Having Your Baby Through Egg Donation. Evelina Weidman Sterling
that they will not be creating a full biological child. The opportunity to become pregnant and to have a child connected genetically to their partner and gestationally to themselves is inviting.
Unexplained infertility
In a time of advances in reproductive technology, unexplained infertility has to be one of the most baffling experiences. How is it that a couple can go to a skilled reproductive endocrinologist and be told there is no identifiable fertility problem? Worse still, they can seek a second and even third opinion and hear the same thing again and again: “Something is wrong but we don’t know what it is.”
Not long ago, couples were labeled “normal infertile.” How bad was that? Bad enough to prompt people to feel that their problems must be psychological. After all, if there was no apparent physical problem, they must be causing their own infertility with ambivalent thoughts, bad behavior, past misdeeds or some other curse.
Families struggling with unexplained infertility find themselves in the world of trial and error. With little to go by, physicians suggest trying IVF, hoping that the explanation of the infertility rests in the way that the egg is released (or not released) or in difficulties that egg and sperm have when they encounter each other. For some people with unexplained infertility, IVF provides a solution. But what of others? What do you do if your infertility remains all the more unexplained after repeated failed IVF attempts?
Some couples with unexplained infertility consider egg and/or sperm donation, assuming that there must be some defect in their gametes, or they may wonder, sadly, if the “mix” between them doesn’t work. Some with unexplained infertility who turn to egg donation still do not become pregnant. What then? One such couple tried donor sperm and, eventually, a gestational carrier before deciding to adopt. Another tried a second egg donor, conceived and enjoyed a successful pregnancy. Still another moved on to embryo placement and had not one but two successful pregnancies. Another option is to continue trying on their own, knowing that some couples with unexplained fertility have spontaneous pregnancies.
Genetic issues
Some people learn, through genetic testing before a pregnancy is attempted, during a pregnancy or after a baby is born, that they are carriers of a serious, even lethal, genetic disorder. They may have close family members whom they have watched suffer from a genetic disorder. Some of these families have a baby die in utero. Some choose to terminate pregnancies when such a disorder is diagnosed in utero. Others deliver a child who dies at birth or soon after. Still others parent children with very challenging conditions. Veterans of each of these experiences may turn to egg or sperm donation in an effort to avoid transmitting the genetic abnormality to future pregnancies.
Preimplantation genetic diagnosis has enabled many families with genetic issues to avoid transmitting them to their offspring. Still, there remain some who turn instead to egg donation. These include women who have diminished ovarian reserve in addition to a genetic issue.
Women who can neither provide eggs nor carry a baby
Sometimes families must face more than one reproductive challenge in their journey to have a baby. Sometimes it is the woman who is hit with this double blow: she can neither produce viable eggs nor carry a successful pregnancy. In some instances, this is something a woman learns early in life and which a couple knows as they enter into marriage and make plans to build a family. In other instances, the double blow unfolds sequentially. A woman undergoing a fertility work-up may be advised that she has a uterine abnormality and later learn she has elevated FSH. Or she may have turned to egg donation and later learns, through a failed cycle of further medical exploration, that she also has uterine abnormalities.
The decision to use both donor eggs and a gestational carrier is very different for those who know from the start and those who learn along the way. Couples who know from the start face one decision: “Do we want to turn to two women to help us bring a child into this world that has a genetic connection to one of us and a parenting bond with both of us or do we want to adopt?” Couples who learn along the way face a two-part decision. For them, one decision is made. Only after they are comfortable with it and accustomed to it do they face a second decision. As one woman who is now the mother of three children, all through a combination of egg donation and a gestational carrier, said:
For us it was a decision made in steps. We ended up doing something we never, ever thought we would do. That is because our reality changed along the way. This experience taught us an important lesson: “Never say never.” It taught us to be much more open-minded.
Families choosing to have a child through egg donation and gestational care face several issues. One is ethical. Is it morally and ethically correct to bring a child into this world when he will have neither a genetic nor a gestational connection to his mother? A second issue is logistical. It is complicated enough to embark upon either an egg donor or a gestational carrier pregnancy; combining the two involves a great deal of medical, psychological and legal coordination. Then there are financial challenges. This is undoubtedly a very costly venture—often upwards of $80,000 simply for the chance of conception. Finally, there is the question of what to do if the gestational carrier does not become pregnant. With so many variables, it is difficult to know which one to address. Families and their physicians wonder if they should try a second time with the same participants and same protocol, change the protocol, change the egg donor or, perhaps, the gestational carrier?
Single women
Look around any fertility center waiting room and there are single women who have decided to try to have a baby before it is too late. Most started with simple donor inseminations, but as they work their way up the fertility center food chain, they often find themselves all the way at IVF. And if that doesn’t work, then what?
Some single women who have already made the decision to use sperm donation unexpectedly find themselves considering egg donation as well. Some do so because they feel so strongly about being pregnant and having a gestational connection to their child. Others turn to egg donation because they know that it is often difficult for a single woman to adopt. Many will say, “I feel I have more control this way than with adoption.”
An additional ethical issue arises with single women. Is it fair to intentionally create a child who will have only one parent? This question becomes all the more poignant when the intended parent is older. Add to that the fact that the one parent is not the child’s genetic mother. Going through this list, it becomes easy to see why many would say, “Stop. This is too much. Reproductive medicine has gone too far when it creates a child who will not be parented by either of his genetic parents, will have only one parent and that parent will be of advanced age.” Everything might seem clear in the abstract, but not always so much when there are real people.
Meet Jenny
Jenny is a 47-year-old physician and the over-the-top-in-love mother of Olivia, now nearly two. Like so many women who eventually turn to egg donation, Jenny wanted to be a mom for most of her life. When she found herself still single in her early 40s, Jenny briefly considered having a child on her own.
Then came Pierre. Pierre, three years her junior, was the love of Jenny’s life. She met him through friends and they were engaged within a few weeks and married in six months. Jenny and Pierre began trying to conceive before their marriage and went right to treatment after a few months of trying. Even with the invasive tests and procedures, they were blissfully happy and totally delighting in finally having lasting love.
But it was not meant to be. Pierre was not feeling well, lost some weight inexplicably and complained of a strange itching feeling. Jenny pushed him to see his doctor who was initially reassuring but soon suspected that Pierre had leukaemia. Although aggressive chemotherapy seemed to be working, Pierre succumbed to the disease barely two years after he and Jenny were married. He left Jenny with several vials of frozen semen which he had frozen upon diagnosis.
Jenny was 44 when Pierre died. She allowed herself several months to grieve but then began thinking, perhaps more intensely than ever, about pregnancy. Jenny questioned whether it was wise for her to embark upon single motherhood in her mid-40s but felt more optimistic when her younger brother and his wife, parents of three children themselves, were supportive of the idea. Their offer