Egg Donation in the USA

The number of infertile couples requiring egg donor treatment to conceive is on the rise in the UK due to the baby boomer effect, where the largest cohort of women are between the ages of 40-to-54.

Currently, despite growing need, there is a severe shortage of egg donors in the UK. The HFEA (Human Fertilization and Embryology Authority) in the UK restricts compensation for egg donors allowing only altruistic egg donation. The practical result is that women wait many years for treatment or they travel to other countries (USA, Spain, E. Europe) where egg donor treatment is more readily available.

Traveling for medical treatment is an intimidating undertaking with patients being understandably anxious regarding a variety of issues. Accurate information regarding the quality of care, logistics and costs are needed to make an informed decision.

Indications for egg donation

Egg donation is an appropriate treatment option for women unable to conceive with their own eggs due to decreased ovarian function. This most frequently occurs with advancing reproductive age. Egg quality typically begins to decrease after the age of 35, is more severely compromised after 40 and is almost uniformly a problem beyond the age of 43 years. This is due to a number of oocyte abnormalities, particularly with the meiotic spindle, that results in a high percentage of aneuploid embryos.

Table 1 below shows the 2005 CDC data from all US programs and illustrates the negative impact of age on IVF delivery rates per embryo transfer and the neutralization of this effect when donor eggs are used.

Egg donors are typically women in their 20s or early 30s who are recruited to undergo ovarian stimulation and egg retrieval. The recipients lining is prepared with estrogen and progesterone and the cycle is synchronized with the donor and the transfer of embryos occurs in the fresh cycle.

Quality of the Medical Care, Regulatory and Ethical Standards

The success rates reported by US programs are excellent and arguably the highest in the world. IVF is a tightly regulated area of medicine in the USA with statistics reported to and audited by the CDC, laboratory inspection by JCAHO or CAP and FDA regulations and inspection of the egg donor programs.

Shady Grove Fertility Reproductive Science Center (SGFRSC) is the largest of approximately 400 IVF programs in the USA. We have 21 reproductive endocrinologists in 11 offices in the Washington DC-Baltimore region. We have close relationships with a number of prominent infertility programs in the UK and treat many of their patients. In 2008 alone, nearly 60 patients from the UK will be treated with donor eggs in our practice.

Our success rates are listed in Table 2. We perform the largest number of egg donation cycles in the USA; with one of the highest success rates and lowest high order multiple pregnancy rates. Reducing the high order multiple pregnancy rate and twin rate has been a major focus at SGFRSC. We limit the number of embryos transferred to 1-to-2 in women using donor eggs. In 2007, 22% of donor cycles utilized elective Single Embryo Transfer (eSET).

Table 2: Donor Egg Program Success at SGFRSC 2000-2007

We are very aware of the ethical concerns regarding egg donation. Egg donors receive extensive counseling regarding the physical and psychological aspects of treatment. Our independent ethics committee limits the compensation they receive. They are screened for medical, genetic and psychological conditions. Our recipients deserve the opportunity to conceive the pregnancy that they desire and are screened to ensure that they are medically and psychologically prepared to carry a pregnancy. We do not offer treatment to women over the age of 50 due to concerns regarding the women’s health and the implications for a future child.

Logistics & Travel Requirements

To reduce the anxiety faced by overseas patients we provide extensive information prior to any travel being required. We have streamlined the treatment process and coordinate care with UK fertility centers so that international patients make only two trips to the US.

We offer the following four services at no charge to provide the opportunity for patients to familiarize themselves with our program and meet us without incurring any cost:

1. 30-60 minute call with our experienced donor egg liaison to orient them to all aspects of the donor program.

2. Extensive information is available on our website. The recipients are provided with information about the anonymous egg donors that includes physical characteristics, ethnic background, medical and genetic history and a picture of the donor as a child. We usually have about 40-50 donors available and the recipient selects their donor after reviewing the profiles online. Most European programs do not provide recipients with detailed information and do not facilitate the recipient selecting their own donor.

3. Telephone consultation with Dr. Michael Levy, Director of the IVF and donor egg programs.

4. Initial face-to-face physician consult and pelvic sonogram, sperm cryopreservation and analysis, and consult with the nurse and administrative staff.

In order to complete treatment, a second visit to our clinic is needed. The treatment cycle is coordinated with the patient’s local fertility doctor in order to reduce the amount of time the recipient needs to be in the USA. The embryo transfer is usually performed 3-to-4 months after the initial consult, and requires 2-to-5 days in the US.

Financial Advantages

Traditional donor egg treatment is expensive as it includes all the usual costs of an IVF cycle as well as the donor fee and prescreening costs. A single donor egg cycle in the USA ranges from $25,000-$30,000. In order to make the cycle more affordable, we have developed the Shared Donor Egg and Shared Risk programs.

The Shared Donor Egg program has been available since January 2007 and provides recipients the option of using all of the eggs from a single donor or sharing with one or two other recipients. On average, 18 eggs are obtained per donor facilitating the sharing of eggs without compromising pregnancy rates. The egg sharing option reduces the cost of treatment by almost 50% and is currently selected by two-thirds of our recipients.

In addition to the usual fee for service option, SGFRSC has offered an innovative Shared Risk financial option for the last 15 years. In this program, recipients pay double the fee for service price but can do up to six (6) fresh cycles and we only earn the fee if they have a healthy delivery. If unsuccessful, patients can stop treatment at any time and receive a 100% refund. This includes all the medical costs, donor fees, medications and prescreening costs (i.e. there are no additional fees). About 90% of recipients choose the shared risk option; to qualify they must have normal uterine function.

These programs have made treatment with egg donation more affordable. The cost of a single cycle in the Shared Donor Egg 1:3 program is $14,600 and the Shared Risk cost is $29,000.

Conclusion

Travel to the US from the UK is relatively easy and the cultural adjustments are small. We literally speak the language (even if it is with an accent). We are pleased to offer an outstanding service to patients from all over the world needing egg donation. Our program has become the largest in the USA on the foundation of providing top quality clinical care, personalized patient support and affordable creative financial options.

Interested patients should contact Amanda Segal at amanda.segal@integramed.com or call 001 301 299 5525 and look for more information online at www.shadygrovefertility.com.