must be monitored with frequent vaginal ultrasounds and blood tests to assess the readiness of her eggs for harvest, and then she must undergo an IVF procedure, where her mature eggs are removed from her ovaries with a needle that is placed via ultrasound guidance. This procedure requires anesthesia. Meanwhile, the recipient must also have testing of her uterus. Most programs will also require a psychological evaluation. This is not because the program thinks that anyone who wants a baby at fifty must be crazy, but rather to help the couple determine if this option is the right way for them to build a family. Issues that are usually discussed at the psych visit include disclosure to the child, grief over the loss of the ability to have a genetic child, and discordance in the readiness to proceed with donor egg between the husband and the wife. The recipient will also likely have a complete medical evaluation and may require consultation with a high-risk obstetrician, cardiologist, or other specialist to determine the safety of pregnancy in an older mother. Finally, the recipient will have to take medication to coordinate her cycle with the egg donor’s cycle and to develop the lining of her uterus so that the embryo can implant successfully.
Who can benefit from egg donation? Egg donation is used in cases when a woman no longer has viable eggs of her own. Typically, the most common cause of this is age. A woman’s fertility begins to decline at 35 and drops precipitously after 40. Other candidates for donor egg are women who have had their ovaries removed or who have lost ovarian function due to chemotherapy or radiation therapy for cancer treatment. Sometimes, recipients are young women who have had premature menopause or who have never had their ovaries develop normally. A final indicator for donor egg is women who produce eggs that are chromosomally abnormal or who have recurrent miscarriages due to chromosomally abnormally embryos. Donor egg is not an appropriate treatment for a woman who has had a hysterectomy or other serious problems with her uterus. It is also not appropriate for women with serious medical problems in which pregnancy would be contraindicated. Finally, it is also possible for age to be a contraindication for donor egg. Many clinics will have a maximum age for recipients although this will vary from clinic to clinic. In general, however, success rates decline after the age of fifty with donor egg patients. It’s also important to remember that with age comes health problems, and these may prevent you from being a candidate for donor egg. Finally, it takes 30 years to raise and socialize a human being. Is it fair to your child to expect him to support you in the nursing home at the same time he is starting a family and career? No one wants to think about that, but these are realities we all face.
So what did happen with Sarah? She struggled with her decision. She found a donor through a reputable agency who was bright, healthy, and looked a lot like her. She had a baby at 50 and the same donor agreed to donate again two years later. Sarah and her husband now have two children, full-blood siblings from donor egg. The kids both look like her husband.