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Genetics & IVF Institute
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Disclosure in Anonymous Donor Egg IVF
Laurence C. Udoff, MD, FACOG
I am often asked what part of my job I find the most gratifying. Though in general, I consider it a privilege to play a role in the care of all of my patients, working with donor egg IVF patients offers special rewards for both the patient and the caregiver. In most situations, the use of donor egg IVF has the most dramatic impact on a patient's chance for conception. In many cases a patient may be told there is little to no chance for success without donor egg IVF. With donor egg IVF, clinical pregnancy rates per attempt are 60-70%. It is usually the most successful form of treatment we can offer. Though a miracle for many, it is clearly not the right choice for everyone. There are many issues to consider, as obviously the donor egg recipient and "birth mother" is not the "genetic mother." There are also the issues of disclosure with anonymous egg donation. Do you tell friends, family and the child the identity of the "genetic mother?"
To address this often difficult question, a review article was recently published that closely examined the issue of disclosure in assisted reproduction involving donor sperm or donor egg IVF. This article summarized recent studies that assessed the impact of disclosure on egg or sperm donors, intended parents and offspring. The following represents excerpts of the study findings related to intended parents and offspring in donor egg IVF cycles. The impact of disclosure on egg and sperm donors has not yet become a major issue in the United States. However, in countries such as the United Kingdom where a donor registry is in place and a voluntary exchange and contact registry is proposed, the number of available donors is declining.
Two recent studies have been published examining how donor egg recipients make decisions about disclosure. In the first study, 79 couples undergoing donor egg IVF underwent an in-depth interview regarding how they dealt with disclosure issues. In approximately half of the couples interviewed, there was a difference in opinion regarding whether or not to tell friends, family or the child that the pregnancy was a result of donor egg IVF. Interestingly, by the end of the study, 95% of couples were able to reach a united decision about disclosure. This suggests that it is fairly common for a couple to initially disagree about disclosure in the setting of donor egg IVF. However, using a host of resources including professional counseling, the vast majority of couples reach an agreement. In the second study, in-depth interviews were conducted with women who conceived through the use of donor egg IVF. From these interviews, two main themes were noted. One was described as "engaging in selective disclosure"- patients would decide what information to disclose and to whom. The other theme was described as "responsibility toward the resulting child." For women that disclosed, this meant the right of the child to know. Non-disclosing and undecided women voiced concerns about the negative impact on parental relationships and possible social stigma and did not see a benefit from disclosing to offspring.
Regarding what is best for the child conceived through donor egg IVF, very few studies have adequately addressed this issue. Golombok and colleagues evaluated 48 families with a child conceived through donor egg IVF (also included were children born through donor sperm and naturally conceived children for comparison). They noted that 54% of families with children conceived through donor sperm or donor egg IVF intended to disclose, 46% did not plan to disclose or were undecided. No differences in parent-child relationships were noted between those families that did not disclose and those that did. However, study conclusions were limited as the children were only 2 years old. Subsequent reports from this group have evaluated families and their children at age 4-5 and 12 years old. At an approximate age of 4-½ years old, children conceived through donor egg IVF were not experiencing increased levels of psychological problems. At age 12, a time at which psychological problems might be expected to develop based on the experience of adopted children, donor egg children continued to show no evidence of psychological problems as assessed by direct interview and questionnaires. Interestingly, at the time of the study, only 6 out of the 17 families studied had already told, or planned to tell their child that they were conceived through donor egg.
Though the issue of disclosure can be a difficult one, patients should be comforted in knowing that research to date has not been able to document any adverse affects on the family or the child, regardless of how a patient approaches the issues of disclosure. However, it must be noted that this research is still in the preliminary stages and that hopefully, future studies will provide more definitive data.
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What's New at GIVF D0NOR EGG IVF SEMINAR / FREE DONOR EGG IVF CYCLE
GIVF will offer a free donor egg IVF seminar at the Mclean Hilton in McLean, Virginia on Saturday January 16, 2010 from 10:00 AM to 12:30 PM. Come listen to Dr. Laurence C. Udoff, a board certified reproductive endocrinologist, and Dr. Harvey Stern, a board certified geneticist, talk about the medical aspects of this treatment option. GIVF's donor egg counselor also will discuss the emotional and personal aspects of donor egg IVF. Meet an actual egg donor. One seminar attendee will receive a single donor egg IVF cycle at absolutely no cost and all attendees will receive a 15% discount on the base fee on donor egg IVF contracts signed after January 16, 2010. Click here for more information or to register.
SIGN UP FOR FUTURE IVF AND DONOR EGG IVF SEMINARS
If you are interested in signing up to be notified when the seminars are scheduled, please register by following this link. The locations for these seminars have not yet been finalized. We welcome your suggestions when you register.
GIVF OFFERS MALE INFERTILITY CONSULTS. GIVF is now offering on site consultations with a board certified specialist in male infertility. Call (703) 698-7355 to schedule an appointment.
0% INTEREST FINANCING GIVF is now making interest-free financing available to qualified patients for single cycle and multiple cycle options for either standard IVF or donor egg IVF. Interested patients should call (800) 552-4363 or click here to request an appointment.
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Ask a Question
David S. Karabinus, PhD, HCLD
What is ICSI and why do we do it?
ICSI, pronounced "Ick-See", is an acronym for Intra-Cytoplasmic Sperm Injection, a microscopic procedure where a single sperm is injected into an egg. Normally for a sperm to fertilize an egg, a sperm has to swim to the egg, penetrate the cells surrounding the egg, penetrate the covering of the egg, and penetrating egg cell membrane. ICSI does all this work for the sperm to make sure the sperm DNA is delivered to the egg. ICSI is performed in circumstances when the number of sperm is insufficient for fertilization to reliably occur, when the sperm's ability to fertilize the egg is impaired, or when the egg is known to resist sperm penetration. ICSI does not require the use of ejaculated sperm; sperm surgically retrieved from the testes or epididymides may be used. Before the development of ICSI, donor sperm, adoption, or childlessness were the only options for men who produced low numbers of sperm or functionally impaired sperm.
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Endocrine Disruptors and Reproductive Function - Is Your Water Bottle Making You Infertile?
Ervin E. Jones, PhD, MD, FACOG
The term "Endocrine Disruptor" is use to describe a class of chemicals that act as agonists or antagonists of estrogens, androgens and thyroid hormones. The term has evolved to encompass hundreds of chemicals. Endocrine disruptors are foreign substances that perturb normal endocrine processes by mimicking the activity of natural hormones and, thereby, disrupt the synthesis, metabolism and functions of natural hormones.
Xenoestrogens as Endocrine Disruptors
The prefix "xeno" is derived from the Greek word "xenos" which means stranger or foreign. Thus, xenoestrogens are, by definition, estrogens that are foreign to the body. Included among the xenoestrogens discussed here are phthalates, bisphenols, organotins, phytoestrogens and diethylstilbesterol. Phthalates are compounds used in a wide variety of consumer products including plastics, adhesives, deforming agents, solvents, lubricants, vinyl upholstery, table cloths, shower curtains, rain coats, personal care products and children's toys. Phthalates are also used in some approved medical devices such as tubing, blood packs and dialysis equipment as well as surgical gloves. Globally, more than 18 billion pounds of phthalates are used each year. Phthalates can readily leach out of plastics since they are not chemically bound to the plastic matrix. Because of their widespread use in consumer products, phthalates are widely distributed in the environment and their potential for incorporation by oral, dermal, inhalation and intravenous means is high.
Bisphenols are organic compounds made by condensing acetone with phenol. Bisphenols are also widely used in plastics and plastic additives. One cross sectional study found bisphenols in 92.6 percent of the United States population examined. Organotins are compounds that contain tin linked to hydrocarbons. Organotins represent another class of widespread persistent organic pollutants with potent endocrine disrupting properties. Organotins are also used in polyvinyl chloride products as stabilizers and, therefore, may come in contact with packaged food products. Organotins bind to receptors that play key roles in fat homeostasis and adipogenesis and are, therefore, potent endocrine disruptors.
Although synthetic chemicals have received the most attention as endocrine disruptors in recent years, substances produced in nature may also function as endocrine disruptors. A notable example is the group of plant hormones known as phytoestrogens. Certain plant hormones are xenoestrogens and are found in many foods such as soy and food supplements. Diethylstilbesterol (DES) was the first recognized and only clearly documented xenoestrogens clearly linked to human disease. The synthetic estrogen was administered to pregnant women in the 1950s and 1960s to prevent miscarriage. DES was implicated in urogenital abnormalities in children exposed in utero and was withdrawn from the market in 1971. Girls exposed to DES showed a high incidence of vaginal abnormalities, spontaneous abortion, premature delivery, uterine malformation, menstrual abnormalities and low fertility. Boys exposed to DES showed Testicular Disgenesis Syndrome which is characterized by hypospadias (posterior displacement of the urethral opening on the penile shaft), undescended testes and low semen quality.
Endocrine Disruptors and Male Reproduction
According to some epidemiological studies the quantity and quality of human sperm has decreased during the last 60 years. In humans, although the causes are not clear, hypospadias has doubled from 1970. Sperm counts decreased and testicular cancer incidence increased. Global declines in semen quality were suggested to be associated with enhanced exposure to environmental chemicals that act as endocrine disruptors as a result of our increased use of pesticides, plastics, and other materials. Adult men exposed to certain phthalate esters were found to have lower levels of testosterone when compared to unexposed controls. Studies using animal tissues support these observations. In utero exposure of rats to the phthalates resulted in dose -dependent decreases in testosterone production in testis tissue obtained from adult rats.
Endocrine Disruptors and Female Reproduction
Recent epidemiologic evidence suggests that women have a unique exposure profile to phthalates. These high levels may be due to the fact that certain phthalate derivatives are used in many beauty products including perfumes, lotions, and nail polish. A study reported by the Centers for Disease Control found that reproductive age women had significantly higher concentrations of phthalate esters in their urine when compared with age- and sex-matched controls. Exposure to high levels of phthalates is associated with decreased pregnancy rates and higher miscarriage rates in female factory workers. Ovarian intrafollicular processes may be targets for environmental endocrine disruptors. Recent studies using animal models have shown that certain phthalates disrupt follicle stimulating hormone induced cumulus cell expansion, oocyte maturation in vitro and alters progesterone production in animal models. An increase in aneuploidy was found coincident with abnormal alignment of chromosomes on the meiotic spindle.
Cells obtained from human ovarian follicles during IVF procedures are steroidogenically active and respond to FSH and LH stimulation. Phthalates disrupted estradiol and progesterone production in these cells, suggesting that certain phthalate derivatives act as specific inhibitors of estradiol production in human granulosa cells. As the in vitro effective doses of the compound were within the range of real environmental exposure levels an inhibitory effect of estrogen production in vivo seems possible.
Obesity has become a global health crisis. Several studies have highlighted the link between obesity and infertility. Obesity contributes to anovulation and menstrual irregularities, reduced conception rates, reduced response to fertility treatment and to increased rates of miscarriage. A set of candidate endocrine disruptors referred to as obesogens (diethylstilbestrol, bisphenol A, phthalates and organotins among others have been proposed. These putative obesogens bind to receptors that play key roles in fat homeostasis and the genesis of adipose tissue. Evidence points to endocrine disrupting chemicals that interfere with the body's adipose tissue biology and endocrine systems to derail the mechanisms essential to weight control. Implantation pregnancy and live birth rates were poor in obese women. Pregnancy and live birth rates were reduced progressively as weight increased. Pregnancy rates in overweight women were approximately half those of normal women.
Conclusions
Endocrine disruptors are natural or synthetic compounds that perturb certain normal endocrine functions Taken together, the key deficits that appear to be imposed on fertility by environmental endocrine disruptors include abnormalities of hormone production, egg maturation and maintenance of pregnancy. Although somewhat controversial and inconclusive, the findings indicating adverse effects of endocrine disruptors on reproduction are compelling. Infertile couples and their health care providers must take in to account the potential impact of life style issues, dietary habits, and potential environmental exposures on reproductive performance.
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