Fresh or Frozen Eggs for IVF: Which is Better?

Which is better for our IVF cycle, fresh or frozen eggs? Frozen eggs seem cheaper, but I’ve heard there are risks. — Gemma

Thanks for this important question Gemma. Many of my clients suggest buying eggs from an egg bank, but I recommend the fresh eggs from a live donor. There are a few reasons to prefer fresh eggs, but only one occasion when frozen may be the better option.
 

Success Rates of Fresh vs Frozen Eggs

First, data shows that IVF cycles with fresh eggs have a higher rate of successful pregnancies and live births than with frozen eggs. SART (the Society for Assisted Reproductive Technology) compared live birth and cycle cancellation rates using either fresh or cryopreserved donor eggs. In the most recent year available, the live birth rate from frozen eggs was 43.1%, while the rate from fresh eggs was 49.2%. In short, surrogates undergoing IVF are less likely to give birth if they use frozen eggs instead of fresh donor eggs.

“Our research demonstrated that — contrary to some claims made mostly by commercial interests — frozen eggs offer a lower chance of pregnancy and delivery chance after IVF than fresh eggs,” said the study’s co-author Dr. Norbert Gleicher, medical director and chief scientist with the Center for Human Reproduction in New York City. “Patients should be made aware of this fact, before making a choice.”

The results of the SART study can be found here.
 

Why Fresh is Often Cheaper

Frozen eggs may seem like a more affordable option because a “cohort” often includes 8 to 10 eggs for a price of about $10,000 USD. But it’s hard to know what you are getting from a frozen cohort of eggs. It’s often impossible to know if the eggs you receive come from the donor you selected, or if they are good quality with a high likelihood of pregnancy. To mitigate the uncertainty, most egg banks will guarantee one healthy Day 5 blastocyst. But success rates with even excellent quality embryos is still only about 60% per embryo transfer. So it’s not uncommon for Intended parents to need more eggs, plus a new IVF cycle to fertilize them.

Meanwhile, a live donor may cost from $14,000 to $20,000 USD. That seems expensive, but it’s not unusual for a donor to produce from 12 to 20 eggs. If you know the fertility history of your donor (she has donated an average of 20+ eggs per previous retrieval, and those eggs have resulted in quality embryos and pregnancies) then the likelihood is very high that you will need just one donation and IVF cycle, and the result will be a successful pregnancy. This makes a live donor much more affordable than eggs from a bank.

If you are planning on having several children from your IVF cycle, using a fresh donor is likely the only option to get adequate numbers of embryos to support multiple pregnancies. This is much less likely with frozen eggs, given the limited numbers of eggs available in each cohort purchased.
 

Ethical Concerns with Overseas Egg Banks

In addition to the better results of fresh eggs, international frozen egg banks are often charged with unethical behavior. US egg banks are generally well regulated, but egg banks in developing countries can be sketchy. Some clinics and agents charge that frozen eggs are unethically collected and resold. They claim that clinics will often hire a donor for a particular couple, then highly medicate her to force the number of eggs retrieved to dangerous levels, then report only a portion of the eggs to the couple that paid for the cycle. The egg bank can then turn around and sell the rest of the eggs to multiple other couples. The practice is unethical, as well as having lower success rates.

There are claims that several large-scale surrogacy agencies are doing exactly as described. Wile a donor believes she is donating for a specific couple, and that all her eggs will be used to help them achieve their dream of a family, the reality is quite different. Many donors have no idea that her eggs are being resold to several couples that she had never met or heard of, while she was paid for just a single donation.

Frozen egg banks in USA have to disclose this to donors, and donors agree legally to this kind of frozen egg banking and give legal consent to the clinic to buy the eggs and resell. While not totally optimal, it’s more ethical since donor has choice and consent.
 

When are Frozen Egg Banks Better?

The only time I recommend frozen eggs is when there are no live donors that meet the Intend Parents’ requirements. Usually that happens when the parents need a donor of a specific ethnicity or cultural heritage. If you are pursuing a surrogacy journey in Ukraine, it can be difficult to find an Asian donor. This is where egg banks can be very convenient. We have regularly purchased eggs fro overseas, where there is a much wider selection of available donors that IPs can choose from. In most cases, it’s relatively easy to transport frozen eggs to the IVF clinic.

But if you are buying a cohort of eggs for transport to your IVF cycle, be careful. If you buy a small number of eggs, and your IVF cycle yields poor results, not only do you need to pay for more eggs and another IVF cycle, but also additional shipping costs and time. Shipping any frozen medical tissues internationally will likely cost from $2,000 to $4,000 USD. So I always advise clients to invest in as many eggs as they can realistically buy, because this is one area where you don’t want to come up short.

The process of getting eggs is much more intense and invasive and expensive than sperm. Plus men have a lot more sperm than women have eggs. Banks of unused eggs could prove wasteful and medically inappropriate, especially if a donor was harmed while retrieving those eggs (and possibly never used).

I hope this is helfpul,
— Bill