Donor Eggs

Although I am a bit introverted and so is my wife, we occasionally venture out to parties and when people hear that I am a fertility doctor they often ask about the latest 63 year old or 67 year old who got pregnant. However, they all seem shocked to learn that the pregnancy was obtained with donor eggs. Human reproduction is very dependent upon the age of the female partner. This burden is not fair. It is not fair that Senator Thurman can father a child in his 80s but there you have it. Occasionally women in their late 40s will conceive and deliver but this is a rare event. The miscarriage rate for women over 40 years old with their own eggs is 50%. That is independent of how they conceived.

During medical school, one of my classmates, who was 35 years old and had children found out that her mother was pregnant spontaneously at age 55! We all ran to the Guinness Book of World Records only to discover that this was not even that close to the record of 57 years 120 days. So my classmate ended up with a baby brother 35 years younger than she was…poor kid (no offense Grace!).

So how about egg donation? Let’s spend the next few days reviewing aspects of egg donation. This topic is on my mind given the fact that I will be on Cable TV this afternoon (not sure when the segment actually airs) speaking about older women and pregnancy. I will let you know when the spot airs so someone besides my Mother can check out my new haircut. Meanwhile, here is the “Question of the Day” from the book that makes all other fertility books out of date…


81. Why does my reproductive endocrinologist think that I need to use an egg donor?


A woman is born with all of her eggs and is incapable of making more over the course of her lifetime. After the age of 30, her fertility begins to decline—markedly so after the age of 35. By age 40, most women will experience infertility.

Egg quality can be assessed, to a limited degree, by obtaining blood hormone levels for FSH and estradiol on cycle day 3. Elevations in either hormone suggest diminishing ovarian reserve. Another test for ovarian reserve is the clomiphene citrate challenge test (CCCT), a simple blood test that measures FSH and estradiol before and after the woman takes Clomid. Many reproductive endocrinologists perform an ovarian transvaginal ultrasound examination and a follicle count to further assess ovarian function. Often, the blood FSH, estradiol, and follicle counts are normal, yet the woman fails to respond to treatment. Thus normal hormone levels can be misleading—but abnormal levels usually suggest that an egg-related problem truly exists. When a woman’s eggs fail to respond adequately to treatment, when the woman has failed to conceive with previous attempts at IVF or other treatments, or when she has abnormal ovarian reserve, then IVF using donor eggs is an excellent option.

Since 1984, egg donation has been a cornerstone in treating patients whose eggs have deteriorated either through the normal aging process or because of disease. By using donated eggs from a woman in her twenties, the infertile patient essentially restores her fertility potential to that of her egg donor. Similarly, the miscarriage rate drops from more than 50% for patients older than age 40 to 10% to 12% with the use of donor eggs.

Egg donation has been used extensively in patients who are perimenopausal or even menopausal. Most clinics enforce an age restriction in terms of their egg-donor recipients, with the most common cut-off age being 50 years old. Unlike the eggs, the uterus does not age and remains receptive to implantation (as long as the endometrium is successfully prepared with hormones) well into a woman’s fifth and possibly sixth decades of life.