When should I think about IVF with donor eggs? When should it be indicated?

The main indication of egg donation is premature ovarian failure. When we have premature ovarian failure, by definition, it means that we do not have any eggs to retrieve. The only way to go around, in this case, is to use donor eggs. Premature ovarian failure can happen by itself, and there is an increased risk percentage in women who have a family history of it. It can be associated with immunological diseases, detected or even undetected. Finally, it is very common after chemotherapy and radiotherapy in women that have suffered from cancer before. All these are indications for egg donation.

Another indication is women’s older age. In my personal belief, if a woman is older than 44, egg donation should be a recommended treatment as we know very well that the quality of eggs depends only on the age (and not on hormones, AMH, etc.). When a woman is more than 44 years old, the chances of success with IVF with her own eggs are much lower than the chances of egg donation.

Another indication is for women who have Turner syndrome. For women like these, the chances of success with their own eggs are very poor. It has also been found that there is an increased risk of miscarriages and chromosomal abnormalities to the offspring, like, e.g., trisomy 21. Such women would definitely benefit from egg donation.

Finally, a genetic disease like autosomal recessive genes is also an indication of egg donation. Of course, nowadays, PGD or PGT-A can be a solution. However, PGT-A, when done in women who have combined factors, like monogenetic conditions and increased age, does not have the best chances of success. On occasions like these, egg donation will give the solution.

One of the questions we always get is when to start thinking of egg donation. This is a question that many women ask as they are dealing with fertility and one of the obvious reasons is menopause and at this point there is no other choice. But there are many other indications for egg donation. Definitely after a certain age, especially women when they get to the age of 44 or 45 and so on ,chances of IVF become very slim and at that point sometimes we recommend moving to egg donation. There are also women who are younger and have issues such as egg quality or failed multiple IVF cycles and at that point, they move to egg donation. I believe one of the most important things to say about moving to egg donation is do it when you feel ready. This is not something that anyone can tell you and until women are going through menopause, no physician can say you cannot get pregnant with your own eggs, this is incorrect. At the end of the day, unless someone is going through menopause, as long as you can still carry out fertility treatments, there needs to be a point where you are comfortable to say that I have tried the best I can and I am now ready. The part of being ready is limited because there is always a part wishing to use your own eggs but there will be a point where you shall feel at peace and say I have done enough, I am ready.

The first indication is age. The success rate with self-owned eggs in IVF after the age of 40 is really low, close to zero. So, that’s the first indication. If you are over 39 or over 40; even with a good hormonal profile, good ovarian reserve, good AMH, FSH, LH level, the recommendation for a higher success rate in IVF is donor eggs.

And then, of course, there are other indications; repeated failure of own eggs IVF, low number of eggs, low quality, and then, of course, a situation when the woman cannot go into stimulation due to some health issues but can be pregnant, and then of course if there is an indication from genetics. If the woman is a carrier of some genetic disorder, then, of course, IVF with donor eggs is the solution.

IVF is generally a difficult procedure for every couple, especially if you go ahead with egg donation. This is probably one of the most difficult decisions that somebody has to take throughout their lifetime. Generally, we would consider egg donation in couples that had a lot of IVF attempts that unfortunately weren’t successful. It’s a very thin line for some couples to decide whether they should try again with their own eggs or go ahead with egg donation.

Generally, egg donation is a very good choice for young women who are already in menopause. They usually suffer from premature ovarian failure, the reason for which we still do not know. It is also a choice for women who had their ovaries surgically removed because of various reasons, such as severe endometriosis or ovarian torsion. It is also for women who had malignant tumours that unfortunately can happen at a young age as well. Similarly, it refers to women who had some form of chemotherapy that impairs ovarian function a lot. They could also consider going for egg donation, especially if they are already in menopause.

When it comes to women who are above 40 years old, it is a difficult decision. A lot of them have ovaries that are working well. However, the statistics have shown that women above 42, even if they are menstruating every month and have regular cycles, have relatively low chances of success with IVF. These women have a really difficult time deciding which road to go ahead.

We can only recommend considering egg donation for women who had 2 or more unsuccessful IVF attempts. Egg donation has proven to have high success rates – in most labs, it’s above 80%. It’s a very cost-effective way. It also results in healthy children with very low chances of chromosomal abnormalities. Egg donation is like travelling back in time and being 22 years old again and getting pregnant. Chromosomal abnormalities rates are based on the donor’s age and not on the recipient’s age.

For couples who had 2 or more unsuccessful IVF attempts, it is a very difficult decision. Some couples have very poor quality embryos, and for them, the choice to go for egg donation is easier. However, there are also couples at the age of 42 or 43 who have good quality embryos. But if you take into account the statistics and costs, in the end, the decision to go for egg donation is made.

I know that the decision about egg donation is very hard for many women. They should bear in mind that thanks to it their babies are going to be healthy in the end. Also, there is something that we call ‘epigenetics’. Women who receive the baby contribute a lot to their health and also the way their baby will look like. They should remember that they will play a crucial role in their babies’ development.

Egg donation is a process during which a healthy young woman donates her oocytes – that is eggs obtained in the process of hormonal stimulation – to another woman who does not have her own oocytes or can get pregnant using her own ones. When should we consider using donor oocytes? A definite indication is the lack of normal eggs in the recipient’s ovaries. The number of oocytes in each woman’s ovary is ultimately determined in puberty and forms the so-called ovarian reserve – a pool of cells from which, during each menstrual cycle, several hundred are used for the ovulation process. Afterwards, no new oocytes appear in the ovaries.

So with age, the ovarian reserve is depleting leading to a physiological period of menopause at around the age of 50. At the same time, the quality of egg cells also decreases, which means the woman’s overall fertility does exactly the same. Thus, after the age of 40, it represents only about 15% of the initial maximum capacity as in the age of 22. Therefore, the first indication will be the woman’s age. Generally, turning 45 means the chances of getting a healthy baby from the woman’s own cells in the IVF procedure fall below 10%. We then propose using an oocyte bank.

Sometimes the lower supply of eggs in the ovaries is caused by previous surgery on the adnexa, for example, due to endometriosis treatment, or is idiopathic as the result of a primary poorly developed ovarian reserve. Such a condition is called a premature ovarian failure or premature ovarian insufficiency. A similar process can take place if the eggs are damaged as a result of oncological treatment (chemo- or radiotherapy). If normal oocytes cannot be obtained as a result of various stimulation methods, we suggest the patient use donor cells.

Sometimes, despite normal ovarian reserve, good partner’s semen parameters, and good quantitative stimulation effects, we don’t get either good quality embryos or any sign of pregnancy in several subsequent IVF cycles. In such a situation, using egg cells from the bank should always be considered.

In some cases, carrying specific genetic defects may also make pregnancy from one’s own cells impossible. Some genetic disorders (e.g., Turner syndrome) lead to a complete lack of eggs. After genetic counselling, the donor eggs will be the only solution to the problem of infertility.