Ep 348: When to Consider Donor Eggs

0:00Dr. Carrie Bedient: You're listening to the Fertility Docs Uncensored Podcast, featuring insight on all things fertility from some of the top-rated doctors around America. Whether you're struggling to conceive or just planning for your future family, we're here to guide you every step of the way.

0:21Dr. Susan Hudson: This episode is brought to you by Receptiva DX. What if unexplained infertility isn't actually unexplained? For many women, hidden inflammation associated with endometriosis and other uterine conditions can go undetected for years, even when everything else appears normal. For more than a decade, Fertility specialists have trusted Receptiva DX to provide deeper insight into the uterine environment, helping women and their physicians uncover answers and make more informed treatment decisions. Hello, everyone. This is Dr. Susan Hudson from Texas Fertility Center with another episode of Fertility Docs Uncensored.

0:58Dr. Susan Hudson: I am here with my snazzy and sensational co-host, Dr. Keri Bediant from Fertility Center of Las Vegas. Hello.

1:07Dr. Carrie Bedient: How are you doing?

1:08Dr. Susan Hudson: Fantastic. I have a random question for you, Keri.

1:12Dr. Carrie Bedient: Uh-huh.

1:13Dr. Susan Hudson: When you go up to a soda freestyle machine...

1:17Dr. Carrie Bedient: Like the ones where you can push all the buttons.

1:19Dr. Susan Hudson: Yes. I think you're a button maniac, aren't you? I can neither confirm nor deny.

1:24Dr. Carrie Bedient: One of my favorite things about doing surgery at the hospital is that they have a freestyle machine because normally nobody in our house drinks soda. So we don't keep it around and it's more of a treat whenever we get it. And so, and the stuff that I tend to like besides your standard Coca-Cola, don't come for me, Pepsi people, but Coke or Dr. Pepper is cream soda. It's never worth me buying because I don't drink enough of it. But when I get a freestyle machine, I always go and get the cream soda. And then I have played with the different flavors. I have to admit, I'm not that impressed with, they've got peach, strawberry, vanilla, and I don't know, some other one.

2:01Dr. Carrie Bedient: And I usually get the vanilla mostly because I can't really taste the other ones. And I think they're kind of weird, even though normally I love peach everything, including peach rings, which are my road trip food of choice.

2:11Dr. Susan Hudson: We'll use the word food as a very wide and encompassing terminology road trip snack of choice that sounds better yeah yeah what do you like to drink when faced with one of these machines kind of a purist so i'm a coca-cola girl regular coke sugar caffeine normal sugar not cane sugar and i think cane sugar is fantastic but cane sugar actually makes me feel bad so regular plain old coke i love and then orange vanta is my other splurge feel like i'm doing something special because that's not something. I have the little bitty mini Coke cans at home for that random time that I want to have something at home.

2:55Dr. Susan Hudson: But the Orange Vanta is probably my biggest splurge.

2:58Dr. Carrie Bedient: Does it taste better if it's in a glass bottle?

3:00Dr. Susan Hudson: Actually, I prefer Coca-Cola in a can.

3:03Dr. Carrie Bedient: No.

3:04Dr. Susan Hudson: Yes. No. I mean, like fountain, can, plastic, glass bottle. But all the glass bottle stuff around here, we call it Mexican Coke. It's all from Mexico. And so it has the cane sugar. So I don't drink it because it makes me feel bad. I think I have a thing with essentially molasses and molasses is what makes brown sugar brown. So I'm pretty sure it's the same thing that makes cane sugar brown. It hasn't been extracted and it just doesn't agree with me. It makes my tummy me upset. Okay. Well, that will never do. I know. I know. All right. Well, let's do a question today. Yes. So our question for today is, hi, my husband and I are both 39 years old and we have been trying for about a year.

3:48Dr. Susan Hudson: We started seeing a RE and recently did a cycle of IUI with Femara, gonal F, and an Ovidral trigger. My ultrasound the day before trigger showed four follicles greater than 16. My husband had a testicle removed as a teenager due to an undescended testicle. His semen analysis showed low motility, 32 % and low volume. My AMH is 0.94 with an FSH of 8 and estradiol of 22. I also have a grapefruit-sized fundal submucosal fibroid. Would I be more successful with a myomectomy and then IVF? I'm worried we are wasting time. That question has six layers to it. It does. It does. Why don't you start with a layer and we'll go from there.

4:29Dr. Carrie Bedient: So the clearest cut layer is her actual question, which is, would I be more successful with a myomectomy and IBF? And the answer is yes, you're going to be more successful with IBF. And that's independent of virtually everything else because there are very few patients where that is not the correct answer. But the shade or the flavor of that question is, will the myomectomy make a difference? And I think grapefruit size in part depends on if you're talking about Arizona, Texas, Florida, or I don't know, Northern Canadian grapefruits because size is relative. Centimeters matter. But let's assume that this is at least 8 to 10 centimeters and that it's a good size.

5:13Dr. Carrie Bedient: There are some fundal fibroids that aren't really going to make an impact. They don't push into the cavity.

5:19Dr. Susan Hudson: I want to make the point that she said submucosal and I'm betting she actually meant subserosal because otherwise it would have been taken out.

5:29Dr. Carrie Bedient: Yeah. Let's talk a little bit about the geography of fibroids. So with fibroids, you can have them submucosal, which is distinctly in the cavity. Those got to go. You can have subserosal, which is distinctly on the outside of the uterus, which we've got way more leeway for those. And then you've got the intramural, which are the ones that are in the wall of the uterus. And for those size, location, all of those things make a huge difference. Whether or not this is a true submucosal or subserosal fibroid makes a huge difference because subserosal, that usually doesn't impact the cavity. And if you're having symptoms from it, like mass effect where you're having to pee every two and a half seconds or you're having pain, absolutely get it taken out.

6:13Dr. Carrie Bedient: But if it's just there and you don't necessarily notice it, those don't always have to come out. That's very worth an in-depth discussion with your RE about how much impact is this going to have? And how much impact will the usually six-month delay from having a myomectomy, how much impact is that going to cause? Because all of those questions about real estate location for the fibroid have a really big impact. And this is an oversimplification. there are fibroids that blend into multiple spaces all at once. And those, of course, have different shades of these answers. That's at least part of this discussion.

6:53Dr. Susan Hudson: Absolutely. So the important thing is know exactly where the fibroid is. If it's interfering with the lining of the cavity, then it needs to be taken out. If it's not interfering with the lining of the cavity and you're not having other bothersome symptoms, it's really not clearly indicated that you have to have it taken out. And if you did have that big of a fibroid removed, then you would pretty much have to have a C-section whenever you do have your baby. So that's something else to keep in mind. Now realize being 39, being pregnant, you're at a high risk of C-section anyway, just because your body's not quite as flexible as it used to be.

7:31Dr. Susan Hudson: But if you have a big myomectomy, then your doctor's going to be like, we're scheduling that C-section. There's not going to be a trial of labor. I agree that whether you try IVF or not, age and time are important. And some of it also has to do with how big a family you want to have. If you're wanting to potentially have more than one child at this point, probably doing IVF with embryo banking for you to create embryos now to use in the future would probably be very worth your while. Some people are like, you know what, we're just going to take one at a time and whatever happens, happens. If that's the case, then IUI is probably a reasonable thing.

8:08Dr. Carrie Bedient: With respect to his sperm count, you had mentioned about a 32 % motility. Having more details on that can be helpful because for the motility, you've got your Olympic swimmers, you've got your Sunday afternoon meandering walkers, and then you've got your couch potatoes that are just twitching lightly. All three of those count as motile sperm, but there's a very different effect. You really want the Olympians there because the others are not necessarily going to get you where you want to be. And so the rapidly progressive motility is going to play a part in that. Also, when the sperm is prepped for an IUI, there's going to be a lot that's washed away.

8:44Dr. Carrie Bedient: And that's intentional because they're trying to get rid of all of the non-swimmers. But sometimes that is very illuminating because you get that final count and you're expecting a total modal count of whatever, several millions, and then you get there and you find out this is a lot lower than you anticipated. And that's revealing too. And that's another good reason to jump to IVF a little bit faster if when push comes to shove and the sperm are tested, they just, they don't go as far. Totally agree. Totally agree.

9:10Dr. Susan Hudson: All right. Well, today we are going to talk a little bit about donor eggs. What are donor eggs? And when should somebody start considering looking at that as an option? Now, I am going to put a little caveat into this conversation. There is never going to be a never or always in what we're talking about today. There is always going to be an exception to the rule, and that's kind of the way that this part of fertility care works. But also know that we are going to talk about what is going to be beneficial in the greatest majority of situations in these specific circumstances. Is that fair, Carrie?

9:53Dr. Carrie Bedient: Totally fair. And that's true really of just about everything we say is that rules were made to think about before you break them. And that is the way that I live my life. I think it's very helpful in medicine because, yes, there are general principles where no, you would never do X, Y, or Z. But if that particular patient's case really does merit that, then you do the unexpected. That's true of pretty much everything we talk about.

10:18Dr. Susan Hudson: All right. So first of all, let's talk a little bit about what are some of the differences in donor egg options. And then we'll talk about essentially what are things you know, not know, and who are the people who probably benefit the most from considering things like donor egg. So when we first start talking about donor eggs, these are eggs from another woman, not the intended parent that is a female partner. Okay. So when we look at that, we generally first have a discussion of known donors versus de-identified donors. Carrie, can we talk about that and what are those differences?

11:06Dr. Carrie Bedient: So there's different flavors of known and de-identified. So the most obvious form of known is someone who is your sister, your friend, a person in your life somehow who is going to donate these eggs. And you typically have a pre-existing relationship with them. And oftentimes they're doing it because they love you to pieces. And that's what a lot of us think of with a known donation. A known donation can also be a donation where there's just a very clear exchange of information. With known donations, oftentimes that exchange happens through the lawyers, and it means that everybody has everyone else's names and basic identifying information and phone number address, some way to communicate.

11:50Dr. Carrie Bedient: And what that allows for is a communication to happen later on after the initial donation is done, whether that's on behalf of the child, whether that's because new information has been found out by either side of the equation. That also counts as a known donation, but it feels a little bit different than someone who is maybe your best friend from growing up versus someone you just haven't really met, but you know what her name and birth date is. Then you've got your de-identified. De-identified donations are what we used to call anonymous. And anonymous is clearly a pipe dream at this point, because with a little bit of inventive sleuthing with the internet, with things like 23andMe and Ancestry.com and whatever the next version of those is going to be, anonymity is a complete and utter fantasy.

12:42Dr. Carrie Bedient: It doesn't exist. And I have heard of cases where someone has found out their donor is a D1 soccer star in a Midwestern college and is six feet tall with blonde hair and blue eyes, and they have figured it out from that information. And so de-identified is mostly just that there's no obvious exchange of that information. And I know whenever I'm counseling one of my donors, I tell them an amenity is no longer reality. Oftentimes, we don't necessarily want that for the kid's sake later on, but that thinking has changed quite a bit over the years.

13:19Dr. Susan Hudson: Does the popularity of de-identified versus known donors vary throughout the world?

13:25Dr. Carrie Bedient: That is a fascinating question. And there are as many answers as there are countries. And there are many places in the world where a donation just is not allowed, period, end of story. There are countries like the United States where there's really a wide range of what information you're allowed to have. Even with a de-identified donor in the United States, you are still typically seeing photographs. You are seeing information about all of her demographics. Did she go to college? What are her interests? What's her favorite movie? What is her family history and her medical history? And on and on and on.

14:01Dr. Carrie Bedient: And when you're choosing a donor, you get really quite a lot of information. There are many other countries where you are either not allowed to have any other information and it's the clinic that picks for you. So they may see, okay, you are 5 '4 with brown eyes and brown hair and have this general skin tone. So therefore we are going to pick this donor because she is the most similar to you. And so there are a lot of places in the world where you don't get any sort of choice and the clinic completely chooses for you. And that can be applied to both egg and sperm donors. There are other places where the only way that you can get a donation is with a known donor and you bring somebody in who's willing to donate for you.

14:43Dr. Carrie Bedient: There's quite a bit of variety. The United States is, I would say, the most forthcoming in additional information about donors.

14:50Dr. Susan Hudson: So when we're talking about the information that's generally available for an egg donor, you are going to know things like age, height, weight, hair color, eye color, ethnic background, family history, medical history, interests, education. if there's something specific that you want to know oftentimes you can ask and whether it's an agency or your clinic whoever is the intermediary can often find out some things one time i had somebody who wanted to know the the woman's shoe size because that was important to them and it was like okay well that's a that's a pretty reasonable thing to ask somebody but it's something that always kind of kept in my mind.

15:37Dr. Susan Hudson: When we're also talking about egg donors, sometimes people have what we call fresh egg donation programs versus we have frozen egg donation programs. And this is either with donors that are being chosen through your clinic or an agency or something of that sort. If we're talking about a fresh egg donor cycle, what does that look like?

16:00Dr. Carrie Bedient: Fresh egg donor cycles are going through IVF essentially from the beginning. So with the donor, she needs to be medically screened. And we'll talk about that in a minute. But after she is screened, when she gets her period, we then have her start the medications just like anybody would in any IVF cycle. So you have to build in the time that it takes for the two weeks of stimulation and the retrieval. And then once those eggs come out, at that point, they're used and typically inseminated with whatever sperm it is we're using for that particular set of intended parents. The biggest advantage of fresh cycles is exactly what it sounds like.

16:37Dr. Carrie Bedient: Those eggs are fresh, they do not get frozen, and there's a direct insemination that occurs typically the day of the retrieval. It's an immediate, they have sperm ready and available that day, whether it's from a fresh collection or a previously frozen specimen, and they create the embryos right off the bat.

16:52Dr. Susan Hudson: So if somebody is looking at using frozen eggs or cryopreserved eggs, these are eggs that have already been retrieved from an egg donor. Those eggs essentially go through a process called vitrification, which is where we dehydrate and quick freeze the eggs. And then these eggs are preserved in what we call lots. So generally, when you're wanting to acquire donor eggs, you want to get at least six eggs. I don't ever recommend somebody getting less than six eggs because it does take more frozen eggs to yield an embryo as compared to a fresh egg. However, once you get to the embryo stage, it doesn't really matter if it came from a fresh or frozen embryo.

17:42Dr. Susan Hudson: So you purchase a certain number of eggs. Some of it has to do with your budget. Some of it has to do with what family size you're wanting to have. Sometimes it depends on what your insurance coverage is. And those eggs are usually shipped to your clinic. The eggs are then warmed. And then ICSI, where we inject the best looking sperm into each egg with the sperm of choice, is performed. And then the rest of the embryology story is the same as the fresh egg story. When we're looking at fresh versus frozen eggs, are there other things that people need to think about?

18:25Dr. Carrie Bedient: Yes, there are definitely things that people need to think about when they're making that fresh versus frozen decision. and one of the biggest things is how many embryos they're likely to need at the end of the day to achieve their family. And some of this is straight up, how many kids do you want? Someone who wants only one child is very different than a couple or a person that does want four kids, for example. The other thing that plays into this is what other factors are we dealing with, infertility or otherwise? The biggest thing that shows up in this is when someone needs PGTM because with PGTM, you are oftentimes losing a large percentage of those embryos to whatever genetic condition it is that we're trying to identify and avoid.

19:09Dr. Susan Hudson: Let's play a game. How many tabs do you have open right now about IVF? One says your chances are great. Another says they're terrible. Reddit has one opinion. TikTok has another. Facebook is full of horror stories. And somehow, after two hours of searching, you have more questions than answers. Sound familiar? That's exactly why we wrote the IVF Blueprint. This isn't another fertility book filled with opinions or miracle cures. It's an evidence-based guide that walks you through every stage of IVF, from understanding your fertility evaluation and choosing a treatment plan, to medications, egg retrieval, embryos, genetic testing, transfers, and the two-week wait, and beyond.

19:52Dr. Susan Hudson: because the last thing you need during IVF is more noise. Close the tabs, put down your phone, open the IVF blueprint instead. Available now wherever books are sold.

20:07Dr. Susan Hudson: So what is the difference between PGTA and PGTA?

20:12Dr. Carrie Bedient: PGTA is something you can do on anybody's embryos anywhere, anytime. It's identifying, do you have 46 chromosomes, no more or less? That is something you don't need any pre-existing testing for. For PGTM, that is much more specific. And what that is looking for is a condition that one or both partners carry or are affected by that we're trying to avoid passing on in a child. So a really common example of this is BRCA, the breast cancer-causing genes, because if someone carries a breast cancer-causing gene, there is a 50 % chance that that will get passed on to a child, and then that child will be affected with those hereditary forms of cancer.

20:53Dr. Carrie Bedient: We have patients very frequently who come in who say, look, I really don't want to pass this on to my child. And as a result, we need to screen for that in the resulting embryos. There's other stuff that applies to this as well. There's about as many genes as you can come up with names for. But when we know that we have to do PGTM and someone has identified, I need to make these probes, I need to select out for this, that means we are going to lose a larger percentage of the embryos than we otherwise might from a donor. And it means we probably want more eggs to start with. Because there's always, even with a donor, there's some aneuploidy, so an abnormal number of chromosomes, that's going to occur just from straight up random accident because the body is careful but not that careful.

21:42Dr. Susan Hudson: Very good. Very good. All right, before we kind of get to the meat of the matter, when we're talking about people who are going to be donors, what are some of the testing and qualifications that they generally need to pass?

21:57Dr. Carrie Bedient: Age is a big factor. You have to be at least 21. Most places don't want donors over somewhere between 30 and 33. There's a variation in the guidelines. Exceptions can be made to that for specific circumstances. For example, if someone really wants their sister to donate for them and she's outside that age range, we'll go through the testing, we'll counsel appropriately, but that's a situation where we would make an exception. She needs to be healthy. She can't have any blood pressure, diabetes, autoimmune conditions, clotting conditions, even if those things are really well controlled, doesn't matter because this is an elective procedure and we're not going to do anything to put her at higher risk.

22:37Dr. Carrie Bedient: And so those are very quick reasons for disqualification as are certain genetic conditions. We're not worried if she just carries a single copy of some random trait that requires multiple copies to cause a problem. But if she carries something that is a known issue like BRCA, like any other autosomal dominant condition where it just takes one gene to cause a problem, that would be a reason for disqualification as well. Certain family histories that even suggest genetic conditions, like someone who's got a heavy cancer history in their family, someone who has a heavy history of alcoholism or substance abuse or mental health disorders, other physical disorders, autoimmune conditions, most of those things have some element of a genetic component to them.

23:23Dr. Carrie Bedient: And a lot of what our job is, is to figure out what risks are reasonable and what are probably too much. So we spend an awful lot of time going through her history and her whole family's history. What most clinics functionally end up doing is you've got the donor who goes through that history once when she's writing down all of the information for her application, another time when she's talking to the intake coordinator, another time when she talks to the fertility doc, another time when she talks to the psychologist, and another time when she talks to the genetic counselor. So there's usually at least four or five iterations of asking these same sets of questions to help jog people's memories, help make sure that stories are consistent and to figure it out.

24:00Dr. Susan Hudson: Absolutely. A lot of times people are like, well, how do you know what they're telling you is the truth? Well, a lot of it is we keep on asking them over and over and over and consistency is key. I can say that in most egg donation programs, people who volunteer and would like to be selected generally 1 to 2 percent of the people who are screened actually get to be egg donors. So it's a pretty tight funnel. And if anything seems off, people aren't included in those processes. Well, let's talk a little bit about who can benefit from using donor eggs. Nobody sits back when they're 12 years old and imagines their family of the future and they're like, you know what?

24:44Dr. Susan Hudson: I'm going to use donor eggs. Using donor eggs is never the situation somebody wants to be in. And we completely recognize that. But also know that using donor eggs, donor sperm, gestational carriers, those are very, very personal decisions. And the right decision is the one that is right for you. And also note that it's okay to change your mind. We've all had patients who came in to see us and they're like, I am never going to use an egg donor. And that's fine. That's a very personal decision. And sometimes over the course of people's infertility journey, that perspective can change. Now, who are some of the most common people who choose to use egg donors?

25:30Dr. Carrie Bedient: I would say the two most common groups of people using egg donors that I see are, number one, women who are 45 years of age or older because their ability to use their own eggs is severely limited by both number and quality. And while it can happen, it is far less likely to be happening. And when you look at the constraints of time and money and life plans and all of those things, that is probably the number one group of people who end up using donor eggs. The other slam dunk have to use donor eggs. And this is one of the few, there's really no ways around this one are male couples or single males because they don't happen to own any of that biology for themselves.

26:12Dr. Carrie Bedient: They need the contribution of somebody else to that. So I would say those are the two slam dunk categories that far and away make up the group of people that we see using donor eggs.

26:21Dr. Susan Hudson: And I would say other people who strongly consider donor eggs are people who have evidence of what we call severe diminished ovarian reserve. So that diagnosis, meaning your ovaries are not functioning well, can be diagnosed a number of different ways. There are some blood tests. So the AMH test, which gives us a good idea of quantity. FSH and estradiol, that gives us some idea of quality, age in general. So even though Carrie talked about people who are 45 and up, we know that people who are 41, 42, 43, 44, or maybe even younger, but with hormone levels that don't look reassuring can be in that situation.

27:11Dr. Susan Hudson: And then people who have been through fertility treatments that have failed and we feel relatively sure that the primary cause of the failure has been egg quality and quantity. Sometimes people go through IUI cycles or they do IVF cycles and we just never can get where we need to be and we know where we should be and we're like it looks like an egg issue.

27:39Dr. Carrie Bedient: There are also conditions where the genetics play into this So, for example, you might have someone who's got slightly lower than average ovarian reserve, but not enough to really force everyone's hand into having to consider donor egg more heavily. But let's say you've got that condition and you've got some sort of dominant trait that we have to avoid in order to help keep kiddo healthy. Those are other situations where patients will sometimes say, screw it. I don't want to mess with this. I don't want to have to go through two, three, four, however many cycles it's going to take me to get the embryo that has the correct number of chromosomes and doesn't have the gene that we're trying to select against.

28:20Dr. Carrie Bedient: And everything falls into place. So sometimes they will just say, screw it. I'm not messing with this. I'm just going straight to a donor. That's very fair.

28:28Dr. Susan Hudson: Sometimes people have genetic traits like they have a fragile X pre-mutation. So on the X chromosome, there's a little area that is coded in what we call CGG repeats. So just like computers are coded in zeros and ones, humans are coded in A's, T's, G's, and C's. And this little area of CGG repeats is supposed to be a little area. Well, it can expand through generations. And once it gets to a certain level with some other genetic things going on that I'm not going to dive into this moment, it can expand into something called Fragile X syndrome, which is the most common inherited form of mental developmental disability.

29:15Dr. Susan Hudson: And so this can be pretty substantial and life-altering, especially for baby boys that are born with this condition. even though fragile X itself has a predisposition towards diminished ovarian reserve, that and knowing that there can be expansion sometimes lends itself to being chosen for going down the path of donor egg.

29:40Dr. Carrie Bedient: Another genetic condition that plays in more often than we might like it to is Turner syndrome. And this is a condition where normally females have 46 chromosomes, two of which are Xs, and males have 46. One is an X and one is a Y. Well, in Turner syndrome, those patients only have 45 chromosomes. They're missing one of their Xs. And the body tends not to tolerate missing chromosomes terribly well. The reason that we can get by with one X is because the other one is totally picking up the slack. But one area where it does not tend to pick up the slap terribly well is in the ovaries. And so those patients have premature ovarian failure or insufficiency where their ovaries in some cases never work and they're in menopause before they ever start.

30:30Dr. Carrie Bedient: And there are some cases where they may have periods for a few years and then it tapers off. There are mosaic conditions where some of their cells have turners and other cells are normal. And in those conditions, they can seem like they're going through life very normally. And it's not until you get into fertility treatment and more in-depth evaluation that you find out some of these cells are not what we thought they were. And it has an impact on your egg quantity and quality.

30:54Dr. Susan Hudson: So anybody with what we call premature ovarian insufficiency used to be called premature ovarian failure. We call it insufficiency because we know nothing is absolute. And with people who have POI, there is about a 9 % lifetime chance of conceiving. That's going to vary a lot depending on ages, the reason why someone may have POI. Turner syndrome is one of the reasons. Having fragile X premutation can be a reason. Sometimes there are other genetic things like galactosemia that can lead to that. But there's lots of times that this happens and there's not a definitive genetic reason. But just because the ovaries aren't working and we know that the likelihood of conceiving, even with all of our bells and whistles, with the most aggressive treatments we can do, sometimes it's that chance is very small.

31:49Dr. Susan Hudson: And people are like, you know what, if I'm going to spend this much money on something like IVF, I'm going to look at something that's going to raise my chances of success to a level that I'm comfortable with. How would you compare the cost of using donor eggs and IVF as compared to doing what we call an autologous or own egg retrieval and embryology fees and all those types of things? How do those things balance out in a lot of circumstances?

32:21Dr. Carrie Bedient: It really depends on what lenses you're looking through it at. And so for many patients, they will get a quote for autologous IVF using their own eggs, and they'll get a quote for donor eggs. And between those two, donor eggs are always going going to be more expensive. But when you are looking at it with what is our end goal, which is to have a child, those can be drastically different. Because typically, if you're also getting the quote for donor egg, you've probably had the discussion with your doc of, hey, this is going to probably require multiple attempts. And there is a very real chance we will get to the end of multiple attempts and still not have what you want.

32:55Dr. Carrie Bedient: In which case, you're not looking at one cycle versus one cycle. You're looking at maybe two, three, four, five autologous cycles compared to one donor cycle. And in many cases, it's that many autologous cycles plus the cost of the donor cycle at the end of the day. Not always, but oftentimes going the donor I grow out is more cost-effective because you're more likely to be one and done.

33:16Dr. Susan Hudson: And I'd like to say that if you consider everything in your autologous cycle, including medications, if you have diminished ovarian reserve, in that circumstance, it's often going to be a wash. Because if you're sitting there and spending$6 ,000,$8 ,000,$10 ,000,$12 ,000 on medications on top of all the fees for your actual IVF cycle, a lot of times it actually ends up being very, very similar. What are other things that you think are important when we're thinking about using donor eggs?

33:49Dr. Carrie Bedient: One of the things that's really important when thinking about using donor eggs, and of course this goes without saying, is what is your comfort level with it? Because there are some people who are exceptionally comfortable with it, and there are others who are not at all and everything in between. And sometimes it's not just a question of, are you comfortable with it? It's how will that fit into your entire family dynamic? You, your partner, extended family, who knows, who doesn't, who is going to be told and when. The recommendation at this point is to tell children that they were conceived by donor eggs when it's age appropriate.

34:22Dr. Carrie Bedient: And age appropriate usually doesn't mean on their 21st birthday where you're dropping bombs, you're having shots and you're dropping bombs. That's not the time to do that. The time to do it is much earlier in life where it can just be built into the normal fabric of their lives. And it's not anything unusual at all, but it is very helpful if you're on the same page with your partner, you know, plus or minus your family as to who gets told and who doesn't, because oftentimes that information will come out one way or the other. And so making sure that you've got that plan in place from the beginning is important.

34:58Dr. Carrie Bedient: Oftentimes people need to try autologous cycles before they do a donor cycle. Even when we tell them, hey, the likelihood for this is 1%, they need to do it because they need to know that they tried. And that is a valid reason to do it. But you need to know what your likelihood of success is going into that.

35:15Dr. Susan Hudson: One thing also I'd like to mention is that we talk about disclosure, non-disclosure how do you tell who do you tell when do you tell know that in the United States the American Society of Reproductive Medicine does recommend that all people who are involved in either side of donor egg type of cycles that they visit with a counselor and discuss all of those things so don't feel if you're listening to this podcast don't feel like oh my goodness I have no idea how I would handle those conversations. There are people who specialize in this who are willing to talk to you. There's lots of books. There's lots of resources.

35:56Dr. Susan Hudson: There's child-appropriate books and resources to help guide you through this. A lot of that data comes from the data that we have from people who were adopted back in the last century and knowing how growing up and knowing this is just part of my identity and it's just part of who I am versus my goodness at this whatever critical age whether it's 21 or 10 that those things they have implications and it's not to say that one formula is exactly right for one person or the other but especially in 2026 where we have AI and all these other different mechanisms out there. Really knowing that this is part of a child's story and that they need to know their story is very essential for success.

36:47Dr. Susan Hudson: Exactly. I agree with all of that. Okay. Well, I think we've talked a lot about donor egg, given a little preview as to what's involved and also who should start thinking about it, because it may help you get to your goal. And again, it's the right thing for some people. It's not the right thing for others. And you're going to know what's the right thing for you. All right. Thank you so much for spending a part of your day with us.

37:11Dr. Carrie Bedient: If you enjoyed this episode, subscribe, leave us a review. Really please. It helps us immensely and it helps the algorithm and all of the technical words. We appreciate that. Send us your questions at fertilitydocsuncensored.com.

37:23Dr. Susan Hudson: And if you want even more fertility information, pick up a copy of the IVF Blueprint, our practical guide to understanding fertility treatment, IVF, and the decisions you'll face along the way. And there are special chapters all about donor eggs, donor embryos, all that kind of good stuff.

37:39Dr. Carrie Bedient: Before we go, remember this podcast is for education and entertainment only.

37:42Dr. Susan Hudson: While we are fertility doctors, we are not your fertility doctors.

37:46Dr. Carrie Bedient: Nothing we discuss should replace medical advice from your own physician who knows your individual story and circumstances.

37:51Dr. Susan Hudson: Thank you so much for listening. Bye.

37:57Dr. Susan Hudson: This podcast is sponsored by Receptiva DX. When fertility questions remain unanswered, Receptiva DX helps reveal why. Trusted by fertility specialists for over a decade, Receptiva DX identifies inflammatory changes in the uterine lining associated with endometriosis and other conditions that may interfere with implantation and pregnancy. From unexplained infertility, recurrent pregnancy loss, or simply undiagnosed pain, Receptiva DX helps women and their physicians make more informed treatment decisions and move forward with confidence.