Today we experienced a setback when we found out that our donor did not pass her FDA-required infectious disease screening and is now disqualified from continuing our cycle. Tomorrow, I’ll speak with the doctor about what we should do next. As I understand it, our options are to choose a new donor who is able to start her cycle pretty much immediately; ditch this cycle, stop taking my meds, choose a new donor, wait for her to be available, start my meds all over again, and pray that nothing goes wrong this time; or order frozen eggs from an egg bank again.
“Fresh vs. frozen” is the eternal question for people who require donated eggs to achieve a pregnancy. For a long time, fresh donor eggs were the only game in town. Frozen eggs first resulted in a human pregnancy in 1999. For many years, a process we now call “slow-freezing” was used to preserve eggs; more recently, an improved method – vitrification – has been used to minimize the production of ice crystals that can damage the eggs. In 2012, egg freezing was officially no longer considered experimental, and is now widely practiced.
First, you’ll need to know a little bit about the donor’s process. The egg donor has many hurdles to cross before she successfully donates. She must first apply, be screened for eligibility, be interviewed by the clinic, receive a psychological evaluation, receive genetic carrier testing, and be screened twice for STIs. If she passes all of these tests, she will begin what people call “stims,” in which she is poked and prodded and pumped with medications at the precise, perfect moments that will allow her to produce a large number of mature eggs. Then, when the eggs have matured, she undergoes a procedure during which a needle is inserted into her ovaries to remove (“aspirate”) the eggs she has produced. If this is a fresh cycle, the donor’s medications will be coordinated with the recipient’s in such a way that the lining of the recipient’s uterus will be the perfect thickness at the very moment that the donor’s eggs are ready to retrieve and fertilize. Sometimes people do what’s called a “shared cycle,” where the donor is stimulated to produce a very large number of eggs that are distributed among several different recipients. This makes a very expensive process much cheaper, but you also get fewer eggs. If the eggs aren’t being used right away, they’ll be frozen and banked for later use.
Fresh eggs and frozen eggs each carry distinct advantages and disadvantages that can make it incredibly difficult to make the best choice.
Frozen eggs are ready when you are. When I used frozen eggs, they arrived at my clinic, ready to use, from an egg bank on the other side of the country, just two days after my payment cleared. Fresh eggs rely on the donor’s availability. Is she currently in a cycle for another couple? Is she busy at work? Is she traveling? You’ll have to cycle on her time.
Bang for the Buck:
Remember my description of a shared cycle? That’s similar to what’s going on when eggs are obtained for banking. The donor produces many eggs, and they are split up into “cohorts.” For example, if the donor produces 24 eggs, they may be split into 4 cohorts of 6 eggs each. You pay your fee and you are guaranteed to get the number of eggs you were told you’d receive. With a fresh non-shared donor, you receive all the eggs she produces. If she produces 24 eggs, you get all 24! And it’s very nearly the same price as the six frozen eggs you’d have received from the bank. But if she produces 5 eggs, well… you get 5 eggs. You stand a great chance of getting more eggs, but there’s a real risk you’ll get even fewer. It’s just an unknown.
In a fresh cycle, you don’t know what’s going to happen. There’s an excellent chance that your donor will clear all her hurdles, produce a nice large batch of eggs, that produce many high-quality embryos to choose from. On the other hand, there’s a very real chance (as I learned firsthand today) that your donor will trip over a hurdle and be disqualified. Or that she will suddenly get cold feet after starting a cycle. Or she’ll have to stop due to an unanticipated life event. Or she’ll take her medications incorrectly. Or she simply won’t respond to them well – we like to think that all the screenings mean the donor is a paragon of fertility, and we as recipients feel betrayed and disappointed when she produces few eggs, or low-quality eggs. But, we as recipients should be well aware that fertility is an unpredictable beast. With frozen eggs, the woman already cleared all the hurdles, did everything correctly, and followed through with lots of eggs before you even became involved.
IVF using fresh eggs has been practiced since the late 1970s, but frozen eggs are more recent. Although they are no longer considered experimental and have been shown to produce pregnancies and live births at comparable rates to fresh eggs (e.g. Grifo & Noyes, 2010), many clinics may still not be as comfortable or experienced with the process of warming and fertilizing frozen eggs. I think, at this point, the question of whether frozen eggs are just as good as fresh eggs in producing babies will have to do with the expertise of your clinic – however, many clinics still claim that frozen eggs are not as effective as fresh eggs, and I can understand their reluctance, since it was only a few years ago that they had to have a review board approve their use of frozen eggs as an experimental technology.
Fresh eggs are usually obtained from either a friend or relative (known donor), a donor registered with your clinic, or an independent agency that represents donors. For whatever reason, there are generally fewer donors to choose from. If your clinic recruits a cadre of 20 local donors for you to choose from, a frozen clinic could recruit 20 donors, cycle them, freeze the eggs, bank them, and then recruit another 20 – from all across the country. If you want more variety to choose from regarding donor characteristics, an egg bank is the way to go.
As you see, there are many considerations. For my last two cycles, I had purchased a cohort of 6 frozen eggs, which produced three embryos. For the first cycle, we transferred one and froze the other two. For the second cycle, we planned to transfer the other two, but I requested that the lab grow them for two more days after they thawed. One of the embryos stopped growing during that time, and we transferred the other ones. This time, we decided to use a fresh donor in the hopes of ending up with more embryos – but, as I feared, a fresh donor carries the risk of ending up with no embryos, and no donor, at all. I’m not really sure what to do next. I can only financially afford one more cohort of frozen eggs or cycle with a fresh donor. Part of this will depend on how many more cycles my husband and I can emotionally and logistically afford. I’m not getting any richer, he’s not getting any younger, and at some point I may need to accept that motherhood isn’t in the cards for my future.
Grifo, JA & Noyes, N (2010). Delivery rate using cryopreserved oocytes is comparable to conventional in vitro fertilization using fresh oocytes: potential fertility preservation for female cancer patients. Fertility & Sterility, 93(2), 391-396.