Donor Eggs vs. Surrogacy for Repeated IVF Failures: What’s the Right Choice?
Patient: Dr. Malpani, I’ve had a couple of IVF failures, and my doctor is suggesting surrogacy for the next cycle. Do you think that’s the right option?
Dr. Malpani: I’m glad you asked, because this is a common area of confusion for many women. When an IVF cycle fails, especially after 2 or 3 attempts, it’s easy to assume that something must be wrong with your uterus. Some doctors even suggest surrogacy for the next cycle. But in reality, this advice is often flawed.
Patient: So, you don’t think surrogacy is the answer?
Dr. Malpani: In most cases, no. The uterus is an incredibly resilient organ. We know that even women who have been menopausal for 10 or 20 years can carry a pregnancy. The uterus regenerates a new lining every month, so it’s usually not the cause of implantation failure. If an ultrasound shows that your endometrial thickness and texture are normal, it means your uterus is functioning just fine.
Patient: That’s surprising. I thought the uterus played a big role in implantation.
Dr. Malpani: It does play a role, but it's a passive one. Think of it like soil—its job is to nourish the seed, which in this case is the embryo. The embryo, however, is the active part. If there’s a problem with implantation, it’s often because the embryo is genetically abnormal, not because something is wrong with your uterus.
Patient: So, if my uterus isn’t the issue, why did my IVF cycles fail?
Dr. Malpani: The most common reason for IVF failure is an abnormal embryo, especially as a woman ages. Even embryos that look good under the microscope or are PGS tested for chromosomal normality can still carry genetic defects because they come from older eggs. As you get older, the quality of your eggs declines, and this increases the likelihood of genetic abnormalities in the embryos.
Patient: I see. So, what would you recommend instead of surrogacy?
Dr. Malpani: In your case, I would suggest exploring the option of using donor eggs or donor embryos. This is often a better solution because the problem usually lies in the eggs, not the uterus. Donor eggs from a younger woman will increase your chances of success, even if you’ve had multiple IVF failures.
Patient: But why do so many doctors recommend surrogacy?
Dr. Malpani: Unfortunately, many doctors either don’t explain this fully or may push for surrogacy because it’s more profitable. It’s also an intuitive assumption for many women to think that if a healthy-looking embryo didn’t implant, something must be wrong with their uterus. But from a biological standpoint, this reasoning is flawed. The real issue is often the embryo quality, not the uterus.
Patient: That makes so much more sense now. Thank you for explaining it.