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About Egg Donation: Knowing Whether Donor Eggs are Right for You

Dr. Norbert Gleicher explains the different types of egg donation, how to make your choice, and the criteria CHR uses for selecting egg donors candidates.

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Hello, I'm Dr. Gleicher from the Center for Human Reproduction in New York. I want to talk to you today about egg donation. Egg donation means that a woman, usually after she learned that she no longer has eggs that allow her to conceive, chooses eggs from a usually young egg donor. There are also egg donations so-called open egg donations or directed egg donations, where eggs are received from a known donor. Most egg donations performed in the U.S., however, are anonymous neither donor knows who receives the eggs nor the recipient knows who the donor is. At our Center, however, and not every center does that, you will see photographs and often even short videos of our potential donors. Let me talk about two very important things when it comes to egg donation: the first one is the clinical aspect of making a decision to go into egg donation, and here we want to stress at CHR and that our course is a little different from most other IVF centers. We never tell a patient that her own chances egg donation, we will always leave the decision when to go to egg donation or whether to go to egg donation to the patient. We do not feel that we are more qualified to make such important life-changing decisions on behalf of our patients, instead, we feel highly qualified to advise our patients what their chances are with their various options. Obviously, some women have better pregnancy chances, some women have poorer pregnancy chances with their own eggs. We can quite well quantify that. The pregnancy chances with young donor eggs are very easy to quantify and are quite accurate, because good centers have pretty consistent pregnancy rates and life birth rates with use of donor eggs, in other words, depending on whether one embryo is transferred in a donor egg cycle or two embryos are transferred, pregnancy rates can be quite accurately predicted, and when patients then are also presented with relatively accurate predictions of what the pregnancy chances are with use of their own eggs, then each patient can, and in our opinion, should for themselves make a decision which way they feel is appropriate to go. In other words, we here at CHR do not force anybody to go into egg donation, nor do we, what unfortunately happens quite frequently, prematurely recommend that patients go into egg donation. Here at CHR, we feel very very strongly that egg donation is a wonderful option for many women but it is only a wonderful last resort option. In other words, when you, the patient, both with your head and with your heart feel that this is the only way for you to become a parent, then egg donation becomes a wonderful option. We do not want anyone of our patients ever to think back, later on, mm-hmm, maybe we could have done it with our own eggs. We want to be absolutely certain but by the time you reach the decision to go with donor eggs that you are convinced it is really your only realistic chance of having a baby. And now let me go to the second main point of what I think is of crucial importance in making the decision to go with donor eggs and that is: where to go with donor eggs and or donor embryos. In the recent years, there has been a sudden development of commercialization of egg donation. What do I mean by that? All over the country suddenly egg donor banks have sprung up. We have had of course sperm donor banks for many decades but freezing eggs is a little bit more complex than freezing sperm, and therefore for a few decades in the existence of IVF they where no egg banks. Now over the last five, six seven years, there are quite a lot of egg banks around and you have a choice: you can get eggs from an egg bank in California, or you can get the eggs for my local egg back. You actually theoretically at least can even get eggs from an overseas egg bank. In other words choices for patients have expanded, but the question is really: is using frozen eggs from an egg bank equal in outcome to using fresh eggs? Now, many egg banks will tell you that there's no difference. Indeed many IVF centers will tell you that there is no difference, but that is really not true when you look at national donor egg IVF cycles and you compare outcomes. Between using fresh cycles and using frozen egg cycles there is a significant difference. Indeed there is by now an almost 10% difference in pregnancy rates. So if you are being told that there is no difference in using frozen or fresh eggs, that is really not true. In the beginning, our center actually studied this difference and we published a paper where we were the first ones to report that there's a difference. In those years the difference was actually smaller and many of our colleagues were arguing that as egg banks would get better and as the experience of IVF centers in dealing with frozen eggs would improve, that the difference would further shrink. But interestingly, once again when you look at national data, the opposite has actually been happening. The more frozen eggs from egg banks are used, the bigger the difference has grown over the years between fresh and frozen egg use.   So that does not mean that frozen eggs are bad. Frozen eggs have some advantages too: They make the cycle easier, timing of everything in conjunction with egg donation is easier when you just have to throw out already existing frozen eggs. Also, egg donation sometimes can be cheaper. More often, another point of caution, it just appears cheaper because eggs are "sold by a certain number" and in doing frozen cycles that is a lot easier, then when you have to stimulate a new egg donor fresh, wait until she produces her eggs. You never know for sure how many she will produce, therefore costs may vary. But it is entirely possible that frozen eggs may, in the end, be a little bit cheaper and so once again, the decision is yours. The patient, in weighing advantages and disadvantages between the two. Here at CHR, we are one of the very few centers that still maintains its own donor program in the sense that we are selecting our own egg donors. We don't leave that to a third party, like for example an egg bank. We want to make sure that the donor we are choosing fulfill all of our selection criteria, and they are quite strict, and we, therefore, accept only about three to four percent of applicants. I don't think that many of the sperm bank - sperm and egg banks - have such strict criteria. They obviously have different motivations. We too have frozen eggs, we, in other words, are offering two separate donor programs. The first the so-called standard donor program offers our patients a selection of a large number of egg donors, and you have then a first call on how many of those eggs you want to purchase. Those eggs that are not purchased by a patient who is going through such a fresh donor egg cycle, they are then frozen and become part of CHR frozen egg bank, where they again become available to another couple. So here at CHR, you have the advantage of choosing whether you want to work with fresh eggs, or you want to work with frozen eggs, which of course is a somewhat cheaper option. I hope that all of this information will help you. A final word, however, egg donation is not a simple decision. It is not simple emotionally, it is not simple socially within a family or a circle of friends, and it is also not simple financially because egg donation is quite costly, therefore you can never ask too many questions, so if what I so far have explained to you here has not made the picture clearer for you, then just come by CHR and we will gladly discuss matters in further detail.

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