Phone Consult with RBA: PART TWO

I’ll just jump right in again. And please note again that there may be inaccuracies below—this is my attempt to make sense of my scribbled notes, taken down while Dr. S (quickly) talked.

PART TWO of phone consult

PROCESS

9. ) Could you please explain the thawing and fertilizing process?

Non-proven donor: 8 eggs are thawed.

Proven donor: 6 eggs are thawed.

Say we thaw 6 eggs.

4 will fertilize normally usually. (85 – 90 %)

2 or 3 will develop into blastocysts, or high-quality embryos.

SET: If patient has a single-embryo transfer: 80 % chance of having 1 frozen embryo left for later transfer.

DET: If patient has double-embryo transfer: 30% chance of having 1 frozen embryo left for later transfer.

10.) Will you support my desire for a DET?

We will do it. But we will try to talk you out of it.

11.) In my estimation, the benefits of a DET outweigh the risks. Do you agree?

No, do not agree. The pregnancy complication rate for twins is way higher than for singleton.

12.) What would be my treatment plan?

  • Aspirin + Lovenox, because of Factor V Leiden heterozygous. (He said that this is “quack-like” of him, but there is basically no risk to it, so he does it. He also said that there is no risk to stopping Lovenox + aspirin at 12 weeks of pregnancy.)
  • CD 21: Lupron injections begin.
  • Get period
  • Drop Lupin
  • Begin estrogen pill or patch
  • CD 15 or 16 progesterone vaginal suppositories or injections
  • CD 15 or 17 thaw & fertilization
  • Day after: fertilization report
  • Culture to Day 5 and transfer
  • In Atlanta for about a week. For a frozen embryo transfer, in Atlanta for only a couple of days.

13.) Is the clinic open on the weekends?

Yes.

14.) Will I have to do local monitoring?

Yes, for a lining check.

15.) Can a regular Obgyn check my lining?

Yes.

16.)  How long would I have to wait between failed cycles to begin a new cycle?

No wait.

17.) Will I have to get my sonohystogram/hysteroscopy re-done in October?

No.

EGG BANK

18.) Will it be noted in the bank how long the eggs have been vitrified (the year)?

Yes.

19.) Does the length of time they’ve been vitrified affect survival and fertilization rates?

No.

20.) Have all of the eggs been vitrified in the same way?

Yes, they are vitrified in the same way. However, a handful of different solutions have been used in the vitrification process, so there is some variation there.

21.) Is there any risk of choosing eggs that have been frozen in an outdated or little-practiced way?

No. None of the eggs have been vitrified via “slow freeze.”

If the freeze process is not going well, the lab techs know right away.

Other information offered at this point:

We are consistent at every level: In selecting donors, vitrifying the eggs, thawing the eggs, following protocols, performing transfers, and carrying out lab techniques. That is how we achieve consistent success rates. One egg-bank affiliated clinic in the Northeast just had 6 negative pregnancy outcomes in a row, and because of our consistency on all of these levels, we can pinpoint exactly where they screwed up.

Because RBA is the pioneer practice, we are constantly checking ourselves.

22.) Is there a particular time of year when the bank experiences high traffic from recipients?

No.

23.) What will we see, in terms of egg availability—lots of how many eggs? Will it be that some will have 2 eggs available and some have 15?

No. Each donor will have a lot of 6 eggs, if not more.

We get multiple requests for the same donor on the same day, so we have to look at the time stamp on the emails to decide who will be matched with the donor.

We added 15 new donors in the last 10 days, and almost all of them have been selected already.

After the match, the deposit is due within 5 days. [The deposit = 30K, see below.]

24.) When we choose a donor, do we have to cycle immediately/as soon as possible after choosing? When do we cross over into territory of “reserving” and needing to pay the 10K reservation fee?

The 10K reservation fee is due only when a patient wishes to reserve additional eggs from the same donor—in other words, a second lot of 6 eggs. But we advise patients not to reserve eggs until we know that the donor worked out. [Not sure what this means…live birth?]

No, you do not have to cycle immediately after selecting a donor. You cycle when you are ready, and when you and your doctor agree is a good time.

Frozen Egg Advantage

25.) When does the Frozen Egg Advantage program begin—the 1st embryo transfer?

Yes, the 1st embryo transfer. From that point, the guarantee runs for 2 years.

26.) When would we pay the 30K?

5 days after selecting the donor.

27.) What if we discover the embryo has Down’s Syndrome during the early 1st trimester, and we terminate—can we come back for another cycle under the guarantee?

We will play this scenario by ear, and respect individual situations. Yes, we try very hard to make sure our patients feel that they are getting what they paid for, and would most likely continue cycling.

We’ve never had a Down’s baby, because of how strictly we screen the donors.

28.) Miscarriage and stillbirth—still able to cycle under the guarantee?

Yes. It is a live birth guarantee. If the stillbirth happens outside the two year window, then you may still come back to cycle under the guarantee.

DONOR

29.) Can I ask if the donor is “proven” or a mother?

Yes, just ask the nurse. In 4 months, we’ll have a new database set up so that you can see this information right away. [I foresee a problem here—if donors get chosen almost as soon as they’re added, and I need to get a hold of a nurse to find out whether the donor is proven, the donor could be chosen before I’ve gotten through to a nurse—stressful.]

30.) What, in your opinion, are the most important things to look for in a donor, if what we are most concerned about is having a successful cycle?

The most important thing is that you follow your medical protocol. The donors have all been rigorously screened and any of one of them would be suitable for success.

31.) Does the clinic maintain contact with donors? Will they inform us of future health status/issues that arise?

Yes. Some donors will not respond to us when we contact them in the future to check in about health issues, but this is not typical.

32.) How often are new donors added?

Every day. Right now we are actually a little low—we’re at 40. But this can change quickly, go up to 60.

33.) I’m concerned about intellectual capacity and what to look for…

I can tell you that we exclude donors who have mental retardation in their family histories.

34.) Photographs: What age are the donors in the photographs?

Up to age 8. So baby pictures on up to 8.

35.) How do you ensure truthfulness of donors’ responses?

We use the Minnesota Multiphasic Personality Inventory and the Minnesota Inventory Lies Scale.

We use the PAI (Personality Asssessment Inventory) as a backup.

36.) Can we see a sample of a donor profile (even a blank one)?

Yes, just ask the nurse.

37.) What else should I know about the donors?

The donors apply online.

We check

  • AFC
  • AMH
  • Genetics (using the Good Star genetic panel)
  • Physical health
  • Infection diseases (there have been zero cases of HIV transmission through donor egg IVF)

Note

Some donors are not eligible for the guarantee program. [I did not catch why.]

RISKS

Me:

Multiple births

Emotional/psychological

Donor:

Protected from OHSS by using Lupron (along with gonadotropins).

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6 Comments

  1. L

     /  May 4, 2013

    So.. I got access to the egg bank yesterday afternoon. I will write more about it on my blog, but I can comment quickly on a few of the things you wrote here about Dr. S’s answers.

    In general, I have found everyone there to be really nice- but the communication is not fabulous. It just seems that it’s mainly set up for people doing the basic plan (which is strange, because everyone I talk to agrees they think the guarantee makes a lot of sense).

    For example, you write that the $30K is due within 5 days of making a donor match. Well, I thought that too. The powerpoint that Mary sent us says that. However, I learned that is not true for the guarantee program. I do not understand why it’s different, but I was having a lot of trouble getting access until I assured them the $29,500 was IN THE MAIL to them. The contact they sent me does say the full amount is due before matching, but it was never told to me before that. I kept being told I’d have access as soon as my pre-cycle screening requirements were complete, not also a million notarized forms and my full payment. I don’t know why the difference in the programs, but what could I do? I coughed up the money and overnighted it. Only then did I get access. So it all worked out, but it was a confusing process as I waited for access, and they were apparently waiting for my check.

    Other things.. hm. Well, the date the eggs were vitrified is not anywhere obvious in the current database. For now, you have to look very carefully at the donors’ profiles. There is a date on some of their profiles, and there is a date on all of the genetic screening documents. I am running with the assumption that the freeze date is somewhere shortly after these two documents. But yeah, it’s not really obvious or clear.

    I don’t have any other comments on what you say specifically, but I can share that the database is very uneven. Older donors (which I am assuming from lower donor ID #s) do not have as complete and helpful a profile as the newer ones that have been added recently. We wanted more info rather than less, so we chose to focus on newer donors. I will write more on my blog after I have lunch (hungry growls happening now), but I am happy with the two donors I am currently focusing on.

    Thanks again for such thorough reporting! I learned many things- like I didn’t know we get 8 eggs for unproven donors.
    Have a good weekend!

    Reply
    • Oh boy! Communication problems. Hmmm. It’s good to hear you say that it has mostly to do with the fact that they are used to doing the basic plan. Did you happen to find out which donors are not eligible for the guarantee? I wish I would have asked questions about that—I don’t understand why some would be eligible for the guarantee and others would not.

      And uneven database…hmm, hmm. Okay. Yes, this sort of things should be discussed up front. They give the impression that they are all exactly the same.

      Gonna go check out your blog! Thank you for the information.

      Reply
  2. L

     /  May 4, 2013

    I don’t know for sure about some donors not being eligible, but my guess is they mean the ones where there aren’t enough eggs left to have the full 6 or 8? You can sort by “available” and “limited availability.” Luckily there aren’t too many that are in the latter category.

    Reply
  3. L

     /  May 7, 2013

    Ok…I just got my protocol instructions and there’s a note that Dr. S would like (but does not require) for me to get a scratch biopsy done. I am not sure about this. It will likely cost a lot of $ (I have no insurance coverage for this) and I almost passed out at my HSG and my hydrosonogram. I apparently have a phobia of people shoving sharp objects through my cervix, who woulda thunk it?
    But, at the same time ,if it helps with implantation….
    Did he happen to mention this to you???

    Reply
    • No, he didn’t—but the thing is, I’ve been pregnant 5 times, so he probably won’t. Because that means there’s no problem with implantation with me. But because of your history of failed IVF—he’s probably rec’ing it for that. Just in case some of those times IVF failed, it was due to implantation problems. I’d say go for it. It should cost you only around $200 and be no worse than a PAP. And it can greatly increase pregnancy outcomes. Who knows, he might rec it for everyone because of how much it can help. But there is the issue of timing it just right. I think you have to have it done a few weeks before transfer (??) or something like that.

      Reply

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