As a fertility doctor, I know that families come in all shapes, sizes… and ages. In fact, you've probably seen older men pushing strollers and attending playgroups, particularly in urban areas. My thirtysomething friends will postulate the backstory: Perpetual bachelor finally settling down? Second marriage with a younger woman? Young grandpa?
Men have always enjoyed the luxury of time when it comes to reproduction—they continue to make new sperm their entire lives. Women’s eggs, on the other hand, are never replenished. Egg quality drops steeply after age 35 and, even with in vitro fertilization (IVF), the odds of pregnancy after 44 are about one per cent. So, while the average age of the dads at playgroup might increase, the moms’ remain the same.
Here are five things you should know about donor eggs:
If a woman wants to donate her eggs, it’s perfectly legal—as long as there’s no payment. This is called known or directed egg donation. Canada has federal laws under the Assisted Human Reproduction Act designed to avoid the exploitation of women’s reproductive capabilities for profit. That means egg donors must be doing it for altruistic reasons and can only be reimbursed for out-of-pocket expenses (e.g. medication or travel costs). Fertility clinics make sure their patients are well aware of the rules, because the penalty for breaking these laws is a $500 000 fine and/or 10 years in prison.
Because pregnancy and miscarriage are primarily related to a woman’s age and egg quality, donor eggs consistently have the highest success rates of any type of IVF cycle. They also come with the highest price tag. The entire frozen donor egg process (see below) can cost $20,000 or more, depending on the egg bank and current exchange rate.
Just like sperm banks, which have been around for decades, we now have egg banks. In 2012, the American Society for Reproductive Medicine deemed that egg freezing was no longer experimental, so, ever since, frozen egg banks have been popping up all over the United States. Unlike in Canada, the U.S. doesn't prohibit donor compensation. Egg banks screen potential donors with extensive testing for infections, medical conditions and genetic disorders. The donors, typically women in their twenties, also provide photos and other personal information like family history and education. However, unlike sperm donation where open-identity is trending, frozen egg donation remains almost entirely anonymous.
The woman donating eggs goes through a traditional IVF cycle. This includes ten days of hormone injections to stimulate the ovaries, along with regular ultrasounds to check how many eggs are developing. The process culminates in a minimally invasive procedure to suction the eggs out of the ovaries. Once the eggs are removed they belong to the recipient, usually referred to as the intended parent.
Women considering frozen donor eggs should first visit a fertility doctor before going online to browse donor profiles. Once a donor is chosen, the egg bank ships a batch of six frozen eggs to the local Canadian fertility clinic for fertilization. The eggs can be fertilized with a partner’s sperm or with donor sperm, to create embryos. Those embryos grow in an incubator for five days before one is transferred into the uterus and the extras are refrozen.
Donor eggs have revolutionized the options available to couples struggling to get pregnant. They are most often used by women who do not have viable eggs of their own. Because women are born with all of their eggs, the quality and quantity decline over time. As a fertility doctor, I have seen how devastating it is when a woman finally feels ready to start a family, only to find out that it’s already too late.
It’s undeniable that women in our society are choosing to have babies later in life. British Columbia and Ontario have the highest ages of first-time mothers in the country, with the large majority of births occurring in women over thirty. The increasing demand for donor eggs is linked to the rise in age-related infertility. In 2017, ten per cent of all the IVF treatment cycles in Canada involved donor eggs—a big jump from just three per cent in 2008.
The increase in older mothers is not the only factor driving demand for frozen eggs. Donor eggs also provide fertility options to prospective parents in the LGBTQ community. Gay men and trans couples can use donor eggs in conjunction with a surrogate. Lesbian couples may choose egg sharing or reciprocal IVF, where eggs are harvested from one woman so that her partner can carry the pregnancy.
I frequently tell my patients that the uterus doesn’t age. What I mean is that, even after menopause, the uterus maintains the ability to respond to hormones and carry a pregnancy. So even if a woman is unable to use her own eggs because of premature menopause or poor egg quality, she can still get pregnant using donor eggs. Estrogen and progesterone pills can simulate a normal menstrual cycle and prepare the uterus for implantation of an embryo.
It’s also important to consider the overall health of the woman, as pregnancy is incredibly demanding on the body. For this reason, obstetricians remain vigilant for pregnancy complications like high blood pressure, diabetes and premature delivery, all of which become more common as women age.
Donor eggs give women the incredible possibility of being pregnant and giving birth to a baby. However, even though that baby is very much their own, it’s important to understand that it will not be genetically related. For example, a DNA test performed on a baby born to a heterosexual couple using donor eggs for age-related infertility would show that the child is genetically related to the father (the sperm), but not the mother. This can be one of the most challenging concepts for couples to overcome with donor eggs. For this reason, fertility clinics usually require a professional psychologist session before embarking on the process.
It’s common to take fertility for granted. Many of us assume that because having a baby is natural, it must also be easy. Sadly, that is not always the case. One in six couples will struggle with infertility. The good news is that innovative fertility treatments are being developed every day. Donor eggs are helping to build families that would previously have been impossible. Although it is not legal to pay for eggs in Canada, women have the option to order frozen eggs from the U.S. or have a friend or family member donate them altruistically. The battle to cure infertility is far from over, but donor eggs are a valuable addition to the list of possible treatments.
Caitlin Dunne, MD is a co-director at the Pacific Centre for Reproductive Medicine in Vancouver and a clinical assistant professor at the University of British Columbia