This episode features Dr. Erkan Buyuk, a reproductive endocrinologist at RMA of New York, who explains the basics of egg and sperm donation. He tells Dr. Fox his story of starting residency over to come to the US from Turkey and explains why patients choose donor eggs or sperm.
“Pregnancy with an Egg or Sperm Donor” – with Dr. Erkan Buyuk
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Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OB-GYN and maternal-fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. Okay, I’m here with Dr. Erkan Buyuk who is a reproductive endocrinologist at RMA of New York. Welcome. Thanks for coming down to the podcast.
Dr. Buyuk: Thank you very much, Nathan, for having me.
Dr. Fox: This is wonderful. So we’re gonna be discussing today egg donation and sperm donation and you run that program for RMA, correct?
Dr. Buyuk: Correct. Yes.
Dr. Fox: Very nice. So first, tell us a little bit about your background, sort of where you’re from, how’d you get into medicine? How’d you get here to the U.S. and into infertility treatment?
Dr. Buyuk: Sure. So I am from Turkey originally, did my medical school there for six years. It is different from United States. And then after medical school, I went into OB-GYN, four years of residency.
Dr. Fox: In Turkey.
Dr. Buyuk: In Turkey.
Dr. Fox: So 10 years.
Dr. Buyuk: Ten years. Yes.
Dr. Fox: Okay.
Dr. Buyuk: And then I worked as an attending for one year in between. I did my military service for a month. And then I came here. I actually came to Cornell, where you were…
Dr. Fox: Yeah.
Dr. Buyuk: …for a research in REI. And then I did three years of research. I was at…
Dr. Fox: At Cornell?
Dr. Buyuk: …at Cornell and Memorial Sloan Kettering.
Dr. Fox: Right. And did you always know you wanted to come to the U.S.? Or did something change that you said, “I wanna leave Turkey?” Or how did you make that decision?
Dr. Buyuk: So that decision was seeded in our brains in high school.
Dr. Fox: Really.
Dr. Buyuk: I’m actually from a French high school. But with my friends who were geared towards to do medical school, we were always talking about how opportunities are so great in the United States, especially science and research. So when I started medical school, I took the USMLEs almost right away. At the end of the second year, the basic sciences and then at that the fourth year, the clinical. And then it was always in my mind, but then I got married at of the medical school, and then, my wife also always wanted to come here, but we still did our residency there. There was no opportunity at that particular moment.
Dr. Fox: She’s a physician, also?
Dr. Buyuk: She’s a physician, too. She’s a psychopathologist. When the opportunity came up, at Cornell for a research opportunity, we took it. I came here first, six months later, my wife came. Actually, I came mainly to do research and to do some basic science, that was my main. Although over there I was working as an attending. I had a nice life, honestly.
Dr. Fox: Sure.
Dr. Buyuk: But the science and the basic science was missing. And I was always research-oriented. I was working in a clinical job, so it was not very satisfying. So after I came here, you know, I worked at Cornell and also, I was doing ovarian freezing and transplantation at Cornell together with Dr. [inaudible 00:02:56] And then I was also doing some basic science research at Memorial Sloan Kettering at the same time.
Dr. Fox: Which is right across the street basically.
Dr. Buyuk: Exactly. Yeah, it was very convenient.
Dr. Fox: Right. And Cornell, obviously, for our listeners who don’t know, has a very well-known reproductive endocrinology and infertility program clinically and also research…
Dr. Buyuk: Exactly.
Dr. Fox: …meaning both. So there was a very strong program to come and work with for several years.
Dr. Buyuk: Exactly. It was at the forefront of IVF and REI. So it was very rewarding experience. After six months, I told my wife, “I don’t think we should go back, why don’t you come?” She was also working at the same time, she was a dermatologist in Turkey. And then she resigned. She came so and then, you know, we stayed. After three years, I said, “Since we are staying, we have to do residency again.” I did another residency.
Dr. Fox: Yeah, that must have been pretty tough to redo a residency in the U.S. after finishing and also practicing already in Turkey.
Dr. Buyuk: That’s right. But it is tough, but it is easy at the same time. Because you know most of the stuff. So it is not as challenging as you are a intern from out of medical school.
Dr. Fox: Right. I guess that’s fair. Where did you do your residency?
Dr. Buyuk: I did at Maimonides.
Dr. Fox: At Maimonides. And was there anyone else like you in the program who had already trained and went through medical school elsewhere? Or were you the only one in the program who had, sort of, gone through this before and you’re with all these people junior to you?
Dr. Buyuk: So there were. There were foreign medical graduates. I wouldn’t say some, I would say one or two were here at that same period. But after I left, there were others who came who did before and then will do it again. But I think it is worth.
Dr. Fox: When I was a medical student, I remember there was…not sort of my class, but there was an intern on the surgical rotation where I was and he had already been a surgeon in South America for like…he’s, like, a brain surgeon for like 5 to 10 years. And here’s this guy, he’s like a really, really good surgeon. He’s got tremendous skills and here he’s doing his internship, this poor guy, he has, like, people 10 years younger than him bossing them around, telling him, “Change that dressing, check that lab, do this,” like they do to the interns. And I was just like, oh, my God, what he has to, like, swallow every day to not just come out and say, “You don’t know anything, I’m smarter than all you people.” Did you have that? Was it hard to, sort of, come in and be, like, the bottom of the totem pole, even though you know more than all the people, sort of, training you?
Dr. Buyuk: So the truth is, first, I did not care. And also, I had been in their shoes before. So I know what they are expecting from me. It doesn’t care what I know. You know, what is important is what they think is right. If something is obviously overtly wrong, of course, I remind them, and they were very nice in general. Even sometimes the attendings were asking me, calling me to delivery, “Do you think she will deliver?” So it was very collegiate and nice. I didn’t feel like, you don’t know anything.
Dr. Fox: Did you know, at the time you started your residency, that you were gonna do infertility afterwards? So you’re like, I’m gonna do residency, I’m gonna do fellowship. I’m gonna do this, like, seven more years. Here we go.
Dr. Buyuk: Correct. I came here to do infertility actually, that was eventually if I were to stay, if I could not make it, you know, I wouldn’t stay here. You know, just a regular OB-GYN. I can do the same thing over there. But there was no formal training in REI in Turkey.
Dr. Fox: Wow. Yeah.
Dr. Buyuk: So I wanted to get that formal training. And then, otherwise, you know, most likely I would not have stayed. I don’t know, you know, things might have changed. But that was my main aim.
Dr. Fox: Right. But it’s amazing. If you think about, it’s 20 years because you did 10 years in Turkey, then you had the year of practice in Turkey, and then 10 years here, 3 years research, 4 residency, 3 fellowship. That’s 20 years-plus one in the middle before you’re practicing. It’s good. So you gotta stay in good health so you can work for a long time.
Dr. Buyuk: Exactly. I’m not planning to quit anytime soon.
Fr. Fox: Yeah. Okay. And so you finish your residency, and then you did your fellowship in REI where?
Dr. Buyuk: At Einstein.
Dr. Fox: At Einstein, right. And that’s where you were until just recently, correct?
Dr. Buyuk: Yes. Until the end of 2019.
Dr. Fox: Until the end of 2019?
Dr. Buyuk: Yes.
Dr. Fox: Wow. And so here you are at RMA in New York, Midtown Manhattan. How’s that going for you?
Dr. Buyuk: It’s great. You know, it is very intellectually stimulating, great colleagues, a lot of patients, a lot of pathology, high volume. It’s nice, very nice.
Dr. Fox: And how did you get interested specifically in egg donors and sperm donors?
Dr. Buyuk: So over at Montefiore when I was practicing, when I finished my fellowship, I stayed there. And I had interest in donors, basically, in general. We had Dr. Christina White who was overseeing that program. And she said, “Do you wanna take this program over?” I said, “Yeah, sure.” I had already interest in it, I learned from her and from Dr. Heather Lehmann, who was director of the practice. And after a couple of months, I took over the program.
Dr. Fox: Just so we can understand, get some background on the whole concept of egg donation. What is the main reason why someone would need an egg donor, why someone would need to be the recipient of an egg donor in order to get pregnant? Like, what are the main reasons?
Dr. Buyuk: So the main reason is what we call diminished ovarian reserve, basically, lack of eggs. So that particular woman may have primary ovarian insufficiency, where it happens before the age of 40, basically, very minimal amount of no amount of eggs left, these patients can still get pregnant on their own. However, within their lifetime, there is a roughly 5% to 10% chance of getting pregnant, but you don’t know when it is gonna happen and if it is gonna happen. Doing IVF or any other treatment for these patients does not increase the chance over the baseline. So there is really no treatment for them to get pregnant. Donor egg is a very good option because it gives them I would say 50% to 60% chance of having a baby,
Dr. Fox: Right. That’s per cycle, basically. Yeah. So meaning if they keep doing it, it’s gonna work.
Dr. Buyuk: So that’s one, diminished ovarian reserve, advanced age. You know, somebody 44, 45, the chances for pregnancy even with IVF is very low. So they would need, often they need donor egg. So basically, lack of eggs. Who else needs? Gay couples will need donor egg for obvious reasons.
Dr. Fox: If they’re two men?
Dr. Buyuk: If they’re two men. Exactly.
Dr. Fox: Right. And then I would imagine the most common reason must be women who are in their 40s or 50s who are trying to get pregnant, in your practice.
Dr. Buyuk: That’s correct. If they are closer to 40, then it is worth doing IVF. If they are closer to 50, most of the time, we don’t even try. If somebody is 48, 49, 50, you know, it is very, very unlikely that they will get pregnant with their own eggs. So donor egg is a great option for those women.
Dr. Fox: How do you decide with them…like, let’s say, you know, if they’re closer to 40, usually they can use their own eggs, if they’re closer to 50, usually they can’t or almost always they can’t. How do you work the break point like if someone’s 43, 44, 45, 46? Is it just, you know, you do blood tests, you give them percentages and give them the choice, or do you have hard cutoffs on how you counsel people?
Dr. Buyuk: So there is really no hard cutoff, it is a discussion between the physician and the patient after determining their ovarian reserve with a battery of tests. So, at the age of 41, 42, off the bat, it is, without looking at anything else, average 12% per cycle live birth rate. If this is above 42, it is quoted as 4% to 6%. However, that 4% to 6% is most likely for the ones that are closer to 43 and 44. And as you get older, it gets less and less. If somebody is 43, 44 year old, but they are aware [inaudible 00:10:54] testing shows that eggs numbers are minimal. We do the sonogram, we may have received one follicle, let’s say. In those cases, again, it is hard to put this patient through an IVF cycle. It is a lot of counseling, regarding the low success, and then recommend I think more towards donor egg.
Dr. Fox: Right. Now, but if you had someone, let’s say 43 years old, but their tests are really good, and their ultrasounds are really good, you would counsel them differently, obviously, because they’re behaving like someone not of their average age.
Dr. Buyuk: Exactly. In that case, there are two things that we discuss. One is the quantity of the eggs. You have very good quantity of the eggs. But the quality of the egg, which is the chromosome number basically is still at the one who is 43. It is not for the one who is 33, for example. So the majority of the eggs are gonna be still abnormal. But for that particular person, let’s say at the age of 43, 80%, 85% of the embryos that are formed from that woman and her partner or from the sperm donor is gonna be abnormal. However, in theory, and statistically, if you have a lot of eggs, there’s a possibility that one of them is gonna be normal. So that person is gonna most likely better chance than someone who has only one follicle, for example.
Dr. Fox: Right, that makes sense. Yeah. No, that makes a lot of sense. Do people ever do egg donors to avoid genetic diseases? Is that something people do sometimes like if they carry a genetic disease and for whatever reason, it’s not amenable to them, you know, testing the embryos of this? Do people ever do egg donors for that reason?
Dr. Buyuk: Absolutely. For the ones that have mitochondrial diseases, for example. Mitochondria for the embryo is gonna come from the egg basically. And that if those are carrying the disease, then the best way to eliminate this is using donor egg.
Dr. Fox: Right, And then what would be the main reasons someone would need a sperm donor?
Dr. Buyuk: So sperm donor, a lot of possibilities. One, heterosexual couple, the male partner has azoospermia and we cannot get any sperm from the testicles. For example, [inaudible 00:13:03] syndrome, where there aren’t any…where precursors of any of the sperm. So that’s one indication. Single woman, one of the most…that’s considered one of our population. Lesbian couples, they will use donor sperm. So…
Dr. Fox: And I guess also the same thing, are there any genetic situations where you may have a sperm donor? The only thing I could think of offhand is sometimes, you know, if a woman has, like, based on blood type or something, and it could be very complicated with the antibodies, but that’s probably not as common.
Dr. Buyuk: It’s not as common. It should be very rare cases. You know, I don’t remember having for blood type [inaudible 00:13:48], because of the rhoGAM, that’s so rare. I don’t remember any of my patients, but it could be definitely an indication.
Dr. Fox: So as you have someone, either an individual or couple, comes to you and they need a donor, how does it work with getting an egg donor? Right, so let’s start with that because that’s a little more complicated than the sperm donor, right? So an egg donor, how do they find them? How are they recruited? Who are these people who are donating eggs? You know, how does that process work?
Dr. Buyuk: So egg donor can be done in a couple of ways. One of them is anonymous versus directed. Directed means somebody is using eggs from someone, it can be a young sister, often, a young niece, a young cousin, or a young friend, or it can be anonymous, somebody they don’t know. So, and if it is anonymous, it can be fresh or frozen. Frozen means, like, sperm banks, we have egg banks now. So women donate their eggs to those banks. And those banks distribute those eggs to clinics for those goes women, or it can be fresh. For the fresh, it can be either recruited through an agency that are donor egg agencies who get the stories of this woman and that they put their profiles on their website or, you know, clinics like ours, or the clinic that I was working at Montefiore, we also used to recruit our own donors, advertisements.
There is an egg donor, universal egg donor form that they fill in about their history, medical history, their interests, of course, their physical characteristics, etc., ethnicity, race, and then we review those, or the egg bank reviews those or the agency reviews those. And then if they are compatible, then they undergo a psychological screening, and if that’s fine, then we do what we call FDA screening, infectious disease screening, that is done in FDA-approved labs. And if all the tests are negative, then that person, that donor is eligible for donation. We do the same testing for directed donors as well. They undergo through the same process. There is a small difference between directed donors though, even though they come back positive for something, for an infectious disease, for example. The embryos are still ineligible, but they can still be used for donation since they know each other. And they want particularly that person. As long as the recipient knows that, let’s say it is positive for an infectious disease, for example.
Dr. Fox: Right. Understood. And then when the donors do it…I mean, the process they go through for the donor is as if they were going through IVF, but it sort of stops after the eggs are collected, and then nothing happens, you know, they go home, they’re done. And if it’s an anonymous donor, they’re recruited just through advertisements, and people do this because I guess it must pay well, right? What do they typically get paid, the donors?
Dr. Buyuk: You know, I don’t know the exact number, but it may change from one side of the country to another, from one clinic to the next, or from bank to bank. But they are being paid, in general, around $8,000 to $10,000. This may be less, again, down to $3,000 in some other [crosstalk 00:17:10].
Dr. Fox: Sure. But it’s thousands of dollars?
Dr. Buyuk: Thousands of dollars. That’s right.
Dr. Fox: Right, and because they have to undergo…obviously, it’s a lot of time, and then they get injections, and there’s procedures. But is this something where nowadays there are a lot of people who are willing and able to donate eggs or is it something that’s very hard to find, like, what is, sort of, the supply for egg donors?
Dr. Buyuk: So, it is not that hard to find. You know, there is a financial incentive. However, like you said, they go through injections for a period of 10 to 14 days, they go through all these screening, and that they undergo a procedure egg retrieval, which is under anesthesia. So, they go through a process. And some of them are doing it because they had somebody who was suffering from infertility. So, they have compassion. You know, it is not just the finance, but they really wanna help other couples. It is not that rare. You can find…it is not like, for example, gestational carrier. Gestational carriers are much harder to find, but egg donors are not that difficult to find.
Dr. Fox: And in your practice, ballpark, what percentage of them are anonymous versus directed donors, would you say?
Dr. Buyuk: You know, I don’t know the exact numbers, but majority are anonymous.
Dr. Fox: Majority are anonymous?
Dr. Buyuk: Yes, directed is much rarer to find. So each has an advantage and disadvantage. For example, the advantage of the director donor is if she’s a relative, then you share some genes. So that’s one of the main reasons why people prefer. It may be less expensive because it is almost completely compassionate.
Dr. Fox: Right. You’re just paying for the medications and, you know, whatever.
Dr. Buyuk: Exactly. But you don’t necessarily pay your sister for it.
Dr. Fox: Right. Right.
Dr. Buyuk: However…
Dr. Fox: It depends on your sister, I suppose.
Dr. Buyuk: Yeah, that’s right.
Dr. Fox: Okay.
Dr. Buyuk: However, that may be social or psychological problems in the future with a directed donor. For anonymous, those social psychological problems are generally less common. However, it is a difference, gene pool, but often, you know, as I said, it is not easy to find somebody you know as an egg donor and also, you know, because of these potential psychological problems in the future, anonymous donation is much more often. I will say maybe 80% to 20% or 90% to 10%.
Dr. Fox: Okay. Yeah, I wanted to talk about that aspect of it, the psychological, social, when it’s an anonymous donation, is that a hard rule, meaning is there any way for a child to then later find out who their egg donor was or is it absolutely closed to them?
Dr. Buyuk: It depends on what the donor and the recipient wants. So in that universal donor form that I mentioned, there is a place where they check if they would like to meet…if the child wants to meet, if they are okay to meet the child, for example. And what I noticed, often they say yes, you know, they don’t have any problem, the donors, meeting the child.
Dr. Fox: Right. But if the donor said no, then it’s closed, the child will not be able to find out.
Dr. Buyuk: It is closed from our parts medically because the donors, their names are not there, it is codes. However, with the advances of technology with 23andMe, etc…
Dr. Fox: People are finding out.
Dr. Buyuk: People are finding out, exactly. There is a potential that they may find out in the future.
Dr. Fox: That’s so interesting.
Dr. Buyuk: So we don’t tell that because yes, it is anonymous, you know, she’s not gonna know the donor. Donor is not gonna know them from our part, yes. But in the future, if the child, you know, makes the due diligence to find, we can we cannot avoid that.
Dr. Fox: Right. But you’re saying many, if not most of the donors tend to be okay with someone contacting them later, you know, 20 years later to say…?
Dr. Buyuk: Exactly, they are generally checking it is okay for them to contact if they want to. Most of them check yes.
Dr. Fox: And in your experience, because you’ve been doing this a while, how often does that end up happening, you think, that the children end up finding out? And do the parents typically tell the children that they were the product of an egg donor?
Dr. Buyuk: They typically do, they are recommended to tell the children because it is worse if the child finds out later without parents telling them. And most couples are okay to tell them. I had patients, you know, couples who said, “I’m never telling.” And that in those cases, they are looking for blood type match to make sure that they are not found…
Dr. Fox: Correct.
Dr. Buyuk: …through that route. But majority of them are okay, and are ready to tell. And they are recommended to tell. There is a small minority that’s never.
Dr. Fox: Right. And when do they tell the children, is it from always or at a certain age? Or is this, you know, when’s it recommended?
Dr. Buyuk: Is it generally, and I would say always, slowly after the age of 4 or 5 once they are…not another shock at the age of 12 or 18.
Dr. Fox: Sperm donation must be easier in the sense of doing it because it’s not as painful…
Dr. Buyuk: Exactly.
Dr. Fox: …to get a sperm donor. But they get less money, I assume.
Dr. Buyuk: That’s true, they get less money, it is less painful, for sure.
Dr. Fox: This is an economic supply-demand.
Dr. Buyuk: Exactly, because it’s easier to produce sperm than to bring the eggs to the lab. So, yes, it is much easier, sperm donation is much easier. they undergo through the same rules though. They have to check, you know, sperm has…if it is anonymous, especially, sperm has to be quarantined for six months. So they produce the sperm, they do blood testing, the sperm is there for six months, after six months, they go back for another blood testing to make sure that they didn’t have infectious disease during that period.
Dr. Fox: Like HIV or something.
Dr. Buyuk: Exactly. HIV, Hep B, Hep C, syphilis, chlamydia and gonorrhea. And for men, HTLV 1 and 2 as well, and they are checked for CMV, cytomegalovirus too. And then six months later, they are checked again. If they are still negative, then it is off the quarantine, that particular specimen.
Dr. Fox: And when parents are making these decisions about egg donors and sperm donors, and let’s assume it’s an anonymous situation, is it something where they get real detailed or saying, “I want someone who plays lacrosse and is over 6 feet tall and has brown hair?” Does it get to that or is it, like…how detailed do they choose from on their list?
Dr. Buyuk: It depends, and it is very different from one patient to another. The majority of patients, what do they care is ethnicity or race. Some of them do not even care about that, but majority do. Yes, they will get their hair colors, their eye colors, they look at their education, these are all given to them as an information. But it is rare that you are gonna find somebody who is gonna look for a specific attribute. You know, it is a general attributes, do they look like them, you know. If they have blue eyes, you know, they’re looking for blue or green eyes, for example. But otherwise, measures of couples do not go into that much detail, if they played lacrosse, etc. However, they check their heights, they check their weight, eye color, hair colors because these are the first attribute that someone sees. So these are important, but otherwise, I didn’t feel that couples are going into much detail. Although they’re doing much of it online. You know, they got to a bank website and they are choosing from there.
Dr. Fox: Got it.
Dr. Buyuk: So I don’t know how much…when I speak to them, they don’t go too much into detail. But maybe they do when they are at the website.
Dr. Fox: And then do the egg donors always come through…I mean, if you have a couple who’s having fertility issues and you guys make a decision, she’s gonna use an egg donor, and she finds someone, does the egg donor then come to your office, or is it the egg donor’s somewhere else and then the eggs get brought to your office, or is it either?
Dr. Buyuk: So there are many scenarios. For example, if that egg donor is our egg donor, then most likely she lives in New York. So then she comes to our office for blood work and everything to collect her eggs, etc. Sometimes it is possible that they find through an agency. If it is an agency, that donor may be anywhere in the United States. So and then, you know, it becomes a little bit more complicated, more expensive. But still we prefer that they can do their screening and monitoring blood work and do sonograms at the place where they live. But then they have to come for retrieval to our office.
Dr. Fox: Because if you have to freeze the eggs and ship them, then the success rate’s gonna be lower.
Dr. Buyuk: Exactly.
Dr. Fox: Got it. So you need the eggs fresh and then you inseminate them right away?
Dr. Buyuku: Exactly. Since we have that option, we should rather do that. In that case, of course, it becomes more expensive for the couples because they fly and the accommodation costs, etc.
Dr. Fox: Right. But if the success rate is higher, then maybe it’s not more expensive?
Dr. Buyuk: Yes.
Dr. Fox: And what do people do at fertility centers that are not in New York City? All right, so they’re in a place that’s more remote, if you’re in a smaller town, and there’s an infertility clinic, do all of them have their own community of egg donors? Or in that case, do they just not do egg donation? How does it work?
Dr. Buyuk: I mean, if there’s an IVF clinic, most likely, often I would say, they have an egg donor program. But if you are in rural areas or in places…there are places where you have to travel, like, two, three hours to go to IVF clinic, for example. Those clinics still collect, I believe, their donors from the local area, or from agencies and…
Dr. Fox: And fly them in.
Dr. Buyuk: Yeah. And then of course, if they can, if the couple can afford it, yes, they can fly them in. Again, from agencies, you can get donor from anywhere in the country, if that particular couple likes that particular donor, and if they have the means…
Dr. Fox: Right, they’ll to do it.
Dr. Buyuk: …they’re gonna do it.
Dr. Fox: Is egg donation ever covered by insurance, by health insurance? I know infertility treatments frequently are, sometimes are not, obviously depends on exactly the scenario. But what about for getting egg donation, is that ever recovered?
Dr. Buyuk: It’s a tricky answer. Okay, so egg donation is not covered by insurance. However, if the couple has IVF coverage…So the egg donation has two parts, the donor gives the eggs and then we fertilize and transfer the embryo to the recipient. So no insurance is gonna cover the donor parts, the screening, egg collection, monitoring, etc. However, if that particular couple has IVF coverage, the embryo transfer…
Dr. Fox: Right, will be covered.
Dr. Buyuk: …may be covered by her insurance.
Dr. Fox: That’s so interesting because they would cover the woman herself to have a stimulation and a retrieval and everything, but they won’t cover to have her outsource it to somebody else even though the success rate is gonna be better.
Dr. Buyuk: No, they won’t. I never heard any insurance that will do that.
Dr. Fox: And so for a couple then, what is the added cost? If they’re doing IVF, and then whatever it is, whether they’re paying or whether it’s insurance, what is the added cost to them to having an egg donor?
Dr. Buyuk: I mean, again, it changes a lot. So now you’re treating two patients at the same time.
Dr. Fox: Right. Sure.
Dr. Buyuk: You know, not only the woman, but we have the…
Dr. Fox: Right. The egg donor.
Dr. Buyuk: …egg donor, and we have the man, of course, because they are also checked, they’re also undergo screening processes. You know, it changes a lot, I cannot give you a specific number, but it may be $20,000, $30,000.
Dr. Fox: But it’s a lot.
Dr. Buyuk: It is a lot. Yes. However, one thing that we do often is split cycles. Because the donors are young and they have [crosstalk 00:29:20]…
Dr. Fox: Oh, two people can use the same donor?
Dr. Buyuk: Correct.
Dr. Fox: Oh, that makes sense.
Dr. Buyuk: They have a lot of eggs. And a good number of these eggs are normal. So we do one cycle for the donor. If they have 20 eggs, it is split 10-10 for the donors, so they share the cost and they share the eggs.
Dr. Fox: Well, that makes sense. Okay, so that would be an interesting way to do it. And then if someone is gonna have a pregnancy through IVF, and they ultimately choose to have an egg donor, obviously on the plus side, the embryo will have a much younger genetic age. So a lower chance of genetic abnormalities, lower chance of miscarriage, lower chance of Down syndrome, all of these. Are there any risks to doing it, any risk that increased by having an egg donor? I specifically know preeclampsia is something that’s interesting, that seems to be higher when you use an egg donor.
Dr. Buyuk: So not that I know of, honestly. I mean, we did this study for the sperm donors. And from SART database, Society for Assisted Reproductive Technology, we published a couple of years ago. We did not find any difference, because we hypothesized that if it is a sperm donor, for example, the woman is not sensitized. You know, there is no prior semen exposure or sperm exposure from that person, so maybe the preeclampsia, for example would be higher, but it wasn’t.
Dr. Fox: In the obstetrical literature, you know, obviously, any woman who’s having egg donation tends to be at increased risk for preeclampsia anyways, because either she’s older or IVF and these are risk factors. Okay. But it does seem to be that if you, sort of, match even at the same age, the ones who have egg donors have a higher risk, and the thought is maybe that, you know, when you don’t have an egg donor, right, the pregnancy’s 50% genetically yours and 50% genetically somebody else’s. And if there’s an egg donor, it’s 100% genetically somebody else’s, and there’s thought that there’s some immune component to this. But it’s interesting. I mean, it’s a fascinating concept.
So that seems to be the case. It’s not a reason not to do it, but it’s just one of the things. And then would you say, in your experience…I was trying to figure out if the trend for egg donation would be going up or going down. On the one hand, you would think maybe it’s going up because the technology is better, and maybe women who are in their mid to late 40s are more eager to get pregnant potentially than they were before, or they know about this. On the other hand, there’s probably a lot of women who are in the same situation, but have now frozen their eggs from 5 to 10 years ago. And so they don’t need egg donors, they’re their own egg donor. So which have you seen in terms of the trends in your practice? Are they going up, down, or about the same?
Dr. Buyuk: I don’t have such a long history. In REI world, I have, I would say 13, 14 years of experience, 3 of these was fellowship. So, what I saw was an increase in demand over the years, because if you look at the SART data, Society for Assisted Reproductive Technology, the proportion of women with diminished ovarian reserve increased over the years. It was maybe 4% or 5% when I started. It was 14%, 15% a couple of years ago. Why, because women are delaying their pregnancies. So during that period, it increased. But then in 2012, egg freezing became clinical and it was research before that. So but those women did not come back.
Some of them…actually, I had a couple of patients who were interested in using their eggs that they froze in 2013 and 2014. But you’re right, as these women come back to us those eggs, then that will not be that much demand for donor egg. However, the counterpart to that is women are still delaying their childbearing. And not everybody is freezing their eggs. So the more they delay, the more likely that they’re gonna need a third party for reproduction. So I guess you’re gonna see the data. It is not easy to speculate. I mean, I don’t think it is right to speculate.
Dr. Fox: Yeah, I mean, I imagine as your egg freezing numbers go up, your egg donor numbers will probably go down. But that’s a lag of about 10 years. You’re meeting with a couple and you’re trying to determine with her, is it better to try our own or try egg donation. Aside from just the numbers, like, you think it’ll work if she tries her own, is there anyone who you would advise against using an egg donor? Is there someone who shouldn’t be having an egg donor, or it’s basically just if they have the means and they’re okay with, sort of, the social, sort of, whatever, you know, to work around, then it’s fine? Is there’s anyone who would not be?
Dr. Buyuk: I mean, the one who would not be is someone for her to getting pregnant is contraindicated. That would be one, but in those cases, they may use egg donor and a gestational carrier at the same time with their partner sperm or with a donor sperm. So there are all these possibilities. So egg recipients, they undergo also psychological screening. And often they pass, that would be one hurdle. If there’s a major psychopathology that is discovered, this may be a hurdle. But otherwise, if they’re okay to get pregnant and if they don’t have the means with their own eggs, I don’t see any reason why we would refuse someone to use donor eggs.
Dr. Fox: It’s great. Well, thank you so much for coming on the talk about this. It’s such an interesting topic and just that it’s available and it’s an option, and it’s allowing many women who otherwise would not be able to conceive and carry a pregnancy to do so, which I think is fantastic for them. And it really does open up opportunities that didn’t exist before, which is pretty much what you guys do every day. That’s your job.
Dr. Buyuk: That right. Thank you very much for having me.
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