Donor-Egg IVF Procedure for Recipients – Protocol & Cost

Donor-egg IVF is a fertility treatment in assisted reproduction that allows a recipient woman to achieve pregnancy using the oocytes of an anonymous donor. Egg donation is indicated for women who cannot have children with their own eggs, either because they are too old, or because they suffer from some genetic alteration or any other problem with their gametes.

One advantage of donor-egg IVF, whether with partner sperm or donor sperm, is that it has a high probability of success and that is why more and more women are turning to it to become mothers.

Indications

IVF with egg donation is not usually the first chosen treatment when a woman or couple goes to a fertility clinic, as patients usually want to try for pregnancy with their own gametes first.

Nevertheless, these are the following situations in which egg donation is explicitly indicated:

• Patients with no ovarian function, either due to primary ovarian failure, premature ovarian failure, absence of ovaries or menopause.
• Patients with ovarian function but who cannot use their eggs because of transmissible genetic abnormalities, repeated failures in previous IVF cycles or because they are over 40 years old.

This last cause is the most frequent, since with age the quality of the eggs decreases: the probability that the embryos obtained have chromosomal abnormalities that compromise their viability and cause abortions increases. The chances of having a child with Down syndrome are also significantly increased.

Chosing the egg donor

Egg donation is a very controlled process. In order for it to be performed, the egg donation candidate must meet a series of legal, medical and ethical requirements.

A selection process will be carried out to assess her suitability to be a donor, in which both her physical condition and psychological aspects are studied.

It should be noted that this is an altruistic, voluntary and totally anonymous process: the identity of the egg donor will always remain confidential. Related Article: How can I become an egg donor?

Types of Egg donation

Depending on the origin of the eggs, there are two main types of egg donation: fresh egg donation or vitrified egg donation.

However, today we can also include two other types of egg donations in this classification: eggs steming from egg banks and mini-egg donation, or shared egg donation which is also referred as to egg sharing or split egg donor cycle.

In the following section, we will discuss each of them:

Fresh donor egg IVF

In these cases, the donor and the recipient of the eggs must have the hormonal cycle synchronized, so the donor is stimulated while the recipient prepares her endometrium.

In other words, in the same cycle, the donor's eggs are extracted and, after 3 or 5 days, the embryos are transferred to the uterus of the recipient.

The disadvantage of this technique is that if the donor does not respond well to ovarian stimulation, the recipient may have to wait until the next cycle to perform the transfer, which involves more hormonal medication and greater emotional distress.

Frozen donor egg IVF

This form doesn’t require the synchronization of donor and recipient. First of all, the donor's oocytes are extracted and the mature ones are frozen by using the vitrification technique.

Once a compatible recipient has been found, these eggs are thawn and fertilized with the partner’s sperm or with the sperm of a compatible donor in the case of a double donation.

As in the previous case, the egg recipient will also have to perform a endometrial preparation treatment prior to the embryo transfer, this will not be coordinated with the donor, though.

The disadvantage of this method is that the number of eggs available for fertilization may decrease because not all of them survive the thawing process. The current survival rates are still very good thanks to the optimization of the oocyte vitrification technique.

Eggs from egg banks

As we have already explained in the previous sections, the donor's eggs can be used either fresh or frozen. In case of fresh egg donation it will be necessary to synchronize the cycles of the donor and the recipient. Otherwise, after harvesting the eggs, they will be frozen until the moment of fertilization, at which point the eggs will be thawed.

For the latter option, the fertility clinic can either have its own donors (its own egg bank) or, on the contrary, work in coordination with an external egg bank.

Health management expert Javier Suarez comments on the advantages of external egg banks:

Having an external egg bank for egg donation treatments offers multiple advantages, such as the variety of phenotypes.

An egg bank is a department in charge of obtaining, evaluating and then distributing donor eggs. Due to their activity, the egg banks have a wide and varied database of donors. For this reason, they can respond to almost any demand from clinics.

This allows fertility centers to offer egg donation treatments almost immediately, as it is rare not to find a compatible donor in the egg bank.

Mini egg donation

Mini egg donation consists of the donation of a smaller number of eggs. While in a complete egg donation the recipient obtains all the eggs recovered from the donor, which may be between 8 and 10, in the mini egg donation only 4 or 5 are received.

Medical Director of FIV Valencia, Dr Miguel Dolz, comments on the two purposes of mini egg donation:

Financial aspect

the cost is significantly lower and thus more women and couples are able to access this treatment.

No surplus embryos are generated

Especially in women or couples who only want to have one child through egg donation. Thus, no surplus embryos are created that must later be donated or vitrified, with the consequent storage costs.

Dr. Miguel Dolz also assures that:

The pregnancy rate per cycle performed in a mini egg donation is the same as with a complete egg donation.

Mini egg donation is also known as shared egg donation, since the eggs extracted from one donor can be used for two or more recipients, always in compliance with current legislation which states that no more than 6 children can be born from the same donor, including their own children.

Egg donation procedure step by step

Once the egg donor has been accepted, it is possible to start the egg donation cycle. The whole process takes a few minutes and consists of the following steps:

Ovarian stimulation of donor

The donor undergoes hormonal ovarian stimulation treatment to ensure that more eggs develop than in a natural cycle, in which only one would mature, thus increasing the chances of success.

Then, by means of follicular puncture, the developed eggs are extracted. The mature ones are fertilized in the laboratory with sperm from the recipient's partner or from an anonymous sperm donor which depends on the characteristics of each couple.

The resulting embryos are kept in culture and their development will continuously be evaluated until the day in which the embryo transfer to the recipient takes place.

Endometrial preparation of the recipient

Before the embryo transfer, the recipient needs to get her endometrium preparated so that the embryos can implant in the uterus.

For this purpose, estrogen and progesterone must be administered either orally, vaginally or in patches, so that the endometrium reaches the appropriate thickness (7-10 mm) and becomes receptive.

Medications for the donor-egg transfer to the recipient

The embryo transfer to the recipient's uterine cavity will take place between 3 and 6 days after fertilization. The best quality embryo or embryos will be chosen for transfer and the rest will be vitrified for use in subsequent cycles, either to make another attempt in case pregnancy is not achieved in this one, or to have another child later.

About 10-12 days after the embryo transfer, the levels of the hormone β-hCG are analyzed to find out whether or not pregnancy has been achieved.

Clinical results of egg donation

Because good quality eggs from young, healthy women are used, the success rates of egg donation are higher than those of IVF with own eggs.

Embryologist Rocio Diaz comments on the success rates:

In older patients, we increase the pregnancy rate when they undergo a fertility treatment with young donor eggs.

According to the statistical report published by the Spanish Fertility Society in 2017 (National Registry of Activity 2017-Registration SEF), in the case of fresh donation the percentage of pregnancy by transfer in an egg donation cycle is 54.7% and the birth rate by transfer at 40.6%.

In the case of the donation of frozen eggs, these percentages decreased somewhat, being 40.6% and 28.4%, respectively.

Read more here: Success rates with egg donation.

Costs

Performing Egg donor IVF makes the fertility treatment more expensive since the medication to stimulate the donor and financial compensation for the discomfort caused must be paid for.

While an IVF/ICSI treatment with own eggs costs between $10,000 and 15,000, when you add in the donation of eggs, the price can range between $14,000 and 20,000 depending on the fertility clinic and the type of egg donation.

The advantage of egg donation IVF is that high-quality eggs are used and the patient usually achieves pregnancy at the first intent. Therefore, it is possible to save the cost of accumulated cycles that would have to be performed if own eggs were used.

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

In this article we have discussed the more general aspects of egg donation. If you are interested in this treatment and want to go into more detail, we recommend you read the following article: Egg donation treatment step by step.

There is also another type of egg donation in which donor sperm is used in addition to eggs. This is what is known as double donation IVF. Find out more about it here: IVF with donor eggs and sperm.