Dr. Barry Witt, Medical Director WINFertility
Pros and Cons of Each
Egg donation has made it possible for thousands of women who couldn’t conceive with their own eggs to get pregnant and have a baby. Donor eggs may be used in IVF treatment for women who have premature ovarian insufficiency (early menopause), diminished ovarian reserve (lower quantity of eggs), or poor quality eggs due to the woman’s age.
Other reasons to use donor eggs are multiple previous failed IVF cycles or being a carrier for genetic abnormalities which can be inherited (when preimplantation genetic testing cannot be performed). Single and same sex male couples may also choose to use an egg donor along with a gestational carrier in order to become parents.
A woman over 40 has nearly the same chance of getting pregnant and having a healthy baby with donor eggs as a younger woman using her own eggs.
In the past, the only donor eggs available were fresh ones. Using medications, the fertility clinic synchronizes the cycles of the egg donor and the recipient. The donor is then stimulated with fertility drugs for 2 weeks and then eggs are retrieved and fertilized in the embryology lab. One of the resulting embryos is transferred to the recipient and any additional embryos may be frozen for future use.
In recent years, improvements in cryopreservation (freezing) methods have made it possible to successfully freeze unfertilized eggs. The process, called vitrification, freezes the eggs ultra-fast so they are less likely to be harmed by the process than with the methods used in the past. In 2013, the American Society for Reproductive Medicine published a guideline stating that oocyte vitrification and warming should no longer be considered experimental, which allowed the organization of egg banks. In 2018, the number of donor egg cycles using frozen eggs surpassed those using fresh eggs for the first time in the US as a result of increasing success and the development of a growing number of egg banks.
Fresh Eggs Are Proven
Fresh donor eggs have been in use in IVF in the U.S. since 1984. Currently, over 7,000 live births from egg donation are recorded annually in the U.S., according to the Society for Assisted Reproductive Technology (SART). IVF with fresh donor eggs has a lot of history and research behind it. It’s proven to work well.
On the down side, it often takes some time to match a donor to the recipient, and the donor’s cycle and the recipient’s cycle have to be synchronized, which can cause scheduling challenges and may make you wait longer for embryo transfer. Fresh donor egg IVF cycles typically are more expensive than IVF cycles with frozen donor eggs. However, the cost per live birth may not be higher, depending on a clinic’s success rates with frozen eggs. It is also possible to share a donor’s eggs with another recipient in order to lower your cost. Fresh donor oocytes are typically obtained locally so there are limits to availability of certain ethnicities, whereas frozen eggs can be obtained from multiple geographic areas across the country, so there is greater diversity of donors.
Since fresh donor eggs typically result in availability of more eggs and embryos, there is a greater likelihood of winding up with more embryos than you need and then having to decide what to do with the excess embryos.
Frozen Eggs Are Convenient
There is less waiting time when using frozen eggs; in fact, many are immediately available. It is important to note that frozen donor egg banks are not required by law to report success rate data to the government like fertility clinics are, although individual clinics do report their success with frozen donor eggs. You can read a clinic’s success rates with donor eggs (both fresh and frozen) on the SART (Society for Assisted Reproductive Technology) website or the CDC website. The national average for live births from embryos using frozen eggs is still slightly lower than that of fresh eggs. In data from SART from 2020, the live birth rate from frozen eggs was 41.4 percent, while the rate from fresh eggs was 44.7 percent. However, this varies from clinic to clinic depending on their individual experience and technical abilities, and the rates have been improving overall. In fact, some programs have reported rates with frozen donor eggs that are equivalent to fresh donor eggs. Also, it is reassuring that no difference has been demonstrated in malformations between children born after vitrification of oocytes and those born through IVF in general.
The major limitation of frozen eggs from a bank is that the number of eggs that are available to a recipient is typically 6 to 8, which is much lower than the number that can be obtained from a fresh donor in an exclusive egg donor arrangement (approximately 10-20). So, if you are planning on having several children from an egg donor, using a fresh donor may provide you with adequate numbers of embryos to have several pregnancies. This is much less likely with frozen eggs, given the limited numbers of eggs available in each cohort purchased. Also, fertilization of frozen eggs requires injecting a sperm into each egg in order to fertilize it (called Intracytoplasmic Sperm Injection or ICSI) whereas fresh eggs only require ICSI if the sperm counts are low.
In summary, there are definitely several advantages to frozen eggs. Frozen donor eggs are immediately available whereas there are often waiting lists to be matched to a fresh donor. You don’t have to synchronize your cycle with the donor, because the donation has already been done. Costs per treatment cycle are generally lower using frozen eggs because many of the costs are shared among several recipients. Because the eggs are already there in the bank, the risk of a donor being cancelled due to poor response, or unexpectedly getting very few eggs, is avoided with frozen donor eggs. Some egg banks may actually guarantee that you get a good quality mature blastocyst or even a live birth or they will replace the eggs. The added convenience and the lower cycle cost have to be balanced against the lower success rate in some programs and the lower number of eggs available in order to decide what makes sense for you.
Make sure to work closely with your reproductive endocrinologist and the fertility clinic to choose the right kind of donor or donor egg bank for you.