Egg Donation: When to Consider It and Why (Episode 520)

Full Transcript: Episode 520

Lisa Hendrickson-Jack:

Today I welcome back Dr. Marc Sklar to the podcast and in today’s interview we talk about some of the common myths around artificial reproductive technology, particularly as it relates to aging. One of the challenges I feel is kind of like an overarching challenge in our modern day society and culture — our ideas around IVF and other artificial reproductive technology is the idea that it will always be available. You know, if natural conception doesn’t work, then we can just go straight to IVF and there’s a reasonable chance that it’ll work. And though there’s some truth to that, the success rates of IVF are directly tied to a woman’s age — more specifically, the age of the egg itself.

And in today’s episode, we talk about the realities of aging and the statistics around artificial reproductive technology. And ask that question — is egg donation something you have ever considered, and at what point would it make sense to consider it if it’s something that you are comfortable with? So definitely a fascinating and informative conversation.

And before we jump into today’s episode, I just want to share a little bit about Marc. Dr. Marc Sklar, also known as the Fertility Expert, is a natural fertility specialist helping couples get pregnant for the past 20 years. His mission is to help you feel hopeful and confident about your fertility journey again. In addition to his doctor of acupuncture and oriental medicine, Dr. Sklar trained at the Harvard Medical School Mind/Body Medical Institute. He is the creator of FertilityTV, marcsklar.com, and reproductivewellness.com, and he’s a fellow of the American Board of Oriental Reproductive Medicine and a medical advisor for Symphony Natural Health. His highly popular YouTube channel FertilityTV shares information-packed videos to educate his followers on all things fertility. And if you happen to be in the San Diego area, that is where he has his clinic, Reproductive Wellness. He also works with couples all over the world through his online fertility coaching program, the Hope Fertility Program. And so without further ado, let’s go ahead and jump into today’s episode with Dr. Marc Sklar.

And I’m excited to have Marc back on the show. Welcome to the show.

Dr. Marc Sklar:

Thanks for having me. Yeah, thanks for having me. I’m always excited to talk with you.

Lisa Hendrickson-Jack:

It’s been a while. And I feel like you’ve been on the show at least three or four times. So we’ll make sure to link the previous episodes in the show notes. You were one of my very early episodes — I feel like you were in like episode 30 or something like that. It was definitely years ago and it was early on. And I’ve loved to see the growth of the podcast and the growth of everything that you’re doing and the development. So it’s awesome to watch and see.

Dr. Marc Sklar:

It’s excited to be here again.

Lisa Hendrickson-Jack:

Well, thank you. And likewise, you have your award-winning FertilityTV on YouTube, which is fascinating. So it’s also been fun to see your growth and all the wonderful work you’ve been doing.

Dr. Marc Sklar:

Thank you. Appreciate that.

Lisa Hendrickson-Jack:

Well, in today’s episode, we’re talking about something you and I have not spoken about before. I haven’t really delved into egg donation in a little bit on the podcast, so I’m excited to delve back into that topic again. I think it’s always really helpful to provide information because we just never know how the fertility journey is going to unfold. So maybe share with us why this is a topic of interest to you at this stage.

Dr. Marc Sklar:

Yeah, you know, I think as healthcare providers, especially as individuals who have a certain preference — our preference is to support couples naturally as much as we can — but I think we also have to acknowledge first and foremost that not everyone’s going to be successful naturally. And there are so many struggles that couples go through, and there’s so many different stages that they’re at. And at some point, you’re going to have a couple that walks into your office or that you’re coaching that hits a wall — whether it’s mentally or physically, they’ve done multiple IVF cycles, they’ve tried naturally, it’s been years, they haven’t been successful, maybe it’s their age, whatever the circumstances are. And either you’re going to bring it up — and I think sometimes from a natural perspective we’re a little nervous about bringing that up, like it’s taboo to talk about using a donor egg — that conversation is going to come up again, whether you bring it up or they bring it up saying, well, is it time? My REI mentioned that maybe I should consider donor egg. So I think anytime we are supporting couples, we have to be prepared and have the knowledge and understanding to know when’s the right time for them to move in that direction or not, and how you’re going to support them through the process, help them manage that situation.

It’s not an easy decision, but it’s an important topic. And couples — all couples — come to it from different angles at different times in their journey. And I think it’s really important anytime you’re supporting someone on the fertility side of things that we understand a little bit more about donor egg. And I will say, I think we’re much more comfortable and much quicker to jump on the fact that someone might need donor sperm. And we’re much quicker to have that conversation with a couple than we are to have the conversation about donor egg. And I think it’s just important that we understand the pros and cons of all of it.

Lisa Hendrickson-Jack:

That’s really interesting. Could you talk a little bit more about that? Because I feel like that’s maybe not the first time I’ve heard that, but in recent years I’ve heard a lot more talk about egg donation. So I wouldn’t have necessarily thought that it would be… I guess now I’m kind of thinking it through just what you said about being more likely to suggest donor sperm. I mean, I think of it as people are more likely to try to go out and find some or do that part. Is that what you mean? More people would be doing that piece of it and the egg donation piece is less common?

Dr. Marc Sklar:

Yeah, they’re more comfortable, and that tends to happen sooner in someone’s journey if it’s needed than moving to egg donor, which — I totally understand emotionally we want to try with our eggs for as long as we can before we switch, and I’m not pushing anyone to do that sooner than is really necessary. But I think because we deal so much more with women in the fertility journey, I think it’s a bit easier to make that suggestion to use donor sperm sooner in that process — at least it is for me. I should speak for myself. I find myself when I’m working with couples and I see some tendencies or some deficiencies on the sperm side of things and we’re seeing that they’re just not changing with treatment and time, that I would probably — let’s just say after six or nine months of we’re just not seeing progress and this is not happening — I’m much quicker to go in that direction for men. Whereas for women, I’m more — I want to try longer. I’m like, I think we just need longer time to see if we can make this change. But some women don’t want to try longer. They’re like, this has been a long journey for me, and I am open to using a donor egg — should that be something I should be considering now? Like, these are the sorts of conversations that I hear, and I’m hearing them more frequently now than I did years ago. And I think it’s important that we’re prepared to have those conversations.

Lisa Hendrickson-Jack:

Well, and I mean, generally speaking, what are some of the situations that you’ve seen where you’re feeling like, okay, this would be something that I would recommend? And just to kind of add to that question — I feel like I’ve spoken to some women who, for them, it feels early in their journey, who a doctor is telling them things like, the only way I’ll be able to conceive is with a donor egg. Like, this might lend itself more to the conversation we had in our most recent interview together. But I feel like sometimes women are feeling like this is being pushed on them and it’s unfair. But then even though the bedside manner might not have been there, there may have been valid reasons why that medical professional was saying that.

Dr. Marc Sklar:

Yeah. I think for me, the number one qualifier is I’m going to look at age and either AMH or ovarian reserve or antral follicle count numbers. I’m going to start to look at some of those variables when I’m looking at potentially having this conversation. But if someone has not at the very least tried with their own eggs — I’m assuming they’ve tried naturally if we’re having this conversation — and they haven’t also simultaneously tried with their own eggs with IVF, I’m always going to suggest doing that first and foremost, because they typically say, I don’t want to regret not trying with my own eggs before I consider donor egg. I’ve had few exceptions where someone says, look, I just know my odds are better with donor egg, I only have a limited amount of resources and finances and time and patience, so I’d rather start looking at that now. Which, again, we all are at a different place in this journey and it’s important to meet them where they’re at.

But I think if it’s just me helping to guide them, I think for me it’s anyone, once we hit 43 and older, they’ve tried maybe multiple IVF cycles and haven’t been successful, their AMH might be lower, their antral follicle count might be lower. Those are for sure times where I would say, you know, maybe it’s time that we have this conversation. But the first part of that conversation I’m always going to ask is, is this even something you’re open to and wanting to consider? Because if it’s not, we’re not going down that road. And we’re going to look at different avenues and different options for what they can do to continue down the journey. But if they are open, then I say, well, I think it’s time that you guys as a couple start to have this conversation to see if it’s even something that works out for both of you.

The scenario that you laid out earlier about even some of these younger women who are being told that, oh, you should go to donor egg — I’m not the biggest fan of that scenario. That really bothers me. I get really upset when I hear those things. I think there are few exceptions to that. If there’s a woman who’s younger, let’s just say somewhere in her 30s, and she’s not menstruating regularly, maybe has amenorrhea, her AMH is extremely low, FSH is really high, and we’ve been trying to regulate that for a period of time and that hasn’t worked out — I think maybe in that situation it’s an appropriate conversation to have. But I see so many times where that’s not the case. They’re just — it’s a woman who’s 38 and she just hasn’t been successful, but her hormones look relatively fine, maybe on a scan they’re saying that they don’t see as many follicles as they would like to see. And in the fertility clinic’s mind, their success rates are going to be higher if you use donor, and they’re not sure what their success rate will be with you in that situation. So they’re much quicker to just say, oh, let’s jump to donor egg. Those situations drive me crazy. I’m very frustrated by that because that becomes a statistical thing for them — what’s better for their statistics and maybe what’s better for their bottom line. And I’m not a fan of that situation.

And I have plenty of those women who we’ve worked with, supported, and been able to help get pregnant naturally. But I think for those individuals who maybe they’ve been trying for several years and they’re just tired — you could hear it in their voice and they’re thinking about giving up — I think those are times where it’s worth having that conversation. Because the success rates with a donor in the right situation are definitely much higher for those individuals. They can go to basically an 80 or 90% success rate of having a child and having a healthy pregnancy, versus low teens or lower than that when we’re talking about success rates for trying with IVF. So those are all reasons to consider potentially looking at that option.

Lisa Hendrickson-Jack:

I mean, I think one thing about this conversation is it’s really geared to clients who are already looking at artificial reproductive technology. I think one of the myths around ART — whether it’s IVF or IUI — is that this is going to be the safety net. So regardless of how old you are and all of that kind of stuff, that it’ll always be there for you. This is one of the myths and it’s harmful to women because we’re not educated about these procedures and we’re not educated about how our age affects them. So we had a podcast episode together and I’ll link that where we talked through this concept of AMH and how low AMH isn’t necessarily reflective of a woman’s natural fertility. And so we had this whole conversation around how women are being told that because their numbers are low, it means they won’t be able to conceive, et cetera. But the one thing that these numbers do predict fairly well is how successful a person is going to be when they choose to go through IVF. And so you listed some very specific factors — age 43, AMH numbers that are low, and antral follicle count numbers that are low. And these are some of the things that would encourage you to talk to a couple about the possibility of egg donation. And I feel like on its face, it could sound like, well, I thought we had this conversation before about age and how it wouldn’t necessarily impact natural fertility — but we’re not talking about natural fertility. So maybe share a little bit about some of the realities of IVF, because I feel like this is a really big issue when you have women in their 40s going to get IVF and they’re not necessarily told how slim the chances are of it working with their own eggs.

Dr. Marc Sklar:

Yeah, you are 100% correct. We’re talking about a very specific population of couples — my assumption is they’ve tried naturally, it hasn’t worked out, they’ve decided that now it’s time for them to move forward with IVF, and in this situation they’ve even tried IVF maybe once, twice, three times or more. I actually just spoke to someone yesterday who said they had a couple who tried 15 IVF cycles, okay? Which goes to your point about success rates. So they’ve tried IVF, they’ve realized that it’s exhausting, the success rates are relatively low for them, they’ve spent a lot of money, and if they want to continue, their money would be better spent with a donor cycle where their success rates are so much higher and they really have a much better chance of conception.

And coming back to those success rates with IVF — if we are just talking about general success rates overall, not talking about age-related or condition-related success rates, they are somewhere around 35% that you will be successful with IVF after about three transfers of IVF. I say transfer specifically because we live in a world where IVF is now really separated very much into two parts — you’ve got the retrieval part and you’ve got the transfer part. And when we’re looking at success rates, it’s not about how many retrievals you’ve had. It’s about how many transfers you’ve had that can lead to a successful pregnancy. And so odds are that your first IVF cycle — your first transfer — is not going to be successful in most clinics, in most circumstances. And that 35% is a general number across the board.

So that number only goes down as we get older. If you did a search on the CDC website or SART — which is where all the clinics report, or all the ones that want to report, because you’re not mandated to report your statistics — when you look at that and you start looking at older couples and their success rates, you look at these clinics and there’s 50 transfers and one success, or two pregnancies. You’re looking at these numbers across the board in all these clinics and these numbers are low overall.

And there’s a big misconception — and it has been for a long time, because of the way the marketing is and the media coverage of IVF — that we go into this thinking, oh well, I always have the safety net of IVF, and IVF is — I see all these people getting pregnant with IVF, so I’ll be successful, not a problem, so now it’s time I want to move forward with IVF. But why am I not getting pregnant? It’s not often that they’re talking about success rates. And so I think it’s really important that we understand that.

And when you’re seeing couples who are in their mid to early 40s and you see that they’ve gotten pregnant and had a child, your assumption today should be that they’ve used a donor. I mean, if you’re looking at all the media coverage on famous people we know that have gotten pregnant older — they like to cover, oh look, they’ve gotten pregnant, and they just had their baby — they might not talk about it, some of them do, some of them don’t. But my assumption is that they used a donor because the likelihood of them getting pregnant with their own eggs at 45 or 44 is low. And certainly the likelihood of them getting pregnant with their own eggs and having multiples is low. And so but they don’t talk about that in the media as much. And so we see it as the public and we just see it as, oh well, so-and-so got pregnant with IVF — oh, you know, I can get pregnant too. And it changes our understanding and preconception of what potential success rates are going to be in that process.

So I think it’s really important to have that understanding and knowledge that if you’re 41 or 42, you can try IVF, but it’s important that you understand that success rates are not in your favor, and that I have a reality so that I can go into it with the right approach and understanding.

I just had a conversation with a woman that we support in my coaching program and she is 45, and she was frustrated by going into the IVF clinic because they said, you know, I think you need to consider using donor egg. And at her age that’s the right conversation for them to have, and it shouldn’t be unexpected — it would surprise me if they didn’t mention it. But she had already said the frustration part is that she already said, I really want to try with my own eggs, and they didn’t hear that. So the frustration for me is that there’s a time and a place to bring up the donor part. She clearly said, I want to try with my own eggs. And my conversation with her was, I’m open to donor, but I’m not open to it today. I want to make sure that I have tried with my own eggs and I feel confident that I’ve tried before I move in that direction. So I just said to her, don’t let them push you in that direction now. Just tell them that you’re not ready today for that, you want to try with your own eggs, and after you try with your own eggs you will be open to considering using a donor. She just had to be more forceful in her conversation with them and more direct with them — telling them, this is what I want and I’ll consider what you’re suggesting afterwards.

Lisa Hendrickson-Jack:

Well, question for you. In that example, your client was 45. From a practitioner standpoint, I think this is one of the challenges and this is why education is so important. When you look at the data of IVF success rates for women who are over 45, there are basically no success rates. It’s very, very low in terms of live birth rates. So there’s a part of me that feels that it’s unethical to take someone’s money when they’re 45 — because it’s not free, thousands, tens of thousands of dollars — when really the chance of it working is maybe 1, 2%. It’s low. But then balancing that with honoring your client and wanting to make sure — I would imagine that’s a difficult line to walk. And not all medical professionals have the best bedside manner when it comes to that stuff.

So I think that’s a big part of the problem. If you were to have that conversation with a client and lay it out in a human way — because I feel like sometimes just the human part is totally lost, they’re just provided this information in the most cold and callous way — but if you were to have that conversation ensuring the person is truly making an informed decision, that’s what I’d call informed consent. Like, I don’t want to discourage you, we never know what’s going to happen, but you really need to know the stats on this and the data, right?

Dr. Marc Sklar:

Yeah, because the IUI numbers — intrauterine insemination — are even worse. And I feel like you’re just taking someone’s money if they’re over a certain age and you’re doing these procedures knowing that the success rate is so low. There are a handful of doctors that I work with in IVF clinics that — one, they’re clear on success rates with them. And I think of one conversation with one IVF doc specifically where he’s like, look, chances are not in your favor and I don’t want you to feel like you just wasted your money. You need to be clear that this is something you want to do before you move forward, that you don’t just feel like this is a money thing. And that’s essentially what he’s saying — he’s not pushing you to do the donor eggs, and he doesn’t want to just take your money.

And I know clinics that won’t accept a patient after a certain age unless they’re going to use donor for this very reason — because they think that’s not fair to you, and they think that’s just taking your money. And I have other clinics who will say, well, we have this informed consent conversation with them but if they want to try, we’re here to support them. And it’s it’s tough — there’s both.

I have another example of a 47-year-old who is trying with IVF and trying with mini IVF. But her and I had a long conversation before she ever went in that direction because I said, look, I want you to know the success rates are very, very low. They are not in your favor. But I see the anguish in your eyes and when we have these conversations I see the pain of not trying and not even having tried. And I mean, she said as much before I ever got there. But she was the type of person who if she didn’t try with her own eggs — fortunate for her she had the financial means — she would have regretted that for years to come. So in her case, even though she’s 47, she knew she had to try with her own eggs before she could even consider donor. I don’t even think she’d consider donor. You know, so in her mind, this was it. This is what she was going to do.

So there’s this — we all go through this journey from a different place, and we end up in different places from one another. We approach this journey so differently. Those who have limited means are going to approach it differently. Those who have more capability financially are going to throw everything they can at it. And then there’s everything in between. Some people from a religious or spiritual perspective don’t want to use donor, so that’s not even part of their thought process. So the approach with them is going to be completely different.

I think the biggest thing for a practitioner in this space is to be able to meet those couples where they’re at, be able to support them through their journey with compassion, but also be able to make suggestions even when they’re hard suggestions and difficult suggestions, even if they don’t want to hear it. You’re bringing it up so that they understand this is an option. Let them have the right to say no. Like, sometimes we don’t want to have those uncomfortable conversations because they’re difficult and uncomfortable for a reason. But maybe this has happened many times — someone was like, no, no, that’s not for me, and they come back like two weeks later and they say, you know what, I gave it some thought and I talked about it with my partner and it’s more important for us that we have a child that we can nurture in this world and pass things on to than that they’re biologically ours 100%. And so we gave it some thought and I think we’re coming around to this idea. If you don’t present the option, they can’t decide if it’s the right thing for them. And that’s important — they have to be able to make that choice.

Lisa Hendrickson-Jack:

Well, it’s interesting because one of the things that I’m known for is going on about birth control and this whole concept of doctors not telling women about the side effects and so on. So if we as practitioners don’t inform — even when it’s uncomfortable to have these conversations, to tell somebody what the rate of success is — if we’re not even comfortable to have that conversation, we’re doing the same thing.

But I feel like you raised an important point as well, which is that you kind of have to be neutral about everything as a practitioner because it’s not about you. You would work with some couples who are absolutely not going to do this — this is just not within their realm of possibility, whether for financial, ethical, religious, or whatever reasons. And then you’re going to have other couples who are open to it but hesitant. And even the example that you gave of your client who is 47 — which falls into the research territory where there’s basically 0% — but also understanding her perspective and knowing that that is likely what she needs for her own reasons, and respecting that, even though professionally you can look at that and say, well, probably 0%.

But at the end of the day, we don’t know what the outcome of anything is going to be. You can’t say this is definitely not going to work or whatever. Certainly I think it’s helpful to be informed by the research, but this is definitely a challenge — to actually be that supportive where your client could choose something that you might not agree with or you might not think is a good idea. But it’s not your choice. It’s actually their choice.

Dr. Marc Sklar:

Yeah, that actually happens all the time. I make recommendations and they’re like, no, I don’t want to do that, I’m going to do this. Okay — it’s not my place, I’m here to support them and meet them where they’re at, and then they make choices on how they want to approach that. Just because if I was 47 in that same situation, I wouldn’t move forward with IVF — doesn’t mean I’m not here to support her in that decision when she wants to. We’re here to support them. And as providers, I think that’s really important, because it’s not about us. We would make totally different decisions when it comes to our own healthcare, or we think we would — until we’re in the situation, because you never know what you think you would do and then you find yourself in the situation and you do something totally different.

Lisa Hendrickson-Jack:

Well, one of the topics I want to touch on before we wrap up today is just the idea of how to select a donor. I think that’s a really interesting concept. I remember years ago, I recorded an episode about this topic and my guest went into great detail about the requirements for a donor for her egg donation clinic. And even hearing about the requirements of what is necessary to be an egg donor can be kind of jarring, especially because we don’t educate our population about fertility at all. This goes right back to the discussion of — the world would be different if when we were in high school, teenagers, early 20s, that we were educated about the realities of fertility and the limitations of artificial reproductive technology. So that we wouldn’t necessarily have as many couples in their early 40s thinking that it’s going to be as effective as they do. And not really understanding what you said — when you see somebody in their early to mid 40s or late 40s who has just had a baby, we should actually be starting to think, like you said, they probably did go this route because that’s biological reality when it comes to IVF especially.

So I had a question — going back to the donor piece of it. Maybe share a little bit about some of the requirements and some of the things, like if you’re selecting a donor. I know some people do that where they have their sister donate an egg and things like that versus what a clinic would accept for a donor.

Dr. Marc Sklar:

So first, if you’re working with a donor agency, they have very strict requirements for a donor to be able to donate their eggs. It’s not done haphazardly — it’s not like they’re on college campuses looking for people and the next week they’re donating their eggs. It’s not like that. There’s lots of testing that needs to happen, psychological evaluations, hormone testing, genetic testing, lots of paperwork and legal work to be done. All of these things have to happen. And it’s like a checklist — at any one of those steps if something doesn’t work out, they’re out.

There’s a preliminary initial questionnaire that every agency has to filter through these individuals, because depending on how they’re finding them, they could be getting lots of individuals coming in, so they have to be very selective. They have to have people who fit the criteria that they’re looking for. So it’s very detailed. I don’t want anyone to think it’s just some random person that they found.

I will say that when we’re talking about finding an egg donor, lots of IVF clinics have an egg donor agency that they’re connected with — but by that I mean legally, it can’t be part of their fertility clinic, so they have to set up a whole separate corporation to be able to manage those things and have basically two separate entities so they’re not necessarily influencing one another. What I find with those specific agencies is that they are limited in the amount of donor options they have for you — it’s not what they mainly do, so they have this as kind of like a benefit to their patients, and as a result they might have like 20 or 30 donors that you can pick from.

In my opinion, you want to work with an agency who’s got a big donor pool to choose from because I think that gives you many more options for a lot of reasons. And don’t feel like just because you’re working with one fertility clinic that you have to use their donor agency. I would suggest also looking at others. And I know at this point you’re kind of like tired and exhausted with the journey and like, okay, they recommend this company so I’ll just use them. But it’s a big decision, and I think you need to give yourself as many options as possible. Maybe look at two or three agencies first and foremost, narrow it down, look at their options. You don’t have to commit to any agency to look at their donor pool. So start to look through it to see — do I see anyone who fits the criteria that I’m looking for?

And then this comes back to — well, how do you select your donor for yourself? I think this is a really important question. What I suggest is that both partners — assuming you’ve already had that conversation and you’re on the same page and moving forward — I suggest that each one create their own list separately from one another and prioritize the things that are most important to each one of you. Then bring that together and have a conversation and come up with a joint priority list.

For some individuals, education is the most important — like they want someone who’s from an Ivy League school, or a doctor, or a lawyer, or whatever. For others, it’s about the way they look — they want someone who looks like them. Or if you’re Southeast Asian and from a specific country or region in that country, you might have very particular requirements about what you’re looking for. Religious background — if that’s important, that’s going to determine some of those things for you. Those will all really change what options you have and who you’re looking for.

So I think the most important thing is determining as a couple what are the one, two, or three most important things to determine where you start. And then — even though you might think it’s really good to just be really narrow in your selection process — initially I suggest being a little bit more broad. Because you don’t know if the donor you want is going to be available with the timing that you want. Are they being used by somebody else? Maybe they’re no longer donating but they’re still in the database. So having a bigger pool is important, and then having some backups so that you understand — just in case this one doesn’t work, do we have others that we would be comfortable with as well? And really a good donor agency is going to have a team that’s going to support you and help guide you through that process.

Lisa Hendrickson-Jack:

Yeah, you said a lot there that was very enlightening — some things I hadn’t considered in terms of the specificity of what type of options you would be using and the characteristics of the individual and all of those things. So is egg donation typically done fresh, where the cycles are synced up? A friend of mine did that — she donated eggs and she had to be put on the birth control pill at the same time as the recipient, et cetera. Or is it ever done with frozen?

Dr. Marc Sklar:

It can be done in any one of those ways. There are a couple different ways. The egg donation agency that I refer to the most has multiple options. You can do a fresh cycle, like you just said, where you find the donor, they get synced up with you — or in some cases now they don’t even have to sync up as much because if you’re doing testing on the embryos, you don’t have to sync up in that way like you had to years ago. But they would still be fresh to you — you’re choosing the donor and all the eggs that that individual creates are for you to use and fertilize and create embryos with. That would still be considered a fresh cycle.

You can use frozen eggs — so you’ve picked a donor and then the agency tells you, oh, we actually have eggs already frozen from her that you could use if you wanted to. The first option — the fresh cycle — is going to be way more expensive by the way. That’s the most expensive way to do egg donation. But some people really want that — they want to make sure they get all those eggs and they’re fresh and they’re for them.

The frozen egg option is typically less expensive. It’s based on the amount of eggs that you’re able to use or that you decide to use. So if you want three eggs or six or nine or twelve or whatever the number is, the cost is going to be based on that. But the time requirement for that is typically shorter because those eggs are already frozen.

And then there’s another option where you could do a split cycle — that’s either fresh or frozen — and that split cycle means you’re sharing the eggs with another couple. So that’s also a way to cut your costs. If this individual produces 20 eggs but you only need 10, then another couple could use the other 10. And so that’s a way to have less of an expense. And again, that could be fresh or frozen as well.

Lisa Hendrickson-Jack:

This is kind of a random question, but I have heard concerns raised about egg donation in the sense that who knows what the consequences are of these young women being stimulated in these half IVF cycles where they’re giving their eggs without the subsequent placement, and if that could possibly cause any issues in the future. I’m not sure if you’ve read any research around that or if that’s something we should be concerned about.

Dr. Marc Sklar:

I don’t think the research is definitive on that. And I would be more concerned — and it should never get to this point, although it can — I would be more concerned for that individual if they had been a donor, let’s say, three, four, five donation cycles or plus. Like, that would be much more of a concern for me than a woman who did one donation cycle. Now, most agencies have requirements around that — you’re not allowed to donate past whatever number. But if that same individual works with this donor agency and then goes to a different donor agency and doesn’t disclose that they’ve been a donor previously, then we would never have that information. We would never know.

Lisa Hendrickson-Jack:

Yeah. No, that’s an interesting point as well. Well, I mean, this conversation — as all of our conversations are — has been fascinating and really informative. I feel like anybody who was tuning into this episode to learn a little bit more about egg donation, or if they did have that frustrating experience where their practitioner was telling them they should do it, this might have hopefully provided a little bit of clarity as to where some of that comes from, and to provide the explanation of some of those situations where it would make more sense.

And from anyone who’s listening to some of my comments around IVF — I do feel that the informed consent piece is where it all should lead back to, because there does come a point where artificial reproductive technology no longer works. There is an age at which it doesn’t work unless we look at other options. And that’s essentially what we’re talking about. We’re talking about when we’ve reached that point where from a scientific standpoint, based on the research, it’s just no longer effective. And when you get to that point, what are your options if you want to persist and look at other ways to build your family?

So I want to thank you for being here today. If you could share a couple of takeaways for somebody who is really interested in this conversation and wants to learn more — feel free. And also you can share a little bit more about you and where we can find out about you and all the work that you’re doing.

Dr. Marc Sklar:

No, thank you. I love the way this conversation went. And my hope is that those listening will find a lot of value in it, whether they’re just trying to educate themselves or maybe they’re in a situation like this where they’re considering it, or they’re a little bit older and they weren’t considering it, but now based on our conversation they might be more open to using a donor.

I think the biggest thing that I’d like to impart to everybody is that I think there’s a place for egg donation and using an egg donor. And I think the biggest hesitation that I always hear from couples who go down this road is that, but that child won’t be biologically mine. That’s not 100% true. When you are carrying that child, you are passing on your genetic makeup to a certain extent. So there’s a small percentage — and the research does show this — of your genetic makeup that you are absolutely passing on to that child. And hopefully they also have your partner’s sperm, and so they have their genetic makeup. But in the end, every couple tells me the same thing who used a donor — they’re so glad that they did. And the most important thing for them was that they have this child in their life now that they wouldn’t have had otherwise. And I have yet to have a couple who ever second-guessed using a donor. They’ve never shared that to me. They’ve always been thrilled about that. And so I think that’s a big takeaway that I want everyone to have — there’s certainly a place for it. And it’s a really special opportunity that is available to everyone who is interested in that.

If anyone wants more information on me and what I do, I always say my favorite resource — which you mentioned at the start of this episode — is my FertilityTV station on YouTube. I’m usually putting out a new episode every week. And then they could always find me at marcsklar.com. If you want more support or have questions around egg donation or about agencies or anything like that, feel free to message me on any of those platforms and I’m happy to help you and give you resources as well.

Lisa Hendrickson-Jack:

Well, thank you so much for that. We will make sure to link all of those places in the show notes page. And as always, thank you for being here. This was a really informative conversation. And at the beginning, if I remember correctly, we started by talking about how we never know how we’re going to build our families. We might have a desire to do it in a certain way, but we don’t always know how it’s going to play out. So I recognize that people have all kinds of different perspectives on this topic and other topics related to artificial reproductive technology. But I do always think that it’s good that we live at a time where we have these different options so that we have different ways to build our families if in the event that we need to. So I’m thankful that we have options.

Dr. Marc Sklar:

Yeah, me too. Absolutely. And thanks for having me today.

Lisa Hendrickson-Jack:

Always a pleasure. Thank you for listening. If you enjoyed today’s show, please share it with a friend. You’ll find the show notes page for today’s episode over at fertilityfriday.com/520.

I hope that you enjoyed today’s episode with Marc. Always a pleasure to talk with him. I feel like today’s topic is extremely important, if for no other reason than how common and prevalent this challenge is becoming. And I think there’s a number of factors — many of which we talked about in today’s show — that are contributing to the increased frequency with which couples are having to look at these types of options. You know, one of those reasons being that many of us are waiting until later in life to start trying for our families. And we lack the complete and useful education about our fertility that would really help to inform us of how our fertility changes with age.

This is one of the things that I find myself talking about quite a bit. Because I feel that when we’re growing up, we’re really educated about our fertility in a negative way — in the sense that we’re told that we can get pregnant every day of our cycle, which is not true. And it puts fear, instills a lot of fear into us. And then we really spend the majority of our reproductive lives actively terrified that we could get pregnant at any time. And obviously there’s some truth to that — when we’re young, when we’re in our teens and our 20s, our fertility is at its highest point. And so we do have to have a strategy for avoiding pregnancy when we’re in relationships and we’re not ready to start our families. But where’s the part of the conversation that tells us that fertility is not guaranteed for everybody? That acknowledges that the current statistics around fertility indicate that 15% — that’s one in six couples — experience fertility challenges. Where is the education that talks to us and informs us that our fertility changes with age?

Even the miscarriage rate — that’s something that I often talk about. The literature shows us that one of the reasons our fertility changes with age is that as we get older, we have a higher risk of miscarriage due to some of the DNA replication errors on both the male and female side that contribute to reduced fertility. And where’s the information that helps us to combat that? How do we strategize to optimize our fertility? How do we even just interact with hormonal contraceptives? Where’s the information that tells us how hormonal contraceptives impact fertility — the fact that they cause a temporary period of subfertility in that transition phase immediately following discontinuing these types of contraceptives.

So obviously these are topics that I talk about quite a bit. You’ll find a ton of fresh new research going into these topics in depth in Real Food for Fertility. And Lily and I have teamed up to certainly try to combat this lack of information, to actually put a lot of this information directly into your hands so that you can be better informed, so that your patients can be better informed, and obviously your family members and your children.

I know a lot of women who I’ve spoken to — a lot of my clients and practitioners — they always tell me, you know, this is what I’m going to share with my daughters. And I actually had a woman who, in a podcast interview last week, shared with me that she feels like every single wedding she goes to, she’s going to gift them a copy of Real Food for Fertility. And I think that’s a great idea.

I always think that we spend so much time planning our weddings, we plan our careers, we have all of these plans. But what I feel is lacking is our plans for our fertility and for building our families. And I feel a big contributing factor to why it’s not the most common thing for us to be planning for our fertility is because after so many years of being told that our fertility is basically given and so strong that we need to fear it, I think it’s just assumed that we’ll get pregnant as soon as we try. And I’ve spoken to countless women over the years who stay on the pill until really the minute before they’re ready to start trying, because they’re just so terrified that they’re going to have an unplanned pregnancy.

So I think it’s really important to empower women with this knowledge. And of course, in my perfect world, we would be able to provide women with this knowledge early on when they’re young, before they’re even actively trying to conceive, so that they could have a variety of options as they get older. And I think one of the challenges that Marc and I were talking about in today’s episode is really what happens when — for all of the different reasons that can come up in life — we find ourselves towards the end of our kind of optimal fertile period of life, and natural conception hasn’t panned out, and then we’re faced with what to do next. And I think one of the biggest myths is that IVF is going to be that kind of effective option when we are in our 40s. And based on what the statistics and research have to say, the chances of success really change as we get older. And this is one of the reasons why many physicians are gearing women towards the possibility of egg donation.

So I hope that you have a wonderful week or weekend whenever you’re tuning into the show, and of course, as always, until next time, be well and happy charting.