Assisted reproduction techniques help thousands of couples with infertility to circumvent their problem and become parents. Nevertheless, when it is not possible for a woman to conceive due to poor egg quality or from having no eggs at all, she may still become pregnant by using eggs from a donor.

The first pregnancy with egg donation was reported in 1983, and ever since, more and more women are choosing this procedure to achieve their dream of having children. The main reason for this trend is that women are increasingly postponing childbearing until later on in life, when their fertility is often reduced; another reason is that over the years, the process has become highly successful due to recent technologies advances and improved freezing techniques.

What is egg donation?

Egg donation is a form of assisted reproduction by which a woman donates her ova to enable another woman to conceive. These oocytes are fertilized by the recipient’s husband sperm, or alternatively by a donor sperm.

The resulting embryos are transferred into the recipient uterus, which has been adequately prepared to receive them. The difference with routine in vitro fertilization (IVF) is that the egg donor is not the recipient; that is, they are two different women.

If pregnancy occurs, the recipient will have a biological but not a genetic relationship to the child, and her partner (if he provided the sperm) will be both biologically and genetically related.

What are the indications for egg donation?

Egg donation may be considered in the following situations:

  • Premature ovarian insufficiency: a condition in which menopause begins earlier than usual, usually before the age of 40 years old. In most cases the cause is unknown, but it may be the result of certain diseases, chemotherapy, radiotherapy or surgical removal of the ovaries. Egg donation is also suitable for women who were born without ovaries.
  • Low ovarian reserve: when there is a decrease in the number of eggs, resulting in reduced chances of pregnancy. Generally, this is due to advanced reproductive age, as the number of oocytes -and therefore fertility- decreases rapidly after the age of 35-40 years old.
  • Genetically transmitted diseases: women affected by, or carriers of a significant genetic disease who would prefer not to pass this disease on to their child.
  • Previous history of failure with IVF: especially when egg quality seems to be the problem.

Who are the egg donors?

1) Anonymous, voluntary donors: According to the Greek law, candidate egg donors are covered by anonymity and are required to sign a specific consent for the donation of their genetic material. In order to accept a woman into an egg donation program she should meet the following requirements:

  • Age between 18 and 35 years old.
  • She should be healthy, non-smoker, with no personal or family history of genetic diseases.

By law, the donor receives financial compensation only for the loss of working days, travel and other expenses incurred during the treatment cycle in which she participates. In any case, egg donation is an altruistic, anonymous and voluntary act.

2) Egg sharing: Women undergoing IVF may agree to donate their surplus oocytes to other women with infertility.

3) Known donor: a person who is known to the recipient, usually a close relative of friend. According to the Greek law, oocyte donation is an anonymous procedure, that is, the donor has no access to the child born, nor the recipient to the donor. Therefore, in Greece the donation of ova to known persons is forbidden by law.

Evaluation of the egg donor

Each candidate donor, after being fully informed about the egg donation program, completes a thorough questionnaire on her family, medical and psychological history. In addition, she is the subject of a series of exams to determine whether her health is in good condition and she can respond properly to the hormonal therapy.

The evaluation involves a comprehensive physical and gynecological examination, as well as the assessment of her psychological and mental status, her genetic material and reproductive system.

In addition, donors undergo the following laboratory testing:

  • Blood type and Rhesus
  • Hepatitis B & C
  • HIV 1 & 2
  • Syphilis
  • Hemoglobin electrophoresis
  • Sickle cell trait testing
  • Cystic fibrosis (CF) mutation
  • Fragile X testing
  • Conventional karyotype. It is also possible to a perform a molecular karyotype, upon request of the recipient couple.

A donor is ineligible if either the questionnaire or the screening tests indicate the presence of risk factors, or clinical evidence of an infectious or genetic disease.

Evaluation of the recipient couple 

Adequate screening and preparation of the recipient couple are essential for the success of an egg donation program.

According to the Greek law, a woman is considered suitable to receive oocytes when her uterus has normal morphology and functionality and has not exceeded the age of 50 years.

The evaluation of the recipient couple is similar to that of couples undergoing routine IVF. First, the physician obtains a thorough medical history from both partners.

The assessment of the woman includes an in-depth physical and gynecological examination, a detailed pelvic ultrasound and laboratory testing. Briefly, the ovarian function, her blood group, and exposure to certain infections are examined. In addition, a Pap smear test and cultures for certain microbes (Neisseria gonorrhoeae, Chlamydia trachomatis, etc) are obtained.

In some cases, the uterine cavity is evaluated with hysterosalpingography (HSG), sonohysterography or hysteroscopy. If the woman is over 45 years old, a more thorough assessment of her cardiac function, pregnancy-induced hypertension and gestational diabetes risk are recommended. The effect of advanced maternal age on pregnancy will be discussed extensively, as well as any medical conditions that may affect pregnancy.

An embryo transfer trial before the actual procedure (“mock” embryo transfer) is strongly recommended. It allows to determine the best way to place the embryos into the uterus, and ensures that there are no unexpected obstacles along the way. Sometimes the cervix is very narrow and hinders the transfer of the embryos into the uterus; this may result in significantly reduced chances of pregnancy. In case of a narrow or distorted cervical canal, a cervical dilation may be recommended.

A treatment trial in a previous cycle with the same medications used for the endometrial preparations is proposed when possible, in order to assess the uterine response to hormone therapy.

The male assessment includes a semen analysis, blood group and genetic testing, among other exams.

According to the Greek law, the recipient couple should be tested for syphilis, hepatitis B and C, HIV-1 and HIV-2 within the six months preceding the treatment cycle.

The procedure

Preparation of the donor for egg retrieval 

The donor follows the procedure of a standard IVF. Initially, she undergoes ovarian stimulation, that is, she receives a combination of hormonal medications in order to achieve the development of a sufficient number of oocytes within the ovaries; egg development is monitored by ultrasound and blood exams at regular intervals. When the oocytes are at the appropriate size, ovulation is triggered by an injection of human chorionic gonadotropin (hCG). Oocyte retrieval, scheduled approximately 34-36 hours after hCG administration, entails the use of a needle which is inserted through the vagina into the ovaries, whereby the eggs are aspirated under ultrasound guidance. The procedure is carried out under a mild sedation.

The ova obtained are evaluated for their maturity and then fertilized with the partner’s sperm, which has been processed in the laboratory. Donor sperm may be also utilized when indicated.

The male partner should provide the semen sample the day of the donor’s egg retrieval. Alternatively, if the presence of the partner is not possible on that day, the semen can be cryopreserved (frozen) at an earlier time.

Preparation of the recipient for embryo transfer

In order for the embryos to implant into the recipient’s uterus, the endometrium (uterine lining) must be prepared and synchronized with the donor cycle.

There are numerous protocols for endometrial preparation. Briefly, women who still have menstrual period may receive an injectable medication for temporary suppression of the ovarian function. When the donor starts ovarian stimulation, the recipient receives a hormone called estradiol to achieve endometrial growth. Estradiol can be administered orally or through a transdermal patch. Ultrasound assessment of endometrial thickness -and occasionally blood tests- are performed during this period. On the day after the donor receives hCG, the recipient begins treatment with progesterone. Progesterone causes endometrial maturational changes that allow the embryo to implant. Progesterone can be administered by intramuscular injection, vaginally or orally. Besides estradiol and progesterone, other medications may be prescribed if required.

The embryos are transferred into the recipient’s uterus, usually within three to five days after fertilization of the eggs in the laboratory. Embryo transfer is done using a thin catheter inserted through the cervix into the uterus. If the recipient couple has extra embryos, they will be cryopreserved (frozen). Thus, it is possible to transfer these embryos at a later time without the need for another egg donation.

Hormonal therapy with estradiol and progesterone continues until the recipient takes a blood pregnancy test (β hCG). If the test is positive, the hormones are continued during the first trimester of pregnancy.

Success rates with egg donation

Since egg donors are young and healthy women, success rates are higher than those obtained with conventional IVF. The age of the recipient does not seem to affect the success of the procedure. According to data from the National Agency of Medically Assisted Reproduction, the pregnancy rate with egg donation in Greece is 54%.

Nevertheless, the greater the number of attempts with donor-egg IVF, the higher the odds of success. Thus, it is estimated that the success rates after the third attempt reach almost 90% in most cases.

Many factors play an important role in the success of the procedure: adequate evaluation and preparation of both donors and recipients, optimal synchronization between them, high laboratory standards and well-trained scientific staff, will all have a positive impact on pregnancy rates in an egg donation program.

Risks of egg donation 

1) For the donor:

Egg donation is a very safe procedure. Nevertheless, it is not entirely risk-free. Medicines taken to stimulate the ovaries, oocyte retrieval and the anesthesia required are all possible sources of complications. Briefly, the side effects of medications are usually mild, as one of the most feared complications in assisted reproduction, ovarian hyperstimulation syndrome is very rare in these cases. The remaining risks are estimated as follows: anesthesia risks: 1 / 10,000; risk of severe bleeding from oocyte retrieval: 1 / 2,500; risk of infection: less than 1/500.

It should be noted that the fertility of women who become egg donors is in no way affected. In fact, the eggs donated would have been otherwise discarded by their bodies.

2) For the recipient:

The possibility a donor transmits an infectious disease to the recipient is virtually non-existent, provided that proper evaluation of the egg donor has been performed, as dictated by the Greek law.

The most common risk for the recipient is the occurrence of a multiple pregnancy (twins) if more than one embryo is transferred. In any case, in egg donation cycles, the transfer of more than two embryos is strictly forbidden by the Greek law. If the couple is opposed to the possibility of a twin pregnancy, then only one embryo may be transferred (single embryo transfer, SET).

Pregnancy complication risk in recipiens with advanced age should be assessed individually for each case.

3) For the child:

To date, thousands of children have been born with this procedure, and the available data is reassuring, and equivalent to that of conventional IVF: the rate of birth defects is the same as the general population.


On Egg Donation

  • Egg donation is an altruistic act, voluntary and with no financial benefit. Donors are compensated only for the working days they lose as part of the donation process and their travel expenses.
  • Donation of ova and sperm is allowed in Greece provided donor anonymity is ensured.
  • Egg donation is not allowed to women over 50 years old.
  • Donors must sign an oocyte concession consent.
  • Recipients sign a document stating that they are married and accept to undergo in vitro fertilization with egg donation. If they are not married, they should sign a notary act stating that they wish to undego IVF using the egg donation method.

On Assisted Reproduction

On January 27 2005, the law 3305/2005 on the application of assisted reproduction techniques was reported.

The Greek law on medically assisted reproduction is one of Europe’s most flexible. It safeguards the couple who wants to have a child based on medical, biological and bioethical principles. Its main purpose is, ultimately, the protection of the child to be born.

Basic principles of the current legislation

Some of the key points of the in-force law are the following:

1) Assisted reproduction methods are legal and allowed for women up to the age of 50 years, as this is considered the limit for natural conception.

2) The donation of ova and sperm is permitted, but the consent of the spouse or partner is also required.

3) Pre-implantation genetic diagnosis is allowed with the purpose of diagnosing whether the resulting embryos are carriers of genetic diseases. Consent of the concerned individuals is required.

4) Sex selection is prohibited unless a serious sex-related hereditary disease is avoided.

5) Cloning for reproductive purposes is prohibited.

6) Cryopreservation of genetic material or fertilized eggs is permitted.

7) The use of a gestational carrier (surrogacy) is allowed. A surrogate is a woman who carries a pregnancy for another couple or woman, who wishes to have a child but is unable to get pregnant for medical reasons. The surrogate woman must undergo medical and psychological examination. There should be no financial transaction other than the costs resulting from pregnancy exams, loss of work, etc. The procedure requires a special permit from a judge.

8) Assisted Reproduction Units are established and operate with the permission of the competent Authority, which shall give its agreement and verify that the legal requirements are met. For any violation, it sets administrative and criminal penalties.

9) The law sets age limits for sperm donors (younger than 40 years old) and egg donors (younger than 35 years).

10) Single women are allowed to conceive with assisted reproduction.

11) Donors must undergo clinical and laboratory testing and are not admitted to donation programs if they suffer from hereditary, genetic or infectious diseases. The use of fresh semen from donor is not permitted; only frozen semen may be used.


More info at


Cystic fibrosis child 64963_275424252527918_2034953432_n

Cystic fibrosis (CF) is the most common inherited disease in most European countries and North America’s white population. Paradoxically though, CF is rather unknown to most people; only the latest years there has been some increased awareness of the disease…

Since 2001, CF prenatal testing is offered to all women of reproductive age as a routine part of obstetric care in the United States. In Europe, the situation is much more heterogeneous: in most countries screening is proposed only to couples at high risk; in the UK and France systematic testing for CF is carried out on newborns, but not on couples without a family history.

In this article I will provide some basic information on cystic fibrosis to help you make your informed decision about prenatal testing…


What is cystic fibrosis?

Cystic fibrosis is an inherited disease, which affects most of the organs of the body, often causing problems with the respiratory and digestive systems. It does not affect a person’s intelligence or appearance. CF generally poses serious risk to a person’s health and shortens life span.

What causes cystic fibrosis?

People have CF because a faulty gene is passed from the parents to the child. Cystic fibrosis is a recessive disorder. That means, both parents must carry the abnormal gene. In that case, there is a 25% (1 in 4) chance the child will have CF, a 50% (1 in 2) chance of the child being a carrier and a 25% (1 in 4) chance he/she will not have the faulty gene. Persons who have one copy of the abnormal gene are called carriers. Almost invariably, carriers will not show no signs of CF.

Cystic fibrosis what-causes-CF(457x300)


How common is cystic fibrosis?

About 4% of the population (1 in 25 persons) are CF carriers. CF concerns 1 in approximately 2500 births (USA’s white population, Greece; 1 in 3000 in UK, 1 in 4500 in France).

What are the symptoms of CF?

The symptoms of CF can vary in type and severity. Many people with CF produce a thick, sticky mucus in their bodies. This mucus clogs the lungs and makes it hard to breathe, leading to infection and eventually severe lung damage. It can also affect the digestive organs, making it difficult for the body to absorb food. Most men with CF are infertile.

Is there a cure for CF?

Currently there is no cure for CF. However, through research and improved care, quality and length of life for people with the condition continues to improve. While in the 60’s, a child born with the disease was lucky to live beyond five years, today around half of persons with CF are expected to live past 41 (median survival 37 years), and approximately 15% of individuals with CF have a mild form of the disease with a median survival of 56 years.



Cystic fibrosis flower lungs

Cystic fibrosis flower lungs @

What is a carrier testing? 

Carrier testing looks at a person’s DNA (genetic material) and tells if that person carries a CF gene mutation (an abnormal gene). The test is taken from cells in a blood sample or from cells that are scraped from inside the mouth.

When can CF carrier testing be done?

Carrier testing can be done when a couple is planning a pregnancy, or during pregnancy (ideally before the 20th week of pregnancy). Initially, only one partner is usually checked. If testing shows that a couple is at high risk, more testing can be done during pregnancy to see whether the fetus has CF.

Should I have prenantal testing?

Having the test to learn if you are a CF carrier is a personal choice and may be influenced by medical, ethical or religious factors. You should carefully consider your options in case of a positive result (see below) and decide accordingly.

How accurate is CF carrier testing?

Cystic fibrosis is caused by mutations in the CF transmembrane regulator (CFTR) gene, located on chromosome 7.

Testing for cystic fibrosis, though, is not straightforward. To date, more than 1700 CF mutations have been identified. Of the laboratory tests available for detection of CF mutations, most of them detect between 20 and 32 mutations. With these tests, about 65-80% of the mutations will be identified.

A more complete analysis of the CFTR gene can be done (by a technique called DNA sequencing); this technique is not appropriate for routine carrier screening because, besides being very expensive, it may yield results that can be difficult to interpret. This type of testing is generally reserved for:

  • patients with CF,
  • patients with a family history of CF,
  • infertile men with a specific abnormality called congenital bilateral absence of the vas deferens, (commonly associated with CF), or
  • newborns with a positive newborn screening result.

It is very important that you and your partner understand the sensitivity and limitations of testing, as well as your reproductive options.



Cystic fibrosis ribbon etsy resized

Purple ribbon for CF awareness

One partner negative: If your test results are negative, the chance that you are a CF carrier is small. There are some rare CF gene defects that the test does not detect. For this reason, you could be told your test result is negative, and you could still be a carrier.

One partner positive: If the test results show that one partner is a carrier, the next step is to test the other partner. Both parents must be CF carriers for the baby to have CF.

If one parent has a negative test result, the chance that the baby will have CF is small. Because the risk is small, if one partner is a carrier but the other has a negative result, no further testing is recommended.

If the father is not available for a carrier test, you may discuss with your doctor to help you decide whether to have prenatal testing of the fetus.

Both partners positive: If both partners are CF carriers, further prenatal testing can be done to see if the baby has CF. As stated before, if two CF carriers have a baby, there is a 25% chance that the baby will have CF, 50% chance the baby will be a carrier, and 25% chance that the baby will not be a CF carrier.




Preimplantation genetic diagnosis

What prenatal tests can be done to know if the fetus is affected?

Prenatal tests done to detect CF (and other disorders) involve obtaining with a needle some of the fetus’ genetic material and analyzing it to see if it is affected. This can be done around the third month of pregnancy by chorionic villus sampling (CVS) or during the fourth month by amniocentesis. With CVS the genetic material is taken from the placenta, with amniocentesis from the amniotic fluid. You should know that both tests have a small risk of miscarriage.

What are our options if the fetus has CF?

You may decide to:

1. Continue the pregnancy. You may, until the time of delivery, get prepared to live with an affected child, learn more about the disease and eventually discuss with other parents who have a child with CF; or

2. End the pregnancy. Each country has its own laws on pregnancy termination. You should discuss this decision with your doctor.

What are our options when planning a pregnancy?

You may decide to:

1. Have amniocentesis or CVS in each pregnancy,

2. Undergo a technique called preimplantation genetic diagnosis, where you do in vitro fertilization with your own sperm and eggs, and then check the embryos for CF by performing an embryo biopsy (see picture above),

3. Use donor sperm or donor eggs (the donor should be tested for CF carrier status), or

4. Adopt a child.

If you are interested in learning more about cystic fibrosis and prenatal testing, discuss it with your obstetrician–gynecologist, or read more here:

Cystic Fibrosis Foundation

Cystic Fibrosis Trust (French and English)



American College of Obstetricians and Gynecologists (ACOG): Cystic Fibrosis prenatal screening and diagnosis. (For patients)

ACOG Committee Opinion: Update on Carrier Screening for Cystic Fibrosis. December 2005

Best practice guidelines for molecular genetic diagnosis of cystic fibrosis and CFTR-related disorders – updated European recommendations. Eur J Hum Genet. 2009 Jan; 17(1): 51–65.

National Health System (NHS) UK: Cystic Fibrosis

American College of Medical Genetics: Technical Standards and Guidelines for CFTR Mutation Testing. 2006 Edition

CF Network

Photo credits

Heading: ahealthiermichigan.orgRecessive disorder:, CF flower lungs:; CF purple ribbon:; PGD: