Donated eggs for treatment? Not everyone can give or receive them.

Author: Xu Liqing, deputy chief physician of Guangdong Provincial Women and Children's Health Hospital

Reviewer: Liu Fenghua, Chief Physician, Guangdong Provincial Women and Children's Health Hospital

Perhaps many people think that egg donation is to give eggs to people in need and get a certain amount of compensation, and think that this is a very normal little thing. In fact, in my country, egg donation is a humanitarian act, and any organization or individual is prohibited from recruiting egg donors for commercial egg donation in any way.

According to relevant regulations in my country, egg donation and acceptance is not such a simple matter. If you want to accept donated eggs, you must not only go to a regular assisted reproductive technology center, but also meet the corresponding conditions.

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1. About egg donation

Egg donation therapy involves having young women donate their eggs to female patients who are unable to conceive due to egg problems, and allowing the donated eggs to be fertilized with the recipient's spouse's sperm to form embryos.

In 1992, a "test tube baby" was successfully born through egg donation in mainland China. With the development of the times, vitrification technology has become more and more mature, providing strong technical support for both egg freezing and egg donation. Women who obtain too many eggs in the ovulation induction treatment of IVF can also freeze some of their eggs to prevent sperm problems from causing fertilization failure or low fertilization rate. After the sperm quality improves or the fertilization method is changed to improve the outcome, or save them for their own subsequent use, they can also consider donating them to women in need to provide them with a new treatment method.

Egg donation treatment sounds simple, but the treatment period is extremely long.

2. The cycle of egg donation treatment

A donation egg cycle begins with a fresh IVF treatment cycle for the egg donor and ends with an embryo transfer from a frozen embryo or thawed egg fertilization to the egg recipient.

In some countries, fresh eggs can be taken from the egg donor and then fertilized with the sperm of the recipient's spouse to form fresh embryos, without a waiting period. However, this operation is not allowed in my country. According to relevant regulations in my country, the human immunodeficiency virus antibody test must be repeated 6 months after the egg donor's egg retrieval. Only after the risk of human immunodeficiency virus infection is eliminated can the embryo be transplanted into the egg recipient.

If the egg donor provides fresh eggs, the quality of the sperm of the egg recipient's spouse will determine whether to use in vitro fertilization or intracytoplasmic sperm injection. On the third or fifth to sixth day of culture, the embryos are frozen and then re-examined for human immunodeficiency virus antibodies six months later. If the human immunodeficiency virus antibody is negative, the embryos can be revived and transplanted to the egg recipient.

If the egg donor provides frozen eggs, the donor's human immunodeficiency virus antibody needs to be determined 6 months after egg retrieval. If negative, the eggs are thawed and fertilized with sperm from the recipient's spouse by intracytoplasmic sperm injection, and the embryo is then transferred to the recipient.

Before embryo transfer, the recipient's endometrium needs to be fully prepared, which is the key to successful transfer. Most recipients are women with ovarian failure, so estrogen hormone replacement is often used. When the endometrial thickness is ≥7 mm, progesterone is used to transform the endometrium so that it enters a stage suitable for embryo implantation, and then the embryo is transferred at the right time. For women who receive eggs due to egg quality, embryo transfer can also be performed in the natural cycle, such as a few days after ovulation.

Since egg donors are required to be young women, they have a better response to ovulation-stimulating drugs and can produce more high-quality eggs. These eggs have a higher implantation rate after fertilization. Statistics show that the average probability of successful pregnancy in an egg donation cycle is greater than 50%, and the miscarriage rate is also significantly reduced.

Embryos that are not transplanted are usually frozen and preserved. If the transplant is unsuccessful or the pregnancy fails, these frozen embryos can be used for subsequent frozen embryo transplants to increase the cumulative pregnancy rate of the recipient woman.

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3. Conditions for becoming an egg recipient

Not all infertile female patients can receive egg donation treatment. The egg recipient must be a female patient who has lost the ability to produce normal eggs.

1. Women whose ovarian function has been lost due to premature ovarian failure, ovarian dysfunction or surgery.

2. Carriers or patients with serious genetic diseases (unable to or patients voluntarily give up screening through third-generation IVF technology).

3. Women who repeatedly have poor quality eggs that cannot be used.

Because the uterus ages much more slowly than the ovaries, after hormone replacement therapy, the uterus still has the ability to accept fertilized eggs for implantation, so the age range of recipients of donated eggs is relatively wide. There are cases of elderly women in their sixties and seventies who have successfully given birth after receiving donated eggs both at home and abroad.

As the age of the egg recipient increases, the body's functions decline, or there are other underlying diseases, the success rate will decrease. From an ethical and health perspective, women who are too old will have an impact on the health of both the mother and the child, and will not be conducive to the child's growth and education, so it is recommended that women under 52 years old become egg recipients.

Compared to an egg recipient, the requirements to become an egg donor are higher.

IV. Conditions for becoming an egg donor

Egg donation involves many medical safety and ethical issues. Egg donors need to undergo ovulation induction treatment and egg retrieval surgery to obtain eggs, which may lead to risks such as ovarian hyperstimulation, infection, bleeding, and infertility, which may be life-threatening in severe cases. Therefore, my country prohibits healthy women from commercializing their eggs in any form [1].

my country's regulations on egg donation stipulate that egg donation can only come from excess eggs in a human assisted reproductive treatment cycle. In other words, egg donors must be women who have undergone in vitro fertilization or intracytoplasmic sperm injection treatment and are between 20 and 35 years old.

In order to protect the vital interests of egg donors, after ovulation induction treatment, the number of eggs obtained in the egg retrieval cycle must be greater than 20, and at least 15 eggs must be left for their own use. Only the excess eggs are allowed to be donated.

Therefore, if there are women who need to undergo human assisted reproductive treatment and finally obtain a large number of eggs, they can consider donating eggs to women who cannot obtain healthy eggs to give them hope.

However, because the number of qualified egg donors is limited, egg recipients need to wait in line at regular hospitals according to their condition and treatment time, waiting for others to donate eggs[2].

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In my country, egg donation is a humanitarian act. Any commercial transactions are prohibited. The health and interests of both the egg donor and the egg recipient must be guaranteed. Therefore, egg donation treatment must be carried out through formal channels.

References

[1] Zhang Dan. Ovarian insufficiency. Beijing: People's Medical Publishing House, 2021.

[2] Chinese Medical Association Reproductive Medicine Branch. Clinical Technical Operation Specifications. Assisted Reproductive Technology and Sperm Bank Volume (2021 Revised Edition). Beijing: People's Medical Publishing House, 2021.