By fertility experts from Spain.
Are you in the middle of your fertility journey and considering using frozen donor eggs from an egg bank? Have you found a suitable egg donor yet? Or perhaps the waiting time at your clinic is too long? Are you curious how egg banks work? If yes, watch the above video recording of our webinar on “Frozen donor eggs: quality, availability and safety” prepared in collaboration with California Cryobank.
The webinar was presented by Heidi Hayes, Executive Vice President of California Cryobank which is a USA based international egg & sperm bank supplying clinics and patients all around the world. Heidi has over 25 years’ experience in healthcare. In 2010, she started Donor Egg Bank USA with a partner, Michael Levy, MD., which was the first egg bank to transport frozen eggs for patients in the US. Currently, the egg bank has over 120 partners on two continents.
Heidi not only has expert knowledge about ART and patients’ needs, but she has also personally experienced infertility and IVF with donor egg treatment. Heidi and her husband are the happy parents of three lovely children and have expanded their family through egg donation treatment and adoption. Heidi was happy she had the opportunity to talk to other women who are just starting their egg donation journey.
We hope the knowledge you get from the webinar will help you make a better, well-informed decision on whether to use frozen donor eggs and how to choose an egg donor who will be the best match for you.
IVF vitrification processes have dramatically improved and the use of frozen donor eggs is a fast-growing medical procedure. However, as wonderful as it is to have an ever-expanding range of options for fertility treatments, this can also present many worries and concerns when deciding which is the right one for creating a much longed for family.
In this webinar, Heidi Hayes, Executive Vice President of the California Cryobank, explains the process of egg freezing and subsequent treatment, discussing their quality, availability and safety. Alongside the medical and professional knowledge Heidi has amassed, she is also the mother of two children who were both conceived from the use of donor eggs.
Even before the question of fresh or frozen is raised, the most important consideration of donated oocytes (eggs) is quality.
Ms Hayes recommends that donors should ideally be between the ages of 18-33 with a healthy weight and lifestyle. As with donated fresh eggs, frozen donor eggs are safe to use if fully screened.
All egg donation services should provide in-depth donor health and psychological testing, with many also offering additional genetic screening; Ms Hayes warns that this type of testing does reduce the risk of having a baby with a genetic disorder but doesn’t completely eradicate the possibility.
There are many differing opinions around how viable a pregnancy actually is from frozen oocytes and Ms Hayes is keen to clarify that, in her experience, frozen eggs are just as good as fresh. However, whilst they may be equal, many external factors do apply to the overall quality.
The skills of the embryologist, in both the vitrifying and thawing processes are key, as are the laboratory equipment and conditions; oocyte quality can easily be compromised due to incorrect temperature and humidity levels. The storage of frozen eggs is also imperative; eggs are fickle and if exposed to air, they could die.
When it comes to fertilising the frozen oocytes, Ms Hayes explains that prior to freezing, eggs are denuded, meaning their cytoplasmic texture is altered and could reduce the fertilisation rate. To overcome this issue, frozen eggs cannot be fertilised using conventional IVF methods and ICSI (Intracytoplasmic sperm injection) must be performed. This is when a single sperm cell is injected directly into the cytoplasm of the egg.
One of the most frequently asked questions, when dealing with frozen oocytes, is how many should be purchased and what are the realistic expectations? In her experience, Ms Hayes would expect that from every eight eggs, circa three would develop into high quality blastocysts. This is based on a rate of 87.9%, or seven oocytes, surviving the thaw, 78.7% fertilising and becoming six embryos, of which three would continue to the five-day (blastocyst) stage. It is expected that the rate from six frozen oocytes would be around two, healthy, five-day blastocysts. However, these are only averages and treatments do result in more or fewer embryos; there is no quick and easy equation.
Whilst biology can never be guaranteed, some programmes do provide assurances regarding their vitrification techniques. The most popular guarantee schemes are oocyte survival, guaranteed three or day five embryos and the certainty of euploidy (embryo/s containing the correct number of normal chromosomes).
Ms Hayes advises that the oocyte thawing promise is not as powerful as suggested as most eggs, if treated properly and professionally, will survive the thaw anyway. The euploid guarantee is something she would also question; euploid embryos do offer a greater and potentially quicker route to pregnancy, however, Ms Hayes states that when using donor eggs, it’s anticipated that approximately 70% of all eggs will result in a euploid embryo. She suggests money would be better spent on the guaranteed three and/or five-day schemes.
Donor availability tends to be higher when using frozen donated eggs as the oocytes have already been retrieved and are ready to go. This also means that logistics, for the cycle, are easier as there is only one patient; no synchronisation between recipient and donor is required.
The use of frozen eggs should result in a decreased timeframe for treatment, but enable an increased range of options as, once vitrified, eggs can potentially be shipped anywhere. The cost implications of frozen oocytes are typically less than using fresh eggs too, yet birth rates are the same. As with any treatment, the birth rate is variable depending on client situation, competency of staff, conditions of laboratories and how many eggs are used.
Whilst Ms Hayes advises equality in the use of frozen and fresh eggs, she does caution that it’s important to understand each case is unique, every patient is an individual and the particular circumstances of each person will inevitably lead to different outcomes. However, whether fresh or frozen, donated eggs truly can provide the ultimate gift, for those struggling to conceive.
Yes, they can. Eggs can be shipped to the UK but they have to meet the UK guidelines. This means that the testing for the donor has to be done at an ISO laboratory. The donor herself has to be willing to be an ID release donor and her compensation must have been less than 750 pounds in order to qualify. Let me actually provide a little bit more information about the UK right now. Fertility practices in the sometimes UK do what’s called a split cycle. They will have a woman come in for IVF, perhaps because she has a male partner that has a male factor concern. She can sometimes receive a discounted cycle if she donates some of her eggs this allows eggs to be frozen in the UK and for an increase in the number of eggs available for donor egg purposes.
Well, first of all, let me share that the embryos will not be damaged. If the success rate is lower, it means that there is something in the attrition process, perhaps they have a few more eggs that didn’t survive the thaw or something in their fertilization technique. It could be an embryologist feeling a little sorry for that egg and not giving it a good kick in the pants to put the sperm in. There’s a wide variety of reasons why the success rate might be lower for frozen eggs, but that doesn’t mean that it’s not still a great opportunity for you to utilize. It just gives you the ability to be completely transparent and informed as to how your laboratory does frozen donor eggs. One other item with this is to ask your clinic how many donor eggs they have thawed because if they’ve only done a few, the denominator is going to be very small: 25% might be 1 out of 4, or it could be 25 out of 100.
I think embryo donation is really always an awesome opportunity. What you want to consider here is not just the donor or in this case the woman that created the embryo, but the male partner as well. What is in their history? What do you know about them? Are there any genetic risks inherent in the embryo that you’re selecting? How was the embryo frozen? If the embryo was frozen utilizing the vitrification technique, the likelihood of it surviving the thaw is increased. If it was frozen quite some time ago, maybe more than 10 years ago, when the slow freeze option was standard in the industry, you may be acquiring embryos that will not survive the warming.
I do have two donor egg children so, like many of you on this call, I have a long history of IVF and infertility and was unsuccessful in the process. Ultimately, I decided to do donor-egg and I had two not great-looking embryos on day 3. In fact, I was told by the physician and the embryologist that they looked ‘crappy’. We decided to put them both back and they made two beautiful babies. So, I do have twins through donor egg and it has been phenomenal. I’ve enjoyed being a mom, I’ve enjoyed being a mom to twins and I’ve never looked back. Typically, people wonder if they’re going to regret utilizing a donor egg: will they look at their children and only see the donor. I can tell you that from the hundreds and thousands of women and couples we’ve talked to, they love their baby. When you choose a donor, feel good about your donor; celebrate the process, because you get the opportunity to choose. When you’re pregnant you will ultimately fall in love with the baby or even if you are utilizing a gestational carrier, you will fall in love with the baby. After I had my children, I think only once or twice did I feel just a little emotional twinge of not having the opportunity to have genetic children, to be able to see what my children with my husband would have looked like. But these children are every bit my children. They talk like me, they walk like me, they follow so many different things that I do that I see the impact that I’ve had on these children. Let me just add one more thing for those that are on this call and for anyone that listens to it in the future. When you’re thinking about donor-egg, you’re really only getting one cell. And, yes, it’s a very important cell that you’re getting from the donor. But it’s actually your body or the carrier’s body that will make that baby, so I am every bit the biological mother of my children because my body made those children and I had the ability to carry them and to be a part of that process. I only got one little egg and it was awesome.
I would say yes. If you are going through a fresh cycle and you have the ability to make embryos, you want to do that. I would only do this if they were going to make embryos to day 3 or to a blastocyst stage. There are some programs that fertilize eggs and freeze them at the what’s called the 2 p.m. stage. This will not afford you any better survival than if you’d frozen only the eggs. The other benefit of freezing the eggs over making embryos is that if anything were to happen in the future, you have eggs, not embryos. Let’s say that your marriage doesn’t work or perhaps there’s a reason why you won’t be having more children, people typically consciously feel better about having eggs in the freezer then embryos.
Preferably, you always want to cultivate to the blastocyst stage, which typically will not happen until day 5 or 6. Many practices are focused on a day-5 transfer. We believe that frozen eggs are a little slower to convert to a blastocyst stage than fresh eggs, so we’re seeing many blastocysts actually occur on day 6 rather than day 5. On day 6, we recommend that you freeze the embryo and then go through another medicated cycle for the transfer of that embryo versus transferring a blastocyst on day 6. You will have a slightly lower pregnancy rate transferring out of day six than you would with the embryo itself.
I would say no. They do believe that ICSI can have some changes with the child but there’s nothing really concrete with that. ICSI is extremely safe, as is IVF.
This is an excellent question. There are some women that are going to donate their eggs for financial gain. Typically, if that’s the reason for wanting to donate their eggs, the process of screening that donor will screen them out. There’s so much that goes into the process that they have to be committed to. There isn’t only just the screening; the IVF cycle itself requires her to come in, sometimes daily in the morning, for monitoring prior to the retrieval. And then, of course, she has her recovery time. We find that the donors that are the best are those that come to us with a combination of an altruistic desire as well as a financial gain. These are women that found out about egg donation because they know somebody that needed it or they have a family member that went through infertility. They come to us with the goal of donating and then they’re pleasantly surprised to find out that there is a financial compensation that goes with it. I also want to add when we look at the donors, there is a small trend where some donors have had a miscarriage or an abortion, typically an abortion, because we don’t always take them if they’ve had a miscarriage, and they have a lot of regrets. And so they feel the need to kind of makeup for that decision and hence they want to be an egg donor.
We are just a bank. We ship eggs to now 180 fertility practices in the United States Canada and other areas of the world. The rates vary by the fertility practice that we send them to, but we have done more than 5000 cycles and we do have some good averages. 58% clinical pregnancy rate is what we’re averaging right now. We’re averaging an excess blastocyst rate of 68% and we have nearly a 50% live birth rate, I believe it might be about 45 to 50% in most clinics.
In many European countries, it is anonymous. This is really a tough question because there’s no perfect answer. I can tell you that I went through an anonymous donation but there is the opportunity to have an open donation now, and it’s increasing. I think it really depends on each partner and how you feel about egg donation. Doing it again, I might lean more toward an open donation but I’d really believe that there will come a day, with the way genetics is going, that any donor-conceived child born through an anonymous donation will one day be able to identify the donor.
ERA is really a new type of test and what we found is some physicians believe in it and others do not. What the ERA test does is to take a biopsy during the cycle to be able to tell if progesterone should be started early or later to optimize the ability for that embryo to implant in the uterus. I think it really depends on your fertility practice and their experience with the ERA test. As I said, some people really believe in it, others do not. I would also question the combination of the donor eggs and the sperm. It might be worthwhile discussing the sperm with your physician as well, which could also be creating the issue of lack of implantation.
If you’re utilizing frozen donor eggs, I think seeing a psychologist is really a great idea. The psychologists that I saw with my husband actually helped me think through some of the questions that I hadn’t been thinking about. I was so focused on becoming pregnant I hadn’t thought through the process, such as whether I was going to tell my children that they were donor-conceived, or when or how I was going to tell my children. Would I tell my friends? Would I tell my family? These are all questions that the psychologist will help you sort through. I chose to tell my children that they were donor conceived. We started very young and we’ve talked to them all along and I would say they’re extremely well adjusted. We have not had any reason to have the children see a psychologist.
Well, first of all, in this case, if we’re utilizing donor eggs, it is the donor that would have to take these supplements. I don’t believe there’s enough research on this at this time but I do believe that there is something in the individual that, if you feel like you can do something that gives you a little bit of control over the process, it helps you feel more relaxed and it may benefit you. It may not benefit you because of the supplement, it may benefit you because of the psychological state that it helps you have during the process. I’ll also add that with this comes the question of acupuncture and again there are mixed reviews. Some people will tell you that it helps. There was a recent study that came out that said that acupuncture does not help you become pregnant. But like I said, it really comes down to individuals, your own experience and how it makes you feel in the process.
My heart goes out to you. I know how frustrating this can be. My husband and I went through 11 failed attempts and it’s really difficult to have this heartbreak happen over and over. I think the thought of getting the ERA test is really a great plan for you. It will hopefully tell you something about the endometrium and it will maybe point you in the right direction as to the timing to put the embryo back in. Trust your doctor with this. If your doctor pulls an ERA test and you find out that you’ve been putting these embryos back at the optimum time all along and you’re still not getting pregnant, there is something else going on. In that case, a donor embryo or an adoption embryo is a great solution to consider. Not every woman and man is going to be successful in this process. I wish I could tell you otherwise. We have a 100% money-back guarantee program and typically there will be about 6% of individuals and couples that we are unsuccessful in helping them have a live birth.
Having twins is not your goal. Most countries tell us that we should have a single embryo transfer and physicians across the world are adopting that mindset. This is because two embryos and twins create a high-risk pregnancy. The average gestation of a twin pregnancy is approximately 33 to 35 weeks versus a singleton pregnancy which is anywhere between 38 and 40 weeks of gestation. The longer the gestation of the baby in the womb, the less the likelihood that that baby will have any health issues. I actually know two couples that had twins and lost those twins around 20 weeks because it is a high-risk pregnancy. Your goal is one healthy baby. You needn’t worry about your cycle because your physician will be able to give you a medicated cycle that will make the endometrium prepared to have a baby. We do know though that the fluffiness of the endometrium or the measurement of it can impact that likelihood. About one out of every 25 women will struggle to get an endometrium that is thick enough to support a pregnancy.
This cost varies between countries. The cheapest source for donor eggs is in Eastern Europe, where it can be quite inexpensive. In those countries, I would question how they screen the donor. You might want to do a little bit more investigation on that front to feel comfortable. If you get a donor egg in, I believe, Spain it also is not too expensive; it’s a little bit more than Eastern Europe, but it’s reasonably priced. Of course, in Spain, it’s anonymous egg donation and there’s very limited information you can get on the donor. If you go to the United States, which is where many individuals from the UK, Australia or other countries come, it is more expensive. Frozen donor eggs start at approximately $14,000 and can go as high as $20,000. A full cycle can run anywhere between $16,000 and $24,000, for the full cycle. But what you’re also getting is a pretty high screening standard across the United States, as well as information about the donor, a complete profile on the donor and genetic screening of the donor.
It is possible, although I would always recommend as a recipient you do a medicated cycle. The reason is that it allows the physician to be able to identify the optimum time to put the embryo back. This can be more challenging in a natural cycle and you have to remember that, with a donor egg cycle, the recipient is only taking some estrogen and then ultimately some progesterone. It’s not a stimulated cycle in which we’re exposing the body to high levels of medication where the donor is exposed to high levels of gonadotropins in order to stimulate a lot of follicles to produce a lot of eggs. I would always choose to take a medicated cycle as a recipient.
I think we all wish that there were some type of registry worldwide in which we could compare clinics against each other. It’s really tough to do. Clinics measure themselves with different standards; some clinics are very transparent, others are not so transparent. There is no good audit at this point for clinics with the exception of asking a lot of questions doing some research. Make sure that you know how they screen the donor in that clinic.
It is becoming increasingly common. More clinics are doing genetic screening than in the past and I believe that we will be seeing more screening year on year. It is becoming the standard of care across the world.
I would recommend that you don’t stop at just one. Maybe two failed transfers from one embryo set might cause you to look at the second set of embryos. You know, pregnancy isn’t 100%, even if you use an ERA test or even if you use a euploid embryo which is chromosomally normal. I would always consider doing a second transfer with any set of embryos before moving on to a different couple. I can also add that we have couples that typically struggle over choosing a donor. We’re often asked how to choose a donor. I think it’s important to know that there’s no perfect Mini-You out there. You should expect to be able to match many of your top requirements, but it’s unlikely that you’re going to match them all. I often tell people, as you’re looking at a donor profile, if you have the privilege of going to a country that provides this information to you, some donors will put nothing on the family history. Sometimes that’s because they did the application quickly, other times it’s because their family history is completely clean. We also see individuals, such as nurses or individuals in the medical community who will give you lots of information, more than you ever wanted to know. So, when you look at the donor profiles, always give consideration as to what you’re viewing and think about the donor that may have put the information in there and what her point was along the way.
We’ve been able to prove that it doesn’t. You can ship these eggs internationally without a problem. We go in and train the embryologist how to unpack the tank to ensure that they are doing it in a way as to not to expose the eggs to any air that could compromise their survival.
We did some recent research of looking at what’s called an E Set, which is an elective single embryo transfer, and the transfer of two embryos, utilizing frozen donor eggs, and the likelihood of having a baby with one was nearly as good as having a baby with two embryos. When two embryos are transferred, your likelihood of having two babies goes up significantly. And as that goes up, so does the risk, and your pregnancy has a higher likelihood of failing in the process. Interestingly, I can tell you it wasn’t my choice to have two embryos. I really only wanted to have one, but my physician and embryologist insisted that the embryos didn’t look very good and that I transfer both back because the likelihood that either one of those embryos was going to take was very small. And now, I have twins. Let’s say if you have two very good quality embryos I would only put one.
I love this question as I also have an adopted son who I adopted from Guatemala. The reason we did the donor-conceived process is that we lost a second adoption after six years of trying to bring our baby home. So this question is really near and dear to my heart because we struggled with this question. Do we adopt again? Do we do egg donation? Do we adopt an embryo? It really comes back to your personal choice. Let me start with the adoption. We found that adopting a child was more expensive than an egg donation cycle and we also knew that it would not be perfect. Approximately 15 to 20% of birth moms will change their mind. If you are choosing to adopt a baby, there is a supply and demand issue. When we started the process we felt like we were really doing a good deed and we felt very altruistic. Once we got into it, we realized that there were hundreds of people lined up behind us that would take that baby as well. If you’re going to adopt an older child, you can feel really good about it because it is truly an altruistic thing to do. As far as embryo donation goes, you are choosing genetics from two different people. This means looking at the genetics of each of those individuals to determine if it’s a match. Personally, I think egg donation is the way to go. This is probably why I helped launch an egg bank; I feel so strongly about it and passionately about it. It gave me the ability to have control over the process. When I looked at adoption I really needed a birth mom to choose me. Embryo adoption gave me the ability to choose the egg donor and I could choose a donor that had perhaps different strings than I had. The egg donor that I chose scored herself as very good at singing and I’m absolutely horrendous at it so I was hoping to be able to pass on to my children the ability to sing because I knew my genetics didn’t have that ability.
My adopted son turned 13 last month. Our process took maybe a year and a half. We adopted from Guatemala before Guatemala pretty much shut down for adoptions. Later we went back to get a little girl and we struggled to get her for a period six years before Homeland Security notified us that we would never adopt her. This is after we had been to visit her and paid for her foster care. We loved her but it was at this point that we decided to do egg donation.
First of all, the age of the recipient doesn’t make a difference. You could be 43 or you could be 50. Your likelihood of success is going to depend on the fertility of the donor or the woman that created the embryo. Women’s fertility begins to drop significantly at age 34, which is why donors are preferably between the ages of 21 and 28 and a repeat donor up to the age of 33, before her fertility starts to decline significantly. The success rate is going to be equivalent to the age of the donor so if you happen to be in a country that keeps statistic as to the age of the donor, you can look up the likelihood of success for women in that age group. Typically, it’s very high. Women in this age group are very fertile, and your likelihood of success is really great.
I did my egg donation a cycle in the United States. It was important for me to do that because I wanted to have all the information on the donor. I have about 16 pages of information. I have photos of the donor as a baby and one at age 11 and I have the information for my children should one day they want to know more. I really like the fact that I have a good family history. Well after we gave birth, we went to see an ophthalmologist and the first thing they wanted to know what the family history regarding our eyesight was and when I started to talk about my eyesight, I quickly remembered that the genetics weren’t mine. I had to tell about the donor and what her eyesight was like and I was really grateful to have that information to help the ophthalmologist make a good decision regarding my child.
You want to know how experienced they are, how they screen the donors if you’re going for egg donation. If you’re utilizing frozen donor eggs, find out if they have been trained in the warming process. Many egg banks will actually train the clinic in the warning process. Get a feel for the standards of the clinic. If this a clinic that’s very detailed, you will have the confidence to know that, in the laboratory, they’re going to match the right sperm with the right egg to make the embryo. If you are just doing an embryo donation cycle check if the lab is pulling the appropriate embryo from the tank for embryo warming and transfer. If you have the ability to look at, for example, the United States, there is something called sart.org which consolidates all of the success rates for each and every clinic in the United States and I would also look at the success rate for that clinic.
The answer is yes and no. I say no because Indian donors are very hard to find and in the United States is just really tough to get women of Indian descent to donate their eggs. I’d say yes because we are now working with a program in India that we’ve been working with for nearly two years. We haven’t had any cycles yet, but are starting cycles next month. They will be cycling donors to a United States standard of care in terms of everything that we already talked about: genetic screening psychological screening and drug screening. They will be doing this in an ISO certified lab and these Indian donors are willing to become known and we hope to have Indian donors available for the UK before the end of the year.
It’s the same thing with the Indian donors. These are hard to find donors because, culturally, they’re not women that typically donate their eggs. In Mainland China it is illegal to do an egg donation cycle, so we’re looking for women living in the United States or Canada to do an egg donation cycle. There’s high demand and very few donors.
They can be shipped to the Czech Republic. Some programs or egg banks will ship embryos and I would have to look at the regulations of that country to ensure that they allow shipments to come in. It would really be the cost of either a courier or we typically utilize FedEx to ship eggs. The Czech Republic is a liberal country. We’ve never priced eggs to the Czech Republic. What we like to do is to put a batch of eggs together we ship them together so it minimizes the cost. But it really does depend on the country and the method of shipping.