AFFORDABLE DONOR EGGS FOR CANADIANS: THE SHADY GROVE FERTILITY PROGRAM by Dr. Robert J. Stillman (Fall 2011)

AFFORDABLE DONOR EGGS FOR CANADIANS: THE SHADY GROVE FERTILITY PROGRAM
by Dr. Robert J. Stillman

It's been seven years since Jackie and her husband, Jeff, began fertility treatment. After a number of unsuccessful treatment cycles and two heartbreaking miscarriages, they were on the verge of giving up. Jackie remembers, "We thought we were done trying, but I knew in my heart I wasn't ready to quit." After researching and weighing their options, the couple decided to use donor eggs to help them realize their dream of having a child. Now on the cusp of turning 42, Jackie says, "I've never felt more hopeful about our chances of having a baby."

Jackie credits her newfound optimism to finding the International Donor Egg Program at our clinic, the Shady Grove Fertility Center. Located in the Washington, DC/Baltimore, Maryland area, Shady Grove Fertility is the largest fertility center in the United States and performs over 750 donor egg cycles annually. Shady Grove Fertility’s in vitro fertilization (IVF) and donor egg success rates are among the highest in the U.S. with one of the lowest multiple pregnancy ratios. In addition, the treatment process for international patients has been streamlined so that trips to the U.S. are minimized, often to only two.

Shady Grove Fertility has a growing number of patients who travel from Canada for its International Donor Egg Program. Before treatment, they have many questions about the donor egg process, the logistics of getting care in the U.S. and their chances for success. Jackie and Jeff agreed to share their story in order to let other Canadian families know about this convenient and affordable option.

Attractive donor egg options

Once Jackie and Jeff had decided to use donor eggs, their next choice was where and how to access treatment. Canada, like the U.K., does not allow egg donors to receive financial compensation beyond reimbursement for documented expenses. This law reduces the chances of donors donating for financial considerations and has resulted in very few donor eggs being available to the many patients in Canada who need them. Many Canadian couples, like Jackie and Jeff, travel to other countries where donor egg treatment is more readily available.

In the U.S., egg donors can be compensated for the time they spend in the extensive screening and egg retrieval process. This allows Shady Grove Fertility to maintain a database of pre-screened, anonymous egg donors and then initiate a donor egg cycle as soon as a couple chooses a donor.

While our process is efficient for egg recipients, that doesn't mean we compromise our care of the egg donors. We are quite sympathetic to concerns about donor exploitation, so we understand and support the ethical stance of Canada, but we also understand the plight of patients in need of donor egg treatment. Shady Grove Fertility is committed to providing a caring and ethical environment for all our patients, whether they are donor egg recipients or the egg donors themselves. Our donor egg program meets the strict guidelines set forth by the American Society of Reproductive Medicine (ASRM) as well as the quality standards of the U.S. Food and Drug Administration (FDA).

In addition to medical concerns, issues of travel, language and culture can weigh on a patient's decision about where to seek treatment. Jackie says she researched donor egg programs in countries like Mexico and Spain but chose the U.S. because of the shared language and culture. She says, "Yes, it was fairly easy for us to travel to the U.S., but more importantly, I knew that when I called, my questions would be understood and I would understand the answers."

High donor egg success rates

A major draw for donor egg patients both in the U.S. and in Canada is the high success rates achieved by Shady Grove Fertility. Shady Grove Fertility has a 62% clinical pregnancy rate per transfer and a 47% live birth rate per initiated cycle. We are particularly proud of the success of our elective Single Embryo Transfer (eSET) option, which has maintained a high rate of live births while reducing the number of high-risk multiples pregnancies (twins, triplets and above).

Money Back Guarantee

While success rates were important to Jackie and Jeff, the most important issue for them was affordability. Like many couples, they had already spent a great deal of money on fertility treatments when they made the decision to use donor eggs. Jackie says the Shared Risk Program at Shady Grove Fertility was the key factor in their decision to choose the Center.

The Shared Risk 100% Refund Program entitles donor egg recipients to undergo up to six fresh donor egg embryo transfer cycles and unlimited frozen embryo transfers related to those cycles for one fee. The fee is about twice the cost of a single treatment cycle, but it is only earned if a baby is delivered. If this does not occur, 100% of the fee is refunded. Patients can stop at any time, after one cycle or more, and receive a 100% refund. Often patients find the Shared Risk Program hard to believe. It is in our best interest and in the best interest of the patient to have them be successful with as little physical and financial strain as possible.

Jackie says, "With Shared Risk, we feel so much less pressure because we know we will either come home with a baby or get our money back. After everything we've been through, we decided that we couldn't go forward unless we had this kind of guarantee."

Shared Donor Egg is another program at Shady Grove Fertility that helps to reduce the cost of treatment. In this program, recipients are able to anonymously share the eggs of a donor and the costs of treatment with one or two other recipients. Since the average number of eggs retrieved from a donor is 18, there are usually enough to share with one or two other couples. About 80% of couples choose to share eggs and the majority combine Shared Donor with Shared Risk to make treatment more affordable and also guarantee them a baby or a refund.

Jackie and Jeff chose the 1:3 program, which means that they are sharing the eggs from their donor with two other couples. On their first cycle, Jackie and Jeff received six eggs, which resulted in three day-five embryos of excellent quality. They transferred one and froze the remaining two.

Extensive donor options

Most patients researching the use of donor eggs have a lot of questions about the donors themselves. "They want to know about their medical and family history and their education level. And they are usually hoping to find a donor that has traits in common with them," says Patsy Inman, the International Patient Liaison for Canada at Shady Grove Fertility.

Jackie and Jeff conducted their search from home in Ontario. They were given an access code to Shady Grove Fertility's online donor database. Jackie says, "They gave us the access code on a Friday afternoon and by Saturday morning, we had picked a donor." They were thrilled to find a donor with a Scottish heritage similar to Jackie's and with green eyes. "I always thought that having green eyes was kind of a unique trait of mine, so I was excited to find a donor who also had them," says Jackie.

Shady Grove Fertility's egg donors are healthy women, 21-31 years old, who are extensively screened for medical, genetic, psychological and other issues. We are incredibly selective, we receive about 6000 applications per year and only about 8% of applicants are accepted as donors. Shady Grove Fertility’s donor database includes extensive information about each donor and pictures of the donor as a child. All potential recipients meet with a donor nurse at the beginning of the process. She knows the available donors and the donors who are currently in the screening process. So, whatever the couple is looking for in terms of a donor's profile, she'll be able to guide them to likely choices.

Streamlined process

As the International Patient Liaison, Patsy Inman coordinates care for all the Canadian patients. She says they are usually surprised at how efficient the process is. Patsy explains, "There are only two trips that Canadian patients have to make to the U.S. and only one of those has to be attended by the male partner." The process starts with a phone consultation with Patsy and then with myself, both without cost.

I personally handle all the patients from Canada. During the initial phone consultation, I learn the patient’s medical history and work with them to create a plan before they schedule the next step, which is the pre-treatment recipient visit. During the pre-treatment Comprehensive Day recipient visit, the couple does much of their pre-screening tests and provides a sperm sample that will be frozen. They meet with me and are introduced to the donor team medical staff, particularly their personal donor team nurse, their donor screener, and their financial counselor. The recipients will also meet with a psychological counselor at either their home clinic or at Shady Grove and talk about any issues they might have with the donor egg process.

This recipient visit was the thing that most impressed Jackie about the process at Shady Grove Fertility. "We were there on one day from 9 a.m. to 3 p.m., and we saw someone every hour. I couldn't believe they could schedule all those tests and meetings in one day. It would probably have taken me weeks to get all that done on my own - and we didn't even have to pay for it."

Both the initial phone consultation and the pre-treatment recipient visit are free of charge. In fact, there is no financial obligation to recipients until they pick their program (e.g. Shared Risk and or Shared Donor Program) and pick a donor.

The recipient visit begins a two to three-month process when care is coordinated with the patient’s own local fertility center in Canada. Shady Grove Fertility has co-managed care arrangements with many Canadian fertility centers which allow much of a recipient's treatment to take place close to home.

Finally, patients come back to Shady Grove Fertility for their embryo transfer. The recipient can travel home the day after the transfer. The initial pregnancy test and obstetric sonogram is performed by the recipient's local fertility center in Canada.

Personalized care

The physicians and medical staff at Shady Grove Fertility are committed to providing a caring and responsive environment for patients. We want all our patients to feel that we are on their side, and we all have our oars pulling in the same direction. Jackie agrees: "They have such a caring approach, you really feel like they are in the business of helping to build families.

Jackie points to her interactions with her nurse, Patty Matthews, as an example of this philosophy in action. "Every time I called with a question or concern, Patty called me back the same day - and I called a lot. I think she deserves a raise just for dealing with me."

Our patients are touched by the personal attention to their case. When Jackie's first embryo transfer did not result in pregnancy, I called her right away to provide support. She commented that with all the unsuccessful cycles she had been through at other clinics, this had never happened before.

Making the first call

Patsy Inman is the first person most Canadian patients speak to when they are inquiring about the International Donor Egg Program. She says she's happy to talk to patients at any stage of their journey. "New patients have a wide range of knowledge and emotions. They may be just starting their research into donor eggs or they may have already gone through cycles in another country." She sometimes talks to a couple over the course of several months before they decide to schedule a phone consultation with a physician.

"The main thing is to let people know is that it doesn't hurt to call,” she says. They don't have to be ready to start treatment and we're not going to pressure them one way or the other. We're here to provide information so they can make an informed decision."

Jackie has recently completed a transfer of one of her two frozen embryos from their first cycle. She is feeling very hopeful as she waits for the outcome. She has told us, "Shady Grove Fertility has been a godsend. I feel so much calmer and more optimistic than I did during my previous treatments, and it's because I feel so confident in them. They have given me renewed hope."

About the author
Dr. Robert J. Stillman is Medical Director and Director of the International Donor Egg Program, Canada at Shady Grove Fertility. Dr. Stillman is a member of the Canadian Fertility and Andrology Society as well as U.S. societies including the Medical Advisory Board of Resolve, American Fertility Association, American Society of Reproductive Medicine, and Society of Assisted Reproductive Technologies, among others. Dr. Stillman is on the Editorial Board of Fertility and Sterility and ad hoc editor on numerous medical journals.

More information about Shady Grove Fertility’s International Donor Egg Program can be found in both English and French at www.internationaldonoregg.com. For questions about the program, contact Patsy Inman, International Patient Liaison for Canada at 301-545-1316.