Donor Eggs and Donor Embryos

What about using donor sperm, donor eggs and donor embryos in an IVF cycle ?

Donor Sperms, Donor Eggs and Donor Embryos
Couples with no sperm or eggs can undergo IVF and GIFT with the use of donor sperm or eggs.

For IVF, cryopreserved donor sperm are processed in the same way as fresh sperm. Today, because of the availability of ICSI, the need to use donor sperm when doing IVF is restricted only to men with complete testicular failure.

Donor eggs can be used for women who have no eggs ( ovarian failure) but who do have a healthy uterus. An embryo resulting from the fertilization of a donor egg and the husband's sperm is placed inside the patient's uterus.

A couple may also choose to use donor eggs if the woman has a genetic disease that could be passed on to a child. Donor eggs can also be used in some cases of long standing infertility when other procedures have failed - for example, women with many previous unsuccessful IVF cycles. The use of egg donation is now becoming increasingly commoner , as older women are seeking infertility treatment. Since the chance of a pregnancy in the older woman depends directly upon the quality of her eggs , many older women opt to use donor eggs from younger women - which increases their pregnancy rates dramatically. This also creates headline news, for example, when a menopausal woman has given birth with donor eggs. In rare cases, when both the man and woman are infertile, donor sperm and donor eggs have been used together.

Today, because we can freeze and store eggs routinely using vitrification, we use our egg bank for our donor egg IVF program. This allows us to physically match the egg donor and the wife ; synchronise cycles much better; and also guarantee that we will have at least 10 mature donor eggs for the treatment cycle.

Egg donation for IVF requires the egg donor to undergo superovulation and ovum aspiration. The donation of eggs carries more risk and inconvenience to the donor than does the donation of sperm.

Fig 1. Ultrasound scan of the egg donor after superovulation. She has grown many follicles and is ready for egg retrieval

For donor egg IVF treatment, the patient ( recipient) needs to be treated with hormones, so that her endometrium is primed and is receptive to the embryos at the time of transfer.

Fig 2. Mature oocyte cumulus complex

For amenorrheic women with ovarian failure, this can be achieved by treating them with exogenous estrogens and progesterone. Other women who are cycling need to be downregulated with GnRH analogs before starting treatment with exogenous estrogens. For women who are ovulating, we can do the transfer in a natural cycle as well .

Couples with both a sperm and an egg problem can also use donor embryos. Since embryos can be stored, some infertile couples going through an IVF cycle, who have chosen to freeze their supernumerary embryos for themselves, are willing to donate their surplus frozen embryos to other infertile couples when they get pregnant. Since donor eggs are still so hard to come by, many couples may choose to resort to using donor embryos, since these are much more easily available. You can think of donor embryo treatment as very similar to adopting a baby - with the difference that you are carrying the pregnancy and giving birth to the baby !

Some couples are worried that if they use donor eggs or donor embryos, their body will "reject " them, because these are genetically foreign. However, remember that all embryos are genetically foreign to the mother, because half the genetic material comes from the father ! The uterus is an "immunologically privileged" site, and donor embryos have as good a chance of implanting as normal embryos.

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.