Using an Egg Donor to Get Pregnant

Egg donation allows women who can no longer become pregnant with their own eggs to get pregnant. The most common reason why women or couples choose to donate eggs is the woman’s exhausted ovarian reserve.

Although there are still eggs in the ovaries in the later menopausal transition, ovulation is very rare, if it happens at all, and the eggs are largely no longer able to develop into a viable embryo.

The hormones FSH and AMH give you an indication as to whether your egg reserve is actually exhausted. A high FSH and a very low AMH show that the ovaries will soon cease their function.

Most women want to use all options to get pregnant with their own eggs. Before turning to egg donation, couples often try to get pregnant for many years and sometimes do many unsuccessful cycles of in vitro fertilization (IVF).

Other reasons for egg donation than an exhausted egg reserve are:

– Turner Syndrome

– Diseases (e.g. cancers) due to which the ovaries had to be removed

– Hereditary diseases or chromosomal abnormalities in women

Which women donate eggs, and why?

Basically, egg donors must be physically and mentally healthy and be of a a certain age. In most European countries that allow egg donation, the age limits of female donors are around 20-30 years. Donors also have to undergo family anamnesis, psychological evaluation and genetic examinations. This ensures the best possible egg quality.

Unlike sperm donation, egg donation requires hormonal stimulation of the ovaries and surgical intervention. Egg donation is therefore much more complex than a sperm donation and is fraught with risks. For that reason, egg donation is prohibited in some countries, e.g. Germany and Switzerland. In many countries where egg donation is permitted, it is highly regulated, for example, by not actively recruiting egg donors or by giving donors only a minimal compensation for their donation.

European countries where egg donation has been permitted for a long time include the Czech Republic, Spain and the United Kingdom. Studies with egg donors there show that for about half of the donors, the financial compensation was decisive for a donation, although donors usually receive no more than EUR 900 for egg donation. About 25% of donors donate eggs both to enable other women to get pregnant and to improve their financial situation. For the remaining donors money is not part of the equation – these women donate for purely altruistic reasons.

In the US, the situation is different. Women who study at an elite university and also meet a certain ideal of beauty can receive more than USD 50,000 from some IVF clinics for one egg donation cycle.

Bring your own donor

Many countries allow you to bring a relative or friend as an egg donor. In countries like the United Kingdom, Austria, and Denmark a long waiting period for a suitable donor can be avoided. Be aware that certain restrictions on mixing sperm and eggs between close relatives may apply.

If you bring your own egg donor, the same rules apply to them as they do to all egg donors according to the respective Reproductive Medicine Act. In Austria, women are only allowed to donate eggs until their 30th birthday. Consequently, if you are 40 and have a 34-year-old sister, she will not be allowed to donate, even if she has a sufficient ovarian reserve and is in good health.

Anonymous versus non-anonymous egg donation

Whether egg donors are allowed to/must remain anonymous is regulated differently from country to country. Countries like the UK, Sweden or the Netherlands do not allow anonymous donation, meaning that the personal information of egg donors must or can be distributed to the child at some point. Some countries with non-anonymous donations have introduced donation registers in which all egg donors are centrally stored. Access to the data is therefore independent and transparent.

In Austria, children conceived via egg donation have the right to receive information about their biological mother as soon as they are 14 years old. The donor’s data is stored for 30 years by the respective fertility institute. Since many couples prefer a non-anonymous donation and in Austria the advertising ban for egg donors applies (and therefore the demand for egg donation is greater than the supply), Austrian fertility clinics usually have long waiting lists.

In the Czech Republic and Spain – the two countries with the most egg donations in Europe – egg donors remain anonymous. If you choose to donate eggs in these countries, your child will never know who his/her biological mother is.

Some countries, such as Denmark, Portugal, Estonia or even the USA, do not have a uniform national system. They leave it to each egg donor to decide whether or not she wishes to remain anonymous.

Irrespective of national legislation, anonymous egg donation is contrary to the human rights of the United Nations, according to which every person has a right to information about their ancestry.

Data from the UK, where a switch from anonymous to non-anonymous egg donation took place in 2005, shows that the number of egg donations has not decreased as a result. According to a Swedish study, 70-90 percent of the egg donors are in favor of a non-anonymous donation and are positive about the prospect of being contacted by their biological children later.

egg donation Europe anonymous

Fig.: Egg donation in Europe

What are the chances of pregnancy with egg donation?

The chances of getting pregnant during the first egg donation cycle are about 70 percent for the vast majority of clinics with a very well-functioning IVF laboratory. This high pregnancy rate is mainly due to the young age of donors.

The uterus of a woman who is already in menopausal transition or menopause  can often accommodate pregnancy just as well as in younger years. If you are going through menopausal transition and are considering egg donation, you should have your thyroid gland checked in advance and prepare your body for pregnancy by taking vitamins, exercising regularly, and getting enough sleep.

The guidelines for the age of the egg donation recipient also vary from country to country. In Austria egg donation is allowed up to the maternal age of 44 (45th birthday), in the Czech Republic until a woman’s 49th birthday. In Spain women are permitted to donate until their 50th or 52nd birthday, depending on the clinic.

What exactly happens during an egg donation cycle?

Both the egg donor and the recipient pair are undergoing a number of examinations, including check-ups for infectious diseases such as hepatitis. On the male partner, an analysis of the sperm, a so-called spermogram, is performed. In the case of the egg donor, a psychological evaluation and an examination for hereditary diseases – for cystic fibrosis and Fragile X syndrome among others – are carried out.

The recipient couple has the possibility to utter wishes regarding appearance, interests, training and family of the donor. After that, the “donor-couple-matching” takes place – an ideal donor is selected for the couple. Depending on the clinic, one or more donors are then proposed to the couple.

After successful matching, hormonal stimulation is started in the donor if a fresh cycle is planned. The alternative would be a frozen cycle, using eggs retrieved a while ago and then cryopreserved.

The hormonal stimulation is similar to that in a “normal” in vitro fertilization (IVF) cycle. If several eggs in the ovary have matured, they are removed through the vagina with a long needle and fertilized with the semen of the male partner. The embryos thus produced carry within them the genetic material of the biological mother – i.e. the donor – and the genetic material of the man of the recipient couple. If the man has an azoospermia (no semen in the ejaculate), male donor sperm can be used. In the latter case, the child does not carry any genetic material from the later parents. Donation of embryos is not permitted in most European countries.

Parallel to the hormonal stimulation of the egg donor, the uterus of the egg donation recipient is prepared for the embryo. Often times hormones are used to support the build up of the uterine lining. Five days after fertilization, the embryo is transferred in a rather quick, painfree procedure. About 8-10 days later a pregnancy test will tell you whether you are expecting.

How do I find the ideal clinic for egg donation?

Depending on your age and whether you are seeking an anonymous or non-anonymous donation, different clinics and different countries may be eligible. By now it is even possible in some clinics to have frozen eggs delivered by foreign egg banks.

If you need to travel abroad for an egg donation, you can find out if a fertility institute near you can take over the preparation and follow-up care. This helps you save money and ensures a higher level of comfort for you.

In terms of costs – if you choose a clinic in Europe – you should expect at least EUR 6,000 for the first donation cycle. In the USA, you will oftentimes pay the clinic and the egg donor separately, with costs of about USD 7,000 to 10,000 for the medical procedure and USD 20,000 to 70,000 to compensate the donor.
As the actual prices vary immensely from country to country and also from clinic to clinic, it is well worth your time getting several offers. Since egg donation is very lucrative for clinics, the procedure is often intensely and sometimes aggressively advertised to recipient pairs as well as egg donors. An actual egg donation tourism is taking place in countries such as Spain, the Czech Republic, Cyprus and Greece. Telling ethical and unethical approaches apart can be a challenge even for experts.

Egg donation is psychologically and physically stressful for both the recipient couple and the egg donor and can be a lengthy process. If you are looking for guidance in this process, I am happy to be there for you. Just send an email to silvia@fertinesse.com!

Psychological care

Ideally, a fertility clinic will offer psychological evaluation and support for both egg donors and receiving couples. At renowned clinics, up to 40 percent of all egg donors who apply are not accepted after the psychological evaluation.

Psychological care also has many advantages for parents later on. The issue of whether, when and how to tell your child that he or she has another biological mother poses a great challenge to most couples. Studies show that mothers who keep egg donation a secret from their children are more likely to have anxiety disorders and depression. The older the children get, the more difficult it is for many parents to inform their children about their biological ancestry.

The differences in the ways anonymous and non-anonymous donations affect the children’s psyche are constantly being investigated. However, since egg donation is a fairly young form of therapy in reproductive medicine, there is currently little information on teenagers and young adults who have been conceived by egg donation.


Sources:

Golombok
S et al: Children Born Through Reproductive Donation: A Longitudinal Study of Psychological Adjustment. J Child Psychol Psychiatry. 2013 Jun;54(6):653-60.

Sälevaara
M et al: Attitudes and Disclosure Decisions of Finnish Parents With Children Conceived Using Donor Sperm. Hum Reprod . 2013 Oct;28(10):2746-54.