Egg Donation: Should You Choose Fresh or Frozen? (with Infographics)

Up until recently, fresh eggs were the preferred source for use in assisted reproductive technology (ART) and are still the most prevalent method used around the world. Recent advances in the way eggs are frozen and thawed; however, have led to frozen egg donation becoming a more viable option, and to the creation of companies like Donor Egg Bank USA (DEB USA) who offer a nationwide database of frozen donor eggs. The results are now more consistent and predictable than they have been in the past with clinics reporting excellent pregnancy and live birth success  using frozen eggs.

There are several advantages to choosing frozen egg donation over fresh. Some of these include:

• Synchronization of cycles between donor and recipient is unnecessary with frozen donor eggs
  
• Any complications that may arise from ovarian stimulation have already been resolved, so this is one less area of stress for the patient
  
• Costs are greatly reduced per treatment cycle using frozen over fresh eggs
  
• The time involved in choosing/locating a suitable donor is reduced
  
• Treatments can begin right away and are not dependent on the donor’s immediate health or availability
  
• Additional frozen eggs may be available for siblings without the donor completing a new cycle
  

The development of frozen egg donation was initially fraught with challenges. Early attempts used a slow-freeze method, which didn’t produce reliable results. After the discovery of vitrification, or flash freezing, success rates greatly improved and it finally became a viable solution. And for women who weren’t ready to start a family in their younger, more fertile years, it allowed them to freeze their own eggs to be thawed at a time of their choosing.

In 2012, the ASRM recognized that the process of egg freezing resulted in an ‘acceptable’ percentage of births, enough for them to remove the ‘experimental’ label on the procedure. Currently, at programs skilled in the technological technique, there is an equal chance of a successful pregnancy from frozen eggs as there is with women undergoing IVF using fresh eggs.

The Choice Between Fresh vs Frozen Donor Eggs

For recipients of donor eggs, the question becomes: fresh or frozen? There are distinct steps towards success in each of these cases. The decision involves the determination of which process is right for each individual. The cycle for frozen egg IVF is much less complicated and has a range of advantages that run the gamut between physical, psychological, legal and financial. The cycle time is also greatly shortened using frozen eggs and recipients have more flexibility in terms of scheduling each step of the procedure.

The process for fresh donated eggs is increasingly unpredictable, as it involves two separate individuals: the recipient of the eggs and the donor who produces them. In this case, the risks are doubled as certain conditions must be met in both cases. The greatest risk in a fresh egg donation cycle is the donor becomes disqualified to move forward. There is extensive testing that must be performed in accordance with the US Federal Drug Administration requirements. All donors who test positive are disqualified from moving forward. Egg donors also receive a psychological test as well as a visit with a social worker.

Programs such as Donor Egg Bank USA require genetic testing and a thorough visit with a physician or physician assistant/nurse practitioner which includes blood work and a physical exam. At any point in the process, the donor may change her mind or it may be determined that she is not an acceptable candidate for egg donation. Typically, in a fresh egg donation process, the recipient bears the financial burden of a donor who is not qualified to move forward. Sometimes disqualification of an egg donor can happen several times before a couple identifies a donor who is deemed appropriate to move forward.

The process for frozen egg donation is less risky because the eggs are already frozen and the egg donor has completed her cycle. Risks of disqualification are nearly zero giving the egg recipient comfort in knowing the egg donor chosen will have eggs available to move forward with a cycle. Removing the risk associated with the donor’s cycle minimizes the time between donor choice and treatment by as much as four to nine months.

How Much Do Fresh and Frozen Donor Eggs Cost?

Frozen egg donation and the implantation procedure can be accomplished at about half the cost of a fresh donor egg cycle. The total cost of a fresh cycle can be as high as $30 - $40K when donor recruitment, screening, preparation, treatment, medication and after-care for both donor and recipient are considered. In contrast, the total cost of a frozen egg cycle is in the range of $15 - $21K. There are numerous differences between the two processes which account for the significant difference in cost.

IVF with Fresh Donor Eggs: The Process

If you are considering going the route of using fresh donor eggs, here is a detailed journey of what you should expect:

1. Search for an egg donor: Many individuals work with an agency which can cost between $5,000 and $8,000 per cycle to recruit an egg donor. Depending on the unique requirements for the donor (e.g., race, eye color, etc.…), this process could take anywhere from one month to several months.
2. Contracts and attorney visit: Once an egg donor is found a contract between the individual and donor is put in place to ensure the rights of the recipient and to relinquish the eggs and ultimate baby from the donor. Typically, this step will involve an attorney.
3. Egg donor testing: The egg donor will then begin her evaluation with base line hormonal testing to determine her suitability to be a donor. She will receive psychological testing, a visit with a social worker or psychologist and genetic testing. She will have a full medical history review and physical completed to ensure she is healthy to perform the donation. At any step, the donor could be disqualified and the recipient may need to start again adding to their financial expenditure.
   
4. Mandatory infectious disease testing: All donors are required to have infectious disease testing as determined by the FDA. A positive test and the donor will be disqualified.
   
5. Recipient workup: The recipient will also receive a full medical evaluation to include a complete physical and psychological workup to determine any risk factors. Tests for the female recipient could include a cervical culture, a hysteroscopy and a hysterosalpingogram or saline sonogram to assess uterine health. The recipient work-up can take three months to complete if the individual is motivated and more if the process if followed leisurely.
   
6. ‘Prep Cycle’ or ‘Mock Cycle’: This cycle is usually coupled with a trial transfer and is a course of hormonal therapy that ensures that the treatment will achieve the desired blood levels and endometrial effects. Some doctors will elect to perform an endometrial biopsy during this cycle to measure the thickness of the endometrial stripe. Typically, a trial transfer is performed during a mock cycle. This procedure is used to discover uterine depth and to ensure the physician can navigate the catheter to just the right spot in the uterus. The mock cycle must be timed with a woman’s cycle and takes only 15 days to complete once her cycle starts.
   
7. Suppression of the normal menstrual cycle and stimulation: The egg donor is given birth control pills to suppress her menstrual cycle and to synchronize it with a recipient. She will receive hormones as a daily, self-administered injection. This phase lasts about two weeks and the donor is monitored through blood tests and ultrasound during this time.
   
8. Endometrial lining development for the recipient: While the donor is taking hormones to boost her egg supply, the recipient takes a combination of first estrogen and then progesterone to prepare the uterus for a successful implantation. Patients with autoimmune issues may require additional medications. Most physician protocols require 12 – 14 days of estrogen prior to triggering ovulation.
   
9. Triggering ovulation and egg retrieval: When an ultrasound determines that the eggs have developed sufficiently, the donor will trigger ovulation with an injection of hCG. After thirty-six hours, the eggs are retrieved in a short procedure, performed under intra-venous sedation. It is a trans-vaginal procedure using an aspiration needle, guided by ultrasound.
   
10. Fertilization and transfer of the embryo: Eggs are retrieved and fertilized with donor sperm or the partner’s sperm. In the latter case, the partner will be required to visit the office to provide a sample. Embryos from this phase are then incubated and generally implanted in the recipient on either the third or fifth day after fertilization.
    
11. Post retrieval check-up: The donor returns to the office to be evaluated to ensure a full recovery from the procedure. In most cases, the donor can return to normal activity in a day or two after egg retrieval. For most donors, and without extenuating circumstances, the entire process will take about three to five weeks.
    
12. Post-implantation check-up: Recipients will have a pregnancy test two weeks after implantation. This is accomplished with a blood test that measures the pregnancy hormone hCG. Once the pregnancy has been confirmed via two rising hCG tests and an ultrasound which looks for the baby’s heartbeat, the recipient is discharged to their OB/GYN for prenatal care.

IVF with Frozen Donor Eggs: The Process

The process for IVF using frozen eggs is much less complicated, as the donor has already completed her half of the process. Eggs are already collected and ready for fertilization.

1. Full medical evaluation: Recipient undergoes a complete physical and psychological workup to determine any risk factors. Tests could include a cervical culture, a hysteroscopy, hysterosalpingogram or saline sonogram to assess uterine health.
   
2. ‘Prep Cycle’ or ‘Mock Cycle’: An optional course of hormonal therapy that ensures that the treatment will achieve the desired blood levels and endometrial effects. Doctors may perform an endometrial biopsy during this cycle to measure the thickness of the endometrial stripe. As well, a trial transfer may be completed to practice for the big event.
   
3. Endometrial lining development: The recipient will take a combination of first estrogen and then progesterone to prepare the uterus for a successful implantation. Patients with autoimmune issues may require additional medications.
   
4. Fertilization, incubation and transfer of the embryo: Eggs are thawed and fertilized with donor sperm or the partner’s sperm. In the latter case, the partner will be required to visit the office to provide a sample. Embryos from this phase are then incubated and generally implanted in the recipient on either the third or fifth day after fertilization.
   
5. Pregnancy test: Recipients will have a pregnancy test two weeks after implantation. This is accomplished with a blood test that measures the pregnancy hormone hCG. Once the pregnancy has been confirmed via two rising hCG tests and an ultrasound to detect the baby’s heartbeat, they are discharged to their OB/GYN for prenatal care.

Legal Issues Surrounding Donated Eggs

Fresh egg donation carries a range of legal implications and greater potential risk as compared with frozen eggs. 

Frozen eggs from an anonymous donor virtually eliminates the need for legal counsel as the donor has completed her cycle and relinquished her eggs.

If a ‘known’ donor is in the picture, an attorney is highly recommended – preferably one who specializes in reproductive law. Proceeding without a legal agreement, in this case, can put much at risk, including challenges to parenting, financial disputes, rights, responsibilities, obligations, contact, presumption of parentage and most importantly, parental rights.

The presumption of parentage on the part of the donor should be effectively relinquished and this is best accomplished with a sound donor agreement. Additional issues could include the disposition of excess embryos and insurance issues, such as denial of payment. Generally, this aspect is the onus of the intended parents, as it is in their best interests to protect their donor-conceived child against any future disputes. However, the donor may also be interested in protecting herself from liability should unforeseen circumstances arise.

When agreements are sound, the intended parents are acknowledged as the legal parents with every parental right that is implicated. The donor is also protected and her rights or lack thereof are spelled out for the future. It is always a good idea to pursue legal counsel as soon as the decision is made to pursue this course of action.

The Role of DEB USA in the Egg Donation Process

DEB USA is a network of the most respected and established fertility clinics in the United States and Canada. With the most diverse database of egg donors and its high rate of success, DEB USA is North America’s preferred donor egg bank. With comprehensive 100% money back guarantee plans and the industry’s most competitive financial packages, DEB USA is the number one choice for collaborative family planning.

If you have been thinking about donor egg IVF for yourself or a friend or if you are wondering if you would be a good egg donor candidate, call or contact us today. It’s about your future, the way you envision it.