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Shared Egg Donor Program

The shared egg donor program addresses an unusual combination of problems. How can you get young eggs for patients who need them without exploiting anyone and while helping people undergo IVF who can't afford the procedure?

Advantages

The shared egg donor program has been in existence here for more than 10 years. The program has two objectives. The first is to provide in vitro fertilization services for some patients who cannot afford them and do not have adequate insurance coverage to pay for them. The second is to provide donor eggs for use in women who either do not produce eggs on their own, or produce poor quality eggs.

Recent data suggests that approximately 10% of patients who undergo IVF over age 40 are using donor eggs. There are several sources for eggs. If one wishes to utilize a "paid" donor there are commercial entities that do a fairly good job of screening patients and can often provide a diversity of donors. (We also use these.) However, utilizing these services can be quite expensive. Probably the best way to utilize a donor is for the patient to find someone who is related to her and who is willing to undergo an IVF stimulation and retrieval for her. For many patients this is either not possible or family members who would be willing to do this are too old to provide useful eggs. Shared egg donors have been used in the United States for a number of years. In some countries, such as Britain, where payment for egg donation is not considered acceptable, shared egg donors are a major source of donor eggs for older women.

Generally, recipients are over age 40 or are younger and have had an early menopause. Optimally, donors are either sufficiently young that they are likely to produce a large number of eggs with superovulation, or they have a condition such as polycystic ovarian syndrome which commonly enables them to produce large number of eggs. The age cut off for donors in this program is 32-years-old.

Disadvantages

The primary downsides to using shared egg donors is their limited availability and the fact that they, themselves, are infertility patients. This introduces an element of uncertainty about their egg quality if they have not had IVf before.

The use of shared egg donors is uncommon in the United States although it is the preferred approach in some countries for ethical reasons. In a small practice such as ours where we can really know our shared donors, we think it is the better way to go when donor eggs are needed. Recipient patients benefit from both the decreased costs and likely increased efficacy. The following is reprinted from a recent newsletter.

Reprint

The availability of donor eggs is essential for current recommended treatment of "older" infertility patients. Although it is our practice to undertake IVF in the well-informed patient who wishes to do so, many IVF programs utilize age (or day FSH level) cutoffs. In such programs donor eggs is the only option for "older" patients. This has led to both a shortage of donor eggs and significant inflation in the fees paid to the donor for the time and trouble involved in going thru a cycle. This adds a minimum of $5000 to the cost of each donor cycle.

In prior newsletters we have written about the ethical desirability of using shared egg donors as opposed to paid donors. In a standard donor program, donors are recruited through advertising and are at least partly induced to participate because of the fee they will receive. This is partly a commercial venture. We are concerned about the issue of paying for someone's eggs and feel that the higher the fee, the greater inducement for the donor to misrepresent herself. In a shared egg donor program, the donor is in a non-commercial doctor patient relationship. Information she has supplied to the doctor needs to be accurate or it will not benefit her. The patient is willing to undertake a vigorous ovulation induction for IVF and the eggs are split between the donor and recipient with the objective of achieving pregnancy in both women. The potential of achieving pregnancy causes donors to accept a much more aggressive ovulation induction than reimbursing them with money would have . In addition to ethical benefits and lower costs of a shared egg program, we strongly believe that a shared egg donor program is also clinically superior to a traditional donor egg program. We would like to take this opportunity to address some of the concerns our patients have raised in the past about the differences between these approaches.

With a shared egg donor program, I will get fewer eggs to work with than a traditional donor program. Because of the shortage of donors, many traditional programs require recipients to share eggs from a single donor. Most paid donors underestimate what they will have to go through to produce eggs for an IVF cycle. Programs try hard not to push these donors very aggressively, which limits the number of eggs that they end up producing. At any age there is significant variability in the number of eggs that different women produce. Most of the patients that we use in our shared egg program have used gonadotropins in the past and have a higher than average likelihood of a good response during the donor cycle.

With a shared egg donor program, I would expect a lower pregnancy rate than with a traditional donor program because the paid donors are likely to be younger. Although no direct comparisons exist, based on published data, this is unlikely to be true. Although the natural pregnancy rate is higher for younger compared to older patients, within the age range of our shared egg donors, this difference can be compensated for by IVF (especially the ability to select the best appearing of several embryos for transfer). Recently IVF data shows no decline in pregnancy rates from age 25 to 33. Our donor cut-off age is 32 and donors can be selected because of prior good response to gonadotropins or because they had a prior IVF cycle with a very good response, which did not result in a delivery.