I’m doing this topic because I have so many patients that need to use a donor. Wherever you are I hope that this show is helpful to you. Take the information, discuss it with your doctor, and apply what’s useful to your journey in order to reach your family goals in the smoothest way possible.
When it comes to finding an egg donor, this is what I discuss with my patients. You have the option to use either fresh or frozen eggs.
Here’s the difference:
When you’re using a fresh egg donor and you’re going through an agency you are picking a profile of a woman who is going to go through an IVF cycle.
What this means is she’s going to take drugs, the same fertility shots that you would have if you were going through IVF. She’ll do this for about ten nights and then undergo egg retrieval. On the day of the retrieval, they’ll mix the egg and sperm together and then you have the option of freezing the embryos, genetically testing them or transferring them fresh.
Regardless of the method you choose, at some point, you will need to get your uterus prepared for an embryo transfer.
Here’s one key difference between fresh and frozen eggs:
When you pay for a fresh egg donor, you have to pay for that egg donors entire IVF cycle, but in exchange, you will have the option of receiving all of the eggs that result from that retrieval. You’re not paying a certain per egg fee. Versus, when you are getting frozen eggs from a donor you are paying for a certain number of eggs from an egg donation bank.
I like to ask my patients the following question:
How many kids do you want?
If the answer is 3–4, it may make more financial sense to use a fresh egg donor through an agency. If, however, you love a frozen egg donor and you want one, two, and maybe three kids, then consider an egg bank. Make sure and see how many eggs that egg donor has frozen for themselves.
Here’s my process for going through an egg bank:
I work with about five different egg banks and ask them the following questions:
How many eggs does this egg donor have now? How many eggs did she get at her retrieval? Can I see her genetic profile and full profile? What was the fertilization rate? What was the blast formation rate? How many normal embryos were created, if this is known, and how many pregnancies has she had?
I introduce my patients to egg bank directors and then my patients will do follow-up interviews with each of the banks until they find an egg donor that they’re really excited about.
Does it sound odd to think about being excited to use someone else’s DNA to have a baby? Trust me, when you’re at that point and ready to have a baby you’ll feel excited. Nobody can force you to that point, but it may come on its own through your journey. You have to get there and be ready on your own terms.
There’s no such thing as an egg donor emergency.
When you get to that point about seeing a profile and excited about an egg donor from either an agency or egg bank then you know you’re ready.
I also have my patients talk with a psychologist and a genetic counselor so that we know everything about the possible match between the egg source and the sperm source. What we can also do is free sperm. What they’ll actually do is send sperm to the different egg banks and they’ll create embryos for us and then ship them back here and then we can prepare the uterus once we know how many embryos we have.
The uterine preparation phase can consist of a number of things, but for the most part, we put women on hormones to get the uterus ready. These hormones mimic ovulation. I also do extra testing on the lining of the uterus in order to make sure I know everything I need to know about, for example, how many hours of progesterone a woman needs to be on before her transfer day. That test is called the endometrial receptivity assay.
I also do a number of other tests like a preconception panel to make sure that the thyroid, vitamin D, and prolactin are normal levels. I also want to make sure that she’s immune from measles.
These are the steps that I take to give my patients the best chance of pregnancy.
At the same time, if we’re using eggs from an egg bank, we don’t want to ignore sperm. We want to make sure that the sperm is not only genetically compatible but also that the sperm quality is where we need it to be.
While it does take one healthy egg, it also takes one healthy sperm to make a healthy embryo.
When it comes to using an egg donor from an agency here’s something to consider:
I work with agencies that allow me to interview egg donors ahead of time without my patients paying the very high agency fees. I also work with egg banks that will allow me to screen the egg donor. To run tests like the AMH level, FSH, estradiol, and do a carrier screen first. I’m also given the opportunity to interview the egg donor, to talk with them over the phone in person or over a video call. This helps me understand if this donor will be a good match for my patient. When I interview the egg donor I will know personality wise if they will be a good match for the patient, that by this point, I will have known very well. I put myself in the patient’s shoes and ask a myriad of questions. I get lots of answers, take them back to my patient, and we discuss as a group with a psychologist.
It’s important to talk to a psychologist and think about the future of how to approach sensitive topics in the future with your children when they learn they are from an egg donor.
So how do you pick a sperm donor?
No, you don’t post an add on craigslist. There are a number of great sperm banks, many of which I work with. I recommend asking your doctor what the best process if for you.
If your doctor doesn’t have a process that jives with you feel free to bring what you learn here to your doctor.
I like to do something that’s called photo matching. I like to get a photo of you and share a photo with the sperm bank to find a sperm from someone that may be a good match for your look. I always like to take my patient’s top three picks for sperm donors and ask the director of the sperm bank—what do you think of these?
There’s a lot of community that can form around the sperm donation process. Some sperm banks have chat groups where children of sperm donation can meet up online and then that may turn into in-person meetings as well. You hear about stories of people who are donor conceived meeting their DNA siblings in the future. If that’s something you want as an option, see if the sperm bank that you’re working with can do that for you.
It’s equally as important to seek counsel from a psychologist when using a sperm bank as it is for fresh egg donation. You’ll want to talk about the same things.
Questions to consider:
When are you going to tell your children? How are you going to tell them?
Is open access or open identity something that you want to have as an option?
There are people that can find you a sperm donor that would want to be part of the child’s life from the very beginning. You can do that through an attorney, and I know many who can help with that, and there are certain companies to help. I’ve been working with one, donor concierge, for close to ten years. They help my families find not only egg donors and sperm donors, but also gestational carriers.
Looking at genetic compatibility when it comes to a sperm donor is really important. More sperm banks will do genetic screens. If for instance, the egg is a carrier for cystic fibrosis, you’ll want to make sure that the sperm is not a carrier for that same disease.
Most sperm banks will check for that disease, but if they don’t then you’ll want to reach out to the sperm bank and see if you can have the sperm donor screened. As a physician, I can send a kit to that clinic and have them reach out to the sperm donor for that screening test if it hasn’t been done.
A lot of people ask me if blood type is important. Blood type is not important from a compatibility standpoint.
Talk to your doctor. Ask questions. Print out donor profiles and bring them in. I ask for my patients to give me their top 3–6 profiles and we’ll go through the pros and cons with each one. I’ll give you an example. If I have a patient whose father is an alcoholic and they have a sperm donor with a family history of alcoholism then that signals to us there is a genetic predisposition to alcoholism so perhaps that’s a donor that we wouldn’t use.
Having a doctor that’s going to look out for you and look at these things with you is really important. If your physician doesn’t automatically do all of the things, that’s okay. Remember that you can guide the process and ask that they sit and review the profiles of donors with you. It’s important to get their professional input on this.
How to find a gestational carrier the Egg Whisperer Way
I would never recommend a gestational carrier to my patients that I wouldn’t use for myself.
What does that mean?
I’m looking for someone that’s very healthy, even-keeled, and in a very stable relationship. If they’re not in a relationship, that’s okay too. I want to make sure the carrier has strong family support and doesn’t plan on having any life changes in the next year. For example, no cross-country moves or separation from a partner or significant job changes. These are the things that I ask my carriers about. I also look at medication they’ve taken for anxiety and depression and I look for a history of postpartum depression.
We do the same screens on a gestational carrier that I would do on a patient of mine that’s ready to carry a pregnancy herself. Things like making sure the thyroid is normal, vitamin D levels are good, and that immunizations are up to date, drug screens and background checks are clear.
When it comes to finding a carrier, how do you actually go through that process? Well, it’s the same process I described for finding an egg or sperm donor! I have relationships with agencies all over the U.S. and I reach out to them with details of what my patients are looking for. I ask my patients—can you please describe your perfect carrier and the type of relationship that you want with them.
I have patients that tell me they would love to work with someone who is a stay at home mom who is under the age of 33 with no history of a c-section. I also have other patients that say they want to work with someone that’s been a carrier before.
It a patient gets really excited about a profile then I will interview that carrier and do a pre-screen. I use the filter of making sure I would use that carrier if I was in my patient’s shoes. I want to make sure my patients are protected and given the best chance for a healthy pregnancy.
The other thing that I talk to carriers about is whether they would be okay with doing a c-section. Believe it or not, that can come up. Or whether they’ll be okay doing procedures like amniocentesis and also talking to them about the possibility of transferring more than one embryo. I have patients that are over forty that choose not to genetically test their embryos. Transferring more than one embryos is something that I talked to carriers about and educate them about because for the most part, most of our transfers are done with single embryos and they’re genetically tested.
There are wonderful agencies out there with high fees. However, it’s really the carrier that we’re working with. I want to interview the carrier and make sure they are a good match. That’s key.
If you’re a carrier and watching this know that sometimes things don’t happen the way that you’re used to. Women become carriers because they’re really good at carrying a pregnancy and sometimes things can happen like a miscarriage and that can just shatter a gestational carrier’s world and my patient’s world. I work hard on making sure the carrier and patient’s emotions are taken care of in this process. We all are on the same team and looking out for one another.
I hope this show was useful for you wherever you are on your fertility journey. As always please reach out if you have any questions or topic suggestions for future shows.
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