Expert interview : How egg donation works in real life

Dr. Elizabet Clua

Dr. Elisabeth Clua has blue eyes and blonde hair.

One could easily think she looks like a typical German doctor. Only that she is not.

Elisabeth is Spanish and a leading expert in reproductive biology. Her daily job is egg donation or, more precisely, matching donated eggs (from healthy, young women) with their recipients (older, infertile women).

In even more simple terms, Elisabeth identifies the “right” biological mothers for couples who seek one for their baby.

Matching healthy, young eggs with infertile couples, deciding on who becomes biological mother – can you imagine having more responsibility in your daily work?

Still, Elisabeth Clua finds time to answer my questions.

She’s relaxed and happy to explain her work, and even mentions her own children, saying she has to help them with their homework almost every day. Parenting used to be easier when children were small.

Today, Elisabeth’s busy finding a donor for a very tall couple (the woman is over 180cm). Though important, height and eye and hair color are not the only traits that are considered. There are almost countless other factors that come together in the equation of finding a suitable biological mother for couples in the egg donation process.

For instance, at the Dexeus Clinic (one of the leading clinics in Europe, there’s a separate post about my stay there), donor eggs are tested for over 200 diseases and young women who donate their eggs – mostly altruistic students who wish to help to those not being able to have children on their own – go through an extensive battery of medical and gynecologic investigations.

I can’t resist asking: If a German couple came to you (because in Germany, egg donation is not allowed and couples go to other countries, mostly Czech Republic or Spain),would you help them find an egg of a blonde woman with blue eyes?

Elisabeth laughs: of course, we would most strongly consider matching blonde hair and blue eyes where necessary. Then we look at each other and raise eyebrows a bit. Both being biologists, we tend to see things from a bit different perspective. Without saying what’s on our minds, we think: how important is it really to have a blonde baby with blue eyes?

And what does it mean to be German nowadays, anyways?

Or Spanish, or European for that matter?

Is it not all that matters to have a healthy baby whose proud parents you will become, probably after years of having coped with infertility?

I’m personally convinced that THE mother of a baby is the woman who gives birth, the one who breastfeeds her child, and takes responsibility for it every hour of the day and night until it has a life of its own.

In this same way, a father is, for me, the one who stands by the mother during these processes.

Everything else is negotiable.

Then, we turn our talk to the daily work of egg donation. I feel that I need to pass on to Dr. Clua the most pressing questions that infertile couples sometimes ask me (here is how you can contact me).

How high is the chance that IVF with donated eggs will work?

Dr. Clua: In egg donation, there is a 50–55% probability of pregnancy in the first cycle. This is sometimes higher, depending on the age and the previous medical history of the recipient (infertile woman receiving the egg donation). This is high percentage given that the group of women who come for a donation typically has a <5% chance of conceiving with their own eggs.

Donor-women are typically young students who agree to donate their eggs and help others for a fairly small compensation (about 800–1000 euros—please compare this with prices in the US that go into the thousands and tens of thousands of dollars for donor eggs). Most people find these mechanisms important as they guarantee some altruism at least and make repeating of donation cycles due to financial stimulation almost impossible.

How else can couples know that the women who donate eggs are physically, mentally, and emotionally healthy?

Dr. Clua: Women who donate eggs go through extensive medical and psychological tests. There is a battery of tests performed: questionnaires, blood tests, and medical examinations. To this, genetic material of the donor gets tested for 200 common diseases via a new-generation-sequencing technique. This test not only reveals many genetically, physically, and mentally devastating diseases, like cystic fibrosis, phenylketonuria, and fragile-X syndrome, but also genetic variations and diseases common in the Mediterranean region.

The price of that test is included in the cost of an egg donation cycle. If a couple wants to test their own genetic material as well (the male side in this case), this can be done for an additional $500 (I personally find this information more than worth its price as it reveals a lot about whether genes of the donor and the corresponding male partner make a good fit; for example, it’s not good if they both turn out to be carriers of a same rare disorder).

Can women bring their own donor?

Dr. Clua: No. Donation in Spain is anonymous. Couples who come to us need to trust us and have confidence that we’ll find best and healthiest eggs for them. This is an incredibly responsible process and, once involved, it becomes clear how much trust is involved on all sides.

Do you see any lifestyle modification that a couple can make to increase their chances to get pregnant, with either a donor or their own eggs?

Dr. Clua: Yes. There are lifestyle habits that do influence the capability of a woman to conceive and to have a successful implantation and pregnancy. Especially in the months prior to conception, it’s important to set the right lifestyle. For example, we recommend that a BMI (body mass index) not be above a certain value. In my experience, it’s also important that men not smoke and to support the quality of their sperm with supplements because substances from the cigarette smoke can increase DNA fragmentation as well as the risk of epigenetic diseases.

What’s your take on most pressing issue surrounding egg donation, who is the mother of the baby – the woman who donates the egg or the woman who gives birth?

Dr. Clua: At the beginning of this process, many couples have psychological obstacles related to egg donation. The reason is obvious: in strictly genetic terms, the child will not be related to its own mother. That part is confusing, but important, so let’s clarify that. In the creation of a child, its dad’s sperm will be mixed with an egg from a donor woman (who the child will never know). Once formed, the resultant embryo will then be transferred into its mom’s womb.

This woman will carry out the “rest”: implantation to her uterus, full-term pregnancy, giving birth, breastfeeding, parenting, educating…Even some of her mitochondria will spill over into the cells of the fetus and the cells of her immune system will populate the body of her baby through milk, just like in any other mom.

Most importantly, her body will undergo strong hormonal changes, which will lead to a strong bonding: women are programmed to get emotionally very much attached to a baby that comes out of their belly and starts pulling their nipples.

So why to ask who the mother is? And why are we bothered with such questions in the first place? How far should anyone go in the obsession with passing on one’s own genes? And what are genes anyway? For anyone coping with infertility, is it genes that you care about, or being a parent and having a family?

The funny thing is: whether genetically yours or not, children will always turn out different than you thought. And just like Dr. Elisabeth Clua at the beginning of this story did, you will someday look back and think: parenting is hard work and it was easier when the children were still small!

More information about egg donation at the Dexeus clinic you can find here.

See you again soon,

Darja

Supplements which are scientifically proven to increase egg quality:

(DHEA, CoQ10, Vitamin D3, Omega-3)