Esther Marbán, MD
, Clinica Tambre
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Donor eggs
The egg donation treatment has completely changed the field of reproductive medicine. It is a great way to overcome obstacles such as patients’ advanced age and the decline of eggs’ quality and quantity. As a result, pregnancy success rates with egg donation are significantly better than pregnancy rates in IVF cycles using woman’s own eggs. In fact, egg donation can raise the likelihood of achieving a successful pregnancy up to 70% in just one cycle.
But despite all those obvious advantages, the idea of using donor eggs to conceive is still considered a touchy subject and remains a taboo for some fertility patients. Many IVF specialists admit that it is generally difficult to convince a woman that the quality of her eggs is not good and the egg donation seems to be the most reasonable solution for her. And, to be honest, it is not surprising at all. Going for donor eggs is probably the toughest decision one has to make over the course of own fertility journey.
The definition
Egg donation is defined as the process in which a fertile woman donates her egg (or oocyte) for the purpose of assisted or third-party reproduction. In other words, donor’s ovaries are stimulated to produce multiple mature eggs, which are then donated to another woman (a recipient) to help her conceive. Eggs may be frozen for later use or fertilised in vitro. In case of the latter, the resulting embryos are transferred into the recipient’s uterus.
If the embryo implantation is successful, it is followed by a pregnancy that is the same as all other pregnancies, either natural or through IVF. The recipient is suggested to have all the necessary pregnancy scans and tests and is expected to remain under obstetrician’s medical care until the childbirth as well as afterwards.
The indications for donor eggs
The basic indications for egg donation are diminished ovarian reserve (DOR) and primary ovarian insufficiency (POI), also called premature ovarian failure. As women age, their natural reproductive potential starts to decrease. It is a well-known fact that women over 40 years old have reduced fertility in general, what comes from ageing of the eggs and leads to reduced pregnancy success and an increase in miscarriages.
DOR is a decrease in the quality and quantity of woman’s eggs in her ovaries, which has serious impact on her fertility. POI, on the other hand, happens when the ovaries stop functioning before the age of 40. The ovaries do not produce normal amount of the hormone estrogen or release eggs regularly, leading to their complete depletion. POI may be referred to as early menopause occurring before the age of 40 and it affects approximately 1% of the female population
DOR can be diagnosed through high levels of follicle stimulating hormone (FSH) and low levels of anti-Müllerian hormone (AMH). Women with POI have raised FSH levels and low levels of estradiol (estrogen). FSH and estradiol levels can be measured by a blood test.
Unfortunately, standard assisted reproduction techniques are no cure for low egg reserve. Pregnancy and live birth rates for traditional IVF cycles with own eggs do not differ much from those achieved as a result of natural conception. It means they’re equally low. In this case, donor eggs are the safest way to ensure a pregnancy.
Among other potential candidates for egg donation, there are fertility patients with previous failed multiple IVF attempts and women carrying transmittable genetic abnormalities (although the latter has declined with the development of pre-implantation genetic diagnosis – PGD). Obviously, the indication for egg donation is also ovarian failure caused by surgery (e.g. removal of ovaries) or chemotherapy.
The options
Donor eggs can come in two forms – fresh and frozen. When using fresh eggs, doctors try to synchronise the cycle between the donor and the recipient. The egg donor receives hormone injections to induce ovulation and get multiple eggs. At the same time, the recipient starts a substituted cycle where she is given a mild hormone replacement treatment to prepare the lining of the womb for the embryo transfer. Frozen eggs, on the other hand, are retrieved and frozen in advance. Cycle synchronisation between the donor and the recipient is not needed – the eggs are thawed, get fertilised with IVF or ICSI and the resulting embryos are transferred within the patient’s natural cycle. The treatment is simpler, faster and allows more time for additional testing – whenever it is needed.
But up to recently, frozen egg donations did have their disadvantages. Most importantly, it was quite difficult to retain eggs’ good quality after being thawed. However, everything changed in the mid 2000’s, when a new method of preserving human eggs was developed – namely, vitrification. It is a much faster process than the previously used ones and a result, it may cause less damage to the eggs. Vitrification significantly improved the survival rate of oocytes and led to pregnancy and live birth rates comparable to those achieved with the use of fresh oocytes.
The egg donor selection
Choosing an egg donor is probably one of the most complex – but at the same time most fascinating – processes in the whole egg donation treatment. Patients generally approach it with lots of doubts and questions, among which the most common one is ‘Will the baby look like me?’. It has to be started clearly that all donor selection processes are always based on phenotypic characteristics and genetic matching. Choosing an egg donor starts with phenotype matching during which doctors make sure that the donor resembles the intended mother in all the important characteristics, such as skin colour, eye and hair colour, facial features, body type, height and weight.
The donor should generally be younger than 35 years old and have no indication of impaired fertility. She undergoes a thorough medical evaluation, including testing for communicable infectious diseases (e.g. hepatitis, HIV, syphilis), genetic screening and karyotype analysis to rule out cystic fibrosis, sickle cell disease, thalassemia and other genetic anomalies that could be dangerous to the child. A formal psychological evaluation is also performed.
Despite all those precautions, we have to remember that egg donation is not a guarantee of euploid (chromosomally normal) embryos. The only solution for that is preimplantation genetic testing (PGT) of embryos Only in this way it is possible to rule out any genetic abnormalities completely. However, the latter is not medically indicated in all the cases.
Anonymity vs. non-anonymity rule
When choosing the clinic for your egg donation treatment, you have to be aware that different countries have different laws in regards to egg donors. Anonymous egg donation is practised in most European destinations. In this case, an egg donor is chosen with the help of your fertility clinic. The clinics have their egg donor base where you can see all the information available on donors, namely their height, weight, age, skin, eyes and hair colour as well as education and profession. Neither you nor the donor can learn each other’s personal, identifying data. The egg donor has no parental rights to the child either.
In the UK, where egg donation is non-anonymous, egg donors must agree to be identifiable to any person conceived from their donation. Children born through donation can learn the identity of the donor once they reach the age of 18. The identifying information includes egg donor’s name, NHS number and last-known address. The recipients can also find out how many other children have been born following the donor’s donation, their gender and year of birth.
Deciding on a non-anonymous or anonymous donor is all up to you. When making the decision, weigh all pros and cons and think what would be the best option for your future child. But regardless of the egg donation type you choose, you have to remember that being truthful with the child is the most important – even if the donor is anonymous. Above all, it allows to establish an accurate medical history for the child in case of potential health risks or life-endangering situations in the future.
The conclusion
It may be overwhelming to learn that your only chance of becoming pregnant is by using donor eggs. Many patients struggling with this life-changing decision experience all sorts of emotions and concerns. They have doubts whether they will truly feel that the child is theirs, if the ‘difference’ will be a problem and how they will approach the discussion about the way the conception took place. Surely, all these implications have to be thoroughly thought over to help you decide whether or not donor conception is the right choice for you and your family. Using donor eggs will obviously redefine your perception of parenthood. But however challenging it may seem, it can, in fact, help you realize that the best parts of you are not necessarily genetic traits. These are your personal qualities as well as love and care that will be of greatest importance to the relationship with your future child.
Disclaimer:
Informations published on myIVFanswers.com are provided for informational purposes only; they are not intended to treat, diagnose or prevent any disease including infertility treatment. Services provided by myIVFanswers.com are not intended to replace a one-on-one relationship with a qualified health care professional and are not intended as medical advice. MyIVFanswers.com recommend discussing IVF treatment options with an infertility specialist.
Contact details: The European Fertility Society C.I.C., 2 Lambseth Street, Eye, England, IP23 7AG
![Anybody who consider IVF treatment faces a lot of difficult decisions. Suddenly you need to find yourself in the vast new world of medicine. It’s not difficult to start to feel overwhelmed. It may seem as if you were discovering a whole new planet in the galaxy. And then at once, you need to know if frozen oocytes are better than fresh? A new question arises after the previous question. Is there any difference at all? How it affects your IVF cycle if it has any influence at all? And if so, does it mean that the success of your treatment depends on this decision? What are the advantages to choose frozen egg donation over fresh? Does it play any role in the process and enforces some other steps? Is it possible that by making this choice it will be easier for you as a patient or it has nothing to do with it at all? Is it related to the success rates? And so on, on and on… To help you stop struggling and to provide you with all the facts from the reliable source we did the webinar covering the topic: Fresh or frozen oocytes for your IVF with donor eggs? Is fresh bread better than the frozen one? This time our expert is Dr Hana Visnova from IVF CUBE [Czech Republic]. All those complicated terms and medical matters are difficult to understand and what to say about execution. It may happen that diagnosis is uncertain, that recommendations are demanding and everybody repeats that the time, relaxation and patience are most desirable. And you don’t feel you have any time and patience. At all. Our webinars help you find the answers for all IVF questions you may have and you can ask these questions live during the live event. Dr Visnova begins her presentation by speaking about the difficulties fertility specialists experienced with egg freezing. As some of you may know, the human egg is one of the largest cells in the body – with a diameter of about 0.1 millimetre, it’s usually visible to the naked eye. Because of its size and of the water quantity inside the cell, preventing ice formation became a major issue. During the early days of fertility treatments, it was believed that because of the slow freeze method which was used at the time, only one in a hundred frozen eggs would result in a pregnancy. In 2007, however, a new method was developed – vitrification, which drastically improved the survival rate of oocytes, as well as the pregnancy rate – five pregnancies can now be achieved from a hundred frozen cells, rather than just one. Sperm freezing, comparatively, is uncomplicated; the method has been known for about sixty years and from the earliest attempts has enjoyed high success rates. Because of the characteristic of human sperm, it is much easier to cryopreserve when compared to egg cells. From the infertility clinics’ perspective, egg banking offers a major advantage – it makes the entire treatment process much simpler to plan, as the need to synchronize cycles between the donor and the recipient simply isn’t a factor. Additionally, the process allows more time for additional testing, if needed. In some countries, such as the United States, clinics are allowed to use donated eggs from affiliated fertility institutions, which significantly expands the available donor pool. If we look at egg banking from the patient’s perspective, advantages can also be found; for instance, about 5% of fresh egg donation cycles are cancelled due to donor-side issues, such as hyperstimulation. Obviously, banked eggs bypass that issue entirely. Additionally, it is much easier to find a donor of a matching phenotype when opting for a banked egg transfer – which cuts down on the waiting time. Another advantage is the complete lack of a down- regulation cycle, avoiding the possible side effects from the medications used in such cycles, making the treatment much more comfortable. Because of the relaxed time constraints, treatments could be scheduled to align with the natural cycle – again, reducing the need for additional medication. This helps patients and clinics schedule treatment to respect job commitments and travel arrangements. The big question, however, remains – does egg banking provide identical or comparable success rates to treatments using fresh egg donations? Dr Visnova’s clinic, IVF Cube, commissioned a study to help determine an answer. They were also interested in whether frozen oocytes resulted in similar numbers of good quality embryos when compared to fresh donor eggs, and whether the implantation and successful live birth rates are comparable. Their analysis compared 266 fresh egg donation cycles to 63 cycles using frozen donor oocytes. The total pregnancy rate for fresh eggs was 68.05%, while that of the frozen oocytes was 42.86%. Of all the egg cells suitable for ICSI fertilisation per cycle, 100% of fresh eggs and 93% of frozen oocytes were suitable. The fertilisation rates per cycle were 84.81% and 72.97% for fresh and frozen oocytes, respectively. Fresh eggs resulted in at least one high quality embryo in 96.24% of all cycles, with frozen ones trailing behind at 61.9%. Dr Visnova sums the study up as such: the numbers indicate that higher numbers of frozen oocytes are required to ensure the generation of a good embryo at the blastocyst stage. Conversely, on average, almost two surplus high quality embryos are produced each cycle, which can be frozen for future use. When it comes to results, we can see a marked statistical difference between using frozen and fresh donor eggs. On average, IVF Cube required only around 7 fresh eggs to achieve a successful pregnancy, while it needed twice that amount in frozen oocytes for the same result. Because the clinic used about 11 eggs per cycle during the study, some patients did not achieve a successful pregnancy during the first cycle. Dr Visnova’s conclusions are then as such: while fresh donor cycles are time-consuming and require more management from both the patient and the clinic to arrange a workable schedule, fresh oocytes have a higher cumulative success rate and have a higher chance of producing surplus embryos which can then be used in future treatments. In her opinion, the freezing and banking of donor eggs is a waste of biological material; her clinic continues to recommend fresh donation cycles for patients. #IVFWEBINARS with Dr Hana Visnova from IVF Cube](https://www.myivfanswers.com/wp-content/uploads/2020/01/14-2019-fresh-or-frozen-eggs-in-IVF-with-donor-eggs-ivfwebinars-768x432.jpg)
