Dr Greet Lammens from IMER Valencia, Spain, talks about when it is the best time to consider egg donation and when egg donation treatment is recommended to IVF patients by doctors.
Women are born with a finitude number of eggs and the number declines with age as does egg quality, especially after 35. Some women in their late thirties and many in their 40s might need to use egg donation. Women who have already tried IVF without success or women with multiple miscarriages might find this option helpful. Some young women may have fewer eggs and greatly diminished ovarian function related to early ovarian failure or as a result of chemotherapy or ovarian surgery, therefore, donor eggs may be their only option for becoming a mother. Egg donation treatment may also be used by same-sex male couples or single males. Finally, certain rare genetic conditions that may be inherited may call for using donor eggs.
When is it time to think of egg donation? Until you are in your mid-30s and you have a regular cycle, there is a 75% chance of a live birth with your own eggs, when that doesn’t happen, you go to a fertility clinic and hopefully with ovulation induction, intrauterine insemination or IVF cycle, you can achieve a live birth using your own eggs. However, if an IVF cycle does not end in a live birth or from the beginning, you know you will need egg donation, at that point, you come to a crossroads. You need to decide what you’re going to do. Egg donation gives you a 50% chance of a live birth per cycle.
3 main causes can lead you to decide to go through egg donation if you want to become a parent. If you do not have any eggs anymore, or your own eggs are deficient, or there is a maternal hereditary disorder, or the fertility road you went down has failed.
Premature Ovarian Failure (POF) = Primary Ovarian Insufficiency(POI)
There can be 2 main reasons for not viable eggs. The first is the condition called Premature Ovarian Failure (POF), also called Primary Ovarian Insufficiency(POI), or you are of advanced maternal age. POI or POF means that the ovaries stop functioning before you turn 40, your estrogen levels go down, and there is no regular ovulation, a woman becomes subfertile. Primary ovarian insufficiency is the main reason for egg donation development in the past. The first birth after egg donation was in 1983-84, which means that the oldest children born from egg donation are now in their late 30s. Premature ovarian failure happens when a woman has irregular or skipped periods, is experiencing hot flashes, night sweats, vagina dryness, dry eyes, irritability, or difficulty concentrating or has a decreased sexual desire.
There are some reasons behind this condition, a woman can suffer from Turner syndrome or Fragile X syndrome, where she has no ovaries or bad working ovaries there or has been exposed to toxins that are known to damage the ovaries badly, if there was chemotherapy or radiation in the past, like leukaemia or breast cancer, these chemotherapy radiations are common causes of a toxin-induced ovarian failure, these therapies can damage the genetic material in the cells, cigarette smoking, exposure to chemicals, pesticides, and viruses might hasten ovarian failure. There could also be an autoimmune disease, the immune system produces antibodies against your ovarian tissue harming the egg-containing follicles and damning the egg, what triggers the immune response is not clear, but exposure to a virus is one possibility. In 70% of women confronted with a primary ovarian insufficiency, no cause has been found.
The risk of premature ovarian failure increases between the ages 35 and 40, but there are also patients under 30 with primary ovarian insufficiency, when there is a family history of a sister or a mother with primary ovarian insufficiency, a woman’s risk increases as well. Sometimes, ovarian surgery is needed, for example, to treat endometriosis, which can also increase the chance of POI.
Advanced maternal age
A more frequent reason for deficiency of own eggs is advanced maternal age. At IMER, 75% of egg donation patients are older than 40 years old. The fertility decline is similar in all women, in some women, the decline goes quicker than the others. A woman’s fertility peaks in the early and mid-20s, after which it starts to decline. Until your mid-20s, the chances of getting pregnant is 75% within a year, it’s 50 to 40% when you are 40, but it’s only 2% when you’re 43, and it declines very quickly. It’s also important that being pregnant over 40 increases the risk of miscarriage, it’s 35%, in younger patients, it’s 15%, and the miscarriage rate rises to 53% by the age of 45. There are also risks of pregnancy complications, like high blood pressure and gestational diabetes, these risks increase after 35 and continue to rise in your 40s. There is a risk of genetic problems, at 40, your chance of conceiving a child with Down’s syndrome is 1 in 100. At 45, it’s 1 in 30.
Another reason is when there is a maternal hereditary disorder. Usually, a woman knows she has a hereditary disorder, so she will not try to conceive spontaneously. Therefore, an IVF/ICSI procedure with PGT might be an option in some cases, depending on the law and the regulations in each country. Hereditary disorders are passed down from parents to their children, women may carry an incurable genetic disease that they do not wish to pass to their future children, such as Thalassemia, Cystic Fibrosis, Tay-Sachs disease, and so on.
At IMER, there is a possibility to compare the blood of the donor with the blood of the partner or the sperm donor to see if they could be the carrier of one of the more than 330 diseases that can be detected and that patients can be a carrier. This test can diminish the risk of a child with a disorder.
Egg donation – decision
Before deciding whether to go ahead with egg donation treatment, it’s important to remember about counselling, which could be a very important factor to help you in your decision. The alternative to egg donation is ending the fertility journey, it’s one of the most important decisions you can face in assisted reproduction. Before taking this step, you have to ask yourself this question is egg acceptance good for me and good for us, which challenges are there to face once the child is born, the egg donation implies acceptance, it’s an alternative form of parenthood, it’s an alternative to adoption or foster care. It’s a process that starts before conception grows along with the child that will be born out of it and goes further many years after that egg donation implies acceptance.
In Spain, egg donation is anonymous, so before you decide to have treatment there, it is important to consider the future and how your partner and your child will feel about not knowing the true identity of your child. You will receive only the necessary information about the egg donor. However, it’s also important to remember that with sophisticated gene testing and many online ancestries and genetic websites, nowadays, full anonymity cannot be guaranteed. There are now at least 4 big databases that invite people all over the world to send their genetic samples so they can find out if, somewhere in the world, there could be somebody genetically linked to them. 21 million people have done it by now, and in 2 years, it is expected to be 30 million.
In Spain, all egg donors are young women between 18 and 30 years old, they must undergo an exhaustive medical, genetic and psychological screening to confirm their good emotional and physical condition, fertility potential and the absence of infectious and hereditary diseases. The selection and matching of the donor are, by law, the exclusive competence of the medical team must ensure the highest possible compatibility of physical and immunological characteristics between the donor and recipient donors.