Fresh vs Frozen Donor Eggs: Does It Matter?

Last updated: January 2026

Journal Club #2. We read the latest fertility research so you don’t have to.

The Paper

“Comparison of live birth and perinatal outcomes between fresh oocyte donation followed by frozen embryo transfer and frozen oocyte donation with fresh embryo transfer”

Zhang S, Dong S, Yu Y, Gu Y, Zhang Z, Li L, Song J, Zhang S, Lin G, Gong F. Journal of Gynecology Obstetrics and Human Reproduction, March 2026.

Read the full paper on PubMed →

DOI: 10.1016/j.jogoh.2026.103159

Why This Matters

If you’re considering egg donation, one of the first choices your clinic will present is whether to use fresh or frozen donor eggs. Fresh donor eggs mean the donor goes through stimulation and retrieval timed to your cycle. Frozen eggs from an egg bank are thawed when you’re ready, more flexible but involves vitrification and thawing, which some patients worry about.

This study directly compares the two approaches in 507 patients at a university-affiliated centre.

Key Findings

Live birth rates were essentially the same:

The difference was not statistically significant (adjusted OR 1.08, 95% CI 0.75–1.55).

Frozen egg survival was excellent: 94.8% of vitrified eggs survived thawing. Consistent with published literature on modern vitrification techniques.

Fertilisation and embryo quality were the same: No significant differences in fertilisation rate, day 3 cleavage rate, or day 3 high-quality embryo rate between fresh and frozen donor eggs.

One difference in perinatal outcomes: Babies born from the fresh-egg-then-freeze-embryo approach were more likely to be large for gestational age (22.6% vs 8.1%, adjusted OR 3.21). This was only significant in twin pregnancies. All other perinatal outcomes (preterm birth, gestational diabetes, hypertension, caesarean rate, neonatal malformation) were the same.

What This Means for Patients

1. Frozen donor eggs work as well as fresh. If you’re choosing between a clinic’s fresh donor programme and a frozen egg bank, the live birth rates are comparable. Don’t assume fresh is better.

2. Frozen eggs are more practical. No need to synchronise your cycle with the donor’s. No waiting for a matched donor to be available. Egg banks let you start when you’re ready.

3. The large-baby finding needs context. The higher rate of large-for-gestational-age infants was only significant in twin pregnancies. This is one more reason clinics recommend single embryo transfer. It reduces this risk along with all the other complications of multiples.

4. 94.8% egg survival is reassuring. Modern vitrification is highly effective. The fear that frozen eggs are “damaged” is not supported by the data.

Limitations

• Retrospective study at a single centre (507 patients), not a randomised controlled trial
• All patients were at one Chinese university hospital. Results may differ across populations and clinic practices
• The large-baby finding was only significant in twins; the study may not have had enough statistical power to detect a difference in singletons
• Different protocols were used for the two groups (frozen ET vs fresh ET), which introduces confounding factors beyond just the egg source

The Bottom Line

For patients considering donor eggs: frozen and fresh donor eggs produce equivalent live birth rates. The practical advantages of frozen egg banks (flexibility, no synchronisation needed, immediate availability) make them a strong option. The one caveat. A potentially higher rate of large babies, applies mainly to twin pregnancies, which single embryo transfer avoids.

Sources

• Zhang S et al. 2026, J Gynecol Obstet Hum Reprod, DOI: 10.1016/j.jogoh.2026.103159. PubMed
• HFEA on egg freezing and vitrification. hfea.gov.uk

This information is for general guidance. It is not medical advice. Always consult a fertility specialist for decisions about your treatment.

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