IVF with donor eggs: is it for me? Indications and good practices

Watch the webinar recording “IVF with donor eggs – is it for me? Indications & good practices” presented by Gynem, a fertility clinic from Prague, the Czech Republic.

Donor egg IVF indications

IVF with donated oocytes (eggs) is a widely accepted and practised treatment for female-related infertility and is associated with higher rates of pregnancy success. Deciding to use donor eggs to conceive can be a hugely overwhelming and confusing decision; how do patients know whether it is the right option, and at what point should donor egg IVF be suggested, by clinics, as the way for patients to create a much longed-for family? In this webinar, Dr Maria Khutorskaya, an IVF Specialist from GYNEM Fertility Clinic in Prague, Czech Republic, looks at various case studies and discusses when the use of donated oocytes might be considered as a treatment for female infertility.

There are five main indicator groups for women considering egg donation IVF; low ovarian reserve; female factor genetic disorders; congenital absence of ovaries; women who have entered an early menopause and those who have tragically suffered from repeated IVF failure.

When understanding low ovarian reserve, it is key to note that this refers to both the number and calibre of a woman’s remaining follicles and oocytes. For women, over 40, egg quality and quantity do decrease. However, despite being the most common denominator of a diminished ovarian reserve, age is not the only concern. External factors also play a role in influencing the condition of a woman’s eggs. These include genetics, environmental factors and medical history, such as endometriosis, autoimmune disorders and idiopathic premature ovarian failure, often caused by treatments for cancer. Genetic disorders also affect a woman’s chances of conceiving when using her own eggs. Many women are unaware of any genetic anomalies until they struggle to conceive. Dr Khutorskaya advises that the most difficult situation for couples arises when both partners are healthy, follicles can be stimulated and eggs are collected, yet IVF constantly fails, either through lack of fertilisation or implantation. Medical teams are able to retrieve eggs from women who have a diminished reserve, but simply collecting an egg does not mean it will fertilise; the quality of the oocyte/s is key to a positive treatment outcome.

For women undergoing IVF, initially using their own eggs, it may be impossible to tell if there are any issues until embryologists have been able to investigate the harvested eggs.

The main indicator of IVF success is embryo quality. However, even with a healthy, euploid (chromosomally normal) embryo, pregnancy is not guaranteed, as additional concerns can affect the outcome. These include endometrial receptivity, immunological and overall health, as well as any anatomical anomalies such as post-infectious tubal damage. GYNEM fertility clinic has therefore established a set of diagnostic parameters, in order to fully assess and investigate whether the use of an egg donor should be considered. The parameters tested for and used are; patient age, AMH (Anti Müllerian Hormone) and FSH (Follicle Stimulating Hormone) levels and/or antral follicle count (measuring of ovarian reserve). If a woman’s test results show two or more of these issues, then the clinic would advise the use of IVF with donated eggs. Data from the GYNEM clinic suggests that the use of an egg donor does appear to reverse the effects of age-related infertility, meaning that even if a woman has a low ovarian reserve, she still has the capacity to carry a child, to term, when oocytes from a younger, or healthier donor are used. Dr Khutorskaya shares real-life case studies, of patients treated at the clinic, to demonstrate when donated eggs have been used, to achieve successful outcomes. The first case study shows a 42-year-old mother of one, naturally conceived, a child with a regular menstrual cycle and no relevant medical history as to why IVF was needed to conceive a second child. Her husband was 45 years old, at the time of treatment, with no fertility issues. The couple underwent two cycles of IVF, using the female’s own eggs, but unfortunately, no oocytes were fertilised during their first treatment. The second cycle resulted in one eight-cell (cleaver stage) embryo being transferred. The embryo did not implant. Secondary infertility, due to maternal age, was diagnosed and egg donation was recommended. On their first cycle, with donated oocytes, pregnancy was confirmed and resulted in a live birth. Another case study details the fertility journey of a 35-year-old primary infertility couple. The female was diagnosed with premature ovarian failure and underwent multiple cycles of own egg IVF. However, even after varying protocols were tried, the couple experienced repeated failures to conceive. It was agreed that an egg donor would be used, resulting in a live birth, plus five frozen embryos, should the couple want a larger family in the future.

Dr Khutorskaya stresses again that the quality of the egg, sperm and embryo is imperative, when it comes to a positive outcome from IVF, but advises that all patients and their cases are individual.

The decision to use an egg donor is incredibly personal and is not always an easy choice to make. Clinics should be supportive in helping couples choose whether this is the right route for them, understanding that no two clients are the same and each situation is unique. RELATED READING When Should I start IVF with Donor Eggs?