I've definitely been through a lot these past few years. I've learned a lot going through IVF but there is SO much more out there that I didn't dive into frankly because it wasn't part of my own journey. With that said, I thought it would be helpful to educate myself further and in turn hopefully help others who are looking into using donor eggs.
I sat down and asked my nurse Robin Handshue, who is also the Third Party RN at Reproductive Partners San Diego, my infertility clinic, all about donor eggs and how this process works. I'm SURE I didn't ask everything and I also want to note that this is just coming from one clinic, meaning the protocols and opinions stated by this medical professional are not a protocol that is set across the board. Just trying to gain knowledge because knowledge is power, especially in infertility when there are so many unknowns.
1). Who is a candidate for donor egg?
Women with Diminished Ovarian Reserve (DOR) - Usually woman 43+ or an Anti-Mullerian Hormone (AMH) of less than 0.3.
Women with Premature Ovarian Failure (POF) - Usually when the ovaries stop functioning normally before the age of 40.
Elevated Follicle Stimulating Hormone (FSH) - Usually when the FSH level is >25. Some patients think proceeding with IVF medications can "wake up" the ovaries but when your FSH get this high, pumping more FSH (from the medications) into your body will do nothing to the ovaries.
Women with a history of poor egg quality - This is usually found out after 1-2 rounds of IVF when the egg and / or embryo quality has been found to be poor.
Absent or non functioning ovaries - Women born with genetic conditions that require an outside egg source.
2) What are the differences between frozen and fresh egg donation?
Fresh egg donation is where an egg donor goes through an IVF cycle for a specific recipient who has chosen her donor profile. Her eggs are retrieved and inseminated with the recipients choice of sperm (either partner or sperm donor) and hopefully day 5 / 6 embryos are created and frozen to be used for a later Frozen embryo transfer (FET). All eggs and embryos from that donor cycle belong to the recipient. The egg and the sperm are frozen only once and thawed only once which is the preferred option between embryologists and REIs.
Frozen egg donation is where an egg donor goes through an IVF cycle at a fertility center or egg bank with no specific recipient in mind. Her eggs are usually divided into Lots. So let's say 30 eggs are retrieved. The fertility center or bank will divide her eggs into five lots of six eggs each. A recipient can then purchase a lot of eggs and proceed with an embryo transfer. Most clinics will thaw all eggs, inseminate with sperm, and then transfer the best overall graded embryo into the recipients uterus (a fresh transfer) and freeze any remaining embryos. The eggs are frozen and thawed at least twice and consequential embryos will be thawed again prior to transfer.
3) How does the genetics of egg donation work?
Also known as donor egg epigenetics. While it's true that a baby's DNA will only come from the egg donor and the sperm provider, there has been abundant research that has shown that prenatal uterine development can play a crucial role in fetal brain development, childhood metabolism, immune health, and other factors.
4) How do you recruit egg donors?
Many fertility clinics and donor agencies recruit through college campus newspapers, other print media, internet and social media, and quarterly egg donor seminars hosted by clinics or agencies. The majority of women who desire to be egg donors do so for financial compensation, the desire to give their eggs to someone who will use them (as they don't have a desire to have children), or from personally seeing someone they know struggle with fertility.
5) What medical screenings do you perform?
A potential egg donor will be required to pass a psychological and medical screening. Medical tests include numerous infectious disease, STIs, an ultrasound to determine antral follicle count (AFC), AMH blood testing, a nicotine and drug screen, a genetic screening to rule out major genetic diseases, blood type, and complete blood count (CBC). She also answers numerous questions to assess her lifestyle risk factor. A donor has to pass all testing in order to be accepted as a donor.
6) What are the average costs?
I tend to aim a little high with my cost estimates and tell my patients that using a fresh egg donor will cost between $35,000 - $45,000 and the cost of a frozen egg donor is between $20,000 - $30,000. The biggest reason for the cost is when you use a fresh egg donor, the recipient has to pay for the donors IVF cycle. That right there is around $20,000. You then have agency fees, which include compensation to the donor for her eggs, legal fees, and agency coordination costs. That cost can vary between $10,000 - $25,000. When you use frozen eggs, you do not have to pay for a donors IVF cycle since it is already completed. You pay the clinic or egg bank for a lot of frozen eggs and that cost is around $15,000 per lot. You pay your clinic for the thawing of those eggs, fertilization, and transfer of an embryo and that cost pans out somewhere between $7,500 - $10,000. I think it is important to note that if you desire at least two children, or more, then proceeding with a fresh egg donor is the most cost effective. If you desire just one child, possibly two, then proceeding with frozen eggs makes the most financial sense. On average, when you use a fresh egg donor, 3-5 embryos for use is common. When using frozen, you can normally get one embryo for transfer and possibly one more embryo for future use.
7) What is the selection process for an egg donor? Meaning how do I know what egg donor would work for me?
That is very much a personal selection. What is most important to you? Do you want your egg donor to look most like you physically? Do you want a donor with high SAT scores? Maybe you want a donor with proven success, meaning they already have children of their own or they have completed previous cycles that have resulted in pregnancies and live births. Maybe you just read a donor profile and click with their writing, attributes, personality, pictures, etc and you say "this feels like the one." In my 11 years of working with women who proceed with egg donation, I can say that it is different for every woman. But I also think that when you know, you know.
8) Are all eggs from one donor used for one recipient or are the eggs split between recipients?
They can be used both ways! Many recipients seek out a donor for only their use but proceeding with a shared donor cycle (meaning one egg donor and two recipients, the donors eggs are divided equally) can be done. The biggest reason why someone proceeds with a shared donor cycle is to save on costs (since you will pay only half of the donors IVF cycle). Shared cycles can be a little more complicated and require more legal paperwork but they are available.
9) What is the process once someone receives their egg donation? Meaning what are steps to getting pregnant?
I tell my patients if you proceed with a fresh egg donor, plan for the entire process to take about four months. From the time you find your egg donor, she has to be scheduled for a new patient appt within your clinic and proceed with medical and psych screenings. This takes around one month. Once medical clearance is given, you can move forward with a legal agreement between you and your egg donor. Legal takes 2-4 weeks on average so now you have two months down. Once legal is completed, the donor can prep for IVF with the start of her next period and usually has to do two weeks of birth control pills before she can start the IVF medication injections. So month three is the donors IVF cycle. Once you have eggs retrieved and embryos created, month four is proceeding with your embryo transfer and pregnancy test! If you proceed with frozen egg donor, plan for the entire process to take 1-2 months. Since the eggs are already frozen, it is just a matter of getting those eggs shipped to your fertility clinic. Shipping normally takes one week. Once those eggs are received, your clinic can proceed with your embryo transfer, thawing your eggs once your uterine lining is ready.
A note from Robin:
"I think it is important to note that if your fertility doctor recommends you proceed with an egg donor, they are giving you the best possible outcome for success. All RE's know how difficult proceeding with an egg donor can be and that many patients will not proceed with this option. Women can feel like their doctor is "giving up" on their ovaries or not hearing them if they desire to try another IVF cycle. I promise you that is not the case. Your RE wants you to be successful and have the child(ren) you desire. They also need to be honest with you and discuss the best option that will lead you to that goal. Sometimes, that answer is donor egg. I also promise you that when you are playing hide and seek, reading books, and watching your child splash bath water everywhere besides in the tub, the last thing you'll be thinking about is your baby's DNA."