How to Choose The Right Egg with guest Dr. Julie Lamb
The topic of today’s interview is how to choose the right egg, and I’m speaking with Dr. Julie Lamb, who is an egg expert. She’s talking to us about her donor egg bank and how to pick the right egg. She is a board-certified reproductive endocrinologist practicing at Pacific Northwest Fertility in Seattle and Bellevue and serves as clinical faculty at the University of Washington.
Dr. Aimee: Welcome to the show, Dr. Lamb! I’m reminiscing about when I came to Seattle to co-host an egg freezing party with you, that was super fun. That was a great night and I really hope that we can do that again. I really wish that we actually lived in the same city and could be partners and take care of patients, because we have such a similar outlook and approach to doing things for our patients.
Dr. Julie Lamb: I love working with you. Every single time I get to see you, it is a total joy.
Dr. Aimee: I agree! What made you go into fertility medicine? How did you think that one day you wanted to be this? What inspired you to do this?
Dr. Julie Lamb: That’s a great question. I grew up with a mother who was an OBGYN nurse, so she brought home all sorts of gynecology stories growing up. I always really respected how well she cared for her patients. It was when I was living in Africa, right after I got married, almost 20 years ago, when I worked at a burn unit. These women had lit themselves on fire from a result of their infertility and how severely it affected their lives. It was seeing this sadness that infertility gave women of all cultures, not just that culture, that really drew me to fertility practice.
Dr. Aimee: I bet you helped a lot of people when you were there, too.
Dr. Julie Lamb: Yes.
Dr. Aimee: We all have a mom story. My story about how I became a fertility doctor also includes my mom and the experiences that I had growing up. You are the egg expert, for sure.
Dr. Julie Lamb: Thank you.
Dr. Aimee: But there’s a reason why you’re actually known as that, not just in Seattle, but all over the country. It’s because of the reputation that your IVF center has not just for IVF but as an egg donor bank. How do you guys know the special sauce, what makes you guys above and beyond everyone else?
Dr. Julie Lamb: That is a great question. I love to freeze eggs. It started with a passion for helping patients with cancer. When I was setting out into practice 10 years ago, I was really looking for a place that knew what they were doing with eggs. Our lab directors have that secret sauce. They really know what they’re talking about when it comes to eggs. That helps me help my patients, whether they’re doing donor egg, fresh eggs, their own eggs, for any reason. That’s the secret sauce is having a great embryologist that you would trust with your own eggs.
Dr. Aimee: I want to know more about your egg bank. What is the name of the egg bank?
Dr. Julie Lamb: We have an egg bank that’s called Simplify Egg Bank. It was an egg bank that was developed almost 10 years ago that allows patients to go through the egg donor process, choose an egg that’s right for them in a setting where they need a donor egg, and allows them to do it with the highest success rates. It’s more readily available than fresh eggs and it’s just a very successful process. That’s what this egg bank is. It was mainly just for the patients at our clinic, but we now share it with other providers outside of Seattle.
Dr. Aimee: You just said 10 years ago. We’re always talking about it’s experimental, it’s investigational, it doesn’t work. You have 10 years of experience freezing eggs. Talk to me about that.
Dr. Julie Lamb: We started it in 2009. It was actually done under an IRB, so that means that it was investigational. We were freezing eggs and donating eggs to patients and having them sign a consent form saying that it’s not currently the standard care. In 2012, they lifted that ban and it’s no longer experimental, and a lot of other clinics and scientists provided the service also.
Dr. Aimee: Exactly. I imagine with that kind of history and just a track record of excellence, you probably also know how many live births you have had, or even pregnancies over the past almost 10 years.
Dr. Julie Lamb: We do. We keep very good track of that. Right now, from the egg bank, so from frozen eggs, we have well over 200 live births.
Dr. Aimee: I have a whole bunch of questions. I feel like my patients when I talk to them about how to choose the right egg when it comes to an egg donor, all of a sudden, all of these things come to mind. If you don’t mind, these are actual questions that my patients have sent me, I’m just going to start asking them.
Dr. Julie Lamb: Perfect. Shoot.
Dr. Aimee: Can I be an egg donor?
Dr. Julie Lamb: No. You do look young enough to be an egg donor, and you’re definitely smart enough.
Dr. Aimee: But 41 is not old enough.
Dr. Julie Lamb: It’s not young enough.
Dr. Aimee: One day. Wouldn’t that be awesome if it was not old enough? Along those lines, do you think there’s going to be a technology where all of a sudden you can turn a 41-year-old egg into a 21-year-old egg?
Dr. Julie Lamb: I sure hope so.
Dr. Aimee: Why aren’t we there? If a man ran out of sperm, there would be a cure. Right?
Dr. Julie Lamb: That would be amazing. I think that in our lifetime we will see that.
Dr. Aimee: I hope so.
Dr. Julie Lamb: One of the things I love about this field is it’s always changing. It’s so exciting to see what’s going to be next.
Dr. Aimee: Totally. How do you find donors? Do you have recruiters or what do you do? How do you find these young women that give this gift of life to other families?
Dr. Julie Lamb: That’s a great question. We actually do it mainly from word of mouth, a referral basis. Someone donates their eggs, they have a smart altruistic beautiful friend who they’ll refer and tell about the process, and they’ll want to help a family build a family too.
Dr. Aimee: Nice. Is there an ideal age? We joked and said you won’t take someone who is 41, but let’s say you have a young woman who is 32 or even young, like 19 or 20. What is the ideal age for an egg donor?
Dr. Julie Lamb: Women need to be old enough to understand the process and the informed consent is very robust. We don’t take anyone that’s under 21 or 22. The age limit is usually about 29. I don’t think anyone in the egg bank is over 29.
Dr. Aimee: When you prescreen them and you’re looking at their AMH, FSH, antral follicle count — there was an article you probably saw published in JAMA about how your fertility levels don’t matter and don’t predict fertility, and you and I both know that couldn’t be further from the truth — what do you look for when you’re looking at those types of numbers in your egg donors?
Dr. Julie Lamb: They might not predict whether they’re able to get pregnant on their own, but they do help us predict the efficiency of the IVF process. We want someone that can donate enough eggs, but not too many that it puts their own health at risk. We want the process to be easy for them, not a burden, and not make them feel sick. We want it to be something that they do for altruistic reasons, to help others, and that it doesn’t affect their own health. That’s the important part.
Dr. Aimee: There are two things that this brings up. Number one is their health risk. You make sure that these donors are well taken care of, safe from harm.
Dr. Julie Lamb: Right. They’re my patients, too.
Dr. Aimee: Exactly. Altruism is really important because if you’re doing it for the right reasons then it’s just good for everybody, but what kind of payment can they expect?
Dr. Julie Lamb: That’s a great question. The American Society of Reproductive Medicine has ethical guidelines about how to reimburse donors, and we follow those guidelines. They’re reimbursed essentially for their time.
We pay each one the same. There’s not a difference depending on ethnicity or education level or how “hot” you are.
Dr. Aimee: Right. So true. What about those numbers, though, what follicle count, FSH, estradiol, AMH are you looking for? The thing is that I think just knowing these numbers as someone who is watching our show right now, I think it can help educate everybody about how to choose the right egg, whether it’s your own egg or an egg donor. What kind of numbers do you guys look for to have the most successful or most efficient IVF cycle?
Dr. Julie Lamb: The success of the egg itself doesn’t necessarily depend on the donor’s AMH or FSH. Certainly, we want those numbers to be really normal, so the FSH has to be below 10 and the AMH has to be above 2. Probably an average AMH for an egg donor is 4 or 5.
Dr. Aimee: Got it. So, in young women, under the age of 30, you just said it, the average AMH is 4 to 5.
Dr. Julie Lamb: Right.
Dr. Aimee: I’m so glad you said this. I see so many women who come in and they’ve Googled online that their AMH is 4 to 5, and they come in and say, “I have PCOS.” I’m like, “Why? You’re a young woman with lots of eggs. Your AMH is actually perfectly normal.”
Rather than getting advice from us, a lot of people go online. Someone who comes to us would obviously know if they had PCOS or not. That’s what kind of education we want to help people with. If you’re someone out there who has an AMH that you’ve gone online and you think it’s either too high or too low, be sure to get the right help, the right advice from someone like us.
How about shoe size? Have you had someone say, “What’s the donor shoe size? What is her mom’s shoe size?”
Dr. Julie Lamb: There are probably more important physical and academic characteristics to focus on. I’ve never actually turned down a donor for shoe size.
Dr. Aimee: I have had someone ask me before and say that she did not want her mother-in-law’s shoe size in their family. That’s just a funny thing.
What about body size, BMI? If someone had let’s say a BMI of 31, would that woman be an egg donor in your program?
Dr. Julie Lamb: The egg donor criteria has to be a healthy body weight, so a BMI of 27 is healthy body weight. Our donors all have a healthy body weight, but they come in all shapes and sizes, just like my patients do.
Dr. Aimee: Sure. That makes sense. What about drug screens? People ask, “How do I know they’re not going to do drugs or smoke marijuana or do that kind of stuff?” Are there things that you guys do to screen them for drugs?
Dr. Julie Lamb: Yes. There are so many things we do to screen these donors. They get criminal history reports, they get drug screens on multiple occasions. They’re not the kind of person that you worry about that, but occasionally you find it and you don’t use those eggs and you don’t use that donor. We really want healthy women donating their eggs.
Dr. Aimee: Right. Because our patients all want a healthy baby. If you’re going to choose the right egg, you want that right egg to also turn into a healthy baby.
You mentioned on that was on my list actually, background checks. What about a diploma check? I had this situation once where someone stated that they went to an Ivy League college, and it was obvious that was not the case. I even called that Ivy League college registrar’s office and they had no record of this individual. Long story short, we did not use that egg donor. Do you guys go so far as to do things like that as well? I’m assuming you do.
Dr. Julie Lamb: Yes. It’s very well documented. No stone is left unturned. Every egg donor that donates for our egg bank is someone that I would use as my own donor.
Dr. Aimee: That’s exactly what I say. I say to patients, “I’ve met your donor. I want her at my house for dinner. She’s wonderful.”
Dr. Julie Lamb: Right. And I’ve met each of them. I love them.
Dr. Aimee: Totally. I agree. They’ve become part of your family.
Dr. Julie Lamb: Right.
Dr. Aimee: What if a patient actually wanted to meet their donor in the future? What kind of things do you set up as far as psychological services? I don’t call it psychological evaluation, I call it counseling. What kinds of things do you guys do for situations like that, or all of the psychological counseling, when does that happen?
Dr. Julie Lamb: Yes. There’s lots of counseling, lots of mental health screening that goes into choosing these donors. Your specific question about meeting them someday, most of these donors do it anonymously. Washington state law says that if the donor chose to be open about it and the offspring from the donor egg wish to contact the clinic once they’re 18 and the donor happened to be somebody who was open to it, we could help facilitate that relationship. But it hasn’t happened yet, no one has asked that.
Dr. Aimee: That’s actually a law?
Dr. Julie Lamb: Yes. In Washington state. It’s recent, a couple years.
Dr. Aimee: That’s interesting.
Dr. Julie Lamb: It’s nice to have that option. I think sperm donors have that option. It’s equal rights for eggs.
Dr. Aimee: Do you ever do chat groups? I know you’ve had 200 babies born, but do you ever create groups from families of an egg donor, or had this request yet, maybe it will come at some point?
Dr. Julie Lamb: We haven’t had that request. Women, in general, want to be very anonymous. It’s no longer the egg of the donor, it’s the egg of your baby. You created it and it’s very much you, you grow it inside of you. I think even though people are very thankful for their egg donor, they no longer see it as someone separate from themselves.
Dr. Aimee: I use words like, “This is a natural pregnancy. This is your egg,” because it is. It’s your blood flowing through that placenta and feeding your pregnancy, for sure.
Dr. Julie Lamb: Absolutely.
Dr. Aimee: How many offspring are your donors allowed to have before they stop donating? Obviously, they’re not like sperm donors where it’s very easy to give a donation. An egg donor has to go through a surgery. At what point do you tell an egg donor to stop? I know you mentioned ASRM. What kind of guidelines do you guys follow?
Dr. Julie Lamb: We use those same ASRM guidelines and limit by the number of cycles, not by the number of offspring. The number of offspring is much less than you would see from a sperm donor. The average number of cycles that a donor would go through is about three, but they can undergo up to six for collection.
Dr. Aimee: I see. What if a recipient wanted to send a letter or a gift thanking a donor in your program? Is that something that is allowed or acceptable?
Dr. Julie Lamb: Yes, we do that. The donors love it. It really encourages them to do it again. They love the impact it has on a family, because they’re all in it for good reasons. They’re lovely people, so they like helping others build families.
Dr. Aimee: For sure. How do you guys deal with health updates? Let’s say there was a baby born from a donor that had a heart defect or something like that. Is that something that other families would find out or you would tell the egg donor and vice versa, if the donor had something in her family and she notified you, is there a reporting system?
Dr. Julie Lamb: Yes. That’s a really important question. As the donor gets older, things have happened in her health history that are important to disclose to other families. So, yes. That’s handled by the egg bank on a regular basis. It can be something pretty minor that could affect potentially the health of their child way in the future when that child is an adult. We reach out to each individual patient and update them, either by phone or in a letter, and offer resources for them to learn more about how that might affect their offspring.
Dr. Aimee: Right. I think the close relationship that you and I have with egg donors makes it so that we’ll hear from them when things like that happen.
Dr. Julie Lamb: Right. They don’t have to reach out, and they always do.
Dr. Aimee: They always do. It’s so true. What is the Simplify Program? Can you tell me about this program and how it relates to your egg bank?
Dr. Julie Lamb: This is a program that helps. The trickiest part about having an egg bank is the fertilization, the growing of the eggs and embryos. That piece of it is really important to me, and it’s important to the patient, to be successful. We know that the success rates of donor egg embryos are the highest when we use blastocyst embryos, so day five embryos. We can transfer on day three, it can work, but it’s not always as successful.
That’s a beautiful picture. I like the color.
Dr. Aimee: It’s actually a blastocyst that I transferred to a patient, she had it made as a gift for me in watercolor. Isn’t that beautiful?
Dr. Julie Lamb: I love that. How thoughtful.
So, this allows providers to transfer a single embryo, but it creates two blastocyst embryos that are available for a patient to build their family with. It’s kind of a guarantee of having a transfer. It allows the egg bank to take the risk.
Sperm is a big component of this. Sometimes the reason why a patient isn’t getting pregnant is related to the sperm. Sometimes it takes four or five eggs to make two embryos, and sometimes it takes a lot more than that. Getting the best chance that you can to build your family is really important to me and our egg bank.
Dr. Aimee: For sure. Let’s say I’m a patient living in Oregon and I’m watching the show right now thinking, “Dr. Lamb looks pretty awesome and fun, and I would love for her to help me have a family.” What does someone who doesn’t live in Seattle do?
Dr. Julie Lamb: We actually see that quite a bit, especially when the donor egg or the frozen donor egg was very new. People come from all over the world to see me or see our clinic. They call the clinic, and they get either a phone appointment or an in-person appointment. I love connecting with patients in person, talking with them and hearing their stories, every single one is so unique and different. So, yes, they make an appointment, we meet and talk, we make your embryos and build your family straight away.
Dr. Aimee: Then they’ll just come in for the transfers? That sounds great.
Dr. Julie Lamb: Right. Often, it’s two visits; an initial visit, consultation either in-person or by phone, and then the embryo transfer.
Dr. Aimee: Perfect. I want to move to the game show. I don’t know that I told you this, but I want to move the game show portion of the show.
Dr. Julie Lamb: Great. I’ve never been on a game show before.
Dr. Aimee: This will be The Egg Whisperer Game Show. I have a list of questions here and we’re going to call this fertility true or false. Are you ready?
Dr. Julie Lamb: Great. I’m ready.
Dr. Aimee: True or false: It takes just one egg.
Dr. Julie Lamb: True. Absolutely true. Not usually. Usually, more than one egg is required to build a family, but it just takes one.
Dr. Aimee: Right. The golden one. True or false: Sperm quality does not matter.
Dr. Julie Lamb: Absolutely false. There’s a lot we don’t understand about sperm. I think it probably matters more than we can imagine.
Dr. Aimee: Right. Do you recommend supplements, put the guy through sperm fitness challenge exercises, and stuff like that?
Dr. Julie Lamb: Yes, a whole obstacle course.
Dr. Aimee: Kind of like that show Wipeout.
I get this all the time because patients feel like, “I’m 41, I have to do egg donation right away before I’m 43, because my eggs are just getting worse.” I’m like, no. True or false: If a woman is in menopause, it means she cannot get pregnant.
Dr. Julie Lamb: Absolutely false.
Dr. Aimee: How does that work? Don’t you need ovaries to have a baby?
Dr. Julie Lamb: Science and medicine is spectacularly amazing, the options for patients post-cancer treatment, even young women go through menopause early for a variety of reasons. We get to build their lining with estrogen and prepare the endometrium with progesterone, and we can emulate the pregnancy hormones and prepare a uterus whether you went through menopause yesterday or 10 years ago.
Dr. Aimee: It’s true. I tell people the same thing. True or false: Transferring one embryo at a time is the safest way to go.
Dr. Julie Lamb: Absolutely true. It’s very important to me for my patients to have successful pregnancies and that’s that best way to do it is to transfer one embryo at a time.
Dr. Aimee: Right. True or false: You should have an orgasm on the day of your transfer to increase chances for pregnancy.
Dr. Julie Lamb: That’s an interesting question I haven’t been asked recently. Let me think about that. False.
Dr. Aimee: There are so many things that people read online, they all go and search stuff about dos and don’ts after the embryo transfer. I get that question sometimes. I’m sure that you have that experience, too.
Dr. Julie Lamb: I like to say whatever you think is going to make it work. If that’s going to make it work for you, go for it.
Dr. Aimee: Go for it. Love it. True or false: If you don’t transfer within six months of the embryos being created, your embryo will have freezer burn.
Dr. Julie Lamb: That happens at my house, but not with embryos.
Dr. Aimee: That’s a good one. I say that, too, it happens in my freezer. That’s very true.
Dr. Julie Lamb: Luckily, with vitrification, there is not a downside of long-term storage of these embryos. It’s wonderful because it allows you to have adequate birth spacing and be ready for a second baby before you use those embryos.
Dr. Aimee: You just said something that I want to bring up; second baby. What if you went through the Simplify Program and you got one genetically normal embryo, because you did the genetic testing as part of your cycle and you got one from your batch, what if you wanted a second baby and you wanted the same egg donor? What do you guys do? Tell me about that.
Dr. Julie Lamb: That’s a great question. That happens all the time. They reach out to us when they’re pregnant with that first child. If they have extra embryos, we go ahead and save those to transfer. But if they just one and they’re pregnant with that one, and they want an identically genetic sibling, the way we do that is file more eggs and make more embryos while they’re currently pregnant with baby number one so that they have something waiting for them for baby number two.
Dr. Aimee: That makes perfect sense to me.
Dr. Julie Lamb: Occasionally, we need to call the donor up and have her donate again. We do that quite frequently, too.
Dr. Aimee: Oh, really? That’s great.
Dr. Julie Lamb: When they hear it’s because they want a genetic sibling, they’re delighted to come back and do that.
Dr. Aimee: That’s awesome. Dr. Lamb, I love having you on our show. I really hope you’ll come back and teach us more about how to choose the right egg, talk to us more about all of your success. I was thinking it might be fun to just do a show on challenging fertility cases that we’ve had over the years. It’s just crazy to think that we’ve actually been in practice almost 10 years now. Right?
Dr. Julie Lamb: I know. It goes by really fast.
Dr. Aimee: I just want to close the show off tonight by asking you if there is one thing you wanted everyone in the world to know about fertility, what would it be?
Dr. Julie Lamb: That’s a great question. I guess the one thing that I would want everyone to know is just to never lose hope. There are lots of ways to build a family. You have to keep trying. You’re going to get there. If you keep trying, your dreams can come true.
Dr. Aimee: You and I are kind of like cheerleaders. We’re doctor-cheerleaders. Someone called me the other day a hope dealer. That kind of sounds like a drug dealer, so I’m not sure that’s a good thing, but I’ll take it.
Dr. Julie Lamb: Yes. It’s a big thing. You need stamina for fertility treatment and a lot of hope.
Dr. Aimee: That’s very true, on both sides. Is there anything else you want to tell our audience before we sign off tonight?
Dr. Julie Lamb: Learn about egg donation and figure out if it’s right for you.
Dr. Aimee: Absolutely. We love you, Julie. Thank you so much for being on the show.
Dr. Julie Lamb: Thank you. I love you, too.
Dr. Aimee: I really appreciate the time you took tonight to answer all of my patient questions that they had sent in. I hope you have a great night. Say hi to your family for me. I look forward to seeing you soon.
Dr. Julie Lamb: Thank you. Thanks for having me.
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