When it comes to using donor eggs to build your family, even those who are veterans of traditional in vitro fertilization (IVF) may not be clear on what to expect from the donor egg process. But you’ll be happy to hear that those who have already worked with a fertility clinic using their own eggs will absolutely not be starting from the beginning. If you’re in this situation, you already have a solid understanding of what goes into an IVF cycle, which is the foundation of the donor egg process.
Women consider using donor eggs for various reasons. Some have low ovarian reserve (egg supply). Some have been through several IVF cycles before without success. Others have been told that their egg quality makes it unlikely that they will become pregnant using their own eggs. In these situations, using a donor egg can significantly improve the chances of having a baby. Especially if someone is over 40, the success rates with donor eggs will be considerably higher than many women can expect with their own eggs.
According to the Society for Assisted Reproductive Technology (SART), if someone is over 40, IVF success rates after one cycle can range from five to twenty percent if she uses her own eggs. But when using donor eggs, the success rate for one cycle is around 50%. So, depending on the situation, using a donor egg can significantly increase your chances of having a baby through IVF.
For others, donor eggs may be the only way to build a family. Whether you are a single dad, LGBTQ+ couple, or cancer survivor — every conception needs an egg.
If you’ve already been through IVF before, you’re most of the way there in terms of understanding the how a donor egg cycle will go. There are just some additional steps with a donor egg that you may not be aware of yet.
Before beginning any donor egg treatment, many clinics will have you and your partner initially speak with a counselor. He or she will talk through using donor eggs to help ensure that this is the right path for you. The idea is to consider how you feel about using a donor egg to help create or expand your family. You may also consider how you will talk to your future children about using an egg donor, including what information you will share and when.
You will then go through an egg donor selection process to find the best donor for you. There are tons of factors to consider here: the egg donor’s education, medical history, values…the list goes on. So it’s worth spending some time with your partner to decide what factors to prioritize.
Also, if you are over age 45, the American Society for Reproductive Medicine notes that you may need to undergo more intense screening, such as a visit with a high risk obstetrics doctor or a heart workup, to make sure that you are a good candidate for an embryo transfer and can carry a healthy pregnancy.
If you choose a matching platform like Family by Co or an egg donor agency, your egg donor will go through a screening process at your clinic to determine if she is eligible for egg donation. You will also sign a legal contract with her regarding the details of the egg donation process. After her screening, she will do an ovarian stimulation cycle and an egg retrieval. If you have been through an IVF cycle before, you are well aware of all the medications and monitoring she might need during her cycle. If you go through a frozen donor egg bank, the bank will ship already-frozen eggs to your clinic. Egg banks will usually provide a batch of a set number of eggs (often 5-10) from egg donors that have already gone through the stimulation process and frozen their eggs.
Fertilizing and growing embryos
Whether you obtain donor eggs from a fresh egg donor cycle or from a frozen egg bank, once your clinic is in possession of the eggs, they will need to be fertilized and grown into embryos. Your IVF clinic will update you to let you know how many of the eggs fertilized and how many developed into embryos. Some intended parents decide to do genetic testing on embryos. If so, the clinic will biopsy the embryo at the blastocyst stage (day 5-6) and then freeze the embryos while they wait for the result.
It’s important to remember that not all eggs become embryos. In general, approximately 70% of eggs will fertilize and of those, about 50% will grow into day 5 embryos.
Preparing for embryo transfer
If you’ve already gone through IVF, you may have already been through the pre-transfer testing. This testing includes infectious disease testing and an assessment to make sure your uterus is normal. Your clinic may do a saline ultrasound or a hysteroscopy to evaluate the inside of your uterus before a transfer. This test rules out fibroids or polyps inside the uterus that could interfere with pregnancy.
At some centers, doctors like to also perform a mock embryo transfer. During a mock embryo transfer, the doctor will pass a transfer catheter into your uterus in advance so they’ll know the embryo transfer catheter will pass easily on the transfer day. If you’ve already done IVF with your own eggs, they may already have this information and can skip this step.
Prior to an embryo transfer, you (or your gestational carrier) will first likely use medication to quiet your own cycle, such as birth control pills or the drug Lupron. Then, you will then be put on estrogen to mimic what would happen during your normal cycle. The estrogen can be given orally, vaginally or with an estrogen patch depending on the protocol your doctor chooses.
Once your lining reaches a good thickness (many clinics have a goal of 7-8 mm), you’ll then start taking progesterone. The progesterone can be in the form of vaginal suppositories and intramuscular injections. This progesterone will stabilize your uterine lining for embryo implantation. Keep in mind, though, that if by some chance you ovulate on your own during the first stage, any embryos will be frozen and the transfer will be postponed.
Your clinic will then schedule your embryo transfer. The embryo transfer is typically performed on the sixth day of progesterone, in order to synchronize the embryo development with your uterine lining.
On the day of the embryo transfer, your doctor will perform a speculum exam and clean the cervix. They will then place the embryo transfer catheter through your cervix into your uterus. An abdominal ultrasound is typically performed so that you and your doctor can see the embryo transfer catheter inside the uterus. The embryo is often loaded into the catheter with a small amount of fluid and an air bubble. At the time of the embryo transfer, you may see a small flash of bright white on the ultrasound screen - that’s where your embryo was placed!
Your clinic will schedule a pregnancy test following your embryo transfer. If you are pregnant, you’ll need to continue to take estrogen and progesterone during the first part of your pregnancy. Although taking these hormones may seem inconvenient (especially the injectable progesterone!), keep in mind that they are essential to sustaining your pregnancy until your body can effectively take over. If a pregnancy test shows that you are in fact pregnant, you will need to continue to take hormones until your placenta can ultimately support the embryo at around week ten.
Hopefully, this provides a solid overview of the donor egg IVF process. The first step here, however, is to find a donor match. We encourage you to take a look at our incredible donors, who are ready to match with your family. Unlike egg donation agencies and banks out there, our donors aren’t motivated by traditional cash compensation. Rather, they get to freeze their own eggs for free when they give half of them to another family — so every donor we work with is not only altruistic and kind, but also motivated for her own future fertility.
No matter what avenue you choose, we’re wishing you all the best!
Dr. Shah is a Medical Advisor at Cofertility. She is an REI and board certified OBGYN at NOVA IVF in Mountain View, CA. She attended UC Berkeley and earned her MD at Stanford, then doing her OBGYN residency at UCSF. Dr. Shah completed her fellowship in reproductive endocrinology at Stanford.
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