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With the rise of assisted reproductive technology (ART), egg donation is now a necessary conversation for many people looking to grow their families.
There are a multitude of reasons why people choose egg donation, including, but not limited to, diminished ovarian reserve, ovarian insufficiency, the absence of ovaries due to surgery, and advanced reproductive age. Egg donation is also an option for same-sex male couples and single people who want to have children.
If working with an egg donor is the right path for you, the next choice you’ll likely need to make is whether it should be a fresh or frozen egg donation.
Just as it’s a personal choice to do a fresh embryo transfer vs. a frozen embryo transfer when undergoing IVF, the same can be said for fresh vs. frozen egg donation. So how do you sort through the pros and cons of this pivotal life choice?
Rescripted spoke with Rachel Campbell, LCSW, the Director of Donor Egg Programs at Everie, an egg donation program committed to helping you make the most informed decision possible. Read on as Campbell walks us through the key differences between fresh and frozen egg donation:
Key differences between fresh and frozen egg donation
Fresh egg donation
If you are using a fresh egg donor, this means a specific recipient is preparing to receive the donated eggs. “The eggs are retrieved, fertilized, and then developed into undifferentiated embryo cells called blastocysts,” explains Campbell. This process also requires both the egg donor and the recipient (either the intended parent or gestational carrier) to synchronize their fertility cycles (usually via medication) – “so that once the blastocysts are ready, one can be implanted into the [recipient’s] uterine lining with the hopes of achieving pregnancy,” says Campbell.
A fresh egg donation also gives you the option of cryogenic preservation of the embryos for future transfer.
Frozen egg donation
In the case of frozen egg donation, the embryos aren’t designated for a specific recipient. Instead, “a frozen retrieval has the potential to help multiple families through one donation,” says Campbell. Therefore, the protocol is different from a fresh egg donation: “A donor completes a medicated retrieval cycle, and the mature eggs retrieved are divided into smaller cohorts or lots,” explains Campbell. “These eggs are then cryopreserved for future use. When recipient parents match with a donor, the donor’s eggs are thawed, fertilized, and developed into blastocysts for embryo transfer.”
Pros and cons: Fresh donor eggs
Pros: The recipient family have the potential to start with a larger number of eggs than if they go the fresh route, ranging from 10-20+ eggs per cycle. “Starting with a larger number of eggs than a frozen cohort typically allows recipient parents and fertility clinics more options when evaluating the number of embryos and embryo quality,” says Campbell. If you’re hoping for a larger family, opting for fresh donor eggs could work in your favor. Another reason to consider fresh donor eggs is in this scenario, the donor will be present for treatment at the recipient’s clinic. “This provides more opportunity to obtain information from the donor in real time during the course of a cycle,” says Campbell.
Cons: Keep in mind that fresh donation cycles take longer than frozen donation cycles. “Cycles average 4-6 months from match to retrieval,” Campbell cautions. In addition, you will need to factor in the synchronization of cycles between the donor and recipient, which can pack on the stress. You will also need to consider the financial implications of choosing a fresh egg donor: “Fresh eggs can cost up to four times more than frozen egg donations, especially when factoring in variables such as an egg donor’s travel and medical costs for the egg retrieval procedure, in addition to donor compensation,” says Campbell. Also, fresh cycles don’t guarantee a starting number of eggs.
Why fresh egg donation might be right for you: You have a flexible timeline for building your family, you are interested in multiple children, require preimplantation genetic testing (PGT), or are hoping to use more than one sperm source to create embryos.
Pros and cons: Frozen donor eggs
Pros: If time and finances are an issue, then it’s worth considering a frozen egg donation. Not only are frozen eggs available immediately, but “the timeline to creating embryos is often cut in half or more from that of a fresh donation cycle,” says Campbell. This is because frozen egg donation “eliminates the need for cycle synchronization with the donor for a fresh transfer.” Also, the price point for frozen eggs is decidedly lower than fresh donor eggs because the donor has already been compensated.
Cons: There will be fewer opportunities for creating embryos because there are fewer eggs to work with when choosing frozen donor eggs.
Why frozen egg donation might be right for you: Finances are a factor in your goal to grow your family; medical/employer benefits coverage is typically only applicable toward the purchase of frozen eggs. Frozen eggs are also a good option for recipients on a specific timeline to create embryos or for those who ultimately desire fewer children.
Will I have more success with fresh donor eggs?
Not necessarily. Although fresh egg donation was, until recently, the more viable option, Campbell points out that this is no longer the case: “A common misconception about frozen eggs is that the outcomes are not as good as those achieved using fresh eggs. Admittedly, this was the case 10 years ago, and even five years ago.”
The data to measure these outcomes, says Campbell, is usage over time and live births per transfer. In the case of usage over time, she says fresh donor usage has decreased between 2010 and 2020, with frozen donor usage increasing during the same period according to data from the Centers for Disease Control and Prevention (CDC): “Fresh donor egg usage has seen a decrease from over 10,000 reported cycles in 2010 to around 1,100 in 2020. Conversely, frozen donor tissues have seen a rise from around 7,000 in 2010, including frozen donated embryos from donor eggs, to approximately 15,000 in 2020.”
As for the second category, Campbell notes that “in 2010, fresh embryo transfers resulted in a 20.9% higher live birth rate than embryos created from frozen donor eggs. In 2020, that live birth difference shrunk to 1.3%.”
Campbell believes this data “demonstrates the notion that the skill required to successfully warm eggs and create viable embryos is mature and frozen eggs can be an equivalent option.”
Ultimately, the decision to go with either a fresh egg donor or a frozen egg donor is a deeply personal choice, and one that shouldn’t be made without thorough consultation. This is even more true considering “the landscape of egg donation is changing every day,” observes Campbell. One of the more significant changes in the egg donation process, for example, is the opportunity for a known relationship between the recipient and the donor, whether it’s through fresh or frozen donation. “Historically, fresh donations provided the only option for recipients desiring a known relationship with their donor,” says Campbell. Thanks to agencies like Everie, however, “both frozen and fresh donation options allow for this connection between donors and recipients.”
Everie is dedicated to helping you make an egg donor decision that works for you and your family. Head over to everiedonation.com for more information and to connect with its team of fertility and donation experts.
Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist, having written and reported on subjects ranging from TV and pop culture to health, wellness, and parenting over the course of her career. Her work has appeared in Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. A staunch mental health advocate, Sarene also hosts the podcast “Emotional Abuse Is Real.” Visit her website here, or follow her on Instagram or Twitter.