Before in vitro fertilization (IVF), there were no options available for women with premature ovarian failure, diminished ovarian reserve, or genetically transmittable diseases. Egg donation is now available for women for whom IVF with their own eggs is discouraged or not possible.

Using donor eggs is not for everyone, but if you're considering eggs from a donor, then read on - this article will explain when egg donation is indicated; the screening and evaluation process for egg donors; how egg donation works; the statistics; and the risks.

Who Is An Appropriate Candidate For Donor Eggs?

The initial indication for egg donation was originally for women with premature ovarian failure (POF), defined as menopause occurring before the age of 35-40 (depending on whom you ask). POF affects approximately 1% of the female population; in effect, this condition indicates depletion of a woman's own eggs and cessation of ovarian function.

In recent years, the indication for egg donation at many IVF centers has grown to include women with diminished ovarian reserve but with intact ovarian function. It has long been known that women over 40 years old have generally reduced fertility, and a lower success rate with IVF using their own eggs. This gradual, age-related decline in fertility is a direct result aging has on the quality of the eggs.

In addition, women who have previously failed multiple IVF attempts, particularly when poor egg quality is suspected, and women carrying transmittable genetic abnormalities that could affect their offspring. This latter indication has declined somewhat with the development and use of pre-implantation genetic diagnosis (PGD).

How Is The Egg Donor Tested And Screened?

A thorough evaluation or screening of each potential egg donor is critically important, whether the donor is known to you (for example, a family member or friend) or is anonymous. The screening tests serve to protect all parties involved - the donor, the recipient and the resulting child(ren).

Briefly, the donor should be in good health, younger than 35, and provide lab test evidence of normal ovarian reserve with no indications of impaired fertility. She must be tested for communicable infectious diseases (hepatitis, HIV, syphilis) and undergo a genetic screening with specific blood tests which are determined by her ethnic/racial background (cystic fibrosis, Tay Sachs disease, sickle cell disease).

A formal psychological evaluation is also performed, along with a detailed questionnaires completed of herself, and both maternal and paternal, family medical history.

Preparing To Use An Egg Donor

Timing of the development of your uterine lining (endometrium) with the growth of the donor's follicles and eggs is critical to the success of an IVF cycle with donor eggs. Recipients with ovarian failure (menopause) will require adequate time for uterine preparation with estrogen and progesterone as the ovaries no longer produce the hormones necessary for this on their own.

Recipients with intact ovarian function (the majority of patients at most IVF centers) require treatment with estrogen and progesterone to align their cycle with those of the egg donor. Recipients with ovarian function are often suppressed with a medications like Lupron®, prior to the initiation of estrogen to ensure the cycle can be properly managed for the IVF cycle.

Prior to the start of the synchronized cycle, you will need to determine how many resultant embryos you will want to transfer following fertilization. In addition, you may wish to share your donor eggs with another woman also undergoing IVF with donation to reduce the costs. Some centers will "split" an anonymous egg donor's eggs, which may shorten the waiting time and cost, but also reduces the likelihood you will have extra embryos to freeze.

Risks To Consider For Recipients of Donor Eggs

Since the recipient does not undergo ovarian stimulation or egg retrieval, there are virtually no significant potential risks from these procedures. The main risk for an egg donor recipient is multiple pregnancy. This is because egg donors are young and pregnancy rates are high. The best way to avoid “litters” is to transfer no more than two healthy embryos. It is becoming more and more popular to transfer only one young, healthy embryo in these circumstances. This is now the norm in Europe.

Your age, even if over 40, does not appear to affect pregnancy rates. The main determinant for success is the youth of the eggs and the quality of the resultant embryos. With this, there is one additional consideration for age; a recent case of exceedingly older egg recipient occurred when the woman lied about her age. Don’t do this! It could kill you. While the risks of pregnancy remain low for for women in their forties, this risk rises steeply after a woman passes 50.

Other theoretical risks include transmission of an infectious diseases such as HIV; it is unknown whether eggs can transmit the AIDS virus, and, to date, no cases of HIV transmission through egg donation have been reported. The extensive screening process of the egg donors makes the risk of disease transmission very unlikely.