Treatments and investigations


For many couples egg donation offers the only realistic opportunity to have a child. Unfortunately egg donors can be hard to come by and the demand far exceeds the supply. Many national newspapers and magazines carry emotional advertisements from couples who are desperate to find an egg donor, inviting a potential donor to contact a particular assisted conception unit on their behalf. Centres are always very grateful to receive enquiries from women who are interested in becoming egg donors. The NHS does not fund egg donation.

Although in theory there is no age limit, for many centres the recipient of donor eggs would need to be below 50 years of age (similar to the menopause).

Who might be in need of donated eggs?

Sometimes a woman is unable to produce eggs for her own use because:

  • her ovaries have failed to develop normally and do not contain eggs;
  • her ovaries have been removed by surgery;
  • she has had radiotherapy or chemotherapy for cancer;
  • she has had an unexpected premature menopause ("change of life");
  • her ovaries fail to produce any eggs of the required quality when stimulated to do so (this may be particularly true for the older woman in her forties).

Sometimes a couple will deliberately decide not to use the woman's own eggs because:

  • she may be the carrier of a serious life-threatening genetic disease (e.g. haemophilia, Huntington’s chorea or Duchenne's muscular dystrophy) and not wish to take the considerable risk of passing the condition onto her own children via her eggs.

Who can be an egg donor?

An egg donor must be over the age of 18 and younger than 36. Very occasionally exceptions may arise when an older donor may be acceptable, e.g. a sister donating to a sister or a friend for a friend. Ideally the potential donor should have already proved her own fertility and have completed her family but this is not an essential requirement.

A donor is required to be fit and healthy and must not have any serious medical disability. Her family must be free from any known inherited genetic disorder. If a donor did not reveal information about an inherited disease in her family that she knew about or should have reasonably known about, an affected child born as a result of her egg donation could then sue for damages. Donors should not be significantly overweight and ideally should be non-smokers.

There are certain women that centres are unable to use as egg donors. Women who have been adopted will have no knowledge of their own family history. Some women are in high-risk groups for HIV (AIDS) infection and should not donate eggs. These include intravenous drug users and women who have visited parts of the world where considerable numbers of AIDS cases have been reported and have had unprotected sex with people living there (men or women).

A full gynaecological examination is carried out. After obtaining consent the GP is written to, to determine if there is anything in the personal or family medical history that would make it inadvisable to accept this particular person as an egg donor. An appointment is arranged for the donor to see an experienced counsellor. All the implications of egg donation including the legal and ethical issues are discussed in detail. It must be remembered that while a sperm donor simply has to produce a semen sample into a container, an egg donor has to go through the whole process of egg retrieval as in IVF and this is not without its hazards (see IVF information). The counsellor will also assess her emotional and psychological suitability to become an egg donor.

The donor needs to go through a series of blood tests.

Firstly a full hormone profile is taken during the first few days of the period to make sure that there is no hormone imbalance that may make it difficult to obtain eggs.

The second group of tests is to ensure that there are no infections that could be passed on to the recipient of her donated eggs. These tests include hepatitis B and C, HIV antibody (AIDS), syphilis, gonorrhoea, chlamydia and cytomegalovirus (CMV).

Finally tests are taken for blood grouping, full blood count, electrophoresis, chromosome make-up (karyotype) and cystic fibrosis screening.

All of the donor's reasonable expenses such as travel, accommodation, subsistence, childminding costs and financial loss are reimbursed by the centre up to a maximum of £55.19 per day, with an overall limit of £250 for each course or cycle of donation.

Once accepted as a donor, a confidential Donor Information Form is filled out registering details of the donor with the Human Fertilisation & Embryology Authority (HFEA). The donor consent form is signed.

The donor may change her mind at any time before egg retrieval without the threat of any financial penalty or fear of recrimination.

Embryos resulting from egg donation are either transferred as fresh embryos or stored by freezing (cryopreservation) for the recipient’s future use.

At any time the donor may vary her consent or even withdraw consent altogether about the use of stored embryos that have been produced from her donated eggs and the recipient’s partner’s sperm. This cannot of course apply to an embryo that has already been used.

Legal Aspects

Apart from the situation where a sister donates eggs for a sister or a friend donates for a friend, the donation of eggs will be anonymous. The donor will be told nothing about the recipient of her eggs. If she wishes, she will be informed if there has been a live birth resulting from her donation.

Only non-identifying information about the donor can be given to the recipient of donated eggs. Physical characteristics such as height, weight, eye and hair colour and skin colour are given so as to try and obtain as close a match as possible or at least one that is acceptable to the recipient. When the donor registration form is completed, the donor is invited to write a "pen portrait" and "goodwill message" giving non-identifying information about herself, such as interests, the type of person she is, her general outlook on life, why she made the decision to donate eggs etc. This information can be revealed to the recipient.

Apart from the treatment centre, only the HFEA will hold identifying information about the donor. The name and details of both the donor and the recipient must be registered with the HFEA.

It is already established in law that the HFEA will be able to give non-identifying information to a future enquirer. From the age of 16 an enquirer can only be told whether or not he or she is closely related to someone they are intending to marry. At the present time, from the age of 18 an enquirer can be told whether or not he or she is the result of IVF, egg, sperm or embryo donation, not who the donor was. All identifying information held by the HFEA is confidential. Unauthorised disclosure of the donor’s identity is a criminal offence

At the present time, it is not possible for an egg recipient to find out who the donor is or vice versa. However, following public consultation, both the HFEA and the government obtained a change in the regulations of the HFE Act (1990). Since 2005, all new egg donors can only be accepted as donors if they agree that identifying information about themselves will be provided upon request to donor-conceived people after they have reached the age of 18 years. This will only be after attempts have been made to contact the donor before her identity is disclosed to a person conceived following the donation of her eggs. The donor will then be advised to seek appropriate counselling.

If I need donor eggs, what happens next?

You will need to be referred to a treatment centre by your GP or consultant. You may of course already be a patient of the centre and have been informed that egg donation is one of the options you could consider.

If you have been referred specifically for egg donation, a full medical history will be taken from you and your partner. All previous tests will be reviewed. A general physical and pelvic examination would be carried out unless recently performed by the unit.

If it is considered that egg donation is appropriate for you, you will both need to see an experienced infertility counsellor. There will be many issues that it is valuable for you to discuss. One of the most important issues will be what you are going to tell a child resulting from egg donation about his or her origins and the best timing for this. Counselling gives the centre a further opportunity to assess your emotional and psychological suitability to receive donated eggs. While this may seem to be a rather drawn out process, it does give you both time to decide that egg donation is definitely what you want. The support counselling you will receive can be most helpful to both of you.

Centres are required to assess both the welfare of any child that may result from licensed treatments such as egg donation and IVF as well as the welfare of any existing children you may already have.

Screening tests will then carried out on both of you before you are seen for a very detailed planning appointment.

As you are essentially being considered for IVF, you will both need to have the same tests as for an IVF treatment cycle with the additional tests required because of the egg donation. This means that both of you are screened for HIV, Hepatitis B & C, Cytomegalovirus (CMV) and syphilis. Your blood groups are determined for donor compatability. You will also have a full blood count, Rubella antibody screen and hormone profile.

Your partner will need to provide a sperm sample for the embryologist so that a "dummy run" preparation can be carried out to ensure that sperm can be adequately prepared for the egg donation cycle. Sometimes if the sperm quality is poor it will be recommended that instead of IVF, ICSI should be carried out. In ICSI a sperm is injected into each donor egg to improve the chances of fertilisation occurring (see intra-cytoplasmic sperm injection ICSI information).

When you have been accepted to receive treatment by egg donation, there is likely to be some delay while waiting for a suitable donor. As a result of the shortage of egg donors, clinics tend to have long waiting lists for potential egg recipients.

When you are near the top of the egg recipient queue and there is a donor who is a suitable match for you, you will have a very detailed planning consultation with one of the centre’s consultants or nurse specialists. The plan of your treatment cycle will be discussed in full and there will be ample opportunity to have all of your queries answered. The consent forms to be in receipt of donor eggs will need to be signed by both of you.

You are not under any obligation or pressure to accept the eggs that are being offered to you. Perfect matching is not always possible. If you are unhappy with the physical characteristics / match of the donor being offered, it would be very unwise to accept that source of eggs. This will not in any way jeopardise your subsequent treatment.

What does the actual process of egg donation involve?

The principles involved in egg retrieval using donor eggs, are exactly the same as in standard IVF (see IVF information).

IVF is then carried out between the donated eggs and your partner’s sperm.

It is preferable to carry out a fresh embryo transfer whenever possible but this depends on whether your cycle can be synchronised with the donor's cycle. Essentially this means that the endometrium lining of your uterus must be prepared to develop in harmony with the endometrium of the donor. So when the donor's eggs are retrieved and fertilised with your partner’s sperm, your own endometrium has developed to a sufficient thickness to allow the transfer of embryos into your uterus to go ahead.

What does my own treatment involve?

The method of treating you will depend upon whether or not you have a menstrual cycle.

If you are still having periods, the centre will need to synchronise your cycle with that of the egg donor. This means that you are initially on daily injections to switch off or "down-regulate" the control your pituitary gland has over your own natural cycle.

If you do not have a cycle it is generally simpler to prepare your uterus for the transfer of embryos. If you are on HRT (Hormone Replacement Therapy), HRT treatment is stopped.

Whether or not you are having periods, you will be asked to start taking oestrogen tablets every day from the day that the donor commences her daily FSH injections to stimulate her egg follicles to grow. The oestrogen tablets develop the growth of the endometrium . The growth of the endometrium is checked by scans.

On the day before the planned egg collection, you are seen again for a further scan to ensure that the endometrium has developed to an adequate thickness. If you are on down regulation injections, these stop.

You now start using progesterone vaginal pessaries or cream twice daily.

On the day of egg collection, your partner will be asked to produce a further sperm sample at the clinic so that the sperm may be prepared for IVF with the donor eggs. The day after egg collection you will be told if any of the eggs have fertilised.

It must always be remembered that fertilisation of the eggs is not guaranteed.

Two, three or five days after egg collection, you will both be asked to return for embryo transfer.

If your endometrium does not grow to an adequate thickness, IVF with the donor’s eggs and your partner’s sperm can still go ahead but embryo transfer will not be carried out in this cycle. There is no point in wasting the valuable resource of your embryos by transferring them in a cycle when there is no chance of implantation occurring. Instead the embryos will be frozen for your future use. The embryos will be kept in storage until the endometrium is ready.

During the course of the planning of your treatment, considerable time will be spent discussing embryo transfer. The maximum number of embryos to be transferred is two regardless of your own age. Remember that the donor is under the age of 36 years and probably of proven fertility. It is far safer to avoid a multiple pregnancy.

Embryos that are surplus to immediate requirements, can (if considered suitable by the embryologist) be frozen and stored for your future use.

Final points

When sperm donation is carried out it is always with the use of frozen sperm. This is in order to obtain the six month’s quarantine between two negative HIV tests. This may not be practical when it comes to screening an egg donor. If you are having a fresh embryo transfer, there will not have been a six month quarantine period with two negative HIV tests separating the egg donation and embryo transfer. Some couples may request that the embryos resulting from donated eggs are frozen until a second negative HIV blood test result is obtained from the donor. A frozen embryo transfer is subsequently undertaken. It is important to appreciate that not all embryos survive freezing and thawing when they come to be used at a later date. Occasionally no frozen embryos will survive. As the number of donor eggs available to a couple is generally low, the majority of egg recipients opt to have fresh embryo transfers and put reliance upon the single negative HIV test for the donor.

If you are receiving egg donation in your forties, your body will be less resilient that it was even a few years ago. There is a significantly increased risk of antenatal problems, such as raised blood pressure and becoming diabetic during the pregnancy. Finally there is a greater likelihood of requiring to be delivered by Caesarean section. And if you have a multiple pregnancy the risks of miscarriage and premature labour are increased.

It must always be remembered that egg donor cycles may sometimes need to be cancelled for both an under and over-response to stimulation of the donor's ovaries. The donor’s safety is of paramount importance. Although cancellation would be very disappointing to you both, you can be certain that the donor’s disappointment will match your own.

Hopefully this will answer many of your initial questions about receiving donated eggs. It does not replace the in-depth discussion that is required. Centres provide written information for prospective egg donors and egg recipients.

March 2009