Creating a Family: Talk about Adoption & Foster Care

Should You Use Fresh or Frozen Donor Eggs

December 12, 2019 Creating a Family Season 13 Episode 47
Creating a Family: Talk about Adoption & Foster Care
Should You Use Fresh or Frozen Donor Eggs
Show Notes Transcript

Should you use fresh or frozen eggs when doing a donor egg cycle for IVF? Which provides you with the most choices and the greatest chance of success. We talk with Corey Burke, an andrologist and embryologist, with over 20 years experience. He is the Tissue Bank Director for Cryos USA – International Sperm and Egg Bank.

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spk_0:   0:09


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* Note that this is an automatic transcription, please forgive the errors.

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spk_1:   0:37
Thank you very much.

spk_0:   0:39
Cory and I see each other at various conferences and throughout the year. And any time we talk, we always have so much fun. We always have. We our conversations are pretty far ranging when you and I get started. So I'm looking forward to see where we go today. We do have a defined topic, however, so we're gonna try to stay to

spk_1:   0:58
it. It always always fun.

spk_0:   1:01
Oh, yeah, we always do it, but we have interesting conversations. We did so, you know, way back, way back at the beginning. It used to be that there was really only one option for couples considering using donated eggs to build their family, and that was to use fresh eggs, you'd find a fresh donor, she would go through a cycle. And you, as a couple or the person if they were not in partner, would end up with the eggs that were created in that one cycle. But now we have a choice because frozen eggs I think I've taken everybody by surprise is how rapidly that that option has grown and it's certainly has grown. Do you happen to know what percentage of donor eggs cycles now are used? Donor frozen versus fresh.

spk_1:   1:47
You know, I've seen a number of things I think we're approaching About 50% of all cycles now are using frozen eggs versus fresh eggs.

spk_0:   1:55
That's I've seen that. That's the number I've seen, too. Yeah, so that's ah, you know. And when did they really begin with frozen?

spk_1:   2:03
Well, we started quite some time ago. Back when I s r a maid. Vitrified eggs. Standard of care. We've gotten better and better since then. Yeah, the last 56 years, I guess would be the started, actually take off. And then it's taken off log rhythmically ever since three years. Bigger and bigger and bigger and bigger.

spk_0:   2:24
Yeah, it's interesting. Now you might have predicted it, but I honestly wouldn't have predicted that how quickly it's taken on. We're gonna talk about some of the reasons here in just a minute, all right, But first, let's talk about what the process is for using it, doing a fresh donor egg cycle. Take us from the beginning once a patient are a couple. If they're. If if she's partner, make it have made the decision that the best their best option for creating a family is to use donor eggs. So walk us from that point on. If you're using fresh air.

spk_1:   2:57
Okay with fresh donations. It'sjust Fairly standard procedure We're all used to for many, many years. You find your donor generally have to then scream the daughters because usually most places have fresh donors on the books. People who want to donate you still have to scream. Go through the screening process with me after them. Sexual disease probably have to do genetic some carrier screening, depending on what you require. Then you have to get the stimulation in line with the recipient. Go to retrieval, retrieve the eggs, you fertilized the eggs, throw the eggs too beautiful. Blast hopefully and you know, on day five or six, you make the transfer. Now, in some cases, today we're having frozen and then going back in for the transfer later. So sometimes we can throw out the The process of getting is in sync with the donor with the recipients cycle.

spk_0:   3:45
Yeah, because I actually now it is almost becoming standard of care that particularly in genetic testing, is involved. And even when it isn't that there, that preference is moving towards doing freezing all and then coming back after the woman's body has had a chance to settle down from the stimulation. Right. Okay, so then you just all the eggs are fertilized with the the sperm of choice, and at the time,

spk_1:   4:13
yes. And one of the one of the things with fresh donation is when you do a retrieval that way, in most cases, you get all of the eggs, and that's that's a major difference between fresh and frozen in most cases is with the fresh. You always get all of the eggs unless you've done a split cycle or something of that nature,

spk_0:   4:29
unless you split it right, and then you take the risk of not getting enough. So Okay, so you get all the eggs, and most people probably still fertilize all. Are you seeing him? Freeze some now. Some of the eggs are. Do most people fertilize them? They used two months. Refer to

spk_1:   4:46
their mostly. I was saying, 90 80 90% of people fertilized everything. Sometimes they will freeze the makes just so they don't have. You know, in the end, they don't have too many embryos left over.

spk_0:   4:56
Yeah. Okay. So what is the cost of a fresh donor cycle?

spk_1:   5:02
Well, fresh donor cycles could go anywhere from 20 to $40,000 depending on how much you're paying for the donor. How much the IVF treatment is in some places, you know that the IVF treatment slower. So you have the lower end. But in general, I would say $20,000 now.

spk_0:   5:18
Okay. And the cost differential there would be in what? What would make it go up

spk_1:   5:24
again? The process you're paying for the donor in particular. You're paying a lot of money for the donors and people in New York particularly, You know, they'll pay a lot of money just for a donor. They may pay $25,000 for a donor they think is a very good, suitable donor.

spk_0:   5:40
Okay, so when

spk_1:   5:42
I say that cost is around 20,000 that's actually probably very low end. I know a few places do a very basement discounted cycle in their 20,000 but I would say on average, you're probably looking at $30,000 up on average,

spk_0:   5:55
okay, and said, That's for one cycle. On the other hand, you will get if you would get all the eggs that are produced and most egg donors are young, so we wouldn't anticipate it would be common to expect to get a fair number of eggs. But it is kind of the average egg, which, of course, there's no guarantee. But what kind of, on average, how many eggs would you get

spk_1:   6:16
again based on the testing that we do and just in general, speaking of us, we get about 20 to 30 eggs. What we freeze depends on the quality, but you're an average end up getting an average of about 20 to 30 eggs for retrieval. Okay, and certainly there's There's times when when you get considerably more, I mean, I've seen retrievals where you get 60 70 88 because I would hate saying that. But you know, people, people who are PCOS or whatever they often put put a lot of eggs out, which is not a good thing that doesn't doesn't result here. Motorcycle. It's actually probably worse than having a donor gives you 15 to 30 eggs. That's that's a good number.

spk_0:   6:54
Yeah, I know. That's well, that would not be a good outcome. That would not be. What should we be going for

spk_1:   6:58
us? Certainly not ideal, not know wherever looking for. But, you know, it's one of those things you can never really tell what you could end up with. You may think you're gonna get 20 to 30 eggs, and next thing you know, you've got 50 coming out. So yeah, and again, this is rare. You don't get it that often, but it does occasionally happen.

spk_0:   7:15
Okay, So what are your choices now for finding a egg donor for a fresh cycle? So patient has decided that that's what she needs. Where does she go to look for a fresh donor?

spk_1:   7:28
Well, there's a

spk_0:   7:29
doctor for a fresh start

spk_1:   7:30
for fresh, like there's there's a number of weight are places to look for that. So there's there's a gate egg donor agencies who that's where they specialize in. They have a number of women who have elected to be egg donors, and you get a big donor that way. Many practices also keep their own file of potential egg donors to use, and usually that's how you find a fresh donor is through that method. But often times you still have the whole screening process to go through once you select that person. So there's really no guarantee with fresh that if you select a donor today that she's gonna pass all the testing the cheese to go through, you could have, you know, something plummet eah, or some sort of infectious disease that doesn't show up, that they would make them ineligible.

spk_0:   8:11
Okay, now that's the process for going through using a fresh doing a fresh donor egg cycle. Now let's contrast that and talk about what's the process. If a couple or a patient decides that they're going to do use donated eggs, but they want to try using frozen eggs. So what's the process like? They're

spk_1:   8:31
okay, so frozen are a little bit different because most banks that are around today go ahead and freeze the eggs. So we will recruit donors. Well, go ahead and do the retrievals on him. Will petrify the eggs will put him in the freezer. Okay, so we've we've done all that work. We've done the straining work for infectious to use again. Genetic testing, psychological evaluation. So we've done all of this thing. The eggs were pre screened as much they possibly can be, and they're ready to go today. So the first part is you have stuff available to you today. That's right there. You can have it tomorrow. You could start your cycle. There is no work on the users and such a cz ast time in cycles. You know that doesn't have to be done. We have everything here. You can start your cycle whenever you're ready to do it. So the process is very similar to fresh donation. Except the egg banks are doing all the work. It's not something that you have to. Sometimes we'll take a fresh donor will go to retrieval. We get one or two eggs or no eggs. No, we don't know that until we get there. but we end up with no eggs or poor quality X again. Frozen eggs. You know that you're gonna get good eggs every time.

spk_0:   9:40
Okay, So, committee. Well, first of all, how do you know when once you get the eggs retrieved, how can you tell whether they're good? Eggs are not.

spk_1:   9:49
Well, that's That's the $1,000,000 question. Okay, You know, we're freezing what we consider to be the best quality morphological e normal in two eggs for the most mature eggs. And that's all we're looking for us is very mature eggs. We're obviously not freezing any amateurs or anything like that. We're basically on looks because that's what we have. We don't necessarily know there's no no magic thing to go. This is a perfect egg. This is a good egg, but we know as embryologists. We generally know what a good egg looks like, and we make sure that we freeze on Lee the best looking ones, that there's defects in the mature eggs themselves. We don't freeze. We just just look for the perfect eggs again. Perfect is a relative term is it's just based on the morphology. As long as the morphology is perfect, we assume that it's a good quality.

spk_0:   10:39
So how many eggs? So you would get on average between 15 and 30 I would assume with your donors as well. So now you're freezing of you Freeze them. They're frozen in a thing called a straw. Usually. Yeah. How many eggs do you put in a straw? So how many? If somebody comes in and says I want to I want to do a use frozen eggs for a donor egg cycle. How many eggs do they need to buy In order to have a good chance of thoughts, They're surviving the thaw and fertilizing and get ready for transfer.

spk_1:   11:14
Yeah, that's a great question. And let me just clarify something first. You know, we're not truly freezing eggs were vitrified eggs and you said straws. We do kind of do some straws, but they're not truly strong devices. They're kind of, ah, half straw that we set the eggs on and freeze. So they're not surely frozen there vitrified, but because of a technicality.

spk_0:   11:33
And it's vitrification. I always Honestly, I thought it was a type of freezing. It was the fastest. Yeah, Okay,

spk_1:   11:39
that's the best. That's easy way to do it. But vitrification implies turning something to glass. So we avoid ice crystal formation.

spk_0:   11:47
Yeah, that that's why I took the longest time for eggs. Work much harder than people don't realize this. But eggs, we're much harder to freeze the embryos because of the water content.

spk_1:   11:57
You're exactly the water content of cell number. If you If you lose a few cells when you're following an embryo, that's okay. The cells will recover. If you lose one cell, that's all there is an egg. So eggs were a big, big challenge for us to learn how to petrify. But back to your ex, your original point. Most places say it takes 6 to 8 eggs to be successful, and that's usually what they sell. 68. You may get anywhere from 6 to 10 but the general ranges 6 to 8 eggs that'll generally end up with with at least one good blastocyst, which is a very good quality embryo. Most the time, I never more than that, but most egg banks also guarantee that out of purchasing that many, you end up with a least one good embryo transfer on Day five.

spk_0:   12:42
Alright, so six date eggs are on average. What you would need to purchase in order to give yourself a fighting chance of a day five embryo. That's quality of transportation. Yes. Okay, So is that what most people are buying is in six date eggs?

spk_1:   13:02
Yeah. Most people purchase at least six takes, but yes, 68 eggs is a good number. 6 to 10 eggs is probably a really good number, provided, you know, if they're gonna do PGD on the eggs, they're doing genetic testing was they have embryos. People who do that often purchase more because, you know, they're looking for a certain sex or something of that nature, which kind of limits the numbers number of successful embryos in the end.

spk_0:   13:27
Yeah. Okay,

spk_1:   13:27
if you're looking for a boy and you've got six girls, that's kind of a question mark for your tip.

spk_0:   13:33
And they're also testing genetically for normal chromosomally

spk_1:   13:38
with donor eggs. We should have a higher incidence of only normal, but there's still a concern. In fact, what I see is most most people are mainly looking for, you know, they may have an issue. That's why they want to do the testing or they're looking for sex selection or they just want to check the chromosomes. But again, for me, that's not as big an issue is just having good embryos.

spk_0:   13:59
And that's because donors are young and chrome zonal abnormalities increase with age and and donors are young. What's the average age on this? Would this would apply to both fresh and frozen? I would assume I'm not sure. I've never seen that. There's really a difference in age. What's the average age of egg donors now? I

spk_1:   14:18
think the average age is around 24 25. Most places take donors anywhere from 18 to 34. And 34 is kind of a stretch for me. Way start to become. We have more occurrences of abnormal eggs when we get closer to 35. So I would say most of her in the 24 25 year old range. We see if we see an awful lot of college students,

spk_0:   14:43
Yeah, and honestly, I would think an 18 year old doesn't have the maturity to

spk_1:   14:47
Yeah, that's That's very, very true. And in fact, well, we can talk about that other time, but I'm not. I'm not a big fan of 18 year old eggs.

spk_0:   14:55
Yeah, having parented a couple of 18 year olds, maturity is not the word I would use to describe Mr

spk_1:   15:03
Absolutely. And I try. I truly think there's some issues with the eggs. And again, it's just something that I kind of see. And I kind of think I think the giving them the gonadotropin is to get in there. I don't think they handle them as well as they do even a few more years of time. I'd be better quality eggs from 2022 year olds than I do from 18 year olds. Oh,

spk_0:   15:25
that's interesting. Okay,

spk_1:   15:26
it is. You would think it be the other way around. You think 18 year olds would be perfect, but for me, I don't see that. I don't know. My colleagues may disagree, but that's what I've seen in the past.

spk_0:   15:38
Well, you know what? Also, I don't know. I mean, 18 year olds have not had a lot of usually hopefully not a lot of medical intervention and their ability to tolerate medications and their and discomfort in the hassle factor of donation. I just wonder if they're how good they would be at

spk_1:   16:01
that That's a good question.

spk_0:   16:03
Yeah. Okay, So you're purchasing generally anywhere between 6 to 10 eggs at for one cycle. So what is the cost?

spk_1:   16:13
Well, you know, that varies from bank to bank, but I eggs run probably about 20. $200 each. Enough. So up to about $2700 each, depending on what bank you buy him from. What? What they're selling.

spk_0:   16:27
All right. Okay. So that's yes. So you're getting that, Per that's

spk_1:   16:32
really what? Six eggs you're looking at about 12,000 close to $12,000.

spk_0:   16:38
And you mentioned that there are again. This would vary by bank undoubtably, but that it is common to give some type of guarantee. So what are the typical guarantees that a patient might look?

spk_1:   16:49
Yeah. Most banks now are giving if they sell a minimum of six eggs there, give me a guarantee of at least one good quality blast assist on day five. Okay. And that sounds like a various few, But generally you get more than that. But we're guaranteeing at least that much. And this is actually this is something that's improved greatly and passed probably four or five years ago. Most banks were only guaranteeing survival's, they would say, We guarantee that 90% of your eggs will survive the warming process. So we've gone from just guaranteeing the fact that the eggs survive, actually guaranteeing that you'll have something in in the end transfer.

spk_0:   17:29
And and if you don't what happens?

spk_1:   17:32
Most places replace the whole cohort. So if you had 10 eggs and you didn't get any blast, it's the sound of it. They'll replace that. Whatever you bought, he bought six. You replaced 68 You replace eight.

spk_0:   17:43
Gotcha. Let me pause for a moment to tell you that this show is underwritten by our corporate sponsor, Faring Pharmaceutical for women who have been undergoing fertility treatment and are still struggling to conceive very much. Do you know about the protocol? Um, it was designed specifically to help women address the many challenging emotional life situations that arise when struggling to conceive. It goes through daily scenarios and provides tested techniques that you can use to help you cope with that situation. It is free. It is a great app you can get it at for tha calm app dot com. All right, we're talking with Korey Burke about the differences between using fresh and frozen eggs and they're in. There are a lot of differences, and quarry is the tissue bank director at Cryo sh USA International Sperm and Egg Bank. All right, so we've talked about the cost, so the cost is somewhere around, probably, you know, 10 to $12,000 for a anywhere from 6 to 8 to 10 eggs if you're using frozen eggs for a cycle. So our choices now have increased for finding frozen eggs. So how would you go about and what if you live? Cem, You live and Tim. But to and there is no Tim, but to Frozen Egg Bank. How would you get eggs? So can you look everywhere? Do you have to look within a geographic area? How do you find frozen eggs?

spk_1:   19:21
Well, that's one of the beauties of having frozen AIT's. We can ship him anywhere in the world, and this is true of any egg bank. It's not just not just price. It's any egg bag. I shouldn't say anywhere in the world. There are some restrictions around the world so can't necessarily shift any place more, but certainly in the United States, It doesn't matter if you live in Idaho or Kansas or wherever you happen to be, we can ship them to you. And finding him is is very simple. World Wide Web. You have to go to the website and everybody has a search function. You can type in the things that you're looking for returns everything that they have available with the parameters that you set. You're making the selection you pay for him. We pack him up, put him in a nice, portable freezer kind of thing. A tank that that holds liquid nitrogen can absorbs the liquid nitrogen into it. And we can ship those anywhere that we need to show him. Well, anyway, the readership of any clinic that we need to shift into So we're not gonna step into your home, but we can ship into any clinic and again, this thing that we the clinic needs to receive him's not handle the the eggs.

spk_0:   20:23
Yeah, that would make sense because they're going to they've got to be fog. And, uh, okay,

spk_1:   20:29
they gotta be thought we just don't be thought before they're supposed to be thought. So that's important.

spk_0:   20:34
Yes. Yes. All right. So with fresh eggs, you go through and you specify ideally what it is you're looking for in a donor. Sometimes you're looking for a donor who resembles the intended mom. Sometimes you're looking for a donor that resembles the intended father, or you have specific things you're looking for. You know, interest in music are a interest in, you know, hi. Academics are good at sports or whatever, So that's that's for fresh. What type of choices do you have as to the donors when you're using friends?

spk_1:   21:14
Love say, frozen actually has probably greater choices, because again, we have the eggs. All the big banks have their heads, so you can virtually find almost anything you're looking for. And it's very interesting because you know, we'll have people contact us looking for eggs and you know they'll say, Well, I'm really interested in this donor because she played the flute in high school band. I played flute high school pants, So this is just the perfect donor for me. So sometimes it's something like that that really isn't necessarily a genetic kind of set up that makes you that much similar. And then most of time, people are looking for someone who looks like that, whether they want somebody looks like the mother or somebody looks like the father. They want somebody who doesn't stand out look different. You don't question you know where the child came from

spk_0:   21:58
and how much racial diversity exists. It used to be that it was, and a relatively easy to find a Caucasian donor. But a black donor or an Asian donor or a mixed Asian and white donor are Puerto Rican and black or whatever. So how much diversity do egg banks half now? And racial makeup

spk_1:   22:20
actually is free? Phenomenal. We have lots and lots of everything. Again. Caucasians are the primary ones with all of them, because that's just it's larger population but Hispanic populations. Priors International has a huge amount of of Hispanic donors because we're in an area that has a lot of Hispanics. California. They probably have a lot of Hispanics as well. So just kind of depends on really located. But every one of us has a huge variety of different ethnicities, races, works. The one that is really tough for all of the banks is a Asian, a pure Asian donor. You know, I see lots of Asian Americans, Asian, whatever. But finding the Asian donors is kind of a challenge for all of us, mainly because it's cultural thing. We just don't get a lot of Asian donors. We're even in a city where it's full of Asians. We don't see a lot of people want to donate.

spk_0:   23:14
That's interesting.

spk_1:   23:15
And in fact, I mean, I'm contacted all the time by people looking specifically for Asians on. And, you know, we just can't really get enough people to actually go ahead and make the donation.

spk_0:   23:26
Mmm. Go through the whole process. Yeah, and then you would have People who are looking for Chinese ethnicity are Korean, are Japanese. And so it gets even harder, I would imagine.

spk_1:   23:38
Yeah, and those again Japanese air. Probably one of the toughest ones, because they usually want Japanese Japanese, and that's all they want. Your Chinese will take Chinese American, but they would prefer to have Chinese Chinese, too. So it's that they are very, very specific in what they select.

spk_0:   23:55
Interesting. Yeah, And so And you're not seeing a big change as time has gone on in there.

spk_1:   24:00
No, not really. Although an interesting thing that I've seen is, you know, you see a lot of Chinese doing Sarah to see in the US or just doing IVF in the U. S. And I have seen kind of a trend of Chinese wanting to use Caucasian eggs, and it makes it really makes a really beautiful baby. But it's kind of an interesting thing that I'm seeing more and more Chinese. They're happy to have occasion eggs for IVF.

spk_0:   24:25
I've heard that I've actually heard that that is it for some clinics say that they even see that as the majority, which honestly surprised. Let me pause here to tell you that this show wouldn't be happening without the support of our partners and our partners or organizations who believe in our mission of providing unbiased education and support for the patient community along the continuum of struggling to conceive. And not only do they believe in our mission, they're willing to put their money behind it, and that truly tells you that they believe in patient education and support. One of our partners is Cooper, Surgical Fertility and Genomic Solutions, their global leaders in IVF and reproductive genetics, and they offer an array of different testing gauging Team A P, G, T M PDT, s R, as well as the air peek S m into mutual receptivity testing for individuals and couples who are planning a family and going through IVF. And what's really important is that they also provide comprehensive genetic counseling to their patients, which is something that I, for one truly am appreciative of, and another one of our partners is reproductive Medicine Associates of New York. They are one of the largest fertility practices in the state, as well as one of the biggest in the country. By combining the latest innovations in reproductive scientists with compassionate and customized treatment plans are made of, New York is able to provide the very best possible care. All right, I've been saving kind of the $64 million question to the two now, and that is, you know, it's all fine and good to talk about convenience. It's in and talking about choices and talking about ease and even talking about costs. But I think what most people fundamentally want to know is what is the difference between the success rates for an IVF cycle? Using fresh eggs versus frozen eggs and an IVF cycle. Obviously, that's in an egg donation cycle.

spk_1:   26:34
Okay, well, there's been a number of studies. I was just looking at one earlier that was done back in 2010. And virtually everything since then has said there's no difference in success between fresh versus frozen X. If you end up in a good end point, you do the transfers. There's no difference in implantation. There's really no difference between the two eggs. OK, that said, when we go back to fresh again, you get all of the all of the eggs from the cycle goes to you so you could end up with a huge number of embryos, which is good. It's two sided. It's very, very good, because if the pregnancy doesn't take, doesn't carry whatever and you need to go back and do it again. You go back and do it again. It's much, much cheaper and have it frozen transfer than fresh transfer. So for cost wise, but the same time, it's also a little bit of a double edged sword. Most women who are at the point of using donor eggs are a little older, and that's part of the reason why they've come to us that they've gotten up into their forties or late thirties, and many of them don't want the supernumerary embryos left that are left over after the cycle. So, you know, if you have 20 eggs that are all yours and you grow them, you know, it goes through a good cycle. You may end up with 10 embryos. You transfer one, you get pregnant, you have your child. Um, you now have nine embryos in the freezer, and now you have to make a decision about you have to think about those. What are you gonna do with those in the future? Do you wanna wanna donate him? Somebody dispose of them? Do you want to continue to storm? And that could be bothersome to some people. But again as faras the fresh versus frozen success, it's very similar. In fact, I didn't talk a little earlier in January of this year and talk about just that. You know what, how it has it's going, and based on some of the other egg banks info that I could gather and talking to some of my colleagues, um, with the clinical pregnancy, success rate has gone up tremendously It used to be that using donor eggs, you got about 64% pregnancy rate on going. And if you look at a start step statistics right now, frozen eggs don't have the same success rate. But I will argue that is stark. Statistics are two years old when we get you come out to your right. And over the past two years there's been a huge increase in the learning curve, so it hasn't been necessary from the from the aspect of the people freezing the eggs. But there's been a big learning curve of the people who are using the eggs again. It hasn't been standard of care for that long, so the process of following the eggs, fertilizing the eggs and growing the eggs it's a little bit different than fresh. And I argue that clinics have have gotten much better over the last two or three years with that portion of it. Now we could freeze the best possible eggs. But if the clinic doesn't know how to fall the eggs, you know that time I've got I going train places and you don't have somebody Tell me, Have you thought eggs Well, Yeah, I did it at a workshop on time. OK, well, that's that's not many. So the fact is, they're starting to use more whether it's their own exit, a frozen or eggs from an egg bank. But they get to the point where now they're starting to be ableto warm eggs as well as a warm embrace which, when we will remember, is 90 plus percent survive and do very, very well all the time. S o I think because people have gotten better at using eggs, success rates have gone up. And I was looking at our own internal success rates and talking to some of my colleagues about the same thing. We're all seeing about it about a 70% clinical pregnancy rate, which is very, very good. And then if you translate that to a ongoing pregnancy rate, we should be right around the 64% that most people see.

spk_0:   30:19
Okay, so would it make sense for patients to look? And I think end will, um yes, it is. This is a start data the Society of Assisted Reproductive Technology, which is the governing body, that it collects the data. We can also see it at the centers for Disease Control, the CDC. But it's even when you're older. I believe there. But ah does start collect data by clinic on their success using frozen eggs. Or is it just lumped together with donor eggs?

spk_1:   30:55
Yes, they're starting to collect data on frozen eggs as well,

spk_0:   30:59
so it might make sense than toe. Look at the success your clinic has if you're thinking about using frozen and,

spk_1:   31:06
yes, absolutely. And if they don't have data on that, at least see if they if they have a good frozen frozen embryo transfer program that says that they're a little better with with doing freezing and thawing. But if they have the frozen egg data available, less stuff to look at.

spk_0:   31:22
Okay, so your success and kind of to sum it up as as of now, it looks like the success rates are about equal. And that meant by success, we mean ongoing pregnancy. Race is in the 64% for both fresh and frozen okay. One difference, however, would be that if you want multiple Children or if you follow into the Nazi, don't fall into the 64% you have extra eggs that you can utilize, um, our exodus point, the probably embryos. But you brought up the point that I was really thankful you brought up. And that is we tend to under at the beginning when people are trying to get pregnant, Does it often feel like a problem to have excess embryos left over after you mean it there, When you're starting out, it's like you give me every embryo Aiken, get that just ups my chances of having one or two Children. And so it doesn't seem like a problem. But for many, many patients, it is a problem. It is hard to make decisions with what to do with excess embryos. And I think people don't think about that because they're so focused on just having a child.

spk_1:   32:41
No, that's absolutely true. I mean, think about the journey they go through to get to the point of using donor eggs. So you come into the process thinking I need every embryo possible. I want I wanna have 15 embryos. That's what it's gonna take for me because I've used my own eggs three or four times and I haven't had a pregnancy. So I think that one they think they want at many because they need that Betty. And then, too. I also think that loss of them just don't believe that they're gonna have excess embryos left room.

spk_0:   33:11
Yeah, that's that's like too much of a good thing,

spk_1:   33:13
exactly. There's exactly too much of a good thing, and they just don't They don't believe that they're gonna have that. And that's usually What I've seen in the past is people thinking just that and they end up with a whole bunch of embryos, and again they have to decide what to do with him, and that's it. That's a tough choice to have. If you got a little child running around, whether it's whether it's an infant that you're holding or you know, a 3456 year old running around, it's kind of like giving up your Children at that point. So you know, of course, you got these embryos in a tank that are frozen, but the way you see them is like this child that's running around, and that makes a very difficult decision for you two to go on. And I was in this business a little bit before I got into the donor business. And you know, I can't tell you how difficult the decision is for people. They just They're people, abandoned embryos, they just disappear, you know, they go away and you can't find him again. They don't pay their bills and company that worked for for many years. We started doing this and we actually sent out detectives to see if we could find the people. We didn't want to pay the bill. We just wanted to say, Look, this is what I'd like done with my embryo because we always felt bad about destroying embryos or getting rid of every isn't and probably most practices in United States feel that way. I know that when I talked to a lot of most people, they don't dispose of embryos. Even if the people have disappeared or whatever, They won't throw away embryos because they think too highly of them. You know, they they are the potential for life, and they just don't want to throw them away.

spk_0:   34:39
And it's hard to of your choices are at that point to either thought and discard. And for some people, that's not a hard decision, and that is the easiest. And that's what they do, you can donate to research. But generally speaking, the only research that's really available now is individual clinics. Who would utilize Amber is in their own lab for training purposes because a lot of the places that we used to recommend that might accept embryos are no longer accepting them.

spk_1:   35:10
An interesting enough. A lot of them are doing research. They're looking for non normal, imperious If if you have something, has a genetic disease to it or something that nature, they'll take those. But they won't take your normal embryos because they're just they're just not doing that type of research.

spk_0:   35:25
Yeah, you're exactly right. Yes, or you could donate your embryos to another couple for them to utilize and building their family. Or honestly, a number of people just continue to pay the cryo preservation bill because they don't want to decide. And then I can't tell you the number of people that I know through our support group who transfer. And even though they really don't want another child, they just can't live with with any of the other options and ah, and that seems counterintuitive, but it really isn't and they have very mixed emotions about whether they're really hoping that the embryo implants or not

spk_1:   36:05
well, and many of them will do what they call a compassionate transfer so they don't get on the wrong on the wrong day. So, you know, in the middle of the other cycle where they're not going to get pregnant and they're doing just to basically dispose of the embryo in a way they feel better about,

spk_0:   36:19
Yeah, you're exactly right. Yes, and I have definitely seen couples. It helps give closure, and that's and that's worth quite a bit of absolute. All right, so how are egg donors chosen? I suppose, in this way, is there any difference? And it probably isn't much difference between how you choose fresh are frozen donors for a fresh cycle versus a frozen cycle. So maybe I should start by asking matter. Is there any difference in if so, what is it?

spk_1:   36:48
Well, I don't truly think there is any difference again. That big thing would be. Most egg banks would have a larger variety to choose from, so that you might find something better about better, but bigger whatever. You might find more variety at a you know, because it's

spk_0:   37:04
better for getting the better choice. Better. 50.

spk_1:   37:06
Most clinics have a limited number of egg donors potentially available, so otherwise, I don't see much difference in choice. Um, you know, most of most the egg banks, we have standards to meet, you know, education and that sort of stuff. But, I mean, in all honesty, if you meet all our other all of our other criteria, you know, first and foremost is it. It's a good, healthy donor. We want to make sure that all the kids that we put out come from good, healthy donors to start with so potentially, that provides good, healthy eggs to make good, healthy babies.

spk_0:   37:38
So you do ask family the most 24 or 25 year olds or, you know, are healthy, thank goodness. But do you ask scream for potential genetic conditions? Do you ask questions about cancer in the family and things such as

spk_1:   37:53
we have? We have a full medical screening. So in addition to being examined by the physician, we do, ah, full backgrounds. We asked about what your parents, what did your grand parents die of? What did your parents die? If they are and we look for things like that. So if you have cancer that runs in the family, we generally won't take you especially like example breast cancer. If a donor comes to us that she has breast cancer in the family, she's probably not gonna become a daughter for us unless she's done screening to prove that she absolutely doesn't have it. But that's the biggest difference. Is is we screen them so well.

spk_0:   38:27
So what about genetic testing?

spk_1:   38:29
Sorry, I forgot about that. Forces, Yes. Yeah. Genetic testing we screen donors for carrier status is so we look personally Christ, we look at 47 carrier diseases. Unfortunately, there's 300 sixty's, however many they screened for these days. But this is the number that's recommended by Genetics Committee and uh, S R. M. Just for that. I'm sorry incognito, but it s our embed a cog. The American Association of Obstetricians and Gynecologists. Right. Looking at a certain things and we scream for those. Those are the most common things that come up with reproduction, you know, But sadly, it's not everything. And at some point in time, we hope to screen for more looking at everything that we can test for but some of the things that we screened for, there's also a lot of variants to it. So, you know, there may be one time that you can do and they can test for that. But they can't necessarily test for every every portion of it. So that's kind of a quandary that we're in now is is being able to match people with donors that match exactly like its carrier status that they have doesn't match with carrier status that recipients have.

spk_0:   39:36
Yeah, me an example of that would be cystic fibrosis. Yes, Uh, the dumpster. That's one of the

spk_1:   39:42
four, essentially a cystic fibrosis, Tay Sachs, sickle cell. You know, that's that's what a lot of you know, even in the old old days, you know everybody. They screamed ethnically. So if you were, if you were Jewish, you've got spring for Cassie Mia's and tastes access or stuff, and everybody got screamed for CF. But the screening was limited. We have six or seven things to be screened for, depending on what your ethnicity was. But again, today we're screening much, much more, and I think that's something that's gonna grow and grow and grow, and every year we get, we get closer to screening for everything

spk_0:   40:17
and you think it will stay itjust carrier screening are or will you scream for? I mean, it's It's such an interesting ethical question about people we think I'll just screen. It's all you know. Why wouldn't you, you know, just screened for everything. But it's not like it's so black and white, and then you're providing information that could be really hard for somebody to make that the donor herself may not choose to have this information.

spk_1:   40:41
Now that's that's the that's The thing is we can't spring for everything. It seems like we could seem like we just sprint across the board. What? Some of the screening test is extremely expensive, and it's not something that affects just a very, very small fraction of people. So it's not something we can do across the board, and some tests are not conclusive. So, you know, if you get screened for again, you gotta back different variants of things. So you know, you screen negative for one thing, but it doesn't mean that you can't transfer in another form, just somebody else. So you know, it's just a huge question. Once the technology is there, we can certainly do more. But right now I think we're where we should be getting better all the time. And, you know, the thing to point out is, do you screen your partner for the same things that we screened for? Okay, I still argue that donors that you get from egg banks are probably sprained much better than most people spring their partners. You know, most people, most people, they don't do any screening, they just have babies. And then it's fun, and it's either fine or it's not. You know, I think sometimes in this business, whether it's sperm donors, your egg donors, I think there's a perception that you're gonna get a perfect damn it. And that's not always the case. We're trying to do as good as we can. But there's still things that elude us.

spk_0:   41:58
You know, in the more ability we have to test, the more the expectation is that nothing can go wrong. And that just isn't the case,

spk_1:   42:05
absolutely. And I just actually read a paper this past weekend about legalities of testing like this, and you know, there's there's several suits out there where practices has tested for a certain disease or something, the screen negative. But there is either an error in the testing or the testing didn't cover the particular strain of what they were looking for. So it's still a really, really hard subject to deal with,

spk_0:   42:31
right, and they're still further testing that can be done, and that is testing during pregnancy itself. But that's been that that raises a lot of other hard decisions. So that's so people are wanting to screen everything they can out. And I mean the other thing to consider. And I don't know how many. If the donor has been screened for carrier, what percentage of the donor egg frozen cycles are frozen are fresh cycles, actually, then go on to do genetic testing of the embryos themselves. Because again, we're not looking. We're not expecting to see from a zonal abnormalities because they're not that common in 24 25 year

spk_1:   43:11
old. No, that's that's actually true, And I really don't know the number that actually go ahead and do the P g t. A or whatever. Um,

spk_0:   43:18
I don't I

spk_1:   43:19
really don't know. I think with in house I would say probably less than 10% of everybody using our eggs has that done? But it just depends. And again, you know, some clinics just do it routinely. And other places, other places, you know, that's what the what the recipient wants. It is usually a very small number. As of right now.

spk_0:   43:42
Yeah, because you're not expecting crumbs are chromosomal abnormalities, which is one of the main reasons.

spk_1:   43:47
If you have several embryos, you have a donor effort with three of Priya's. Okay, so if they're crumbles, only abnormal. Other than two conditions, basically, they're not gonna survive. They're not gonna do anything. They'll kill aboard. They won't become a baby. So you know, it's not that the end of the world to just go, OK, I have three here. Will do the transfer, see what happens. So it's almost more practical from a monetary standpoint to not do screening and just do transfers. Of course, the downside is you have things like, you know, trust every 21 or something of that nature. But those were few and far between, and egg donor age girls,

spk_0:   44:24
right? Yeah, that's that's the other thing. Well, I guess that goes back to where you were saying at the beginning that ah ah, lot of the genetic testing at that point is being done for families who know they have a daughter and they would like to have a son. So gender matching are they have a strong preference for one gender over another? Exactly. Yeah, but let's The genetic testing is not inexpensive, and most people are paying for it out of pocket. So

spk_1:   44:51
exactly they know of very few insurance is a cover.

spk_0:   44:55
Yeah, even even insurance that covers IVF. Unless maybe there's a medical reason

spk_1:   45:01
for it. Yeah, everything's peachy. Ta. Usually it's not covered. But if they were doing specific genetic screening, that may be covered.

spk_0:   45:10
Yeah, but again, for donor egg, it would be fairly unusual.

spk_1:   45:14
Yeah. I mean, in the most cases, you would have to think that it was more of a sperm issue. That an egg donor issue of that case?

spk_0:   45:21
Yeah. At that case, you would think that, right?

spk_1:   45:24
Let's say that said, you know, I mean, even young women, they probably have an unemployed of about 30% of all their eggs. They're still in employed, but they often just don't develop well anyway. And you just don't end up with that many unemployed eggs.

spk_0:   45:37
Yeah, they're not going to. You're saying you're, um you're making choices on freezing based on morphology, but they tend not to look normal as well. Got your interesting. And so how often do you see dual donor cycles where donor egg and donor sperm are both being used?

spk_1:   46:00
Ah, that's a good question. Well, okay. We do have a homosexual crowd these days, okay? So obviously, if if they're homosexual, sometimes we will use both. I've seen that actually more with them, and I'm not sure exactly why. Either. They don't want to use one partners and not have the other partners. Otherwise, maybe to buy more eggs and do do both partners. But I have noticed that a lot of homosexual couples will use a sperm better, and that's kind of odd to me, but I've seen that overall, I would say probably about 5 to 10% of all cycles that we do. Our donor daughter.

spk_0:   46:37
Yeah, and I would think it with less means it might be more common only because they would be If they are older, they're gonna need obviously unless

spk_1:   46:46
being a very good point. Yes, Absolutely.

spk_0:   46:48
Loves being single is gonna They obviously gonna need sperm. But we're seeing lesbians couples anyway, making the choice to have Children younger. So we're not seeing as many fertility issues, but I think it's still not uncommon for waiting until they're at an age where fertility could be a problem. So

spk_1:   47:09
and it is probably even more so true today. I mean, we probably have for you. I hate to see you to turn colder, because, of course, 40 is not necessary. Older. But, you know, older

spk_0:   47:18
sure doesn't seem old to me. Exactly what?

spk_1:   47:21
You probably have a lot of that age 35 to 45 year old lesbian couples who haven't had the opportunity previously. You know, we just had more time for gay marriage, much more of that thing. So So they haven't had Children for prior to this, but they are probably interested in it now. And that we would be a situation where, you know, they may need both.

spk_0:   47:44
Yeah, Okay. I was just kind of curious about that. All right, so we got a question from someone in our audience wanting to know how much our donors paid that you've talked about how much a fresh cycle is, and I'm assuming that you at least part of that, is going to the donor herself. But so how much are donors paid? And does it matter? And if so, what factors influence how much she has paid?

spk_1:   48:14
Well, we have a set rate, so we pay a certain amount, depending on whether they're anonymous or not. Anonymous donors We pay him $500 more if they're not anonymous, are reimbursement rates. We pay $5000 for anonymous donors. We pay for 5500 for non anonymous donors, and that's pretty much, uh, standard. You know, they may end up paying a little more California. They manage paying a little more in New York, but I think that's kind of the range anywhere from 4000 to $8000. It is pretty much the compensation for the daughters.

spk_0:   48:47
How many times can a donor donate

spk_1:   48:50
a SA? M says you can do it six times. I've never had a an egg donor do six cycles. Um, I think I think our Max, I think we've had three, and even at that That's probably the most that I'm I'm willing to go. Yeah. Yeah. Six times is the max according to the s arm.

spk_0:   49:08
Wow. Okay, Yeah. One has to question whether that's, uh, good for her saying,

spk_1:   49:14
I can tell you, I was last year. I was at Astra and, you know, I was approached by several Ukrainians, Russians, and, you know, a guy was telling me We'll get you all the eggs you need. No problem. Get you all the action really, really cheap. And then he goes on to tell me that he retrieves these girls 13 14 15 times and they're and they're paying. I'm about 2 to $500 per cycle. And me? I mean, it's exploitation. It really is great. Argue that Well, you know, for them, it's great money. It's a month's salary, but it is still to me is exploitation.

spk_0:   49:51
Yeah, I would feel the same way. And and although we have evidence that this that we've been doing it a while and we're not seeing a health problems but these air not innocuous medication that you're taking

spk_1:   50:03
absolutely not just in just the whole process of it, it's just I can't imagine going through it that many times I mean, six times to me would be phenomenal. And I have known probably some egg donors in the past that maybe maybe got close to six, but and I can't see going 10 to 15 times. That's just that's crazy.

spk_0:   50:21
Yeah, it is. Yeah, that is crazy. And, you know, and and then we have the because you're not getting that many and they're being distributed geographically. You've got less opportunity for consequent ity. I didn't even practice saying very I know, I know. I didn't even usually I practice beforehand. I completely didn't think about it. That is Ah, where you've got Ah ah, ay Ah too. Well, I guess in this case it wouldn't be the case because you would have two women. I know. I know you could. Yeah. So you know, we're genetically a child to Children who were conceived through the same. It's a concern with donor sperm because of the quantity of sperm we have. When the ease of donation, that's really less of a problem. It's really not talked about much with egg donation. The last topic I want to talk with you about is anonymity. Is it possible there is more and more evidence coming out that it is that the generation of people conceived through donor, gammy, egg and sperm and embryo, for that matter, there is growing concern that there is going to be a movement amongst these people for having information about their genetic background. So there's, you know, a lot of mental health providers are recommending against anonymous donation. So what are the options in either fresh or frozen eggs for choosing a donor that is willing to be known by the child at a certain age? Or they had died that the adult at that

spk_1:   52:02
point? Okay, well, I'll start by saying anonymity doesn't exist anymore. You can you can find out just about anybody. And that's kind of a sad thing because, you know, people who donated in the past, you know, 5 10 20 years ago they kind of expected anonymity. And today they don't have it. So, you know, I understand both sides. I understand the Children side and and the potential parents suck. It is also even more complicated than that. So we set all over the world, and in many countries in Europe, you're not allowed to pick your donor. They have to be anonymous donors. So we offer donors to be either anonymous or not anonymous, and we tell them straight up. You know, you're probably not truly going to be anonymous. If somebody wants to find you out, there's 23 me or whatever else you could be found out. And it's been interesting. In the past 20 years, I've seen a swing where every donor wanted to be anonymous. I mean, every donor years ago was anonymous, and that's what they wanted to be. And a lot of the parents wanted to be that way, too. They didn't want to tell your Children. You know, this is a big secret. Now you've seen it go the opposite way. Now we have. I think probably about 70% of our donors are non anonymous donors, and that just means that they are anonymous today. But when the child reaches 18 they can contact, they contact information. So it's been a big change in the industry, really, had I really think that most of us would would completely go away from anonymous donors, but at the same time we can't place is that just you know Sweden, for instance. Sweden, Switzerland. I'm sorry. Might might might be confused in the two, but what other, too? Yeah, They select

spk_0:   53:40
what does the s European countries. Yes, I've got a present as

spk_1:   53:43
well. That's it. Not that I don't know where they are, but just the regular regulatory stuff. Got it. Confused me. But anyway, one of them, they select their donors. So when you want to go get eggs, they've bought 50 eggs and they say, OK, I have the perfect a piece for you. Come on down to the clinic and let's get going. And you don't know who they are at all. You just that's That's what you know about him. Is there an egg donor? The donor that the doctor selected for you? You know anything about

spk_0:   54:07
it? So you don't have any choice as to saying okay, I want this donor to be it looked like my husband or look like me. That's not an option.

spk_1:   54:16
Well, I don't know that. I mean, I can't say that the doctors may take that into consideration and may say, OK, I've got the perfect person for you. He looks just like you but yeah, theoretically, they make this decision for them and just say this is for your daughter's gonna be so we can't, you know, in that regard, we can't move away from anonymous, but truly, I would I would I think that it will happen at some point in time. But, I mean, I would love to move much, much more away from anonymous.

spk_0:   54:41
Well, and, you know, I'm glad I was really glad to hear you say Anonymous is a myth. No, Um, and it's what people don't realize. It's not that the donor herself, she could choose not to enter into one of the genetic ancestry databases. You know, 23 me or ancestry get calmer, whatever she could choose not to. But if her second cousin of chooses to do it and then that's I mean, it doesn't take super close with for people to be able to find him. And you're right. I mean, your point was well taken that if you think about in particular sperm donors, who in the past had every expectation nowadays I think we're telling people don't have that expectation. But in the past, they had every expectation that they would be completely anonymous. And now they're having to face that Gosh, you know, who do I need to tell in my own family? That something that I you know I did when I was 22 you know, to help pay off some college debt. And now I've got to tell my family. Yeah,

spk_1:   55:44
well, I mean, you can make an agreement with the donors. You could make it a agreement with the recipients. You know, you can say the recipients you not to look for these people, but the thing is, we can't make that agreement or a contract with the child. So every child had No, They're free to do what they want to. D'oh! As much as we'd like him not to track down their daughters, necessarily. I mean, not that we wouldn't like them to know as a courtesy to the to the donors themselves. We can't. We can't control that It all, you know, if they want to go out, do 23 me. That's what they're gonna do. And as is, it's amazing. I was trying to recently get some get some speakers for cars that were doing and one of the places I want to get. Talk was 23 May, and they politely declined my invitation to do so. But, um, anyway, it's kind of interesting. I would like to hear them say, You know, just see if they have any take on it. I think it's an unintended byproduct that donors are being outed because of it, but it is what it is.

spk_0:   56:42
But yeah, that's exactly right. But that is what it is, and it's it is only going to continue and an increase. So exactly I agree with you. So Yeah, interesting. Well, thank you so much. Korey Burke, for talking with us today. Cory is the tissue bank director for Cryo CE, USA International Sperm and Egg Bank. This has been fascinating. I am so appreciative of your expertise in and sharing it with us since is the topic that we get a lot of questions on. So let me remind everybody that the views expressed in this show are those of the guests do not necessarily reflect position of creating a family, our partners, or are underwriters. And keep in mind that the information given in this interview is generally eyes to understand how it applies to your specific situation. You need to work with your infertility professional. Thank you, everyone for joining us today and I will see you next week.