The Mayo Clinic Guide to Fertility and Conception is the ultimate guide to expanding your family through pregnancy, with clear information and tips for getting pregnant as well as inclusive expertise on options available to all individuals and families. Based on their extensive expertise in helping people build their families, Mayo Clinic physicians break down what contributes, to healthy eggs and sperm, steps you can take to get ready for pregnancy, how babies are made, and tips for ovulation tracking, timing sex, and improving your chances.
In the world of modern fertility medicine, building your family may be more of a team sport than a couples activity.
Third-party reproduction refers to a donation by a third person — in the form of donor sperm, donor eggs, donor embryos or a gestational carrier — to enable an individual or couple to become parents. Third-party reproduction is routine at most fertility clinics in the United States.
Donor eggs or embryos are used in around 20,000 attempts at pregnancy using in vitro fertilization (IVF) in the United States every year. Most women younger than age 40 still use their own eggs for IVF. But over age 40, women more often opt for donor eggs from a younger person to increase their chances of success.
Donor eggs
Donor egg cells (oocytes) can be used with in vitro fertilization, a fertility treatment in which mature eggs and sperm are combined outside the body in a specialized laboratory, and other assisted reproductive technology (ART) procedures.
When donor eggs are used for IVF, the egg donor undergoes the first two steps in the IVF process — ovarian stimulation and egg retrieval. If there is a male parent providing sperm, this sperm is used to fertilize the donor eggs in a laboratory. The fertilized embryos are then transferred into the female parent’s uterus to implant and develop. In some cases, donor sperm is used along with the donor egg to create embryos. In other cases, a gestational carrier is used along with donor eggs.
Do you need donor eggs?
Fertility treatments using egg donation have been around for more than 40 years.
Donor eggs were originally offered to women whose ovaries were dysfunctional because of disease or surgery, or to women who were known carriers of significant genetic diseases. Assisted reproductive technologies with donor eggs are still an effective treatment in these cases.
Today, donor eggs are also an option for a variety of people who are unlikely or unable to conceive using their own eggs. This includes:
- Women with diminished ovarian reserve.
- Women who have consistently produced poor-quality eggs or embryos during previous fertility treatments.
- Women who have tried fertility treatments with their own eggs without success.
- Women who are unable to tolerate ovarian stimulation and egg retrieval.
- Men without a female partner who are planning to use a gestational carrier.
- Transgender and gender-diverse individuals or couples who are planning to use a gestational carrier.
- Older women.
Donor eggs are increasingly used for the last group, who may have delayed having children due to school or a career, who found a partner later in life, or who chose to be a single parent at an older age. For these women, donor eggs can reverse the decline in successful IVF outcomes that comes with age.
In general, eggs produced by older women face several hurdles. They form embryos that are less likely to implant and more likely to result in miscarriage if they do implant. They also are more likely to have chromosome abnormalities that can affect the chances of having a healthy baby. IVF success rates drop sharply with age for women who use their own eggs — from more than 50% among women younger than age 35 to less than 8% among women age 40 and older.
In contrast, the female uterus can sometimes respond normally at any age.
Given the right amount of estrogen and progesterone, women can successfully carry pregnancies even when they have reached menopause and their ovaries are no longer producing eggs. When donor eggs are used, the percentage of embryo transfers that result in live births remains consistently high — generally above 40% — among women at various ages.
The bottom line is this: The likelihood of a fertilized egg implanting during IVF is related to the age of the person who produced the egg, not the age of the person having the embryos implanted into her uterus. For older women, donor eggs can result in pregnancy rates comparable to those of women in their 20s. Most couples willing to undergo IVF with donor eggs end up with a successful pregnancy.
How egg donation works
The donated egg may come from someone you know or someone you don’t. In a directed donor egg program, people receive healthy eggs from someone they have asked — often a good friend, sister or other relative. In a non-identified donor egg program, people choose an unknown young woman recruited and screened by a fertility clinic or agency specializing in egg donors. These women are typically between the ages of 21 and 34 and have volunteered to donate their eggs to other people. The non-identified donor doesn’t know the identity of the person receiving her eggs, and the recipient doesn’t know the donor’s identity.
Another option is to purchase frozen eggs.
Remember, the egg donor is a genetic progenitor — a biologic parent — of the baby. So if you use a directed donor such as a younger sister who donates her eggs to an older sister, the younger sister will be both the baby’s aunt and genetic progenitor. Some people are elated to accept such a gift from a favorite sister, while others squirm at the thought of living with this unusual family dynamic.
You and your partner will need to evaluate which choice is best for you. Your doctor or a fertility counselor can help you work through your feelings and concerns. Many fertility clinics require meeting with a trained professional to talk about your readiness and potential issues before the process is begun. Whether you recruit a directed donor or select a non-identified donor, the medical process is the same. All donors must submit to a comprehensive series of tests. Once you have selected a donor, that person will begin a regimen of fertility drugs to stimulate her ovaries to produce multiple mature eggs that can be retrieved and used for in vitro fertilization. The medications your donor will take (or did take if you buy frozen eggs) are similar to the ones you would have used if you were using your own eggs for IVF.
When the donor’s follicles have reached the right size and are likely to contain mature eggs, a final hormone shot is given to help mature and release the eggs. About 36 hours later, the eggs are retrieved. Most doctors use transvaginal ultrasound aspiration to insert a needle through the donor’s vaginal wall and into the ovaries to suction out the follicular fluid containing the eggs. At this point in the process, your donor’s job is done, and yours begins in earnest.
For a fresh embryo transfer, however, before the time of egg retrieval, your uterus needs to get in sync with your donor’s ovarian stimulation cycle so that you’re ready to carry the transferred embryos. Embryos implant only if the uterine lining is at the right stage of development, so this is a critical part of the process.
If you have regular menstrual cycles, you may need to take a birth control pill or other medications to suppress your own menstrual cycle before the donor’s cycle begins. Once your donor starts taking ovary-stimulating medications, you’ll likely need to take estrogen to synchronize your cycle with hers and to help prepare the lining of your uterus (endometrium) for pregnancy. Finally, after the embryo transfer, you’ll take progesterone supplements to encourage the lining of your uterus to thicken and be more receptive to embryo implantation.
As for the sperm contributor, on the day of egg retrieval, they will need to provide a sperm sample that will be used to fertilize the donated eggs in the laboratory. If frozen eggs are used, the sperm will be needed on the day of the egg thaw. Then, 3 to 5 days after fertilization, the embryos will be transferred into your or your carrier’s uterus. Most commonly with donor eggs, just one embryo is transferred 5 days after fertilization.
You may continue taking hormone medications after the embryo transfer to help foster a healthy pregnancy. And you’ll probably know if you’re pregnant about 10 to 14 days after the transfer.
Since embryos that come from donor eggs are expected to be high quality, transferring multiple embryos can have a significant risk of multiple babies. That can pose significant health risks to the babies and the mother. If you have a surplus of fertilized embryos created with the donor eggs, you’ll also need to determine what to do with the embryos. You can freeze them for a future IVF treatment or use them in some way.
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