The procedure of egg donation is an alternative option to IVF with own eggs. In this case, a woman becomes an egg donor for an infertile intended mother that cannot use her own oocytes. The success rates of donor-egg IVF are lower in women over 40. The donor baby will not have the genes of the birth mother but those of the donor, i.e. the biological mother.
The pros and cons of having a baby with donor eggs, whether fresh or frozen, should be weighed before making a hasty decision. Factors such as the cost, which is higher than a normal IVF procedure, and the risks involved are of outmost importance. The following is a comprehensive guide to this fertility option.
The different sections of this article have been assembled into the following table of contents.
Definition of ‘egg donation’
Egg donation is an option for infertile women willing to have a baby. It involves the presence of two main parties: the recipient or intended mother, and the egg donor. When using donated oocytes, in vitro fertilization (IVF) is the only treatment of choice.
Broadly speaking, the following are the main pros and cons of egg donation:
- Pros: the woman can go through all the stages of pregnancy, have a baby and give birth as if it was a natural pregnancy. Also, the baby has a genetic connection to the male partner.
- Cons: the first one is that the child will not have any biological connection to the mother. Secondly, egg donation cycles are expensive, although it depends on the country.
The history of this treatment goes back to 1984, and was specially aimed to those women who have fertility problems due to early menopause, surgery for ovarian cysts, or malignant diseases, and until then saw themselves with the impossibility of becoming pregnant.
Who is a good candidate?
The use of donor eggs is especially indicated for women who find themselves in any of the following situations:
- Previous IVF failure with own eggs: a poor response to ovarian stimulation drugs, low egg and/or embryo quality, fertilization and/or implantation failure, or recurrent miscarriage are the most common reasons why a woman might not be able to get pregnant via IVF.
- Women with a genetic alteration that is likely to be inherited by offspring, and is not detectable by means of preimplantation genetic diagnosis (PGD)
- Poor ovarian reserve or absence of ovarian function: either due to primary ovarian insufficiency, premature ovarian failure, menopause, or surgery in the ovaries.
Women of advanced maternal age, even those who already have a biological child, often consider using donor eggs, especially those over 40 years old. From this age onwards, chromosomal alterations in the fetus and are more likely to appear. Also, the miscarriage rate increases at this point.
As a matter of fact, advances maternal age is the most frequent cause among patients who move to donor eggs.
As a woman ages, the quality of her eggs becomes poorer, and her ovarian reserve keeps on diminishing. Today, the phenomenon known as delayed motherhood is a major reason leading to an increase in the demand for IVF with donor eggs among women over 35-40.
In these cases, the chances of getting pregnant with own eggs are very low. For this reason, donated eggs might be the reproductive solution for these women to have the opportunity to become mothers.
The eggs from a donor can be used exclusively for the IVF cycle of a single recipient. However, in order to reduce the overall cost of the treatment, recipients choose egg sharing or shared egg donation, an option by which, as the name suggest, the oocytes collected from a single donor are used by two recipients.
IVF with donor eggs is probably the most confusing of all fertility treatments, and oftentimes, a misleading one. Transparency is one of our strict selection criteria when it comes to recommending fertility clinics to our readers. You can use "The Calculator" to filter clinics based on our selection criteria and get an individual report based on your preferences with answers to your queries and most importantly, to prevent potential frauds.
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Selection of the egg donor
There exist a series of basic requirements that every potential egg donor has to meet:
- Having reached the age of legal majority: between 18 to 35 years old
- Being physically and mentally healthy
- Absence of genetic or infectious diseases that could be transmitted to offspring
In addition to making sure that candidates meet these criteria, a complete gynecological evaluation is carried out as well in order to make sure that the reproductive system works properly, and she has a normal ovarian reserve.
Thus, before being admitted to the donor program, every prospective egg donor must have been screened to make sure that they are fertile and free from infectious and genetic diseases. Also, a psychological evaluation that guarantees that they enjoy good mental health, and a review of their family history are required before being accepted.
The matching of an egg donor to an appropriate recipient is done making sure that they share the maximum number of similarities in relation to the phenotype (physical features) and immunological characteristics.
Also, when evaluating the compatibility between the egg donor and the recipient, a Compatibility Genetic Test (CGT) might be useful. It consist in analyzing which genetic diseases are the egg donor and the intended father carriers of, in case he contributes his own sperm, to prevent them from being transmitted to offspring.
Should you need more information on how what are the criteria followed when selecting an egg donor, we recommend you to visit the following article: Requirements to become an egg donor.
Once the adequate donor has been selected from the pool, an official match will be made. Although it depends on whether the donor is known (e.g. a sister) or anonymous to the recipient, compatibility between the phenotype characteristics and the blood types of both women is essential for the it to be properly done.
IVF using donor eggs step by step
In order to use donor eggs, the only treatment of choice if in vitro fertilization (IVF). Artificial insemination is not possible because the eggs retrieved from the donor have to be fertilized in the laboratory. Then, the resulting embryos will be transferred to the recipient’s uterus.
The protocol followed in donor-egg IVF cycles depends on whether the eggs used are fresh or have been frozen previously via egg vitrification:
- Fresh donor eggs
- in this case, synchronization between the donor’s and the recipient’s menstrual cycles is required. For this purpose, the donor starts a process of ovarian stimulation on the same day the recipient starts taking hormonal medications for endometrial preparation. By doing this, the embryo transfer can be scheduled depending on the growth pattern of the follicles, fertilization, embryo development, and the status of the endometrial lining.
- Frozen donor eggs
- after undergoing ovarian stimulation and egg retrieval, the eggs collected from the donor are vitrified, that is to say, frozen. They are stored in an egg bank up until the recipient gets started with the hormonal treatment that will get her endometrial lining ready for the transfer. When it reaches the optimal conditions for embryo implantation, donor eggs are thawed and fertilized. The obtained embryos are transferred to the recipient’s womb with the purpose of achieving a pregnancy.
Both options have a series of pros and cons. On the one hand, synchronizing both women’s cycles is not as easy as it might seem, and it should be taken into account that unexpected events that might require the cancellation of the cycle. On the other, egg freezing might worsen the quality of the eggs.
Hormonal treatment to donate eggs
It is necessary for the egg donor to go through a hormonal treatment so that she produces multiple oocytes, that is, a bigger amount than in a normal menstrual cycle in which only an egg would mature.
This process is known as Controlled Ovarian Stimulation (COS), and involves the administration of exogenous hormones that trigger follicle growth, which leads to the production of multiple ova. This is done in order to increase the chances of getting pregnant in a donor-egg cycle.
To evaluate if these medications are working as expected, regular monitoring by ultrasound, as well as a close follow-up of the response to hormonal treatments, should be done every 2 or 3 days.
Endometrial preparation of the recipient
Since the eggs that are to be used have not been collected from the woman who will get pregnant (i.e. the recipient), there is no need for her to go through the first stage of conventional IVF procedures: ovarian stimulation and egg retrieval.
By skipping this phase, the need for taking hormone medications to induce ovulation is removed, along with the surgical procedure necessary for harvesting the oocytes from the ovaries. Nonetheless, egg dono recipients have to get the endometrial lining prepared for the embryo transfer (ET).
To boost the chances for embryo implantation after ET, the endometrium has to acquire a triple line pattern, as well as an approximate thickness of about 7-10 mm. For this reason, egg donor recipients have to undergo a hormonal replacement therapy based on:
- Estrogens: administration normally starts from the first day of menstruation.
- Progesterone: it is normally taken from the day of egg collection or fertilization.
The medications can be administered by mouth, vaginal, or patch route. They should be maintained until, at least, the day of the pregnancy test, which should be done not earlier than 14 days after fertilization. Should the result be positive and implantation achieved, they might be extended up until more advanced stages of pregnancy (normally, until weeks 12-20).
Alternatively, if the conditions are adequate, it is possible for recipients to do a natural cycle IVF to take only progesterone, thereby avoiding the need for estrogen-based medications. This is, however, less common un egg donation cycles, especially when fresh donor eggs are used, as it might make be complicated to synchronize the recipient with the donor without extra medications.
If the recipient still has menstrual cycles, that is, she is not a postmenopausal woman, oral contraceptives or GnRH-analogs might be administered too in order to prevent the possibility of spontaneous ovulation, as it might compromise endometrial receptivity, thereby reducing the likelihood of embryo implantation. If required, they will be administered prior to the ET, so that the menstrual cycle is controlled from the very beginning.
Would you like to learn more about the fertility drugs used for endometrial preparation? Then do not miss the following post: Preparing the endometrial lining before the embryo transfer.
Collecting the eggs from the donor
Donor eggs are obtained by follicle puncture or ovum pick-up (OPU), a transvaginal, ultrasound-guided surgical procedure that is donde under sedation.
It involves the aspiration of the fluid from the follicles in the ovaries, which is where we will find the oocytes that are about to be harvested.
When this fluid is taken to the laboratory, the eggs contained within are aspirated and kept under optimal culture conditions up until in vitro fertilization (IVF) is done, if it is a fresh cycle, or frozen for later use.
Fertilization and embryo culture
Only the mature eggs will be fertilized at the laboratory. It can be done either by means of conventional IVF or via Intracytoplasmic Sperm Injection (ICSI), being the latter the most commonly used in these cases.
For fertilization, either sperm from the husband or from a sperm donor can be used. In case the latter is the option of choice, the treatment is known as double-donor IVF.
Embryos are obtained with IVF, and then cultured under conditions that promote their optimal development. Then, their evolution is monitored up until the day of the embryo transfer.
This close and thorough follow-up allows the specialist to select only the best embryos for the transfer, that is, those with the highest implantation potential.
Once the donor’s eggs are retrieved, your partner or sperm donor has to provide a semen sample on the day of the ovum pick-up, so that the eggs are inseminated for the creation of human embryos.
The embryos are left in culture until they reach the proper stage for transfer, usually on day 3. That is the moment when recipients have to return to the clinic for transfer to the uterus.
Once the endometrium acquires the ideal thickness, that is, trilaminar appearance and a 8 mm lining, the embryos will be transferred and their implantation awaited.
Embryo transfer (ET) is a simple, painless procedure after which the only thing left to do is waiting for embryo implantation. In other words, pregnancy is what every woman expects after performing an ET.
Pregnancy test and fetal monitoring
A woman can find out whether she is pregnant within 10 days by means of a quantitative beta-hCG blood test. For the result of this test to be accurate, recipients should wait at least 14 days or more after fertilization.
You can learn more about this test by reading the following post: Normal beta-hCG levels during pregnancy.
Should you get a positive result, the first ultrasound scan will be scheduled. This is the moment when you will be able to hear the fetal heart rate, and find out whether it is a singleton or a multiple pregnancy.
Donor eggs are from the highest quality, since they have been donated by young, healthy women who do not suffer from any fertility problem. To be accepted as donors, they must undergo a series of thorough medical tests to ensure their optimum state of health.
Bearing this in mind, it is only logical that IVF cycles using donor eggs usually present higher success rates than those cycles that are performed using the patient’s own eggs.
The following statistical data should be taken into account when deciding to use donor eggs:
- Recipient’s age: Women over 40 have lower implantation rates, live birth rates, and clinical pregnancy rates. Subsequently, the miscarriage rate is higher.
- Uterine receptivity: It declines with advanced maternal age, especially if there is history of pathological conditions in the uterus such as myomas or polyps.
- Hypertension: Along with other systemic disorders, it is more common in older women, something that might contribute to reduce the implantation potential.
Chances of getting pregnant with donor eggs may vary depending on other factors such as the recipient’s anatomy of the uterus, using frozen versus fresh eggs, the ages of the donor and the recipient, what is causing infertility on the recipient, etc.
Risks and psychological effects
The number of side effects recipients may experience during and after undergoing an IVF cycle with donor eggs is considerably lower than that expected for donors.
Since recipients do not undergo ovarian stimulation or egg retrieval, they are not exposed to the risks of these procedures, such as the ovarian hyperstimulation syndrome (OHSS).
Having a multiple pregnancy is the principal risk of egg donation for the recipient. This may occur when multiple embryo transfers are carried out, because the fact that donors are young women increases the pregnancy success rate.
Experts do recommend to limit the number of embryos to transfer, generally to no more than 2 or 3 for day 2-3 transfers. If the embryo is transferred on day 5 (blastocyst stage), a single or two embryo transfer.
Using donor eggs means the intended mother has to say “no” to her own DNA. For some intended parents, coping with the idea that they will not share their genetic load with that of their children might not be easy to accept. For this reason, many patients need psychological support before, during and even after the process in order to deal with it.
Those who decide to become parents via egg donation should be sure what is the meaning of being a mother. In this sense, motherhood is defined as the desire to see the birth of your child, as well as bringing him up, educating and taking care of him, putting aside the genetic load.
Another aspect to keep in mind is that it is not all about genetics. Even though the child might not be genetically related to the recipient of donor eggs, as they do not share the same genetic information, the baby is going to be influenced by the epigenetic changes that take place in her the uterine lining.
FAQs from users
How many IVF cycles should you do before using donor eggs?
This is an extremely difficult question to answer because Fertility is a physical, emotional, and financial investment. Unless a woman is in menopause, one can never definitively provide a 0% chance for pregnancy using her eggs. However, as a woman ages, particularly above age 39 along with very poor ovarian age testing (ultra low AMH and/or elevated FSH), the prognosis for success with IVF becomes very poor.
So, there is no absolute number of IVF cycles to recommend undergoing before moving to egg donation. Nevertheless, one should consider egg donation if her IVF cycle was cancelled due to a poor response or a low number of eggs were retrieved despite a high dose of stimulation with poor embryo development.
Donor-egg IVF vs. adoption, which one is better?
Both donor assistance and adoption offer the pleasures of parenting, so it is up to you. Prospective parents should focus on long-term aspects such as how this decision could affect their family life.
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.
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.
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
Can you get pregnant with donor eggs after menopause?
Yes, it is possible to have a baby after menopause, a phenomenon known as postmenopausal pregnancy. Menopause is defined as the cessation of menstruation, which means the loss of ovarian activity. However, this does not affect the uterus, which is still functional, and able to carry a pregnancy. This is perfectly possible with either donor eggs from a young girl, the woman’s own previously frozen eggs, or the couple’s frozen embryos, if any.
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.
Can I use donor eggs from my sister?
It depends on the country where the process is taking place. In the United States, for instance, the answer to this question would be yes, as egg donor recipients can choose a known, semi-known, or anonymous donor depending on their preferences.
In Spain, Cyprus, Ukraine, the Czech Republic, etc., donors must remain anonymous by law. In the UK, since April 2005, anonymous are not required to be anonymous in accordance with the HFE Act. All donor-conceived children have the chance to know the identity of their donor if they wish to after turning 18.
Are you interested in learning more about this? Do not miss this article: Egg donation to a family member.
How can recipients cope with feelings of regret after using donor eggs?
The loss of one’s own genetics is a dramatic step in many women’s lives. The good news is that grieving the use of one’s own egg cells is a normal part of the process, and many women understand that parenting is not 100% about genetics after a few months.
Remember that the donor may be the genetic DNA source, but she is not the mother. You are the one who is going to be a mom, regardless of whether it is a donor-conceived or biological child.
More info here: Telling children about their conception by gamete or embryo donation.
What are the most common pregnancy symptoms with donor eggs?
Firstly, it should be noted that, when a woman gets pregnant using donated ova, pregnancy develops as any normal, natural pregnancy would do. However, the symptoms can vary a little bit due to the medications egg donor recipients have to take. In short, nausea and vomiting, frequent urination, exhaustion, extreme hunger or loss of appetite, heightened sense of smell, etc., among others, are the most common early pregnancy symptoms.
See also: Pregnancy symptoms after DE-IVF.
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.
What is the relationship between epigenetics and egg donation?
Epigenetics is the study of physiological phenotypic characteristics in babies that result from environmental factors. Such variations have an influence on how cells express genes.
In this sense, women who regret having used donor eggs because they do not share their genetic expression with the baby should know that, during pregnancy, the metabolism of the pregnant woman may have an influence on the baby’s future behavioral patterns.
Does a baby conceived via donor eggs resemble birth mom?
Keeping in mind that egg donors should be compatible with recipients, so that they share certain characteristics such as the hair, eye, and skin color, ethnicity, height, etc., the donor-conceived baby will share certain physical traits with her.
I used donor eggs, when should I tell my child?
Deciding when to tell your child depends on your preferences, though experts are in favor of disclosure at some point in the child’s life. Telling earlier may help them absorb the information more easily over time.
Suggested for you
In order to use donor eggs, in vitro fertilization (IVF) is the only technique of choice, as we have seen throughout this post. If you want to learn more about the entire process, do not miss this specific article: What is donor-egg IVF?
How can a woman become an egg donor? Whether you are a woman considering donating your ova or a patient willing to know how are potential donors screened, the following post will enlighten you and clear any doubt you may have: How to become an egg donor.
Should you need a gestational carrier (GC) in addition to an oocyte donor, you should know the IVF process in these cases is almost the same, with the difference that the embryos are transferred to the GC’s uterus instead of the intended mother’s. Learn about the process here: Gestational surrogacy.
Finally, if you have any further questions, we have created a compilation of the most common FAQs from egg donor recipients. Just follow this link to read more: Egg donation FAQs: 18 common questions for egg donor recipients.
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