Posts Tagged ‘IVF’

Embryo Transfer after Egg Donation: Is Two Better than One?

Monday, October 12th, 2009

During the early years of IVF treatment, it was always assumed that transferring more embryos would improve success rates.  Even 20 years ago, it quickly became apparent that this success came at the expense of a high multiple birth rate.  In response o this, many European countries and Australia limited the number of embryos that could be legally transferred to woman’s uterus.  While laudable, these restrictions tend to be rigid and do not always take into account the age of the producer.

In the U.S., we have adopted a voluntary system through the American Society of Reproductive Medicine (ASRM).  The ASRM has published guidelines that take into account maternal age and are more flexible.  However, as seen in the recent case of the famous octuplets, there are no serious consequences when a poor outcome is attributed to not adhering to these guidelines.

While these measures have greatly reduced the incidence of triplets and higher-order multiple births, the incidence of twins remains high, especially with egg donation.  Many patients may think this is fine.  In fact, many couples express a desire to have twins.  Their preferences are affected by a belief that transferring two or three embryos improves success rates, and, for some, a financial motive that sees twins as a “two-for-the-price of one.”

The success rate belief may be inaccurate.  Many European studies, as well as our experience, strongly suggest that the success rates with two day-3 embryos is equal to the success rate with one good quality (day-5) blastocyst.  The ASRM guidelines allow either choice.  Yet, many clinics are still transferring two blastocysts, with predictably high twin rates.  So, what’s wrong with that?

The problem with twins is that they have a 50% chance of being born prematurely.  As a result, they have higher rates of cerebral palsy and other complications of prematurity.  The combined medical costs from IVF twins due to ICU care and life-long complications from prematurity are easily in the billions of dollars.  Furthermore, from conception to delivery, there is a reduced chance of actually delivering two live babies.   Even when twins are born close to term and are healthy, there are considerable financial and emotional costs associated with them.

With appropriate statistical analysis, it may be possible to demonstrate that the chance of a live birth is the same after the transfer of one blastocyst compared to the transfer of two embryos.

While twins may seem cute and a bargain at first, patients undergoing egg donation should inform themselves of the risks of twins and discuss the potential merits of single embryo transfer (SET) with their physician.

- Michael Feinman, MD

Medical Director, HRC Fertility

Huntington Reproductive Center Medical Group

feinmanivf@havingbabies.com

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I’m Jewish. Do I Need a Jewish Egg Donor?

Friday, October 2nd, 2009

When choosing an egg donor, it is understandable that women will want to select a donor who is similar to themselves in appearance and ethnic background.  As with many aspects of Jewish Law, what may seem obvious and desirable may not conform to rabbinical interpretations of the Law.  Ironically, since it is sometimes difficult to find suitable Jewish donors, these legal twists can actually help some people “let go” of their desire to work only with Jewish donors.

There are three concerns that rabbis have addressed in their discussions regarding the selection of egg donors.  The first is accidental incest.  The second is the legal status of a woman’s eggs.  The third, and possibly the most important to recipients, is the Jewish status of the children born through egg donation.

jewish7 Im Jewish.  Do I Need a Jewish Egg Donor?

Reasonable concerns exist that due to the anonymity of most egg donation arrangements, the actual children of the donor could accidentally marry the offspring of the woman who received her eggs.  Sounds far-fetched, but rabbis worry about such things.

As to the status of the eggs, rabbis have agreed that according to Jewish Law, a husband has a legal attachment to his wife’s eggs.  In theory, according to Jewish Law, the resulting offspring could have a claim on the donor’s husband in a Jewish court of law.

While Reform Judaism recognizes that parentage can come from either parent, traditionally most, but not all, rabbis have agreed that if a Jewish woman gives birth to the baby, that child is fully Jewish.  The Laws determining a child’s family and religion of origin were established thousands of years ago – long before genetic testing – and so Jewishness is passed from the mother who gives birth rather than from the genetic parents.

Based on these three considerations, the following principles can guide most Jewish couples considering egg donation:

A Jewish donor is not legally required for a Jewish couple.  Based on the concerns about accidental incest and the legal status of eggs, a non-Jewish donor may actually be preferable.  Accepting this idea can alleviate much of the angst over trying to find a Jewish donor which can be difficult.

If a Jewish woman is chosen, she should be single or married to a non-Jewish man.  If she is divorced, she needs a Jewish divorce, including a “Get.”

The process of choosing an egg donor is different for every family.  There are an endless number of things to consider in making such an important decision.  If observing Jewish Law is a priority for the Intended Parent(s), then finding a Jewish donor is not only unnecessary, but potentially undesirable.  Ideally, this will be helpful to some as the pool of potential donors will be enlarged significantly.

- Michael Feinman, MD

Medical Director, HRC Fertility

Huntington Reproductive Center Medical Group

feinmanivf@havingbabies.com

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