I think by now you have guessed I am fertility obsessed. Meeting our amazing Warrior Woman Maeve gave me a glimpse into the world of of egg donation, a world like that of so many other assisted fertility protocols, that has its own set of codes and acronyms and emotional considerations. In this post I discuss why and for whom egg donation might be an option for and what the process really entails.
Every person’s fertility journey is beautiful and unique. Egg donation, while definitely less talked about than IVF, may be an option for a whole number of reasons: poor egg quality, damage to reproductive organs from something like chemotherapy or as another avenue to explore after unsuccessful IVF. I needed to know more but from a trusted source; someone in my eyes who is the best in her field and that person was Eilis. This is a woman who has more than 15 years experience working as a Fertility Nurse Specialist. Not only is she the Egg Donation Nurse Coordinator at Waterstone Clinic, she actually developed the Egg Donation Service there. She was there to give me advice and support on many an occasion during my own IVF journey and I don’t ever recall meet Eilis and not crying (me being emotional, not Eilis being mean….she’s lovely!). Having looked into Egg Donation online and being utterly bewildered by crazy terminology and unclear explanations, I knew I would need someone like her to try and do the impossible - actually explain this process to me in plain English. So off I went with my list of questions under my arm and this is what I learned and yes .. I cried again!!
So who are the women that may choose Egg Donation?
Reduced Ovarian Function
A woman’s ovaries has a few jobs to do, hormone production, carrying and maturing eggs (follicles) and typically once a month having a bon voyage party for one lucky little egg and sending it on it’s way down the fallopian tube, in the hopes of getting pregnant. When or if said ovary starts slacking on some of these jobs the quality and or quantity of her eggs can be affected and therefore reduce her chances of getting pregnant.
This might explain why we might see more articles in the media focused on women who become pregnant through egg donation in their late 40’s and 50’s. As with everything (sigh!) aging does impact ovarian function it doesn’t wholly represent the profile of women coming into Eilis who are choosing to go down this route. In reality the majority of women that Eilis meet are women in their 30’s and 40’s who are still actually producing eggs and who are still having regular cycles but that ovarian function we talked about is reducing.
But if she’s still having cycles and still producing eggs what’s the problem right? See an embryos quality, i.e. how quickly the cells are dividing and how well it’s developing, is dictated by egg quality. Poor quality eggs may result in poor quality embryos which lower the chance of that little fertilised cutie implanting in the uterus and going on to become a baby.
Primary Ovarian Failure
Another group of women who come through the clinic doors for Egg Donation are those who have had ‘primary ovarian failure’. I don’t actually like the word failure here. It’s a bit too close to home for someone battling with infertility for whatever reason but I now understand what this refers to in the medical context. While ‘diminished ovarian reserve’ means lowered function of the ovaries, primary ovarian failure refers to the complete loss of ovarian function before the age of 40 .
Again there are a host of reasons why a woman may not be having a cycle but has a perfectly working uterus sitting there, tapping its hypothetical foot and impatiently waiting for a baby.
Cancer survivors having undergone chemotherapy and radiotherapy fall into this category. These treatments can permanently and severely damage ovarian function rendering the patient infertile in so far as being able to produce eggs and have a typical cycle.
Some women may have had ovarian cystectomies or cyst removal that may have affected their ovarian function or in some cases women may have had both ovaries removed. You may have women who have genetic or hormonal abnormalities. These women may have a uterus but never had ovaries that functioned.
These are the women who may consider egg donation.
Ok, but where do the eggs come from?
Regardless of whether Egg Donation was always going to be the first stop on the fertility bus or it comes to pass after rounds of IUI, OII and or IVF, it’s a huge step. As Laura will discuss in her upcoming post about the psychological aspect of this treatment, this is a road less travelled and the emotional and moral implications can be huge. It’s vitally important that women and a partner, if involved, are completely aware of what the process entails from beginning to end.
This means step one is a frank conversation with someone like Eilis to discuss options and your treatment plan to date.
For those that choose to continue on down the donation path they’ll be faced with a decision with three possible choices, to go with a known, identifiable or anonymous donor.
A Known Donor
This is an option that may be available to some women. They may have a sister, a cousin, a friend who has offered to donate eggs to them. Eilis at Waterstone Clinic will arrange for the donor to have blood tests done, meet with the Doctor and counsellor so that the option of donating eggs can be explored.
An Identifiable Donor
This donor is not known to the couple receiving the eggs but a child born as a result can have the option of accessing identifiable information on the donor at the age of 18. This option is available in the UK.
An Anonymous Donor
This is what the majority of people opt for. Information on the donor’s characteristics: age, eye colour, hair colour and whether they have proven fertility or not, etc. is made available to you, the recipient. You even know their blood group. Knowing these characteristics can allow for physically matching a donor as closely as possible with the couple in question. That is as much information as you will have on the donor. This treatment option is available in Spain.
By Spanish law the donor is not entitled to any identifiable information on the recipient and the recipient is not entitled to have any other identifiable information on the donor.
Legislation can vary widely from country to country. In the States for example, this same ‘anonymous’ option allows you to select your donor with a huge amount more detail available. Information available on the ‘donor database’ include physical attributes and lifestyle, personal statements, personal medical information, reproductive history, family medical history and genetic information. You even get access to photographs! This is information that you will be able to give to your child.
Egg donation in the States is expensive: usually an upfront fee which can include six egg donation cycles. Costs can be anywhere from $36,000 upwards, based on varying services, fees and medical expenses. 
Look out for clinics which offer refunds for unsuccessful rounds of donation as this is more common place in the US. Find a list of clinics with up to 90% success rates HERE.
What happens when I select my egg donor?
Strictly speaking about egg donation (and not sperm donation), once the egg has been retrieved from the donor it’s ready to go get fertilised in vitro (i.e. out of the body). This is where the ole good quality vs poor quality investigation comes back in. Embryos are monitored over the coming days and graded, kinda like exams, A is really good…..well actually AA is the best although rare, you’re much more likely to see B and C grade.  The good ones are then selected for implantation.
Given that donation solves the ‘egg quality’ issue, the other major factor for successful implantation is a receptive and friendly uterus. Alongside a lovely little embryo being implanted, your treatment plan which will also ensure there is a nice thick uterine lining among other things, will most likely depend on your specific fertility and reproductive status.
With these two components, i.e. good quality embryo and happy uterus all checked off the list, you’re into the dreaded two week wait as with a usual menstrual cycle before being able to take a pregnancy test around day 28.
Doing egg donation is hard enough but travelling abroad brings a whole new level of stress to the couple, think travel delays, flight cancellations, extra time off work, uncertainty around dates that cannot be confirmed at the outset. Eilis is there to work this through with you.
This protocol can be an option up until your 51st birthday. Couples should spend some time considering the option of egg donation, attend counselling to explore implications and emotional considerations and decide if it is for them. It tends to be the last biological option for most people before considering adoption.
There are lots of clinics not offering this treatment. If you would like to find out more about what the Waterstone Clinic offer you can visit their egg donation treatment page HERE
or watch Eilis talk more about this HERE
A very special thank you to Eilis for taking time out of her very busy schedule to chat with me. It was an education!
 Mayo Clinic. (2019). Premature ovarian failure - Symptoms and causes. [online] Available at: https://www.mayoclinic.org/diseases-conditions/premature-ovarian-failure/symptoms-causes/syc-20354683 [Accessed 22 Feb. 2019].
 ConceiveAbilities. (2019). Egg Donor Cost: Agency & Egg Donor Fees, Prices & Payment. [online] Available at: https://www.conceiveabilities.com/parents/egg-donor-cost [Accessed 22 Feb. 2019].
 Winfertility.com. (2019). Understanding Embryo Grading: Why It’s Important for Successful IVF | WINFertility. [online] Available at: https://www.winfertility.com/blog/understanding-embryo-grading-important-successful-ivf/ [Accessed 22 Feb. 2019].