The decision whether to try to conceive with one’s own eggs or to use donor eggs is often the hardest choice a person will have faced up until that moment in their lives. There is no “playbook” for how to make the decision, and the consequences feel everlasting.
For many, having to consider the alternative of using donor eggs feels “abrupt” and “premature”, and nearly all of us need a period (often years) to mourn the loss of possibility. Our perceptions of parenthood, of childhood, of our relationships will be impacted in facing the dilemma. As those perceptions change, for some, so will their decision.
To try to distill an impossibly-complex, life-altering choice, experts tell us, patients often evaluate three criteria: medical facts, emotion perception, and financial circumstances. These factors are likely top of mind right now, so we’ll unpack each of them.
As you may have seen in another lesson, during the IVF process, the number of eggs / embryos available diminish with each milestone. Generally speaking, the more eggs retrieved, the higher the odds of success.
Most patients weighing egg donation produce few eggs. However, the odds any given egg will turn into a healthy embryo (and in turn, a live birth) vary dramatically, most notably based upon female age.
The data suggests an egg produced by a female under the age of 38 is of comparable quality regardless of whether that patient has a relatively low or high ovarian reserve result.
Let’s look at a study on nearly 1,000 IVF patients under age 38 with patients broken down by pre-cycle ovarian reserve markers (e.g. AMH) in the lowest 10% or in the middle 25%–75%.
As you can see, the number of eggs retrieved was different between these two groups, but of those retrieved eggs, the odds any given egg would lead to a baby were similar.
When the same investigators cut the data based upon the number of eggs retrieved (again, lowest 10% vs 25%–75%), they saw pretty much the same thing.
The inference is that for patients in this age range, egg quantity and quality are not correlated. This study was published in Human Reproduction, the journal for Europe’s largest fertility society.
For reasons elucidated by this study, many doctors seem more prepared to let these patients (mid-30s and younger) continue to try with their own eggs notwithstanding other factors.
Below you can see IVF and IUI success rates at a single, well-respected clinic for women under age 40 who have a small number of follicles growing on their ovaries. Even lesser expensive modalities (e.g. IUI) still have a chance of working in this population.
Women in their mid-40s are less likely to produce many eggs during IVF, and each of the eggs they produce is less likely to lead to a live birth. Let’s look at data from Italy following a similar rubric as the Morin studies above.
As you can see each fertilized egg is less likely to become a blastocyst embryo, and each blastocyst embryo is less likely to be genetically normal. As a result, many clinicians are less optimistic about these patient’s chances of succeeding with their own eggs, regardless of whether they manage to produce an egg naturally or with the help of treatment.
Let’s look at U.S. IVF success rates for women age 45 using their own eggs. The odds a first cycle will work are around 3%, and the odds each subsequent cycle will work begin to approach zero. After three cycles, the cumulative odds of success are about 1 in 20.
While some governments, insurers, and clinics institute age-oriented cut-offs (often for a woman age 43–47), others feel that as long as the treatment is safe and the odds-of-success are “above 0”, it should be the patient’s decision whether to continue treatment using their own eggs.
Again, for context, we’ll showcase cumulative IVF success rates using donor eggs in comparison to a woman’s own eggs at age 42 should IVF be needed.
Most experts suggest seeking a second opinion as to whether additional approaches using your own eggs will be productive. As you can see in our laboratory course here, a clinic’s laboratory is a pivotal determinant in success rates, and it’s plausible a clinic has reason to believe its laboratory might produce different results.
What’s more, the element of time may be less pressing than you think. For younger and older patients considering donor eggs, a year delay is not likely to dramatically change the absolute odds of success with your own eggs. Should you delay, but ultimately decide to do IVF with donor eggs, a delay is highly unlikely to change (the already lofty) odds of success.
There is often a long and deep grieving period for those of us facing the risk we won’t be able to conceive with our own eggs. Our vision for the future can feel jeopardized; meanwhile, we’re likely physically, emotionally, and financially exhausted from “empty” cycles.
For many of us, when a doctor introduces the concept of donor eggs, it can feel “premature”, “abrupt”, “cavalier”, and “unsympathetic.” It’s not unusual for many of us to recoil at the notion and to develop complex feelings towards the first person who surfaces the option.
Some of us come to refine our perspective with time and new information, while for others of us, our position remains clear and unchanged. Here are a few of the subjects that seem to weigh on hopeful parents as they consider their options.
For many, the concept of using an egg donor and severing their genetic connection to a child is difficult to absorb. Many fear we’ll come to see the child as not our own, and when we look in our child’s face, we won’t see a reflection of ourselves. For many of us, this is a troubling vision.
How often these fears are realized can be hard to say but as we show in other lessons, studies show the relationship between parent and child (and between spouses and partners) tends to look the same whether the child was conceived using donor eggs or not. Many experts will point out that patients of some cultures and heritages may face unique challenges here, and studies looking at a diverse group of patients are still needed.
As we cover in another lesson, a genetic connection between a parent and child can be ensured when an egg donor is a sister or cousin. However, as we’ll address, asking a family member to be an egg donor has trade-offs, and in many circumstances, is simply not feasible.
Should a person carry their donor-conceived child themselves, while they won’t have a chromosomal link to the child, they will have a biological link. The study of epigenetics teaches us that the carrying person’s biology and lifestyle helps determine which genes are expressed and activated. Said differently, how a child develops is partially reflected by who’s carrying that child. This is a subject we recommend you discuss in detail with your doctor.
Another factor that weighs on people is the challenge around disclosing to the child they were conceived with the help of donor eggs. As we show in another lesson, and have learned from adoptees, the child’s well-being likely will coincide with how early the subject is normalized in their family.
Mental health professionals tell us often the greatest benefit they provide is showing patients how to talk about the subject with a two year-old, a five year-old, a 10 year-old and so forth. After seeing the discussion modeled, and given resources (e.g. children’s books), this worry often seems less daunting.
Often our emotional wherewithal is tested during this process.
For some of us, we feel like, “I can only endure so much treatment and disappointment.” We know our emotional reserves are low, and we have few cycles left in us.
If we’re committed to trying with our own eggs one last time, this may represent a “closure cycle” where we recognize we’ve done all we can, made efforts against diminishing odds, and if that cycle doesn’t work, we can then weigh donor eggs with a clearer mindset.
For others of us, we see this next cycle as our last, using our own eggs or someone else’s. Some say the finality can help force a decision by:
Sometimes our momentum and commitment to this process can grow with every passing cycle and setback. We look to the next cycle as a beacon of hope and draw strength from the forthcoming challenge of “beating the odds”. We worry that discontinuing our rhythm will sap us of the strength we’ve historically used to triumph in important and against-all-odds pursuits (e.g. career, education). For the moment, and for those of us with certain traits, even entertaining the possibility of using donor eggs can feel like “giving up”.
These emotional challenges are common, but can feel overwhelming. Mental health professionals with a background in fertility and egg donation can help you sort through the emotions and support you in your decision making.
Most experts say that amongst couples the decision-making process on using donor eggs can create a rift. Often, the partner who’ll have their genetic connection severed is more unsure.
Naturally, this disconnection can well up related issues that at times can seem to imperil the relationship itself and put the family-building process on hold.
Even when couples are “on the same page”, the process can be emotionally trying. Watching a loved one sort through pictures and attributes of donors can be harrowing, especially when you’ve always imagined your genetics and attributes combined with theirs.
It’s not uncommon for donor recipients to receive pictures of their donors and to worry about one day encountering that person. In such cases, it's often possible to request baby-pictures only from a donor agency and to work with third parties who find donors in another region.
As we highlight in other lessons, the cost of fertility treatment in general, and using donor eggs specifically, varies both country-to-country and within regions themselves.
In regions where the cost of treatment is substantial, financial factors tend to play a role in a patient’s decision whether to use their own eggs or donor eggs.
To oversimplify, we tend to look at the issue as a function of:
A primary consideration is how much money patients are prepared to devote to the effort to bring home a child. These figures naturally range dramatically but tend to reflect a person’s or couple’s:
As you’ll recall, IVF success rates using donor eggs are dramatically higher than when similar patients undergo IVF using their own eggs. Yet, in many circumstances, the costs to do a donor egg IVF cycle are also higher.
Many of us search for a basis to compare the costs to plausibly (e.g. 50% likelihood of success) bring home a baby. To oversimplify, and in a purely U.S. context, a relative basis of a comparison might look like this.
The meaningful difference in “cost to target” may mean different things to patients with varying remaining financial capacity to commit to their goals.
It’s also worth remembering that in the eyes of many doctors, younger patients (e.g. in their 30s) with a low egg count still stand a chance of conceiving with less expensive approaches like timed intercourse or IUI provided they meet a few basic criteria (e.g.open tubes, decent quality sperm).
Finally, and in tandem, some patients may also look at the highly regional but often non-trivial cost to adopt or the less-expensive role of fostering a child who needs a loving home.