Donor-Egg IVF Procedure for Recipients – Protocol & Cost

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.

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.

Endometrial growth monitoring

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 15^th 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.

Endometrial growth in donor-egg IVF patients

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).

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 14^th 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 15^th 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.

Medications for the donor-egg transfer to the recipient

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.

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:

• Intracytoplasmic sperm injection (ICSI)
• Preimplantation genetic diagnosis (PGD)
• Sperm cryopreservation
• Embryo vitrification

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.

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

What is the difference between egg donation and IVF?

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.

How much does IVF with egg donation cost?

The cost of egg donation depends widely on the country where the patient undergoes treatment.

While in European countries such as Spain, Cyprus, the Czech Republic, Portugal, or Greece it ranges from €3,800 to €5,500 approximately, in others such as Ukraine and Russia, it can be as high as €8,500-11,000. In the UK, however, egg donation costs about £9,500.

As for the USA, it is the most expensive destination, but at the same time the one that offers the possibility of choosing between a known, a semi-known, or an anonymous donor, which is an advantage for many egg donor recipients. On average, the price there reaches $20,000-40,000.

Other popular egg donation destinations around the world are Barbados and South Africa, where the price range is €4,500-5,900.

Read more in the following post: Cost of IVF with donor eggs.

If I use donor eggs, will the baby look like me?

When matching an egg donor to a recipient, fertility clinics take into account that there is compatibility between them and that they share as many phenotype and immunological characteristics as possible. So, theoretically, yes, a baby conceived with donor eggs is likely to look like the birth mother.

However, it is important to note that the biological mother of the baby will be the egg donor, so in terms of genetic inheritance, the answer to this questions is no, the baby will not look like the recipient, since he or she does not share the genetic load with her.

Does a donor egg have my DNA?

No, donated eggs contain the DNA of the donor. The fact that it is later fertilized in the laboratory and transferred to the recipient's uterus does not modify the original genetic code of the egg. The embryo, therefore, contains the donor's genetic material.

How can I prepare for IVF with donor eggs?

From the medical point of view, the recipient has to get her body ready to receive the embryo that has been created using donor eggs in order to maximize the chances of implantation.

If fresh donor eggs are used, then synchronization between the cycles of the donor and the recipient is required. Inversely, this step is not needed when frozen donor eggs are used.

The recipient has to prepare her body for donor-egg IVF by means of endometrial preparation, which makes the uterus to grow its lining so that it is prepared for the embryo to implant successfully after the transfer (ET). To this end, the patient has to follow a strict drug protocol.

What are the success rates with donor eggs in women over 40?

With donor eggs, the chances of getting pregnant stand at 50-70% per cycle for women in their forties. It should be kept in mind that uterine receptivity might decline with advanced age. The reasons behind it might include biochemical and/or molecular aberrations of the endometrial lining, incidence of pathological conditions in the uterus (e.g. polyps, myomas...), hypertension, etc.

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

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.

Do babies from egg donation share genes with the birth mother?

Egg donor babies do not share the genetic load of the birth mother, but that of the egg donor, who is in fact the biological mother.

Nevertheless, recent studies have shown that recipients of donor eggs still pass some traits of their DNA through a phenomenon called epigenetics, a branch of Biology that studies the influence of a person's lifestyle on who he or she is, regardless of the gene expression.

So, factors such as the mother's diet during pregnancy could affect the development of the baby-to-be's gene expression.

If I use donor eggs, will the baby be mine?

Absolutely. Having a child is not only about sharing your DNA with him or her, but about educating, bringing up and enjoying life together as a family. Women who become mothers via egg donation love the baby exactly as any other female who got pregnant naturally with her own eggs would do. Having a child, no matter how you do it, is one of the most gratifying and rewarding experiences in life.

So, those women who are afraid of developing feelings of regrets once pregnant or after the birth of the child should know that this idea will disappear eventually.

How successful is IVF with donor eggs?

In general, the use of donor eggs makes an IVF treatment more likely to succeed, as the oocytes have been donated by young, healthy girls who enjoy a good ovarian reserve, features that make the quality of the eggs they produce optimal.

In comparison, if the normal pregnancy rate of IVF with own eggs stands at 35-34% on average, with donor eggs it increases to up to 55-63% approximately. These figures, however, depend on the uterine receptivity of the patient.

Visit the following article to learn more: Pregnancy success rates with donor eggs.

How many embryos should be transferred with donor eggs?

Specialists do recommend everyone undergoing IVF, whether it is done using own or donated eggs, to transfer one embryo in order for a multiple pregnancy to be prevented. There exist certain cases where transferring two embryos would be justified, including poor embryo quality and previous failed IVF attempts with a single embryo.

Also, given that the final decision is in the hands of the patient, sometimes younger patients who wish to have twins request a 2-embryo transfer from the beginning. The older the woman is, the higher the number of risks associated with a multiple pregnancy.

Why does donor-egg IVF fail?

Several complications not necessarily related to egg quality can lead to IVF failure or the impossibility to carry the pregnancy to term in spite of having used donor eggs, including:

• Genetic abnormalities, which might lead to embryonic arrest at any point of embryo development
• Uterine alterations that might prevent the embryo from continuing its development and cause the woman to miscarry
• Implantation failure due to poor endometrial receptivity

What are the miscarriage rates with donor eggs?

While in women younger than 45, the implantation rate is 45% on average, it drops to 35% in women from the 45-50 age group. Subsequently, the miscarriage rates increase with age in spite of using donor eggs: while they are less than 10% when the woman is 45 or less, they stand at 16% on average for women over 45. As explained above, a decline in endometrial receptivity is usually the reason behind this.

What are the chances of twins with donor eggs?

The chances of twins with egg donation are higher than in normal IVF cycles using the woman's own eggs due to the young age of donors, which translates into very healthy oocytes. This is the reason why multiple embryo transfers are unadvisable.

On average, if more than one embryo is transferred, the likelihood of becoming pregnant with twins is about 40%, while the chances of carrying triplets or greater is roughly 4%.

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

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.

What are the risks of egg donation for recipients?

The main risk of egg donation for recipients is becoming pregnant with multiples if more than one embryo is transferred. To avoid this, recipients are encouraged to bet on a single embryo transfer (SET), as the high quality of the eggs used guarantees a high success rate even with a SET. As for the side effects derived from the medications for endometrial preparation, these are considerably lower than those associated with the medical process for egg donors.

When should I take a pregnancy test after a donor-egg embryo transfer?

Like in any other IVF procedure, after an embryo transfer with donated eggs, women have to go through the two-week wait or 2WW, a time period necessary for beta-hCG levels to be detectable by a pregnancy test.

The presence of the hormone hCG in blood increases gradually from embryo implantation up until the end of the third trimester approximately. This, along with other hormonal changes, is the reason why the common pregnancy symptoms appear (nausea, vomiting, etc.)

Why does IVF fail with donor eggs?

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?

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.

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

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.

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.