When Do Egg Donation and Gestational Surrogacy Make Sense?

December 6, 2005 - Tuesday
1:35 PM to 2:35 PM (EST)
Guest Speakers: Shaun C. Williams, MD Connecticut Fertility Associates

Categories
Donor Egg • Egg Donation • Endometriosis • Gestational Carrier • Infertility • IVF • Surrogacy • Third Party Reproduction

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deb_capone	Welcome, Dr. Williams. We are thrilled to have you with us.
ShaunWilliamsMD	Good Evening. I'm very happy to be here tonight, and I hope this can be informative and helpful for all those here.
deb_capone	We are going to wait a few more minutes until the clock strikes 8 to begin.
deb_capone	In the meantime, welcome to Kat_1569, mega2002 and milena_ohara!
kat_1569	Good evening all
deb_capone	I hope some of you are warmer than we are here in the northeast!
milena_ohara	It's pretty cold here in California...60.
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deb_capone	welcome Shelia!
kat_1569	Had snow here in NY
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deb_capone	and Milena...I don't feel sorry for you...it is well below freezing here
milena_ohara	I understand! ::smile
ShaunWilliamsMD	I am originally from Texas, so 60 is fairly cold in my opinion, but I've become used to the Connecticut winter quickly!
deb_capone	Ok, Ladies and Gentlemen, let's get started. Tonight we are going to be discussing when egg donation and gestational surrogacy make sense.
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deb_capone	Welcome Shimrit and pam and Shelia
ShaunWilliamsMD	Our topic tonight involves some specialized treatments, but egg donation is very common and routine in most centers.
ShaunWilliamsMD	Gestational carriers and surrogacy are more uncommon and not offerred in some centers or areas.
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ShaunWilliamsMD	Welcome kisochka.
deb_capone	Ideally pregnancy can be established using one's own eggs or partner's sperm in one's own uterus but as many of you know this ideal situation is not always possible. Fortunately, 3rd Party options can make the impossible possible.
kisochka	I am for the first time. How does this work?
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ShaunWilliamsMD	I'm here to help answer any question you may have pertaining somehow to the topic...
deb_capone	Dr. WIlliams, kisochka wants to know if FSH levels play an important role in determining if her eggs are good.
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Linda	How do I find a center that do both Linda
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kat_1569	Is surrogacy permitted in NY?
ShaunWilliamsMD	FSH levels can help us understand how well the ovaries are functioning, and what the overall quality of the eggs are.
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deb_capone	Good evening, and welcome to tonight's Online Education Session. I am Deb Capone and I will be your moderator tonight. If you need to speak with me privately, you can double click on my name in the box on the left. Tonight we are fortunate to have with us, Dr. Shaun Williams from Connecticut Fertility Associates. We will be discussing when egg donation and gestational surrogacy make sense.
ShaunWilliamsMD	FSH levels can be tricky, and we don't know exactly why the FSH levels are elevated, but this hormone does rise in ALL women the closer one gets to the menopause.
milena_ohara	Excuse me for answering, but our law offices work with many centers that do both surrogacy and egg donation, most of which are in California. Unfortunately, surrogacy is illegal, for the most part, in NY.
kat_1569	Thank you
ShaunWilliamsMD	Surrogacy is only illegal in NY if there is an exchange of money...sisters and family members can take part.
pam	how many ivf cycles do you recommend before moving on to egg donor? I had one neg IVF and one etopic.
pam	My hormone levels are normal but I am 37 and my embroys dont make it to freeze. they arent great quality.
pam	I got 4 good ones out of 23
ShaunWilliamsMD	There is no limit to any of our treatments, but many things that occur during a treatment cycle can help guide the next steps.
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ShaunWilliamsMD	Important things would include egg production during IVF, embryo quality, and medications needed.
shimrit	After 4 unsuccesful IVFs my doctor suggest considering sperm/egg donor. according to him since the infertility cause is unknown it make sense to begin with a sperm donor than if needed consider egg donor. We told him we weren't ready at that time to consider such option. We since then switched doctors and are know about to begin a cycle. I was wondering, was he right suggesting to consider sperm donor when my husband has sperm?
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ShaunWilliamsMD	Some individuals may be offerred egg donation earlier, if the results of prior treatments are poor, but for some, tryin gwith one's own eggs again ca be successful.
ShaunWilliamsMD	Shimrit--again it may depend on the characteristics of the unsuccessful cycles. It is uncommon to have embryo quality problems stemming from sperm abnormalities, whereas egg quality issues definitely play an important role in embryo quality and IVF success.
kisochka	What are the chances of successful surrogacy with egg donnor?
lorimeyers	Assuming there are NOT age-factor infertility issues presented, how many attempts do you yourself think is reasonable before recommending egg donation? Four full IVF's seem like a lot, though I realize it may depend on the outcome of the IVF cycles. I'm assuming 4 IVF cycles yielded quite a few transfer attempts.
ShaunWilliamsMD	Kisochka, many reproductive medicine centers have a donor program 'in house', but some rely on national or local donor agencies to match women with donors.
shimrit	the embryos didn;t develop more than 4 cells and my doctor considered egg quality and suggested relxation, yoga etc. I strongly disagreed and that is one of the reasons i switched docs
ShaunWilliamsMD	Many centers only use donors that they screen and recruit, but most are open to using donors that are matched through agencies, as long as there is a familiarity with the agency and the screening process used is approved.
kisochka	Is is possible that my FSH level is high and I still can conceive?
megan2002	Doctor Williams, I am 37 and have history of endometriosis. Except endo, my dh I passed all other infertility check ups (day 3 hormone, SA, HSG, chromosomal analysis, APA, hystoscopy etc). This year I had 2 failed fresh ivfs in a "top" clinic. The RE there asked me to try gestational carrier on my 3rd ivf to see if I have a "bad" uterus. If GS does not work, that means I have "bad" eggs and then I should try DE on 4th. Do you think his suggestions make sense? I am a good responder (14-28 eggs/
ShaunWilliamsMD	Kisochka, we achieve higher success rates when we use donor eggs compared to convential IVF cycles--most centers maintaint success rates in the 50-70% range for egg donor cycles.
yola	How many IVF cycles so you recomend before moving to egg donor? Iam 43 2 neg. IVF egg production as ok bu egg quality not so good from 9 eggs only 2 o3 good quality embrios
ShaunWilliamsMD	Shimrit, consistently poor embryo quality can be a sign of poor quality eggs. That is one of the factors I consider when making the reccomedation to proceed to egg donation.
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HRW	Hello. I just logged on so I missed any intro you might have given at the beginning...I am a forty years old and have a daughter who is just turning four. We had absolutely no problem concieving or having her. We have been trying on our own to conceieve without success so I recently went to a specialist and had the clonid challenge test. It truns out that my day 3 FSH was 32 and my day 10 was in the 40s. My inhibin B was very low as well. Based on this, the Dr. seemed to think that our onl
deb_capone	Good evening, and welcome to tonight's Online Education Session. I am Deb Capone and I will be your moderator tonight. If you need to speak with me privately, you can double click on my name in the box on the left. Tonight we are fortunate to have with us, Dr. Shaun Williams from Connecticut Fertility Associates. We will be discussing when egg donation and gestational surrogacy make sense.
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ShaunWilliamsMD	Kisochka, there is no FSH level above which you just can't get pregnant, but as this level elevates the likelihood of pregnany diminishes significantly, and we are limited in our ability to overcome egg quality issues---except through the use of donor eggs.
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ShaunWilliamsMD	Megan2002,
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kisochka	What is the highest number of FSH level that equates to bad eggs
deb_capone	We are so grateful to Dr. Williams for joining us tonight.
deb_capone	If you aren't already a "No Barriers" member of The American Fertility Assoc, you can register for free at www.theafa.org!
ShaunWilliamsMD	Megan, endometriosis is tricky. We used to believe that we could overcome all effects of endometriosis by proceeding with IVF, but we now know that endometriosis within the pelvis can cause changes within the linig of the uterus, possibly impairing the ability of an embryo to implant. This is an aspect of the process that we cannot study very well or provide much insight; we do consider the possibility of an implantation disorder in women who have good responses during an IVF cycle, but still ar
starr	hi doctor williams, i am 34 and have pcos, had 2 ivfs done, unsuccessful-poor egg quality, how can i know that egg donation will work- what else can go wrong?
ShaunWilliamsMD	Megan, we unfortunately have no tests to help us determine if one should consider using a gestational carrier, but it sounds as if you fall into the category of potential implantation failure. If teh egg production and embryo quality was good, then using a gestational carrier may help, but again, this is something to discuss in great detail with your own physician who is more familiar with all aspects of your care.
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deb_capone	Tonight we are discussing when egg donation and gestational surrogacy makes sense with Dr.Shaun Williams from Connecticut Fertility Associates.
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deb_capone	Welcome to the session, Paulette!
paulette	hi, thanks!
ShaunWilliamsMD	HRW, FSH is one of the surrogate markers of egg quality that we use when counseling patients about the expectations for success with any treatment. Unfortunatley we have no good means to improve egg quality, but using donor eggs can overcome those issues--but the decision to proceed sometimes is not so simple, depending on what your goals are.
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HRW	Hi. I'm 40 years old with a four year old daughter. We had no problems at all conceiving or having her. We have been trying to conceive for approx 9 mths with no success so I recently saw a specialist. I had the clonid challenge test and my FSH levels were high. Day 3 was 32 and day 10 was in the 40s. My inhibin B was very low. Based on this, the Dr. said that our only options are adoption or Donor Egg...Do you agree? Is there anyone who would ever try using any fertility drugs on me with
deb_capone	Join the AFA as a free "No Barriers" member: go to www.theafa.org
starr	i am in the process of doing my last ivf using my sister as egg donor, she suffers from asthma, are any medications harmful for her asthma?
ShaunWilliamsMD	Starr--we sometimes see poorer egg quality and resulting embryo quality in some women with PCOS. This may be due to the underlying hormonal aberrations causing the disorder, or due to the high response some women with PCOS experience. Many times we are able to adjust dosages or add additional medications, such as insulin sensitizers to help make a stimulation more normal, and improve egg quality.
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deb_capone	Once again, we are grateful that Dr. Shaun Williams is with us tonight as we discuss when egg donation and gestational surrogacy make sense.
paulette	I have had 6 unexplained misacarriages, no live births. Would you reccomend egg donotion in my situation, or would that be a bad idea?
kisochka	is FSH level 12 considered too high?
deb_capone	Dr. Williams is having some technical difficulties and will be logging back in asap.
deb_capone	Welcome back, Dr. Williams!
HRW	You mentioned that the success rate with DE is usually 50-70%. Could you break down preganancy vs delivery? Also, how many embryos do those stats assume are being used? If you only put in one embryo, by how much do those percentages decrease?
ShaunWilliamsMD	HRW--but any treatment that can increase the number of eggs that you produce can improve your chances of realeasing a good egg. However the high FSH level already present in your body usually indicates that when we add more FSH (the injectable, more potent stim meds), responses are usually poor and sometimes not worth the economic costs of the medications.
HRW	Thank you for the answer, Dr.
ShaunWilliamsMD	HRW--we see the same miscarriage rates as in any pregnant population, about 12%, so birth rates are generally a bit lower. But for women over 40, approximately 25% of pregnancies end in miscarriage, and for those who achieve pregnancy at the age of 43 and above using one's own eggs, the miscarriage rate is almost 50%, so we can overcome those age related adverse outcomes as well with donor eggs.
ShaunWilliamsMD	I'm sorry, but I was disconnected and had to log back in, so I cannot see any questions that have been asked previously. Please repeat these if I have not provided any help with your question...Thanks!
Kinuko_Brown	Hi, Dr. Williams. This is the case of having surrogate but using her own eggs. Her FSH on day 3 sometimes 11, and sometimes 7 or 8. She had a first time IVF but it was canceled because of poor response. Second time, she had 6 eggs, and 5 good embryos. 2 embryo was transfered but it was a chemical pregnancy. She will try FET with the surrogate. She is wondering if it will not be sucessful. she should go on egg donation or she should try it again?
paulette	I have had 6 unexplained miscarriages, no live births. Would you reccomed egg donation, or would that be a bad idea?
deb_capone	Dr. Williams is logging back on. This is a great chance for you to repeat your questions for him, if they have not been answered.
Linda	How do I find a center that will do both in Ma.
ShaunWilliamsMD	Kinuko--I would consider the production of ony 6 eggs a low response, however with very good quality embryos, I would still expect success with ones own eggs--the elevated FSH level to 11, and the poor response however are signs of a potential egg quality issue as well. Again, using donor eggs is our only method to completely overcome most egg quality issues.
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Kinuko_Brown	Thank you for your answer, Dr. Williams.
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deb_capone	Dr. Williams will be right back....sorry about the technology glitches!
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HRW	With DE, how many embryos do you usually put in? If the recipient requests to only have one put in, by how much do the success rates decrease?
deb_capone	Welcome Jane, we are discussing egg donation and gestational surrogacy and when they make sense with Dr. Shaun Williams, from Connecticut Fertility Associates.
SWilliamsMD	Ok..I keep getting disconnected for "disrupting the chat session." I must be angering someone...
jane_wilson	Hi, and thanks for the update
deb_capone	Certainly not any of us....we are thrilled to have you despite the glitches.
jane_wilson	I am intrested in older women that want to have a baby using their own eggs
deb_capone	Dr. Williams, I don't know if you saw Paulette's question, but she has had six miscarriages-unexplained and no live births. Is egg donation an option for her?
yola	I am 43, 2 neg. ifv cycles , good egg production about 11 an 9 but few good embryos 2 o 3 with more than 5 cells should i move to egg donor ?
SWilliamsMD	Paulette--many miscarriages are due to embryo chromosomal problems that are a result of egg abnormalities. We can test embryos prior to transferring these to the uterus to ensure that normal embryos are being used to hep establish pregnancy--a process call PGD (preimplantation genetic diagnosis.) This is one way to help understand if using donor eggs can overcome this. PGD can be an involved process however.
SWilliamsMD	Paulette--we still can't identify a reson for recurrent pregnancy loss in over half of the individuals who experience this, but using donor eggs can overcome any problem resulting from an abnormal egg. If you have had multiple chromosomally abnormal miscarriages, this option may make more sense.
paulette	Thank you Dr. Williams.
jane_wilson	I know that it is considered almost impossible to try at 48 to use your own eggs, but is there a octor that you know of that is willing to try?
kisochka	What is the highest level of FSH for IVF cycle?
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deb_capone	We are nearly out of time. One of the reasons that we are able to get professional like Dr. Williams to participate is that we respect their 60 minute time commitment. I can see that you have lots of questions for Dr. Williams. I hope we will be able to convince him to return soon.
SWilliamsMD	Yola--at 43, we see fewer successful cycles, as you have experienced, with egg and embryo quality being the most common reason. It would completely reasonable to consider donor eggs at this point--I would expect much better embryo quality and higher likelihoods of success in that scenario.
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deb_capone	Thank you again, Dr. Williams for your time and persistence with the technology. We all learned a lot.
jane_wilson	I am sorry I missed most of the session
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jane_wilson	I will check out your center, Dr Williams
HRW	Thank you, Dr. Williams
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jane_wilson	Thanks a lot for making yourself avalilable
tearsheetj	When will the transcript from this session be posted?
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deb_capone	Please join us next week when our guest Dr. Bill Petok, Ph.D. discusses "Fertility and Sexuality". See you next week at 8pm (Eastern) sharp!
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deb_capone	We will be posting the transcript within a week of the session.
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deb_capone	Thanks for joining us!
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When Do Egg Donation and Gestational Surrogacy Make Sense?

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