Egg donation is a very successful fertility treatment and is usually recommended based upon a woman’s age or her previous experience with fertility treatments. Unlike men who are constantly producing new sperm, a woman is born with all of her eggs and is incapable of making more over the course of her lifetime. After the age of 30, fertility begins to decline—markedly so after the age of 35. By age 40, most women will experience infertility. Fertility medications can induce the continued growth of follicles that were initially destined to undergo atresia, allowing patients to undergo treatments with multiple eggs/embryos. However, these drugs will not improve egg quality, as they can only increase the egg quantity.
Egg quantity can be predicted, to a limited degree, by obtaining blood hormone levels for FSH and estradiol on cycle day 3. Elevations in either hormone suggest diminished ovarian reserve. Another test for ovarian reserve is the clomiphene citrate challenge test (CCCT), a simple blood test that measures FSH and estradiol before and after the woman takes Clomid. Many reproductive endocrinologists perform an ovarian transvaginal ultrasound examination and a follicle count to further assess ovarian function. Antimullerian hormone (AMH) is a newer blood test that can be used to predict a patient’s response to fertility medications (see Question 10). Women with normal ovarian reserve testing (FSH/estradiol, AMH, antral follicle count, etc.) may rarely demonstrate a low response to fertility medications whereas those with poor ovarian reserve testing almost always have a disappointing stimulation.
When a woman’s response to fertility medication is poor, or when she has failed to conceive with previous attempts at IVF or other treatments, or when she has diminished ovarian reserve, then IVF using donor eggs is an excellent option. Since 1984, egg donation has been a cornerstone in treating patients whose egg quality/ quantity have deteriorated, making stimulated IVF a poor choice. By using donated eggs from a woman in her twenties, the infertile patient essentially restores her fertility potential to that of the age of her egg donor. Similarly, the miscarriage rate drops from more than 50% for patients older than age 40 to 10% to 12% with the use of donor eggs.
Egg donation has been used extensively in patients who are perimenopausal or even menopausal. Most clinics have an age restriction in terms of their egg donor recipients, with the most common cut-off age being 50 years old. Unlike the eggs, the uterus slowly ages and remains receptive to implantation (as long as the endometrium is successfully prepared with hormones) well into a woman’s fifth and possibly sixth decades of life.