I am often asked about the differences of using frozen donor eggs (unfertilized donor eggs from an egg bank) vs. doing a fresh donor egg cycle. Here are a few things to consider:
The benefits to frozen donor eggs (not embryos) are:
- Patients aren’t at any risk for donor fees, travel, donor testing, etc. that you typically would be with a fresh cycle in the US. And you don’t have to worry whether the donor will respond well. You already know the donor performed well and are getting a specified number of her eggs. Clinics abroad typically are responsible for whether the donor responds well, so in those cases you are not at risk for donor fees, travel or testing anyway, so it is less of an advantage for cycles abroad.
- Travel costs may be lower because you aren’t waiting to see how the donor will respond and then booking last minute flights (typical in the US), it can all be planned well in advance. When compared to traveling abroad for a fresh DE cycle, you can usually shave a few days off of your travel itinerary since we don’t need extra time in case the donor was ready for retrieval a day or two early or late.
- There is less stress over how the donor will perform – this is particularly important in the US because these clinics are typically not offering guarantees for the donor’s performance. This is less of a benefit abroad since clinics are typically guaranteeing a certain number of mature oocytes or a certain number of quality embryos for transfer with their fresh cycles.
- No wait time – you could potentially cycle in 4 weeks.
- Frozen eggs have a significant cost advantage in the US. At European clinics, the price difference between a fresh donor egg cycle and frozen donor eggs is nominal.
The potential less attractive aspects to frozen donor eggs can be:
- Potentially fewer options of donors than if you were using agencies or clinics to recruit a specific donor for your requirements. Overseas, a clinic that may have 1000 donors in their fresh donor database may only have 20 or 30 in their frozen database. Much of this depends on the individual donor egg bank though as to what they have available.
- You typically only receive a limited number of eggs from a donor – so unless you negotiate for extra eggs from that same donor to be held for you, the chances may be lower of having a full genetic sibling in the future if you don’t end up with any frozen embryos from your initial cycle with the frozen donor eggs.
- You typically cannot do genetic testing on embryos (PGD/PGS) which means no gender selection options and not a good choice when the male partner is a carrier of something that would recommend genetic testing of embryos before transfer – also severe male factor issues may make it a less advantageous option. Overseas, many countries prohibit gender selection anyway.
- It is more likely that you will have to travel for the transfer if you want a top clinic; this is sort of a given if you are going abroad for treatment.
- Frozen donor eggs typically have slightly lower success rate (usually about 5 – 15% lower) when comparing between the highest success rate clinics with frozen donor eggs and highest success rate clinics with fresh donor eggs. However, this can vary widely as success rates by procedure vary signficantly by clinic.
- In this case, because egg freezing has not been widely performed at most IVF clinics, you definitely want to go with a top clinic that has at least several years experience with egg freezing and good success rates – just because a clinic offers frozen eggs doesn’t mean their success rates are good with them. Until just a few months ago it was still considered an experimental treatment in the US.
- Typically the donors in the US donor egg banks are anonymous donors – although not always. Since in the US we have options of anonymous or open ID donors, this makes it less appealing for a family who only wants an Open ID donor. Most clinics abroad are legally mandated to only allow anonymous donation, so there is no difference in those cases.
- And this last one is questionable, but some people feel the chances of there being other offspring from the same donor may be higher since the donor’s eggs typically are distributed to more than one family (assuming enough eggs were retrieved) compared to a non-shared fresh cycle where one family gets all of the eggs. So, with frozen donor eggs each donation could be distributed to multiple families increasing the chances of more offspring from the donor. However, the same distribution could be true if someone did a fresh donor cycle then donated the remaining embryos.
As a side note, there are frozen donor embryos available in the US and abroad. Typically I see the cost difference between frozen donor eggs and fresh donor egg cycles in the US to be quite significant (fresh can be twice as expensive). When going abroad, the cost differential is not as significant, so absent other factors that might make frozen eggs more appealing, many patients elect to do a fresh cycle abroad instead for higher success rates.
On average, in the US, top programs for frozen donor eggs are around $15,000+; and abroad we see programs starting around $3200 (for 6 eggs). Comparatively, a fresh donor egg cycle at a top clinic in the US can cost $30 – $45K (including donor and donor medications); whereas a fresh donor egg cycle at a clinic abroad typically costs between $6K – $12K (including donor and donor medications).
One interesting thing I am seeing is that a few US clinics are now testing models of fresh (presumably shared) donor egg cycles based on the “per egg” pricing model of the frozen donor eggs. This limits the recipient patient risk related to the donor somewhat (they pay for the eggs they get) and is providing a lower entry price for fresh donor egg IVF in the US. It remains to be seen if this model will spread, particularly as there has been some ethical concerns about this being too close to “buying eggs”.
Regardless of how that plays out, frozen donor eggs do offer some advantages that warrant close consideration, and I anticipate seeing higher success rates and more frozen donor options in the future now that the “experimental” label has been lifted by ASRM.