Egg donation – its role in fertility treatment

Egg donation, like sperm donation, can give an infertile couple a chance to have a child when they do not have the option of using their own eggs as part of in vitro fertilisation. Women may opt for egg donation because they are unable to produce their own eggs or because they carry a genetic condition that they do not want to pass on to their children.

Egg donation is difficult for many cultures, religions and individuals to accept, but others see it as a way of enabling infertile couples to have a child that is genetically related to the father, and that is carried in the mother’s body, even though it is not genetically related to her.

The rules about making use of egg donation vary around the world. In some countries, eggs are more easily available, but checks on donors may not be as stringent. Where donor checks are thorough, it is likely that the use of donor eggs is strictly controlled and subject to legal and ethical considerations

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Who can benefit from egg donation?

Women who cannot produce their own eggs can use donated eggs that are fertilised by their partner’s sperm in the process of in vitro fertilisation. Her body is prepared for pregnancy in the same way, and the embryos or blastocysts are transferred using the same methods, and she can experience the pregnancy and birth. The child is the biological offspring of the father, but not of the mother, and this is something that couples need to consider carefully before they go ahead with egg donation as part of their fertility treatment.

Women may opt for egg donation if they cannot produce their own eggs. This can happen for several reasons:

  • Premature menopause or premature ovarian failure (POF): this is not that common, but around one in a hundred women experience premature menopause (they no longer ovulate and their periods stop) before the age of 40. One in a thousand women go through premature menopause before the age of 30, some in their late teens. This can happen well before the woman concerned has even thought of having a family, so there is no possibility of storing her own eggs.
  • Cancer treatment: treatment for leukaemia in childhood, for example, involves chemotherapy, drug treatment and possibly radiotherapy that can lead to failure of the ovaries.
  • A congenital condition: one in 2,500 women are born with Turner’s syndrome, a genetic condition that means they produce no eggs at all. Without egg donation they can never have children.

Other women may produce eggs but have other reasons for needing egg donation:

  • A genetic condition: genetic testing is becoming more common, and if a woman knows that she is a carrier of a potentially harmful genetic condition, it is understandable that she doesn’t want to pass it on to any children. Using egg donation gets around this problem, but still allows her to carry a child and give birth.

The process of egg donation

For a woman, donating gametes requires more consideration than for a man. Sperm donation is a straightforward process that requires no treatment and, usually, no medical intervention. Women who donate eggs must have hormone treatment and/or fertility drugs to control their menstrual cycle and stimulate their ovaries to produce several eggs. This carries the risk of side effects, and also of ovarian hyperstimulation syndrome (OHSS), which causes swelling and a build up of fluid around the ovaries.

The donor first has daily hormone injections to suppress her own menstrual cycle. Most egg donors are shown how to do this themselves, if possible. Daily injections of hormones to stimulate her ovaries to release several mature eggs then follow, followed by an injection of human chorionic gonadotrophin, a hormone that releases the eggs from their ovarian follicles, just before they are collected.

If the egg donation is being timed to coincide with in vitro fertilisation for the recipient, the donor’s cycle and the recipient’s menstrual cycle must be synchronised. This complication is sometimes avoided by freezing the donated eggs and storing them before having a frozen embryo transfer (FET).

Implications of egg donation for the donor

The main impact on the egg donor is the time that the process takes, and the amount of treatment that it involves:

  • Hormone treatments have side effects, and can make the egg donor feel sick, tired, or she can have menopausal symptoms such as hot flushes and night sweats.
  • The physical removal of the eggs requires laparoscopy; a needle is placed through the abdomen to retrieve the eggs from the ovaries.

Financial and social implications of egg donation

Egg donors and recipients need to consider these important donor issues. In some countries, women can receive financial compensation for egg donation, but in others this is not allowed. Some, such as the UK, allow some payments to be made to an egg donor for time taken off work and subsequent loss of earnings.

Countries around the world also differ with respect to the anonymity of the egg donor. Women who opted for egg donation before 2005 in the UK, for example, remain anonymous and can never be contacted, but after 2005, the rules changed. Children can now contact their egg donor at the age of 18 if they apply for their details. A similar change in rules in Canada occurred in May 2011 after a test case, and donor anonymity, for both egg donation and sperm donation, was abolished.

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