Egg Donation IVF Explained: When is it time to turn to egg donation?

Deciding when to move to egg donation is typically based on ovarian reserve, egg quality, age-related decline, and specific clinical situations such as repeated IVF failure, premature ovarian failure, or genetic considerations. The decision depends on individual circumstances rather than a single universal threshold.

This article is based on the webinar “When is it time to turn to egg donation?”

Watch here the full webinar

Summary

• Ovarian reserve (AMH, AFC) is a key marker but does not always match biological age.
• Egg quality and quantity decline significantly after age 35, with increased miscarriage risk.
• Egg donation may be considered in cases such as low ovarian reserve, menopause, genetic concerns, or repeated IVF failure.
• Success rates with egg donation are relatively high, but not guaranteed per transfer.
• The process, donor selection, and treatment pathway vary depending on country regulations and patient-specific factors.

Understanding Ovarian Reserve and Age

When considering egg donation, ovarian reserve is often one of the first factors evaluated.

• Ovarian reserve does not always correspond to biological age or physical appearance.
• Live birth rates remain relatively stable up to age 35, after which they begin to decline.
• By age 35, approximately 10% of the original egg supply remains.
• Both egg quantity and quality decrease rapidly beyond this point.
• The risk of miscarriage increases significantly after age 35.

Diagnostic Markers

• AMH (Anti-Müllerian Hormone): Produced by ovarian follicles and relatively stable throughout the cycle, although it can vary between populations.
• AFC (Antral Follicle Count): Used alongside AMH to assess ovarian reserve.

When to Consider Egg Donation (Indications)

Egg donation may be considered in women whose eggs are unlikely to achieve an ongoing pregnancy due to:

• Age-related decline in egg quality
• Menopause or premature ovarian failure (typically before age 40)
• Diminished ovarian reserve (low AMH, low egg numbers, or poor egg quality)
• Being a carrier of a genetic condition that could be passed to a child
• Previous IVF failures using own eggs
• Prior cancer treatments affecting fertility

This is not a single-path decision; the indication depends on the underlying cause and clinical context.

Donor Selection: Anonymous vs Non-Anonymous

Regulatory Differences

• In Spain: Donation is anonymous only
• In UK/Ireland: Non-anonymous donation is possible

Anonymous Donation Process

• The physician selects the donor based on:
  • Physical characteristics
  • Psychological profile
  • Blood group
• Patients receive general donor information (e.g., traits, age), but:
  • No photograph is provided
  • The child cannot identify the donor at age 18

Donor Criteria

• Age: 18–35 years
• Screening includes:
  • Psychological assessment
  • Karyotype (chromosomal testing)
  • Infectious disease screening
  • Genetic mutation screening (common in European populations)
  • Family medical history review

Matching typically includes:

• Blood group
• Eye, hair, and skin color
• Physical traits
• Psychological parameters

Patients may express preferences, but these are not always guaranteed.

Egg Donation Success Rates

• Cumulative success rate per donation cycle: ~91% (across all embryos created)
• Per embryo transfer: ~60%

These figures do not mean each transfer guarantees success.

Embryo Transfer Strategy

• Single embryo transfer is used in ~90% of cycles
• Twin pregnancy rate is ~5%

Clinical reasoning:

• Transferring two embryos may slightly increase success probability (e.g., from ~50% to ~60%), but:
  • Does not double success rates
  • Increases twin pregnancy risk to 20–30%

Twin pregnancies are associated with:

• More complex obstetric management
• Higher likelihood of premature birth
• Lower birth weight

For these reasons, single embryo transfer is generally recommended.

Egg Donation Process

Step-by-Step Pathway

1. Cycle Synchronization
   • Donor and recipient cycles are aligned
   • Often begins with a contraceptive pill
2. Recipient Preparation
   • Estradiol is started after menstruation
   • Monitoring occurs via ultrasound in the patient’s home country
3. Fertilization
   • Donor eggs are fertilized with partner’s (or donor) sperm
4. Embryo Transfer
   • Typically performed at day 5 (blastocyst stage)
   • Patient may travel only for transfer
5. Post-transfer Medication
   • Estradiol and progesterone are continued
   • If pregnancy occurs, medication continues for ~8 additional weeks

Notes on Protocol

• A standard protocol is used initially
• Adjustments may be made if response is suboptimal

PGT-A (Pre-implantation Genetic Testing)

PGT-A may be used in egg donation under specific conditions:

• To exclude embryos with inherited conditions
• In cases of abnormal parental karyotype
• In recurrent miscarriage
• When male factor infertility is suspected

It is not routinely required for all egg donation cycles.

Embryo Donation

Embryo donation involves embryos donated by individuals (typically under 35) who have completed their own fertility treatment.

Characteristics

• No genetic link to the recipient
• Similar to adoption in concept
• Pregnancy is carried by the recipient

May be considered by:

• Individuals considering adoption
• Those avoiding fertility treatments for ethical/religious reasons
• Women without a male partner and unable to use own eggs
• Patients with repeated IVF failure or recurrent miscarriage

Success Rate

• Approximately 57%

Additional Clinical Considerations

Blood Group Matching

• Not medically necessary
• Often done to avoid unintended disclosure if parents choose not to inform the child

Supplements

• Folic acid:
  • 400 mcg daily (standard)
  • 5–10 mg in specific cases (e.g., certain medical conditions)
• Vitamin D:
  • May be beneficial if deficient
• DHEA:
  • Used in IVF with own eggs
  • Not needed in egg donation

Endometrial Preparation

• Usually achieved with estradiol
• Alternatives (if response is poor):
  • Natural cycle
  • Occasionally IVF medications

Nutritional supplements are not generally recommended specifically for endometrial growth, although some patients use vitamins E and C.

Shall I move on to donor eggs?

This depends on ovarian reserve, age, IVF history, and underlying fertility factors. It is typically considered when egg quality is unlikely to support pregnancy.

I am 46 and unable to conceive after a previous natural pregnancy at 42. Is egg donation the only way forward?

At age 46, natural or IVF pregnancy with own eggs is very rare. If no younger frozen eggs are available, egg donation is likely the main option, although continued attempts may still be made.

I am 40, embryos do not reach day 5. Should I consider egg donation?

Egg donation may offer higher success due to donor age (<35). However:

• The issue may relate to eggs, sperm, or both
• Sperm fragmentation may be modifiable
• Genetic testing of embryos may help clarify

A stepwise approach may be considered before transitioning.

I am 48 and single. Will I need egg donation?

At 48, natural conception is extremely rare. Options include:

• Egg donation (with sperm donor)
• Embryo donation (often simpler and less costly)

Is it better to transfer one or two embryos after PGT?

One embryo is generally recommended because:

• Two embryos do not double success rates
• Twin pregnancy risk increases significantly
• Twin pregnancies carry higher obstetric risks

Are tests the same as IVF?

Many are similar:

• Infectious disease screening
• Thyroid function
• Ultrasound

Additional considerations include:

• Blood group (for matching)
• Uterine evaluation for implantation potential

Do donors donate to multiple recipients?

Typically:

• One donor is matched to one recipient
• Occasionally, eggs may be shared if response is high

Donation frequency is monitored to limit total live births per donor.

Are there lifestyle restrictions after embryo transfer?

No specific interventions have been shown to improve implantation.

• Patients are advised to continue normal daily activities
• Avoid excessive inactivity
• Take prescribed medication consistently

Conclusion

Egg donation is considered in specific clinical contexts where egg quality or availability limits the likelihood of pregnancy. The decision depends on multiple factors including age, ovarian reserve, prior treatment outcomes, and individual preferences. The process, success rates, and treatment pathway involve multiple conditional steps and should be interpreted within the full clinical context rather than as a single uniform recommendation.