Until the last few years all donor eggs cycles were done with fresh eggs retrieved and fertilized the same day with the male partner’s sperm. Over the years egg donation using fresh eggs has become highly successful at some fertility clinics in the US.

Live birth rates with fresh donor eggs are over 70% per fresh transfer procedure at the best egg donation clinics. Success rates at these same donor egg programs using fresh eggs are over 50% for live birth per transfer using a single embryo for transfer. This approach almost totally eliminates the risk for multiple pregnancy.

In recent years the techniques for freezing and thawing eggs have advanced significantly. As a result of these advances, success rates at some frozen donor egg banks has increased from about 10% success in the past to approximately 50% – at least this is what they claim.

Accordingly, business models have developed for frozen donor egg banks. Egg banks sell frozen donor eggs on a per batch or per egg basis. This can make the cost of using frozen eggs seem to be less than the cost of egg donation with fresh eggs. However, there are some significant problems with this approach.

1. Uncertain and relatively low success rates – with low success rates the cost per baby is actually higher
2. Uncertainty about long-term health issues for the children born from frozen eggs

Currently, success rates using frozen donor eggs are not well documented – or consistent between different centers. There are certainly babies being born from frozen eggs. However, the number of births is tiny in comparison to the many thousands of births using fresh donor eggs that occur every year in our country. There are very few published reports on live birth success rates per cycle using frozen donor eggs.

A few egg bank centers claim to have success rates above 50% with frozen donor eggs. However, other clinics using frozen donor eggs are not saying anything about their live birth success rates – and this is not being tracked and reported publicly by SART or the CDC at this time. In my opinion, the use of frozen donor eggs is an area in our field with a high likelihood for couples to pay a lot of money for something with (at best) very uncertain results.

The business model for selling frozen donor eggs can be attractive for those interested in recruiting donors, stimulating them, retrieving the eggs and freezing them for later sale to recipient couples. This is very similar to the current situation for donor sperm banking.

The big difference is that sperm freezes and thaws quite well but eggs are much larger cells and do not tolerate the freezing and thawing process well. Because of the damage to the egg that can occur with the freeze/thaw process, success rates with frozen eggs are generally reported to be significantly lower than with fresh eggs.

Another concern is the potential for birth defects or other problems in the children arising from frozen eggs. It is very possible that this will not be a problem at all. However, at this time there are not enough studies that have looked at the long-term health of the offspring using frozen eggs to make a thorough assessment of whether there are negative consequences for the resulting children.

Donor sperm is been frozen and kept in quarantine for 6 months, then the sperm donor is retested for infectious diseases. If the repeat testing for infectious diseases is negative then the sperm can be released from quarantine for use.

The sperm quarantine process should eliminate the risk of infection from virus (such as HIV) in the semen because it allows time for antibodies to develop in the donor within the 6 month quarantine time. The repeat testing of the sperm donor would find the antibodies and the sperm would be disposed of.

As far as I know, there has never been a case of an infectious disease passed on through transfer of a donor egg. With hundreds of thousands (possibly millions) of egg donation cycles performed worldwide over the past 30 years, the risk is extremely low for any significant infection to be transmitted with fresh egg donation.

Therefore, we should not think we need frozen egg banks in order to reduce the risk of infectious disease transmission – because this does not seem to be a significant risk. It appears that the main reason that frozen eggs are used for egg donation at this time is that it suits the business models for some providers of fertility services.

Egg banks could also provide a convenient way for couples to search online egg donor databases to find a suitable donor. However, I suggest that this is not a good reason to move from the tried and tested, safe and effective method of fresh egg donation.

The best approach is to continue using fresh donor eggs until:

1. Research demonstrates that using frozen eggs is a safe procedure for the resulting children
2. Success rates with frozen donor eggs are better documented for the clinics providing that service

Consumers of egg donation services should certainly know if they are paying their money for a a 70% expectation to have a baby – or only a 10% chance for  success.

Another way to say it is, “If it ain’t broke, don’t fix it”.

Our donor egg success rates

Our egg donation costs

See our list of available egg donors

How to donate an egg

A comparison of clinic success rates may not be meaningful because patient medical characteristics, treatment approaches and entrance criteria for ART may vary from clinic to clinic.

Richard Sherbahn, MD is a fertility doctor practicing in the Chicago, Illinois area. Connect with me on Google+

Mail | Web | Google+ | More Posts

Can you freeze eggs in an attempt to preserve fertility for a future pregnancy?

• Yes, egg freezing (oocyte cryopreservation) is being done – some women freeze eggs to try to reduce the impact of aging on fertility
• Success rates for IVF with fresh eggs are high in young women
• Success rates for IVF using frozen eggs are generally much lower – but are improving. This technology is rapidly evolving.

There is currently controversy about:

• Who should be offered egg freezing?
• What should women of different ages be told about their chances for having a baby with frozen eggs?
• Are women who freeze eggs well informed about the chances to have a baby in the future with their frozen eggs?

What do recent studies show regarding pregnancy success rates using frozen eggs?

Egg freezing is relatively new

• IVF with fresh eggs has reportedly resulted in the birth of about 3 million babies worldwide
• IVF with frozen eggs has resulted in the birth of about 2000 babies worldwide
• Studies continue to investigate whether the older “slow freezing” technology or the newer method of “vitrifying” eggs will be better

Older studies

• Studies from the 1990′s to early 2000′s showed pregnancy success rates with frozen eggs of about 2% to 10% (live birth rate per embryo transfer cycle).

Recent studies

• A recent study from an Italian group found similar fertilization and embryo development rates of vitrified versus fresh eggs. Vitrification is a relatively new freezing method.
  • This study involved 40 cycles in women (average age 35.5)
  • The ongoing pregnancy rate (beyond 12 weeks of pregnancy) with vitrified eggs was 30% per cycle.
  • This is a good rate since only 3 eggs can be inseminated under Italian law.
    • Study by L Rienzi, et al, Human Reproduction; January 2010

• A 2009 study of 23 IVF cycles using frozen eggs (average age 31.5)
  • There were 14 pregnancies, 1 miscarriage and 13 ongoing pregnancies (57% per transfer)
    • Study by J Grifo and N Noyes, Fertility and Sterility; May 2009

• A large multicenter Italian study compared IVF using fresh vs. frozen eggs
  • Italian IVF clinics tend to have lower success rates because only 3 eggs can be inseminated per cycle (by law)
  • They compared 2209 cycles with fresh eggs to 940 cycles with frozen eggs
  • The success rate was halved using frozen instead of fresh eggs
  • 748 thawing cycles in women less than 39 years old (average age 33.6)
    • Live birth rate per transfer with frozen eggs was 13.3% (age < 39)
  • 192 thawing cycles in women 39 and older (average age 40.5)
    • Live birth rate per transfer with frozen eggs was 8.1% (age 39+)
  • Study by A Borini et al, Fertility and Sterility; January 2010

Aging and female fertility issues

Many women pursue advanced education and career advancement – and delay childbearing. Fertility specialists commonly see women with fertility issues due to aging in their late 30′s and 40′s who  are disappointed when told that it may be too late to have a baby with their eggs.

When an “older” woman switches to using “young” donor eggs, she is very likely to have a successful pregnancy outcome. Some women are comfortable moving on to using donor eggs to have a baby. For others, using their eggs is critical.

Think of the uterine lining as the “garden”  and the embryos as “plants”:

• Aging does not compromise the garden
• Aging “weakens” the plant
• That is why success rates with egg donation are so high – regardless of the age of the recipient woman
• Egg freezing could let women extend their biological clock and delay childbearing for social or professional reasons.
• Women could “self-donate” eggs – freeze and store them for the future in case they age significantly by the time they want a baby.

Risks of egg freezing to the woman donating are low:

• Women are stimulated with medications as for IVF to produce multiple eggs prior to aspirating eggs from the ovaries and freezing.
• The rate of serious complication (severe ovarian hyperstimulation, serious bleeding, infection, etc.) is less than 1%.
• There is the risk that women might delay having children because they have frozen eggs that they expect to have success with. Some would have poor results later after thawing, fertilization and embryo development.

Questions and potential problems with elective oocyte cryopreservation to  delay childbearing

• Do the women have realistic expectations of the pros and cons and alternatives to freezing their eggs?
• What effect would deferral of childbearing with egg freezing have on our society if it becomes common?
• Will some fertility doctors mislead women about benefits of this process for their own economic gain?
• Is it proper to allow women to make their own decisions about using this new technology now, or should “social” egg freezing to extend fertility be reserved for the future – after we have better outcome studies?
• At what point is an “experimental” procedure done enough, understood enough, and researched enough so that it is no longer considered experimental?

The definition of ‘‘experimental procedures’’ according to the Practice Committee of the American Society for Reproductive Medicine (ASRM):

• “Procedures (including tests, treatments, or other interventions) for the diagnosis or treatment of infertility will be considered experimental or investigational until the published medical evidence regarding their risks, benefits, and overall safety and efficacy is sufficient to regard them as established medical practice.”

What is the position of the American Society for Reproductive Medicine (ASRM) regarding egg freezing?

It appears that the current position of the ASRM is:

• Egg freezing is appropriate for women with cancer and other medical conditions needing treatment that is likely to impair their fertility.
  • These women usually do not have any other good option for having a baby with their own eggs.
• ASRM currently discourages egg freezing for women who want to electively extend their fertility into the future. Apparently, this is due to concern that there is some risk, and could even be harm done by using new technology prematurely.
  • “Prematurely” means before both safety and efficacy have been reasonably established.
• When eggs are frozen, it should only be done with appropriate informed consent in an IRB approved study protocol.
• There is not enough data to properly inform women about chances for success using frozen eggs.
• There is not enough data to know if egg freezing might cause an increase in problems in children.

Conclusions about egg freezing

• Egg freezing for extending female fertility is showing great potential for the future.
• It is currently being used for women with cancer that need treatments that impair their future fertility.
• Some IVF clinics are offering social egg freezing to extend fertility.
• Although some recent studies report good success rates for IVF with “young” frozen eggs, there is little data on success rates using “older” eggs.
  • Women considering freezing eggs tend to be in their late 30′s and early 40′s.
  • We need more outcome data using frozen eggs in this age group.
• This is an evolving technology with important questions still to be answered before it is “ready for prime time”.

The Advanced Fertility Center of Chicago is currently involved in an IRB approved study on egg freezing using vitrification technology.

• Read more about our egg vitrification study
• Call us  for details about enrolling in this study.
  • 847-662-1818

Richard Sherbahn, MD is a fertility doctor practicing in the Chicago, Illinois area. Connect with me on Google+

Mail | Web | Google+ | More Posts

Our society has evolved and many women are pursuing advanced educations and career advancement – and delaying childbearing as a result. However, in general women should be more knowledgeable about the impact of delaying childbearing on fertility potential.

Fertility specialists know this is a problem. We commonly see women in their late 30s and early 40s that are very bright and well-educated who are surprised and very disappointed when told that it may be very difficult (or impossible) to get pregnant and have a baby using their own eggs.

I like to use a “garden” analogy when discussing infertility with patients. The uterine lining is the “garden”  and the embryos are the “plants”. As women age, the garden is rarely the problem – the plant is often the problem. This is why using donor eggs is so successful regardless of the age of the recipient woman.

When an “older” woman switches to using “young” donor eggs, she is much more likely to end up with a high quality “plant”. The ability of the uterus to accept implantation of embryos does not decline significantly with aging (the older garden is receptive).

Sometimes when in vitro fertilization (IVF) is not successful, women ask about using a surrogate to carry their embryos – hoping that would solve the problem. However, it is not an effective solution. We would be switching from her uterus (which is not defective) to using another woman’s equally receptive uterus. There is no point in it.

However, switching to higher-quality eggs from a younger woman is more likely to result in successful pregnancy outcome. If the problem is in the “plant” then we can switch the “seed” and expect a better chance for success. But switching the “garden” doesn’t help because that was not the problem.

So what should women and their primary care doctors do regarding aging and fertility issues?

Women that might want kids (or more kids) in the future should:

• Educate themselves regarding fertility and female age
• Ask their doctors to test their egg supply as they get into their 30′s

Tests of the egg supply are referred to as “ovarian reserve” tests.

Blood tests for ovarian reserve

• Day 3 FSH, LH and estradiol
• AMH, anti-mullerian hormone

Ultrasound tests for ovarian reserve

• Antral follicle counts
• Ovarian volume

However, regardless of the ovarian reserve, female age is a very important consideration.

Conclusions:

• Many women want to have kids – but delay it too long
• Our society is not educating women well about aging and fertility
• Women should learn about declining fertility potential – and be tested for it

In a perfect world:

• Women would be well educated about fertility and aging
• Early screening for ovarian reserve should be done by the OB/GYN, or other MD
• Then women can make well-informed choices about delaying childbearing
• Society should better accommodate childbearing during educational and early workforce years

Related links:

Age and fertility

Fertility after 40

IVF and age

Testing for egg supply – ovarian reserve

Egg donation
__________________________________

Richard Sherbahn, MD is a fertility doctor practicing in the Chicago, Illinois area. Connect with me on Google+

Mail | Web | Google+ | More Posts

• An abnormal number of chromosomes is referred to as aneuploidy
• Aneuploidy causes the increased rate of miscarriage with aging
• Aneuploidy is responsible for most of the decline in fertility with advancing age (both with and without IVF)

In recent years research has shown the importance of a structure in the egg called the meiotic spindle. This spindle is involved with aligning chromosome pairs so proper division of pairs can occur during egg maturation.

• As women age they are more likely to have an abnormal spindle apparatus that does not efficiently line up chromosomes prior to division
• This causes a higher likelihood for an unbalanced chromosomal situation in the mature egg – and then in the embryo

A recently published study (referenced below) might help us to understand why some women have more chromosomally abnormal eggs at a given age. This study was performed in mice, but may well have relevance for human reproduction as well (in many ways we aren’t as different from mice as we might like).

• The researchers identified a specific gene mutation in mice that is associated with a high rate of chromosomal abnormalities in the eggs and embryos
• The gene is called Bub1
• They showed that this gene is involved in regulation of division of pairs of chromosomes during egg maturation
• The severity of the chromosomal problems increased with age
• Because the chromosomal abnormalities were passed on to the resulting embryos, there were high rates of loss after embryo implantation

This could give us insight into reasons for some couples having infertility, repeated miscarriages, or repeated failures with in vitro fertilization. More research is needed in this area.

If humans are found to have a similar gene, it is possible that a blood test could be developed to see if women are at increased risk for having eggs and embryos with chromosomal abnormalities. Then fertility specialists could more accurately advise couples about effectiveness of available treatment options.

Reference for article discussed above:

S. Lelanda, et al: Heterozygosity for a Bub1 mutation causes female-specific germ cell aneuploidy in mice. PNAS August, 2009; Pages 12776-12781.

Links to related pages:

Eggs and chromosome problems

Age and fertility

IVF and age

Fertility and IVF in women after age 40

Egg donation

PGD, preimplantation genetic diagnosis: Should we test chromosomes of embryos?

Richard Sherbahn, MD is a fertility doctor practicing in the Chicago, Illinois area. Connect with me on Google+

Mail | Web | Google+ | More Posts

• A recent report on the average age at first childbirth from the CDC’s National Center for Health Statistics showed that as of 2006, women in the US waited an average of 3.6 years longer to have their first baby, as compared to 1970.

• There is not enough discussion in our society about the effect of age on fertility.

• Women’s liberation is a good thing and women have made very significant advances over the past 40 years. Many women are pursuing advanced education and careers.

• However, there is a potential “disconnect” involved. Women are waiting longer to have children – but many are not educated about what that delay can do to their fertility.

These days, many couples try to have their first child when the woman is in her mid-to-late 30s. Some will get pregnant easily, and others end up needing fertility treatments. It is not uncommon for me to see a couple with the woman in her early or mid-40s who say that they had no idea that getting pregnant would be a problem. These are educated and intelligent people. Maybe they were not exposed to the right information about fertility and aging – or maybe they never paid attention to it.

• As the American Society for Reproductive Medicine has pointed out: “As women delay childbearing, there is now an unrealistic expectation that medical science can undo the effects of aging”.

• We try our to overcome the effects of age with advanced treatments such as in vitro fertilization. But IVF success rates decline significantly with advancing female age.

What causes fertility to drop with age?

• Success with fertility treatment using the woman’s own eggs is closely tied to her age.
• When using donor eggs, the recipient woman’s age is not important. It is then the egg donor’s age that matters.
• This tells us that the age of the egg is important and the age of the uterus is not.
• Because of declining egg quality, chances for successful pregnancy begin dropping in the early 30′s and usually drop faster in the mid-30′s (by about 36-37).
• For many women there is little or no fertility potential left by about age 40, and very few women over 43 are fertile.

Even with aggressive fertility treatment (such as IVF) success rates are very low by the mid-40′s. In 2006, the national average for live birth success rate in women over age 44 using their own eggs was less than 1% per attempt (CDC data). Miscarriage rates also increase significantly with advancing age.

Both the fertility decline and the increase in miscarriages are largely due to increased rates of chromosome abnormalities in eggs as women age. Research has shown that a structure called the meiotic spindle in the microscopic eggs in the ovaries becomes damaged with aging. The spindle is involved in organizing pairs of chromosomes for proper division into 2 sets during maturation of the egg. An abnormal spindle can cause disordered chromosome arrangements in the mature egg – and therefore in the embryo.

Can we test the quality or quantity of eggs in a woman?

Since we know that the issue causing fertility problems as women age is declining egg quality, it would help to have a test to check how good a woman’s eggs are. Unfortunately, there is not a good test for egg quality. A woman’s age is the best “test” for quality.

There are screening tests for “ovarian reserve”. However, these are tests of quantity rather than quality. Ovarian reserve tests include:

• Day 3 FSH and AMH levels – blood tests
• Ovarian antral follicle counts – determined by ultrasound.

Conclusions

• “Society” and the medical field should do a better job educating women about declining fertility with advancing age.

• If women are making a conscious choice to delay childbearing and understand the fertility implications – then at least they make a conscious choice.

• However, if they go to their doctor annually for a checkup – at some point (early to mid-30′s) there need to be discussions about declining fertility potential.

More information:

Age and Fertility

PGD – preimplantation genetic diagnosis (or PGS) – does it help to test the chromosomes of IVF embryos?

In Vitro Fertilization

Egg Donation

Richard Sherbahn, MD is a fertility doctor practicing in the Chicago, Illinois area. Connect with me on Google+

Mail | Web | Google+ | More Posts