Fertility Q & A - Redbook's Fertility Diaries

Wisdom from Wisot Wednesdays, Round 12! - Reprint from Redbook's Fertility Diaries
January 14, 2009 at 10:00 AM by Cheryl | 3 comments


Hello! Sorry I've been MIA. My Hunky Husband and I took a little vacation. But I'm back just in time for our weekly Q&A with top fertility expert Dr. Arthur Wisot. I love how the questions seem to take on a theme each week. Today's hot topic: egg donation. Before we get started, the doctor's disclaimer: "My answers to questions on this blog do not constitute medical advice, but are merely meant to create an educational forum for consumers. It is always best to discuss these issues with your health care provider." The good doctor's answers are below, in bold:

Question #1: Hi. I am 34 and have been trying for almost two years. I have done two IUIs with injectables and got pregnant both times, but miscarried. I just did my first IVF. I was on the pill for a month (I get a lot of cysts on my ovaries, they needed to disappear before IVF) then did the flare protocol, using 300 Gonal F, 225 Menopur, and 10 units Lupron. I got 5 follicles but only one had an egg, and that was immature and did not fertilize. I have mild to moderate endometriosis (90% removed in September) and some of it has already returned to my ovaries. FSH 7, AMH around 1. My questions: Since this cycle was a spectacular failure, do you think I should move to donor eggs? Or, do you think the fact I got pregnant from two out of two IUIs is encouraging and I should try once more with a different protocol? Thanks so much.

Answer: I really can't give a good opinion without all the information. But this strikes me as a situation which we see often in women with severe endometriosis. Between the damage the endometriosis does and the surgery to remove it, one may be left with few early follicles capable of stimulation. But with the normal FSH and your response in the two IUI cycles I would guess that the eggs you produce may be good. Maybe IUI is a better treatment for awhile before jumping into another IVF. Sometimes pretreatment before IVF with Lupron for three months or birth control pills with letrozole for two cycles may deal with some of the bad effects of the endometriosis. It's not so much about how many eggs you can make, but to make the best of the few you do make. All the follicles contain eggs and I do not understand why they only retrieved one. That can and does happen but it's more about the maturity of the follicles and the adequacy of the dose of hCG than about endometriosis. Depending on your tolerance for more of this, I would not yet be running to egg donation. But if you are tired of all this and want a quick fix, egg donation might be the way to go.

Question #2: Hi. I'm not actually dealing with infertility, but I'm very interested in your thoughts regarding the risks and benefits of becoming an egg donor. I'm currently a college student, very healthy, and recently became curious about the process. I really like the idea of helping a deserving couple become parents. However, I'd like to know a bit more about the donating process and what the risks and benefits are. Thank you.

Answer: Sounds like you would make a good egg donor. Most of the risks are related to the egg retrieval in which a needle is passed through the vaginal wall into the ovary. Stick a needle in someone and you can cause bleeding, introduce infection or injure some adjacent organ. The other major issue is overstimulation of the ovaries which can vary from a nuisance to a serious medical condition. Fortunately both of these occur very infrequently. We have a 13-page informed consent that the donor has to read and sign that outlines the entire process and risks. The process involves birth control pills, fertility drug injections, ultrasounds, and blood tests and then the egg retrieval under sedation or anesthesia. The most frequent complication of egg donation is...well maybe I'll let you all guess and tell you next week. Post your guess.

Question #3: And one logistical question: I am a So. Cal. girl and was intrigued by Dr. Wisot's post about participation in a national study. Should we just call his offices in the South Bay to try and participate?

Answer: Just call our toll free number (877) 273-7763 and they can have you make a consultation appointment at your nearest Reproductive Partners office in Los Angeles and Orange Counties. We are definitely looking for subjects. You can check out this link to more information about the study.