pregnancy

Infertility can be a challenging journey, especially when miscarriage happens. For those who have experienced pregnancy loss or failed IVF, your doctor may have brought up the use of donor eggs. Egg donation is when a woman who is medically cleared donates her eggs to be used by another woman (or gestational carrier) who cannot conceive with her own eggs. You may be wondering whether donor eggs can decrease the risk of miscarriage and increase your chances of bringing home a healthy baby. In this article, we’ll lay it all out.

Why do miscarriages happen in the first place?

Miscarriage, also known as pregnancy loss, is a devastating experience. It occurs when a pregnancy ends on its own before the 20th week of gestation. Miscarriage can happen to anyone, and it's estimated that up to 20% of pregnancies end in miscarriage. When a family suffers two or more pregnancy losses, it is called recurrent miscarriage.

There are many reasons why miscarriage can occur, and in most cases, it's difficult to pinpoint a specific cause. Here are some common reasons why miscarriage happens:

• Chromosomal abnormalities: The most common cause of miscarriage is chromosomal abnormalities. This means that the fetus has an abnormal number of chromosomes or a structural problem with a chromosome. These abnormalities are usually random events and not related to anything the parents did or did not do.
• Infections: Infections during pregnancy can cause miscarriage, especially if left untreated. Infections such as rubella, cytomegalovirus (CMV), and toxoplasmosis can be harmful to a developing fetus.
• Structural issues: Structural issues with the uterus or cervix can lead to miscarriage. For example, if the cervix is weak or incompetent, it may not be able to support the weight of the growing fetus, leading to premature delivery or miscarriage. Uterine anomalies, such as a uterine septum, can also increase the risk of miscarriage. 
• Autoimmune problems: An overactive autoimmune system can mistake the fetus as a foreign object and attack it, causing miscarriage.
• Lifestyle factors: Certain lifestyle factors can increase the risk of miscarriage. These include smoking, alcohol use, and drug abuse. 

Unfortunately in most cases, the exact cause of miscarriage is unknown, and it's not always possible to prevent it from happening. Read more about the common causes of miscarriage. 

What is the risk of miscarriage with donor eggs?

The short answer is that using donor eggs decreases the risk of miscarriage for most women. Especially when those miscarriages were due to chromosomal abnormalities. Because egg donors are young (under 33) and medically cleared, outcomes with donor eggs are better than outcomes with a patient’s own eggs. 

Women who use donor eggs tend to be older, and age is a significant factor in miscarriage risk. As women age, the quality of their eggs decreases, and the risk of chromosomal abnormalities increases, which can lead to miscarriage. By using younger, healthier eggs from a donor, the risk of chromosomal abnormalities is significantly reduced.

Furthermore, the donor egg IVF process involves extensive screening of the donor to ensure that she is in good health and has a low risk of genetic disorders. This can further reduce the risk of miscarriage, as genetic disorders can be a significant contributor to pregnancy loss.

What does the research say?

There is a paucity of research on donor eggs. But one 1997 study of 418 embryo transfer cycles among 276 egg donor recipients at one clinic found that:

• 36.2% got pregnant on the first try with donor eggs, and 29.3% had a live birth
• 87.9% got pregnant within four cycles and 86.1% had a live birth

This data did not differ for women of various ages of diagnoses. Another study from 1998 found that the miscarriage rate for donor eggs was 7.2% for women under 45 and 16.1% for women 45-50. 

However, because these studies were 25+ years ago, and each included outcomes data from a single clinic, we can take it with a grain of salt. We’ve had incredible progress in fertility treatments over the last 25 years, including ICSI and PGT testing,  and one would hope for even better outcomes today. 

Why do donor eggs miscarry?

Donor eggs miscarry for some of the same reasons any pregnancy ends in loss. There could be implantation issues, or issues with the lining of the uterus or other factors that make implantation more difficult, increasing the risk of miscarriage. Or there could be other health issues such as hormonal imbalances, autoimmune problems, or structural problems like fibroids. Of course, there’s also just chance / luck which is sometimes not on our side. 

While donor eggs can reduce the risk of certain fertility-related issues, it does not eliminate the risk of miscarriage entirely. Miscarriages are common, and it's important to work with your doctor to understand the potential risks and to receive appropriate care throughout the pregnancy.

How to reduce the risk of miscarriage with donor eggs

We recommend adopting a relaxed lifestyle and moderating physical activity after an embryo transfer. The most important factor in predicting successful implantation is the quality of the embryo and the optimal hormone environment in the uterus. After the transfer, the most important thing you can do is to take your medications as prescribed. You can rest assure that no other external factors will impact the outcome of your cycle (ie. high stress, specific foods, bumping your abdomen against a hard surface). If you have any problems with the injections, let your clinical team know as soon as possible.

Are donor egg pregnancies high risk?

Donor egg pregnancies may be higher risk, but more research is needed. One meta-analysis of 11 studies found: 

• The risk of developing hypertensive disorders is nearly 4X higher for donor egg pregnancies
• The risk of having a cesarean section is 2.71X higher for donor egg pregnancies
• Preterm delivery is 1.34X more likely with donor egg pregnancies

Another study from Columbia University found that age doesn’t impact risk of complications, and that both older and younger women had similar rates of gestational hypertension, diabetes, cesarean delivery, and premature birth. When undergoing IVF, your doctor will give you an idea of your specific health risks and how to help reduce the risk of complications.

What is the success rate of IVF with donor eggs?

Here’s some good news: donor eggs can drastically increase your chances of success! 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.

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.

Ready to move forward with donor eggs? We can help!

Cofertility is a human-first fertility ecosystem rewriting the egg freezing and egg donation experience. Our Family by Co platform serves as a more transparent, ethical egg donor matching platform. 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 today!

Pregnancy can be an exciting and nerve-wracking experience for many, but when carrying life made from a donor egg, it can be a unique and challenging experience. In this article, we will explore the process of using a donor egg, the potential risks and benefits, and what to expect during pregnancy.

What is a donor egg pregnancy?

A donor egg is an egg that has been harvested from an egg donor who is not the intended mother. This egg is then fertilized with sperm from the intended father (or sperm donor) and implanted into the uterus of the intended mother or a gestational carrier. This process is known as egg donor in vitro fertilization (egg donor IVF).

Why would someone use donor eggs?

There are several reasons why someone might choose to use donor eggs to build their family. For example, you may have fertility issues that prevent you from producing viable eggs, or you may be at an increased risk of passing on genetic disorders to her child. Additionally, same-sex male couples or single men who wish to have a biological child may also choose to use an egg donor and gestational carrier.

The donor egg process

The process of using a donor egg typically begins with selecting an egg donor. Egg donors are healthy women who have undergone extensive medical screening and genetic testing to ensure that their eggs are likely healthy and free from genetic disorders. 

Once an egg donor has been selected, she will undergo ovarian stimulation, which involves taking medication to encourage the ovaries to produce multiple eggs. This process can take several weeks and involves regular monitoring to ensure that the eggs are maturing properly.

When the eggs are ready, they are retrieved from the donor through a minimally invasive procedure called transvaginal ultrasound-guided egg retrieval. During this procedure, a needle is inserted through the vaginal wall and into the ovaries to collect the mature eggs.

Once the eggs are retrieved, they are fertilized with sperm in a laboratory setting. The resulting embryos are then monitored for a few days to ensure that they are developing properly. At this point, some families choose to do preimplantation genetic screening. The best quality embryos are then selected for transfer to the intended mother or gestational carrier.

What to expect during donor egg pregnancy

A pregnancy via donor egg IVF is treated the same as any IVF pregnancy. You will likely require additional hormone support (progesterone) during the early stages of pregnancy, for 8 to 10 weeks. After that, you will “graduate” and be discharged to the care of your OBGYN.

It is likely you waited a long time for this pregnancy – so cherish the miracle that you are experiencing! 

Medical risks of an egg donor pregnancy

There is evidence that donor egg pregnancies are independently associated with a higher rate of pregnancy risk. For instance, a Columbia University study found that women who use egg donation to become pregnant are at an elevated risk for obstetrical complications, particularly hypertensive disorders and cesarean section¹. 

However, the risk association remains a challenge to substantiate because of confounding variables (e.g. other characteristics of those who are more likely to need donor eggs). One hypothesis is that an immunological maladaptation causes placenta-mediated disorders in egg donation pregnancies², but this has not been proven. 

Gestational hypertension

Gestational hypertension is a type of high blood pressure that occurs in pregnant women who did not have high blood pressure before pregnancy. It usually develops after 20 weeks of gestation and resolves after you give birth. 

Gestational hypertensive disorders affect 5-10% of all pregnancies in the United States³. But the risk of gestational hypertension is 3X more prevalent in egg donation pregnancies compared to pregnancies from other methods of assisted reproductive technology (such as IUI and IVF) and 7.94X greater than in unassisted pregnancies³.

If you get diagnosed with gestational hypertension, it’s helpful to know that pregnancy outcomes for people diagnosed with mild gestational hypertension are similar to those of the general obstetrics population³.

Preeclampsia

Preeclampsia during pregnancy is defined as the combination of high blood pressure and protein in your urine or other problems after 20 weeks of pregnancy.  Preeclampsia happens in about 1 in 25 pregnancies in the United States⁴. Research has suggested that there may be a slightly higher risk of preeclampsia in pregnancies conceived using donor eggs compared to other pregnancies. One study found that the risk of preeclampsia is 2.54X higher in egg donation pregnancies compared with pregnancies from other methods of assisted reproductive technology and 4.34X higher than in unassisted pregnancies³. 

Mild preeclampsia may be treated with bed rest and close monitoring of blood pressure and urine protein levels. Severe cases may require hospitalization, medication to lower blood pressure, and sometimes early delivery of the baby to prevent further harm to the mother and baby. 

Getting the care you need

We generally see that egg donor IVF pregnancies, especially when the intended mother is over 35, see a maternal fetal medicine (MFM) specialist in addition to their OBGYN. This is a good thing, as people who receive MFM care get additional attention and support. 

Connecting with your baby in utero

Connecting with your baby during pregnancy can be an incredible experience, as it creates a sense of closeness and bonding. While your baby is growing and developing inside you, there are so many ways to connect with them before they arrive. 

One of the easiest ways to connect with your baby is to simply talk to them. Whether it's singing a lullaby, telling them about your day, or expressing your excitement about their upcoming arrival, your baby will be able to hear your voice and recognize it after birth. 

You can also try playing music for your baby, gently massaging your belly, and taking time each day to rest and focus on your baby's movements. 

You can also write letters to your baby, letting them know your journey and how hard you fought to bring them into this world. These simple practices can help you feel more connected to your baby during pregnancy and beyond.

Do I need to tell my doctor I’m pregnant via donor eggs?

I don’t see any reason not to tell your doctor your pregnancy is with donor eggs. Given the rise in use of donor eggs, you are certainly not their first patient to conceive via egg donation. Plus, there may be certain screening tests based on using donor eggs.

There is no shame in using donor eggs to get pregnant. And if you feel judged or misunderstood by your OBGYN, then by all means find a doctor who understands. 

If you’re finding that you feel guilty, ashamed, or embarrassed about using donor eggs, it may actually be something you can discuss with your doctor, who can provide support and connect you with resources such as counselors or support groups. Remember, using donor eggs does not diminish your ability to be a parent or your love for your child, and you should be free to focus on the joy and excitement of becoming a mother.

What is the risk of miscarriage with donor eggs?

The short answer is that using donor eggs decreases the risk of miscarriage for most women. Especially when those miscarriages were due to chromosomal abnormalities. Because egg donors are young (under 33) and medically cleared, outcomes with donor eggs are better than outcomes with a patient’s own eggs. 

Women who use donor eggs tend to be older, and age is a significant factor in miscarriage risk. As women age, the quality of their eggs decreases, and the risk of chromosomal abnormalities increases, which can lead to miscarriage. By using younger, healthier eggs from a donor, the risk of chromosomal abnormalities is significantly reduced.

Furthermore, the donor egg IVF process involves extensive screening of the donor to ensure that she is in good health and has a low risk of genetic disorders. This can further reduce the risk of miscarriage, as genetic disorders can be a significant contributor to pregnancy loss.

Cofertility is a human-first fertility ecosystem rewriting the egg freezing and egg donation experience. Our Family by Co platform serves as a more transparent, ethical egg donor matching platform. 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 today! 

More resources:

• Epigenetics and Donor Eggs
• Will My Baby Look Like Me If I Use an Egg Donor?
• Will a Donor Conceived Child Have My DNA?

‍

Sources:

1. Kort DH, Gosselin J, Choi JM, Thornton MH, Cleary-Goldman J, Sauer MV. Pregnancy after age 50: defining risks for mother and child. Am J Perinatol. 2012;29(4):245-250. doi:10.1055/s-0031-1285101
2. Savasi VM, Mandia L, Laoreti A, Cetin I. Maternal and fetal outcomes in oocyte donation pregnancies. Hum Reprod Update. 2016;22(5):620-633. doi:10.1093/humupd/dmw012
3. Masoudian P, Nasr A, de Nanassy J, Fung-Kee-Fung K, Bainbridge SA, El Demellawy D. Oocyte donation pregnancies and the risk of preeclampsia or gestational hypertension: a systematic review and metaanalysis. Am J Obstet Gynecol. 2016;214(3):328-339. doi:10.1016/j.ajog.2015.11.020
4. High Blood Pressure During Pregnancy CDC. Accessed May 2023. 

The embryo transfer is an exciting and pivotal time in the in vitro fertilization (IVF) process. It’s when the embryo is transferred to the uterus of the intended mother or a gestational carrier, in hopes that it snuggles in for nine months and becomes the child you’ve always dreamt of.

You may be wondering if you should transfer one (single embryo transfer, or SET) or two (double embryo transfer, or DET) embryos, to increase your chances of a happy, healthy baby.  

This article will dissect the complexities of this decision-making process, taking into consideration both personal choices, and also help answer this question to intended parents using donor eggs.

First off, what is an embryo transfer?

Understanding what an embryo transfer entails is important to appreciating the decision-making process between single or double embryo transfer.

After an egg, or eggs, are fertilized with sperm, an embryo develops in a controlled laboratory environment for a few days under the careful watch of a trained embryologist. If and when the embryo reaches a particular developmental stage (ie. blastocyst stage), it is suitable for transfer.

Now, at this point, some families opt to do PGT testing, which looks to see if the embryo contains the correct amount of chromosomes. Embryos with the right number of chromosomes — 46 — are considered “euploid,” and those with extra chromosomes or chromosome deletions are considered “aneuploid.” PGT is a way to screen for genetic disorders in embryos created through IVF before they are transferred to the uterus. Read more about PGT testing.

All embryos are then “graded” by the embryologist to evaluate their quality and chances of developmental success into a healthy pregnancy. Based on this assessment, your fertility doctor will recommend the order and number of embryos to be transferred. This is the stage where the choice between a single embryo transfer or a double embryo transfer is usually made.

Finally, the selected embryo(s) is transferred to the uterus via a thin catheter, typically under ultrasound guidance. If the embryo implants in the uterine lining, it may lead to pregnancy.

Embryo transfers and the history of IVF

When IVF was in its infancy, following the birth of the first IVF baby, Louise Brown, in 1978, the process was distinctly different from what it is today. In the early days, IVF involved the transfer of fresh embryos, without the technological advancements available now. This is because we didn’t have the technology to freeze and preserve embryos for genetic testing or future transfer.

At the time, this approach was taken to increase the likelihood of pregnancy, compensating for the uncertainties around embryo viability. However, this practice led to a higher incidence of multiple pregnancies (pregnancies of twins, triplets, or more), with associated health risks for both mothers and children.

With the development of cryopreservation techniques, it became possible to freeze embryos for later use, allowing for more flexibility and planning in the transfer process. This technology also enabled better timing for embryo transfer, and gave patients a break between the egg retrieval and embryo transfer. 

Simultaneously, genetic testing of embryos significantly increased the success rates of IVF, even with the transfer of a single embryo.

Guided by these advancements, the American Society for Reproductive Medicine (ASRM) now recommends elective single embryo transfer (eSET) in most cases, especially for women under the age of 35 with a favorable prognosis. This shift towards eSET reflects a growing emphasis on minimizing the risks associated with multiple pregnancies without compromising success rates.

So how many embryos should I transfer?

The decision regarding the number of embryos to transfer should weight the potential success rate against the risks associated with multiple pregnancies. Factors such as age, the quality of the embryos, previous IVF attempts, and individual patient preferences play an important role in this decision.

Let’s go through the pros and cons of each option:

Elective single embryo transfer (eSET)

Pros:

• Reduced risk of multiple births: eSET almost eliminates the chance of a multiple pregnancy (twins, triplets, etc.), thus reducing the associated health risks for both the mother and the babies.

Cons:

• Possibly lower success rates: Some studies have shown that eSET may yield a slightly lower live birth rate compared to double embryo transfer.

Double embryo transfer (DET)

Pros:

• Potentially higher success rates: By transferring two embryos, DET may improve the chances of pregnancy, especially when there are concerns about embryo quality.
• Chance to have twins: If you always wanted twins, transferring two embryos gives you a better chance of that dream.

Cons:

• Riskier pregnancy and birth: DET significantly increases the risk of twins or higher-order multiples, leading to more complicated pregnancies and a higher chance of preterm births and low birth weight.

It’s important to discuss this with your fertility doctor and get their input. Because ASRM usually recommends a single embryo be transferred, in most cases fertility doctors will recommend just that.  

How many donor egg embryos should I transfer?

When donor eggs are utilized, a couple other factors need to be considered. Donor eggs are from younger women who have gone through extensive medical screening, and thus, embryo quality tends to be higher. Because of this, it increases the chances of success, even if the mother is older, or if she experienced failed IVF in the past. In donor egg cases, eSET is generally preferred to minimize the risk of multiple pregnancies while maintaining a satisfactory success rate.

Summing it up

If you are wondering if eSET or DET is right for you, talk to your fertility doctor. They can help talk you through the pros and cons, and help select an approach that best fits your needs.

For those using donor eggs, the generally higher quality might lean the decision towards eSET, while personal preferences and specific medical situations might suggest otherwise. By carefully considering the nuanced pros and cons, you can make a well-informed choice in your pursuit of parenthood. We wish you all the best!