Many couples think the value of their egg donor is the genetic material she provides for your surrogacy procedure. They find an egg donor with specific physical characteristics, such as hair or eye color. In reality, finding your egg donor is a far more crucial component on the success of your procedure.
A good egg donation will mean the difference between a successful IVF procedure or a heartbreaking disappointment. Some couples obsess over finding a donor with a specific “look” or with whom they connect on an emotional level. But a successful egg donation is never measured in terms of the donor’s appearance. Success is only measured in the number and quality of the eggs retrieved — and in the successful pregnancy that results.
Why your Egg Donor is So Important
The probability of success for any surrogacy procedure ranges from 65% for high-quality fresh embryo transfers to 45% for medium quality embryos. Even among the world’s best clinics, it is not certain that your first embryo transfer will be a success. Therefore a successful pregnancy depends upon being able to repeat your embryo transfer, with multiple high-quality embryos, perhaps several times. The more high-quality embryos you have, the more opportunities you have to repeat the procedure, and the greater your chance of success.
An average egg donation may result in 12 eggs, which become 8 to 10 viable embryos. Of these, perhaps 2 will be high quality (enough for two good embryo transfers). Obviously the goal of any IVF and surrogacy procedure will be to have as many high-quality embryos as possible. For this, you will need to choose an egg donor that will provide the most eggs possible. If fewer eggs are retrieved, you may not have sufficient high-quality embryos to repeat your embryo transfer procedure and ensure a successful surrogacy.
A young and fertile donor with good fertility history and an aggressive stimulation protocol may produce up to 20 or more eggs per donation. This will likely be enough for 4 to 6 transfer attempts, and an excellent likelihood of an eventual successful pregnancy.
When you choose an egg donor, it is important to work closely with your agency, ask questions about the fertility history of each candidate, and pay attention to fertility indicators including age and previous pregnancies. Your agent can help you work with them to find suitable donor candidates.
Among the most critical factors in choosing an egg donor is the woman’s age and her previous fertility history. Young donors (between 20 and 28 years) respond more predictably to fertility treatments, and will provide a greater number of healthy eggs. A proven history of fertility (previous pregnancies and children) shows that the donor not only can provide eggs, but healthy, fertile eggs.
Six Things to Look for When You Choose Your Donor
Here is the list of criteria to consider as you find an egg donor…
1. Fertility Hormone LevelsThe best indicator of your donor’s fertility are standard blood hormone levels. On day 2 of your cycle, you will need to undergo a blood test to gauge hormone levels and overall fertility. Along with basic information, the scan should include fertility hormones including AMH, LH Hormone, FSH Hormone, Estradiol hormone levels. The AMH score is the best predictor, and the level should be high: most clinics will not accept an AMH score below 1.0, and many prefer a score over 3.0. (As a reference, typical donors fall between 1.8 and 3.0.) FSH levels on day 2 should be less than 10.
2. Inspection of the OvariesAlso on day 2 of your donor’s cycle, you need to do a ‘Baseline Ultrasound’ (also known as a Follicular Scan). This is used to visibly confirm the ovarian volume and an antral follicle count. The number of follicles seen is a strong indicator of the number of eggs to be retrieved. The clinic normally requires a minimum of 6 visible follicles.
Before you get a chance to run the standard medical checkup on your donor, there are some tips on judging if she’s likely to be medically cleared…
3. Has your egg donor been successful before? How often and how many eggs were retrieved each time? Women who have produced lots of mature eggs in the past are likely to do so again and again.
4. Has she donated too recently (or not recently enough)? Be sure your egg donor hasn’t donated in the past 3 to 4 months. Ovarian reserve takes some time to replenish after a good donation. On the other hand, even a donor with a previous donation of 20+ eggs can have her fertility diminish over time. The best bet is to find a donor with a successful donation with many mature eggs retrieved in the past couple of years.
5. Are your donor’s eggs fertile? Does she have children or have her previous donations resulted in pregnancy? Even the best donation has little value if the eggs carry damaged chromosomes than can prevent a pregnancy.
6. What is your egg donor’s age? This is one area where a woman’s age really matters. In general younger is better, and women in their early 20s give the best results. Once past 30, a woman’s fertility drops off quickly and dramatically. (But balance this with the fact that most young women don’t have a fertility history yet, so a very young donor may not have the information to answer questions 1 to 3 above.)
Finally…. don’t choose just one donor candidate. You should make a list of your top 5 and then let the clinic run evaluations as to who is the most fertile at the moment. Women’s fertility fluctuates from month to month, and someone who is the excellent choice today may not be the best choice next month.
Collect the egg donor’s medical records and recent test results (as described elsewhere in this Guide) and provide them to the IVF clinic. If you are working with a donation agency they will manage this. Otherwise your surrogacy agent can assist you in managing the paperwork.
Based on the date that you have set for your sperm donation and desired IVF, the clinic will define a complete procedure calendar. The detailed calendar includes the egg donor’s fertility treatments and clinic appointments, the surrogate’s treatments, your donation, as well as the dates for the egg donation, IVF procedure, embryo transfer and pregnancy test.
If you are not working with a egg donation agency, you and your donor will need to coordinate all of her treatments and tests with a local fertility specialist. The treatments are not over-the-counter, and will require a doctor’s oversight.
Three Options for Finding an Egg Donor
If you need to find an egg donor, here are the possible sources you can consider. The option you choose will depend on your personal preference and cost.
1. Choose an egg donor through your clinic.
Some US clinics offer donation services, and can match intended parents with local donors for a relatively low fee. If your clinic offers donors, the price could range from $7,000 to $12,000 USD.
Most overseas programs offer very affordable egg donors from the local area, for about $3,000 to $6,000. The cost of local donor is typically quite low because cost of living in most overseas destinations is lower than in the US, and the donor will not need to travel. However the limitation is that local donors are always the ethnicity of the local population. For some couples it is important their donor “look like their family”, which can disqualify local donors.
2. Choose an egg donor through an international donation agency.
International agencies have donors of almost any ethnicity, and they are generally the most thoroughly screened and evaluated donors available. The cost of a donor is about $14,000 to $20,000 USD. This cost includes her travel expenses to the overseas clinic for the stimulation and donation (which is about 15 days).
Your agent should work with a few excellent donation agencies, and they will make that introduction and then facilitate the donation process. Part of the agent’s responsibility is to make sure that you get an excellent donation, which will be critical for the success of your surrogacy program.
3. Have a friend or family member donate for you.
Not many people choose this route, but it’s an option. If you know someone who is willing to donate, she should first have a series of basic fertility tests to make sure she’s fertile. Once she is approved, she will need undergo 15 days of daily hormone therapy, much of which must be done at the overseas clinic, prior to the donation.
The cost of your donor may or may not be included in your surrogacy package. The cost of the egg retrieval procedure and medication should already be included in your surrogacy package. If a donor is not included, you will need to pay for her compensation, her travel expenses (possibly with a chaperone), and any fees to her representing agency.
About Anonymous Egg Donors Overseas
By law, egg donation in many countries is 100% anonymous. This means that parents are not allowed any personal information when they choose an egg donor other than her medical history. They are not given any name or even a photograph. When you consider a local donor you will need to base a decision solely on the medical evaluation of the woman. Once you choose a profile that meets your needs, the clinic can send a photograph of the woman, but without identifying details. At that time, IPs can refuse the woman based on her physical characteristics, and then can look for another anonymous profile.
Anonymous egg donor services work like this… You will fill out an egg donor request questionnaire. In this document you can specify your personal criteria, including the physical characteristics. Based on this information your clinic will provide a collection of profiles that meet the criteria. Once you choose an egg donor you like (and usually make a down payment) the clinic will send a photograph of the woman. If you do not like the photo, you have the option to refuse that donor and select a new one.
Before starting stimulation treatments on your donor, the clinic should provide a ovarian scan of your donor, which will allow the doctors to see the number of follicles available to be retrieved. If there are only a few eggs, the clinic will recommend that you choose a new egg donor.
If you choose a donor from an international agency, you will have more information about the donor, including multiple photos of her and her family, and often some personal information.
Preparing Your Egg Donor for the Retrieval
Your egg donor will require fertility treatments to ensure an excellent egg retrieval and successful surrogacy journey.
Whether the Intended Mother or a hired egg donor, the egg donation will require appropriate fertility treatments. Fertility medications stimulate the ovaries to mature and release multiple eggs in a single menstrual cycle. Without stimulation meds, the donor will release only 1 mature egg per month, which is not enough to ensure a successful IVF cycle.
Treatments can best be described in 3 steps, each is required of every egg donor:
1) Validate the viable candidate. Initial blood tests and ovarian scans will reveal if the egg donor has an adequate supply of eggs, and whether she is likely to respond to the fertility treatments. If the results are poor, a different donor should be sought. These tests/scans can be performed by the donor’s local fertility clinic.
2) Synchronize the cycles. The egg donor’s cycle must be synchronized with that of the surrogate, so that the implantation can happen as soon as the embryos are fertilized and ready. This entails using standard oral contraceptives to suppress the donor’s cycle for about 22 to 28 days. This can happen at the donor’s local clinic.
3) Stimulate follicles. Once the egg donor’s cycle resumes, she immediately begins 15 days of stimulation injections to mature the ovarian follicles and produce viable eggs. These injections typically happen at our clinic, although the first week can be done at a local clinic in coordination with our fertility specialists.
Following these 3 steps, a final ovarian scan will determine if/when the donor is qualified for egg donation.
About the authors
Author: William Houghton
Bill Houghton is the founder of Sensible Surrogacy, author of the Sensible Surrogacy Guide, 2x surrogacy dad, and a dedicated advocate for secure, legal and ethical Gestational Surrogacy. Read Bill's Biography