Egg Donation

Trounson and colleagues from Melbourne reported the first successful treatment with Egg Donation in 1984.

Some medical conditions make pregnancy unlikely, impossible or undesirable using your own eggs.

These include

1. Premature menopause
2. Poor response to previous IVF/ICSI treatment
3. Maternal age
4. Menopause
5. Risk of inherited disorder

The Dorset Fertility service does not offer egg donation however we have regularly helped in the monitoring of egg recipients, ensuring that their womb lining (endometrium) is of an appropriate thickness for that part of the treatment cycle. There is a wealth of experience at Dorset Fertility and therefore most units are happy for their egg recipients to have some scans there to avoid the necessity of a long journey to the treating centre for monitoring. Decisions regarding timing and change of medication will always rest with the treating centre. Usually the scans can only be done on a private basis for a modest fee.

Eggs can be harvested from a donor female and fertilised with either your partners or donor sperm (dependent upon need). The resultant embryo can then be placed into your uterus. A maximum of 2 embryos can be replaced. Your will have to decide whether to replace 1 or 2 embryos and this would be discussed before treatment.

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Timing is important and the donors and your cycle need to be synchronised so the uterine lining is in the correct phase of the menstrual cycle to allow implantation. This is crucial to the process. You will normally be given a schedule and would be wise to follow it.

Embryos can be replaced in a natural cycle shortly after ovulation or an artificial one where your hormones are blocked using a drug called Buserelin or similar GnRH drugs (naferelin, decapeptyl, zoladex,luporelin).and oral hormones are given to stimulate the growth of the womb lining. The latter will be oestrogen and progesterone derivatives. The latter method is much more common and allows the recipients cycle (your cycle) to be adjusted to fit in with the donors treatment cycle. If you have no natural cycle you do not need Buserelin or similar GnRH drugs (naferelin, decapeptyl, zoladex,luporelin).

Embryo transfer is usually scheduled for two, three or 5 days after the donors egg collection. It is usual policy to replace the best one or two embryos. The procedure is usually very simple, involving the passage of a fine tube through the cervix, high up into the middle of the uterine cavity, where the embryos are released in a small volume of fluid. An anaesthetic is rarely needed for this process. You may well be advised to come with a full bladder for the transfer: this can make the procedure easier by 'tipping' the uterus in the right direction. The time required at the hospital is usually about 1 hour. It is usually done under ultrasound control.

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Donors come from 3 main sources:-

1. Known donors
   These are known and chosen by you

2. Unknown donors
   These are donors who volunteer to clinics to donate eggs

3. Egg sharers
   These are people who are also having IVF or ICSI treatment and are prepared to share half their collected eggs. Usually they are having reduced cost treatment or sometimes free treatment in exchange for sharing their eggs. In the UK this is now the most common source of eggs. Note that these patients are also infertile.

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The chance of success with egg donation is usually related to the age of the donor. This is why older women may electively choose egg donation. For example, if you are 45 your chance of a baby is about 1% with IVF and 30-40% with egg donation. Most clinics will not recruit donors over 35 years old.

If you are donated more eggs/embryos than are replaced at the time of treatment then it may be possible to freeze the spare embryos for use in a later treatment. The process for the recipient is the same whether the embryos are fresh or frozen (although timing of replacement can be worked out more exactly with frozen embryos) but the results may be better with fresh embryos.

The donor of the eggs, if anonymous will remain anonymous to you and only non-identifying information will be given to you. If treatment is successful then since 2005 your child has the right to obtain identifying information about their genetic parent on reaching 18 years of age if your treatment was in the UK. This information can be obtained from the HFEA. The child (now adult) has no other right

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The donor has no legal obligations to any child created from your donation. The person who received the donation (and their partner if they have one) will be the child’s legal parent(s).The donor cannot be named on the birth certificate and have no rights over how the child is brought up, nor will they have any responsibility to contribute financially. However, as they are genetically related to the child they may feel you have certain emotional and psychological responsibilities (adapted from HFEA document 2008).

The legal situation for married couples and non-married couples is different as regards parental rights-see HFEA.gov.uk for explanation

A donor-conceived person born with an abnormality could sue the donor for damages if it was proven that the donor had deliberately not told the clinic of relevant facts about their, or their family’s, medical history when they donated. This is why it is important that the clinic take an accurate history of any inherited disabilities or physical or mental illnesses affecting the donor or anyone in their family.

Most clinics do offer occasional egg donation. We suggest asking how many egg donation cycles they do per year. If it is under 6-12 then they are likely to be less experienced. Some clinics have far more egg donors than others and therefore more experience.

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UK Clinics that we have had dealings with include (in no particular order)

• Centre For Reproductive Medicine (St. Johns Wood) now owned by CARE
• The Lister
• The London Women’s Clinic
• The Bridge Centre
• London Fertility clinic (London Egg Bank)
• Chelsea and Westminster Hospital (for hepatitis positive patients where other clinics do not offer treatment)

Many of our patients have travelled to Spain for egg donation. This is done largely because there are a large number of egg donors in Spain and therefore the wait to treatment is short. The Spanish clinics enjoy a high success rate, possibly because most of their donors are not also fertility patients and they are also around 25 years old. Many have proven fertility. The approach to egg donation is different in Spain. Donors are either paid or generously reimbursed in their expenses and donation is strictly anonymous. If your child wished to have identifying information about their genetic parent at a later stage this would not be possible. This is likely to be the case in the event of a child having an abnormality.

Spanish Clinics we have dealt with include

• Institute Bernabeu, Alicante (easy flight from Bournemouth)
• Imfer, Mercia
• IVI, Barcelona
• Marques, Barcelona

We have also helped patients going for egg donation treatments in the USA. Donation there is usually not anonymous and you can get a great deal of information about the donor including education, interests and a photograph of the donor with a resume written by them. You essentially buy eggs from them which are then yours to use or freeze as you see fit.

Some patients are also going to the Czech Republic where egg donation seems widely available. We have successfully monitored patients for IVF CUBE and Prague Fertility Centre.

Most of these units will not treat patients of 50 or more. For that you would have to go outside the EU. Northern Cyprus, where the legislation is less rigid, has a number of clinics that would be worth considering.

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