"Hope has two beautiful daughters; their names are courage and anger"
"Anger that things are the way they are, Courage to make them the way they ought to be"
- St Augustine
It always amazed me that the most number of questions I received, have to do with options, costs and opinion on egg donor IVF. I am not a doctor but given the almost singular question, I have come to realize that the demand and hunger for women in the world to be mothers is incredible and overwhelming, so I will try to pass on some information that I have read.
After the fast and furious responses I have received, I am humbled by the number of women who may see your funds running out, with no clear understanding of why IVF is not working for you. Or women who may have gone through three cycles of IVF or more without success. Or others, who may be experiencing recurrent miscarriages with no clear explanation as to the reason.
I think the best opening resource for egg donor cycles is The Donor Source, which is actually an agency. I would start by reading their "Where to Start" segment.
The overall cost of egg donation is comprised of paying the egg donor, the egg donor agency, your fertility center and other professionals, such as legal counsel. While some egg donor costs are fixed, such as the egg donor psychological evaluation and administration fees, others are highly variable.
Many intended parents have been able to successfully reduce their overall egg donor costs by choosing a donor that lives local to their fertility center. For example, if you choose a donor that lives in California, and your fertility center is in Boston, your travel fees associated with the egg donation cycle could become more expensive. If you choose an egg donor from Boston, New York or other states nearby, your variable egg donor costs will be much less.
Another opportunity to reduce egg donor fees is by researching the egg donation costs charged by the fertility centres near you. This can be a significant portion of your egg donor costs, including screening, medication and IVF treatment. As with any service, diligently researching your options is highly recommended.
What are the pros of US DE clinics or agencies? The sort of things that are not necessarily guaranteed in Asia — high levels of medical regulation and process, strict egg donor screening, reliable and comprehensive information and service, favourable fertility laws, fairly high IVF success rates and the presence of guarantee programs. What are the cons? Cost, time, travel and the shortage of Asian donors.
The following on choosing a clinic or egg donor is put together by PVD (Parents via Egg Donation):
An anonymous egg donor is an egg donor you do not meet, selected with the help of an IVF clinic or an egg donation agency. You do not know her name or anything else about her that is not stated on her profile. You may or may not see a photo of the donor. The donor would know nothing about the recipient/intended parent(s) or the cycle other than how many eggs were retrieved, and in some instances, whether or not a pregnancy resulted.
A semi-known egg donor is an egg donor who knows the recipient/intended parent(s') first name(s) and the state in which they live. The donor and recipient/intended parent(s) might exchange emails and photos; however, no specific personal information is provided about the donor or the recipient/intended parent(s).
A known egg donor can be a friend, family member, or someone selected by the recipient/intended parent(s) with the intention of meeting face-to-face. The donor may know the recipient/intended parent(s') first and last names and/or where they live, and in addition the two parties may be willing to exchange email, telephone calls, and personal information as well as to continue to keep in contact with one another.
The donor and the recipient/intended parent(s) may agree upon the child meeting the donor at a future point in time. The recipient/intended parent(s) may or may not send photos of their child with updates to the egg donor as well. The arrangement regarding exchange of information is agreed upon and put into place between the egg donor and recipient/intended parent(s) at the time of the cycle. In many instances, information is shared for medical purposes.
All egg donors should complete an in-depth egg donor profile compiled of several pages of questions covering their medical history, personal history, social history, and reproductive history. You do not want to do business with an egg donor agency, broker, or clinic that does not require their egg donors to complete at least a medical profile. All egg donors should meet with a psychologist to be administered a multiphasic personality inventory (clinical personality test) and a psychological evaluation.
What should I look for in an egg donor?
The following is a list of important qualities to look for in a potential egg donor. Ideally, egg donors should:
- Be between the ages of 21 and 30 and exhibit maturity, responsibility, and dependability
- Be in good physical health as documented by history and testing
- Be in good psychological health as documented by history and testing
- Be of proportionate height and weight [being overweight may affect egg quality, as well as necessitate higher doses of stimulation drugs to create follicles, which translates to additional costs for the recipient/intended parent(s)]
- Be drug free
- Be a non-smoker of tobacco and marijuana
- Have regular menstrual periods and is not using Depo-Provera or any other birth control that stops her from having regular monthly periods
- Have a normal value for Anti-Müllerian hormone (AMH) levels which are between 1.0-3.0 mcg/L
- Have an FSH (Follicle Stimulating Hormone) level on cycle day three (3) of no more than eight (8), preferably under six (6)
- Have an E2 (Estradiol) level on cycle day three (3) of less than fifty (50)
- Have an Antral follicle count*** of at least fifteen (15) combined count
**Egg donors younger than 21 may not be emotionally mature; egg donors older than 30 are not at peak fertility. Always follow your reproductive endocrinologist's advice regarding age.
***Antral follicles are small follicles (about 2-8 mm in diameter) that a reproductive endocrinologist can see, measure, and count with ultrasound. Antral follicles are also referred to as resting follicles. Vaginal ultrasound is the best way to accurately assess and count these small structures. The antral follicle counts (in conjunction with female age) are by far the best tool that we currently have for estimating ovarian reserve and/or chances for pregnancy with donor eggs through IVF.
Specific questions to ask an egg donor (or to ask the clinic/agency about an anonymous donor) or information you may find on an egg donor profile:
1. Do you have or does anyone in your family have a tendency towards any particular illnesses, i.e., allergies, intestinal problem, cancer, heart disease or psychological problems? Who had one or more of these illnesses, and at what age did the onset occur? (These questions should be answered completely within the donor profile.)
2. Are your blood relatives living, i.e., parents, siblings, grandparents, aunts, and uncles? If not, how old were they when they died, and what did they die of? (These questions should be answered completely within the donor profile.)
3. Have you or any member of your immediate family ever smoked, drank alcohol to excess, or used illegal substances? To what extent are any of these, or have any of these ever been, a problem? Note: Some agencies don't like to ask this question. However, it is a reasonable and important question, as studies have shown that some forms of addiction have hereditary components. (These questions should be answered completely within the donor profile.)
4. Have you ever been pregnant? What was the outcome? (These questions should be answered completely within the donor profile.)
5. Have you ever donated eggs before? If you have, how many follicles developed? How many eggs were retrieved? How many successfully fertilized? Was there a resulting pregnancy or multiple pregnancy, and a live birth(s)? Note: The donor may or may not have this information.
6. What can you tell us about your family of origin? Who are they and what are their ages? What are their vocations and vocational interests, hobbies, talents and dispositions? What are their physical characteristics, such as coloring, size, weight and height? (These questions should be answered completely within the donor profile.)
7. Do you have any children? If yes, how old are they now? When did they learn to sit up, walk and talk? Were there and are there any significant health issues we should know about? What are their sleeping and eating habits? What are their special abilities and interests? What was their birth weight and length? (These questions should be answered completely within the donor profile.)
8. What is your family's genealogical heritage or history? What country(s) did your ancestors come from, where did they settle here, and when? (These questions should be answered completely within the donor profile.)
9. Why do you want to help us have a baby using your egg(s)? What do you think you will get out of it? If you have already donated, what did you get out of it? If you do not already have children, have you considered the unlikely circumstance that at a later date you might be unable to conceive? (This should be discussed with a psychologist before the donor donates.)
10. If we get pregnant, will you tell your family members including your children? If so, how will you tell them, and when? Would you want your children to know that our child would share half of their genetic heritage? How will you handle their questions?
11. May we see or have pictures of your family, siblings, and children? If we desire [in a known donor agreement], may we meet with your immediate family, including your children?
12. Have you thought about how you'd feel if, after all this interaction and sharing, we don't get pregnant?
13. Have you thought about whether you would like any ongoing contact such as pictures, phone calls or meeting the child?
A few last words about choosing an egg donor:
Using a donor is always a really thorny issue, even when it is someone whom you may know or be related to. The process is very emotional, not least because you are thinking about your priorities — how do you weigh someone who has a family history of diabetes, against someone who has small eyes? Is height important to you, if so, how tall or how short are you willing to accept?
It sounds judgemental, even upon your own, imaginary child, but it is a really delicate and often conflicting struggle to process in your mind, what it means to you, indeed what each one of these characteristics means to you. Do you make value judgements about SAT scores, over beauty? These are all normative decisions and I believe that if and when there is an actual child born to you, you won't even remember half of this.
In the meantime, do your homework, research, ask questions, and if something doesn't sit well, listen to your gut. Don't be led to believe that if you pay a top price for an egg donor, you will get a premium donor. That's not the way it works. Don't believe that paying a higher fee to an agency or a donor is going to create or produce a top quality (or even a better quality) egg – or, for that matter, increase your chances at becoming a parent. Again, that's not the way it works.
If you are looking for clinics, specifically, these were the statistics in the US for 2012: clinics who reported to SART, performed at least 50 fresh donor egg cycles in 2012, and have at least a 70% live birth rate. Success rates are reported as live birth rate per transfer.
#1 – Colorado Center for Reproductive Medicine (aka CCRM – Dr. Schoolcraft) – 83% in 106 cycles with an average of 1.6 embryos transferred: in 2011 they had a 76.3% live birth in 139 cycles; in 2010 they had a 76.4% live birth rate.
#2 South Florida Institute of Reproductive Medicine – a newcomer to my list this year – 82% in 50 cycles with an average of 1.9 embryos transferred; in 2011 they had a 68.6% success rate; in 2010 they had a 63.2% live birth rate.
#3 Advanced Fertility Center of Chicago (Dr. Sherbahn) – 81.7% in 93 cycles with an average of 1.7 embryos transferred; in 2011 they had a 80% live birth in 75 cycles; in 2010 they had an 81% live birth rate
#4 Oregon Reproductive Medicine (aka ORM – Dr. Hesla) - 77.1% in 144 cycles with an average of 1.7 embryos transferred; in 2011 they had a 74.5% live birth in 106 cycles; in 2010 they had a 73% live birth rate.
#5 Reproductive Medicine Associates of New Jersey (aka RMA NJ) – 73% in 63 cycles with an average of 1.7 embryos transferred; in 2011 they had a 71.3% live birth rate in 94 cycles; in 2010 they had a 68.8% live birth rate.
#6 San Diego Fertility Center – 72.3% in 184 cycles with an average of 2 embryos transferred; 2011 was not reported due to a transmission error; in 2010 they had a 77.2% live birth rate.
#7 HRC Fertility- Encino – 71.6% in 81 cycles with an average of 1.9 embryos transferred; 2011 they had a 65.2% live birth rate in 46 cycles; in 2010 they had a 61% live birth rate.
#8 UCSF Center for Reproductive Health – 70.7% in 75 cycles with an average of 1.4 embryos transferred; in 2011 they had a 50.8% live birth rate in 65 cycles; in 2010 they had a 47.8% live birth rate.
Here are some honorable mentions – clinics who didn't make the 50 cycle cut off, but are showing good rates:
• Dallas Ft. Worth Fertility Associates – 80% (40 cycles)
• Delaware Valley Institute of Fertility and Genetics – 78.3% (23 cycles)
• Utah Center for Reproductive Medicine – 75.9% (29 cycles)
• HRC- Orange County – 75% (36 cycles)
• Houston IVF – 72.7% (44 cycles)
• Center for Fertility and Gynecology – 72.2% (36 cycles)
• Cardone Reproductive Medicine and Infertility LLC – 72% (25 cycles)
• Bethesda Fertility Center – 70.8% (24 cycles)
• Reproductive Specialists of New York LLP – 70.8% (24 cycles)
• Pacific NW Fertility and IVF Specialists – 70.2% (47 cycles)
