Medical Examiner

Did Elizabeth Edwards Use Donor Eggs?

All signs point to yes.

Staying mum

During the past several months, the image has flickered into our homes with increasing regularity: Following the end of a campaign-trail speech, little Emma Claire Edwards, 6, and Jack Edwards, 4—both blond and cherubic—joyfully run up to the stage where their dad, Sen. John Edwards, 51, scoops them into his arms. Standing nearby beaming, always, is Elizabeth Edwards, 55.

Do the math, and it’s not hard to figure out that Edwards gave birth to Emma Claire at age 48 and Jack at 50. And yet if Edwards used her own eggs, this is all but impossible—a woman’s ovaries completely stop producing viable eggs by age 45 in all but a tiny percentage of women.

Edwards has publicly stated that she “used fertility treatments” and “took hormone shots” in order to have Emma Claire and Jack. (She wouldn’t comment for this story.) That doesn’t really explain much since any fertility expert will tell you that “taking hormone shots” is part of nearly all high-tech fertility treatments used today. (Click here to read more about these treatments.) But Edwards has refused to get specific; a July Chicago Tribune story quoted her as saying she won’t discuss the details of her infertility because “it’s not ladylike.” This comment stood in sharp contrast to the Edwards we’ve seen on the campaign trail, a woman who’s candid and fun and not at all the prim political wife we’ve grown accustomed to in the last four years.

So how did Edwards have children at such a late age (late in reproductive terms, anyway)? It’s likely she used donor eggs. By employing a younger woman’s eggs, a woman can have babies well into her 50s. The process consists of finding a willing donor with desirable traits, supplying her with fertility drugs, extracting the multiple eggs that mature in her ovaries, placing them in a Petri dish with the man’s sperm, and waiting for three to five days. A few of the embryos that result are then transferred to the woman’s waiting uterus. The rest can be cryogenically frozen for later use, given to another couple, donated to science, or discarded.

Alas, no one but the Edwards family and their doctor—and maybe an egg donor, though most remain anonymous—can say for sure if donor eggs were used in the creation of Emma Claire and Jack. But reproductive endocrinologists agree that having babies with your own eggs at 48 and especially 50 is, well, just not going to happen: “The probability [that she used donor eggs] is 99.9 percent,” said David Adamson, a Palo Alto, Calif.-based reproductive endocrinologist and clinical professor at Stanford University’s School of Medicine. “If she hadn’t, she’d probably say, ‘No, I didn’t use donor eggs.’ ” Adamson, who sits on the medical advisory board of RESOLVE: The National Infertility Association, added that in the 25 years he’s spent treating thousands of infertility patients, he’s only seen one woman of 45 and one of 46 give birth using their own eggs. Fecundity starts to drop off long before that, he says. At 35, one in four women trying to have a baby will run into difficulties. At 40, about half will fail to conceive naturally. Above 45, there are so few births using one’s own eggs that no one keeps records of it, said Adamson. When it happens, you’re in miracle territory.

Still, even though it seems obvious to many that Edwards likely used donor eggs, the media haven’t focused on it, perhaps owing to ignorance about infertility and treatments (it’s complicated stuff) or to the long-held tradition of giving a pass to the underage offspring of presidents and presidential candidates. Think Amy, Chelsea, or the Bush twins (at least until fairly recently). No one has pushed Edwards to spill the beans about little Emma Claire and Jack, and so she hasn’t.

But her silence on the matter has some people miffed. “I think someone in her position can serve a great public good by being more outspoken,” said Richard Silverstein, 52, a fund-raiser in Seattle whose wife, Janis White, used a donor egg to give birth to their son, Jonah, three years ago. White, now 48, is currently pregnant with twins, a boy and a girl, also from donor eggs. Silverstein doesn’t understand why Edwards—if she used donor eggs—doesn’t speak up. “There’s an enormous level of ignorance about egg donation,” he said. “She could use the bully pulpit to clear some of it up.”

Fady Sharara, a reproductive endocrinologist who heads the Virginia Center for Reproductive Medicine in Reston, Va., underscores the ignorance that surrounds issues of infertility. Somehow, says Sharara, women aren’t getting the message about what happens to their fertility as they age. “A lot of my patients wait to come in until they’re in their mid-40s because they think they have forever and can get pregnant very easily at 45. ‘What about Geena Davis, who just had twins at 48?’ they say. When I tell them these women use donor eggs, they get the biggest look of shock on their face.”

Edwards could use the limelight to become the infertility and/or donor-egg spokesperson so people could see that many people—6.1 million of them in the United States, in fact—experience infertility, and many of them are seeking out treatments to have babies. Indeed, the number of couples availing themselves of IVF (in vitro fertilization, in which the woman injects fertility drugs, produces multiple eggs, has them surgically extracted and placed with her partner’s sperm in the lab, and the resultant embryos are deposited back in the uterus) has steadily increased since 1978 when the first IVF baby was born. According to the CDC, in the United States in 2001, the most recent year for which such numbers are available, there were 69,515 IVF cycles begun using nonfrozen, nondonor eggs, which resulted in 21,813 deliveries (and even more babies, as the rates of multiple birth rises with the use of IVF). The use of donor eggs is increasing, too, since the first donor-egg baby was born in 1983. CDC numbers show that more than 11 percent of all high-tech fertility treatments now involve donor eggs. In 2001, 12,018 IVF attempts using donor eggs were made. Knowing that someone like Elizabeth Edwards had also dealt with infertility might make infertile couples realize that it doesn’t mean there’s something defective about them or the child they may conceive using advanced reproductive technologies.

Perhaps most important, Edwards could also speak out about the cost of such procedures and the fact that the vast majority of states don’t require insurance companies to cover any of it. Currently, according to the American Society of Reproductive Medicine, only seven states mandate that insurance companies cover some of the cost of IVF, and no states require coverage of donor-egg costs. Indeed, the cost of treatments can add insult to injury for infertile couples. Most couples opting for IVF, for example, face paying an average of $12,400 out-of-pocket per try, according to the ASRM. Add anonymous donor eggs into the mix, and you can count on dropping an additional $6,000 to $15,000 per try—that’s $3,000 to $10,000 to the donor for her troubles and possibly another $3,000 to $5,000 to the agency that found her for you if your infertility clinic doesn’t provide ready-made donors. Such treatments are thus available only to those high on the socioeconomic ladder—or those willing to go into debt.

But if Edwards—who mothered two children before Emma Claire and Jack (Catharine, now 22, and Wade, who died in a car wreck in 1996 when he was 16)—did go vocal, it’s likely she would provide all manner of fodder for the religious right. Many organized religions have serious misgivings about the use of donor eggs or sperm, not to mention the very concept of conception taking place outside the womb. And then there’s one question that might really trouble the right: If Edwards did use IVF—a procedure one must undergo when employing donor eggs—what did she do with the embryos that weren’t transferred back to the uterus? If she and Sen. Edwards discarded them or donated them to science (read: stem cell) instead of freezing them for later use or donating them to another couple, the right-wingers would have an absolute field day. It’s no wonder Edwards has kept her lip tightly zipped.

Of course, there are personal considerations that may loom much larger than politics. Infertility is a tremendously painful experience and many who have suffered from it don’t talk about it with anyone—sometimes not even family members or close confidants. Then, too, for most parents, the privacy of the children is of utmost importance. The Edwardses, if they did use donor eggs, may or may not plan to tell their children. According to a study in the June issue of the journal Fertility and Sterility, 10 percent of parents with a young child conceived through egg donation had already told them by age 3; 49 percent planned to tell the child later; 10 percent were unsure what they were going to do about disclosure; and 31 percent said they did not plan to ever reveal to the child that he or she does not possess any genetic material from Mom.

Finally, let’s face it—in a volatile political race where sexuality (the vice president’s daughter is a lesbian!), gay marriage, and reproductive rights are major issues, a frank public discussion about Sen. Edwards’ sperm and his wife’s uterus might be too great a distraction for these carefully scripted final moments of the campaign. And so, the Edwardses remain mum—and they likely will for the foreseeable future.