The Donor Egg Decision – By Dr. Guy Ringler with California Fertility Partners

by Admin on October 15, 2009

THE DONOR EGG DECISION
By Guy Ringler, M.D.

THE TREATMENT OF INFERTILITY HAS UNDERGONE DRAMATIC IMPROVEMENTS IN THE LAST TWENTY-FIVE YEARS. THE APPROACH TO TREATMENT HAS CHANGED AS SCIENCE, TECHNOLOGY AND CLINICAL PRACTICE HAVE ALL PROGRESSED IN THIS STILL RELATIVELY NEW AREA OF MEDICINE. AS A RESULT OF THESE ADVANCEMENTS THE PREGNANCY RATES TODAY WITH IVF AND THE ASSISTED REPRODUCTIVE TECHNOLOGIES ARE HIGHER THAN EVER BEFORE.

For individuals and couples who are unable to conceive with basic infertility treatments such as intrauterine inseminations, IVF offers the greatest chance for achieving a successful pregnancy. The basic requirements for IVF are good quality eggs, healthy sperm, and a receptive uterine environment. One of the most important factors determining the overall success rate of IVF is the age of the woman producing the eggs. As the age of a woman increases, not only does the number of eggs remaining in the ovaries decrease, but the number of chromosomally normal eggs decreases as well, resulting in fewer normal embryos available for initiation of pregnancy. To counteract this effect, we generally transfer more embryos into the uterus per IVF cycle as maternal age increases. If a woman does not produce a sufficient number of eggs in response to ovarian stimulation drugs, if the eggs retrieved in an IVF cycle are assessed to be of poor quality, or for patients who are in their middle forties, donor eggs are a good treatment option. Egg donors are healthy young women, ages 21-34 years of age, who have been carefully pre-screened, and selected by the recipient individual or couple. The egg donor essentially undergoes an IVF cycle. Her ovaries are stimulated to make multiple eggs and since she is young, the egg quality is very high. The clinical pregnancy rate using donor eggs is approximately 60-65% per embryo transfer with a live birth rate of 50% (CDC, National Summary 2002). Other indications for the use of donor eggs would include: absent ovaries secondary to disease or genetics, to bypass known genetic disease, premature ovarian failure, and initiation of pregnancy for gay individuals and couples. Although the success rate with donor eggs is several times higher than possible pregnancy rates for patients with decreased ovarian reserve, the decision to proceed with this treatment option can be agonizingly difficult for many patients. The decision to proceed with donor eggs means one has to give up their pursuit to have a child using their own genetic tissue, and this can be a major stumbling block for many individuals. Why is it so difficult for many individuals to not reproduce using their own genes? Is it our innate biological drive that makes us persevere to have our own offspring, or is it our success driven culture that makes it hard for us to “give up?” My experience has taught me that everyone must come to terms with this issue in their own way, in their own
time. Consultation with a clinical psychologist with experience counseling couples with infertility related issues is a
good starting point. It is essential that one has been carefully evaluated by a reproductive endocrinologist and has been informed of success rates with all of the treatment options. Recently, I had the opportunity to visit with a former patient who had undergone fertility treatments including donor egg. She shared her joy over her newborn son. Her comments on her journey to donor egg were very insightful and I thought they might be helpful to others who may be dealing with these issues. I decided to conduct an interview and share her story with you.

Dr. Ringler: “When you presented for evaluation of infertility we discovered a very large uterine polyp that filled the uterine cavity and could have prevented conception. After recovering from surgical excision of the polyp, we outlined a treatment plan of several cycles of ovarian stimulation with insemination. If you did not conceive within this interval we would then re-group and discuss other options. Since you were 44 years of age, and the success rate with IVF is not significantly higher than IUI for most patients at this age, in vitro was not presented as a viable treatment option. However, IVF with donor egg was mentioned as a treatment alternative. Can you remember your response to the donor egg option?”
Robin: “Yes, I was determined to have a child with my own egg. That was why I came to you for treatment. I wanted my own child, like I had with Mark – my first son, and I thought that I just needed a little bit of help, perhaps some inseminations. Since I hadn’t had any difficulty the first time, I assumed it would be pretty easy even though I was 44 years old. At my initial consultation, you discussed the effects of aging on pregnancy and miscarriage rates. You were direct and to the point; there was nothing flowery about it. You gave me realistic expectations and it was helpful to hear this. You made me feel comfortable. Pregnancy wasn’t a pipe dream; it was something that was a reality the way you presented it to me. Although the statistics were not encouraging, I really believed that I could achieve it with my own egg at that point. You stressed that we needed to be realistic, and encouraged us to give it a “stop treatment date.”

Dr. Ringler: “Had you and your husband discussed donor egg prior to that date?”

Robin: “We had, but we immediately dismissed the idea.”

Dr. Ringler: “Why was that?”

Robin: “It wasn’t ideally what I wanted. I was only focused on what I thought I could do, and I wanted to just focus on getting pregnant with my egg and not think about anything else. I just wanted to concentrate on getting pregnant. My father had passed away just two months prior to starting fertility treatment, and that was another determining factor, I wanted his lineage to continue through me, and I felt really strongly about that. There were no male offspring that had my father’s last name, and I wanted my father’s name to continue. That was probably one of the strongest factors as to why I needed my own egg.”

Dr. Ringler: “We encountered difficulty getting your ovaries to respond to the medication. The goal of this therapy is to increase the number of eggs released each cycle. When your ovaries did not respond in an encouraging manner, how did this make you feel?”

Robin: “Every time that I had a menstrual period I was completely devastated. After the second or third time I began to entertain the thought of donor egg because my stop date was approaching quickly. It was very painful going through it; not the injections – those were easy – it’s psychologically – when you fail each month, it means that you didn’t have an egg that lived. So as we got closer to my stop date, I began to ask questions about donor egg and you suggested that I meet with a psychologist to explore all the issues that it brings up. I made an appointment with the psychologist, even though I still was hoping that it would be my egg that would get me pregnant, but I thought I would at least talk to her about the option. After hearing my history, the psychologist seem to encourage me to pursue donor egg, which I really didn’t want to hear at that point, but she said something that hit home with me. She said that I’m listening to you and what you told me when you first came in was that the most important thing for you and your husband, is to have a sibling for your son and that donor egg is a way that you can make that happen. That statement stayed with me as I continued to try with my own eggs. It was very helpful because when we finally reached the stop treatment date, I pulled that out from my brain and presented it to my husband as we discussed our next steps.”

Dr. Ringler: “Were those easy discussions? Did you know that you would proceed with donor egg or did you consider stopping your attempts all together?”

Robin: “The two of us had individually mulled over what we were going to do, and when we sat down to discuss it, we broke it down to three options: either no sibling for John, donor egg, or adoption. We eventually chose donor egg because even though we both felt that we could love any child, the bonding process that occurs when you carry a child for nine months, might be stronger than the bonding that occurs through an adoption process. In addition, the donor egg route enabled us to use my husband’s sperm, and thus allow his genetic material to be a part of our new
family member. We decided that stopping attempts at adding to our family was not an option for us. We really wanted a sibling for our son. It was very important to us for him not to be an only child because we didn’t want him to be left alone when we were gone. We wanted our children to be connected to family and not to be alone in the world.”

Dr. Ringler: “So you decided that you would proceed with donor egg because it would lead to a sibling for your son and it would give you the opportunity to bond during the gestation. What was the donor
selection process like for you?”

Robin: “It was very interesting because you have to really be honest to yourself about what matters to you. What is it that really matters to you? Is it education, music, ethnicity?”

Dr. Ringler: “Did you make a list of what was important to you?”

Robin: “I don’t think we ever wrote it down, we just discussed it. We spent a lot of time with it. We are an inter-racial couple and I wanted my son to look like my family. I am a black American woman and my family is a mixture of so many different ethnicities and I wanted someone who had a multiple of ethnicities in her family as well. So that was kind of interesting to find. It was a difficult process…because there were some great, highly educated candidates, but they didn’t look like me, so I couldn’t choose them. My family mixture is black, American Indian, European, and Cuban. The second most important factor was education…college with a good grade point average…and third, music in the family.”

Dr. Ringler: “Are your family members extremely musical?”
Robin: “Yes, Steve is a musician and I am a singer. We found a woman from an interracial family with a mixture of black, European, and American Indian. She was in graduate school and her mother was a teacher. There was even some music in the family.”

Dr. Ringler: “During this time while you were choosing a donor, were you completely comfortable with the concept, or did you entertain doubts?”

Robin: “Yes, I had some second thoughts, even after we had made our selection.”

Dr. Ringler: “How did you deal with those doubts?”

Robin: “My fear was that once I had the baby, I wouldn’t think of him as being mine. I remember talking to you and my gynecologist about these fears, but I didn’t share this fear with my husband because I didn’t want to plant a seed that there was some doubt. I am happy to say that those thoughts have vanished. In fact recently I found an envelope with photographs of the donor and some of her family members that I was given in the selection process. When I looked at the photo, I saw a stranger. I didn’t see my newborn son, and I didn’t think – oh this is where he came from. I realized that I didn’t need these photographs to remind me of where he came from, so I stored them away. Once the baby is in your arms, you don’t think about it and you don’t look at him and think he’s not mine. It’s very interesting because people stop me on the street and say things like oh he has your nose, he has your eyes.”

Dr. Ringler: “During the pregnancy, did you need to learn to think of him as yours and not as a product of the egg donor?”

Robin: “Early on in the pregnancy, I had some thoughts about whether this was my baby or part of the donor…and then those thoughts just sort of evaporated and he became mine. And now I look at him and he’s definitely all mine. But it wasn’t always so easy. I really did think when I was going through the donor selection process that it was going to haunt me every waking moment of my life that it really wasn’t my child, but that hasn’t happened and I’m so glad. I can talk about this very lightly now.”

Dr. Ringler: “What was the fear? That you wouldn’t be able to relate to the child or that he would just seem foreign?”

Robin: “That he would seem foreign. That I wouldn’t bond. That I wouldn’t feel the same way towards him that I do towards my other son. I didn’t want to have separate feelings for the two of them.”

Dr. Ringler: “And do you feel any different towards them today?”

Robin: “No, they are both my sons and I love them dearly.”

Dr. Ringler: “I think that this is a common fear among women going through this process.”

Robin: “Yes, I think it is. In fact, I have a friend who had gone through this process before me and she was very open about the whole thing. She had no doubts in her mind whatsoever that her child was completely hers, and I really admired her for having that strength, but I didn’t think that I would be able to do it. But I did.”

Dr. Ringler: “Congratulations!”

Robin: “Thank you.”

Dr. Ringler: “What advice would you give other women who are facing these issues and decisions?”

Robin: “I think that you need to be very honest with yourself and find out what’s really important to you. If you can be that honest with yourself and really find out what that important thing is for you, and go in that direction, then you won’t have any doubts. It’s something that you must feel comfortable with, and not forced or talked into, and then you’ll be fine.”

Dr.Ringler: “Thank you for sharing your story with us. It’s very gratifying to hear of your successful pregnancy outcome and see how happy you are with all of the decisions and choices you made to add to your family.”

My reason for presenting this patient’s personal story was to help other women who might have some of the same fears and uncertainties about a donor egg pregnancy as those expressed by this woman. The use of donor eggs in the treatment of infertility provides a strong and successful tool that enables many women to fulfill their dream of getting pregnant. In my clinical experience, most individuals initially express some reservation about the concept, but after careful contemplation and personal exploration, they are able to overcome these doubts and proceed confidently. After the birth of the child, all patients are able to accept their new family member with open arms and hearts, and any fears which they may have hidden along the way seem to vanish.

Dr. Guy Ringler is a board certified Reproductive Endocrinologist and an Assistant clinical Professor at the UCLA School of Medicine. Dr. Ringler studied medicine in Michigan, and then trained in Obstetrics and Gynecology at the University of Chicago. He completed his fellowship training at the University of Pennsylvania where he gained extensive experience in microsurgery, performed basic science research and practiced clinical infertility. Dr Ringler can be reached at 310-828-4008, www.lainfertility.com

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