By Cristina Mestre Ferrer BSc, MSc (embryologist).
Last Update: 05/29/2017

In both donor-egg IVF treatments and embryo adoption cycles, the recipient has to prepare her endometrial lining so that it is receptive, thereby boosting the chances for embryo implantation after the embryo transfer. For the endometrium or uterine lining to be optimally prepared, your doctor will establish a medication protocol of hormone medications adapted to your particular case.

How does the procedure start?

In the process of donor-egg in vitro fertilization (IVF), we use donor eggs instead of the patient’s own eggs to create embryos after fertilizing them with either partner-donated sperm or donor sperm. The new embryos are transferred to the recipient’s uterus in order for her to get pregnant.

The primary indication for donor-egg IVF is for women with premature ovarian failure (POF), a condition that is defined as having menopause earlier than the age of 40 years. POF indicates the cessation of ovarian function, and therefore the depletion of a woman’s ovarian reserve.

That is why the process should start with a fertility evaluation. The presence of elevated FSH (follicle-stimulating hormone) and/or estradiol levels can be detected by taking a blood sample on cycle days 2 or 3. It helps uncover evidence of POF even in women younger than 40.

Medical evaluations should include a complete history and physical examination to make sure pregnancy will not affect the woman’s overall state of health. It is important to seek factors which could have a negative impact on fertilization, embryo implantation and/or pregnancy.

Some IVF clinics perform what is known as mock cycles or prep cycles prior to the actual treatment. It is a preparatory cycle of programmed hormone replacement that helps ensure the prescribed hormone medications will help achieve endometrial receptivity.

Recipients with premature menopause require uterine preparation by means of estrogen and progesterone, as they lack ovarian function. When fresh donor eggs are used, patients with intact ovarian function may be prescribed this treatment or birth control pills for synchronizing their menstrual cycle with that of the donor.

What is the ideal endometrial thickness?

The endometrium, endometrial lining, or uterine lining is a mucous membrane that covers the inner layer of the uterus as well as the functional layer responsible for providing the optimum environmental conditions to the embryo. In IVF, before scheduling an embryo transfer (ET), we should make sure that this layer is in adequate conditions. To that end, its growth is monitored by ultrasound.

We can qualify as optimum an endometrium that has acquired a trilaminar or triple-line pattern, that is to say, when the ultrasound shows two layers that look darker separated by another layer of a lighter color. Also, the recommended endometrial thickness should be about 7 to 10 mm. With the appropriate pattern and thickness, the chances for the embryo implanting and the woman getting pregnant are higher.

Naturally, the endometrium gets prepared for receiving the embryo thanks to the hormonal changes produced throughout the woman’s menstrual cycle. Depending on the phase of the menstrual cycle, this layer might be under the influence of two different hormones, which allows us to distinguish between two stages:

  • Proliferative phase: At this stage, which starts on day 1 and ends on day 14 of the cycle, the estrogens produced in the ovaries allow the endometrial lining to grow. It can become about 10 mm thicker approximately.
  • Secretory phase: It begins on the 15th day of the cycle, and ends when the menstrual period starts. The ovaries produce progesterone in order for the endometrium to create the adequate environment for embryo implantation.

Should embryo implantation not take place, progesterone levels decrease, thereby causing the endometrial lining to shed, which is the stage known as menstruation or menstrual period, and a new menstrual cycle begins.

When a woman undergoes IVF, egg donation or embryo adoption, endometrial growth can be achieved with fertility medications. Embryo transfers are rarely performed during a woman’s natural cycle, that is, without exogenous drugs, as there exists the risk that the ET cannot be done because the endometrium has not reached the adequate thickness.

Medication protocol for recipients

Usually, in egg donation and embryo adoption cycles, hormone medications containing estrogens and progesterone are commonly used with the purpose of getting the endometrium to thicken appropriately. Conversely, in cycles of IVF with own eggs, women are prescribed progesterone only, as long as the ET is done in the same cycle as the ovum pick-up (OPU).

Do you need donor eggs to fulfill your dream of being a mother? inviTRA has reached agreements with fertility clinics to get you special prices for your IVF cycle using donor eggs.

You can choose any of the following options:

In those cases where the recipient’s ovaries are still functional, it might become necessary to stop the natural releasing of hormones via oral contraceptives or GnRH analogues, such as Decapeptyl. If needed, they are administered during the previous cycle to control the start of the cycle during which IVF is going to be carried out.

During the first phase of the cycle up until the 14th day, the medications of choice are based on estrogens. The administration can be done either through patch route, e.g. Evopad, or via estradiol oral tablets, such as Meriestra.

From the 15th day onwards, we switch to medications containing progesterone, like Utrogestan. Normally, they are administered vaginally, in the form of soft capsules. They can be taken orally, too.

In fresh donor-egg cycles, the woman starts with progesterone on the same day when egg retrieval is scheduled. On the other hand, with frozen donor eggs, progesterone should be started on the day when the oocytes are thawed.

Some studies have suggested that it can be also started the following day without altering the chances for success. Carrying it out a day earlier, however, might have a negative impact on the final outcome.

Should the specialist consider that the endometrial lining is growing appropriately, a date for the embryo transfer into the intended mother’s uterus will be set.

It should be noted that patients have to continue taking progesterone medications also before the embryo transfer, specifically up until the moment indicated by the doctor supervising the case, which can be extended to weeks 12-20 of pregnancy.

In some medication protocols, the treatment with progesterone is supplemented also with estrogens during the luteal phase (from day 15 of the cycle) to improve endometrial receptivity. If a pregnancy is not successfully achieved, medications are cancelled till the next cycle.

If you want to learn how IVF embryo transfers are carried out step by step, as well as the things that should be taken into account throughout this process, click this link: What is embryo transfer (ET)?

Needs and requirements might change on a case-by-case basis, though. While some women might need a lower dose, others might need a larger one due to a number of factors. This is the reason why a duly qualified doctor should be the one deciding what medications should be used and what is the adequate dose for each patient.

Cost of fertility medications

In general, the price of IVF with donor eggs is substantially higher than normal IVF programs using the patient’s own eggs. However, it depends on the country where the donation is done, the type of egg donor chosen (anonymous or known), and the need for additional techniques such as the following:

Also, the use of fresh or frozen donor eggs should be kept in mind when calculating the cost of donor-egg IVF. With fresh donor eggs, it is necessary to synchronize the menstrual cycles of the donor and the recipient, thereby increasing the cost and number of visits to the clinic. If frozen donor eggs are used, the treatment becomes cheaper, as the process becomes shorter and simpler.

Fertility clinics may offer different financing options. Full money back guarantee programs cover up to 3 or 4 donor cycles, and if a live birth is not achieved, the 100% of the total fee is refunded. Shared-risk plans and pregnancy-on-the-first-attempt programs are further examples.

More often than not, private clinics do not include the cost of the medications for endometrial preparation the overall cost estimate for IVF and embryo adoption. Drugs containing progesterone and estradiol should be purchased by patients directly at the pharmacy at their own expense.

The price of these medications ranges from €200 to €300 on average. It usually varies on a case-by-case basis.

There exists an alternative method that may reduce the cost of donor-egg IVF. It is called shared egg donation or just egg sharing and differs from donor-IVF cycles, where single donors are used, because the eggs produced are shared with other recipient couples.

Both the egg donor and the recipient benefit from this alternative procedure:

  • On the one hand, the donor receives medication and the IVF cycles for free after completing the egg donation process.
  • On the other hand, the recipient avoids waiting so long for being matched with a donor, and is given a second chance if the first cycle fails.

FAQs from users

Is donor-egg IVF with PGD for gender selection an option?

By Cristina Mestre Ferrer BSc, MSc (embryologist).

Sex or gender selection is not allowed in every country. Thus, the availability of IVF with PGD for gender selection depends on the location of your fertility clinic. Most patients who wish to select the gender of their baby-to-be travel to the United States to do so, as the majority of laws by state are favorable to its performance.

Embryos can be genetically biopsied with PGD prior to fertilization with IVF. Once one cell of the embryo is removed, its chromosomes can be analyzed to detect potential genetic defects and determine the embryo’s gender. Then, only the embryos of the desired gender are selected for the transfer.

What is the difference between egg donation and IVF?

By Cristina Mestre Ferrer BSc, MSc (embryologist).

Broadly speaking, by in vitro fertilization (IVF) we mean the process of fusing artificially the eggs and the sperms of the intended parents, with the purpose of creating new embryos and achieve a pregnancy after transferring them to the patient’s uterus.

On the other hand, egg donation is a procedure that is part of the IVF process when the patient’s own eggs are unable to be used. In these cases, donor eggs are fertilized exactly as explained in the previous paragraph. To sum up, egg donation is all about receiving donated eggs in order for the patient to get pregnant through IVF.

Donor-egg IVF vs. adoption, what is the best option?

By Cristina Mestre Ferrer BSc, MSc (embryologist).

It is not that one option is better than another, but a question of preference. In both cases, intended parents are addressing childlessness, and in this sense both options have their pros and cons, although there is some asymmetry between them, including embryo adoption.

While in adoption neither parent has a genetic connection to the child, donor-egg IVF gives the chance for one parent to have a genetic link with the baby-to-be. This, however, may create in the non-genetic parent a feeling of “exclusion”, while with adoption both share the same status.

For some, the level of privacy of assisted conception is appealing, and for others adoption is the best option because it is a more established system that gives a child the opportunity to have a home. Be it as it may, our advice is that you consider both the advantages and disadvantages carefully.

What are the chances of getting pregnant with twins using donor eggs?

By Cristina Mestre Ferrer BSc, MSc (embryologist).

The side effects of egg donation for recipients are minimal, being the most common the risk of getting pregnant with multiples. It depends on the number of embryos to transfer.

If multiple embryos are transferred, the rates of having a multiple pregnancy shoot up overnight. It should be taken into account that donor eggs have high implantation rates, given the young age of egg donors, which translates into healthier eggs.

On average, the rate of having twins with egg donation is at 36.6%. To reduce this risk, the general recommendation is to bet on single embryo transfers (SET). Two-embryo transfers are advisable only in cases of repeated implantation failure (RIF) or poor embryo quality.

Why does IVF fail with donor eggs?

By Cristina Mestre Ferrer BSc, MSc (embryologist).

On average, the chances of success with donor-egg IVF are as high as 60% per transfer, since egg donors are young and healthy women with a high reproductive potential.

But egg quality is not the only factor influencing the outcome of this treatment. The patient’s uterine conditions and sperm quality, among others, are also key factors when trying to get pregnant with donor eggs.

In some cases, however, in spite of transferring high-quality embryos and having a good endometrial receptivity, the embryos are still unable to implant for no apparent reason.

If you have gone through multiple failed IVF with donor eggs, the likelihood or risk for RIF or recurrent miscarriage with donor eggs depends on the cause behind your previous miscarriages. When it is caused by uterine abnormalities, using donor eggs will not change the situation to a large extent.

Down syndrome runs in my family, can I pass it to my offspring despite using donor eggs?

By Cristina Mestre Ferrer BSc, MSc (embryologist).

If you use donor eggs, preimplantation genetic diagnosis (PGD) is not required, as the hereditary factor disappears when donor eggs are used. Also, it should be taken into account that donors are young women, so the chances for their eggs to carry a genetic abnormality associated with advanced maternal age are very low.

Suggested for you

This post focuses on the egg donation procedure from the medical perspective. However, if you are an egg donor recipient and are wondering what does using donor eggs involve, do not miss the following information: Guide to being an egg donor recipient.

Also, we have talked about the success rates of donor-egg IVF treatments in general. To learn more details about the chances of getting pregnant with donor gametes, follow this link: Pregnancy success rates with donor eggs.

Finally, if you are considering the possibility of using donated embryos, this post will clarify any doubts you may have: What is embryo donation and adoption?

We have created a section devoted to clarifying the most common question raised by egg donor recipients. If you are interested in learning more about the process of IVF with donated oocytes, we recommend you to visit the follow post: 18 common FAQs from egg donor recipients.

Authors and contributors

 Cristina Mestre Ferrer
BSc, MSc
Bachelor's Degree in Biological Sciences, Genetics & Human Reproduction from the University of Valencia (UV). Master's Degree in Biotechnology of Human Assisted Reproduction from the UV and the Valencian Infertility Institute (IVI). Embryologist at IVI Barcelona. More information


  1. Featured
    katherine williams

    And how soon can women start feeling pregnancy symptoms after using donor eggs? I’m feeling kinda sick these dayz but I think it’s probably too soon – it’s been 11 dayz post ET. Thanks!!

    • Sandra Fernández

      Hello Katherine,

      Regardless of whether you undergo donor-egg IVF or IVF with own eggs, the two-week wait (2WW) is a phase every patient has to go through after IVF. It is a 15-day period of time before you can take a pregnancy test to confirm whether you’re pregnant or not. More info here: What is the two-week wait?

      If the treatment works, you may start feeling pregnancy symptoms by this time, but take into account that not every woman notices pregnancy symptoms so soon, and some women feel no symptoms at all, without it meaning the treatment has failed. It’s just that each woman experiences it differently.

      You may like to visit the following post: Having a baby through egg donation: early pregnancy signs.

      I hope I have been able to help,

      All the best