Having Your Baby Through Egg Donation. Evelina Weidman Sterling
reason: they say that age brings a wisdom and maturity that can be as valuable in parenting as youthfulness and energy. Either way, the question must be asked: is it fair to a young adult in his mid-20s to have a parent or parents in their late 70s?
Another ethical concern for recipients involves the promotion of anonymity. Until recently, donors and recipient women were often discouraged, sometimes even prevented, from meeting one another. Fortunately, as a result of increasing work with families doing open adoptions, awareness is growing of the potential benefits to the recipient, as well as to the donor and child, of meeting someone you will, in a sense, be connected to for life. It is increasingly common for donors and recipients to meet and to transform anonymous donation into a new form of known donation. These meetings may not include fully identifying information, but both donors and recipients proceed with egg donation aware that, in some ways, they will have a lifelong connection. In her article “Parents Anonymous” in New Ways of Making Babies Cynthia Cohen, writes:
The special nature of this gift—assistance in bringing a child into being—obligates recipients to express their gratitude by viewing donors as more than anonymous surds. It obliges recipients to view them as actual, characterizable, morally considerable persons who are deserving of respect and appreciation. Donors are individuals whose needs, interests, and rights ought to be taken into account in the process of gamete donation. Givers also incur a moral obligation when they provide a gift—the obligation to give a complete gift and not just part of one. The gift that gamete donors give includes their genetic material. To complete this gift, donors must provide recipients, and ultimately the resulting children, with relevant information that may be carried with the genetic material. (Cohen 1996, p.95)
Who chooses egg donation?
Let’s imagine that you are standing in the “departure lounge for egg donation.”
It’s a large, busy space, and you are, most likely, feeling somewhat bewildered. Whatever it is that brings you to consider egg donation, you are not where you once expected to be in your family-building journey. Yes, this departure lounge offers you hope and opportunity, but you are probably feeling a bit dazed. As you look around you at others considering egg donation, you will see a variety of people and a range of expressions on their faces. Some are weary travelers—they have been struggling to become parents for a long time, and their faces reveal the arduousness of their journey. Others look excited and energetic—perhaps this is their first departure lounge. Some women stand alone, some with their husbands or partners, and you may notice a few male couples, as they too have joined the ranks of those considering and pursuing egg donation.
In the pages that follow we will introduce the various situations that bring women and men to egg donation. We will also identify some of the specific questions and challenges that face each cohort of prospective egg donor parents. We hope that familiarizing you with fellow travelers will help ease your journey.
Primary ovarian insufficiency
Because women in their 20s and early 30s are assumed to have young, healthy eggs, most women in this age group do not anticipate infertility—at least not infertility due to egg quality. Sadly, there are young families who excitedly decide to have a baby only to learn that the woman has “bad eggs.”
Because there has been no reason to assume an egg problem, some young women with poor egg quality try for years to conceive with no success. They may learn they have primary ovarian insufficiency (POI, which is sometimes also called premature ovarian failure, or POF, in cases where the ovary has stopped working completely) when a physician takes—and often retakes—a Day 3 FSH (follicle stimulating hormone) level, AMH (anti-mullerian hormone) levels or levels of other hormones such as estrogen. Together, these tests can provide an indication of a problem with egg quantity and/or quality.
As if it is not confusing enough, there are some women whose FSH and other levels appear to be normal but who, nonetheless, are probably infertile due to poor egg quality. These women are usually considered to have unexplained infertility until they undergo more extensive testing. To everyone’s surprise, they are then found to be “poor responders.” This unfortunate label refers to those women who, even when prescribed large amounts of potent ovulation-stimulating drugs, fail to produce more than a few follicles at best. However they come upon it, the diagnosis of poor ovarian reserve in a young woman is bewildering and often devastating. Women wonder how this could be, what they might have done to harm their eggs, why they had no warning of a problem. Indeed, they, like their fellow travelers, will learn, again and again, that reproduction is a mystery, but, at the time of diagnosis, it is only natural to look for answers, for causes, for blame and responsibility. Some will explore environmental factors, such as exposure to toxic chemicals, which can damage both eggs and sperm. Others will wonder about genetics. For example, I (Ellen) have a client, a young physician, who was found to have POI at age 33. When she discussed this with her mother, who had had her three children in her 20s, her mother remembered that she had begun to experience symptoms of menopause in her early 30s.
When a young woman under 40 learns that she has “old eggs,” she faces several questions. The first is: is the condition permanent? While a 44-year-old woman with high FSH should be pretty certain that her egg supply is not going to be replenished, a young woman may wonder if the condition might reverse itself. Most reproductive endocrinologists have had a patient, here and there, who had elevated FSH, or otherwise documented poor ovarian quality, and who spontaneously became pregnant. Despite discouraging FSH or AMH levels, a good egg happens along and is fertilized. Sadly, this is not the norm.
In addition to hoping for a spontaneous reversal and pregnancy, questions inevitably arise about what a woman might do to improve her egg quality. Since it is a mystery why she has diminished ovarian reserve, she must also wonder whether there is something she can do to give her a better chance of conceiving. Some women have turned to acupuncture, diet or herbal remedies in an effort to reinvigorate or regenerate their eggs. In the book Inconceivable: A Woman’s Triumph over Despair and Statistics (2001), author Julia Indichova claims to have lowered her FSH through more holistic approaches. However, scientific evidence of women improving their egg quality through alternative therapies or diet is not well established.
The young women who come to the departure lounge for egg donation because they have “old eggs” may not be so quick to request egg donation. For one thing, they may need to take some time before they are really convinced that they can’t use their own eggs. Some are hoping for a medical advance that will resolve their problem. Or they may simply want to wait a bit in the hope that they may be one of the lucky ones who find themselves unexpectedly pregnant.
There are other reasons for waiting. Cost is one. Egg donation is costly, and young couples are the least likely to have the savings at hand to pursue this option. For them, infertility is all the more devastating because it comes at a time when they are still launching their careers and perhaps saving for a house.
FXPOI
FXPOI (Fragile X-associated primary ovarian insufficiency) is a condition in which the ovaries are not functioning at full capacity in a woman who is an FMR1 premutation carrier, which is the gene that causes Fragile X syndrome—a genetic condition that causes intellectual disability, behavioral and learning challenges, and various physical characteristics. Common symptoms of FXPOI include absent or irregular periods, symptoms of menopause such as hot flashes and vaginal dryness, and infertility. For women who are diagnosed with POI, it is important to know if you also have an FMR1 premutation. If you have already been tested and are confirmed to be a FMR1 premutation carrier, there is about a 20–25 percent chance you will also experience POI. While many women with the FMR1 premutation can become pregnant, all carriers are at risk for having children with Fragile X syndrome so it is important to talk with a genetic counselor about your risk.
Declining ovarian reserve
There was a time, not all that long ago, when a woman giving birth after age 30 was labeled a “geriatric mother.” In fact, there was a documentary in the 1970s called Joyce at 34 (Chopra and Weill 1973). It was about a couple who decided—at the “old age of 34”—to have a baby. The film shows the couple announcing their “geriatric” pregnancy to Joyce’s family, all of whom react with surprise and wonder.