What is egg donation?
Egg donation is when an egg (oocyte) is removed from a fertile woman and donated to another woman for an IVF.
This option for couples with female factor fertility problems has raised enough social, ethical and moral questions to fill a library of books on the matter. From the point of view of the woman faced with accepting a stranger’s DNA into her body the key question is usually; “But, will it be my child?”
In the majority of countries the person who carries the embryo to term is considered the legal mother of the child but obviously there are more considerations than that. Will it look like me? If it doesn’t have my genes what happens to my family’s heritage and traditions? Will it bring unwanted traits into my bloodline? Will I have to explain the birth circumstances to the child as it grows up?
Sometimes there is very little choice in female based fertility problems. You may be forced to consider using a donor egg after several failed IVF cycles, being over 40, an early menopause or an intractable medical condition.
If you decide to opt for a donor egg, there are still questions but the answers are thankfully more clear-cut. The key question is whether to use fresh or frozen sperm. There is no proof at the moment that fresh sperm is better than frozen sperm. Frozen sperm is definitely significantly less expensive and more convenient.
What is the egg donation process?
IVF with an egg donations requires more choreography as it now involves a third person. This is a brief description, using fresh sperm:
- Choose the egg donor. This could be a family friend or someone from a donor organization. The donor has to undergo an application process which will include stringent screening; an interview, physical and psychological examinations, including genetic testing. Whether it is an anonymous or known donor, some agencies like a picture of the donor as a baby.
- Prescribed, but self-administered medication will be used to synchronize the donor and recipients’ menstrual cycles. The donor receives ovarian stimulation to produce extra eggs. This might have mild side effects and she may be required to abstain from sexual intercourse. The recipient will use oestrogen and progesterone to encourage her endometrial lining to thicken to at least 7mm. This stage will be monitored by ultrasound and blood tests.
- When the eggs are mature the donor will have an hCG (human chorionic gonadotropin) injection to trigger ovulation and 36 hours later, the eggs will be retrieved via her vagina using an ultrasound-guided needle. The donor will be mildly sedated and will need a day’s rest. She will return to the clinic for a full check-up after 3 weeks.
- In a standard IVF the donor eggs are placed in a petri dish with the partner’s freshly ejaculated sperm for fertilization. If the couple have elected to have an ICSI, the donor eggs are matured for a few hours in an incubator. An embryologist selects the most mature and sperm will be injected directly into the most viable eggs and they are monitored for fertilization.
- On the fifth day the two best embryos (now called blastocysts) are transferred to the recipient’s uterus. Any extra embryos are usually frozen.
- The recipient will return after two weeks, hopefully to confirm the pregnancy via a blood test.
What are the risks of using donor eggs?
The risk factor is as low as 1% and could include hyper-ovarian stimulation, multiple pregnancy, abdominal pain and fluid retention.
The first IVF baby was born in 1978. In those days the woman was required to crouch forward with her bottom in the air for two hours after the embryo transfer to use gravity to enhance the implanting process! We have come a long way since then.
Current research is looking at using stem cells to “create eggs” and male skin cells to “create sperm”. Even more promising is the finding that the uterus membrane, in preparing to receive the embryo, releases RNA into the endometrial fluid that will feed the developing foetus. RNA is a component of DNA and is important in gene expression. It seems that the recipient of donor eggs could actually contribute her own DNA to the child she is carrying. That may be why people often remark on the puzzling similarity of a donor child to its mother or siblings?