Case Report: Egg Donation-Mother Uses her Daughter’s Eggs to conceive

The case involves D.R, a recently remarried, premenopausal woman in her late 40’s, who had a daughter (N.R.) some 33Y ago, in a prior marriage. D.R. inquired whether I would be willing to do IVF on her daughter, fertilize the eggs with her husband’s sperm and then transfer the embryos to her (DR’s) uterus. Needless to say, it was recognized that if successful, and D.R. were to give birth to a baby born from NR’s eggs, she would be giving birth to her own genetic grandchild who would be her daughter’s sister.

I emphasized to D.R. that it was imperative that there be no pressure put on her daughter to do this and that it had to be by her own free will. I advised professional counseling and to think carefully on the implications of any decision reached.

I scheduled and then had a separate meeting with N.R, in order to satisfy myself that she was not being coerced to proceed and discussed the process involved, with all parties. I assured N.R that ovarian stimulation and egg retrieval (done properly) would be very unlikely to compromise her subsequent fertility, that since she had never been pregnant before, she should recognize this possibility, however remote it might be.

Fully cognizant of the implications, we all agreed to proceed. I implemented a modest protocol for ovarian stimulation. N.R produced 12 follicles and 11 eggs, Eight of the eleven eggs were mature (MII’s) and were fertilized with husband’s (her stepfather’s) sperm using intracytoplasmic sperm injection (ICSI). This resulted in 4 good quality blastocysts. I transferred 2 blastocysts to D. R’s uterus and cryobanked the leftovers for subsequent dispensation.

D.R. conceived with twins and subsequently gave birth to twins (a boy and a girl). I had the extreme privilege of attending their christenings and had the opportunity to once again meet and confer with the genetic mother and the biological parents who were all elated. I hope and pray that it will remain so.

Conclusion: While it is not unusual for the son of an infertile man to provide sperm to impregnate his stepmother, this was the first case that I had encountered in a 35 year IVF practice, where the reverse has occurred, i.e., that a daughter donated eggs to her mother so that she could procreate using her step father’s sperm. However, when one thinks carefully on, you cannot escape the fact that refusal to provide such a service while being willing to do so when it comes to donated sperm, would be sexist. I do recognize that there’s a far greater commitment and physical investment when it comes to a woman undergoing ovarian stimulation and egg retrieval than there is for a man providing sperm for insemination or IVF and that albeit minimal, there is always a risk that complications could arise in the process of stimulating a woman and performing egg retrieval, that might compromise her future fertility.

I guess, “all is well that ends well” and I have no regrets whatsoever. The children are both healthy, loved/wanted, beautiful and the parents are happy and the egg provider (N.R) is nothing short of proud and elated at her ability to contribute towards the expansion of her family tree.

2 Comments

Yasmin Breithardt

Hi!

I am 45 and my daughter is will he 21 and I would like to do the same. How much is this?

reply
Dr. Geoffrey Sher

Hi Yasmin,

At 45y, the chance of a successful pregnancy using your own eggs is VERY small. You need IVF with egg donation.

Hardly a day goes by when I am not asked the question of “How old is too old to do IVF?). The standard answer is that for women under 43Y, IVF using own eggs is advisable, while older women should use donor eggs and women above 50y should not be considered as candidates for IVF. BUT it is not as simple as that! I will never forget a couple that travelled from Munich Germany to consult with me re Egg Donation-IVF about 15 years ago. The lady, who will here be referred to as (JS) was 52 years of age and her husband (PL) was 45. At that time we had a general policy not treat women over 50 years of age. When I informed her of this, she became very agitated. She responded that she was in perfect health, while her husband suffered from moderately severe hypertension and type 2 diabetes and then went on to say that our policy amounted to sexual discrimination because, had PL been 52Y of age and she , 45Y, we would never have rejected her….and you know what? She was right! I suggested that the couple address our Ethics Advisory Board on the matter…which they did. Upon hearing her argument the board authorized me to perform IVF with egg donation. I did so and subsequently transferred two embryos to PL’s uterus. She conceived and gave vaginal birth (without turning a hair) to two healthy female babies. I hear regularly from this couple, and receive family photographs, virtually every year. The two girls are in high school and the family is thriving.

Any woman, regardless of age, given access to “competent eggs/embryos (self-or egg donor/sperm donor-derived) and a receptive uterus (her own, or that of a gestational carrier), is, capable of achieving motherhood through IVF. This ability is of course predicated upon the patient having access to a full spectrum of advanced assisted reproductive technology (ART) options.

Herewith, a few basic considerations:

1. Access to at least one “competent” embryo. It is a fact that as women advance in years beyond their mid-thirties, both the number and chromosomal integrity of their eggs, will inevitably decline. At age 30Y about 1:2 are chromosomally normal (“competent to propagate a baby). By age 40Y about 1:6 and by the 42nd year, only about 1:10 will be chromosomally normal and be capable of propagating a healthy bay. In the vast majority of cases, by the time the woman reaches her 40’s, the number of eggs remaining in her ovaries (ovarian reserve) will start to decline This diminishing ovarian reserve (DOR) will be reflected in her basal FSH level rising progressively and her blood antimullerian hormone (AMH) dropping. What this means is that the woman’s pregnancy potential drastically declines as she emerges from her 30’s into her 40’s. By the time the average woman reaches 43y, her egg/embryo competency and ovarian reserve (the “biological clock”) will usually have declined substantially such that by the time she reaches 43 years of age, she would be best advised to preferentially choose egg donation. The transfer of a single expanded blastocyst to the uterus of a 42 year old woman, (without knowing the chromosomal configuration of that embryo) will likely yield less than a 10% chance of a baby. Conversely, an embryo, found through chromosomal testing (CGH) to be chromosomally normal (“competent”) would produce a live birth in more than 50% of cases. It thus follows that for women with such declining fertility, CGH testing with “banking” (stockpiling) of several embryos over multiple IVF cycles cycle of IVF will at the time of transfer to the uterus, dramatically improve the odds of success and significantly reduce the risk of miscarriage…
2. A receptive uterus: For an embryo to propagate a viable pregnancy the uterus needs to be as anatomically normal as possible, its endometrial lining needs to develop normally in response to estrogen and any underlying immunologic implantation dysfunction must be identified and corrected. Conditions such as uterine fibroids and adenomyosis are more prevalent in older women. And post-menopausal women who are estrogen depleted will find their uteri shrinking and the endometrial lining becoming ever less responsive to estrogen. It is important in such cases to prescribe estrogen hormone replacement therapy for 2-3 months, prior to performing embryo transfer.
3. A healthy parturient, who is capable of carrying a baby to term. The Hippocratic Oath demands that physicians never knowingly put patients in harms way. Since pregnancy is inevitably associated with increasing maternal risk as the woman ages, it is important prior to embarking on fertility treatment in such cases, to perform a thorough physical examination and a barrage of tests that includes (but is not limited to) EKG; Chest X-ray; Blood chemistry (BUN, electrolytes, creatinine, liver enzymes, lipid profile, glucose etc..); mammogram and PAP smear. It is also important to explain to the patient/couple.
4. A medical and laboratory team with the necessary experience/expertise, with ready access to the most advanced ART-options such as:
a. Egg Donation
b. Gestational Surrogacy
c. Donor sperm (if needed)
d. Genetic embryo selection (e.g. CGH- PGS) with staggered IVF and/or Embryo banking d) gestational surrogacy.

This having been said, when it comes to how/ whether or not a woman’s age should affect a medical decision of whether or not to proceed to IVF, the most important issues should also take into consideration social and ethical factors such as how the age of the prospective parent(s), in terms of projected life span as well as their physical, emotional and financial ability to provide for the needs of the child must also be given serious consideration.

So in the final analysis, what it boils down to is that each case must be considered on its own merit. While it is advisable for women of 43Y or older to do egg donation and for younger women to still consider using own eggs, the decision is also very much influenced by the woman’s ovarian reserve. By way of example, a woman over 42Y who has good ovarian reserve (a high AMH and low/normal FSH) and accordingly is likely to produce many eggs might still be a candidate for using her own eggs with “Embryo banking” and CGH embryo selection, while a younger woman with severely DOR, who is unlikely to produce more than one or two eggs at a time, might best be advised to choose egg donation. There is no hard and fast rule. When it comes to a “cut off” for IBVF eligibility, age is a moving target.

Geoff Sher

PS: Consider calling my my assistant, Patti Converse (702-533-2691) to set up an online consultation with me to discuss!

reply

Ask a question or post a comment

Your email address will not be published. Required fields are marked *