Oocyte donors’ health before and after their donation—a national Swedish register study

Abstract

STUDY QUESTION

Are Swedish oocyte donors comparable to an age-matched control group of women with regard to medical conditions, drug prescription, and hospitalization both before and up to 15 years after their donation?

SUMMARY ANSWER

Compared with age-matched controls, Swedish oocyte donors exhibited higher outpatient healthcare utilization and medication use, were more frequently diagnosed with genitourinary disorders, and, among donors born in 1973 or later, had mental and nervous disorders.

WHAT IS KNOWN ALREADY

During the donation process, oocyte donors self-assess their health as good, but longitudinal studies based on objective data are scarce.

STUDY DESIGN, SIZE, DURATION

Longitudinal study initiated in 2005 following identity-release oocyte donors’ health from 1995 until 2023.

PARTICIPANTS/MATERIALS, SETTING, METHODS

In total, 170 women recruited and accepted as identity-release oocyte donors in a non-commercial setting between 2005 and 2008 were included in this national register study. Of these, 21 women were directed donors, donating to a known recipient couple. For each donor, four age-matched controls from the general population were identified to form a control group of 680 women. Data from the National Patient Register, the Prescribed Drug Register, and Cause of Death register were used to obtain information on diagnoses using the ICD classification, medications, and hospitalizations from 1995 until 2018.

MAIN RESULTS AND THE ROLE OF CHANCE

Before donation, ∼10% of donors had received specialized healthcare for neoplasms, mental disorders, respiratory disorders, digestive disorders, or skin disorders. Genitourinary disorders were common, with 50% of donors diagnosed prior to donation. With post-donation period included, this proportion increased to almost 80%, which is markedly higher than among controls (58%, P < 0.001). The younger oocyte donors, born from 1973 onwards, were more often than the matched controls diagnosed with mental disorders due to psychoactive substance use, neurotic and stress-related disorders, and behavioural syndromes associated with physiological disturbances (all P < 0.05). Oocyte donors had approximately twice as many outpatient visits compared to the controls, even after excluding visits related to genitourinary disorders (mean number of visits/SD 17.9/20.6 versus 10.1/17.1, P < 0.001). The oocyte donors had also more often received prescribed medications, including systemic hormonal preparations, excluding sex hormones and insulins (73.5% vs 34.7%, P < 0.001) and drugs related to the nervous system (75.9% vs 65.0%, P < 0.012). More than 40% of the oocyte donors had used antidepressants, and 37% had used sedatives. Hospitalization rates did not differ between donors and controls. Directed donors had more outpatient visits than non-directed donors and were also more often treated for anxiety and depression.

LARGE SCALE DATA

National register data.

LIMITATIONS, REASONS FOR CAUTION

This study of the health of oocyte donors is limited by the difficulty in retrieving information on primary care from national registers in Sweden. Consequently, a potential underestimation of healthcare use and of health diagnoses must be taken into consideration when interpreting the results.

WIDER IMPLICATIONS OF THE FINDINGS

A society that accepts gamete donation must strive to ensure rigorous medical and psychological assessments. The pre-donation assessment of health status and hereditary disease risk does not appear to reliably identify women with a lower predisposition to future disease or need for medication.

FUNDING

The study was financed by grants from the Swedish state under the agreement between the Swedish government and the county councils, ALF Grants, Region Östergötland, and from the Swedish Research Council (2013-2712; 2021-03174).

DISCLOSURES

None of the authors have any competing interest to report in relation to the current study.

TRIAL REGISTRATION NUMBER

n/a.

Introduction

The use of ART, including the use of donated gametes, has increased and continues to do so (Kawwass et al., 2016; Authority, 2022; Braun et al., 2024) in Western societies. There are many different stakeholders that might be affected by the donation treatment, both in the short term as well as in the unforeseeable future, such as the recipients, their offspring, their partners, and extended families. In third-party donation, the mental and physical health of gamete donors is significant for the recipients and for the donor-conceived offspring. From a long-term perspective, it is of great importance to have healthy and mature individuals who fully understand the consequences of being donors in fertility treatment. This may be especially important to offspring, as they might be interested in their genetic heritage in the future, e.g. when starting their own families (Amor et al., 2018; Lampic et al., 2022; Widbom et al., 2024).

Due to e.g. social desirability, it is also plausible that a donor either withholds or provides incomplete medical information about their own or their family’s health history. The donor could also have an undetected serious genetic, mental, or physical condition. Missing or undetected conditions may place additional strain on the health care system, which in turn may lead to a negative societal impact. While being understudied among gamete donors, non-disclosure of medical conditions due to a variety of reasons has been established in studies in general populations (Levy et al., 2018; Paskins et al., 2018; Nong et al., 2022). Therefore, an assessment of mental and physical health in prospective donors must be meticulously performed at fertility clinics and commercial sperm and oocyte banks.

Before acceptance as an oocyte donor, screening for medical and psychological conditions is mandatory in most countries, but the procedures and medical testing vary widely, from being unsystematic and limited to very comprehensive. Oocyte donation was permitted by Swedish law in 2003, and it was not until 2006 that the law explicitly stipulated that an assessment of donors should be carried out; however, no detailed criteria were specified. More comprehensive regulation of the psychosocial and medical evaluation of donors was introduced in 2009 (Ministry of Social Affairs, 2006; National Board of Health and Welfare, 2009a, 2009b). The way the screening is conducted is not always standardized but is under constant reevaluation. Most clinics in the Western world nowadays follow national and international guidelines from the American Society for Reproductive Medicine (ASRM) and the European Society of Human Reproduction and Embryology (ESHRE) (ESHRE Psychology and Counselling Guideline Development Group, 2015; American Society for Reproductive Medicine (ASRM), 2021).

Commonly, donors are routinely interviewed by a physician about their own and their families’ medical history, including siblings, parents, and grandparents, to assess genetic and medical conditions that may affect their suitability as a donor. In addition, other medical professions, such as nurses, midwives, and psychologists, may also be present in the reproductive team at the clinics or commercial gamete banks to evaluate a donor-to-be’s medical and psychosocial situation. In most clinics, mental health, criminal records, willingness to donate, and motives are assessed, mainly during an interview performed by a psychologist. Personality tests of different types might also be used during the screening process.

Some clinics also require the donor-to-be to fill out a special health declaration that he/she must sign before being accepted as a donor. The health declaration provides information on the donor-to-be’s medical situation as well as consent to the clinic’s routines, such as donating solely to that clinic and the maximum number of children that might be the result of the donation. Also, genetic screening for heterozygous carrier status for certain conditions, e.g. hemoglobinopathies, spinal muscular atrophy, and cystic fibrosis, is nowadays either offered or mandatory in oocyte and sperm banks.

While most women donate their oocytes without a specific recipient in mind, some women donate to an individual or couple they know, i.e. directed donation. These women undergo the same screening and testing as non-directed donors-to-be. However, they may be accepted as donors despite identified medical issues, provided both the donor and the recipient(s) are informed of the theoretical infectious or genetic risk. In the case of directed donation, extended psychosocial counselling is nowadays recommended for both the donor and the recipient(s) (The Practice Committee of the American Society for Reproductive Medicine and the Practice Committee for the Society for Assisted Reproductive Technology, 2024).

In Sweden, where only non-commercial gamete donation is permitted, the number of children born from oocyte donation between 2003 (when oocyte donation was first permitted by law) and 2020 was ∼1300 (Q-IVF: Nationellt Kvalitetsregister för Assisterad Befruktning, 2024). The Swedish Study on Gamete Donation (SSGD) has followed a national sample of 181 women who were accepted as oocyte donors between 2005 and 2008 with repeated postal surveys, up to 17 years post-donation. Using validated self-report instruments, these oocyte donors were found to be mature individuals with a clinically stable personality and character (Sydsjö et al., 2011), and their self-assessed psychological health was found to be satisfactory in the short term as well as in the long term after the donation (Skoog Svanberg et al., 2013; Sydsjo et al., 2023). Directed and non-directed oocyte donors have reported similar levels of long-term satisfaction with their donation, both in the longitudinal SSGD (Thorup et al., 2025) and in a large retrospective Finnish study (Söderström-Anttila et al., 2016).

Other studies have also shown that oocyte donors’ self-reports on their psychosocial well-being are good (Söderström-Anttila et al., 2016; Adlam et al., 2025), but there is a lack of research on gamete donors’ objective health situation using medical records and registers, including potential differences between directed and non-directed donors.

To our knowledge, no other scientific studies have followed oocyte donors’ health from before being accepted as an oocyte donor to almost 20 years after their donation, in a non-commercial donor programme. Gamete donation is widely used and increasing. Both recipients and the future donor-conceived children have an interest in the short- and long-term health status among the donors. As both psychological and medical evaluations are performed prior to inclusion in a donor programme, our hypothesis was that women accepted for oocyte donation would have fewer registered diagnoses and be hospitalized to a lesser extent than age-matched women in general. The SSGD provides an excellent opportunity to explore this relationship in a long-term perspective using register data and not relying on self reports.

Thus, the main aim of the present study was to investigate Swedish oocyte donors’ medical conditions, drug prescriptions, and hospitalizations both before their donation and up to 20 years afterwards, in comparison with an age-matched control group. A further aim was to compare directed and non-directed oocyte donors regarding these health outcomes.

Materials and methods

Study population

Index women

The index women group consists of all oocyte donors who agreed to participate in the SSGD. The SSGD is a longitudinal study of individuals who were accepted as either donors or recipients of donated gametes between 2005 and 2008 at any of the seven Swedish university clinics performing non-commercial gamete donation during that time period. More information about the SSGD and results from previous assessments involving gamete donors are available (Sydsjö et al., 2011, 2012; Svanberg et al., 2012; Skoog Svanberg et al., 2013; Isaksson et al., 2014; Lampic et al., 2014). As part of the SSGD, all women accepted as oocyte donors (n = 217) were consecutively approached, of which 181 (83%) accepted participation in the SSGD and completed the first survey before donation. For the purpose of the present study, we were unable to identify 11 of these 181 women using the unique personal identification number assigned to every person residing in Sweden. Thus, the final study population consisted of 170 women, of which 21 women donated to a known recipient couple whereas the remaining 149 women underwent non-directed donation.

Sociodemographic data on the study participants at the time of inclusion in the SSGD are presented in Table 1. The donors were born between 1965 and 1987, the median age for donors at inclusion was 31 years, and ∼70% were born from 1973 onwards.

Table 1.

Sociodemographic data of oocyte donors at time of inclusion in the Swedish Study on Gamete Donation.

	Donors n = 170	Directed donors n = 21	Non-directed donors n = 149	<1973 n = 49	1973–1987 n = 121	Comparing <1973 and 1973–1987
	n (%)	n (%)	n (%)	n (%)	n (%)	P-value
Age at inclusion
Median/min–max	31/20–40	31/20–40	28/20–36	35/33–40	29/20–34	<0.001*
Type of donation
Directed (known)	21 (12.4)
Non identified	149 (87.6)
Year of birth
1965–1972	49 (28.8)	6 (28.6)	43 (28.9)	49 (100.0)	–
1973–1987	121 (71.2)	15 (71.4)	106 (71.1)	–	121 (100.0)
Educational level						0.002**
Elementary	7 (4.1)	2 (9.5)	5 (3.4)	2 (4.1)	5 (4.1)
Lower secondary	24 (14.1)	2 (9.5)	22 (14.8)	15 (30.6)	9 (7.4)
Upper secondary	62 (36.5)	11 (52.4)	51 (34.2)	15 (30.6)	47 (38.8)
University	77 (45.3)	6 (28.6)	71 (47.7)	17 (34.7)	60 (49.6)
Partner						0.009**
No	43 (25.3)	9 (42.9)	34 (22.8)	13 (26.5)	30 (24.8)
Steady relationship	17 (10.0)	5 (23.8)	12 (8.1)	0 (0.0)	17 (14.0)
Cohabiting/married	110 (64.7)	7 (33.3)	103 (69.1)	36 (73.5)	74 (61.2)
Children
Biological, yes	52 (30.6)	8 (38.1)	44 (29.5)	4 (8.2)	48 (39.7)	<0.001
Step, yes	9 (5.3)	0 (0.0)	9 (6.0)	4 (8.2)	5 (4.1)	0.282**
Adoptive, yes	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	NA
No children (either biological step, or adoptive)	109 (64.1)	13 (61.9)	96 (64.4)	41 (83.6)	68 (56.2)
Anxiety***						0.976
No	145 (86.8)	16 (72.5)	129 (88.4)	40 (87.0)	105 (86.8)
Yes	22 (13.2)	5 (23.8)	17 (11.6)	6 (13.0)	16 (13.2)
Depression***						0.675**
No	160 (95.8)	21 (100.0)	139 (95.2)	45 (97.8)	115 (95.0)
Yes	7 (4.2)	0 (0.0)	7 (4.8)	1 (2.2)	6 (5.0)

^*Mann–Whitney U-test;

^**Fisher’s Exact test;

^***Derived using the Hospital Anxiety and Depression Scale. Due to missing data, totals for the Hospital Anxiety and Depression scale may not sum to population totals.

Of the 170 women, 21 women donated to a known recipient couple, whereas the remaining 149 women underwent non-directed donation (Table 1). In order to study directed and non-directed donation, we analysed these two groups separately to establish if their health was comparable or if any differences could be detected.

Medical data as well as data on expedited prescription drugs have been retrieved from the National Health and Welfare for the period 1995–2023.

Comparison group(s)

To evaluate the oocyte donors’ health in reference to the general population of women in Sweden, a comparison group comprising all women born between 1973 (the year the Swedish medical register was initiated (Cnattingius et al., 2023)) and 1987 was used (n = 713,057), with medical data and information on expedited prescription drugs from the National Board of Health and Welfare’s registers available until 2018. As the presence of diagnoses increases with age and to avoid mass significance, a subset of this comparison group consisting of four matched control women was used, where the matching criterion was year of birth (n = 680). Oocyte donors born before 1973 were matched to control women born in 1973.

Thus, to ensure that the study comprised data as comparable as possible, the final study period for comparisons was restricted to follow-up until 2018. To provide an approximation on before and after donation events in the comparison group, a proxy variable for ‘before donation’ among the age-matched controls was created using 2009 as cut-off.

Medical data

All donors’ medical history, diagnoses, and use of prescribed drugs are based on information from Swedish national registers, which are all considered to be of high quality (Brooke et al., 2017; National Board of Health and Welfare and Department of Registers and Statistics, 2021; Everhov et al., 2025) and maintained by the Swedish National Board of Health and Welfare.

The National Patient Register (NPR) was initiated in 1964, but it was not until 1987 that the register included all of Sweden. The NPR includes all inpatient care since 1984, and from 2001 onward, outpatient visits are also included in the register. The register contains background information such as sex and age, as well as medical information including date of admission and discharge, main diagnosis and up to 30 secondary diagnoses (Everhov et al., 2025). Diagnoses in the register are based on the Swedish version of the International Classification of Diseases (ICD).

The Prescribed Drug Register was introduced in 2005 and provides information on dispensed drugs in Sweden, including the Anatomical Therapeutic Chemical Classification (ATC) of the drug, date of prescription, date the prescription was filled, dosage, drug strength, and pharmaceutical form (National Board of Health and Welfare and Department of Registers and Statistics, 2021).

The Cause of Death Register was established in 1961, and its coverage rate is close to 100%. The register includes information about the cause of death and underlying causes of death of Swedish residents, including those who pass away abroad (Brooke et al., 2017).

ICD Diagnoses and ATC classifications

As the study period includes information from January 1995 up to June 2023, ICD, version 10 (ICD-10) codes were included. In Table 2, diagnoses included in the study are presented. Visits and treatments occurring during the donation process are not included in the number of visits or diagnoses as diagnoses related to the donation process were not registered as visits in the NPR. The few instances of misreporting were removed prior to data analysis.

Table 2.

Diagnoses^* included in the study.

Diagnosis	ICD-10 code(s)
Infection	A00–B99
Neoplasms	C00–D49
Malignant neoplasm of breast	C50
Malignant neoplasm of female genital organs	C51–C58
In-situ neoplasms	D00–D09
Benign neoplasm	D10–D36
Neoplasms of uncertain or unknown behaviour	D37–D48
Endocrine	E00–E90
Mental and behavioural disorders	F00–F99
Mental and behavioural disorders due to psychoactive substance use	F10–F19
Schizophrenia, schizotypal and delusional disorders	F20–F29
Mood (affective) disorders	F30–F39
Neurotic, stress-related and somatoform disorders	F40–F48
Behavioural syndromes associated with physiological disturbances and physical factors	F50–F59
Disorders of adult personality and behaviour	F60–F69
Disorders of psychological development	F80–F89
Behavioural and emotional disorders with onset usually occurring in childhood and adolescence	F90–F98
Diseases of the nervous system	G00–G99
Extrapyramidal and movement disorders	G20–G26
Demyelinating diseases of the central nervous system	G35–G37
Episodic and paroxysmal disorders	G40–G47
Other disorders of the nervous system	G90–G99
Diseases of the circulatory system	I00–I99
Diseases of the respiratory system	J00–J99
Diseases of the digestive system	K00–K93
Diseases of the skin and subcutaneous tissue	L00–L99
Diseases of the musculoskeletal system and connective tissue	M00–M99
Diseases of the genitourinary system	N00–N99
Other disorders of the urinary system	N30–N39
Disorders of the breast	N60–N64
Inflammatory disease of the female pelvic organs	N70–N77
Non-inflammatory disorders of the female genital tract	N80–N98
Congenital malformations, deformations, and chromosomal abnormalities	Q00–Q99
Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified	R00–R99
Injury, poisoning, and certain other consequences of external causes	S00–T98
Factors influencing health status and contact with health services	Z00–Z99*

^*Diagnoses and treatments related to the donation process are not included.

The ATC classifications included in the study are presented in Table 3. These specific ATC classifications were chosen as they may act as markers or reflect adverse effects resulting from the treatment during the donation procedures related to cardiac, oncological, or mental health diagnoses. Medications received during the donation process are not included, as they are administered at the clinic and are not reported to the Prescribed Drug Register.

Table 3.

The Anatomical Therapeutic Chemical (ATC) classifications included in the study.

ATC
C—Cardiovascular system
G—Genitourinary system and sex hormones
H—Systemic hormonal preparations, excluding sex hormones and insulins
L—Antineoplastic and immunomodulating agents
N—Nervous system
N05A—Antipsychotics
N05B—Anxiolytics
N05C—Hypnotics and sedatives
N06A—Antidepressants
N06B—Psychostimulants, agents used for ADHD and nootropics

Donors’ medications related to the donation-process are not included.

Sociodemographic data

Sociodemographic data on the index women were retrieved from the first questionnaire answered at the time of acceptance as a donor. Comparable data regarding the comparison group could not be retrieved from the national registers used in the current study.

Ethical consideration

The study was approved by the Swedish Ethical Review Authority with dnr: 2020-04431. All data have been pseudonymized. Following Swedish legislation, no informed consent was needed and thus not obtained for the current study.

Statistics

Data are presented as numbers (n) and percentages (%). Pearson’s chi-square test was used to analyse categorical variables. Continuous data were presented as mean and SD, and differences between oocyte donors and comparison groups were analysed using Student’s t-test. Analyses were stratified by type of donation, i.e. directed vs non-directed donation as well as year of birth, <1973 vs ≥1973, respectively. In the analyses of the total use of specialized health care, the ICD-chapter I through ICD-chapter XVII were included. All analyses were performed using SPSS version 29 (SPSS IBM Inc., Armonk, NY, USA). Statistical significance was defined as P < 0.05 (two-sided).

Results

Among the oocyte donors, 49 of the women were born before 1973, and 121 women were born between 1973 and 1987 (Table 1). At inclusion, their median age was 31 years, ranging from 20 to 40 years. The donors at the extreme ends of the range were directed donors known to the recipients, i.e. sisters or close friends.

The overall median age, in 2018, among oocyte donors was 42 years, 46 years among oocyte donors born before 1973, and 40 years among oocyte donors born between 1973 and 1987. The median age in 2018 was 37 years in the comparison group and 42 years among the matched controls. For the donors before 1973, the median age at the end of follow-up in 2023 was 52 and 46 among donors born 1973 and onwards. Two donors were deceased at the end of the follow-up due to colon cancer and breast cancer.

In Table 4, all medical conditions requiring specialized care are shown for all women included in the study.

Table 4.

Medical conditions requiring specialised hospital care, presented by oocyte donors and comparison groups.

	Oocyte donors								Comparison groups
	Before donation			Total Before and after donation					Total	Matched
	All donors n = 170	Directed donors n = 21	Non-directed n = 149	All donors n = 170	Directed donors n = 21	Non-directed n = 149	<1973 n = 49	1973–1987 n = 121	All women born 1973–1987 n = 713 057	Four matched controls n = 680	<1973 vs 4 controls	73–87 vs 4 controls
	n (%)	n (%)	n (%)	n (%)	n (%)	n (%)	n (%)	n (%)	n (%)	n (%)	P-value	P-value
Infection	13 (7.6)	0 (0.0)	13 (8.7)	37 (21.6)	7 (33.3)	30 (20.1)	9 (18.4)	28 (23.1)	203 967 (28.6)	180 (26.5)	0.211	0.441
Neoplasm, total	18 (10.5)	2 (9.5)	16 (10.7)	51 (29.8)	12 (57.1)	39 (26.2)	19 (38.8)	31 (25.6)	184 949 (25.9)	185 (27.2)	0.081	0.717
Malignant	0 (0.0)	0 (0.0)	0 (0.0)	3 (1.8)	0 (0.0)	3 (2.0)	2 (4.1)	1 (0.8)	5372 (0.8)	3 (0.4)	0.003	0.585
Benign	12 (7.0)	2 (9.5)	10 (6.7)	36 (21.1)	11 (52.4)	25 (16.8)	15 (30.6)	21 (17.4)	138 315 (19.4)	140 (20.6)	0.098	0.566
In-situ + unspecified	5 (2.9)	–	5 (3.4)	18 (10.5)	5 (23.8)	13 (8.7)	4 (8.2)	14 (11.6)	58 393 (8.2)	61 (9.0)	0.848	0.818
Blood	2 (1.2)	–	2 (1.3)	5 (2.9)	0 (0.0)	5 (3.4)	1 (2.0)	4 (3.3)	39 386 (5.5)	47 (6.9)	0.184	0.134
Endocrine	7 (4.1)	–	7 (4.7)	31 (18.1)	5 (23.8)	26 (17.4)	8 (16.3)	23 (19.0)	113 795 (16.0)	116 (17.1)	0.895	0.602
Mental	17 (9.9)	4 (19.0)	13 (8.7)	41 (24.0)	11 (52.4)	30 (20.1)	8 (16.3)	33 (27.3)	156 818 (22.0)	131 (19.3)	0.613	0.044
Mental and behavioural disorders due to psychoactive substance use	2 (1.2)	1 (4.8)	1 (0.7)	13 (7.6)	3 (14.3)	10 (6.7)	2 (4.1)	11 (9.1)	31 484 (4.4)	23 (3.4)	0.795	0.004
Schizophrenia, schizotypal and delusional disorders	–	–	–	–	–	–	–	–	5700 (0.8)	4 (0.6)	–	–
Mood (affective) disorders	9 (5.3)	1 (4.8)	8 (5.4)	24 (14.1)	3 (14.3)	21 (14.1)	4 (8.2)	20 (16.5)	72 730 (10.2)	62 (9.1)	0.822	0.013
Neurotic, stress-related and somatoform disorders	7 (4.1)	1 (4.8)	6 (4.0)	30 (17.6)	7 (33.3)	23 (15.4)	7 (14.3)	23 (19.0)	98 349 (13.8)	77 (11.3)	0.531	0.018
Behavioural syndromes associated with physiological disturbances and physical factors	2 (1.2)	1 (4.8)	1 (0.7)	9 (5.3)	1 (4.8)	8 (5.4)	0 (0.0)	9 (7.4)	22 899 (3.2)	20 (2.9)	0.223	0.015
Disorders of adult personality and behaviour	3 (1.8)	1 (4.8)	2 (1.3)	5 (2.9)	2 (9.5)	3 (2.0)	0 (0.0)	5 (4.1)	17 909 (2.5)	10 (1.5)	0.392	0.047
Disorders of psychological development	–	–	–	3 (1.8)	1 (4.8)	2 (1.3)	0 (0.0)	3 (1.8)	6662 (0.9)	7 (1.0)	0.475	0.186
Behavioural and emotional disorders with onset usually occurring in childhood and adolescence	–	–	–	10 (5.9)	2 (9.5)	8 (5.4)	0 (0.0)	10 (8.3)	17 523 (2.5)	17 (2.5)	0.263	0.001
Nervous	9 (5.3)	1 (4.8)	8 (5.4)	34 (19.9)	7 (33.3)	27 (18.1)	6 (12.2)	28 (23.1)	76 685 (10.8)	98 (14.5)	0.675	0.015
Extrapyramidal and movement disorders	–	–	–	2 (0.7)	0 (0.0)	2 (1.3)	1 (1.0)	1 (0.6)	1950 (0.3)	0 (0.0)	<0.001	0.018
Demyelinating diseases of the central nervous system	–	–	–	2 (0.7)	0 (0.0)	2 (1.3)	0 (0.0)	2 (1.1)	2961 (0.5)	4 (0.6)	0.590	0.211
Episodic and paroxysmal disorders	6 (2.1)	1 (4.8)	5 (3.4)	28 (10.0)	4 (19.0)	24 (16.1)	6 (5.8)	22 (12.6)	46 045 (7.5)	57 (8.4)	0.353	<0.001
Other disorders of the nervous system	2 (0.7)	0 (0.0)	2 (1.3)	3 (1.1)	0 (0.0)	3 (2.0)	0 (0.0)	3 (1.7)	4376 (0.7)	6 (0.9)	0.509	0.125
Eye	6 (3.5)	3 (14.3)	3 (2.0)	33 (19.3)	9 (42.9)	24 (16.1)	10 (20.4)	23 (19.0)	106 620 (15.0)	96 (14.1)	0.228	0.163
Ear	3 (1.8)	0 (0.0)	3 (2.0)	17 (9.9)	4 (19.0)	13 (8.7)	8 (16.3)	9 (7.4)	77 195 (10.8)	54 (7.9)	0.042	0.850
Circulatory	9 (5.3)	1 (4.8)	8 (5.4)	21 (12.3)	3 (14.3)	18 (12.1)	8 (16.3)	13 (10.7)	65 775 (9.2)	70 (10.3)	0.187	0.881
Respiratory	19 (11.1)	5 (23.8)	14 (9.4)	48 (28.1)	10 (47.6)	38 (25.5)	14 (28.6)	34 (28.1)	209 095 (29.3)	196 (28.8)	0.970	0.871
Digestive	18 (10.5)	1 (4.8)	17 (11.4)	50 (29.2)	10 (47.6)	40 (26.8)	12 (24.5)	38 (31.4)	213 894 (30.0)	197 (29.0)	0.503	0.588
Skin	19 (11.1)	2 (9.5)	17 (11.4)	48 (28.1)	9 (42.9)	39 (26.2)	14 (28.6)	34 (28.1)	195 087 (27.4)	169 (24.9)	0.562	0.449
Musculoskeletal	24 (14.0)	1 (4.8)	23 (15.4)	58 (33.9)	6 (28.6)	52 (34.9)	21 (42.9)	37 (30.6)	213 663 (30.0)	229 (33.7)	0.191	0.505
Genitourinary	84 (49.1)	13 (61.9)	71 (47.6)	134 (78.4)	19 (90.5)	115 (77.2)	39 (79.6)	95 (78.5)	391 547 (54.9)	366 (53.8)	<0.001	<0.001
Other diseases of the urinary system	12 (7.1)	3 (14.2)	9 (6.0)	33 (19.4)	5 (23.8)	28 (18.8)	11 (10.6)	21 (12.0)	59 696 (9.7)	73 (10.7)	0.013	0.037
Disorders of the breast	3 (1.8)	0 (0.0)	3 (2.0)	12 (4.3)	1 (5.9)	11 (7.4)	7 (6.7)	5 (2.9)	35 531 (5.8)	50 (7.4)	0.081	0.197
Inflammatory diseases of the female pelvic organs	16 (9.4)	4 (19.0)	12 (8.0)	33 (11.8)	7 (33.3)	26 (17.4)	7 (6.7)	26 (14.9)	114 047 (18.5)	102 (15.0)	0.892	0.063
Non-inflammatory disorders of the female genital tract	70 (41.2)	9 (42.8)	61 (40.9)	120 (43.0)	18 (85.7)	102 (68.5)	34 (69.3)	86 (71.1)	249 522 (35.0)	272 (40.0)	<0.001	<0.001
Other disorders of the genitourinary system	–	–	–	–	–	–	–	–	954 (0.2)	0 (0.0)	NA	NA
Pregnancy	106 (62.0)	12 (57.1)	94 (63.1)	135 (78.9)	16 (76.2)	119 (79.9)	40 (81.6)	95 (78.5)	520 758 (73.0)	551 (81.0)	0.011	0.518
Congenital	2 (1.2)	–	2 (1.3)	7 (4.1)	2 (9.5)	5 (3.4)	1 (2.0)	6 (5.0)	43 422 (6.1)	30 (4.4)	0.427	0.789
Symptoms	42 (24.6)	5 (23.8)	37 (24.8)	105 (61.4)	15 (71.4)	90 (60.4)	30 (61.2)	75 (62.0)	362 867 (50.9)	319 (46.9)	0.072	0.002
Injury	34 (19.9)	5 (23.8)	29 (19.5)	79 (46.2)	13 (61.9)	66 (44.3)	23 (46.9)	56 (46.3)	289 377 (40.6)	258 (37.9)	0.211	0.061
External	7 (4.1)	7 (33.3)	0 (0.0)	7 (4.1)	7 (33.3)	0 (0.0)	3 (6.1)	4 (3.3)	18 157 (2.5)	32 (4.7)	0.654	0.493
Factors	119 (69.6)	16 (34.1)	–	152 (88.9)	21 (100.0)	–	41 (83.7)	111 (91.7)	587 494 (82.4)	556 (81.8)	0.738	0.007

Before donation, around 10% of the oocyte donors had been treated in hospital for non-malignant neoplasms, mental disorders, or respiratory, digestive, or skin disorders. Before donation, just over 5% of the women had sought specialized healthcare treatment due to diseases of the nervous system, and 6 out of 10 donors had been treated in accordance with the ICD chapter ‘Pregnancy, childbirth and the puerperium’ (indicating pregnancy, though not necessarily the live birth of an infant) (Table 4).

When comparing oocyte donors to the matched control group, oocyte donors in the older cohort (born before 1973) seemed to have a higher incidence of malign neoplasm, but the absolute number of women with a malignancy was low (two individuals), and conclusions cannot be drawn.

Comparing the oocyte donors to the matched control group with regard to diagnoses in the 15 included ICD chapters during the total study period, there were relatively few group differences (Table 4). Oocyte donors born in 1973 and onwards had significantly more diagnoses within mental, nervous, and genitourinary chapters. The older donors (born before 1973) had also significantly more genitourinary conditions than did the control group (Table 4).

Directed donors seemed to have been diagnosed more often with a mental health disorder than non-directed donors (52.4% vs 20.1%, NS).

Comparisons of the proportions of women with diagnoses across different ICD chapters before and after donation revealed few statistically significant differences between non-directed donors and matched controls (Table 5). Significant differences were observed for infectious diseases and diseases of the eye and the ear, where non-directed donors had a lower prevalence of diagnoses before donation but a higher prevalence after donation compared with matched controls. A similar, although non-significant, pattern was observed across most other diagnostic groups. Disorders of the nervous system constituted a non-significant exception to this trend. In contrast, genitourinary conditions were significantly more prevalent among non-directed donors than among matched controls both before donation (47.6% vs. 35.5%, P = 0.005) and after donation (29.5% vs. 18.5%, P = 0.003; Table 5).

Table 5.

Medical conditions requiring specialized hospital care, presented by before and after donation.

	Controls		Non-directed donors
	Before 2009	After 2009	Before donation	After donation	Donors vs controls before	Donors vs controls after
Diagnosis chapter	n (%)	n (%)	n (%)	n (%)	P-value	P-value
Infection	120 (17.6)	60 (8.8)	13 (8.7)	17 (11.4)	<0.001	<0.001
Neoplasm	94 (13.8)	91 (13.4)	16 (10.7)	23 (15.4)	0.312	0.510
Blood	19 (2.8)	28 (4.1)	2 (1.3)	3 (2.0)	0.307	0.220
Endocrine	46 (6.8)	70 (10.3)	7 (4.7)	19 (12.8)	0.348	0.280
Mental	71 (10.4)	60 (8.8)	13 (8.7)	17 (11.4)	0.529	0.325
Nervous	40 (5.1)	58 (8.5)	8 (5.4)	19 (12.8)	0.808	0.108
Eye	40 (5.9)	56 (8.2)	3 (2.0)	21 (14.1)	<0.001	0.078
Ear	33 (4.9)	21 (3.1)	3 (2.0)	10 (6.7)	0.006	0.002
Circulatory	40 (5.8)	30 (4.4)	8 (5.4)	10 (6.7)	0.808	0.235
Respiratory	102 (15.0)	94 (13.8)	14 (9.4)	14 (9.4)	0.057	0.470
Digestive	117 (17.2)	80 (11.8)	17 (11.4)	23 (15.4)	0.061	0.218
Skin	94 (13.8)	75 (11.0)	17 (11.4)	22 (14.8)	0.289	0.199
Musculoskeletal	114 (16.8)	115 (16.9)	23 (15.4)	29 (19.5)	0.016	0.457
Genitourinary	240 (35.3)	126 (18.5)	71 (47.6)	44 (29.5)	0.005	0.003
Pregnancy	384 (56.5)	167 (24.6)	94 (63.1)	25 (16.8)	0.139	0.041
Congenital	21 (3.1)	9 (1.3)	2 (1.3)	3 (2.0)	0.240	0.523

Investigating the total use of specialized healthcare during the study period, it was found that oocyte donors had about twice as many outpatient visits as compared to the comparison group, even when excluding visits regarding genitourinary disorders (donors’ mean number of visits/SD 17.86/20.62, control group 10.09/17.11, P < 0.001) (Table 6). However, oocyte donors had not been hospitalized more often.

Table 6.

Total¹ number of visits to specialized healthcare service during the study period.

							Comparison group(s)
	Oocyte donors All Mean/SD	<1973 Mean/SD	1973–1987 Mean/SD	Directed donors Mean/SD	Non-directed donors Mean/SD	P-value	MFR 73–87 All women comparison group Mean/SD	MFR 73–87 4 matched controls Mean/SD	<1973 vs 4 controls P-value	73–87 vs 4 controls P-value
Total including genitourinary
Inpatient	4.50/4.15	3.74/3.02	4.84/4.54	5.22/4.83	4.41/4.07	NS	4.96/10.25	4.05/6.60	0.749	0.214
Outpatient	25.69/21.97	24.70/15.87	25.94/24.03	35.38/26.38	24.18/21.03	0.028	13.64/19.78	14.03/19.82	<0.001	<0.001
Total excluding genitourinary2
Inpatient	4.42/4.08	2.91/1.76	4.03/3.56	4.94/4.80	3.53/2.86	NS	3.95/7.42	3.80/6.30	0.325	0.699
Outpatient	17.86/20.62	16.30/13.51	18.36/22.87	25.19/26.86	16.71/19.48	NS	10.09/17.11	10.24/17.57	<0.001	<0.001
Before year of donation
Inpatient	2.88/2.04	2.35/1.77	2.93/2.04	2.78/1.56	2.82/0.39	NS
Outpatient	10.74/19.48	9.53/12.29	10.98/21.64	9.52/13.29	10.70/20.13	NS
From year of first donation and onwards
Inpatient	3.04/3.39	2.72/1.86	3.14/4.26	3.92/1.33	2.88/2.04	NS
Outpatient	18.7/17.15	17.04/15.22	19.18/17.83	30.05/27.86	16.95/14.41	<0.001

¹Infection, Neoplasms, Blood, Endocrine, Mental, Nervous, Eye, Ear, Circulatory, Respiratory, Digestive, skin, Musculoskeletal, Genitourinary, Congenital.

²Visits related to the donation process have been removed.

NS, not significant.

Before donation, donors-to-be had not had more outpatient visits than the comparison group.

Moreover, in comparing the use of specialized health care among directed and non-directed donors, directed donors had a much higher number of outpatient visits from the year of first donation onwards (30.05/27.86 vs 16.95/14.41, P < 0.001; Table 6).

In Table 7, drugs from ATC levels C (cardiovascular system), G (genitourinary system and sex hormones), H (systemic hormonal preparations, excl. sex hormones and insulins), L (antineoplastic and immunomodulating agents), and N (nervous system) prescribed and dispensed from 2005 onwards are presented. Overall, the oocyte donors had more often received prescribed drugs compared to the matched controls. More than 40% of the oocyte donors had used antidepressants, and 37% had used sedatives (Table 7). However, among directed donors, the use of anxiolytics, hypnotics and sedatives, and antidepressants after donation was markedly higher (ranging between 57 and 76%) compared to women who donated their oocytes to unknown recipients (ranging between 33 and 39%), all P-values < 0.05 (Table 7).

Table 7.

Dispensed drugs from 2005 onward.

						Comparison group(s)
	Oocyte donors All donors	Donors born <1973	Donors born 1973–1987	Directed donors	Non-directed donors	MFR 73–87 All women comparison group	MFR 73–87 4 matched controls	<1973 vs 4 controls	73–87 vs 4 controls
	n (%)	n (%)	n (%)	n (%)	n (%)	n (%)	n (%)	P-value	P-value
ATC
C—Cardiovascular system	55 (32.4)	17 (34.7)	38 (31.4)	6 (28.6)	49 (32.8)	162 841 (22.8)	92 (27.1)	<0.001	0.213
G—Genitourinary system and sex hormones	166 (97.6)	46 (93.9)	120 (99.1)	20 (95.2)	146 (98.0)	602 192 (84.5)	288 (84.7)	<0.001	<0.001
H—Systemic hormonal preparations, excluding sex hormones and insulins	125 (73.5)	37 (75.5)	88 (72.7)	16 (76.2)	109 (73.2)	238 296 (33.4)	118 (34.7)	<0.001	<0.001
L—Antineoplastic and immunomodulating agents	61 (35.9)	19 (38.8)	42 (34.7)	7 (33.3)	54 (36.2)	45 755 (6.4)	30 (8.8)	<0.001	<0.001
N—Nervous system	129 (75.9)	36 (73.5)	93 (76.9)	16 (76.2)	113 (75.8)	466 716 (65.5)	221 (65.0)	0.012	<0.001
N05A—Antipsychotics	10 (5.9)	0 (0.0)	10 (8.3)	2 (9.5)	8 (5.4)	NA	NA	NA	NA
N05B—Anxiolytics	63 (37.1)	35 (71.4)	38 (31.4)	14 (66.7)	49 (32.9)1	NA	NA	NA	NA
N05C—Hypnotics and sedatives	62 (36.5)	20 (40.8)	42 (34.7)	12 (57.1)	50 (33.6)2	NA	NA	NA	NA
N06A—Antidepressants	74 (43.5)	19 (38.8)	55 (45.4)	16 (76.2)	58 (38.9)3	NA	NA	NA	NA
N06B—Psychostimulants, agents used for ADHD and nootropics	7 (4.1)	0 (0.0)	7 (5.6)	1 (4.8)	6 (4.0)	NA	NA	NA	NA

Oocyte donors and comparison groups—follow-up until 20171231; NA—data not available; Donors’ medications related to the donation-process are not included.

¹ P = 0.003;

² P = 0.036,

³ P = 0.001 when comparing directed vs non-directed donors.

During the final 5 years of follow-up (2018–2023), the prevalence and distribution of diagnoses among the donors were broadly similar to those observed earlier in the follow-up period. Any deviations appeared consistent with age-related changes, such as a lower prevalence of pregnancy-related disorders (data not shown).

Discussion

During the recruitment process to become an oocyte donor, an assessment of health and risk of hereditary disorders is performed, suggesting that this group of women is assumed to have a lower risk of developing diseases in the future following the donation. This could not be confirmed in this prospective and longitudinal 20-year follow-up of a national sample of oocyte donors in Sweden, as the donors had a rather similar burden of diagnoses as women in the general population. In contrast, where differences were found, the proportion of women with a specific diagnosis appeared higher in the group of donors compared with the control group of women.

Approximately 10% of the women who had donated their oocytes in a non-commercial IVF programme had received specialized care for non-malignant neoplasms, mental disorders, respiratory disorders, digestive disorders, or skin disorders before their donation. It was expected that donors would have various diagnoses before their donation. However, it was assumed that conditions present before donation had either been cured/healed or were not regarded as severe, as the donors were allowed to proceed with their donations. Nevertheless, 10% of the donors had mental disorder diagnoses such as substance abuse or affective disorder, and just over 5% of oocyte donors had sought pre-donation treatment from specialized healthcare due to diseases of the nervous system. Approximately 50% of the donors had received a genitourinary diagnosis prior to donation, and this proportion increased to almost 80% when including the period after the donation. In general, these diagnoses were non-inflammatory disorders (ICD-10 codes N80–N98). Complications of the donation procedure itself (caused by the hormonal stimulation or the ovum pick-up) cannot be ruled out as an explanation but complications are rare according to the Swedish quality register of IVF treatments (Q-IVF: Nationellt Kvalitetsregister för Assisterad Befruktning, 2024). Furthermore, the prevalence of genitourinary conditions was higher among non-directed donors than among matched controls donors both before and after donation (with diagnoses registered before and after 2009 as proxies for the controls). Taken together, these findings suggest that donation-related complications alone are unlikely to account for the elevated prevalence of genitourinary diagnoses.

Few women (12%) donated to a known recipient couple. These women indicated a higher incidence of multiple diagnoses compared to non-directed donors, though not reaching statistical significance. This could possibly be explained by a more generous view on existing diagnoses at the pre-donation assessment and not expected to impact the health of the child or the donor when accepted as a directed donor. There might also be a possibility that these donors did not provide a complete medical history.

From the year of donation onwards, the donors had approximately twice as many outpatient visits to specialized health care compared to the controls. This does not necessarily imply that the donors’ disease burden was more severe but could indicate more frequent use of specialized health care instead of primary care. Donors were also more often diagnosed with symptoms not elsewhere classified (ICD-10 R00–R99), which could indicate a different health-seeking behaviour.

As the donors had used more specialized care, one could assume that they also had more visits to primary care, as reflected in the oocyte donors’ use of prescribed drugs, which was higher in the donor group than in the comparison group. The difference in filled prescriptions was statistically significant for all investigated groups of ATC codes, except for drugs used for cardiovascular diseases (ATC code C). The study does not allow conclusions to be drawn on whether the higher use of prescribed drugs was caused by a true higher burden of diseases or was a consequence of an increased tendency to seek health care among previous oocyte donors. The use of medication for mental conditions was higher among women who knew the recipient couple compared with non-directed donors. This might indicate that these women are more vulnerable and might have needed a more thorough assessment process before donation. Also, these women could perhaps benefit from being offered medical and psychological follow-up after the donation.

The oocyte donors in the present study had their mental health assessed across five waves of data collection for the SSGD. At the first follow-up, 4% of the women showed symptoms of depression, and 13% showed symptoms of anxiety on the Hospital Anxiety and Depression scale (HADS). At the fifth follow-up, these numbers had doubled: 9% and 24% showed symptoms of depression and anxiety, respectively (Sydsjo et al., 2023). The increased rates of depression and anxiety could partially explain the high rate of antidepressant use among the donors found in the present study, as more than 40% had filled at least one prescription. Also, after the donation, donors born from 1973 onwards were more often diagnosed with mental disorders due to substance use, neurotic disorders, and behavioural syndromes associated with physiological disturbances.

It has been shown that the personalities of oocyte donors reflect greater persistence and lower levels of worry, shyness, uncertainty, and fear compared to an age-matched control group of women (Sydsjö et al., 2011). One can speculate that, since the vast majority of women who donate their oocytes state that they want to help other women to have a family, and therefore they want to do good, there is a risk during the assessment before acceptance that the women may present themselves as healthy with no hereditary or present medical conditions. They may fail to recall or even deliberately conceal information on hereditary or their own diseases. In commercial egg banks, this might be more prevalent since the financial compensation provided has been shown to be a motive for some oocyte donors (Pennings et al., 2025). During the assessment procedure, access to the donors’ medical records is recommended for screening purposes. A register of donors would be beneficial not only to provide information on the number of children conceived per donor but also to allow follow-up on donors with respect to future health issues.

Due to a shortage of donated oocytes, there is also a risk that the medical staff assessing a donor-to-be may normalize the medical history and, in an attempt to increase the number of donors, accept a donor-to-be even if they are not completely healthy. One must also keep in mind that determining the severity of a previous condition and to what extent it might influence potential offspring is not a standardized medical procedure.

The oocyte donors in the present study were between 20 and 40 years of age when accepted into the donor programme. The oldest women and the youngest women were all known donors to the recipient couples, and it could be speculated that this might have had an influence on the results regarding the number of healthcare contacts and also the prescriptions of drugs. The possible complications after an oocyte donation were found to differ slightly between the directed and the non-directed donors. Directed donors are likely to form relations with the donor-conceived child, as they already have a relationship with the recipient parents. If the directed donor develops disorders or if they experience worsening of diseases that were present before the donation, this might raise concerns regarding the risk of inheritance. After the donation, disorders that develop could be attributed to the donation procedure, leading to feelings of guilt or regret. These are concerns that are important to discuss with both recipients and donors before a donation can take place.

The medical development in the field of third-party donation and the shortage of high-quality oocytes have made it possible to establish oocyte banks storing frozen oocytes that can be sold and used in many countries, not only the country and clinic where the actual donation took place. The recruitment procedures and safety for both donors and recipients are of the utmost importance. Guidelines have been developed, and most countries follow the recommendations of fertility associations in the USA and Europe, as well as national guidelines (ESHRE Psychology and Counselling Guideline Development Group, 2015; ASRM, 2021; ESHRE Working Group on Reproductive Donation et al., 2022; The Practice Committee of the American Society for Reproductive Medicine and the Practice Committee for the Society for Assisted Reproductive Technology, 2024). A society that accepts gamete donation to help individuals have healthy children must strive to ensure rigorous medical and psychological assessments. Donor-conceived persons seeking information about their donors and who are also interested in personal contact with their donor are often concerned about the donors’ health and the presence of hereditary illness in the donors’ family (Widbom et al., 2024). The intention of assisted reproduction using donated gametes must therefore be to achieve the birth of a healthy child, and the recruitment programme of donors must be designed to fulfil this purpose. However, even though the birth of a healthy child is the ultimate purpose, this cannot be guaranteed, as the ability of the screening process to detect severe hereditary diseases can never be fully comprehensive. Also, there are hereditary factors and genes from the other parents-to-be that need to be considered and included in the information provided to the recipient couples or individuals.

Strengths and limitations

The main methodological strengths of the present study are the registers’ reliability and the use of an age-matched control group of women derived from the same national registers. Other strengths are the combined use of registers for drugs, healthcare use and diagnoses, and the longitudinal perspective when evaluating the health conditions in women both before and after their donation of oocytes. However, a limitation of this study is the difficulty in retrieving information on primary care from national registers in Sweden. Consequently, a potential underestimation of healthcare and of health diagnosis must be taken into consideration when interpreting the results, but these conditions apply to the group of oocyte-donating women as well as to the control group. Also, some diagnoses might be inconsistent or wrongly recorded in the patient records. An age-matched control group for the oldest donors, born between 1965 and 1972, could not be constructed; therefore, these donors are compared to a slightly younger group of controls, born in 1973. Finally, the present results concern a national cohort of oocyte donors who underwent medical and psychosocial evaluation between 2005 and 2008. Thus, it is possible that current screening procedures for oocyte donors-to-be in Sweden differ in certain regards from those used with the present study participants.

Conclusion

Overall, oocyte donors had approximately twice as many outpatient visits as matched controls, while outpatient healthcare utilization prior to donation appeared similar between the groups. Donors were hospitalized as often as the control group. Directed donors exhibited a substantially higher number of outpatient visits than non-directed donors from the year of donation and throughout follow-up. Following the donation, disorders of the genitourinary system—and, among donors born in 1973 and onwards, certain mental and nervous health disorders—were more common among oocyte donors.

Additionally, oocyte donors were more frequently prescribed medications compared to age-matched controls. Our findings suggest that the pre-donation assessment of health status and hereditary disease risk does not reliably identify women with a lower predisposition to future disease or need for medication.

Data availability

The data will be shared on reasonable request by the corresponding author.

Authors’ roles

GS, MB, SL, CL, ASS, and EN conceptualized, planned, and designed the study. MB was responsible for data analyses. GS was primarily responsible for writing the paper. All authors were involved in interpreting the results and revising the paper with respect to content. All authors approved the final version of the manuscript for submission.

Funding

The study was financed by grants from the Swedish state under the agreement between the Swedish government and the county councils, ALF Grants, Region Östergötland, and from the Swedish Research Council (2013-2712; 2021-03174).

Disclosures

None of the authors have any competing interests to report in relation to the current study.