Everything about egg donation – procedure, regulatory situation, costs.

Brief overview: What is egg donation and how does it work?

In egg donation, a woman donates her eggs to another woman or couple for the purpose of artificial insemination. The donor’s eggs are retrieved through a minor procedure and then fertilized in a laboratory with sperm from her partner or a donor and continue to develop for a few days in an incubator. 1-2 of the resulting embryos are then transferred to the recipient’s uterus, where they can develop as part of a normal pregnancy.

Egg donation is what is known as split motherhood: the donor is the genetic mother, while the recipient is often referred to as the gestational or social mother, who also assumes legal motherhood.

When is egg donation useful?

Egg donation is an option for couples or single women for whom conventional artificial insemination (e.g. IVF or ICSI) can no longer help them get pregnant. This may be the case, for example, in the event of (premature) menopause or genetic disorders in the woman, or if the woman has become infertile due to chemotherapy. Sometimes affected couples have already undergone several unsuccessful IVF or ICSI cycles before they try to become pregnant with the help of egg donation.

Medical requirements for egg donation

The recipient’s uterus must be healthy and functional for the embryo transfer to be successful.

The donor should be as young as possible, must be in good general health and naturally fertile. In addition, she must undergo a check for infectious diseases, which should exclude the transmission of HIV or hepatitis.

What are the types of egg donation?

In principle, egg donation can be differentiated according to various aspects, e.g. according to the motivation or situation from which the donor makes her eggs available to another woman.

Ordinary egg donation vs. egg sharing

In ordinary egg donation, a woman donates her eggs to another person or couple directly for the purpose of artificial insemination.

In so-called egg sharing, a woman donates a portion of her surplus eggs from her own artificial insemination possibly in exchange for free or discounted fertility treatment. In artificial insemination, several eggs are usually retrieved, but for one cycle not all of them are necessarily fertilized and only 1-2 fertilized eggs are used. If a woman does not need surplus eggs, she can give them to another woman.

Altruistic donation vs. commercial donation

In altruistic egg donation, the donor does not receive any financial compensation for her eggs (however, compensation for expenses may be required by law). Instead, the donor donates her eggs out of altruism and a desire to help another woman become pregnant. In some countries, altruistic egg donation is the only permissible form of egg donation.

In commercial egg donation, on the other hand, the donor receives financial compensation for her donated eggs. This form of egg donation is not allowed in all countries.

Depending on the amount of any allowance provided for altruistic egg donation, the transition from altruistic to commercial egg donation may be fluid.

Anonymous donation vs. open donation

In anonymous egg donation, the donor and recipient remain unknown to each other. The identity of the donor is not disclosed to the recipient and vice versa. This form of egg donation is often preferred by couples or single women who want to maintain their privacy.

In open egg donation, on the other hand, the identity of the donor is disclosed to the recipient. In some cases, donor and recipient may even get to know each other. This form of egg donation is often preferred by couples or single women who want to know more about the donor and her background.

Special case: embryo donation

Strictly speaking, embryo donation (also known as embryo adoption) does not constitute egg donation, since in this case eggs that have already been fertilized in the course of artificial insemination are made available to another woman. Most often, an artificial insemination cycle results in more embryos than are transferred to the expectant mother – usually only 1-2 embryos are transferred per cycle. Patients treated by artificial insemination and their partners may decide to release the surplus embryos for embryo donation.

How does egg donation work?

Before egg donation, all persons involved (donor, recipient and, if applicable, the recipient’s partner) should ideally receive psychological counseling so that they are aware of the scope and consequences of their decision.

Donor selection

In the case of commercial egg donation, the fertility center assists the woman/couple wishing to have a child in selecting a donor – usually, appropriate fertility centers maintain a database here as part of their egg donation program. The following criteria usually play a role in the selection of the donor, the goal being that the donor, and thus the foreign egg, has the highest possible resemblance to the recipient from an optical and biological perspective:

• Physical similarity to the recipient: ethnic background and build, skin and eye color, hair texture and color.
• Immunological compatibility with the recipient: blood group and rhesus factor

In addition, there are certain requirements for potential donors and appropriate testing is performed to minimize health risks to the recipient and the developing embryo. These include:

• Age limits: female donors are usually not allowed to exceed a certain age; in Greece and Spain, for example, they must be younger than 35 years old
• Psychological examination: donors must be healthy from a psychological point of view to rule out personality disorders and to ensure that the donor is emotionally prepared for the donation
• Gynecological examinations: Donors must be suitable for donation from a gynecological point of view – i.e. be fertile. Various examinations are carried out for this
• Blood tests: The donor’s blood type and rhesus factor must be determined and the donor’s general health is checked via blood values. In addition, infectious diseases must be excluded by blood test (e.g. HIV and hepatitis).
• Genetic history and genetic screening: donors are screened for genetic history based on their family history and genetic testing to minimize the risk of genetic diseases in the embryo. Donors with certain pre-existing genetic conditions are usually excluded from donation
• Genetic compatibility testing: a compatibility test with the DNA of the father or sperm donor can be performed to further reduce the genetic risk of the embryo

The legal requirements and screening of potential donors differ in different countries.

Hormonal stimulation and egg retrieval from the donor woman

The egg donor must undergo hormone treatment so that multiple eggs mature and are available for egg donation. Otherwise, only one egg matures in a normal cycle.

If the hormone treatment is successful and several eggs have matured, the so-called follicular puncture is performed. In this procedure, the doctor removes the mature oocytes from the follicles with the help of a fine needle. Usually this procedure is performed under light anesthesia through the vagina.

In some cases, donated eggs are already available in a frozen state and do not need to be matured and collected separately for the donation process with the help of hormonal stimulation – this is the case, for example, with egg sharing.

Fertilization of the eggs

As in IVF treatment, the eggs obtained in this way are mixed in the test tube with the sperm of the father or a sperm donor so that they are fertilized and mature for a few days in an incubator.

If fertilization is successful, the zygotes created from sperm and eggs are then frozen.

Preparation of the recipient’s endometrium

The recipient’s uterus must now be prepared for the transfer. For this purpose, the recipient is administered hormones that cause increased blood flow and thickening of the uterine lining so that the embryo(s) can implant in the uterus in the best possible way after the transfer.

Embryo transfer

When the uterus is ready, the embryos are transferred to the uterus. 1-2 of the fertilized embryos are thawed and transferred to the woman’s uterus. The number of embryos transferred is agreed with the attending physician and depends, among other things, on the age of the recipient. The embryo transfer is performed without anesthesia using a thin and flexible tube (catheter) through the woman’s vagina and is usually not painful.

Surplus fertilized oocytes can be stored in the frozen state (cryopreservation) for further experiments.

Pregnancy test and checkups

About 2 weeks after embryo transfer, a test of the pregnancy hormone human chorionic gonadotropin (HCG) in the woman’s blood can be used to test whether pregnancy has begun. Usually, several tests are performed to ensure a reliable result.

If the pregnancy has been successfully induced, the appropriate check-ups are performed as in any other pregnancy. About one month after the beginning of pregnancy, an embryo or embryos can be detected in the womb by ultrasound.

What are the chances of success of egg donation?

The success rate of egg donation depends on a number of factors, including the age and health of the donor and recipient, the quality of the eggs and sperm used, and the skills of the fertility specialists. In general, egg donation has a higher success rate than other forms of artificial insemination. According to European data, women who use egg donation have an average live birth rate of approximately 31%, which is significantly higher than the live birth rate for in vitro fertilization using their own eggs, as shown in the following graph:

Source: ART in Europe, 2017: results generated from European registries by ESHRE

What are the medical risks of egg donation?

With regard to the risks of egg donation, a distinction must be made between the risks for the donor and risks for the recipient of the egg donation, as the respective treatment steps and the use of medication are different. The majority of the risks are borne by the egg donor.

Risks for the donor:

The medical risks of egg donation arise for the donor from taking the medication to stimulate egg maturation and from the egg retrieval procedure:

Ovarian hyperstimulation syndrome (OHSS): This syndrome can occur when the ovaries are overstimulated by the fertility medications used for egg stimulation, causing them to swell and hurt. Symptoms may include abdominal pain, nausea and vomiting. In severe cases, ovarian hyperstimulation syndrome can become life-threatening.

Infection: There is a small risk of infection during oocyte retrieval.

Injury to bladder, bowel and blood vessels: Injury to the bladder, bowel and blood vessels may occur during oocyte collection (follicle puncture). According to the German IVF Registry, this was the case in approximately 0.8% of follicular punctures performed in Germany in 2020.

Blood clots: After egg retrieval, blood clots can form in the veins of the legs or pelvis, which can become dangerous if they travel to other parts of the body.

Allergic reactions: Allergic reactions to fertility medications used in egg donation are possible, although rare.

Long-term effects: The number of studies assessing the long-term effects of hormone stimulation is insufficient; therefore, long-term health effects cannot be excluded. For example, it is possible that egg donation could cause the development of new infertility or menstrual cycle changes through hormone stimulation and egg retrieval, and that hormone-dependent tumors could increase.

Risks for the recipient:

The risks to the egg recipient are generally considered to be low. However, as with any medical procedure, there are some potential risks associated with egg donation. These include:

Miscarriages: The risk of miscarriage is higher in pregnancies after egg donation than in pregnancies after natural conception.

Multiple births: Multiple births can occur when more than one embryo is transferred to the uterus. This increases the risk of complications for both the mother and the children. In particular, the risk of hypertensive disorders, premature birth and low birth weight of the children is increased in multiple pregnancies.

Blood pressure disorders in pregnancy: According to scientific research, there is an increased risk of blood pressure disorders in pregnancy (e.g. gestational hypertension and pre-eclampsia) after egg donation.

Birth defects: The risk of birth defects is slightly higher in pregnancies after egg donation than in pregnancies after natural conception, although this risk is still low.

What is the legal situation of egg donation?

In Switzerland

Currently (January 2023), egg donation is prohibited in Switzerland. However, egg donation could soon become legal in Switzerland; in March 2022, the National Council approved a motion to that effect, and in September 2022, the Council of States also approved it. This mandates the Federal Council to create a legal basis for egg donation.

Currently, affected Swiss women have to travel abroad if they want to become pregnant with a donated egg – there are no legal obstacles to this in Switzerland.

In Germany

As in Switzerland, egg donation is also currently prohibited in Germany.

In Germany, embryo donations are in a legal gray area and are only carried out in isolated cases. However, commercial embryo donation is clearly punishable.

In Austria

In Austria, egg donation has been allowed since 2015 under the following conditions:

• The recipient of the egg donation must not be older than 45 years of age.
• The donor must not be older than 30 years and may donate for a maximum of three families, as well as not receive any money for her donation (altruistic donation)
• The donor child can request information about the identity of his or her genetic mother from the age of 14 years

As a result of this regulation, there are hardly any donors, so donors often have to be organized themselves.

In other European countries

In the majority of European countries egg donation is allowed, together with Turkey and Bosnia-Herzegovina, Germany and Switzerland are the only European countries where egg donation is prohibited. However, in some countries there is de facto hardly any egg donation – this is the case for Croatia, Ireland and Italy, for example. However, despite the frequent legality of egg donation in Europe, the framework varies from country to country. Here are a few key legal issues that may make egg donation unavailable to foreign women:

Anonymity: In most European countries, egg donation is anonymous (e.g. in Spain, Greece and the Czech Republic), which means that donor children usually do not know who their genetic mother is for the rest of their lives.

Altruistic vs. commercial donation: Finding a suitable donor is more difficult when commercial egg donation is not allowed. As mentioned above, this is the case in Austria, for example. If donors are not paid for their donation, there may be few eggs available for egg donation.

Singles and lesbian couples: single women and lesbian couples are not allowed to access egg donation in all countries where it is allowed. For example, the Czech Republic does not allow single women or lesbian couples to use egg donation. Greece does not officially allow lesbian couples to use egg donation, however, this restriction can be easily circumvented by having one of the partners treated as a single woman.

How much does egg donation cost?

The cost of egg donation depends greatly on the country where the egg donation is performed. Here we would like to list approximate costs in various currently popular travel countries for egg donation:

• Denmark: EUR 7’000 – 8’300
• Greece: EUR 5’200 – 7’000
• Austria: EUR ~8,500
• Spain: EUR 5’900 – 8’500
• Czech Republic: EUR 4’300 – 5’500

The following table gives an overview of the corresponding costs of egg donation supplemented by the costs for normal IVF / ICSI cycles.

Sources: Fertilityroad.com; various fertility center price lists.

Last update: 06 March 2023