Thursday, July 8, 2010

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.

16 comments:

  1. S...excellent post. My DH and I are going down the road to DE right now. We just picked out a donor a week ago today through CCRM's DE program. Your sentiments about DE EXACTLY mirror my own. I was already grieving the loss of a genetic connection for a bio child but just could not let my DH go through that as well. But I'm doing it for more reasons than to "satisfy" my husband...I have found out that I have a very primal fear that I'll never be a mother and that I must at least try to have a baby so that I can satisfy the "shoulda, woulda, coulda" 10 + years down the road. I can say that once DE feels right...it feels TOTALLY right. We are wholeheartedly against adoption for virtually the same reasons you and DH have - although a wonderful option - just not for us. So DE felt like the perfect happy medium but with WAY more perks. But yes, do not rush your decision. Read lots of books on the topic. My favorite is Mommies, Daddies, Donors and Surrogates by Diane Ehrensaft. I purchased it thorugh ama.zondotcom.

    I can say that we have been nothing but extremely satisfied with our care at CCRM. They are expensive and they do have a program in place that if DE doesn't work out then you try for another round for very little cost or 100% free except drugs. This program is an additional $5000 on top of the already paid fees. We did not do this...we're gambling that we'll be on the good side of their 81% success rate and hope that our donor will be able to create many eggs for many embryos that will be vitrified (superior to cryopreservation) that allows FETs to be as good as fresh.

    And CCRM's one day work up thoroughly tests both you and your DH to make sure there are not anymore blindsides...worth the cost in our opinion and already saved us a tonne of money by not going forward with my eggs due to my chromosomal inversion and low AMH. Long story.

    Anyway...enough rambling. Good luck and I look forward to following your journey wherever that may lead.

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  2. Your reasons for wanting to do donor IVF make complete sense. You don't need to justify any of them, of course, but I enjoyed reading about your decision and how it came about. You have to do what's best for you in every way. I think the scariest part about IVF is that that odds are not great. Like you and your husband, it seems like such a large amount of money with no guarantee (can you tell I'm not a fan of gambling?). It sounds like you've made a great choice and I can't wait to see how it all plays out.

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  3. I applaud your reasoning in the face of what is/ could be a very emotional issue :) Your reasons make so much sense and I found myself nodding along - from what you said, it does sound like a good option for you and MM. Not perfect, of course, but a good option for sure.

    I was struck my the part where you said:

    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.

    When you think about it, it's kind of amazing that there *is* no such drug. As far as medicine has come, I'm continually astounded by the things we still can't do.

    Thanks for sharing your thoughts with us.

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  4. Thank you for being so honest about your thoughts and feelings towards this extremely personal decision.

    For me, DE IVF was my last resort. I guess I am a bit of an IVF junkie doing 4 OE IVFs by the time I was 30. In my case, I don't have advanced maternal age, just really crappy eggs. All the doctors (including CCRM) were optimistic about my chances for success which led us to continue to try with my eggs.

    Finally when it was time to move forward with DE, it was and is not an easy road for us. Our first donor backed out right before starting stims, which in many ways left me feeling the same as a BFN. I had already started the Lupron to build my lining so it was just an awful situation to be in. We then chose a second donor and my lining didn't cooperate. This was also extremely difficult as I wasn't aware of lining issues beforehand so again, I felt like a failure. I was put on a high estrogen protocol which involved pills and injections and A LOT of monitoring (probably the same as if I was doing the stims) and in the end my lining was only at 6.5mm, not ideal. We transferred 2 beautiful looking blasts and had a BFP, but sadly it ended in miscarriage.

    Again, at 30, I feel to the wrong side of the statistics. We chose CCRM because of those great 80% live birth rates, but it hasn't worked for us yet.

    All I can say, is that everything is a gamble even when you think that it is in the bag. For ME, I am glad that I tried with my OE first, because I needed to give it a shot. It was really important for me to have that genetic connection and giving that up was extremely difficult, but I totally understand and support your decision. Creating a family is such a personal decision and I will offer you and DE support I can.

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  5. It sounds like you and MM have given a lot of thought and consideration to this decision. The IF journey is one that we all travel with only our partners and ourselves as the final decision makers, and all we can do is try, in the moment, to make the best and most informed decisions that we can, and then hope for the best. It sounds like you two have a really good plan. It may not be ideal in the same way that life may not always be ideal. We do the best we can with the hand we are dealt. But it sounds like the path you've chosen has a really good chance of success, and I'm looking forward to being able to congratulate you in the very near future!

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  6. It sounds like a well thought out plan! I think you will feel that the baby is "yours" even though it won't be genetically related just from feeling it grow inside of you. Good luck!

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  7. I find that a lot of what you wrote were thoughts that crossed our minds prior to going down the donor egg route. I mourned the genetic connection a lot, I meant to the point that I was having panic attacks. I worked through it and even during that time, I knew deep down that we were making the right choice for us - the choice that gave us the best odds of getting pregnant. As you know, we were successful our first time out. We were incredibly lucky. When we got the call telling us how many eggs had fertilized, there was no question in my mind who's embryos they were. They were mine; ours. That hasn't changed 14 weeks in to this pregnancy.

    I think that we all have different paths to how we build our families and you should do whatever feels right for the two of you. Good luck with moving forward (if that's what you decide to do.)

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  8. I can tell you are an attorney; your thought process is crisp and clear, and you explained your position quite well. I am 100 percent with you about the financial aspect. I will not go bankrupt or "charge" fertility treatments. If we have the cash, we're paying for it. If not, we are not.

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  9. Thank you for taking the time to share all of that. (You must be a real morning person to have posted such a well-thought-out summary at 5:30 a.m.!) I had read (and just reread) your previous rationale for not pursuing IVF and was very interested to read this update. I see myself in some of what you wrote because my home clinic said to adopt, try DE, or talk to Schoolcraft at CCRM. I was already grieving the loss of that genetic connection you talked about and looked to Dr. S. to simply confirm that my doc in Atl was right. It took some convincing for me to believe that there was still hope for my eggs, but I am so glad I did.... I don't want you to give up on your eggs too soon. I think that with an egg retrieval, you may learn a lot about your own eggs. My Atl clinic retrieved a total of 10 eggs in 2 IVFs and only 2 fertilized. We were sure my eggs were "bad eggs" because the only 2 embryos we made here were quite fragmented and had poor grades. But go figure, Colorado gets 17 eggs in one retrieval and 14 fertilized.... Make sure you also consider the boost in success rates when you do the comprehensive chromosome screening on your embryos -- it might put you well over the 50% rate for just $5,000 more. (But Dr. S. probably will never tell you that. He's totally conservative with his evaluations of the possible success rates, which is so nice in many ways, but makes it more difficult to take that gamble and go for it.) I became convinced about the CCS and the extra $5K when I realized it would help us avoid another miscarriage by identifying the embryos that weren't viable, anyway. I felt like time was running out for us and I needed to do everything I could to speed things up... One other thought: CCRM's success rate is what it is with some of the toughest cases around.

    I hope I've not annoyed you with this comment. You are such a good, deep thinker, I don't have any illusions that I'm going to really influence your decision -- nor am I trying to. The issue of your "hidden" ovary is a huge concern. You and MM will make the right decision for the two of you. I just want you to have all the information you can about your eggs before you make a decision about how to proceed. I am with you all the way!

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  10. Wow, you've outlined your reasons very very thoroughly and it's obvious you've given this a lot of thought.
    I am one of those women you mentioned in your post--who failed five IVF treatments. We aren't in debt over it (we're financially responsible people who worked hard, saved hard, and paid money for treatment we hoped would work) but we did spend a lot of money. I was 32-34 when we did our IVFs. It was emotionally a tough road but we were always both 100% on the same page about pursuing further treatment. We have a strong marriage and ultimately, going through that kind of challenge has strengthened it further. I won't lie and say there weren't very dark days, but they were always dark days we got through together, holding on to each other.
    At any rate, we had always been interested in international adoption, even pre-infertility. We 100% believe in zero population growth and thought of 'having one then adopting one' would keep us helping combat the uber fertiles who are madly procreating out there and continually straining the earth's resources. As you said--it's all so intensely personal. When I read your reasons for wanting a caucasian baby I thought how funny because we feel the opposite--we don't want there to ever be a question that we adopted, just have it be 'out there' from the beginning because we aren't trying to hide anything. We also never considered donor egg--I could never get my brain around those 'future conversations' with my child and we decided that it was either both of us genetically connected or neither. Again, so intensely personal. And while this is not our primary reason because I do not believe in the whole 'rescue a child' idea the plain truth is there are 6 million children without good prospects for a home in Ethiopia alone...and while our heart breaks for our child knowing she will not be growing up in her own culture, we plan to do our level best to give her a good--albeit compromised--life.
    Whew this stuff is so hard!
    Wishing you nothing but success and happiness whatever road you choose.

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  11. It's a tough decision, but it seems like you've really thought it through. For what it's worth, one of my best friends successfully conceived on her first donor IVF and now has a beautiful son. She was 44 when her son was born. She always tells me that she would have never considered it, but after many unsuccessful IUI's with her own eggs, the donor IVF was the way to go. Best of luck to you.

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  12. I have a two "hidden" ovaries and with a skilled RE, egg retrievals are possible. On my second IVF, 9 eggs were retrieved, 6 fertilized and 4 were transfered which resulted in a twin pregnancy. I lost one twin at 9 weeks and gave birth at 28.5 weeks. My daughter is nursing now.

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  13. You have clearly put much thought into this very important decision. You are so right, that everyone has to decide what is right for their family.

    Doing donor IVF here in the US is very expensive, but the success rates are terrific and there are a lot of options. For some, the costs make it out of reach. However, there are many other countries that offer slightly lower pregnancy rates (65%) for 1/4 ro 1/3 the cost of DE IVF here in the US (around $8000). As with any decision, there are pluses and minuses to each option - but it may be something worth exploring.

    For some people who simply can't afford DE IVF here in the states, going abroad for IVF offers just one more option for family building when it may seem that all other doors are closing.

    I wish you the best in whatever path you pursue. You might find this website interesting (if you haven't seen it already) www.pved.org - Parents Via Egg Donation - it is specifically for people going through DE IVF and has a lot of great information.

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  14. I can totally tell you are an attorney! Youseem very logical about your choice. IVF is emotional no matter what path you take. But, I also believe that no matter your choice - if you do DE or use your own eggs - the blood running through that baby's body will be yours...and that is a pretty awesome thing. Biology isn't always just about chromosomes...and your heart will not know the difference.

    Good luck.

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  15. Is it possible for you to use a donor egg as well as your own egg? That is the route I am going. I am what they consider to be advance age (which I disagree with) and I am still producing eggs. My egg was retrieved and fertilized with hubby's sperm. The lab called and stated that normal fertilization took place and that they were able to freeze the egg. I will then have my egg implanted with the donor's egg in the next few weeks. If I become pregnant, and carry successfully, I will not know if I am genetically related without a DNA test.

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  16. Your decision to go for DE IVF is the right one.However, while this sometimes works out at the very first attempt for some, others will have to try more than once...Going through IVF and dealing with repeated failure is hard. You need to be emotionally strong to pick yourself up and prepare for the next attempt. I am 44 years old and started DE IVF in Spain two years ago. IVF using my own eggs was not successful and as maternal age seemed to be the only factor, DE IVF seemed to be the obvious option. The second DE IVF resulted in a pregnancy but I miscarried very early in the pregnancy. I can't help thinking of this each time a fresh attempt fails...those few days when I was pregnant have acquired a dream-like quality and I think I have never been as happy as I was during those few precious days.Why am I continuing DE IVF? I am more than happy with the clinic in Spain (Day 5 blastocysts for the last two attempts), I do not see myself living the rest of my life without a child in my home; DE or not, I know that I will bond with the child growing in me so that it will be my baby;I love my husband so much and I so want to be able to see him hold his child in his arms. Irrespective of the number of attempts, DE IVF carries a 50 percent chance of success per attempt, and so if you can financially afford it, and perhaps more importantly, you have the courage to face yet another attempt, then you should keep trying. In any case, the pain at this stage cannot be harder to bear than the pain you could feel later in life for not having had the courage to continue...

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