Pregnancy Over 45: When is the Right Time to Consider Egg Donation?
By Guest Blogger Vito Cardone, M.D., Medical Director of Cardone Reproductive Medicine and Infertility
Recently I had the pleasure of being interviewed by Dr. Veronica who is exploring motherhood in her 40’s. Like many mature women who come to my practice, she wants first to see if there is anything she can do to enhance her chances of getting pregnant the “old fashioned” way, but if she does need help, to be able to use her own eggs. Of course, we want to give patients every conceivable chance of doing this. But we also want to give them their best chance at becoming parents when other methods have failed. And this often means using donated eggs. There are limits to what we can do, so one of the most challenging aspects of my work is helping patients decide when egg donation is their best option.
Naturally there are indications that are very straightforward, such as premature ovarian failure when there are no more eggs in the ovaries or when the ovaries have been surgically or medically destroyed from chemotherapy or radiation therapy.
However, those diagnoses are probably the least frequent reasons for using egg donation. We most frequently see women over the age of 40 who usually have a limited egg reserve and/or produce very few eggs after ovarian stimulation. Even though it is true that you only need one egg and one sperm to create a successful pregnancy, the reality is much more complicated. Eggs are not continuously renewed in the ovary. In fact, quite the opposite occurs. Eggs die in the ovaries when females are still in their mother’s womb. From the fifth month of gestation to birth, millions of eggs already are lost and this continues throughout reproductive life. Unfortunately, this is not the full story. Not only are there fewer and fewer eggs as the ovaries advance in age, but the remaining eggs also age. They become abnormal and, therefore, not capable of producing a normal pregnancy. For example, eggs obtained from the ovaries of women who are 45 years or older have upwards of an 80-90% chance of being abnormal. This last point is the most important reason why IVF success rates are so poor for women in the 40 plus age range as their ovaries age.
So the main question we face is: after how many treatment cycles should the couple resort to donor eggs? The answer is not easy and it definitely and ABSOLUTELY needs to be individualized.
As clinicians we need to examine many factors. First, we must review all cycles the patient underwent to look at the ovarian response. A patient who produces many eggs will have a higher chance of having a normal egg among them. We also assess what the embryos look like. Naturally, there is a higher chance of success when there are larger numbers of embryos, as well as more high-grade embryos. On the rare occasion when we have many embryos that look good, genetic testing on the embryos (PGS) may help us define their normality and the probability of success.
Many clinical variables can influence the decision-making process regarding proceeding with egg donation. But patients also need to look at the psychological aspects of using a gamete donor to determine if this is emotionally right for them. We suggest speaking to a mental health therapist who specializes in infertility and third party reproduction and who can help them weigh the pros and cons of choosing this path to parenthood.
One of the most important steps an infertility specialist can take is to help patients navigate through all the information they are presented. By providing my patients with all available options and their realistic success rates, I am equipping them with the ability to make their own decision.
Some patients need to leave no stone unturned and will want to go through treatments using their own eggs even though they are aware of the very low chances of success. It is important to respect their wishes. Other will just opt to go directly to egg donation because of the much better success rates. It is never an easy decision, regardless of their choice. But we are here to educate and support them.
Dr. Vito Cardone, M.D., is founder and medical director of his third infertility clinic in the U.S., Cardone Reproductive Medicine and Infertility (www.cardonerepromed.com) in Stoneham, MA. Dr. Cardone received his medical and infertility training in Canada and France, but has been practicing in the U.S. since the late 1980’s. His career is highlighted by several firsts, including heading the team that achieved the first donor egg pregnancy in New England. Fluent in Spanish, Italian, French and English, Dr. Cardone has earned a reputation for successfully treating all patients with honesty and compassion.