How to choose the ideal egg donor for your IVF treatment?

The egg donation process, for its many advantages and opportunities, still remains a touchy subject for many patients. The anonymity enforced by many European countries often makes patients uneasy – how sure can I be that the donor actually looks like me? What if my child ends up looking different from me? These are some of the most common concerns expressed by patients.

To dispel some of the myths and shed some light on the donor matching process, we invited Prof Evangelos Papanikolaou and Petroula Tatsi from the Assisting Nature clinic in Thessaloniki, Greece. Their clinic is considered one of the best in Europe, if not the world – and they’re kind enough to share their knowledge and experience with all of us.

As all of you know, egg donation treatments are offered mostly to patients of advanced maternal age (between 43 to 50 years of age), those affected by premature ovarian failure, women who have experienced multiple implantation failure, as well as former cancer patients and those suffering from chromosomal anomalies or genetic disorders. Fortunately, the negative effects of all of these medical histories can be bypassed simply by substituting the mother’s own oocytes with those of a healthy donor. Since the donors undergo very detailed testing before they’re allowed to donate, patients can be sure that the eggs they receive are of a sufficiently high quality.

The question, however, remains: why would anyone decide to be a donor? Many potential egg donation patients express that concern. As monetary compensation for donations are minimal (as dictated by the current legislation), why would anyone undergo such a time-consuming and sometimes physically uncomfortable process?

On the other hand, what about the patients? While their hopes often lie with the donation program succeeding, the prospect of undergoing such a treatment still is a stressful one. Many patients report feelings of doubt and guilt associated with egg donation, as well as a fear that they will not have a biological bond with their child.

From the clinics’ point of view, egg donation programs are some of the most sensitive undertakings to handle; the responsibility for the entire process is in the clinic’s hands. As such, doctors and other specialists involved with the process focus not only on the medical aspects of the program – examinations, tests – but also on managing patient expectations and their state of mind, by establishing accurate success rates, providing counselling and explaining the minute details of the process to dispel any doubts or concerns.

The initial visit to the clinic involves the specialists explaining the entire process as well as scheduling the donation program. Following all the required examinations, success rates are estimated for the patient. The sperm from the patient’s partner can also be cryopreserved at this point; as we all know, thanks to advances in cryopreservation, using frozen sperm does not differ at all from using fresh samples.

Following that, the initial donor matching process begins. As we mentioned previously, minimal monetary compensation ensures women who decide to become donors do so out of purely altruistic motives. They then undergo extensive testing to ensure they’re healthy both physically and mentally, and that they are fertile enough for donation. Additionally, they also undergo extensive psychological screening to ensure they understand the full implications of the egg donation process.

Different countries have different criteria and requirements for their donors. In Greece, for example, donors are aged between 20 and 32, have an AMH of over 2 and are proven to be fertile – that is, they already had a child or they had an induced abortion. Additionally, they need to undergo extensive testing – their hormones are measured, a thorough family and genetic history is established alongside existing treatment history, and full bloodwork is commissioned to rule out issues such as vitamin D or vitamin B12 deficiencies. On the psychological front, the MMPI test is used to filter out potential donors with behavioural or psychopathological issues.

Other parameters are also taken into consideration while evaluating potential donors: they cannot have any history of drug abuse or STDs; they must be in a good physical condition – only non-smokers need apply, while their BMI must be under 28. Additional factors, such as blood group and educational status are also recorded for the purpose of matching with recipients.

Donors must also undergo testing for infectious diseases – HIV, syphilis, hepatitis B and C, and more. Additionally, a genetic screening and karyotype analysis is ordered to rule out thalassemia, cystic fibrosis, fragile X syndrome and other genetic anomalies that could endanger the life of the child. Additional testing can be ordered by the patient couple, if required.

Assisting Nature also offers additional genetic testing on demand, if the patient is worried about autosomal recessive diseases or diseases linked to the X chromosome. Genetic Compatibility Testing and Next Generation Sequencing services are also available. Finally, embryos themselves can undergo genetic screening in order to rule out any genetic anomalies.

Next Generation Sequencing allows for more in-depth analysis of patient-donor compatibility than ever before. By analysing over 200 genes, the risks of genetic diseases can be accurately estimated. The list of examined genes and disorders associated with them can still be expanded in the future, although by now over 300 diseases can be detected before the oocytes are even fertilized. Although the “perfect donor” may never exist, current medical science allows us to get reasonably close.

Once a donor successfully passes all of these tests, only then can they be matched to potential recipients. Donors are matched based on physical appearance – their phenotype – with recipients, taking into consideration factors such as height, weight, skin tone, eye and hair colours and more. Greece, unlike other European countries, allows potential recipients to also learn about the donor’s education, personality traits, religious background, and interests and hobbies in order to ensure a better match.

Greek law is very explicit as to the rights of both the donor and the intended parents. Anonymity is guaranteed – neither party learns the other’s identity, while the child is legally considered the offspring of its intended parents; the donor has no rights to the child and can never learn its identity. Legal consent from both parties is needed to undergo the egg donation process, which can be withdrawn up to the point of embryo transfer. Up to two embryos can be transferred per cycle, while surplus good quality embryos can be cryopreserved for future use.

The legislation states in no uncertain terms that the act of egg donation is an altruistic, voluntary and unpaid act. The only compensation the donors are entitled to includes days off work, and travel and medicinal expenses. It’s a completely anonymous process, with the donor’s identity kept strictly secret by the clinic.

Donated eggs come in two varieties – fresh and frozen. Fresh eggs are fertilized on the day of retrieval and usually require less eggs to achieve the same goal as with frozen ones. The cycles of the recipient and the donor don’t require synchronisation in this scenario, although it can be done if time is a concern. However, sometimes the patient needs to wait a certain amount of time for matching eggs to become available. Conversely, frozen eggs are retrieved and frozen in advance. Cycle synchronisation is not needed – the eggs are simply thawed, fertilised and ready to be transferred within the patient’s natural cycle. The treatment is simpler and faster, as broader choices are available immediately.

However, frozen egg donations are not without their drawbacks. For instance, not all eggs retain their good quality after being thawed, which leads doctors and fertility specialists to require more eggs to achieve the same result as with fresh eggs. Some oocytes also don’t survive the vitrification process – although that’s a rare case, as the survival rate for cryopreservation is up to 96.8% in some cases. Overall, however, the choice between frozen and fresh eggs does not carry a significant difference in success rates.

The delivery rates at Assisting Nature for different kinds of donation are as follows: fresh oocytes, 68%. Frozen oocytes, 60%. Frozen embryos generated from frozen oocytes, 55%. These success rates reflect the results achieved elsewhere around the world.

Patients considering undergoing egg donation at Assisting Nature can be assured that the clinic takes every step possible to make sure the process delivers the best results. Only high quality eggs are considered, while just as strict selection criteria are applied to the sperm. Generated embryos are placed in a time lapse incubator, which allows embryologists to monitor their development process in real time. Only blastocyst stage embryos are transferred, and even those undergo screening to ensure only the best quality ones make the cut. Steps are also taken to ensure a successful implantation within a properly prepared endometrium.

The clinic also prides itself on attempting to create the perfect personalized donation program for each of its patients. This personalisation includes embryo transfer tests, ultrasound scans and hormonal tests, a prerequisite hysteroscopy to evaluate the status of the endometrial cavity and a personalised hormonal preparation plan to ensure the best possible conditions within the endometrium. Their high success rate speaks for itself.

Prof Papanikolaou sums up his presentation by recommending patients give themselves time to come to grips with the egg donation process. A therapist may be helpful in processing feelings and stress which is commonly associated with IVF treatments. As for stress though, he recommends leaving everything in the hands of the clinic – that’s what they’re for, after all.