Women are born with a lifetime supply of eggs within their ovaries. Ovaries contain 1-2 million eggs at birth and approximately 300,000 to 400,000 at puberty. Every month during the ovulatory cycle, one or more of these eggs are recruited and develop under the influence of follicle stimulating hormone (FSH). In stimulated cycles (IVF), additional FSH is administered to cause the development of multiple follicles, each of which contains one egg.
Infertility specialists are seeing an increase in female infertility, partly due to changes in our societal morals and values. In the past, females usually married in their late teens or early twenties, which is the period of highest fertility. With the freedom provided by family planning, education and career choices, many women are waiting until their thirties to get married and start a family. They are waiting to become pregnant until they have established their careers and can devote the time necessary to raise a child. Unfortunately, nature does not recognize societal changes. As women age, their chances of having fertility issues increases.
Declining egg quality is a “natural process” that culminates in menopause. Many women prematurely enter menopause in their thirties and some as early as their twenties. This condition is termed “perimenopause.” Older women should see a board certified fertility specialist as soon as possible. The American Society for Reproductive Medicine defines infertility as twelve months of regular, unprotected intercourse without conception. For women under the age of 35, this definition is often shortened to six months. This supports the notion that a fertility specialist should be soon early in the infertility evaluation. Some women may only have six to 12 months of quality eggs available.
Declining egg quality is usually referred to as a “diminished ovarian reserve,” and the complete lack of fertilizing capability is termed “ovarian failure.” The day 3 FSH test is often the first sign of a diminishing ovarian reserve. Abnormally high values are a prognosticator of poor egg quality.
In the past, women with ovarian failure had no chance of conceiving a child. This was true until the introduction of donor egg IVF, which has enabled thousands of couples to have genetically related children.
Causes of Ovarian Failure and a Diminished Ovarian Reserve
Advancing age is the most common causative factor, and the effects of age on the ovary vary widely. Diminished ovarian reserve is a form of ovarian aging, since ovarian function declines long before the “date projected” time of menopause. Premature ovarian failure (POF) refers to an early menopause, which may occur 10 or more years before naturally anticipated. POF indicates a very low or minimal chance of natural fertility. Any woman in her thirties with suspected fertility issues should not delay seeing a fertility specialist.
Ovarian failure or a diminished ovarian reserve can be caused by other circumstances. In rare cases, a woman may be born with one or no ovaries. Severe pelvic inflammatory disease (infection) that spread to the ovaries and destroyed tissue or caused scarring is another potential cause.
Cancer chemotherapy and/or radiotherapy can destroy eggs. Fortunately, with the advent of egg freezing, healthy eggs can be removed prior to cancer treatments and frozen, thus preserving fertility. Once therapy is completed, the eggs can be thawed and used in an IVF cycle.
The donor eggs are used in concert with an IVF cycle (see our IVF page). The egg donor undergoes stimulation with injectable FSH, causing her ovaries to produce numerous eggs, which are needed for the procedure. She receives injections until the physician judges that the ovarian follicles are mature. She also receives ovulation regulation drugs (Lupron, Ganirelix, and Cetrotide) that will not allow her to ovulate until the eggs are mature. Ovulation of the eggs before they can be retrieved results in a “lost cycle.” The donor comes to our office during the stimulation phase for checks of her E2 levels and ultrasound examinations. These tests document normal follicular development and help prevent potential medication side effects.
The recipient mother receives medications, such as progesterone, to synchronize her cycle with the egg donors. After incubation, the embryos are transferred to the recipient mother's uterus, and the endometrium must be thick and vascular to provide appropriate support for implantation and fetal development.
Egg Donor Requirements
Egg donors are young females who must meet specific requirements that vary from program to program. In general egg donors must meet the following requirements:
- Age 21 to 33 years
- Non-smoker
- Generally healthy family health history
- BMI< 30
- Day #3 FSH and antral follicle count showing good prognosis
- Flexible schedule to accommodate occasional AM monitoring
- Must meet FDA eligibility screening. More information can be reviewed on our “Egg Donor Application”.
More information can be reviewed on our Egg Donor Application.
Success Rates Using a Donor's Eggs
Donor egg IVF success rates are typically high because women (donors) are most fertile in their late teens and early twenties. Women in their forties typically have bleak IVF success rates, and many programs exclude these women from standard IVF procedures.
When the eggs from a 22-year-old female are used to create the embryos, which are then transferred to a 45-year-old female, the pregnancy success rates are equal to that of the 22-year-old. In fact, as long as her uterus is intact and she is healthy, a woman as old as her fifties could be a donor egg recipient. Virtually all programs have a maximum age for women desiring children via donor egg IVF. Our age limit is 45.
Our donor egg program has been in operation since 1995 and our physicians have extensive experience. This clinical experience is evident in our donor egg IVF success rates. If you are interested in being an egg donor or a donor egg recipient, please call our office for more details.
