Setting Patient Expectations When Using Donor Eggs

May 14, 2024
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The Fairfax EggBank Roundtable Series Launched in 2023 with the goal of engaging industry leaders in dialogue aimed at addressing practice patterns in emerging and non-standardized areas of practice.

Fairfax EggBank hosted a roundtable on the topic of Setting Patient Expectations When Using Donor Eggs in Q1 2024. We brought in experienced experts who work with intended parents wanting to use donor eggs to discuss how they set patient expectations and best practices to help support the patients.

The panelists who discussed this topic included:

  • Obehi Asemota, MD, Hope Fertility
  • Sara Boyd, WHNP-BC, Piedmont Reproductive Endocrinology Group
  • Andrea Braverman, PhD, Thomas Jefferson University
  • Meghan Dean, MS GCG, Brigham and Women’s Hospital
  • Carter Owen, MD, CCRM
  • Ellen Winters Miller, LMFT, Fertility Counseling Center

Read on to learn more

How do you effectively communicate the concept of using donor eggs to your patients?

It’s important to understand where your patient is in the IVF process. Some patients are coming in with the expectation of using donor eggs, but some are very resistant to this option. Doctors and nurses must tailor their communication to where the patient is in their journey.

Communicating the use of donor eggs with a patient requires empathy, clarity and sensitivity. Below are some steps to do so effectively:

1. Establish trust
Create a safe and supportive environment for the patient to express their feelings and concerns.

2. Assess Understanding
Gauge the patient’s knowledge and understanding of fertility treatments, including the use of donor eggs.

3. Provide Information
Offer clear and comprehensive information about the reasons for considering donor eggs, the process involved, success rates, and emotional implications.

4. Address Concerns
Be prepared to address concerns or questions the patient may have, such as genetic connections, disclosure to family or the selection process.

5. Offer Support
Provide resources for emotional support such as counseling or support groups to help navigate their feelings.

6. Respect Autonomy
Respect the patient’s autonomy in decision making and ensure they feel empowered to make a choice that aligns with their values and preferences.

7. Follow-up
Offer ongoing support and follow-up appointments as needed to address any additional questions or concerns.

Highlights from the conversation:

  • Every patient’s journey is different, and you need to tailor the communication and message to that.
  • Certain patients need time to adjust to the idea of using donor eggs. Allowing them the time to understand donor eggs and why this is the next step can help them process what they are going to do better].
  • When explaining the donor egg process, it is more efficient to communicate simply and plainly. If the patient still doesn’t understand, they may need to hear it a few times for them to fully understand.
  • Consistent communication one-on-one is key to ensure that patients know they are supported throughout their journey.

“It’s almost like reading, reading the room and understanding where my patient is in the process and understanding what they’re ready for.”

Dr. Carter Owen

“So, I think, especially for some patients, some patients need time, some patients are ready. I think everyone’s path is different, but it’s a very viable option to discuss donor eggs when the chance of using your own eggs is futile.”

Dr. Obehi Asemota

What role does counseling play in helping patients to navigate the emotional challenges of deciding to use an egg donor?

The American Society of Reproductive Medicine strongly recommends that each patient receive a Psychoeducational consultation or a Family Building Consultation before pursuing the path of Donor Egg IVF. This consultation is an opportunity to discuss each patient’s feelings, but also to educate the intended parents and share the resources available. This provides comfort to intended parents as it reminds them, they are not alone.

Mental health providers serve as amazing resources as they specialize in this field and can help many intended parents feel more comfortable with the language. Also, they can reinforce that everyone they are working with throughout the process is intending for them to be the parents.

From a mental health standpoint, many intended parents face much grief when deciding to use donor eggs. They experience fear around the legitimacy of their parenthood and the influence from the outside world. Many intended parents have concerns around the biological connection with their child, however once their child is born, many concerns fade to the background.

Counseling can help intended parents navigate the best practices for explaining to their children that they used donor egg. Many of the feelings intended parents have at this point really surround their future child and more specifically what and when they are going to tell their child. Helping the intended parents know how to explain, but also when it is most age appropriate to tell them.

  • Mental health providers help intended parents navigate the emotional aspects that surround this new landscape.
  • Counseling also gives each mental health provider a chance to discuss some of the misinformation and direct each patient back to their physician for clarification.

“What I find is that most of the anxiety the people that I meet are feeling has to do with ‘What am I going to tell my child?’'”

Ellen Winters Miller

How can we set and manage patient expectations regarding success rates and timelines for a successful pregnancy? 

Clear communication between clinic teams (including physicians), mental health providers, and intended parents is imperative to setting patent expectations for their donor egg journey. A data first approach is a great way to lay out the different options for intended parents; starting with the numbers and success rates, then going into the expectations for each option.

Repetition from the physician, the clinical team, and the mental health providers, will help reinforce the timeline. Sometimes patients want to hear that donor egg is 100%, but it is important to be repetitive so that they do truly understand the donor egg process, especially accurate success rates. When establishing a timeline with patients it is important to clarify which options take the longest. Using frozen donor eggs will typically be the fastest option, but there is always a risk it won’t work on the first try. This will help patents be more realistic when it comes to how long the process will take.

  • Clear and repetitive communication with the intended parents on the success rates and timeline with the whole team will help manage patient expectations.

“I always tell them sometimes even using donor eggs could be a marathon. It may not be a sprint.”

Dr. Obehi Asemota

AUDIENCE Q&A

What do you tell your patients to consider when choosing an egg donor? 

1. Choose a trusted egg bank

Before considering a donor, it is important to consider the reputation of the egg bank you are working with. What are your clinic’s success rates with the egg bank you are working with?  When it comes to egg banks to work with it is important to select an egg bank that has screened their donors’ personal and family medical history.

2. Choosing a donor that is the right fit for you

After you decide on the top things that are important to you in a donor, think about these other elements that will help you find a donor that best fits you.

  • A donor with proven fertility or prior pregnancies is nice to have but not a necessity.
  • It is important to consider whether an egg donor is a genetic match with the sperm source.
  • It also depends on what the recipients are contributing to their gametes
Do you consider the donors’ own personal pregnancies as proven? Do you consider them a proven donor?  

Personal pregnancies indicate that the donor has proven fertility, but they are not considered a proven donor.

Any advice regarding comparison of genetic carrier screens?

With the genetic panel sizes changing and genetics labs merging, we know it can be very challenging to compare similar panel results.

  • Bigger isn’t always better. Labs that test for 500+ genes seem helpful, but the panels have become so obscure to the point that the carrier frequency is so low.
  • Flexibility from a lab is important, even if a lab is just screening for 300 conditions, it is better to have a lab that will allow you to add genetic tests that are not normally included in the core panel. 
Do you recommend PGT-A with Donor Eggs? 

While recommending PGT-A for all egg donor-conceived embryos may not be the standard of care, it could be recommended for certain patient-specific factors. To learn more, read this blog from a previous roundtable that goes in-depth on this topic.

If an egg donor finds something about their health post donation, even years later, is there a way to contact the parent who used the egg donor to notify them of the medical history? 

Fairfax EggBank has a very robust program that is constantly updating their donor information and notifying recipients of adverse outcomes or updated medical information.

Stay tuned for our next Roundtable on May 29: Mental Health and Third-Party Reproduction.
Save your spot here!

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