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OOCYTE DONATION (OD)

Within an Arm's Reach

 I

     The introduction and widespread use of advanced reproductive technology has enabled millions of couples to achieve their dream of having a family.  There are a growing group of women who through traditional treatments are unsuccessful because their ovaries are either unable to produce eggs -- called oocytes – or their oocytes lack the quality to create an embryo and finally a healthy baby. 

     The first report of successful pregnancy trough egg donation was in 1984. After more than 20 years, egg donation is viable option for more than 15% of the couples seeking fertility treatments.    Oocyte donation “OD” is process in which the sperm from the recipient man fertilizes an oocyte from a donor, whose subsequent embryo is inserted into his partner’s uterus with the intention of her becoming pregnant.  Thus, oocyte donation is a common and routine treatment option for many infertile couples.

     OD has the advantage that the couple can share a pregnancy, whose half the genetic make-up comes from the father.  OD cannot protect the expectant mother from the complications of pregnancy and childbirth.  Women who have children by OD have exactly the same risk of an abnormality in their children as those who conceive naturally, based on the same age of the donor. Since the donor is on the average in her early 20s, this risk is low.  There is no decrease or increase in the risk of congenital abnormality due to the technique. 

Who are candidates for oocyte donation treatment?  

Women with Premature Ovarian Failure - Premature menopause: Egg donation can be used successfully for this group of women. These are women who for a variety of reasons have entered menopause at an early age (under age 40, at times in early 20’s).  In some cases, they don't have ovaries. Some women had their ovaries surgically removed for various reasons. This group also includes women who have developed ovarian failure as a result of chemotherapy or radiotherapy treatment for a cancer.

Women with Occult Ovarian Failure: These are women who still have monthly periods and ovulate, but whose eggs are very unlikely to produce a pregnancy. This group is said to have decreased ovarian reserve and can only be diagnosed by Ovarian Reserve Test. This is the largest group of women needing egg donation. Women in this group have the most difficulty deciding to do an egg donation since they still ovulate and have regular menstrual cycles.

Women with Advanced Maternal Age: As a woman’s age increases, her ability to conceive a pregnancy decreases and her risk of miscarriage increases. This is due to a decreased number of eggs remaining in her ovaries and to a decreased potential of those eggs to produce a viable pregnancy. This is true even if they haven't shown to have abnormalities in the ovarian reserve testing

Women who failed with Other Assisted Reproductive Treatments: Occasionally, a couple will choose to use egg donation if they have attempted multiple other treatments without success. Egg donation is most commonly used for patients who have failed in vitro fertilization (IVF) cycles.

Women with Maternal Genetic Abnormalities:  Rarely, women may have genetic or chromosomal abnormalities that they don't want to pass on to a child.  Egg donation can also be a viable option when the problem is known to be hereditary but the exact gene mutation or problem is not known and therefore impossible to test for.

The upper age limit to be an oocyte recipient that we establish in IRIP is 50 years of age

OOCYTE DONATION STEP BY STEP

1. COUPLE APPLICATION TO BECOME EGG RECIPIENT 

2. RECRUITMENT OF AN OOCYTE DONOR

3. MATCHING PROCESS

4. OOCYTE DONOR SCREENING

5. OOCYTE RECIPIENT COUPLE SCREENING   

6. SYNCHRONIZING THE DONOR AND RECIPIENT

7. OVARIAN STIMULATION OF THE OOCYTE DONOR

8. PREPARATION OF OOCYTE RECIPIENT ENDOMETRIUM

9. EGG RETRIEVAL AND FERTILIZATION

10. EMBRYO TRANSFER

11. SUPPORTING THE PREGNANCY WITH HORMONES AND PREGNANCY TEST 

 OOCYTE DONATION

1. COUPLE APPLY TO BECOME DONOR EGG RECIPIENT 

Couples are asked to complete the following questionnaire.  After completing this form you can send it online, or you can fill the pdf form and send it through regular mail

2. RECRUITMENT OF AN EGG DONOR

 What types of women donate oocytes?

There are two forms of donation; one is to recruit known donors (such as a sister, other relative, or friend) and anonymous donors.  Anonymous oocyte donation has gained popularity by providing a larger pool of oocyte donors to meet the growing demand of infertile couples.  In certain circumstances, women who are undergoing IVF themselves, who do not intend to use all of their oocytes may donate them.  CEGYR offers both alternatives: the couple can bring their own known donor or we can provide an unknown donor who matches the recipient’s physical features. Our voluntary and anonymous egg donation program includes healthy women of 21 to 33 years old, with proven fertility.    

Many people are interested in finding out why women become donors.  Studies indicate the most common characteristic donors possess is a desire to help others.  Oocyte Donors are often blood donors and many report having friends and/or family members who have had a fertility problem.

3. MATCHING PROCESS

We understand that choosing to receive donated oocytes carries some uncertainty in terms of matching one’s personal characteristics, however, we work very closely with the donor to match the recipient’s background.

 CEGYR will search for a donor who meets the recipient’s most important expectations, within limitations. One requirement of most anonymous donation program is that anonymity be maintained. In order to accomplish this, we are limited in the amount of information that we can give you about the donor. We cannot tell you much more than donor’s height and weight, hair and eye color, race, blood type, age and formal education.  The donor will not be given any information about the identity of the recipient, nor will she find out about the outcome of the oocyte fertilization or the pregnancy.

We will also provide the recipient with as much known family medical history from the donor. Yet, please keep in mind that the more donor characteristics that you request may result in delays.

Differences in ABO type between mother and fetus pose little risk to the health of the fetus. Therefore, the use of an oocyte donor that has a different ABO type from the recipient and husband is not such a serious medical consideration. While ABO incompatibility is not of medical importance, we understand that some recipient couples request similar ABO types, so as to not reveal the child’s identity later in life.

The matching process takes around 2 to 3 months from the time you confirm your participation in our Egg Donation Program

4. EGG DONOR SCREENING

Our donors are screened according to American Society of Reproductive Medicine guidelines in order to maximize the success rates of oocyte donation and minimize the rates of fetal abnormalities.  All donors undergo a psychological evaluation.  If a donor is determined to be a good candidate, she is counselled regarding the details of the medical procedure that she will undergo, with a complete explanation of the risks and potential complications of taking fertility medications and undergoing the surgical procedure to harvest oocytes. The donor meets our mental health professional who evaluates the psychological tests and performs a detailed assessment of the donor’s psychological well-being. Once it is determined that the donor can proceed, she is then counselled to determine whether she understands the medical information and is able to give an informed consent. Donors are extensively screened for medical diseases, hereditary diseases, psychiatric disease, substance abuse and other high-risk behaviors.

Family and Personal Clinical Records Include:

-Education

-Work Experience

-Medical History

-Reproductive History

-Family Medical History

-Sexual Practices

-Infection Risk

-Psychological History

-Social Habits (tobacco, alcohol, drugs)

-Physical characteristics

-Previous Egg Donor Experience

Psychological Assessment: personal evaluation and MMPI2 personality test when is considered by Psychologist

Infectious Diseases: HIV, Hepatitis B and C, Syphilis Serology. Gonorrhoea, and Chlamydia

Genetic Evaluation: Karyotipe and Cystic Fibrosis ∆F508 gen mutation (to all our Caucasian donors), Sickle Cell (African, Hispanic), Thallasemias (Mediterranean, African, and Asian), and Tay-Sachs disease (Jewish)

Gynecological Evaluation:  Ovarian Reserve tests, Hormonal Profile, Pap smear, Transvaginal Ultrasound and Breast examination.

Clinical evaluation: Blood type, Cardiological assessment with ECK, and laboratory tests CBC, Coagulation tests, Glycemia, Liver function, Kidney function.

5. EGG RECIPIENT COUPLE SCREENING 

Please Download here the pdf document with all the test required to enter to our Oocyte donation program.   Feel free to contact our staff if you need further information regarding the screening test.

6. SYNCHRONIZING THE DONOR AND RECIPIENT

The cycles of the donor and recipient should be synchronized for oocyte donation and embryo implantation to work best. This synchronization often first requires halting the menstrual cycles of both the donor and recipient. This objective is achieved taking Oral Contraceptive Pills. Once the cycles are sufficiently suppressed, the recipient is started on medications (estrogen and later progesterone) to prepare her uterus for the implantation of the embryo. At the same time, the donor is given a series of medications (FSH and hCG, also hormones produced by the body) to stimulate oocyte maturation.  Once the oocytes are mature, they are removed by the doctor and fertilized with sperm in the laboratory.  Since the donor's and recipient's cycles are synchronized, these embryos can be transferred to the recipient shortly thereafter.

7. OVARIAN STIMULATION OF THE OOCYTE DONOR

Ovarian stimulation is a process in which hormones are administered to encourage oocyte production in the ovaries.  These hormones are produced normally by the body in the course of a woman's cycle.  Ovarian stimulation may result in the creation of numerous oocytes, so multiple eggs may be harvested from the donor.

In general, stimulation of the oocyte donor’s cycle is a similar regimen of fertility drugs that a woman using her own oocytes for in vitro fertilization-embryo transfer is commonly given. Late in the cycle which precedes ovarian stimulation, the donor is started on daily treatment with Lupron® . Daily injections of Lupron® will continue for a total of nearly three weeks. After the donor’s period has started, daily subcutaneous injections of a pharmaceutical gonadotropin preparation, such as FSH (GONAL F) and HMG (MENOPUR), will be added to the daily Lupron® injections. Various brands of these hormones can be used. Generally, the donor will receive daily gonadotropin injections for a total of seven to twelve days. During the time that the donor is receiving the gonadotropin injections, she will have frequent vaginal ultrasound examinations and blood drawing for determination of estradiol (E2) level. When ultrasound and blood testing indicate that development of the follicles (follicles are the ovarian structures that contain the oocytes) is optimum, the donor receives a subcutaneous injection of different pharmaceutical medication called human chorionic gonadotropin (hCG). Two days (35 hours) after hCG injection, oocyte retrieval is performed. We will need a sperm specimen from the recipient’s partner on the day of the retrieval, because the oocytes are inseminated on this day.

 8. PREPARATION OF OOCYTE RECIPIENT ENDOMETRIUM  

The endometrium (the inside lining of the uterus) is prepared by giving the recipient the female hormone estrogen, often in increasing dosages.  It is commonly administered either orally or via a patch placed on the skin. Progesterone is given to transform the endometrium so that it will be receptive to an embryo.  Progesterone may be administered through the vagina (as a vaginal gel, suppository, or capsule), by mouth, or by injection into a muscle. All of the hormones used artificially in this process are natural hormones produced by a woman's body.

In general, we try to arrange for recipients to have a "fresh" as opposed to frozen embryo transfer.  

Recipients who have regular menstrual cycles and bleeding on their own will take a medication which suppresses their own cycle. Sometimes oral contraceptives will be used to precede Lupron® administration based upon our medical team considerations. The formulation of estrogen that works best, is the Estradiol Valerate (RONFASE, PROGYNOVA or ESTRACE) 4 to 6 mg a day When the donor’s cycle has “caught up” with the recipient’s, a simulated (artificial) 28 day menstrual cycle will be created in the recipient with the hormonal medications.  We perform ultrasounds as the oocyte retrieval approaches to ensure an appropriate response. On the day of oocyte retrieval, progesterone treatment is begun. Progesterone is given usually as a daily intramuscularly injection of a preparation of progesterone in oil or Vaginal Suppositories. The day before embryo transfer, Lupron® is discontinued. The recipient will continue taking Estrogens and progesterone at least until the day her pregnancy test is performed. A sensitive blood pregnancy test will be performed on the 12th day to 14th after embryo transfer. If the recipient is pregnant, estrogen and progesterone treatment will continue through the twelfth week of pregnancy.

In most instances a "trial cycle" is not performed to evaluate endometrium lining prior to the actual synchronized cycle. It has been our experience that endometrium thickness and hormonal levels during most patients’ artificial hormone cycle are adequate for implantation. In the rare instance that the physicians feel that the endometrium lining is not adequate for embryo transfer, a recommendation for freezing embryos and doing a trial cycle prior to embryo transfer is made. This has proven to be a policy that is both cost effective and time saving for the recipient without compromising success rate.

Download Medication required for egg recipient file.

9.  EGG RETRIEVAL AND FERTILIZATION

When ultrasound and blood testing indicate that development of the follicles of the donor (follicles are the ovarian structures that contain the oocytes) is optimum, the donor receives a subcutaneous injection of a different pharmaceutical medication called human chorionic gonadotropin (hCG). Two days (35 hours) after hCG injection, oocyte retrieval is performed. We will need a sperm specimen from the recipient’s partner on the day of the retrieval, because the oocytes are inseminated on this day. 

10. EMBRYO TRANSFER

 Transfer of fertilized eggs (embryos) to the recipient’s uterus is generally performed three days after the oocyte retrieval, based upon recommendations by the embryologist and physician team.

 The embryo transfer is a simple procedure similar to having a Pap Smear Test.  It is done in the clinic and does not take long.  Afterwards the recipient is required to lie quietly for a few minutes before resuming her normal activities. In order to avoid multiple pregnancies, two embryos will be transferred to the recipient uterus.   The remaining embryos will be frozen, with the possibility of transferring them later.

11. SUPPORTING THE PREGNANCY WITH HORMONES AND THE PREGNANCY TEST

After the embryo transfer, recipients are continued on estrogen and progesterone until there is evidence of pregnancy.  Pregnancy tests should be scheduled 14 days after the date of oocyte retrieval.  After a positive pregnancy test, the estrogen and progesterone support is continued until 10 weeks after the transfer and is then stopped.

  Contact us now and we can clarify any concerns or questions that you may have.

It is within your Reach -

You can Conceive!

It is yours for the Asking

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