Egg Donation

Who will benefit from oocyte donation?

Oocyte (Egg) donation is offered to a woman who desires to carry and deliver a child that she could not otherwise conceive due to one of the following medical conditions:

1. She has no ovaries, or

2.  She has ovaries which do not produce oocytes (premature ovarian failure), or

3. She has ovaries which produce poor quality oocytes, or

4. Her oocytes are genetically abnormal, or

5. Her oocytes cannot be retrieved due to ovarian inaccessibility.

Sources of Donor Oocytes

Women who are interested in oocyte donation may choose to have a Known or Anonymous donor.

Known Donor

The known donor recipient has to identify a donor oocyte of 21 to 30 years of age, nonsmoker, with a healthy medical and genetic history. The known donor screening testing for infectious diseases is similar to all oocyte donors and is performed according to the standard criteria of the CRH and following the American Society for Reproductive Medicine (ASRM) guidelines. Since the donor and recipient know each other, it is recommended to contact an attorney to prepare a legal contract and have it signed by all parties.

Anonymous Donor

For the anonymous donor, the identities of the donor and the recipient are maintained in strict confidence. Although anonymous oocyte donation is medically analogous to sperm donation and in the present state of technology, oocytes cannot be successfully cryopreserved (frozen) as sperm.

In our program anonymous donors are women of 21 to 30 years of age, nonsmoker, normal body weight, with a healthy medical and genetic history, who must test negative for all the infectious disease screening performed according to the standard criteria of the CRH and following the ASRM guidelines.

These donors are not patients of the CRH but come to the CRH to donate their oocytes for the compassionate reason of helping an infertile woman to achieve a pregnancy. Since they have to receive daily hormonal treatment, several blood testing and vaginal ultrasound monitoring, and a surgical procedure to remove the oocytes, our center strongly feels that these donors should receive a financial consideration for their time, effort and risks involved in the donation of oocytes. In addition, the recipient couple is responsible for paying the entire donor medical expenses related to the oocyte donation.

Screening Requirements for Recipient Couple of Donor Oocytes

1. Initial consultation of the couple with a staff physician of the program to review previous medical records.

2. Physical examination of the female partner to ensure general good health.

3. Female laboratory testing Rubella Immunity, Blood type and RH, HIV antibody, Hepatitis B and C surface antigen, RPR for Syphilis, Cytomegalovirus (CMV), Cervical cultures for Gonorrhea, Chlamydia, Ureaplasma Urealyticum, and Mycoplasma Hominis.

4. Hysterosalpingogram within the past two years to ensure normal uterine (womb) cavity.

5. Male laboratory testing Blood type and RH HIV antibody Hepatitis B and C surface antigen RPR for Syphilis CMV

6. Semen analysis within the past 6 months

Screening Requirements for Donor Oocytes

1.  Complete the Donor Profile questionnaire

2.  Initial consultation and physical examination by the physician

3.  Laboratory testing, to include but not limited to:

4. Cervical Cultures for Gonorrhea, Chlamydia, Ureaplasma, and Mycoplasma.

Matching Physical Characteristics and Treatment Protocols for Donor and Recipients

Physical characteristics of the egg donor such as skin color, eye color, hair color and body build are matched closely as possible to the characteristics of the intended recipient couple. In addition, ethnic background, physical traits, and blood group & Rh factor are matched as accurately as possible. CRH has a large pool of donors oocytes and is usually able to meet most of the recipient’s wishes.

Protocol for the Donor Oocyte Cycle

Recipient

Most recipients undergoing a donor oocyte treatment cycle will receive Lupron, a medication used in women who still have periods to prevent the pituitary gland from releasing the hormones that usually stimulate the ovaries. This is required to synchronize both the recipient and the donor oocyte cycles.

After approximately two weeks of Lupron, the recipient will begin the two-week treatment with Estradiol Valerate, to prepare the uterine lining for implantation. In addition, close to the time of embryo transfer the recipient will start the Progesterone supplementation, another hormone required for implantation of the developing embryos.  The hormonal treatment is continued until the pregnancy test is performed. If a pregnancy is established, the hormonal treatment will continue through the first trimester.

During the treatment cycle both partners should not smoke nor take more than one alcoholic beverage per day, eat healthy food and vitamin supplementation. They should not take any additional medication other than the prescribed by the CRH.

Oocyte Donor

The oocyte donor will undergo ovarian stimulation, which requires the use of fertility drugs such as Humegon7, Repronex 7, Metrodin 7, Fertinex 7 and other commercially available products. This treatment is known as superovulation, and it is used in conjunction with Lupron. To assist in evaluating the response to the superovulation treatment and predicting the time of the expected ovulation, the oocyte donor will be carefully monitored. This is accomplished by several blood testing and vaginal ultrasound examinations.

When the most ovarian follicles have reached adequate development the oocyte donor will receive human chorionic gonadotropin (hCG), an injection to produce the simultaneous development of several oocytes and to control the timing of ovulation, so the oocytes can be retrieved before they are spontaneously released. The oocyte retrieval is usually scheduled 36 hours after HCG administration.

Oocyte Retrieval

The oocyte retrieval is conducted by ultrasound-guided transvaginal follicle aspiration, under mild conscious sedation. For the procedure, a vaginal transducer is placed in the vagina, and then an aspiration needle is inserted alongside the transducer and through the upper part of the vagina directly into each large ovarian follicle. The fluid contained in the follicles is withdrawn and collected into test tubes and examined under the microscope in the IVF laboratory for the presence of the oocytes.

Sperm Collection

The day of oocyte retrieval, a sample donor from the recipient's partner or designated semen donor will have to be available to the IVF laboratory for processing.

In Vitro Fertilization

The mature donor oocytes are combined with the sperm (insemination) about six hours after the oocyte retrieval. If the recipient couple is diagnosed with male factor infertility, then another procedure called Intracytoplasmic Sperm Injection (ICSI) will be required to assist the sperm to fertilize the oocyte. Each oocyte is observed the following morning for fertilization.

The normally fertilized oocytes are then returned to the incubator for an additional 24 hours to allow cell division (cleavage) to occur, and thereafter the fertilized oocyte is called embryo.

Embryo Transfer

If the embryos have developed satisfactorily in the laboratory, up to four of them are selected and placed in the woman's uterus three to five days after the oocyte retrieval. The embryo transfer is a simple painless procedure performed without anesthesia. A speculum is placed into the vagina to visualize the opening into the womb. The embryos are then loaded into a narrow catheter, which it is gently introduced into the uterine cavity, where the embryos will be released for implantation.

The patient is required to stay at the CRH in the transfer room for about one hour, and to limit all her activities for the following 96 hours. A pregnancy test is done approximately ten days after embryo replacement. If a pregnancy ensues, then the Progesterone supplementation is continued for ten more weeks.

Embryo Cryopreservation

Any excess of fertilized oocytes and/or normally developing embryos may be cryopreserved and stored for the patient's future use at the patient's request.

Outcome of Oocyte Donation

Excellent pregnancy rates are reported with oocyte donation; these rates are typically much higher than those for IVF-ET without donation. Possible explanations include the fact that most donors are not infertile and may have higher quality oocytes than infertile patients. Secondly, the recipient endometrium is not hyperstimulated, and may be more receptive to implantation. For these reasons, usually three donated embryos are replaced at any one time.

With high quality embryos, delivered pregnancy rates above 40% have been reported.

A Path Towards Success

We acknowledge that participation in an In Vitro Fertilization Cycle with donor oocyte is a complex procedure. It requires additional time than a routine In Vitro Fertilization cycle because it requires matching of the physical characteristics of the recipient with a donor, preparation of both treatment cycles, financial counseling for the recipient and have the consent forms of both parties explained and signed.

CRH is committed to your success and will lead you through the process towards a successful pregnancy.

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