Everything You Need to Know About 3rd Party Reproduction

//Everything You Need to Know About 3rd Party Reproduction
Everything You Need to Know About 3rd Party Reproduction 2018-07-31T20:05:30+00:00

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Everything You Need to Know About 3rd Party Reproduction

July 25, 2018
By Victoria Greenwald

Whether having children is totally off your radar or one of the greatest desires for your life, understanding your reproductive options is important at any stage of your life. For some of us, complications can prevent a traditional conception-to-birth story — but in the last few decades, incredible medical advances have made family planning around fertility complications totally possible(for instance, did you know that today is the 40th anniversary of IVF success?!). Questions about how to make that happen? Here’s your guide to third-party reproduction options, as told by the godfather of fertility, Dr. William Schoolcraft, MD, HCLD, the founder of CCRM (Colorado Center for Reproductive Medicine), one of the country’s leading fertility clinics that operates 11 fertility centers throughout North America. Having a child through an egg donor, sperm donor, or gestational carrier — whether you’re a heterosexual couple, same-sex couple, or single woman — is becoming more and more feasible. Read on for an expert explanation of your options and for real stories from women who have been through it, too:

Donating Eggs and Using an Egg Donor

What exactly is egg donation/donor?

Egg donation is a fertility treatment where a woman receives an egg donated by another person, typically a younger, fertile woman. These eggs are then fertilized with her husband’s sperm. Embryos are created, and the subsequent embryo is transferred back into her

What’s this process like? What does the timeline look like?

The first step in the egg donation process is for the couple to have a workup. This assures that the woman has a healthy uterus to carry a baby and that her husband has adequate sperm to fertilize and create embryos.

Next, the couple actually chooses an egg donor. This often involves looking at a database or list of potential donors that might meet their requirements. Some of the criteria that couples use when choosing a donor include ethnicity, education level, medical history, family history of genetic disorders, as well as results of the thorough screening that donors go through. Some of these screening tests include chromosome analysis, single gene testing, psychological evaluation, and other basic health screens.

Once the donor is selected, then the donor is stimulated with fertility drugs to recruit multiple eggs. This allows one to harvest sometimes 12 to 15 eggs for the couple instead of just one egg, which would occur in a natural cycle. While the donor is being stimulated to produce eggs, the intended parent, who is going to receive the donor eggs, is prepared with estrogen and progesterone to prepare her uterus for the embryo implantation.

Once the eggs are harvested from the donor, they are fertilized and allowed to divide into multi-cell embryos over three to five days. At that point, the recipient undergoes what is called an embryo transfer.  In this procedure, which is painless, a small catheter is inserted into the uterus to deposit typically one embryo.

Twelve days later the patient can have a pregnancy test, hopefully, to determine that she is successfully pregnant, and then a few weeks after that, an ultrasound is performed to visualize a healthy pregnancy. With a single embryo transfer, multiple gestations are avoided.

What’s the financial investment for egg donation?

The cost of egg donation is typically in the range of $30,000 to $35,000 including all fees for the donor, medications, the donor’s treatment to harvest eggs, as well as her treatment to prepare her body for an embryo transfer, and the completion of an embryo transfer.

Why would a couple choose this option? How about a single woman?

The reasons for choosing egg donation are usually due to the woman having advanced age or other reasons that leave her with poor egg quality such that she is not able to reproduce or have a baby with her own egg and yet has a functioning uterus and very much wants to carry a baby and become a mother.

Single women can also pursue egg donation if they have found themselves at an age where they do not have a partner and require donor sperm, yet in addition, their egg quality has declined to a point where they cannot conceive. They can use both a donor egg and donor sperm to create an embryo to transfer into their body. Even if they have gone through menopause, estrogen and progesterone can adequately prepare the uterus for pregnancy.

What challenges might a couple face or single woman face if they choose this option?

The challenges for a woman considering egg donation are often more psychological than physical.

What are the success rates?

Using young eggs from a fertile donor achieves very high pregnancy rates or high success rates. Typically, 65% to 80% of patients conceive on the first attempt with egg donation.

Sperm Donation

What exactly is sperm donation?

Sperm donation entails the use of sperm donated by a male who is volunteering to help another woman or couple conceive.

What’s this process like? What does the timeline look like?

The process begins with testing of the patient and her partner. To use a gestational carrier the woman has to have viable eggs so that she can have eggs retrieved and produce healthy embryos and, of course, the partner must have viable sperm. They also must be free of any infectious disease that they could transmit to a volunteer gestational carrier. Psychological testing is also important during the workup to be sure the couple has thought through psychologically the ramifications of having another person carry their baby for nine months.

Once the workup is completed, the parents select a gestational carrier. This is often done through a so-called agency, which has a list of women who have volunteered to carry babies for other couples. They go through this list and hopefully get matched up with a carrier that is a good fit for them. This often involves meeting the carrier, interviewing the carrier, and determining if their personalities mesh and if they feel they can work well together during the nine months of pregnancy.

Following this matching process, the gestational carrier undergoes her workup to be sure that she is healthy, her uterus is healthy and able to carry a pregnancy without any risk of complications. The gestational carrier also undergoes psychological evaluation to be sure that she is psychologically comfortable with relinquishing the baby to the intended parents once delivery occurs. We also obtain a clearance from her prior obstetrician to confirm that she has had at least one full-term pregnancy in the past that was uncomplicated and very routine.

Once the screening of the carrier is completed, then the intended parents undergo in vitro fertilization. The woman is stimulated with fertility drugs to create multiple eggs, those eggs are harvested, fertilized with the husband’s sperm, and embryos are created. At this time, the embryos are transferred back into the uterus of the gestational carrier. Often a single embryo is transferred to avoid the risk of multiple gestation and the gestational carrier finds out that she is pregnant about 12 days later.

The rest of the pregnancy is typically managed routinely, as any other pregnancy would be by the carrier’s obstetrician. There is often a great bonding experience between the patient, her husband, and the gestational carrier and they often go to the prenatal visits together. It is not unusual for all three to be present during the delivery of the baby and, of course, in the hospital post-delivery as the baby is being cared for in the nursery.

What’s the financial investment for sperm donation?

In addition, the cost is not prohibitive with donor sperm itself often costing between $500 and $1,000.  The medical treatment to take the sperm and inject it into the uterus, called insemination, is also a matter of hundreds of dollars per month, so relatively inexpensive compared to most other fertility treatments.

Why would a couple choose this option? How about a single woman?

The reasons for selecting sperm donation are typically either a single woman who wants to have a baby and has no partner and, therefore, no sperm source, or a married couple where the husband has no viable sperm production, often testicular failure.

What challenges might a couple face if they choose this option?

The challenge of this procedure, whether the woman is married or single, is largely psychological. For a married couple the husband undergoes counseling, as well as the wife, to be sure they are comfortable creating a child and parenting a child when the husband will not be the biological father. As you can imagine, there is significant stress and adjustment to this concept.

What challenges might a single woman face in choosing this option?

For single women, psychological counseling is important as well to be sure they have thought through the idea of having a baby as a single parent and how they will raise the child and what they will tell them about their origins given that they were a product of donor sperm and do not have a father typically in their life on a daily basis.  Often sperm donors are willing to be contacted later by the child when they are a teen or adult if they wish to meet their biological father.

What are the success rates?

Donor sperm treatment is highly successful because often the woman herself is fertile and simply lacks a fertile partner to conceive with.  Thus, once sperm is placed in the uterus at the time of ovulation, conception occurs in the normal manner at a high rate. After three to four months of donor sperm insemination treatment, pregnancy rates of 60% or higher are frequently seen.

How readily available are these methods?

Many large sperm banks exist across the country, often having hundreds of donors, so this procedure is readily available.

This sperm is typically frozen at a sperm bank and kept in an inventory waiting to be chosen by a couple who needs donor sperm.  The donor is screened for health factors, sperm quality, infectious disease, and medical and genetic history before the sperm is released for use in another couple.

The insemination procedure is painless compared to a Pap smear, thus not invasive and does not require any anesthesia.  Typically, the woman is allowed to ovulate on her own so a single egg is released and, therefore, there is not an increased risk for multiple gestations.

Gestational Carrier

What exactly is a gestational carrier?

The use of a gestational carrier entails finding a volunteer who is willing to carry a baby with her uterus for another couple.  The baby is not related to her biologically, since it is not her egg nor is it her husband’s sperm. That is why we term the procedure a gestational carrier.  The term surrogacy is also used in some circumstances for the same process.

What’s this process like? What does the timeline look like?

The process begins with testing of the patient and her partner. To use a gestational carrier the woman has to have viable eggs so that she can have eggs retrieved and produce healthy embryos and, of course, the partner must have viable sperm. They also must be free of any infectious disease that they could transmit to a volunteer gestational carrier. Psychological testing is also important during the workup to be sure the couple has thought through psychologically the ramifications of having another person carry their baby for nine months.

Once the workup is completed, the parents select a gestational carrier. This is often done through a so-called agency, which has a list of women who have volunteered to carry babies for other couples. They go through this list and hopefully get matched up with a carrier that is a good fit for them. This often involves meeting the carrier, interviewing the carrier, and determining if their personalities mesh and if they feel they can work well together during the nine months of pregnancy.

Following this matching process, the gestational carrier undergoes her workup to be sure that she is healthy, her uterus is healthy and able to carry a pregnancy without any risk of complications. The gestational carrier also undergoes psychological evaluation to be sure that she is psychologically comfortable with relinquishing the baby to the intended parents once delivery occurs. We also obtain a clearance from her prior obstetrician to confirm that she has had at least one full-term pregnancy in the past that was uncomplicated and very routine.

Once the screening of the carrier is completed, then the intended parents undergo in vitro fertilization. The woman is stimulated with fertility drugs to create multiple eggs, those eggs are harvested, fertilized with the husband’s sperm, and embryos are created. At this time, the embryos are transferred back into the uterus of the gestational carrier. Often a single embryo is transferred to avoid the risk of multiple gestation and the gestational carrier finds out that she is pregnant about 12 days later.

The rest of the pregnancy is typically managed routinely, as any other pregnancy would be by the carrier’s obstetrician. There is often a great bonding experience between the patient, her husband, and the gestational carrier and they often go to the prenatal visits together. It is not unusual for all three to be present during the delivery of the baby and, of course, in the hospital post-delivery as the baby is being cared for in the nursery.

What’s the financial investment for a gestational carrier?

Cost is a major factor with gestational carrier treatments.  Between the costs of IVF, payments to the carrier, and often agency fees for finding and screening the gestational carrier, a total expenditure of over $60,000 to $80,000 is not unusual.

Why would a couple choose this option? How about a single woman?

Couples or single women could both elect to use a gestational carrier.  The reason for selecting such treatment is typically a contraindication to pregnancy or the inability to carry a pregnancy.  Some examples are women who have had a hysterectomy, so they simply have no uterus, but still have their ovaries and can make eggs and, therefore, embryos, or women that have disease processes with their uterus such as fibroid tumors, scar tissue, and other disorders that would not allow the uterus to carry a pregnancy successfully.  In other cases, the woman has a serious medical condition such as diabetes, kidney disease, heart disease, or other chronic medical problems that could make a pregnancy be dangerous for her health, as well as compromise the health of the baby.

What are the success rates?

The success with a gestational carrier is typically very high because the embryos are being placed in a known fertile uterus that has previously carried babies to term without difficulty.

On choosing an egg donor…

“I quickly learned the ropes of selecting a donor. It felt like online dating but for a girl to essentially take my place genetically. A dozen pictures from childhood to adulthood, the medical and mental health history of the donor and her entire family, education level, blood type, and even how she spends a typical day. I had to begin to ask myself what was important. Is it more important for a girl to look like me physically? Have a higher degree? To love dogs and birds?” -Hayley

On the process of becoming an egg donor…

After I did the initial application I was contacted to go to an office for some blood work and an ultrasound. You have to create a “profile” which is probably the most grueling part. It’s all about you, your medical history, your family, your family’s medical history, pretty much everything ever! You also have to do an evaluation that is 500 statements that gets reviewed by a psychologist and a nurse will go over everything you need to know about the donation process and they fill you in on what the recipients go through as well. At that point, the psychologist can recommend you be declined from the program. I obviously got past that point and had to schedule a time to meet with the psychologist.

I had to get on birth control pills to sync up my schedule with the recipients, which takes about a month. Then once I was “synced,” I had to start going to appointments just about every other day and taking the injections every night. About a week in I started getting really bloated and uncomfortable. Loose dresses really saved me!

Then the second week which is when you start to get closer to the retrieval date, I had appointments just about every day. Always bloodwork and an ultrasound.  It’s pretty cool to actually see the follicles (eggs) growing.  (That’s what the injections do). At that point, I basically just waited for the doctors to tell me when the procedure would happen.

When retrieval day came I was a little nervous, but the staff was incredible! I cannot say it enough! Everyone is literally the nicest person ever! The procedure was over in half an hour and I felt no pain! Just a little discomfort for the rest of day and then back to normal.  From what I’m told, that’s not always the case, but I guess I’ve been lucky all four times!” -Elena

On the emotional journey of egg donation…

“I hadn’t really been phased by donating my eggs.  At my appointment, my doctor talked to me about the lifelong commitment that this truly is. I also have to deal with the reality that in this day in age, even though the donation is anonymous, if any child that came from this wanted to find me, they probably could. I won’t lie, I thought about it long and hard and decided to move forward because at the end of the day, I’m able to make a difference in someone’s life.” -Emily

“Emotionally, I have experienced feelings of shame and failure [as someone needing egg donation]. If any of this resonates with you, you are not alone. These journeys are tremendously challenging. For us, we have been treated and counseled by no less than 10 doctors and specialists. Finding a doctor and a practice that takes the time to understand the uniqueness of your experience and treats you with compassion can be challenging and often feel like steps in the wrong direction.

But moving on to donor egg has been the most difficult decision to come to terms with for both myself and my husband. Even when decisions have been made to move forward, I have had a deep sense of uncertainty, moments of grief, and sleepless nights. I’ve changed my mind. I’ve changed it back. I’ve developed a heightened awareness and sensitivity to seeing children that look like their mothers. Just writing that sentence puts a lump in my throat. The grief around letting go of the ideal family you picture for you and your partner is inexplicable.” -Hayley

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