| IVF with Egg Donation
IVF with egg donation is a form of Assisted Reproductive Technology and is widely used in the treatment of infertility. It offers hope for a large number of women who previously thought they could never become pregnant and have children. Donors may be known or anonymous to the intended recipient. Egg donation involves fertilization of eggs in the laboratory. Egg donors are identified and eggs are obtained from the donor's ovaries to donate to recipient. After the eggs have been obtained, the role of the egg donor is complete. Sperm obtained from the recipient's partner is used to fertilize these eggs, after which embryos are transferred into the recipient woman's uterus.
Egg donation is recommended for women:
· Whose ovaries do not produce eggs due to different reasons (early menopause, infection, removed ovaries, chemotherapy, radiation therapy, congenital disease, etc.)
· Women who have a high risk of passing on genetic disorders to their offspring (carriers of sex linked disease) and couples with recurrent pregnancy loss due to chromosomal abnormalities. This indication also includes women who have a significant family condition where their carrier status cannot be determined.
- Older women who have inadequately functioning ovaries.
- Women with multiple failures to conceive after IVF.
- Women with inadequate response to ovulation induction.
The Egg donation and Recipient Process
Donor Selection and Screening
There are selected groups of women who may donate their eggs anonymously to the egg donation pool or to known relatives or friends. Anonymous donors may be recruited through established egg donation programs or may be identified through agencies.
Prospective recipient of donor eggs can choose a donor from provider's donor database or she also may choose a donor, such as a relative or a friend. Egg donors, both known and anonymous, should be screened according to the most recent guidelines. Complete medical history should be obtained for both known and anonymous donors. A medical professional reviews this history with the donor and conducts a comprehensive physical examination.
Mental health professional (MHP) reviews donor's psychometric test and evaluates her, discusses complex ethical and psychosocial issues she may encounter and confirms that donor is truly able to provide informed consent for egg donation.
The laboratory testing of all donors should include screening and testing for syphilis, hepatitis B and C, HIV, Neisseria Gonorrhea and Clamydia Trachomatis. Donors should also have documentation of their blood type and Rh status, complete blood count and rubella titer. Genetic screening of donors should be based on ethnicity.
Not every woman can be an egg donor. IVF centers have adopted selection criteria that should be known to potential egg donors.
Evaluation of the Recipient
It is essential that recipient be adequately screened before being accepted onto the program. The physician should obtain complete medical history from both partners. The recipient female assessment should include a comprehensive gynecologic history and complete physical exam. The doctor may order some investigations such as a detailed pelvic ultrasound and may require a hysterosalpingogram (x-ray of the uterus) or hysteroscopy (to assess the cavity of the womb by viewing of the uterus with a tiny camera). Additional tests and screening may be required depending on recipient's age, medical history and ethnicity.
The recipient will be screened for infectious diseases, such as HIV, Hepatitis B & C and for sexually transmitted diseases such as Gonorrhea, Syphilis, CMV and Chlamydia. Recent Pap smear results should also be available for review. The male assessment will include a semen analysis.
Synchronizing the Donor and Recipient
Egg donation can be provided by an anonymous egg donor. In this case, recipients are matched with a suitable donor by the fertility clinic considering their physical characteristics, ethnic background, height and weight, complexion, medical history, IQ, personality traits as closely as possible.
Once the egg donor and the recipient pass all the necessary screenings, hormones are given to both the recipient and the donor to synchronize the ovarian stimulation of the donor, as well as uterine receptivity of the infertile woman.
The recipient will be given hormone replacement therapy that will prepare the recipient for the transfer. These therapies will allow the body to imitate the natural ovulation cycle - the ovaries produce hormones that thicken the uterus in preparation for implantation of a fertilized egg. At this time, recipient's blood hormone levels and the lining of the uterus will be carefully monitored. Numerous methods of endometrial preparation have been described, although the principle of hormonal preparation is similar.
Preparation of the Donor for Egg Retrieval
Once the donor and recipient are synchronized, additional medication is required to continue the egg donation process. Therefore, the recipient is placed on an estrogen replacement program to prepare her uterus to receive a fertilized embryo. Estrogen can be introduced to the body via either an oral route or transdermally (skin patch).
Following the recipient's hormone therapy, the egg donor begins preparation for egg donation. A combination of hormonal medications is given to donor to stimulate the development of multiple eggs within the ovary. This technique is called ovulation induction. The medications may include a gonadotropin-releasing hormone agonist (GnRH-a) or gonadotropin-releasing hormone antagonist (GnRH-ant) and either human menopausal gonadoropin or recombinant follicle stimulating hormone (r-FSH). Growth and development of the follicles will be monitored by ultrasound scans and blood hormone levels.
Poor response to the fertility drugs or serious side effects of the medications is rare but can happen. Once the follicles are mature, HCG injection will be administrated to the donor to insure the final maturation of the eggs. About 34-36 hours later, the donor is placed under mild sedation and skilled physician removes the donor egg by transvaginal ultrasound aspiration. It usually takes about 30 minutes. Sometimes eggs are collected by laparascopy that involves making a small incision in the stomach and extracting the eggs with a fine needle. The eggs are obtained, evaluated for maturity and then inseminated with the male partner's sperm (donor sperm may also be used).
Fertilization of the Eggs and Embryo Transfer
Once the egg donor is ready to have her egg retrieved and the recipient's uterus is ready for implantation, the recipient's male partner will provide a semen sample (or donors semen may be used) that is processed and used to inseminate the donor eggs. Once the sperm and egg are collected, the sperm is injected into the egg through the process of ICSI. A thin needle is pierced through the cell membrane, and is loaded with a single sperm. The sperm is then injected into the cytoplasm of the oocytes to allow fertilization
Once an egg has been fertilized with sperm, it becomes an embryo. Embryos are usually ready for transfer after fertilizaition occurs, depending on different factors, such as low sperm count and embryo development. Transferring the embryos about 4 hours after fertilization is becoming more common as it allows recipients to undergo the procedure on an outpatient basis. Although it is recommended that the recipient waits until day five to transfer the embryo, as it increases chances of successful implantation and decreases the likelihood of multiple pregnancies.
The embryos are transferred into the uterus through the cervix with a catheter. It usually does not require any anesthesia Usually 2-4 embryos are transferred into the uterus to increase the chances of pregnancy. If the recipient couple has extra embryos, these embryos may be cryoperserved (frozen) for utilization for later time for additional attempts of successful pregnancy.
If done successfully, the patient can go home and should rest for the remainder of the day. The hormonal replacement regimen is continued until the recipient achieves a positive pregnancy test. If the pregnancy test is positive, the hormone therapy is continued through the first trimester to support the early pregnancy.
If the IVF is successful, a normal pregnancy can be carried out. For menstruating women and menopausal women, the treatment stages are the same and both must take medication prior to the embryo transfers.
Success rate of egg donation
The success rate of egg donation depends on various factors but is generally independent of the age of recipient. The major risk of donor egg programs is multiple gestations.