IVF with donor eggs
Egg donation refers to a form of assisted conception treatment whereby another person’s eggs are used. The woman who donates eggs is the donor and the woman who receives the embryos (fertilized eggs) is the recipient.
Unfortunately, some women and couples face a difficult situation in which their only chance of conceiving is with donated eggs. In many cases this is because the woman’s biological clock – the woman’s store of eggs in her ovaries has run out. Typically, this occurs as women reach their mid 40s, ahead of the menopause but it can also occur in younger women who have premature ovarian failure.
The increasing demand for donor eggs
Over the past two decades, the age at which women have their first baby has been increasing. Currently, the average age of first pregnancy for women in European countries is close to 30. One of the many consequences of this dramatic social change is a greater occurrence of age-related infertility. Many have simply left it too late to conceive naturally. Donor eggs are also needed for young women surviving cancer for whom cancer treatment has caused loss of ovarian function and for some women who are increased risk of passing along a genetic disorder. Hence, there is an ever increasing demand for egg donors.
The increasing availability of donor eggs at HSFC
Due to recent changes in the legislation by the Human Fertilisation and Embryology Authority (HFEA), the UK regulator of fertility and increasing awareness of the demand for donor eggs, our clinic has seen an increasing number of donors come forward. This has resulted in our waiting list for donor eggs being dramatically cut. We now expect to match most recipients with a suitable donor within 3 months even for patient of ethnic minority origins! Our donor egg bank was started due to the increased availability of egg donors: we often found ourselves unable to match an egg donor with a suitable recipient. Therefore, we freeze the eggs from such donors. This has only be made viable due to the new egg freezing techniques that provide over 90% survival rates for the freezing process.
Who will benefit from egg donation?
- Women whose ovarian reserve is low or nil
- Women born without functioning ovaries (e.g. Turner syndrome)
- Women who have their ovaries removed for cancer, ovarian tumour, or endometriosis
- Women whose ovaries were damaged by previous chemotherapy or radiotherapy
- Women who have recurrent IVF failures
- Women who have inheritable conditions: sex linked diseases such ashaemophilia, Duchene’s muscular dystrophy and Huntington’s chorea. There could be other chromosomal or genetic abnormalities which could be passed on to the children.
Issues pertaining to egg donation
Donors can be known or anonymous. A family member (sister or niece) or a close friend can act as an egg donor. The other option is to advertise and recruit anonymous donor.
The long-standing debate is whether it is morally correct to pay the donors. In the UK, from 2012 legislation from the Human Fertilisation and Embryology Authority (HFEA), the UK regulator of fertility treatments, allows clinics to compensate donors (up to £750) for their travel and expenses.
Another potentially controversial point is anonymity. Some donors would like to meet the recipient and to know what sort of person is going to receive her eggs. But this can lead to other social problems. Some donors do not wish to know or meet the recipient. They would like to know only the basic information about the recipient. Along the same lines, many recipients do not like to know or meet the donors. But, some would like to meet and know the donor before proceeding with the treatment.
Who can be an egg donor?
Any healthy woman who is:
- Less than 35 years old
- Not overweight (BMI less than 30)
- No family history of genetic or inherited diseases
- No history of mental illness
It is preferable for the donor to have had a healthy child (or children) of her own but not required.
Types of donor
Altruistic egg donors
Altruistic egg donors generously choose to donate their eggs for altruistic reasons. Altruistic egg donors are not paid but can be compensated for the expenses they incur in connection with the donation process, such as travel costs, accommodation, loss of earnings and childcare. Altruistic egg donors may receive compensation of up to £750 per cycle of donation. Should you choose to receive eggs from an altruistic donor in a fresh egg donation treatment cycle, we will allocate all of the eggs collected from that donor’s treatment cycle to you, i.e. you will not share the eggs with another recipient.
Egg share donors
Egg sharing is process whereby a woman who needs IVF shares half of the eggs collected during her treatment cycle with an anonymous recipient in return for heavily subsidised treatment costs.
Frozen eggs from HSFC’s egg bank
Due to recent advances in egg freezing techniques, which provide freezing and thawing success rates are over 90%, it is now not necessary to use fresh eggs for egg donation cycles. Harley Street Fertility Clinic has established an egg bank of frozen eggs from UK donors. One of the benefits of using frozen donor eggs from our egg bank is the lack of worry of the number eggs you might receive for your treatment: we guarantee a minimum of 10 mature frozen eggs for each treatment cycle. Frozen eggs do require fertilisation by intracytoplasmic sperm injection (ICSI) and the extra charge for this is included in our treatment cost for a recipient using frozen donor eggs.
Screening of donors
Egg donors initially have a consultation with a doctor who will take a detailed medical history and perform a physical examination. The doctor will explain the procedure involved in egg donation treatment. The donor will then see a nurse to fill out some basic information about herself. She will then be provided with a letter, containing a medical history form that she must complete and have confirmed by her GP.
Once we receive the completed medical history form (provided everything is clear), the donor will be offered a session implications counselling, with an accredited fertility counsellor, to discuss the social and ethical issues pertaining to egg donation.
The donor will also be asked to attend the clinic for a vaginal ultrasound scan and hormone blood tests between days 2 and 5 of her period. These tests are performed to assess the current fertility of the donor.
All donors are then screened for the following:
- Full blood count
- Blood group and Rhesus type
- HIV and HTLV
- Hepatitis B and C
- Syphilis (VDRL)
- Cytomegalovirus virus (CMV) antibodies screening
- Chromosomal analysis
- Cystic fibrosis screening
- High vaginal swab
- Chlamydia and gonorrhoea (urine test)
In non-Caucasian donors, other screening tests are carried out in suitable cases:
- Sickle cell tests for Africans
- Thalassaemia screening for Asians and Mediterraneans
- Taysach’s disease screening for Jews
Donors must inform the clinic of any medical information that may come to light after donation that may have health implications for any woman who receives treatment with their eggs or for any child born as a result of such treatment.
The screening process may reveal previously unknown conditions or infections, some of which may be treatable. Donors’ chromosomes are screened and therefore previously unsuspected genetic disorders may be brought to light. We will arrange referral to Genetics Counselling and provide support. In some situations genetic disorders may affect other members of a donor’s direct family and we will discuss the relevant issues with the donor should these come to light.
Immediately prior to starting her stimulation the donor will be screened once more for infectious diseases (HIV, Hepatitis B and Hepatitis C, Chlamydia, Gonorrhoea) by a new method called the nucleic acid amplification technique (NAT). In addition to providing a repeat set of results, this technique allows early detection of viral infections that may have a incubation period during which they cannot be detected by traditional methods (e.g. HIV can be dormant for up to 180 days).
Matching of donor and recipient
Typically, donors and recipients are matched for ethnicity, and physical characteristics such as eye-colour, hair-colour, skin-colour, height and build. You will be offered donors who our egg donation team believes are a close match to you and your partner. You will be provided with the following information for each donor:
- Non-identifying physical characteristics (including height, weight, body build, skin colour, hair, colour and eye colour)
- Medical history
- Hobbies and other interests
- Whether or not they have had previous pregnancies and/or children
Please note that all egg donors and recipients must be matched for their CMV status (please speak to a member of our egg donation team for further information).
Is the process anonymous?
The law regarding donor anonymity was amended in 2005. For the avoidance of doubt, we provide the HFEA’s guidance notes pertaining to this matter:
The HFEA keeps a confidential register of information about donors, patients and treatments. This register was set up on 1st August 1991 and therefore contains information concerning children conceived from licensed treatments from that date onwards.
People conceived as a result of licensed treatment aged 16+ (if contemplating marriage) or 18, who ask the HFEA, will be told whether or not they were born as a result of licensed assisted conception treatment and, if so, whether they are related to the person they want to marry.
As the law now stands, children born as a result of treatment in the UK using donor eggs will have the right to learn the identity of the donor on reaching the age of eighteen, if the treatment was carried out on or after 1st April 2005. No information about patients, their children and donors related to treatment before this date* will be given out by the Authority under any circumstances other than those outlined above. The names of the children are not collected.
*An exception would be if the child was born with a disability as a result of a donor’s failure to disclose inherited disease. If he or she were to sue a clinic for damages, a court might require the HFEA to disclose the donor’s identify under the Congenital Disabilities (Civil Liabilities) Act 1976.
In the UK, per the HFEA guidelines, a donor’s cytomegalovirus virus (CMV) status should be matched with that of the recipient. If the recipient is CMV (IgG) positive, she can use a CMV (IgG) positive or a CMV negative donor. If a recipient is CMV negative she can only be matched with a CMV negative donor.
What does an egg donation cycle involve?
Once a donor is matched with a recipient, both of them will be given the contraceptive pill to synchronise their periods. Can you believe that we use the contraceptive pill to make a woman pregnant?
After a period, the donor will start taking daily hormone injections for approximately 10 days in order to stimulate growth of follicles, containing eggs, in her ovaries. These injections are self-administered and typically come in the form of a pen. During this period of injections, the donor’s ovarian response will be closely monitored using ultrasound scans and/or blood tests every two to three days. Hence, the donor will need to attend the clinic three or four times during this time. Usually, there are no side effects due to these injections apart from mild discomfort and occasional bruising at the site of the injections. However, some women may experience tiredness, stomach bloating, headaches, mood changes, hot flushes and weight gain. These side effects are temporary and will usually disappear once the egg collection has been performed.
When the follicles reach a mature size the donor will be given a “trigger” injection to start the maturation process of the eggs. This will typically be an injection administered late in the evening, exactly 36 hours prior to the egg collection. The egg collection is performed under mild intra-venous sedation to minimise any pain or discomfort. The follicles are aspirated under ultrasound guidance and the egg collection typically procedure takes less than 30 minutes. Since the donor will be receiving sedation, she will be monitored for two hours after the procedure before being discharged. She will also need to be escorted home and will be unable to drive or operate heavy machinery that day. We would advise her to take full rest for the day.
Egg donors typically produce eight to fifteen eggs in donation cycle. Occasionally, the treatment can be cancelled due to poor ovarian response or due to excessive response, which can lead to ovarian hyper-stimulation syndrome (OHSS).
After the egg collection procedure, the eggs are fertilised in our laboratory with prepared sperm by conventional IVF or ICSI (please refer to our IVF and ICSI information sheets for further information). On the day of the donor’s egg collection (or the day that corresponds to it if you are using frozen donor eggs) you will be asked to start Progesterone, in the form of pessaries or injections, for luteal support. The remaining treatment process goes through the same steps as per IVF using your own eggs (please refer to our IVF information sheet for further information).
What are the risks of using donated eggs?
The risks of using donated eggs from a registered donor at an HFEA licenced clinic are minimal because all clinics must adhere to a strict code of practice. At Harley Street Fertility Clinic we take the following precautions:
- Donors have a consultation with a doctor to ensure they understand the medical implications of donating their eggs
- Donors see a qualified counsellor to discuss the psychological, social and ethical implications of donating their eggs.
- A donor’s family history is checked to see if there is any increased risk of inherited diseases
- Donors undergo thorough fertility check-up (including ultrasound scans and hormone blood tests) to ensure they are fertile enough to donate without impacting their own fertility
- Donors undergo stringent screening (please see above)
- There are strict limits on the number of families a donor may create
Other important questions
Will a donor have a continuing responsibility to any child born following the donation?
No. The HFEA Act, 1990, states that a person donating eggs will not be the legal parent of any resulting offspring. At the time of donation you relinquish all legal rights and claims over offspring that may result from the donated eggs.
Will a donor be held responsible if a child born from their donation is disabled?
It is a donor’s responsibility to inform the clinic of any genetic or inheritable diseases present in their immediate family. Failure to do so is an offence and it is the right of any child disabled as a result of failure to pass on this information to sue the donor for damages. However, most abnormalities arise from spontaneous genetic mutation or complications during deliver, in which case the donor would not be held responsible.
Can they change their mind?
A donor may withdraw or vary their consent to donate their eggs for the treatment of others up to the point where an egg, or an embryo created using those eggs, is:
- transferred to a recipient
- used in a research project (defined as being under the control of the researchers and being cultured for use in research)
- used for training (if it has been donated for this purpose)
- allowed to perish
How many times can a person donate?
The law states that there should be live births in no more than 10 families from any one donor. However, we recommend that donors only donate for a maximum of 5 cycles, so this limit will not be reached. Additionally, a donor may specify an upper limit of families that may be created from their donation.
Can a donor be paid for their donation?
Donors cannot be paid for donating their eggs but they may be compensated for their time, expenses and lost earnings. Donors may be compensated a maximum amount of £750 per donation cycle.
Do you have a lot of donors?
There is a huge shortage of egg donors in the UK. The waiting list in a lot of clinics can over 1 year for an egg donor. Luckily, in our clinic the waiting time is shorter (typically 3 months or less) but there is still a shortage of egg donors, particularly among ethnic minorities.
Is there anything negative about egg donation?
Egg donation is a relatively recent scientific development. Twenty five years ago, people who did not have eggs or ovaries could not have a child. Now, using donated eggs, such women are able give birth to a healthy baby. We believe this is something very positive!
Further resources for patients considering treatment using donor eggs
Your decision to receive treatment using donate eggs is an important one with life-long implications. There are many issues to consider, and some of them are complicated. There are a number of organisations that can provide further information about the issues involved.
You may also wish to discuss issues with the counsellor at the clinic prior to your treatment, as they will have experience in helping you explore the implications of your decision, now and in the future.
We recommend the following websites for further reading