Once you get to the decision to use an egg donor, you may already feel overwhelmed and exhausted by the process. It doesn’t help that you need to now decide how you want to approach egg donation. But one of the first decisions you will likely need to make is whether to use Fresh or Frozen eggs. Until recently, the technology for freezing eggs was not sophisticated enough to be able to successfully freeze and thaw eggs. However, in 2012, the Society for Advanced Reproductive Technologies (SART) announced that vitrification (a rapid flash freeze process) made frozen eggs a viable option.
So what are the main considerations when choosing between fresh and frozen eggs? In my opinion, there are three main considerations: success rates, cost, time and desired amount of information about the donors.
The main considerations are:
- What are the comparative success rates?
- How much are you willing to spend?
- How quickly do you want to start treatment?
- How much information do you want about the donors?
- How many embryos do you want? Do you want more than one child?
Vitrification made it possible for the creation of frozen egg banks akin to sperm banks. However, the statistics on the use of frozen eggs has been fairly limited. SART data for 2015. The data breaks down the pregnancy and live birth rates for fresh donor eggs, frozen donor eggs, thawed embryos, and donated embryos.
The SART data for 2015 reports Fresh donor egg transfers lead to a 53.5% live birth rate as compared to 38.5% live birth rate for frozen donor egg transfers. And the preliminary data for 2015 reports 50.2% live birth rate for fresh donor eggs vs. 38.3% for frozen donor egg transfers. Considering the chances of conception are about 5% per cycle if you are over 40 and using your own eggs, these are very high numbers.
And, notably, there has been one controlled-randomized clinical trial that concluded there is no difference between frozen and fresh eggs.
Some of the more advanced and stringent clinics and egg banks report higher numbers—60-69% for frozen eggs and 70-80% for fresh eggs.
There is a long lag of data from SART and the technology is constantly improving. And many frozen egg banks state that the success rates for fresh and frozen egg transfers are now comparable. But pay careful attention to the stats being reported and the difference between pregnancy rates and live births etc.
For many people this might be the single most important factor in deciding whether to use fresh or frozen eggs. Frozen eggs are usually around $8000 for the “lot” of 6-8 eggs, making the whole cycle cost about $18,000 – $25,000. Many egg banks list the price for the entire cycle so make sure you understand what’s included, such as shipping, storage, thawing etc.
There are a few ways to work with a fresh egg donor. You can use an egg donor agency that recruits women for donation or you can often work directly with a fertility clinic that maintains their own selection of donors. There is currently no regulation around what egg donors get paid and it can range from about $15,000 – $50,000 for the egg donation plus cycle costs which can bring the total to anywhere from about $30,000 – $70,000.
For many the decision to use an egg donor, comes at the end of a long journey with many failed cycles and a constant cycle of hope and despair. When it comes time to use an egg donor, they just want to get it done. Or they have limited vacation time and need predictability.
Using frozen eggs, means that you don’t need to coordinate your cycle with a donor. You simply do whatever is necessary to prepare your uterus for implantation and do the transfer. The eggs that are available are in the bank. So, the time from deciding to use a donor and transfer can be around 1-2 months. There is no risk of a cancelled cycle due to donor issues because the eggs are ready. Most banks have some sort of guarantee policy the ensures you will end up with at least one, sometimes 2 embryos for transfer.
When using fresh eggs, the donor may still need to be screened. The donors often undergo a preliminary screen but are not required to undergo full psychological, medical and emotional testing until someone expresses interest in them as a donor. Therefore, you may have to wait a few months after choosing your donor for her to be cleared for donation. And then you still have to synchronize your cycles which can take an extra few weeks. Or in some cases, if you choose a repeat donor, you may have to wait for her to rest between cycles before she is available. The whole entire process can take as much as 5 months. The other risk is that with a fresh cycle, you have no idea how the donor will respond to medications or how many eggs she will produce. There are times when the cycle has to be cancelled due to donor issues.
If time is of the essence, frozen is the way to go.
Number of Embryos
As I mentioned before, with frozen eggs, you usually get a “lot” which is defined by each clinic but ranges from about 6-8 eggs. Of that, they guarantee at least one, sometimes two, transfer quality embryos. If you were interested in siblings, you could purchase another lot of eggs and pay for storage.
In contrast, a fresh egg cycle could yield up to about 20 eggs per cycle. This can be extremely important for people who want to have the option of a genetically related sibling. However, read the fine print of your egg donor contract carefully because there may be no guarantees about how many eggs or whether there will be any embryos produced in a fresh cycle.
All egg banks, fresh and frozen, will conduct medical testing on the donor which includes genetic testing for some of the main genetic diseases such as Cystic Fibrosis, Tay Sachs, Fragile X, Sickle Cell etc. Ask the bank to provide a list of the sexually transmitted diseases and genetic diseases they test for.
It is also becoming more commonplace to conduct comprehensive chromosome screening (CCS) or pre-implantation genetic diagnosis (PGD), on fresh embryos before they are implanted. This testing can detect monogenic disorders—that is, disorders due to a single gene only (autosomal recessive, autosomal dominant or X-linked)—or of chromosomal structural aberrations (such as a balanced translocation). These tests allow you to rule out any genetic abnormalities so that you only transfer healthy embryos. This can drastically reduce miscarriage rates. However, if your egg donor is young, (and to some extent the sperm donor is young too) the chances of having genetic abnormalities is greatly reduced. If you are using frozen eggs it is not possible to conduct PGD or CCS testing.
Information About Donor
At the time of writing this, most, banks only offer anonymous egg donors. You will only have the option to know the information contained in the file. However, industry pressure and lessons from anonymous adoption are shifting the tide. Fairfax Frozen Egg Bank is one of the first frozen egg banks to offer Identity Release Donors akin to what most sperm banks offer. However, if you live in a country that forbids anonymous donation, The World Egg Bank maintains the required information. This means that the child has to option to contact the donor at the age of 18. If you use an anonymous donor, you or your child will not be able to find the donor, (unless you find each other on the Donor Sibling Registry.)
With fresh egg donors, many different options are available. It depends on the clinic, egg bank, and donor as to whether you may be able to meet the donor. I know some people who have actually met their donor before beginning the cycle as part of the decision process. Others who have an agreement that the bank will put the parties in contact after the baby’s first birthday and others that will remain anonymous forever.
Fresh Donor Eggs
Cost: $15-50,000 with a total cycle costs of $30-70,000.
- You’re likely to end up with enough eggs (20 or more) to try multiple cycles or save embryos for siblings.
- It is possible to conduct genetic testing such as comprehensive chromosome screening (CCS) or pre-implantation genetic diagnosis (PGD), which require fresh eggs.
- You may be able to get more information about the donor or even meet the donor before entering into a contract.
- Donors must be screened (psychological, medical, and emotional testing) and undergo IVF.
- You must sync the cycles of donor and recipient, which requires time.
- The process (donor selection, screening, and syncing) takes on average 4-5 months, but can take up to 12 months.
- You won’t know in advance how the donor will respond to IVF medications.
Frozen Eggs From An Egg Bank
Cost: $8-15,000 with a total cycle costs of $16-25,000.
- There’s no need to sync cycle with donor, so you can complete a cycle in 4-8 weeks compared to 3-5 months with fresh eggs.
- There are fewer variables since eggs have already been retrieved and exist in egg bank.
- All of the medical, psychological, genetic, and legal testing and consents have been completed.
- You may be able to see donor photos or find Identity Release Donors.
- It’s much cheaper than fresh eggs.
- There are more banks which operate nationwide so you may have more options with national banks.
- The technology is newer.
- You only receive one lot of eggs—typically 6-8 eggs—which may not be enough to get a viable embryo. At most, likely to end up with 1-2 transfer quality embryos per lot. As a result, it’s difficult to plan for siblings.
- Most frozen egg banks will contract with almost any IVF clinic. If your clinic does not already have a relationship with the bank, most will establish a relationship if necessary.
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Moving to Egg Donation?
- How can you balance fertility treatments with moving onto donor eggs.
- Weigh factors such as time, money, age etc.
- Examine your firmly held beliefs against egg donation.