Syracuse Herald American (NY)

December 27, 1998

EGG DONATION COMES TO CNY FERTILITY SPECIALIST LOOKS FOR MATCH BETWEEN DONORS AND WOMEN WANTING CHILDREN.

Author: Amber Smith Staff writer

Dr. Robert Kiltz is offering another option to women with difficulty getting pregnant. The Syracuse fertility specialist now oversees Central New York's first egg donation program, and he embarked on the area's first donation procedure Dec. 22.

His advertisements for egg donation have dozens of women examining their emotional fiber: Can they bring themselves to give away their eggs so that women they don't know may bear children?

Can $2,000 help them make their decision?

Kiltz is looking for healthy women between the ages of 21 and 32 who honestly want to help other women achieve pregnancy. "Women helping women," his advertisement says. Potential donors have to complete a 14-page questionnaire of their physical characteristics, medical, sexual and family histories, and their philosophy about donating eggs.

It asks their beliefs about who owns the eggs, whether they would feel like a mother, how often they would think of the resulting children in coming years.

It's far more extensive than information collected from men who donate sperm. "Women are far more connected to their eggs than men are to their sperm," Kiltz said.

He sifts delicately through the answers. It is his role to decide whose eggs he'll offer. Should he disqualify a woman who attempted suicide as a teen when her parents were divorcing? Should it matter that the woman has something wrong with her teeth or that she's clumsy?

"I kind of have a problem looking at these little, little details," the doctor acknowledges. The answers, he says, are collected more for the child to read at some point in the future - maybe.

Nobody needs to know the child was the result of a donated egg, Kiltz says. That secret can stay with the woman who receives the egg.

Kiltz will handle donations between women who know each other, or he'll orchestrate an anonymous donation. In those cases, the women may or may not agree to meet.

Sure, a donor could lie on her questionnaire.

Kiltz says he's a good judge of character. He can't verify everything.

He interviews potential donors and screens them, as required by state law, for hepatitis, human immunodeficiency virus, syphilis, gonorrhea. He also screens for genetic diseases such as sickle cell anemia and Tay-Sachs. He eventually wants to add tests for cystic fibrosis.

When it comes down to picking donors, he admits some of the selection is arbitrary.

"Life is risky. We all drive cars, but we accept the risk. When we adopt, we don't have the same selection bias as we do with this," he says.

"The premise is that most people are honest."

Egg donation is a technique that helps mostly women in their mid- to late 30s or 40s, many of whom have postponed starting their families. Some women who have had repeated miscarriages blamed on genetic abnormalities, or those with premature ovarian failure may also turn to donor eggs.

"Male fertility does not drop with time as female fertility does," Kiltz says. "With women it's the egg that's the culprit."

Production and quality of eggs diminish when a woman hits her mid-30s.

But using donated eggs, a woman way beyond her peak fertile years - the 20s to early 30s - can become a mother. Sixty-three-year-old Arceli Keh of Highland, Calif., proved that to the world when she delivered Cynthia in 1996, after lying about her age to an egg donor program.

Kiltz says it's not for him to decide who becomes a mother. He'll take care of anyone seeking fertility treatment. "I turn no one away," he says.

Women whose bodies aren't producing eggs have few options. "It's either adoption, or nothing, or egg donation," Kiltz says.

Adoption can often be a complicated and stressful process. Also, many women yearn to experience childbirth.

Egg donation allows for childbirth, and it offers a woman more selection than adoption. Kiltz says many of his female patients asked him to start offering egg donations. The first step, he says, is to find a pool of women willing to donate their eggs.

Kiltz will then meet with a woman who wants to get pregnant, learn what characteristics she's looking for in a child and attempt to find them from within his pool of women willing to donate.

Most women say they just want a healthy child. Kiltz recalls women from his training in California who were more picky. They'd ask for a child of a certain stature or intelligence level, or musical ability.

Samuel Gorovitz noticed an advertisement in the Stanford University alumni magazine that arrived at his home this month. Gorovitz is a professor of philosophy and public administration at Syracuse University and a member of the state's life and law task force.

"Special egg donor needed," the ad began. "Desperately seeking smart, sensitive, sassy Samaritan. Ivy League alumni looking for a donor match: beautiful blue or green eyes, slender build, fair skin, warm smile. Compensation: $7,500, plus expenses."

Gorovitz says the ad caught his attention. "Implicit in this is the idea that if you want genetic material with that kind of pedigree, the price is higher," he says.

The emerging market for eggs is inherently appealing to women who don't have a lot of money. The $2,000 Kiltz offers is an incentive a poor woman may find hard to resist, he says.

One woman says on her application that the money will help her pay for college.

Though he doesn't want women who donate eggs just for the money, Kiltz says $2,000 is fair compensation.

Guidelines from the American Society for Reproductive Medicine say payment can be made to the donors for the "direct and indirect expenses associated with their participation" and "their inconvenience, time, discomfort and for the risk undertaken." The guidelines go on to say "payments should not be so excessive as to constitute coercion or exploitation."

Kiltz plans to pick four or five donor candidates and allow the woman who wants to become pregnant to read the completed questionnaires. Together, the doctor and patient make the selection.

Of course there are no guarantees.

The baby the woman bears will be biologically related but not genetically related. The child will have the genes of the woman who donated the egg, but the baby's development during pregnancy will be influenced by what the carrier woman eats and how she takes care of herself.

"Carrying a baby and delivering a baby, there's a huge connection that you can't ignore," Kiltz explains.

The connection doesn't come cheap. Women can expect to pay $10,000 per attempt with donor eggs, and many health insurance plans don't cover this procedure.

And, the chances of getting pregnant through donor eggs are 30 percent to 40 percent, according to data from the American Society for Reproductive Medicine. In 1995, fertility centers throughout the United States reported 3,555 pregnancy attempts through donor eggs and 1,756 resulting pregnancies.

Donor sperm has been used for more than 100 years, but only in the past decade has technology existed for women to donate eggs.

Frozen donor sperm is widely and easily available, so Kiltz has no plans to open a sperm bank. The Rochester Regional Cryo Bank, for example, charges $130 for sperm. Sperm donors get $40.

For women who need donor sperm, Kiltz has catalogs listing the sperm donors' ages, races, blood types, ethnic origins and such. He can place an order for overnight delivery.

Eggs are different, he says. "Current technology does not allow us to freeze them."

Unfertilized eggs must be implanted soon after they are retrieved, or fertilized and frozen as an embryo for later implantation.

Kiltz received 75 calls from women interested in donating their eggs the first week his ad appeared in the New Times, a free tabloid newspaper geared to young adults. In the weeks since then, he's accumulated more than 200 applications from interested women.

One came from a 28-year-old woman in Oswego. Sussanne would not allow her last name to be used because she doesn't want the woman who may receive her eggs to be able to find her later.

Sussanne has two children and has been trying to get pregnant for six years. She still produces eggs, but the eggs don't make their way to her uterus.

She had talked with Dr. Kiltz about in vitro fertilization.

Later she broached the topic of donating her eggs.

Sussanne wanted Kiltz to remove her eggs and divide them. Half would be fertilized with Sussanne's husband's sperm and implanted in her. The rest would be donated to another woman. That would shave $2,000 off the costs of her in vitro fertilization.

"It's something that I've thought about for the last three years," Sussanne says. "After dealing with infertility for so long, I want to help another woman who hasn't had the experience of being a mother."

Kiltz says such a procedure is called a shared egg donation, and it carries additional concerns.

What if the woman who receives the eggs gets pregnant, but Sussanne does not?

"It can be a difficult situation. It's not for everyone," the doctor says.

Sussanne spent almost four hours filling out Kiltz's questionnaire. "You have to draw these things from the inside," she explains.

Would Sussanne feel like a mother to the baby born to the other woman?

"Oh, no. Gosh no," she says. "I didn't carry that baby. I didn't get up at 4 a.m. for the feedings."

Sussanne says her husband thinks this is a good idea. Her mother thinks it's wonderful. One of her sisters is ambivalent, but the other is supportive.

Soon after she turned in her application, Kiltz told her he had a patient who wanted Sussanne's eggs.

Sussanne doesn't want to know much about the other woman. The fact that she has such a strong desire to be a mother is all Sussanne needs to know. "That satisfies me completely."

Sussanne began her medications Dec. 22.

The egg donation process takes time.

The donor and the woman who will receive her eggs have to be on the same menstrual cycle. Kiltz accomplishes this by placing them on medications.

The donor will take injections to help stimulate her ovaries. She must go to the doctor's office for one to two hours two or three times a week for three weeks. Then in the third week of her cycle she undergoes a surgical procedure in Kiltz's office to remove the eggs.

The risks to egg donors are minimal but not zero, Kiltz says. The injected medicines stimulate the ovaries to produce lots of eggs and that can cause the ovaries to enlarge. That enlargement can lead to ovarian cysts, which can produce anything from mild discomfort to a condition that requires hospitalization. And the retrieving of eggs is a minor surgical procedure that carries risks of bleeding and/or infection, as with any surgery.

The woman receiving the eggs takes injections to help prepare her uterine lining.

The egg is fertilized with sperm, usually but not necessarily from the recipient's husband or partner. Then the embryo is placed in the woman's uterus.

Sussanne has weeded through all the questions that concern her, and she's emerged grateful for the ability she has to give life.

She's realistic, too. These reproductive techniques are expensive. The desire for motherhood is strong.

"I would do this for free, to help someone," she says. "You have to be a mother to see through the eyes of a mother."

She recognizes that women who've had trouble getting pregnant have trouble being around young children. It hurts too much.

She simply wants to relieve that hurt for someone else, she said, and at the same time, herself.