02.02.2015

Trouble getting pregnant after egg donation

One of the most common procedures that women rely on to become pregnant when they have been struggling for some time is IVF.
While IVF is a procedure that is very effective, many women find that they still struggle to become pregnant with it as well. This can be a very frustrating experience and quite expensive, especially if you are using donor eggs.
Women who donate eggs aren't harming their chances of later becoming pregnant, a new study from Belgium finds. Out of a group of 60 women who had donated eggs, 54 later became pregnant within a year of trying to conceive, and three more women became pregnant within 18 months of trying to conceive, all without reproductive assistance, the findings showed. The remaining three women in the study became pregnant with the help of fertility treatments.
Women who donate eggs are treated with hormones that ramp up their ovaries' egg production, and previous studies had suggested that fertility problems might follow in the wake of these hormone treatments, according to the study. The question of how egg donation may affect future fertility is important not only for those who donate eggs to others, but also for women considering freezing their eggs to delay childbearing, the researchers said. In the new study, researchers asked 194 women who had donated eggs at a fertility center in Belgium questions regarding their attempts to become pregnant. The researchers noted that there is some evidence that the egg donation procedure, which involves puncturing the ovary, may cause the immune system to produce anti-ovary antibodies, and that higher levels of these antibodies have been seen in infertile women. While I have written that it is easier to get pregnant when you’re younger than when you’re older, we have developed a wonderful new method for getting pregnant with your own eggs even at an older age.  I have urged women in their thirties not to delay high-tech treatment until it is too late. I recently saw a woman in her forties who first got pregnant seventeen years ago, and because she was not married had an abortion.
Naturally, if you receive a donor egg, the genes of the baby will be a combination of your husband’s genes and those of the woman who donates the egg, even though you will carry the baby for nine months and deliver it.
Much older women (late forties and fifties) have no difficulty getting pregnant (greater than a 50 percent pregnancy rate per cycle) so long as the donor eggs come from young women. Women as old as sixty-three years of age have gotten pregnant quite easily with egg donation and have delivered healthy, happy babies. Many of these older women getting pregnant with egg donation have multiple and often large fibroids in the uterus.
Many women in their late 30’s and early 40’s who have run out of fertile eggs initially resist adamantly the suggestion of using donor eggs. Another approach is for patients to search among their younger friends or relatives for someone who is willing to donate an egg, to make all the legal arrangements privately with them, and then to go through a screening and counseling evaluation. Our first egg donation case in the mid-80’s prompted consternation by some administrators and “ethicists” who feared the future, but was endorsed enthusiastically by the patients, their doctors, their parents and grandparents, and even the clergymen who represented the patients. I was confronted years ago by a nurse who had gone through menopause early, was now 42 years old, and who strongly wanted to have a child with her husband knowing full well that it would require donor eggs.
We need to talk further about the technical aspect of: 1) synchronizing the cycles of the donor and the recipient, and 2) giving the proper hormone replacement to recipients so that their uterus is prepared for implantation of the embryo and also to maintain the pregnancy until such time as the placenta starts making its own hormones by eight to twelve weeks of pregnancy. It is all timed out with the same goal in mind, that the recipient first receives proper estrogen priming of her uterus, and then one day after the donor receives her HCG injection the recipient begins taking progesterone injections in addition to the estrogen. Even after it is clear that you are pregnant you will have to stay on estrogen and progesterone supplements for up to twelve weeks longer, until the normal time in pregnancy when the placenta takes over the function of the ovary and produces all of its own self-sustaining estrogen and progesterone. One of our earliest surrogate cases was a 27 year old woman who had lost her uterus from a hysterectomy necessitated by severe bleeding occurring in her previous pregnancy. The common legal and psychologically sound theme behind all this is that the “intended parent” is the parent, no matter where the eggs come from. Surrogate uterus pregnancies are here to stay; they are morally and ethically completely proper, and they offer an opportunity for a relative or a loved one to give the greatest gift possible to a woman without a uterus. However, on the chance that her problem all along might be related to her history of tubal infection, her husband’s cousin (who had already had five normal pregnancies and five children and whose husband was vasectomized so they could not have anymore children) agreed at age 42 to be a surrogate for this patient.
We’ve had many similar cases whereby the history of prior tubal disease has conferred a low pregnancy rate on couples, and after many failed attempts at pregnancy with IVF (to bypass the tubal blockage), resorting to a surrogate, who is usually a family member or close friend, solved the problem. You will see our protocol for synchronization, whether it involves a surrogate uterus or an egg donor, two clinically opposite situations. Please recognize that legally you are completely protected, whether using donor eggs or gestational surrogates. Unfortunately, many treatments are typically required before a woman is able to become pregnant. Struggling with a becoming pregnant can be very stressful, but stress is also something that can cause issues with pregnancy as well. Clinically proven to dramatically increase your chances of conception and help you get pregnant fast from the very first use.


On average, the women's age at the time of their egg donation was 29, and their age at the time of the telephone survey was 34.
Egg donors are a select group of women — women with fertility problems are unlikely to be able to participate. Still, other studies have suggested that increase does not affect egg production, the researchers said. I’m going to turn around completely now and point out that if you have completely run out of eggs it is really still not too late to have a baby.
The age of the uterus is not what is significant in the high pregnancy rate of these patients, but rather the fact that: 1) the eggs came from healthy younger women, and 2) the recipient’s only infertility problem was that she had run out of fertile eggs.
They may insist on going through one unsuccessful IVF cycle after another, unwilling to even consider donor eggs.
A 40 year old woman who was a very prominent lawyer had run out of eggs, and was married to an equally prominent lawyer who had no sperm.
Yet she was very intellectually bothered by the idea of bringing technology into the process of getting pregnant. It is amazing how many bright young women there are who would like to anonymously help women who have run out of eggs have a baby.
This assures that the IVF transfer will be performed at that time in the cycle where the window of receptivity for egg implantation is open.
This may require considerably less than twelve weeks, and the latest data indicate that by six weeks (contrary to our previous thinking) the placenta may be making enough estrogen and progesterone to sustain the pregnancy. Well of course if you go to a poor or mediocre clinic to donate your eggs then you could have risks of a poorly done egg retrieval, hyper stimulation syndrome or anesthetics risks. One 40 year old patient of ours had already gone through four cycles of IVF elsewhere and failed to get pregnant.
Although removal of the fallopian tubes in these patients may improve their pregnancy rate with IVF, often it doesn’t. Keep clearly in mind that the donor-recipient synchronizing is exactly the same whether this is the case of gestational surrogate recipient, or in reverse, of a donor giving eggs to a patient with a uterus who has no viable eggs of her own.
And now for a limited time, Try a FREE starter pack today & receive 20 FREE pregnancy tests and a FREE Digital BBT Thermometer! All that is needed is an egg donor, and you can still carry your baby in your late forties or fifties, or even sixties. With these two operative factors, pregnancy rate using IVF and donor eggs in menopausal women is over 50 percent per transfer, and when frozen extra embryos are BLANK with BLANK over 95%, no different than what one would expect in younger women.
On the basis of the ease with which these women become pregnant with donor eggs and deliver healthy babies, it is now apparent that the vast majority of uterine fibroids, no matter how large, have no effect on a woman’s fertility, and should not be overzealously operated upon. One extremely odd seeming application of donor eggs I saw recently, was a 44 year old woman who had a female child when she was 23 years old, decide not to abort her and raised a beautiful girl who is now 21 and going to law school.
This requires very careful psychological discussions to ensure everyone knows who the mother is and it is not the friend or relative making the donation. The way to determine that is to get blood tests every week for estrogen and progesterone levels, and when the progesterone level begins to rise dramatically over what we know you’re getting from replacement, then we know the placenta has taken over and you no longer need to take hormone replacements. The reason is the that all women have a storehouse of immature eggs in the outer ring of their ovary, usually about six million in the female fetus, about 2 million at birth, 400,000 by their teen years.
After agency and legal fees are paid, it can add up to $10,000 dollars over the cost of regular IVF, which can cost $9,000 to $12,000 dollars. Performing this kind of procedure is so simple that it turned out not to be a problem, and indeed, when I saw her at that meeting, her best friend was already pregnant with her genetic baby and ready to deliver and give it to her.
The egg must come from a source other than the surrogate, therefore a surrogate for another couple must not be the egg source also.
In women who have diseased fallopian tubes, if they don’t get pregnant on their own with several cycles of IVF, using a surrogate will be a simple solution to the problem. So therefore, whether you are using a donor egg from someone else, or you are putting your eggs into someone elses uterus, the intended parent is always the legal parent.
The main determinant of pregnancy rate is the age of the woman from whom the eggs originate. Her 44 year old single mother raised her beautifully and finally now is in a loving relationship, married to a 38 year old man, but she has run out of eggs.
She and her family brought the idea up to us of egg donation and despite some concern and trepidation, it felt right to me.
Every month in young women, about 1,000 eggs leave this primordial pool, and this is inexorable.
But the success rate is so high, especially considering these are patients who otherwise have no eggs, that the expense is worth it.


The story of that first case, reported in the New England Journal of Medicine, was absolutely spellbinding: A thirty-seven-year-old woman became pregnant, but the uterus spontaneously ruptured at twenty-eight weeks of gestation, necessitating a cesarean section and a hysterectomy. In her family, one of her sisters was willing to donate an egg, the husband of course would provide his sperm, and another sister would allow the eggs and the sperm to be transferred to her so that she could carry the baby.
Nonetheless her cousin did become pregnant and delivered a healthy little baby girl nine months later. The key factor in synchronizing the cycles of donor and recipient is that the recipient must start on progesterone injections one day after HCG is given to the donor. I can say unequivocally that carrying that baby for nine months results in a solid, loving bond between the mother and the child, regardless of the genetic origin of the donated egg. Paulson normally will not perform egg donation for women over fifty-five years of age, but this healthy-looking sixty-three-year-old woman successfully lied in order to get into the program. But removing fibroids is an easy operation and certainly can be removed before the embryos are transferred, again it is the age of the egg that matters. Despite years of negative feelings about the idea, all of them are overjoyed when they finally have a baby via donor eggs.
This privacy is guaranteed by law and also guarantees that the “intended” mother is the mother no matter where the egg came from. Again, to maintain absolute anonymity, the patient recipient pays the agency and the agency pays the egg donor. But by the time this futuristic medical prediction became a reality, this lady had already run out of eggs and was in menopause. This couple now has a beautiful daughter, with two special aunts, one who provided the eggs, and one who carried her. Her main problem was that women with blocked fallopian tubes caused by infection are known to have lower pregnancy rates with IVF. Despite the woman’s vastly reduced ovarian reserve after so many years of unsuccessful treatment, the problem all along was simply that because of prior infection her uterus was not receptive to implantation. The wives naturally understand this and no donor eggs are no problem after they think about it and the men have no issue because it is their sperm anyway.
Although she was only two years away from being eligible for Medicare, she had no trouble conceiving and carrying the pregnancy normally because the eggs came, of course, from a younger woman. Detailed psychological counseling revealed there was no confusion emotionally that it would be her mother’s baby and this is another happy case of egg donation. Sometimes one can find close friends or younger sisters who are more than happy to donate an egg. Thus the embryos generated by his wife’s brother’s sperm and his sister’s eggs, allowed them to continue their family line, and yet avoid consanguinity. So when you donate say 5 eggs, they all would have died anyway so you lose no eggs at all by egg donation. If the surrogate was also the egg donor there would be a severe danger of psychological “bonding” conflicts, regardless of the original intent of the would-be parents and the surrogate. The daughter was stimulated in the usual fashion for in vitro fertilization, her eggs were fertilized with her husband’s sperm, and her embryos were transferred into her mother’s uterus.
However, in the vast majority of cases we have to find and match egg donors for such patients. That is why we have become so good at helping older women and women with very few eggs get pregnant with their own eggs.
However, as long as the egg donor and the woman carrying the baby are different, we have never seen such a conflict. Nonetheless she failed to get pregnant with four IVF treatment cycles in another center and in her fifth IVF cycle with us.
The patient’s eggs were incubated with sperm from the husband, and three days later an eight-cell embryo was transferred to the uterus of the surrogate.
It was natural to attribute the fifth failure to her biological clock, since she was forty years old and pregnancy rates in forty year olds are much lower with IVF.
Whenever the donor receives HCG, which is often (but not always) on the tenth to twelfth day after gonadotropin has begun, the recipient starts on progesterone one day later.
When that is the case, donor eggs are a very good (though at first strange seeming) option. The surrogate became pregnant and nine months later delivered the healthy genetic baby of her ecstatic friend.



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