with their own eggs. Others decide to hold off on pursuing egg donation, feeling that they need to exhaust any possibility of using their own eggs.
Age-related infertility
Late marriages, second marriages, no marriages or occasionally the death of a child prompt women in their mid to late 40s or older to seek pregnancy. Unlike the women with diminished or diminishing ovarian reserve, these women know that their eggs are no longer viable. Although this awareness brings profound feelings of loss for some, many are also relieved to learn that there remains a way for them to be pregnant and, for those who have a male partner, to have their husband/partner’s baby. They are happy to hear that their age does not adversely impact their chances of having a successful pregnancy with egg donation. It is true there are some pregnancy complications, such as pre-eclampsia and gestational diabetes that increase with age. However, older women who maintain a recommended body weight, are otherwise in good health and seek appropriate prenatal care should be able to anticipate healthy pregnancies.
Egg donation releases older women from the grip of the biological time clock. However, it does not free them from concerns about what it means to be older parents. Although they are youthful and energetic at 45 or 46, some are looking ahead and wondering how they will be at 68 or 70 when they have a child in college. They want to do right by their child and avoid being any older when their hoped-for child is born. For this reason, many choose to move as rapidly as they can with egg donation or to take a serious look at adoption.
Lost ovarian function due to surgery or illness
With advances in cancer treatment, increasing numbers of people are surviving at the expense of their fertility. Infertility after chemotherapy and/or radiation cannot always be accurately predicted. There are women who have aggressive treatment and who are later delighted to find that their menses return. They may go on to conceive and carry without difficulty. By contrast, there are others whose treatment damages their fertility. With chemotherapy, the common observation (a National Cancer Institute Alert, May 1988) has been that the greater the dose, the longer the duration of chemotherapy and the older the age of the woman at the time of treatment, the more likely the sacrifice of ovarian function.
The emerging field of “Oncofertility” is offering more options for both men and women facing cancer treatment. Increasingly, infertility clinics are developing programs to meet the needs of the ten percent of newly diagnosed cancer patients who are under the age of 45 (Rodrigues, Camp-Engelstein and Emanuel 2013). A woman likely to lose ovarian function may take a chance on egg freezing. If she is married or with a partner, she may undergo an IVF cycle, have her eggs inseminated with her husband or partner’s sperm and cryopreserved for future use. In addition, there are newer and more experimental options such as whole ovary cryopreservation and the freezing of ovarian tissue. For boys younger than reproductive age, and thus unable to cryopreserve semen, an option being investigated includes freezing testicular tissue. Oncofertility is becoming increasingly important as more and more young people are surviving cancer and going on to live full lives that include building families.
Cancer is not the only medical problem that causes a woman to lose her ovaries and/or her ovarian function. A woman may have a cyst that ruptures and causes her to lose an ovary. Or a ruptured ectopic pregnancy may result in surgery in which she loses both ovary and fallopian tube. While most women have two ovaries and one may remain after a medical and surgical emergency, there are instances in which a woman loses both ovaries.
Egg donation after surgery, chemotherapy or radiation is attractive to some women, but not to others. Those who find it most attractive tend to focus on its restorative capacity: here is a woman who has lost half of her reproductive function and who can now use the remaining half—her ability to carry—to bring a new life into the world. For a woman who has been ill, and who probably confronted her own mortality, the opportunity to plant two (or more) new feet on this earth is profoundly moving.
Why, then, would some survivors of illness or surgery be reluctant to pursue egg donation? Some say that it brings back painful memories of the illness that robbed them of their fertility. Until they face their desire to have a family, they had been moving on in their lives, moving away from the cancer. The prospect of being back in a medical setting, of having invasive tests and procedures and of having the constant reminder of their battle with cancer is painful. Others may avoid egg donation because they fear the reactions they may see or perceive in others. What if the physician suggests a delay of a year or two or three before pregnancy? This could frighten a woman into fearing that her physician is waiting to see if she will have a recurrence. Cancer survivors need to believe in their own futures and, for the most part, feel confident that others do as well.
Women born without ovaries or without ovarian function
Sometimes women are born without ovaries or without the capacity to produce eggs. We can easily imagine what the opportunity to carry a baby must mean to these women. In this regard, they may be traveling lighter than others considering egg donation. Although some will choose adoption, many will regard egg donation as a gift, one that enables them to use another part of their reproductive function. As we mentioned, women in this situation may face fewer decisions than those with other reasons for considering egg donation. These women know that they will not be creating a full biological child. The opportunity to become pregnant and to have a child connected genetically to their partner and gestationally to themselves is inviting.
Unexplained infertility
In a time of advances in reproductive technology, unexplained infertility has to be one of the most baffling experiences. How is it that a couple can go to a skilled reproductive endocrinologist and be told there is no identifiable fertility problem? Worse still, they can seek a second and even third opinion and hear the same thing again and again: “Something is wrong but we don’t know what it is.”
Not long ago, couples were labeled “normal infertile.” How bad was that? Bad enough to prompt people to feel that their problems must be psychological. After all, if there was no apparent physical problem, they must be causing their own infertility with ambivalent thoughts, bad behavior, past misdeeds or some other curse.
Families struggling with unexplained infertility find themselves in the world of trial and error. With little to go by, physicians suggest trying IVF, hoping that the explanation of the infertility rests in the way that the egg is released (or not released) or in difficulties that egg and sperm have when they encounter each other. For some people with unexplained infertility, IVF provides a solution. But what of others? What do you do if your infertility remains all the more unexplained after repeated failed IVF attempts?
Some couples with unexplained infertility consider egg and/or sperm donation, assuming that there must be some defect in their gametes, or they may wonder, sadly, if the “mix” between them doesn’t work. Some with unexplained infertility who turn to egg donation still do not become pregnant. What then? One such couple tried donor sperm and, eventually, a gestational carrier before deciding to adopt. Another tried a second egg donor, conceived and enjoyed a successful pregnancy. Still another moved on to embryo placement and had not one but two successful pregnancies. Another option is to continue trying on their own, knowing that some couples with unexplained fertility have spontaneous pregnancies.
Genetic issues
Some people learn, through genetic testing before a pregnancy is attempted, during a pregnancy or after a baby is born, that they are carriers of a serious, even lethal, genetic disorder. They may have close family members whom they have watched suffer from a genetic disorder. Some of these families have a baby die in utero. Some choose to terminate pregnancies when such a disorder is diagnosed in utero. Others deliver a child who dies at birth or soon after. Still others parent children with very challenging conditions. Veterans of each of these experiences may turn to egg or sperm donation in an effort to avoid transmitting the genetic abnormality to future pregnancies.
