Advances & Insights: Women’s Health
September 15, 2006
What the news means for you
Ken Muse, MD
New technology likely to become the norm
Infertility is a problem for about 15 percent of the married couples in this country. A couple is said to be infertile when they’ve been trying to become pregnant for a year without success. In the past, the condition was due chiefly to problems with sperm count, the fallopian tubes, ovulation or the uterus. But in recent years, the most common diagnosis physicians treat has become age factor, which means the female patient is unable to make eggs healthy enough to achieve pregnancy, usually because of advanced age.
“The convenience of frozen donor eggs is a tremendous advantage for infertile couples experiencing the age factor.”
Banking sperm and eggs
Sperm banks, commercial enterprises that help infertile couples when the male patient is unable to produce enough healthy sperm, have been around for decades to provide appropriate help for men. For couples who feel this option is right for them, such companies provide a very valuable and family-building service.
Women didn’t have a similar option until two or three years ago. There were no egg banks until recently. The convenience of frozen donor eggs is a tremendous advantage for infertile couples experiencing the age factor. The use of fresh eggs from donors requires synchronization of the patient and the donor, which can be difficult, and about 15 percent of attempts are cancelled for various reasons.
In addition to convenience, the risk of transmitting an infection from the donor to the patient is much less with frozen eggs. Donors can be tested for infection long after the eggs have been harvested, eliminating the risk of an early, undetectable infection being present at the time of egg collection. We anticipate, as the use of frozen donor eggs becomes more widespread, the fresh egg donor will disappear.
New technology requires special expertise
Nevertheless, the freezing and thawing technology is somewhat challenging. It’s taken many years of research to learn how to freeze and thaw human egg cells so the majority can survive. It takes a special expertise, such as that we have at UK, which gives patients a unique advantage and an option they can pursue if they feel it’s appropriate for them.
Going through an IVF cycle is very expensive, and the addition of frozen egg donor therapy raises the total cost to $12,000 to $18,000. Insurance seldom pays for this, and unfortunately, not all women who are appropriate for this therapy can afford it. On the other hand, the cost is much less than many other important health care bills and less than other significant bills one pays in life, such as for a new house or car.
Advances in fertility medicine
Fertility medicine has made great strides in the last 20 years, and the pace of change has radically increased in just the past five years. The use of frozen donor eggs is a major leap forward in reproduction. There’s no doubt that for many couples with a devastating genetic problem, it has the potential to take away the worry of passing that problem to their baby. It also will give many newly diagnosed, female cancer patients the hope that, when they survive their cancer, they will not have to sacrifice their fertility to do so.
Dr. Muse is chief of the division of reproductive endocrinology and associate professor of obstetrics and gynecology at the UK College of Medicine.
Frozen donor eggs offer new option for infertility treatment
A healthy baby girl born last January at the University of Kentucky Chandler Hospital is believed to be the first infant conceived in the United States using a frozen donor egg from a commercial egg bank. While the use of fresh donor eggs has been around for more than a decade, the procedure for freezing and thawing eggs-cryopreservation-has become routinely successful only in the past two years.
“Frozen egg technology is expected to become universally available in the next few years and replace the use of fresh donor eggs.”
Donor eggs are used in an infertility treatment called in vitro (Latin for “in glass”) fertilization (IVF). First introduced in 1978, IVF is a highly sophisticated procedure. The American Society for Reproductive Medicine (ASRM) reports IVF accounts for less than 5 percent of all infertility treatment in the U.S.
Whether IVF is called for typically depends upon the reasons for infertility. For some couples, IVF may be the only option to have “biologically related” children.
When IVF was introduced 25 years ago, most infertile women used their own eggs in the treatment. Recently, however, more women are considering donor eggs because they are unable to produce healthy eggs on their own, often due to the early stages of menopause. IVF with donor eggs has also become a successful therapy for younger women who have poor quality eggs or have had their ovaries removed, as well as those concerned about passing a genetic abnormality on to their child.
According to ASRM, 10,000 babies worldwide are born each year from donor eggs. Typically, fresh eggs have been used, with the harvesting of the donor’s eggs timed so they can be immediately fertilized in the laboratory and put into the recipient’s uterus.
Frozen eggs vs. fresh eggs
One problem with fresh donor eggs is that the reproductive cycles of the recipient and the donor must be synchronized, which may not be successful. Additionally, the donor can give eggs to only one recipient at a time. Frozen donor eggs, on the other hand, can be thawed and used at the woman’s convenience, and one donor can contribute to multiple women.
Only about 120 babies worldwide are thought to have been born from eggs that have been frozen and thawed prior to fertilization. It’s difficult to determine the success rate, but estimates of successful births range from 30 to 50 percent. The federal Food and Drug Administration still considers the procedure experimental. However, this technology is expected to become universally available in the next few years and replace the use of fresh donor eggs, just as frozen donor sperm replaced fresh sperm more than 20 years ago.
Originally, women who needed donor eggs turned to a friend, relative or anonymous donor. But because of increasing demand, the need for donor eggs is growing rapidly, and many women have difficulty finding an appropriate donor.
Anonymous donors are solicited chiefly through advertisements, many in college newspapers or Web sites such as Craigslist. Potential donors are rigorously screened and must pass medical and psychological tests before they are accepted. They must also be willing to undergo approximately 10 days of drug treatments and retrieval of the eggs, a process that is akin to minor surgery. Although slight, there is a chance of complications.
ASRM considers donating eggs safe when proper screening and treatment are conducted. The organization acknowledges there are potential risks to the donor, primarily from the drugs used to stimulate the growth of multiple eggs at the same time and from the procedures used to obtain the eggs.
According to Cryo Eggs International, one of two commercial egg banks worldwide, about 70 percent of the frozen eggs survive the thawing process. Donated eggs are frozen for at least six months and released for sale only when the donor has been tested a second time for HIV and other infectious diseases.
A sign of the rapid progress in fertility medicine has been the quick commercialization of IVF with frozen donor eggs. Within the past year, commercial egg banks have begun advertising frozen donor eggs on the Internet. Women can now browse Web sites, check out potential donors and order eggs no matter where they live. The challenge is to find a facility, such as UK’s Division of Reproductive Endocrinology, with doctors who can perform IVF with frozen eggs.
Future applications of this technology include fertility preservation, an umbrella term for postponing fertility. It currently applies to cancer patients who preserve their fertility by freezing their own eggs prior to potentially damaging treatments for use at a later date.
For more information, see:
UK HealthCare Women’s Health Services
Advances & Insights: Women's Health – Past Issues
For more information, or to make an appointment with a UK HealthCare physician, please call UK Health Connection at 1-800-333-8874.