Thoughts on donor egg IVF

First, I went to say that the thoughts expressed in this post are solely mine and those of MM.  In no way do I wish to imply that we are right and that anyone who may disagree with us is wrong.  I think decisions about ART are EXTREMELY personal and individual, and what might be right for you may not be right for us and vice versa.

Also, I welcome anyone reading who knows more about this topic than I to educate me.  Feel free to either leave a comment or email me at the address provided in my profile.

Since the beginning of our TTC efforts, MM and I have been opposed to doing IVF using my eggs.  Over a year ago, I wrote a post about the reasons why we do not plan to go that route, and as our reasons have not changed, I will not rehash them here.  (If you're interested in reading them, my original post on the topic is here.  I will be alluding to our reasons at certain points during this post.)

Several months ago, around the time that we took our last (indefinite) treatment break in late November/early December 2009, MM asked me if we could "use a surrogate" to have a baby.  Like most normal, healthy men who do not work in health care, MM was wholly uninformed about the options available for treatment of infertility and thought this was a logical suggestion and possible solution to my inability to have a baby.  (Note: MM also doesn't ask many questions when we visit the RE and has done zero research or reading related to our infertility.)

Once I explained to him that, so far as we know, there is nothing wrong with my uterus specifically, or my body in general, that would make it impossible for me to have a healthy pregnancy and delivery and that it appears to be the quality of my eggs (due to my "advanced" age) which is our primary problem, MM then wanted to know what, if anything, could be done about that.  Like many uninformed people, he thought there would be a medication that the RE could give me which would improve my egg quality, and when he found out there is no such drug, he wanted to know what, if anything, could be done.

Enter discussion of donor egg IVF.  MM had never even heard of such a thing, and it was quite an education for him when I explained how women can become pregnant doing donor egg IVF or using donor embryos.  (Donor sperm he had thought of on his own.)

As I've written about here before, MM's primary--though not only--motivation for wanting a child is to have his own genetically related child.  He has a number of reservations about adopting for this reason.  (His feelings on the matter are the main reason why we are not considering adoption, and I wrote at length about why we've made that choice here.)  Doing donor egg IVF would allow MM to not have to give up his desire to have a child who is biologically "his."  (Obviously, he would give up the dream of having a child who is biologically "ours," and that is no small sacrifice to him, but it is a smaller sacrifice than never having his own child at all.)

MM's primary objection to IVF is, and has been, the cost relative to the rate of possible success.  I understand and, to a degree, share this objection.  For women my age (39), so far as I've learned through research online, there is not a fertility clinic anywhere which can boast success rates of more than 50% for IVF using your own eggs.  A quick check of the 2008 success rates for CCRM, which is widely considered to be one of the best fertility clinics in the U.S. with the highest success rates, even for "difficult" cases, reveals that only 45.9% of IVF cycles for women aged 38-40 resulted in live births.  The 2007 ART Report from the CDC (the latest one available online) shows that not a single clinic in the metropolitan area in which I live can boast a success rate anywhere near that.  The highest rate of any clinic in my area for women aged 38-40 in that report is 19.2% for live births, while our clinic has an even-more-dismal 12.5% live birth rate.

Thus, any IVF cycle using my eggs is more likely to fail than to succeed. It's hard to try anything extremely grueling and involved when you know that the odds are against you.  I know some people might view this as a challenge to be overcome, but that is not the way I, or MM, think.

Our RE pointed out to us at our last sit-down with him that success rates look at each cycle individually and thus do not include the possibility of future FETs with eggs which are retrieved and fertilized.  But those future FETs are neither free nor effortless; they still involve daily injections of hormones, sometimes multiple injections a day, and monitoring.  (At my age, I do not qualify for a shared risk program.)  And FETs have even lower success rates than fresh cycles, making it even less likely that any individual cycle will result in our taking home a baby.

For me personally, there is another complicating factor with all this that might adversely our chances of success.  One of my ovaries is positioned behind my uterus, in a place which would make it inaccessible for egg retrieval.  Our RE has told us that the position of this ovary should in no way affect my ability to conceive naturally.  However, if I did IVF using my eggs, there is absolutely no way of knowing, or controlling, which ovary will produce more eggs.  So theoretically, it is entirely possible that my left, unreachable ovary would produce the majority of the eggs, making those eggs basically a waste from an IVF standpoint because they could not be retrieved.

The other factor against us is just the expected age-related egg quality factor.  I know that my tubes are patent and functional, based on a HSG and based on the fact that I did become pregnant once, though it ended in a very early miscarriage ("chemical pregnancy").  So we know that I have no tubal issues.  Based on that same chemical pregnancy, we know that MM's sperm are able to penetrate and fertilize the egg.  So that means that the most likely problem we have is, in fact, poor egg quality.  But who's to say that every egg I have left isn't of an equally poor quality to the one which resulted in my chemical pregnancy?  Given that, in over two years of TTC, I have never been more than 5 weeks pregnant and have only even conceived once, I believe the likelihood is pretty high that I have no, or at least very, very few, decent quality eggs left.

Given all the information that we have, we feel that the odds are not in favor of our ever having success getting pregnant with my eggs.  Neither of us wants to shell out $12-15K+ per cycle for something which would give us a 12.5%, or even a 45.9%, chance of taking home a baby from the hospital.  I realize that IVF is always something of a gamble, but I don't like our odds at all.

Even putting cost issues aside--because really, can cost be the only consideration for a decision this important?--truth be told, I don't think I would be willing to do IVF with my eggs even if it were free.  The physical and emotional stress associated with the many drugs given to stimulate the ovaries for an IVF cycle is something I truly wonder if I could tolerate.  I have had only a taste of what being on stims feels like, having used Follistim in conjunction with Clomid, and it wasn't easy.  I don't want to think about how much worse it would be once the dosage of Follistim is ratcheted up and other drugs are added to the mix.  And I am even more loathe to try when there is a greater chance that the cycle will fail than that it will succeed. 

I am more than a little concerned about the possible future effects of ovarian over-stimulation, too.  Our RE had me sign a very alarming consent form when we started treatment which advised me that the drugs used could increase my future risk of ovarian cancer.  Though I have no specific authority for this thought, it is logical to me that higher doses of these drugs would create an even greater risk.

Also, I think that ART can be a slippery slope.  If you'll do IVF once, why not twice?  If twice, why not three times?  And so on and so on, until one day you wake up, emotionally spent, and you may now have tens of thousands of dollars of debt and still no baby.  Every single one of us who regularly reads infertility blogs can tell you about someone, or several someones, she knows who has done five or more IVF cycles and is still childless.

MM and I promised each other when we started TTC that we would not put ourselves deeply in debt or ruin our relationship to become parents.  I fear starting down the path of IVF could do either or both.

I understand that there are injections, drug side effects and monitoring involved with a donor egg IVF cycle, too, but my preliminary research into the matter had led me to believe that this option is preferable for us.  For one, it seems that the donor, not the recipient, is the one taking more drugs and requiring more monitoring.  Sure, I would have to take drugs to prepare my lining and to support my (potential) pregnancy, but I wouldn't have to stimulate my ovaries.

The most attractive part about a donor egg IVF cycle is the success rate.  CCRM's website indicates that their live birth rate for donor egg cycles has been right around 80% for the past few years.  I have seen other clinics with similar success rates.  I realize that the price tag for donor egg IVF is about two to three times what it would be for an IVF cycle using my eggs. . . . but if there is a four out of five chance it would work, it would be worth the risk.

I will admit that I am a little sad at the prospect of giving up my own genetic link to a future child and at giving up the chance to see what a child who is a combination of my and MM's DNA would be like.  But it is looking more and more like I would be giving these things up in any case.  Certainly the odds of our achieving a pregnancy naturally are low--around 5% per cycle, according to our RE--and the odds of achieving a pregnancy through IVF using my eggs is low, too, though not quite as low.

Donor egg IVF is preferable to adoption for us in a number of ways.  Unlike with adoption, it would allow at least MM (though obviously not me) to have a biological child of his own.  Although I know my husband loves me, and he has told me repeatedly that he would not leave me because of my inability to have a child, I feel horrible knowing that I am depriving him of his only chance to be a father.  (And his parents of their only opportunity to be grandparents.)  I'm not sure I can live with and accept that by being with me, MM had to  forfeit his chance at fatherhood and give up a dream that has been so long-held and so close to his heart.

With donor egg IVF, even though I would not be genetically related to our child, I would get to experience pregnancy and be in complete control of our child's environment literally from day one.  I would never have to worry whether our child's mother smoked, or drank alcohol, or used drugs, or even ate nothing but junk food while our baby was in utero, as I know I would if we were to adopt, because I would know exactly what the intrauterine environment was like. . . to the extent that anyone can know this, at least.  

The timing of when we would become parents would be at least somewhat within our control with donor egg IVF, too, though obviously also based upon clinic and donor scheduling.  I know from seeing the experiences of others waiting to adopt that sometimes the wait can be long and is likely to be longer if many pre-conditions are placed upon an adoption.  Even if MM were willing to adopt, we would be looking for a healthy, Caucasian newborn.  Waiting for a birth mother to choose us to parent her baby could take years.

Finally, if we use donor egg IVF vs. adoption, no one will ever know that our child is not genetically "ours" unless we choose to tell them.  To that end, we would pick a donor who shared at least my ethnic background and coloring (though given the apparent strength of my husband's paternal genes, the child may end up looking more like him in any event).  I am sure that adoptive parents are accustomed to, and perhaps don't mind, the curious looks strangers sometimes give them if they are with their adopted child who in no way resembles them.  But we would rather not deal with that if we can avoid it.

So these are the reasons we are considering donor egg IVF.  If we decide to do it, we almost certainly go somewhere other than our current clinic, and likely somewhere with the highest possible success rate.  Because of the cost involved, and because of the slim hope which MM still has that we will somehow, miraculously, get pregnant on our own, we are not looking to put this plan into effect soon.  Likely it will be at least 6-9 months or more before we do anything more than investigate this option.