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Frozen Egg Donation
a guest blog by Daniel Shapiro, M.D., Clinical Director, MyEggBank-North America; Medical Director, Reproductive Biology Associates, June 10, 2013
For the last decade the Society For Assisted Reproductive Technology (SART) has recorded about 10,000 fresh egg donation cycles per year. This number hasn’t changed much in all that time. The reported live birth rate hasn’t varied at all in the last decade either. It is stuck around 55% per cycle nationwide despite great improvements in laboratory technique and ovarian stimulation protocols over the same time period. Each of the recorded cycles is a ‘fresh donation’ meaning that the eggs were collected from a donor, inseminated immediately after collection, and then transferred (as an embryo or two) into the intended Mom or surrogate no more than 5 days later. None of the recorded cycles resulted from frozen eggs, but as of this writing we can safely say that about 2000 cycles of egg donation with frozen eggs have been performed in the US since 2006. There are probably about 1200 babies already born from the process. More than half of these cycles have been performed in one center alone.
A recent blog by Sheryl Steinberg of The Donor SOURCE did a good job explaining the difference between fresh and frozen egg donation. Her blog also was careful to differentiate between frozen ‘eggs’ and frozen ‘embryos’ which are eggs after insemination. Frozen embryos can be from either ‘fresh’ or ‘frozen’ eggs and the SART registry does not indicate whether a frozen embryo came from a fresh or frozen egg.
Some large and historically successful egg donation practices have either switched almost entirely to frozen donor eggs or have incorporated frozen donor eggs into their programs. SART data unfortunately does not reflect in real time what is happening in the world of egg donation since none of the ‘frozen egg’ cycles is counted in the registry. Patients often rely on official statistics to choose their donor program and the power of the internet to influence patient opinions about ‘where to go’ cannot be underestimated. That said, how on earth can a patient make a reliable decision about which to choose? Ms. Steinberg offered several good points of differentiation in her blog but her comments were not based on the facts of what is really happening in the largest egg banks in the US as of now.
Though I cannot speak for the other banks in the US regarding stats, I can accurately report certain averages based on over 1000 frozen egg cycles for which I have first hand knowledge.
First, frozen donor egg cycles are MUCH less expensive than fresh. A single cycle incorporating 6 eggs costs roughly 18 to 20,000 dollars and includes everything related to the donation including the donor’s fee, the lab fee, the doctor’s fee, the donor’s meds, the recipient’s meds and the freeze and storage fee for any additional embryos. An egg donation using fresh eggs performed in a Northeastern or West Coast program would cost nearly 40 to 45,000 dollars if you include everything mentioned above (plus the fees charged by the agencies to find the donors and make the match).
Second, a batch of six eggs on average yields almost three good quality embryos. In programs that stress elective SINGLE embryo transfer, a recipient will, on average, have two to three transfers available from a single egg thaw. It is now standard of care to do SET whenever possible in egg donation treatments. Most of the leading donation programs are trending that way and some have already achieved an ‘average number of embryos transferred per cycle’ statistic of 1.3 per cycle. Put another way, some programs are doing SET in about 70% of their recipients. Though not yet validated by SART, the cumulative pregnancy rate per recipient will be about 85%, which is exactly the statistic quoted by a very large fresh donor program in the New York metro area. Put another way, a patient has about an 85% chance of leaving treatment with a baby after all the available transfers from either a single fresh or frozen egg cycle have been completed. The difference though, in cost, is huge. For the frozen egg cycle and up to three transfers (one initial and two FETs) patients will pay no more than 22-24,000. (about 17,000 for the initial cycle and about 1000 for each frozen embryo transfer, plus the cost of uterine prep meds). That compares to nearly 50,000 dollars if the initial cycle was ‘fresh’. Since all three major US egg banks offer some sort of guarantee on their egg lots, patients are often eligible for a free set of replacement eggs when certain embryologic benchmarks are not met. These guarantees vary between the banks but the net effect is to protect patients against a cycle ‘gone bad’. These kinds of guarantees are rare for single fresh egg donation cycles and to get them patients often pay even more than the high number quoted above and commit to a minimum number of attempts/transfers.
It is true that in several states with insurance mandates that the insurers will not cover frozen egg donation. However in just the last few months we have seen that begin to change and expect that this will be a non-issue soon enough. Even so, VERY FEW recipients in this country have any coverage at all so the cost is often the deciding factor.
Third, Sheryl Steinberg asserted that users of frozen eggs ‘will not have the option of meeting the donor or negotiating with the donor in any way. You cannot ask more questions or get more photos’. It is true that the largest American egg bank currently uses an anonymous donation model but as the paradigm matures, we expect that some donors will be willing to be contacted. As for the negotiation piece, I am not sure what needs to be negotiated since the clinic, not the recipient, pays the donor. It is flatly false that recipients of frozen eggs cannot ask more questions or see more photos. The staffs of each of the egg banks and the donors to those banks are usually quite forthcoming with information (controlled by HIPPA and the clinics’ contracts with the donors) and some will provide adult photos when asked to do so. Moreover, egg banks most definitely tell prospective patients whether a donor has been successful in the past and how many babies have resulted. In sperm banking the recommended limit is 10 babies per donor and at least in our bank we follow that guideline. The risk of marrying a half brother or sister is miniscule to begin with, but whatever the risk, it is the same for fresh and frozen donation models since fresh donors often donate multiple times too. The best defense against this non-problem is simply to have everyone be truthful with their children about their origins!
Fourth, sibling matches can easily occur in an egg-banking model. A recipient can reserve extra eggs at the moment they select a donor and release them for a full refund of the reservation fee at any time. It is true as Sheryl asserts that a single fresh donation is likely to produce more embryos than a frozen egg cycle. It is still significantly less expensive to use a bank than to go with a fresh donor, even with the addition of an ‘egg reservation fee’ to the cost of an Egg Bank cycle. In our experience, most recipients want one child only; less than 25% of our patients seek a sibling match.
Fifth, the idea that frozen egg banks are somehow scraping together adequate donor rosters when the world is awash with fresh donor candidates is laughable. It is true that eggs ‘move fast’ in an egg bank, but new donors are coming in at an exceptionally fast clip because the process IS EASIER FOR THE DONOR than working with an agency. Case in point: New Yorkers are waiting an average of 9-12 months for a fresh match while there is no wait for a frozen egg cycle. In an egg banking model the donor is not contractually bound to donate under the watchful eye of the agent; she can donate whenever she wants and does not need to accommodate anyone’s schedule but her own. In fact, the egg banking model makes the process SAFER for the donor too because the inherent conflicts of interest that exist in coordinated fresh cycles are gone. The clinic can focus its attention on the care of the donor as much as the recipient. The financial incentives present in a fresh donation do not exist in a banking model. The clinic works off of averages and knows there is no downside to cancelling a donor cycle that is too intense or too tame; the recipient takes eggs already collected and cannot pressure her doctor to push a cycle that should be cancelled to completion; there are no agents in a banking model pushing cycles to completion either and most importantly, a banking model allows the donor to be treated as a primary patient in the process rather than as an adjunct to treatment of a recipient.
Frozen egg donation is still relatively new, though since the ASRM lifted the ‘experimental’ tag from the process last October the public’s awareness of the option for frozen eggs has risen dramatically. Our experience is that patients have responded to the lower price point and some of the guarantee programs currently offered by the pioneering banks. Sheryl correctly pointed out that everyone in this process wants the same result; a healthy baby. What we have learned since starting our frozen donor egg program in 2007 is that patients are also looking for the path of least resistance, stress and cost in pursuit of that goal. Since it is now established that frozen egg donation works as well as ‘fresh’, patients are rapidly coming to the conclusion that frozen egg donation is the way to go to keep their sanity secure and their bank accounts intact. There is still a role for fresh donation of course (think :24 year old with ovarian failure who wants 3 children, or directed donation from a sister or a friend as examples) but we think fresh donation numbers will decline while frozen egg cycles will skyrocket in the years to come. We also believe that the lower price point for frozen egg donation will allow more patients to be treated and that the total number of cycles will jump way above the 10,000 per year we have seen since the millennium began. Whatever happens, these are exciting times for patients seeking this service and for the doctors and embryologists who have the privilege of bringing it to them.
Danny Shapiro, MD is a co-founder and clinical director of MyEggBank-North America. He is also medical director of Reproductive Biology Associates in Atlanta. Dr. Shapiro has been married to Dr. Nadine Becker for 25 years. They met and became married while at Emory Medical School before training together in Philadelphia at The Pennsylvania Hospital. They have three children, Lauren 19, Jeremy 16 and Hannah, 12 who forbid them from discussing their day jobs at the dinner table.