Innovative Programs Make IVF with Donor Egg Affordable

One of the most miraculous technologies in assisted reproductive treatment facilitates the creation of a child with the help of a donor's egg. For many women, the option of using donor egg (DE) with in vitro fertilization (IVF) brings about their only chance of experiencing the unique events of pregnancy and childbirth.

Shady Grove Fertility Center has just launched a program that makes IVF with donor egg more affordable. The result is that many patients who might never be able to afford fertility treatment can now with the remarkable Shared Egg Donor Program.

Created by Dr. Michael Levy, IVF Program Director, and one of the founders of Shady Grove Fertility Center and a pioneer in addressing patients' treatment financing issues, the Shared Egg Donor Program is based on studies which indicate that in one medication cycle, an average egg donor will produce enough eggs for use in up to three IVF treatment cycles.

"The major practical benefits of the Shared Egg Donor Program," explains Dr. Levy, "are that it costs patients less, and it enables us to expand our successful Shared Risk Refund program."

Financial Innovation, Accessible Treatment

Several years ago, Dr. Levy created the world's first financial assistance program for fertility treatment in which patients can pay for the equivalent of two cycles in advance at a discounted rate per cycle and even receive a refund if no baby results. At the time believed to be controversial, Shared Risk Refund programs are now widely accepted as one of the best financial avenues for patients needing IVF to conceive.

Shared Risk programs were at first criticized as being contingency-fee based medicine. The criticism was frustrating to Dr. Levy and many other practitioners who were tired of seeing treatable patients walk away empty-handed because of lack of insurance.

"In my mind, it was the most ethical thing we could've done," says Levy, "to help make IVF more accessible to patients who needed it." A few conferences later, and the American Society for Reproductive Medicine came out for the record with statements supporting Shared Risk Refund as an ethical option for patients without health insurance coverage for IVF.

Dr. Levy enjoys finding ways around challenges. "I've never felt comfortable seeing patients get priced out of treatment."

The new Shared Egg Donor Program is another way that Shady Grove Fertility Center will be helping make pregnancy a reality for more mothers.

One Donor, Several Recipients

The use of donor eggs with IVF treatment has proven over the years to be a highly successful path toward pregnancy for women who have decreased ovarian function but a structurally sound uterus. Some of the situations that might warrant DE are:

• women who are closer to menopause due to either age or health condition
• cancer survivors whose previous life-saving therapy rendered them infertile due to ovarian compromise
• patients who wish to avoid the transmission of certain genetic conditions

Because donor egg use is often seen as a last resort by fertility patients, they may feel more disheartened about the possibility of their own pregnancy ever happening. In fact, the use of IVF with donor egg is consistently proving to be tremendously successful in terms of pregnancy rates per embryo transfer. Shady Grove Fertility even sees many patients from abroad who come to the U.S. in order to become pregnant in spite of their countries' often harshly restrictive fertility treatment regulations.

Traditionally, DE utilizes the donor services of one woman to produce eggs which are then fertilized with the sperm of the recipient's male partner. Resulting embryos are then transferred to the recipient. The newer concept of using one donor to help more than one recipient conceive has numerous benefits related to time and cost. Shared Donor Egg recipients have greater access to available donors and share fixed costs while still maintaining an estimated 41 percent (in the 1:3 program) or higher delivery rate per embryo transfer.

Several variables -- such as how a donor responds to ovulation medication or whether a donor is currently available at the time of treatment -- can delay the progress of a typical donor egg treatment cycle. Sharing the eggs created by a donor can lessen potential wait time and expedite the treatment process, an aspect that is particularly important to the many women in their late 30's and early and late 40's who turn to DE to have a baby.

Patients in the Shared Donor program who also make use of the expanded Shared Risk financial program will realize additional financial advantages as any donor-related expenses are included for up to six attempts, with a 100% refund if they do not deliver a baby. This includes the donor, prescreening and medication fees.

For logistical reasons, patients enrolling in the Shared Donor with Shared Risk program are required to use donors from Shady Grove Fertility's group.

Michele Purcell, RN, Supervisor of Shady Grove Fertility's Donor Egg Program, explains, "When patients use an outside agency to find and select their egg donor, they pay the agency an additional fee, plus the egg recipient is responsible for covering any travel related costs for their donor. But patients who use the Shared Donor program will realize a savings of about $8000 to $10,000 since all those expenses are rolled into a fixed fee."

Patients can choose whether to share a donor's eggs with one or two other recipients. Sharing donor eggs by two recipients has already proven successful, with resulting pregnancy rates (55%) of little difference from cycles in which one recipient uses all of a donor's eggs (59%). A published study from Argentina¹ demonstrated that high success rates can also be maintained when three recipients use one donor's eggs. Shady Grove Fertility's additional experience suggests that since most donors will produce enough eggs for recipients to share, their already substantial pool of available donors makes 1:3 sharing a viable option.

The Important Details

As illustrated by the table (Fig 1), significant financial advantages are realized when patients choose to use the Shared Donor Program, if they are 1 of 2 recipients or 1 of 3. Those who also opt in to the all-inclusive Shared Risk financial program will see the greatest savings. For example, Patient A is going the traditional 1:1 (one donor, one recipient) DE route and not using the Shared Risk program. She will pay $27,000 for each pregnancy attempt. Patient B will instead share a donor's eggs with two other recipients (1:3) and also utilize Shared Risk. Patient B will pay only what amounts to $2,000 more than Patient A, for up to six attempts at conceiving.

There are two important points that Dr. Levy discusses with all patients considering the Shared Donor Egg program.

• Those choosing the 1:3 option must keep in mind that patients who are listed as the third recipients to receive eggs in a donor's cycle have a statistical chance of 40% that the cycle will be canceled. However, the program was constructed with such possibilities in mind, giving patients whose cycles have canceled the opportunity to receive a refund, to have prior payments applied toward a new cycle, select a new donor, and to be the second recipient in the following cycle.
  
  Similar allowances apply for patients who are second recipients of a cycle cancellation, of which there is a 20% chance.
  
  
• There are slightly lower pregnancy rates when Shared Donor Egg is used. Again, the table illustrates that the “delivery rate per embryo transfer” decreases as the number of recipients increases.
  
  However, given the very high success rates of IVF with donor egg in general, the staff of Shady Grove Fertility believes that the financial benefit of the program will outweigh the statistical odds by giving more patients more chances at trying to get pregnant.

Each patient who is presented with donor egg as an option for creating pregnancy will be given as much time and discussion with staff as necessary to help them fully understand the details of the new Shared Donor Egg program, so that they can feel solid about their choices. Recently, Dr. Levy spoke to a patient who was trying to decide whether or not to use the traditional DE program or instead choose to share a donor's eggs.

“Naturally, such conversations are very patient-specific,” Dr. Levy qualifies, “but in general, the extra money potentially spent on the traditional 1:1 donor IVF is significant. For this particular patient, her chances at pregnancy were quite good. Still, she had to bear in mind the additional chances of cancellation and lower pregnancy rates [for using 1:3 Shared DE] might mean she would have to undergo one or two cycles more before achieving pregnancy.” A savings of $20,000 makes the small increase in time seem minimal to many patients.

Another point of comparison that's really a by-product of the Shared Donor Egg program is that there will be no leftover embryos from each cycle. This will positively result in patients not having to face the dilemma of paying ongoing cryopreservation fees or making other choices for their embryos such as donating them to other patients or to research. On a societal level, it will help to decrease the hundreds of thousands of frozen embryos currently in a suspended state. Young, healthy egg donors are capable of creating far more embryos in any one cycle than a recipient can safely have transferred. The result of traditional 1:1 IVF with DE is often leftover embryos. Especially given that so many older mothers opt to use this method of successful fertility treatment, those unused embryos can present quite a perplexing situation for the parents. As Dr. Levy illustrates, “You don't typically find 48 year old patients who want to have 15 frozen embryos.”

Innovative Patient Access to Success

Just as with the creation years ago of the Shared Risk 100% Refund program, Dr. Michael Levy's newly formed Shared Donor Egg program will open the doors of fertility treatment to countless families.

Levy sums up the simplicity of purpose for his innovations: “For a high percentage of people interested in pursuing IVF with donor egg, the primary reason they did not was strictly because it can be cost-prohibitive.”

The results of this unique, premier offering that combines financial program with giving patients a chance to share a donor's eggs will be carefully observed over time. Shady Grove Fertility anticipates success rates for patients like no other ART practice in the world has produced, and for patients who might not otherwise have had the chance at pregnancy.

REFERENCES
1. Glujovsky D, Fiszbajn G et al. Practice of sharing donated oocytes among several recipients. Fertil Steril 2006;86:1786-87.