Having Your Baby Through Egg Donation. Evelina Weidman Sterling
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August 3, 2012, issue of the New York Times Magazine features an interview with then Cosmopolitan magazine’s editor-in-chief, Kate White, in which she says:
We ran an article that pained me to run, but I felt it was important. It basically said the key time to try to get pregnant is between 25 and 35. There has been so much said about still waiting until you’re older, and I didn’t have my first kid until I was 37, but we’re taking a chance—you need to know it. (Zimmerman 2012)
The author (Edith Zimmerman) writes, “I asked her why it pained her.” White offered the following response: “I want every girl to feel that she can have her first child at 50 if she wants.”
Perspectives have changed and the popular media has played a big role in promoting these changed perspectives. White openly acknowledges the wish to let women think that they can have children at 50, but she also acknowledges that biology has not changed. The fact is that although many women want to become pregnant in their late 30s and early 40s, and shifting social norms support this, women’s eggs still age at the same pace. Although some women are able to conceive successful pregnancies with their own eggs into their early 40s, the fact remains that women experience declining fertility after age 35 and rapid drop-off after age 40.
Many women in the departure lounge of egg donation are in their late 30s and early 40s. They have come here from various places. Some have delayed childbearing while others have been struggling with infertility for a number of years. Along the way their eggs have aged and diminished ovarian reserve compounds their problems. Some were worried about fertility all along and had considered having a baby on their own or explored egg freezing. I (Ellen) recently had a client who was one of the first to electively freeze eggs five years ago. Sadly, when it came time to thaw them and attempt pregnancy, few survived the thaw and none of the resulting embryos led to an ongoing pregnancy.
Another group are women with secondary infertility. Some may have had a child or children years earlier and now find themselves wanting another. However they got here, women who arrive at the departure lounge of egg donation in their late 30s and early 40s feel they are racing against a biological clock that is ticking rapidly. Each month that passes weighs heavily upon them. They fear that the last good eggs are slipping away, and they worry that even if they do conceive, they will be prone to miscarriage. FSH numbers loom large, taking on a life and power of their own.
Women with diminished ovarian reserve are not in menopause. These are women whose egg quality is declining, but it is unlikely that all their “good” eggs are gone. While fertility starts to decrease significantly after the age of 35, it is impossible to predict exactly when this will happen for individual women or how long a woman’s eggs will actually last. Hence they face a dilemma in considering egg donation: if they move forward and conceive with donated eggs, they may miss out on that one last opportunity to have a baby with their own eggs. Such “miracle” conceptions could occur with IVF or spontaneously. Some of these women face this dilemma and conclude that it is more important to have a baby now than to hold out for the off chance they will conceive and carry with their own eggs. Others decide to hold off on pursuing egg donation, feeling that they need to exhaust any possibility of using their own eggs.
Age-related infertility
Late marriages, second marriages, no marriages or occasionally the death of a child prompt women in their mid to late 40s or older to seek pregnancy. Unlike the women with diminished or diminishing ovarian reserve, these women know that their eggs are no longer viable. Although this awareness brings profound feelings of loss for some, many are also relieved to learn that there remains a way for them to be pregnant and, for those who have a male partner, to have their husband/partner’s baby. They are happy to hear that their age does not adversely impact their chances of having a successful pregnancy with egg donation. It is true there are some pregnancy complications, such as pre-eclampsia and gestational diabetes that increase with age. However, older women who maintain a recommended body weight, are otherwise in good health and seek appropriate prenatal care should be able to anticipate healthy pregnancies.
Egg donation releases older women from the grip of the biological time clock. However, it does not free them from concerns about what it means to be older parents. Although they are youthful and energetic at 45 or 46, some are looking ahead and wondering how they will be at 68 or 70 when they have a child in college. They want to do right by their child and avoid being any older when their hoped-for child is born. For this reason, many choose to move as rapidly as they can with egg donation or to take a serious look at adoption.
Lost ovarian function due to surgery or illness
With advances in cancer treatment, increasing numbers of people are surviving at the expense of their fertility. Infertility after chemotherapy and/or radiation cannot always be accurately predicted. There are women who have aggressive treatment and who are later delighted to find that their menses return. They may go on to conceive and carry without difficulty. By contrast, there are others whose treatment damages their fertility. With chemotherapy, the common observation (a National Cancer Institute Alert, May 1988) has been that the greater the dose, the longer the duration of chemotherapy and the older the age of the woman at the time of treatment, the more likely the sacrifice of ovarian function.
The emerging field of “Oncofertility” is offering more options for both men and women facing cancer treatment. Increasingly, infertility clinics are developing programs to meet the needs of the ten percent of newly diagnosed cancer patients who are under the age of 45 (Rodrigues, Camp-Engelstein and Emanuel 2013). A woman likely to lose ovarian function may take a chance on egg freezing. If she is married or with a partner, she may undergo an IVF cycle, have her eggs inseminated with her husband or partner’s sperm and cryopreserved for future use. In addition, there are newer and more experimental options such as whole ovary cryopreservation and the freezing of ovarian tissue. For boys younger than reproductive age, and thus unable to cryopreserve semen, an option being investigated includes freezing testicular tissue. Oncofertility is becoming increasingly important as more and more young people are surviving cancer and going on to live full lives that include building families.
Cancer is not the only medical problem that causes a woman to lose her ovaries and/or her ovarian function. A woman may have a cyst that ruptures and causes her to lose an ovary. Or a ruptured ectopic pregnancy may result in surgery in which she loses both ovary and fallopian tube. While most women have two ovaries and one may remain after a medical and surgical emergency, there are instances in which a woman loses both ovaries.
Egg donation after surgery, chemotherapy or radiation is attractive to some women, but not to others. Those who find it most attractive tend to focus on its restorative capacity: here is a woman who has lost half of her reproductive function and who can now use the remaining half—her ability to carry—to bring a new life into the world. For a woman who has been ill, and who probably confronted her own mortality, the opportunity to plant two (or more) new feet on this earth is profoundly moving.
Why, then, would some survivors of illness or surgery be reluctant to pursue egg donation? Some say that it brings back painful memories of the illness that robbed them of their fertility. Until they face their desire to have a family, they had been moving on in their lives, moving away from the cancer. The prospect of being back in a medical setting, of having invasive tests and procedures and of having the constant reminder of their battle with cancer is painful. Others may avoid egg donation because they fear the reactions they may see or perceive in others. What if the physician suggests a delay of a year or two or three before pregnancy? This could frighten a woman into fearing that her physician is waiting to see if she will have a recurrence. Cancer survivors need to believe in their own futures and, for the most part, feel confident that others do as well.
Women born without ovaries or without ovarian function
Sometimes women are born without ovaries or without the capacity to produce eggs. We can easily imagine what the opportunity to carry a baby must mean to these women. In this regard, they may be traveling lighter than others considering egg donation. Although some will choose adoption, many will regard egg donation as a gift, one that enables them to use another part of their reproductive function. As we mentioned, women in this situation may face fewer decisions than those with other reasons for