During a cycle of donor-egg IVF, the egg donor, usually a young healthy woman in her 20s, undergoes a cycle of ovarian stimulation culminating in an egg collection. The eggs are then fertilized with the sperm of the egg donor recipient’s partner and the embryos are ultimately transferred into the uterus of the recipient. Most donor-egg IVF arrangements are anonymous, although known donor-egg IVF is possible. In the latter case, the known donor is usually a family member or friend. In our experience, most of our patients prefer to use an anonymous egg donor to avoid family and interpersonal conflicts.

Most medical practices recruit egg donors for their patients, but third-party agencies are also available that act as brokers. The American Society of Reproductive Medicine (ASRM) has developed a set of egg donor screening guidelines, which most practices utilize for screening donors. The guidelines encompass comprehensive screening for infectious and genetic diseases, physical examination, and psychological testing. Since May 2005, the U.S. Food and Drug Administration (FDA) has mandated extensive infectious disease testing in screening all anonymous egg and sperm donors.

The actual treatment cycle for donor-egg IVF essentially combines a fresh IVF cycle (the donor) and a medicated FET cycle (the recipient). The two treatment cycles are synchronized by using GnRH analogs. Usually, the recipient begins estrogen therapy 5 days prior to the start of the egg donor’s stimulation so as to provide an adequate time frame for the recipient’s endometrium to grow and thicken. After 10 to 14 days of stimulation, the donor receives an injection of HCG (Pregnyl, Profasi, Ovidrel, Novaryl) to mature her eggs. On the same day, the recipient starts progesterone therapy to create a receptive endometrium.

Because most egg donors are young, they tend to respond very well to the ovarian stimulation drugs, producing many high-quality eggs and embryos. Implantation rates with these embryos are also very high, so that usually only one or two embryos are transferred to the recipient. Pregnancy rates usually exceed 50% per initiated cycle, making donor-egg IVF the most successful therapy currently available for infertile couples. Usually, extra embryos that were not transferred can be frozen and stored for later transfer, with excellent pregnancy rates achieved in subsequent conception attempts.

Donor-egg IVF can be very expensive and is frequently specifically excluded from the list of treatments covered by insurance. Donors often receive compensation of $5,000–$10,000 per completed cycle. When one includes the cost of fertility medications ($4,000), the cost of donor screening (genetic, infectious disease, psychological) and the clinical procedures performed then the total cost can approach $25,000–$30,000.