Does Donor Egg IVF Increase Chances of Twins?

The world of fertility treatments is a rapidly-evolving landscape, teeming with options, intricacies, and promises of renewed hope for LGBTQ+ families as well as those struggling to conceive. Among these treatments, donor egg in vitro fertilization (IVF) has become an increasingly common path, with a substantial 12% of all IVF cycles in the U.S., over 16,000 a year, involving eggs retrieved from a donor.

But does donor egg IVF increase the chances of conceiving twins? In this guide, I’ll dive into the essentials of donor egg IVF, its odds for success, the chances for twins, and the potential risks associated with multiples.

What is donor egg IVF?

IVF with donor eggs is a medical procedure where eggs are collected from a donor, fertilized in a laboratory with the intended father's or a donor's sperm, and the resulting embryo is then implanted in the uterus of the intended mother or a gestational carrier. 

This process may be an option for women with diminished ovarian reserve, repeated IVF failure, infertility due to recurrent miscarriage, or those who carry genetic disorders that they do not want to pass on to their children. It is also an option for LGBTQ+ families and single males. 

Donor egg IVF typically involves several steps: the selection of an egg donor, extraction and fertilization of the donor eggs, and transfer of the embryo(s). To learn more about the process, check out this article. 

What are the odds of getting pregnant with donor eggs?

Success rates for donor egg IVF are often more promising compared to traditional IVF. At Cofertility, for those who match with a donor in our fresh egg donation program, the average number of mature eggs a family receives and fertilizes is 12. The number of eggs retrieved varies by patient and cycle, but can be predicted by a donor’s age, AMH, and antral follicle count, all of which will be known to you after the donor’s initial screening. Qualified candidates have an ample ovarian reserve for both their own needs and sharing. Egg share donors also often work closely with a fertility doctor to determine, based on their own medical history, the optimal number of eggs needed for their own future family-building goals. Should it make sense for the donor, they may choose to pursue a second egg-sharing cycle to maximize the chances of success for everyone.

Matching with a donor in our frozen program can provide the opportunity to move forward with your family-building plans faster, as frozen eggs can be fertilized or shipped to your clinic immediately or as soon as the cycle is complete. Donors undergoing frozen cycles complete equally rigorous ovarian reserve testing. While the total number of frozen eggs available will vary based on the donor’s retrieval outcomes, every frozen match is guaranteed to have a minimum of at least 6 frozen eggs. To learn more about these programs and the differences between them, click here.

Around 53 percent of all donor egg cycles will result in at least one live birth. This percentage varies depending on the egg donor, recipient body mass index, stage of embryo at transfer, the number of oocytes retrieved, and the quality of the clinic.

At every age, the chances of birth with donor eggs is better, but those who benefit the most from donor eggs are women over 35 and those with low ovarian reserve. In fact, about one-quarter of women over 40 who succeeded with IVF did so through the use of donor eggs. 

The chart was made using the SART Patient Predictor for an average woman (5’4”, 150 lbs) with diminished ovarian reserve. As you can see, the chances of live birth after one donor egg cycle is 54% for recipients under 40, and only goes down slightly after this.

The advantage is primarily due to the utilization of eggs from younger donors, typically between the ages of 21 and 34.

It’s important to remember that your age when you get pregnant is not as important as the age of the eggs with which you get pregnant. The success of egg donation depends on many factors, but is not considered to be related to the age of the recipient.

Chances of twins with donor eggs

One question we get a lot is the likelihood of conceiving twins with donor egg IVF. 

According to the CDC, in 2021 live births from donor egg IVF had a slightly higher chance of twins compared to IVF with a patient’s own eggs.

• General population: 3.2%
• IVF with patient’s own eggs: 5.2%
• Donor egg IVF: 6.0%
• Donor embryo IVF: 7.4%

But as you can see from the data above, IVF (regardless of whose eggs are used) is associated with higher chances of twins. 

How does that work? First, the chances of an embryo splitting and becoming monozygotic twins (aka identical twins) is 2.25 times higher with IVF than with unassisted conception. 

But twins after IVF are usually due to a patient having more than one embryo transferred to the uterus, making them dizygotic twins. When IVF was just starting out, there was no genetic testing and fertility doctors would transfer multiple embryos at one time. This led to a multiples rate of over 20% for those who underwent IVF. Nowadays, as technology has advanced, single embryo transfers are the norm, and the incidence of twins has gone down drastically. 

Can I transfer two donor egg embryos?

The transfer of two embryos is an option in some fertility clinics, and it often increases the chances of pregnancy. However, it's important to consider the associated risks, benefits, and guidelines.

The American Society for Reproductive Medicine (ASRM) recommends that clinicians and patients carefully discuss the number of embryos to be transferred, considering factors like maternal age, embryo quality, and the patient's individual medical situation. In some cases, transferring two embryos may be a viable option, while in others, a single embryo transfer may be the preferred route to minimize the risk of multiples,

Risk of pregnancy with multiples

While the prospect of twins may be appealing to some, there are increased risks associated with multiple pregnancies. Twin pregnancies are associated with higher rates of preterm birth, low birth weight, and maternal complications such as gestational diabetes and preeclampsia.

• Preterm birth, defined as delivery before 37 weeks of gestation, occurs more frequently in multiple pregnancies. Preterm infants may face an array of health challenges, including respiratory distress syndrome, infections, and long-term developmental issues. These risks underscore the importance of careful monitoring during pregnancy and specialized neonatal care following birth.
• Low birth weight, often linked to preterm birth, is a common occurrence in twin pregnancies. Infants born with low birth weight are at increased risk for health problems both immediately after birth and later in life. Challenges may include difficulties with feeding and temperature regulation, as well as potential long-term developmental delays.
• Other complications from twin pregnancies due to added stress on the mother's body can lead to an increased risk of gestational diabetes and preeclampsia, a condition characterized by high blood pressure and damage to organs such as the liver and kidneys. Other potential complications may include an increased likelihood of cesarean section (C-section), excessive bleeding during childbirth, and higher rates of postpartum depression.

You should understand these risks and engage in thoughtful, well-informed planning and decision-making with your fertility doctor if you are considering the transfer of multiple embryos in donor egg IVF.

The bottom line

Donor egg IVF represents a beacon of hope for many aspiring parents. With its relatively high success rate, more and more families are turning to donor eggs to build their family.

However, the decision to pursue this treatment—and whether to transfer one or two embryos—requires careful consideration of the odds, potential risks, and individual medical circumstances. Consulting with fertility doctors, understanding the available scientific data, and considering personal preferences and ethical considerations will equip you to make informed choices on your journey towards parenthood. We wish you all the best!

Learn about egg sharing

At Cofertility, our program is unique. After meeting with hundreds of intended parents, egg donors, and donor-conceived people, we decided on an egg donation model that we think best serves everyone involved: egg sharing.

Here’s how it works: our unique model empowers women to take control of their own reproductive health while giving you the gift of a lifetime. Our donors aren’t doing it for cash – they keep half the eggs retrieved for their own future use, and donate half to your family.

We aim to be the best egg sharing program, providing an experience that honors, respects, and uplifts everyone involved. Here’s what sets us apart:

• Human-centered. We didn’t like the status quo in egg donation. So we’re doing things differently, starting with our human-centered matching platform.
• Donor empowerment. Our model empowers donors to preserve their own fertility, while lifting you up on your own journey. It’s a win-win.
• Diversity: We’re proud about the fact that the donors on our platform are as diverse as the intended parents seeking to match with them. We work with intended parents to understand their own cultural values — including regional nuances — in hopes of finding them the perfect match.
• Baby guarantee. We truly want to help you bring your baby home, and we will re-match you for free until that happens.
• Lifetime support: Historically, other egg donation options have treated egg donor matching as a one-and-done experience. Beyond matching, beyond a pregnancy, beyond a birth…we believe in supporting the donor-conceived family for life. Our resources and education provide intended parents with the guidance they need to raise happy, healthy kids and celebrate their origin stories.

We are obsessed with improving the family-building journey — today or in the future — and are in an endless pursuit to make these experiences more positive. Create a free account to get started today!