Egg donation and surrogacy: An introduction

Egg donation and surrogacy: An introduction

by Prati A. Sharma, author on The Conception Diaries Prati A. Sharma 28 November 2019

Dealing with infertility and its associated treatments is hard. The appointments, missed work, shots, and emotional ups and downs take their toll. Oftentimes, women undergo multiple treatment cycles and failures and then are told that now is the time to move on to an egg donor or surrogate. This new path can be daunting, and a million questions come to mind.

What does it mean to work with an egg donor? How do we know that a surrogate is safe to carry our baby?

Suddenly, everything seems to be even more complicated!

Here is a step-by-step Q&A guide to egg donor and surrogacy treatment that will hopefully ease your concerns a bit!

Third-party reproduction, or the practice of using an egg donor and/or surrogate is, believe it or not, more common than one would think! Why?

  • Women are delaying childbearing. They are starting to have kids later on in life, advancing their careers, and waiting for Mr. Right. What does this mean? Often, women are over 40 when they start trying to conceive. We know that egg quality and reproductive potential decrease with age, particularly over 40, and for some women, even after repetitive treatments with their own eggs, things do not work out and they need to consider using “younger” eggs, via an egg donor.
  • Same-sex male couples need an egg donor and surrogate to start a family. By using an egg donor’s eggs, one or both of the male partner’s sperm samples, and a surrogate to carry their pregnancy, they can have a family.
  • Uterine abnormalities — such as fibroids, uterine and cervical cancer, uterine architecture abnormalities, and miscarriage — are very common, and certain patients cannot carry a pregnancy to term in their uterus and, therefore, need a surrogate to ensure a safe and healthy pregnancy and delivery.
  • Some women have medical problems that make pregnancy risky; examples of these include kidney failure, lupus, and severe heart or lung disease. By doing IVF either with their own eggs or an egg donor’s, then putting embryos into a surrogate, these women can start a family without bearing the risks of pregnancy and delivery.

What does it mean to work with an egg donor or surrogate?

Egg donation

Egg donors are young women, typically between the ages of 18 and 34, who volunteer to donate their young and healthy eggs to a couple who cannot use their own eggs. These are compassionate, giving women who want to help a family achieve their dream. Most infertility patients know how hard it is to undergo IVF, with its needles, clinic visits, side effects, and time commitment. These amazing women undergo one or more IVF cycles to donate their eggs to a patient or couple in need.

Eggs from an egg donor may be fresh or frozen. A number of agencies recruit egg donors, who are then screened by fertility clinics to ensure they have good egg quality and are suitable donors. The fertility specialist then stimulates the donor and retrieves her fresh eggs to create embryos, which can then be genetically tested (if desired) and frozen and eventually transferred into the intended parent or egg donor recipient (i.e. the woman who is using the egg donor) or gestational surrogate.

Typically, one IVF cycle in an egg donor yields 15 to 25 eggs, and anywhere from 2 to up to 9 or 10 good-quality embryos (usually blastocysts — day 5 embryos, which are the best!). Once embryos are created, the recipient, whether the egg donor recipient or surrogate, has her lining prepared, usually with hormones (estrogen and progesterone), and once the uterine lining is adequate, an embryo transfer is performed.

Pregnancy rates are approximately 70 to 80% after the first embryo transfer! Egg donation cycles are amongst the highest success rates in our clinics!

Frozen eggs from an egg bank are another option. These eggs have been retrieved from viable egg donors and stored in egg bank facilities. The egg donor recipient or intended parent can choose eggs from an egg bank and have them shipped to the clinic of their choice to be fertilized by ICSI (intracystoplasmic sperm injection) to create embryos. Usually with frozen egg bank cycles, the embryo yield and the success rates are slightly less than fresh cycles. This is a good option for couples who want one or two children (not necessarily three or more!).

Egg donors are thoroughly screened by agencies and fertility clinics. There are strict guidelines to ensure they have good egg quality, no genetic or hereditary issues, negative testing for sexually transmitted diseases (STDs), psychological counselling, and usually drug testing.

Egg donors may be anonymous or known to the recipient couple, depending on both parties’ wishes.

Gestational surrogacy

Surrogates are generous women who have had one or more successful and healthy pregnancies and are willing to help those patients who cannot achieve a pregnancy on their own either because the intended parent cannot carry or, in the case of same-sex males, because they need a uterus to carry their pregnancy. These women are lovely patients who want to give the gift of a family to the intended parents.

The surrogate is screened by the agency and fertility clinic to make sure she has had a safe and successful pregnancy history, is free of medical issues that could complicate a pregnancy, is in an optimal state of health, and has a normal uterus (by ultrasound and sonohysterogram). She also undergoes psychological, STD, and toxicology screening.

Embryos are created after one or more IVF cycles in which eggs are harvested after ovarian stimulation, either from the intended parent or from an egg donor. Sperm is obtained and used for ICSI to fertililize the eggs in the laboratory, and ideally a good number of day-5 blastocysts (preferably, genetically tested with PGT-A) are obtained and usually frozen.

The surrogate’s lining is then prepared with hormones (estrogen and progesterone), and a frozen embryo transfer takes place once the lining is adequate.

Success rates with top-quality embryos and well-selected surrogates are very high, usually up to 90% after the first transfer!

While daunting, and seemingly yet another layer to what might feel like an infertililty adventure, once the decision is made to progress to using an egg donor and/or a surrogate, you can be sure that this is truly one of our most successful types of treatments. And what sometimes can be a string of failed cycles with negative results often transforms into a wonderful, happy, and successful experience with a lot of positive outcomes and happy families. :-)

Talk to your doctor about whether egg donation or surrogacy is right for you!