Cost, technology drive frozen egg donation growth

The use of frozen donor eggs to assist with in vitro fertilization is on the rise, and it could be headed toward a tipping point in terms of public awareness and acceptance.

Advances in an egg freezing method known as vitrification have shown encouraging results in terms of live births, rivaling the results seen with fresh egg donation cycles. Add to that the significantly lower cost of in vitro fertilization (IVF) using frozen eggs and the increasing acceptance in the medical community, and it’s a recipe for growth in frozen donor egg banking.

"There’s been very rapid and very wide acceptance of this," said Dr. Daniel B. Shapiro, the medical director of My Egg Bank North America, a multicenter network of egg banks with locations throughout the United States including Atlanta, Boston*, Orlando, and Seattle.

The technology to freeze eggs has been around for decades, with the first baby born as a result of a cryopreserved oocyte reported in 1986. But the process was inefficient then and between 100 and 150 eggs might be needed to get a single pregnancy, according to Zsolt Peter Nagy, Ph.D., the scientific director for Reproductive Biology Associates, which is a partner in My Egg Bank.

"That was the level of efficiency for about 20 years," said Dr. Nagy said.

But the landscape started to change when scientists began experimenting with improvements to the egg freezing technique. A breakthrough came around 2006 with the use of a new process called vitrification. Although there are various methods of vitrification, it generally involves using a cryo-protectant and rapid cooling to solidify the cell without forming ice crystals. Many of the vitrification methods call for directly exposing the oocytes to liquid nitrogen.

In a randomized controlled trial of 600 recipients, which compared vitrified to fresh oocytes, researchers found no significant differences in fertilization, implantation, or pregnancy rates. Pregnancy rates per transfer were 55.4% for vitrified eggs, compared to 55.6% for fresh eggs (Hum. Reprod. 2010;25:2239-46).

It’s these types of results that are fueling the interest in frozen donor egg banking, said Heidi Hayes, CEO of Donor Egg Bank USA, a Rockville, Md.–based bank that opened for recipient use in March 2012.

"That is what changed it. Now it can be done successfully," Ms. Hayes said. "It’s going to change the field as a whole because of the new technology."

The field got another boost when the American Society for Reproductive Medicine (ASRM) issued a new guideline saying that the cryopreservation of mature oocytes – using both vitrification and slow-freeze protocols – was no longer experimental.

Removing the experimental designation means that practices wishing to use frozen eggs in IVF cycles won’t have to counsel patients that the procedure is experimental. It also means that an Institutional Review Board (IRB) won’t have to be involved in the informed consent process. That’s a significant change because a lot of practices don’t have access to an IRB, said Dr. Samantha M. Pfeifer, chair of the Practice Committee of the ASRM, which wrote the guidelines.

But ASRM is not endorsing frozen egg banking. Although the guidelines state that much of the best data supporting the use of oocyte cryopreservation was in the setting of donor oocyte cycles, the group said it would need more clinic-specific data on the safety and efficiency in the donor population before it could recommend universal donor banking. The ASRM statement does recommend oocyte cryopreservation for cancer patients who are at high risk for infertility because of chemotherapy.

There are a lot of advantages to moving toward frozen eggs, Dr. Pfeifer said, such as the ability to quarantine eggs to check for communicable diseases. But there are also lingering questions about how to use frozen eggs, she said. For instance, how long can these eggs be frozen and still be viable?

The other concern with moving rapidly toward universal donor banking with frozen eggs is that not every practice has the capability to freeze eggs. "There was some concern that if there was a sudden mandate from the government that everyone [would have] to use frozen eggs; we’re not equipped to do that yet," said Dr. Pfeifer of the department of obstetrics and gynecology at the University of Pennsylvania, Philadelphia. "A lot of things have to happen before that can become a standard procedure in this country."

The first step is removing the experimental label, she said. "Now that it’s not experimental, the reality is that people will be using this technique."

Even without a full-scale endorsement from the ASRM, momentum for frozen donor egg banking has been picking up. The cost is a big part of that, Dr. Shapiro said.

The price tag for a cycle of IVF using fresh donor eggs can run anywhere between $26,000 and $44,000, depending on the local market and whether an agent has been hired to find a donor. The cost rises quickly because everyone has to get paid, Dr. Shapiro said, including the donor, the agent, and the clinic performing the procedure.

In contrast, My Egg Bank North America "sells" its cycles to its affiliate practices for $16,500, which includes all the donor costs, vitrification, and technical assistance with the thawing of the eggs. Other egg banks also advertise the availability of frozen cycles at about half the cost of fresh IVF cycles.

And many of the banks offer some type of guarantee. For instance, at My Egg Bank, recipient patients are guaranteed two high-quality embryos. About 20% of patients don’t get two high-quality embryos so they are offered another cycle at no cost if no pregnancy results, Dr. Shapiro said. My Egg Bank also offers a program called "Frozen Egg Advantage," which offers a money-back guarantee when patients pay for five cycles. Patients either go home with a baby or get full reimbursement of treatment expenses at the end of five cycles.

"People sit down and they do a simple little [math]," he said. "They quickly come to the conclusion that a couple of cycles with us gives a higher cumulative likelihood of pregnancy than one fresh cycle any place else, and it still comes out less."

Convenience is another factor. Traditionally with fresh egg donation, both the egg donor and recipient would have to synchronize their cycles so that once the eggs are retrieved, they could be immediately fertilized and transferred. "When you have the possibility to freeze the donor eggs, then basically you can disconnect the egg donation from receiving those eggs," Dr. Nagy said.

That has the potential to take some of the uncertainty and stress out of the process for patients, said Barbara Collura, president and CEO of RESOLVE: The National Infertility Association. She has heard first-hand from infertile women who have had to start over when their donor dropped out of the process.

"They pick out an egg donor, and then she gets into law school and her whole life changes and she’s no longer available," Ms. Collura said. "Those things happen and they sound very trite, but when you’re 38, 39, 40 and you’ve been at this already for several years, having the ability to use a vitrified donated oocyte and to be able to use that when you’re ready, is amazing."

Frozen egg banking also may offer women greater choice when it comes to choosing an egg donor. That’s another factor that is driving the increasing popularity of this option, said Ms. Hayes of Donor Egg Bank USA.

"Cost aside, the donor is the most important factor to them," she said.

It’s not just about numbers, Ms. Hayes said, it’s also about ethnic and racial diversity. With fresh donation, it can be difficult to match recipients with donors of certain ethnic backgrounds. With frozen donation, it becomes logistically easier for egg banks to spend time building a more diverse database. At Donor Egg Bank USA, they are working with an affiliate program in Hawaii with the hopes of getting more Asian donors into the bank.

"I think culturally there are some women of ethnic background that are less likely to donate eggs," Ms. Hayes said. "These recipients, they want a baby as much as any other couple does. You want your baby to mirror your family."

Despite the growing interest in select circles, general awareness of the frozen egg donation model is fairly low. Ms. Hayes said she thinks social media will help it get into the mainstream as more women talk online about their success with frozen donor eggs.

"The more women have babies, the more they’ll talk about it, and the more people will utilize a frozen egg as an option," she said.

[email protected]

*Update: This article was updated 1/30/2013.

The use of frozen donor eggs to assist with in vitro fertilization is on the rise, and it could be headed toward a tipping point in terms of public awareness and acceptance.

Advances in an egg freezing method known as vitrification have shown encouraging results in terms of live births, rivaling the results seen with fresh egg donation cycles. Add to that the significantly lower cost of in vitro fertilization (IVF) using frozen eggs and the increasing acceptance in the medical community, and it’s a recipe for growth in frozen donor egg banking.

"There’s been very rapid and very wide acceptance of this," said Dr. Daniel B. Shapiro, the medical director of My Egg Bank North America, a multicenter network of egg banks with locations throughout the United States including Atlanta, Boston*, Orlando, and Seattle.

The technology to freeze eggs has been around for decades, with the first baby born as a result of a cryopreserved oocyte reported in 1986. But the process was inefficient then and between 100 and 150 eggs might be needed to get a single pregnancy, according to Zsolt Peter Nagy, Ph.D., the scientific director for Reproductive Biology Associates, which is a partner in My Egg Bank.

"That was the level of efficiency for about 20 years," said Dr. Nagy said.

But the landscape started to change when scientists began experimenting with improvements to the egg freezing technique. A breakthrough came around 2006 with the use of a new process called vitrification. Although there are various methods of vitrification, it generally involves using a cryo-protectant and rapid cooling to solidify the cell without forming ice crystals. Many of the vitrification methods call for directly exposing the oocytes to liquid nitrogen.

In a randomized controlled trial of 600 recipients, which compared vitrified to fresh oocytes, researchers found no significant differences in fertilization, implantation, or pregnancy rates. Pregnancy rates per transfer were 55.4% for vitrified eggs, compared to 55.6% for fresh eggs (Hum. Reprod. 2010;25:2239-46).

It’s these types of results that are fueling the interest in frozen donor egg banking, said Heidi Hayes, CEO of Donor Egg Bank USA, a Rockville, Md.–based bank that opened for recipient use in March 2012.

"That is what changed it. Now it can be done successfully," Ms. Hayes said. "It’s going to change the field as a whole because of the new technology."

The field got another boost when the American Society for Reproductive Medicine (ASRM) issued a new guideline saying that the cryopreservation of mature oocytes – using both vitrification and slow-freeze protocols – was no longer experimental.

Removing the experimental designation means that practices wishing to use frozen eggs in IVF cycles won’t have to counsel patients that the procedure is experimental. It also means that an Institutional Review Board (IRB) won’t have to be involved in the informed consent process. That’s a significant change because a lot of practices don’t have access to an IRB, said Dr. Samantha M. Pfeifer, chair of the Practice Committee of the ASRM, which wrote the guidelines.

But ASRM is not endorsing frozen egg banking. Although the guidelines state that much of the best data supporting the use of oocyte cryopreservation was in the setting of donor oocyte cycles, the group said it would need more clinic-specific data on the safety and efficiency in the donor population before it could recommend universal donor banking. The ASRM statement does recommend oocyte cryopreservation for cancer patients who are at high risk for infertility because of chemotherapy.

There are a lot of advantages to moving toward frozen eggs, Dr. Pfeifer said, such as the ability to quarantine eggs to check for communicable diseases. But there are also lingering questions about how to use frozen eggs, she said. For instance, how long can these eggs be frozen and still be viable?

The other concern with moving rapidly toward universal donor banking with frozen eggs is that not every practice has the capability to freeze eggs. "There was some concern that if there was a sudden mandate from the government that everyone [would have] to use frozen eggs; we’re not equipped to do that yet," said Dr. Pfeifer of the department of obstetrics and gynecology at the University of Pennsylvania, Philadelphia. "A lot of things have to happen before that can become a standard procedure in this country."

The first step is removing the experimental label, she said. "Now that it’s not experimental, the reality is that people will be using this technique."

Even without a full-scale endorsement from the ASRM, momentum for frozen donor egg banking has been picking up. The cost is a big part of that, Dr. Shapiro said.

The price tag for a cycle of IVF using fresh donor eggs can run anywhere between $26,000 and $44,000, depending on the local market and whether an agent has been hired to find a donor. The cost rises quickly because everyone has to get paid, Dr. Shapiro said, including the donor, the agent, and the clinic performing the procedure.

In contrast, My Egg Bank North America "sells" its cycles to its affiliate practices for $16,500, which includes all the donor costs, vitrification, and technical assistance with the thawing of the eggs. Other egg banks also advertise the availability of frozen cycles at about half the cost of fresh IVF cycles.

And many of the banks offer some type of guarantee. For instance, at My Egg Bank, recipient patients are guaranteed two high-quality embryos. About 20% of patients don’t get two high-quality embryos so they are offered another cycle at no cost if no pregnancy results, Dr. Shapiro said. My Egg Bank also offers a program called "Frozen Egg Advantage," which offers a money-back guarantee when patients pay for five cycles. Patients either go home with a baby or get full reimbursement of treatment expenses at the end of five cycles.

"People sit down and they do a simple little [math]," he said. "They quickly come to the conclusion that a couple of cycles with us gives a higher cumulative likelihood of pregnancy than one fresh cycle any place else, and it still comes out less."

Convenience is another factor. Traditionally with fresh egg donation, both the egg donor and recipient would have to synchronize their cycles so that once the eggs are retrieved, they could be immediately fertilized and transferred. "When you have the possibility to freeze the donor eggs, then basically you can disconnect the egg donation from receiving those eggs," Dr. Nagy said.

That has the potential to take some of the uncertainty and stress out of the process for patients, said Barbara Collura, president and CEO of RESOLVE: The National Infertility Association. She has heard first-hand from infertile women who have had to start over when their donor dropped out of the process.

"They pick out an egg donor, and then she gets into law school and her whole life changes and she’s no longer available," Ms. Collura said. "Those things happen and they sound very trite, but when you’re 38, 39, 40 and you’ve been at this already for several years, having the ability to use a vitrified donated oocyte and to be able to use that when you’re ready, is amazing."

Frozen egg banking also may offer women greater choice when it comes to choosing an egg donor. That’s another factor that is driving the increasing popularity of this option, said Ms. Hayes of Donor Egg Bank USA.

"Cost aside, the donor is the most important factor to them," she said.

It’s not just about numbers, Ms. Hayes said, it’s also about ethnic and racial diversity. With fresh donation, it can be difficult to match recipients with donors of certain ethnic backgrounds. With frozen donation, it becomes logistically easier for egg banks to spend time building a more diverse database. At Donor Egg Bank USA, they are working with an affiliate program in Hawaii with the hopes of getting more Asian donors into the bank.

"I think culturally there are some women of ethnic background that are less likely to donate eggs," Ms. Hayes said. "These recipients, they want a baby as much as any other couple does. You want your baby to mirror your family."

Despite the growing interest in select circles, general awareness of the frozen egg donation model is fairly low. Ms. Hayes said she thinks social media will help it get into the mainstream as more women talk online about their success with frozen donor eggs.

"The more women have babies, the more they’ll talk about it, and the more people will utilize a frozen egg as an option," she said.

[email protected]

*Update: This article was updated 1/30/2013.

The use of frozen donor eggs to assist with in vitro fertilization is on the rise, and it could be headed toward a tipping point in terms of public awareness and acceptance.

Advances in an egg freezing method known as vitrification have shown encouraging results in terms of live births, rivaling the results seen with fresh egg donation cycles. Add to that the significantly lower cost of in vitro fertilization (IVF) using frozen eggs and the increasing acceptance in the medical community, and it’s a recipe for growth in frozen donor egg banking.

"There’s been very rapid and very wide acceptance of this," said Dr. Daniel B. Shapiro, the medical director of My Egg Bank North America, a multicenter network of egg banks with locations throughout the United States including Atlanta, Boston*, Orlando, and Seattle.

The technology to freeze eggs has been around for decades, with the first baby born as a result of a cryopreserved oocyte reported in 1986. But the process was inefficient then and between 100 and 150 eggs might be needed to get a single pregnancy, according to Zsolt Peter Nagy, Ph.D., the scientific director for Reproductive Biology Associates, which is a partner in My Egg Bank.

"That was the level of efficiency for about 20 years," said Dr. Nagy said.

But the landscape started to change when scientists began experimenting with improvements to the egg freezing technique. A breakthrough came around 2006 with the use of a new process called vitrification. Although there are various methods of vitrification, it generally involves using a cryo-protectant and rapid cooling to solidify the cell without forming ice crystals. Many of the vitrification methods call for directly exposing the oocytes to liquid nitrogen.

In a randomized controlled trial of 600 recipients, which compared vitrified to fresh oocytes, researchers found no significant differences in fertilization, implantation, or pregnancy rates. Pregnancy rates per transfer were 55.4% for vitrified eggs, compared to 55.6% for fresh eggs (Hum. Reprod. 2010;25:2239-46).

It’s these types of results that are fueling the interest in frozen donor egg banking, said Heidi Hayes, CEO of Donor Egg Bank USA, a Rockville, Md.–based bank that opened for recipient use in March 2012.

"That is what changed it. Now it can be done successfully," Ms. Hayes said. "It’s going to change the field as a whole because of the new technology."

The field got another boost when the American Society for Reproductive Medicine (ASRM) issued a new guideline saying that the cryopreservation of mature oocytes – using both vitrification and slow-freeze protocols – was no longer experimental.

Removing the experimental designation means that practices wishing to use frozen eggs in IVF cycles won’t have to counsel patients that the procedure is experimental. It also means that an Institutional Review Board (IRB) won’t have to be involved in the informed consent process. That’s a significant change because a lot of practices don’t have access to an IRB, said Dr. Samantha M. Pfeifer, chair of the Practice Committee of the ASRM, which wrote the guidelines.

But ASRM is not endorsing frozen egg banking. Although the guidelines state that much of the best data supporting the use of oocyte cryopreservation was in the setting of donor oocyte cycles, the group said it would need more clinic-specific data on the safety and efficiency in the donor population before it could recommend universal donor banking. The ASRM statement does recommend oocyte cryopreservation for cancer patients who are at high risk for infertility because of chemotherapy.

There are a lot of advantages to moving toward frozen eggs, Dr. Pfeifer said, such as the ability to quarantine eggs to check for communicable diseases. But there are also lingering questions about how to use frozen eggs, she said. For instance, how long can these eggs be frozen and still be viable?

The other concern with moving rapidly toward universal donor banking with frozen eggs is that not every practice has the capability to freeze eggs. "There was some concern that if there was a sudden mandate from the government that everyone [would have] to use frozen eggs; we’re not equipped to do that yet," said Dr. Pfeifer of the department of obstetrics and gynecology at the University of Pennsylvania, Philadelphia. "A lot of things have to happen before that can become a standard procedure in this country."

The first step is removing the experimental label, she said. "Now that it’s not experimental, the reality is that people will be using this technique."

Even without a full-scale endorsement from the ASRM, momentum for frozen donor egg banking has been picking up. The cost is a big part of that, Dr. Shapiro said.

The price tag for a cycle of IVF using fresh donor eggs can run anywhere between $26,000 and $44,000, depending on the local market and whether an agent has been hired to find a donor. The cost rises quickly because everyone has to get paid, Dr. Shapiro said, including the donor, the agent, and the clinic performing the procedure.

In contrast, My Egg Bank North America "sells" its cycles to its affiliate practices for $16,500, which includes all the donor costs, vitrification, and technical assistance with the thawing of the eggs. Other egg banks also advertise the availability of frozen cycles at about half the cost of fresh IVF cycles.

And many of the banks offer some type of guarantee. For instance, at My Egg Bank, recipient patients are guaranteed two high-quality embryos. About 20% of patients don’t get two high-quality embryos so they are offered another cycle at no cost if no pregnancy results, Dr. Shapiro said. My Egg Bank also offers a program called "Frozen Egg Advantage," which offers a money-back guarantee when patients pay for five cycles. Patients either go home with a baby or get full reimbursement of treatment expenses at the end of five cycles.

"People sit down and they do a simple little [math]," he said. "They quickly come to the conclusion that a couple of cycles with us gives a higher cumulative likelihood of pregnancy than one fresh cycle any place else, and it still comes out less."

Convenience is another factor. Traditionally with fresh egg donation, both the egg donor and recipient would have to synchronize their cycles so that once the eggs are retrieved, they could be immediately fertilized and transferred. "When you have the possibility to freeze the donor eggs, then basically you can disconnect the egg donation from receiving those eggs," Dr. Nagy said.

That has the potential to take some of the uncertainty and stress out of the process for patients, said Barbara Collura, president and CEO of RESOLVE: The National Infertility Association. She has heard first-hand from infertile women who have had to start over when their donor dropped out of the process.

"They pick out an egg donor, and then she gets into law school and her whole life changes and she’s no longer available," Ms. Collura said. "Those things happen and they sound very trite, but when you’re 38, 39, 40 and you’ve been at this already for several years, having the ability to use a vitrified donated oocyte and to be able to use that when you’re ready, is amazing."

Frozen egg banking also may offer women greater choice when it comes to choosing an egg donor. That’s another factor that is driving the increasing popularity of this option, said Ms. Hayes of Donor Egg Bank USA.

"Cost aside, the donor is the most important factor to them," she said.

It’s not just about numbers, Ms. Hayes said, it’s also about ethnic and racial diversity. With fresh donation, it can be difficult to match recipients with donors of certain ethnic backgrounds. With frozen donation, it becomes logistically easier for egg banks to spend time building a more diverse database. At Donor Egg Bank USA, they are working with an affiliate program in Hawaii with the hopes of getting more Asian donors into the bank.

"I think culturally there are some women of ethnic background that are less likely to donate eggs," Ms. Hayes said. "These recipients, they want a baby as much as any other couple does. You want your baby to mirror your family."

Despite the growing interest in select circles, general awareness of the frozen egg donation model is fairly low. Ms. Hayes said she thinks social media will help it get into the mainstream as more women talk online about their success with frozen donor eggs.

"The more women have babies, the more they’ll talk about it, and the more people will utilize a frozen egg as an option," she said.

[email protected]

*Update: This article was updated 1/30/2013.