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Egg freezing changing fertility treatments

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Posted at 10:43 AM, Oct 22, 2012
and last updated 2012-10-22 10:43:19-04

By Elizabeth Cohen, Senior Medical Correspondent

(CNN) — It seemed the fertility gods just were not with Debbie Vernon.

She and her husband started trying in 1999 to have a baby naturally — and they failed. Then they tried in vitro fertilization — and failed. By this time, Vernon was 45, and her eggs were kaput, so she used an egg donor. The doctors were enthusiastic — this young woman’s eggs had helped two other couples get pregnant — but they didn’t work for Vernon.

Vernon had to wait six months until another donor became available near her in the New York area. Then, at the very last minute, just as the second donor’s eggs were about to be harvested from her ovaries, doctors discovered she had endometriosis, and she was immediately disqualified.

“It was such a huge disappointment,” Vernon says.

Vernon (not her real name) found herself in a predicament. There aren’t enough donors to go around in big cities like New York, where there’s an abundance of women in their late 30s and 40s looking for eggs. Waits of up to a year are common, and Vernon didn’t want to wait that long — especially since her last two donors had been such failures.

That’s how the psychiatrist found herself becoming an egg pioneer of sorts: She went online to an egg bank to find donors from other cities who were willing to have their frozen eggs shipped to her doctor’s office at the Institute for Reproductive Medicine and Science at St. Barnabas in New Jersey.

She had some reservations about frozen compared with fresh, but she clicked through the various profiles, found a donor she liked, and put in her credit card number.

Today, most donor eggs are fresh, meaning the donor has to live near the infertile couple, or get flown in at great expense. But egg freezing technology has improved so much that in the past six months, two egg banks have started websites where patients can order frozen eggs and have them shipped, and many experts predict that in the not too distant future, nearly all donor eggs will be frozen.

Last week, the American Society for Reproductive Medicine took the “experimental” label off frozen eggs, which will likely help the industry grow even faster.

“It’s catalog shopping — that’s what it really is,” Vernon says of her experience on the frozen egg bank website. “I made my order and hoped it would work.”

An uncooperative donor

Several banks — including My Egg Bank, World Egg Bank and Donor Egg Bank USA — have websites where patients can order frozen eggs and have them shipped.

My Egg Bank, the one Vernon used, started shipping eggs commercially in June. So far, 43 patients have ordered eggs, and 27 have gotten pregnant, according to Dr. Daniel Shapiro, clinical director of the bank, which is based in Atlanta.

Patients must be treated at a clinic that’s affiliated with the bank. So far, My Egg Bank has shipped to patients at seven clinics — three in the New York area, and one each in Miami, Boston, Seattle, and Charleston, South Carolina — and 11 more clinics have signed up.

Patients usually buy one lot of six to eight eggs, costing $10,000, which is considerably less expensive than fresh eggs. Insurance usually doesn’t pay, although that may change for some patients now that the “experimental” label has been lifted.

Dr. Juergen Eisermann, a fertility specialist in Miami, says he’s a big fan of frozen eggs, because using fresh eggs is “never fun.”

Take this past Friday. He was explaining to an egg donor that her estrogen levels were perfect, and she needed to come in the next day to have her eggs harvested. They would then be fertilized and transferred to the uterus of another woman who’d been waiting a long time to become a mother.

“The donor said, ‘No, I can’t come in, because I’m going to Boston with a friend to the Head of the Charles Regatta.’ And I said, ‘Honey, I just put $4,000 worth of medicines in you that you didn’t pay for and the recipient has been waiting half a year for this, and you’re going to escape on the last day?’ I had to call the egg donor agency to lean on that lady, to read her the riot act, and finally she decided to stay,” he said.

Dealing with egg donors who want to fly off to boat races is just one of the wrinkles of using fresh eggs. First, doctors have to recruit the donors and screen them for medical and psychological problems. Then they have to use drugs to synchronize the donor’s and recipient’s menstrual cycles; if they get out of sync, the transfer can’t happen. Then problems can pop up at the last minute that are deal breakers, such as the endometriosis diagnosed in Vernon’s second donor.

With frozen eggs, the clinic opens the package, thaws and fertilizes.

Eisermann says his success rate with frozen eggs is about a third lower than with fresh, but the frozen egg success rate has gone up over time, and he thinks the rates will continue to get better with experience.

“You have no idea how much administrative time it saves us. It’s incredible,” says Eisermann, medical director of the South Florida Institute for Reproductive Medicine. “We want to convince more of our patients to do frozen.”

He’s set the prices accordingly. It costs $16,000 to buy and use frozen eggs, about $11,000 less than fresh. If the first round of in vitro fertilization doesn’t work, he does the next round for free if the eggs are frozen, but he charges if the eggs are fresh.

‘Is this child going to be a moron?’

When Vernon picked the genetic mother of her child, she had a lot of options: She could choose a woman who was short or tall, a blonde or a brunette, someone who loved animals or was athletic or spoke several languages. Using the site’s built-in filters, it didn’t take long to find her dream donor, who, like Vernon, was tall and white with green-blue eyes and — for her this was the most important part — had no family history of severe psychiatric illness or obesity.

Then she encountered yet another disappointment: In the time it took Vernon to click “select,” another woman had already picked her favorite donor.

“I missed it by like 10 minutes,” she says.

Vernon was forced to go with her second choice. Just to be sure — she is 47, after all — she spent another $10,000 for a second lot of the donor’s eggs.

Vernon doesn’t have buyer’s remorse, but she does worry about the woman whose eggs she chose. When she selected her fresh egg donors, a trusted doctor and psychologist at her own clinic had met each donor, and could give her a feel for what kind of person she was. What if the frozen egg donor lied to the egg bank? What if she really does have a family history of obesity or mental illness?

“Someone can look really good on paper, but when you sit in a room with them you find out they’re a disaster, a nightmare,” she said. “I’m absolutely not as confident as I was with the fresh donors. You sort of think, ‘Is this child going to be bright? Is this child going to be a moron? A giant? A sociopath?’ You just don’t really know what you’ve chosen.”

(My Egg Bank encourages patients to call and speak with a nurse in Atlanta who’s met the donors personally.)

A dozen frozen eggs were shipped from Atlanta to New York for Vernon. Eight survived the thaw, she says, and five were successfully fertilized and grown from embryos to blastocysts. Only four of the blastocysts were viable on the day they were to be transferred into Vernon’s uterus. Two were transferred.

She wanted to freeze the other two blastocysts, but they didn’t survive long enough to be frozen. She had no more left.

After 13 years of trying to have a baby, this really did feel like her last chance.

One of the blastocysts didn’t take, but the other one did. Debbie Vernon is now eight and a half weeks pregnant, full of both hope and fear for the baby she’s carrying.

“This bank is really a remarkable resource for women,” she says, despite her doubts. “Soon, I imagine frozen is all there’s going to be.”