Egg donation is the proposed method of treating female infertility in which the women cannot produce viable eggs or they have chromosomal defects making natural conception undesirable. Our centre provides an active egg donor programme without being related to any egg donor agencies. We are very sensitive in the selection of egg donors. They must meet the following criteria:
– They are healthy women between the ages of 19 and 30.
– Preferably they have children of their own.
– They are well educated
– They have no history of mental disorders
-The donors are physiologically and psychologically well prepared for the programme.
-They have not met the recipient couples.
The donors and the recipients are matched according to the similarities in many factors such as skin tone, ethnicity, hair and eye colour, education and medical history.
As in normal IVF cases, some powerful hormones are used to synchronize the natural cycles of the female donor and recipients. Sperm, from the recipient’s partner is used to fertilize the donor’s egg(s) in the laboratory and the resulting embryos are placed in the recipient’s uterus that has been prepared to sustain pregnancy.
EGG DONATION CYCLE
There are several problems underlying egg donation cycles. The main problems related to advanced reproductive age are diminished ovarian reserve, insufficient production of eggs or the production of poor quality eggs. In other cases, not only in advanced age, women of all ages, may meet infertility problems and choose oocyte donation as an alternative. Their infertility may be linked to several factors such as:
– Disease of the ovaries
– Absence of the ovaries
– Severe endometriosis
– Elevated levels of FSH
– Premature ovarian failure
– Severe Pelvic inflammatory Disease
A donor egg cycle is much more complex than a regular IVF cycle. It requires synchronization of both the donors and the recipients systems. The donors natural reproductive processes are supressed at first in order to prevent production of their egg-producing follicles. The recipient’s body is then prepared to accept the fertilized embryo when the egg donor begins controlled ovarian stimulation.
After oocyte retrival, they are taken to the laboratory for fertilization. Sperm is collected from the male partner of the recipient on the day of egg retrieval and prepared for intracytoplasmic sperm injection (ICSI) which is the fertilization procedure routinaly used in our laboratory. In cases of inavailability of sperm in the semen, it is obtained by surgical techniques and extracted from the testes or scrotum. In other cases, couples may choose to use donor sperm.
The fertilized embryos are placed in a fresh cleavage medium and left to develop for several days before the transfer. The transfer is generally done on day 3 when embryos are normally developed to the 6 or 8 cell stage. In some cases, depending on the embryo quality, they are allowed to develop until day 5 up to the blastocyst stage that contain more then 100 cells.
Finding an appropriate egg donor:
Candidates are between the ages of 19 and 30 and they must not have donated more than three times. Each egg donor undergoes an extensive consultation with the assistance of a doctor and nurse, to determine her suitability for ovum donation. This medical screening process includes:
– baseline ultrasounds and blood work: to determine hormone levels, absence of substance abuse, sexually transmitted or other diseases, and her physical ability to undergo follicle stimulation and oocyte retrieval.
– Genetic screening, when indicated, to test whether the individuals carry a genetically transmitted disease.
– Psychological screening and counselling: to discover whether the candidate egg donor is able to deal with the psychological aspect of the stimulation.
The history of the egg donation is very important to us. The donor must not have donated in excess of what we recommend. If the previous donation with us was successful, if the resulting embryos were good quality, she may qualify for shared egg donor cycle.
Both partners are screened to determine their suitability for the donation process. They are evaluated and counselled in order to determine that they fully understand the nature of the process. The physical screening of the female partner includes examination by a gyneocologist and several tests such as:
– blood tests including CMV, Hepatitis B and C, HIV, Rubella, Syphilis, blood type and Rh factor, TSH.
– Examination including catheter check, mock cycle, hysterosalpingogram(HSG)
Also, a medical review and evaluation by a physician may be required for recipients over age 47 who are more susceptible to medical problems.
The male partner is screened for the same blood tests as females and will also have:
– semen analysis
– blood type and Rh factor
Cycle synchronization for egg donation
You must call us on the first day of your menses. Blood work will be done on the 21day of your cycle and following it; you will begin an injection of a GnRH agonist(synarel,suprefact or suprecur) each night. This will ‘turn of’ your natural ovarian stimulation and after 7 to 10 days, new menstrual period begins. You will call us on the first day of your menses and blood work, ultrasound and further medication will be begin on the third day. Routine monitoring will continue in our office approximately every four days. This may be carried out in our clinic or in your own country, but we must be aware of the timelines involved so as to be able to synchronize with the donor.
If you are on the birth control pill, an agonist may be given at the same time for 4-7 days. Then the pill will be stoped, this usually induces menses in 1-3 days. After that you will have an ultrasound and then you will start on progesterone. Those women without ovaries will not need to use agonist, they will simply stop their usual hormone replacement regimen, get an ultrasound and blood work and then start estrogen replacement tablets.
On day 3 of their menses, the donor will start taking their follicle stimulating medications and you will begin to take estradiol valerate or dihydrate or estrofem. This drug is an oral form of estrogen and is used in different dosages a day as we instruct. It induces growth of the uterine lining. At the same time, you will continue taking an agonist to eliminate development of your follicles.
During this time,you will visit us or your own consultant approximately every four days for blood work and ultasound monitoring. On the day of egg retrieval, your partner will give a semen sample for the eggs to be fertilised with his sperm. That evening, you will discontinue agonist and begin progesterone supplementation. The dose of estrogen that you continue to use may be adjusted. You will also take a low dose steroid that helps to supress your immune system and aid in implantation. Additionally, an oral antibiotic is used in order to decrease bacteria in the uterus that interfere with implantation.
This estrogen and progesterone protocol will continue until pregnancy test, 12 days after the transfer and if positive until the 12th week of pregnancy.
Before embryo transfer, you will be monitored carefully by our donor team in order to determine that you are ready for transfer. If the result of the pregnancy test is positive we will also continue to monitor your progress for approximately 4 to 5 weeks.
A few days after the donor oocytes are fertilized by your partner’s or donor sperm, you will come to our laboratory for the embryo transfer. Transfer is a simple and painless technique but some patients require anesthesia to relax their muscles. On the same day the embryologist will give you information about the quality of embryos to be transferred. The proceedure is very similar to that of intrauterine insemination. You have to drink approximately 1 lt of water before the transfer, as a full bladder allows the Doctor to identify the uterus using a transabdominal ultrasound more easily, it straigthens out the cervix and allows the transfer to go more smoothly.
Risk and side effects:
Any possible risks are discussed fully with you and your partner before the whole procedure. The physical effects of blood testing and hormone therapy are minimal. The intramuscular injections may be painful and if you have highly sensitive skin you may have some minor reactions at the injection sites. Also the transfer may carry the risk of cramping and bleeding.
Our success rates are very high related to a combination of high quality oocytes and the expertise of our team of highly experienced physicians, nurses, embryologists and other laboratory staff.
Our chances for success are significant but there is no quarantee regarding the outcome since the pregnancy is affected by factors that differ in every case. You and your partner may face clinical problems that prevent fertilization or the donor’s cycle may be effected because of stimulation problems. This may decrease the number of the oocytes retrieved from the donor or affect the quality of the embryos in a negative way. Another risk factor is multiple pregnacy but we take precautions to minimise this by decreasing the number of embryos transferred.
We actively recruit egg donors, the number of our egg donors is not limited and you do not have to wait many months, the process of donor screening is very selective and over 70% of potential egg donors are rejected during screening process. The process may be delayed if the recipient couple wants special characteristics in the donor. It is particularly difficult to find egg donors of Asian and African/ American characteristics, however, recently we have been able to identify potential donors so it is possible that we may be able to help.
Cryppreservation and disposition of embryos:
At the end of the cycle, you may end up with more embryos than needed for transfer. If those remaining embryos are of a high enough quality, they will be frozen. Approximately 50% of our donor cycles have extra embryos for freezing. Embryo freezing will allow you to undergo a subsequent transfer without stimulation.