Egg Donation – Other Consideratons
Following a thorough medical history and examination, and perhaps after alternative courses of treatment, your physician will discuss egg donation if it is appropriate. You should consider this option if you and your spouse have ruled out adoption in favor of the chance to produce a child with your husband’s genetic material, and you have carefully considered all of the associated issues.
To help you with this important decision, the Institute for Reproductive Medicine (IRMS) will require that you and your spouse meet with our psychologist, Dr. Claudia Pascale, PhD. She will help you consider issues that recipient couples often face, such as:
- A sense of loss associated with the woman’s self-esteem and body image, femininity and inability to make a genetic contribution.
- Importance of the role of genetic parenting.
- Source of the donor eggs.
- Risks associated with an IVF cycle, as well as pregnancy and the demands of parenting at an older age.
- Issues related to disclosure of use of a donor egg to friends and family, including the child.
Finding an Appropriate Egg Donor
Once you have chosen egg donation, you can designate a potential donor from family, friends or others sources. However, most couples choose anonymous donors from IRMS’ list of eligible candidates or an outside egg donor recruitment agency. We recruit potential egg donors through referrals, advertising and other sources.
Candidates must be between the ages of 21 and 32, and can donate to a maximum of 6 times as per ASRM (American Society for Reproductive Medicine) guidelines. Each egg donor undergoes an extensive consultation with a donor nurse, along with thorough medical and psychological screening to determine her suitability for ovum donation. This screening process, which meets the standards set by the American Society for Reproductive Medicine, includes:
- Medical screening, 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 identify individuals carrying genetically transmitted diseases such as cystic fibrosis, sickle cell anemia and Tay Sachs disease.
- Psychological screening and counseling to discover whether a potential egg donor understands and is willing to deal with the physical, emotional and legal ramifications of egg donation. This includes a Personality Assessment Inventory (PAI).
- History of egg donation to make sure that she has not already donated in excess of our guidelines. If she has not, and a previous donation with us was successful, she may qualify for a shared egg donor cycle.
Both partners are screened to determine suitability for the egg donation process. This includes an evaluation and consultation with a physician, donor team nurse and our psychologist to determine whether they fully understand the nature of the process, as well as all of the significant implications associated with creating a child from a donor egg. The physical screening includes a consultation and examination by a physician, and the following for the female patient:
- Blood tests:
– Antisperm antibodies
– Blood type and Rh factor
– CBC (complete blood count)
– CMV (cytomegalo virus)
– Hepatitis B and C
– HTLV 1 & 2
- – HIV 1 & 2 Screens
– Indirect coombs
- – MMR
- – Prolactin
- – Rubella
– TSH (
- – Varicella Titer
- Physical Exam:
– Baseline Ultrasound
- – Catheter check
– Chlamydia and gonorrhea cultures
– Mycoplasma/ureaplasma culture
– Pap Smear
- Special Testing
– Prep cycle
- – Saline Sonogram
- – Cavity check by hysteroscopy, hysterosalpingogram, or sono-hysterogram
– Mammogram (age 35 or family history)
- Additional testing for recipients over age 44
– A system review and evaluation by an internist also may be required for recipients with medical problems
– CXR (chest x-ray)
– GTT (Two hour glucose tolerance test)
Clinical screening required for the male partner includes blood tests similar to the females’ with a few additions:
- Additional Bloodwork:
- – Hemoglobin Electrophoresis
- Semen Testing
– Antisperm antibodies
– Semen analysis
- Genetic Testing (if indicated)
– Canavan’s disease
– Cystic fibrosis
– Fragile X
- – Karyotype (Chromosomal Analysis)
- – Tay Sach’s Disease
- Ashkenazi Panel:
– Bloom Syndrome
– Canavan’s disease
– Cystic Fibrosis
– Familial Dysautonomia
– Fanconi Anemia Group C
– Gaucher disease
– Glycogen Storage Disease Type 1
– Maple Syrup Urine Disease
– Mucolipidosis Type IV
– Niemann-Pick Type A
– Tay-Sachs DNA Analysis
Cycle Synchronization for Egg Donation
Once you are matched, you will be asked to call us on the first day of menses, and to visit our office on the third day to assess your ovarian function and begin the monitoring process. Blood will be drawn to determine your hormone levels and you may be instructed to begin birth control pills. This medication will regulate your hormone levels, preventing ovulation. In effect, your reproductive cycle will be on hold to help put you in step with the donor and prepare for the Suppression Phase of this process.
You will be asked to call us on the first day of menses. Following a visit to our office on Day 21 for blood work, you will begin an injection of Lupron each night, as instructed by a donor nurse. Lupron will “turn off” your body’s natural ovarian stimulation process, and result in a menstrual period in about 7 to 10 days after the injections begin. You will call us on Day 1 of menses, and visit us on Day 3 for blood work, ultrasound and further medication instructions. After that, monitoring will continue in our office approximately every four days.
If you are on the birth control pill, Lupron may be given (overlapped) at the same time for 3-5 days. Then the birth control pill will be stopped, usually inducing menses in 1-3 days. Two to three days after stopping the pill you will be brought in for an ultrasound and blood work to determine if estrogen replacement can begin. The Lupron will continue through the estrogen replacement phase, until progesterone is started.
Some women without ovaries, or with non-functioning ovaries, will not need to use Lupron. They will simply stop their usual hormone replacement regimen, get an ultrasound and blood work, and then start estrogen replacement.
On Day 3, while the donor is taking medications to stimulate her ovaries to produce multiple, mature eggs, you will begin to take Estrace. This drug, an oral form of estrogen, will be taken two or three times a day as instructed, to stimulate growth of the uterine lining. At the same time, you will continue your Lupron injections each night to preclude development of your follicles and eggs. During this time, you will visit us approximately every four days for blood work and ultrasound monitoring.
On the day of egg retrieval, your partner will supply a semen specimen if the ovum is to be fertilized with his sperm. That night, you will discontinue Lupron and begin progesterone supplementation in the form of an intramuscular injection. You will continue the estrogen, although the dose may be adjusted. You also will take Medrol, a low dose steroid that helps suppress your immune system and aid in implantation, and an oral antibiotic, Doryx, that will help decrease bacteria in the uterus that might interfere with implantation.
This protocol of estrogen and progesterone will continue until your pregnancy test, 11 days after the transfer, and for six or seven weeks beyond that if test is positive.
Prior to embryo transfer, you will be monitored carefully, with periodic blood tests and ultrasound when necessary, to determine your hormone levels and insure that you are not producing your own follicles and eggs. Our donor team relies on these tests to regulate your medications and track development of your uterine lining to determine that you are ready for embryo transfer. Four days after the procedures, you will visit our office for blood work, followed by a pregnancy test nine days later. If you are pregnant, we will continue to monitor your progress for approximately 4 to 5 weeks (or until you are approximately 8 to 9 weeks pregnant, at which time your care will be transferred to your obstetrician.
A few days after the egg donor’s oocytes are retrieved and fertilized in our laboratory, with sperm from your spouse or a donor, you will come to our office for the embryo transfer. Although embryo transfer is a simple technique and anesthesia is not required, some patients require some medication to relax their muscles. On the day of transfer, the physician will discuss, with you and your spouse, the number and quality of embryos being transferred.
During the actual procedure, the physician will pass a long, thin catheter containing the embryos and a small amount of fluid through your cervix. These embryos, usually three or fewer, are then injected directly into your uterus.
This procedure is very similar to an intrauterine insemination and is similar in discomfort to a PAP smear. You will be asked to start drinking water after you arrive in the Atkins Kent building. A full bladder during the transfer allows the physician to visualize the uterus with transabdominal ultrasound and straightens out the cervix, making the transfer go smoothly.
Following the embryo transfer, you will be instructed to continue required medications and to resume normal activities the following day.
Risks and Side Effects
All of the possible risks associated with being an egg recipient will be discussed with you and your spouse as part of the informed consent process, prior to the start of your cycle. The physical effects related to blood testing and hormone therapy are minimal. Injections, especially intramuscular ones, can be painful. The most common problems include bruising, discomfort or other minor reactions at the injection sites. Minor risks associated with hormone therapy include bloating and breast tenderness, as well as occasional irregular vaginal bleeding.
In rare instances, recipients suffer side effects from estrogen and progesterone therapy. These can include blood clots and the potential risk of liver disease, gallstones and high blood pressure, all extremely rare. Also, the transfer procedure, though simple, carries the risk of cramping, discomfort, infection or bleeding.
Other Considerations – Egg Donation
Success Rates and Multiple Births
Our success rates for donor egg cycles are very high compared to other programs due to a combination of quality oocytes and the expertise of our team of highly experienced physicians, nurses, embryologists and other laboratory staff. Our egg donor program is licensed by the State of New Jersey, NJ and our screening measures go well beyond those employed by many other programs.
Although the chances for success are significant with oocyte donation, as with all other IVF cycles, there is no guarantee regarding the outcome. Whether you become pregnant is affected by factors that differ in every case. You or your spouse may face clinical problems that preclude fertilization or successful transfer of the embryos. An egg donor’s cycle may be cancelled because of stimulation problems, she may not produce enough eggs or the eggs may not fertilize and develop into quality embryos. Finally, when the process is successful, you may face the risk of multiple pregnancies.
At IRMS, we take steps to avoid multiple gestations by limiting the number of embryos transferred, but you still may have to choose between having more than one child and undergoing multifetal reduction to reduce the number of embryos carried to term.
Psychological Screening and Issue Resolution
Each couple is required to meet with our on-site psychologist, Dr. Claudia Pascale, PhD. before acceptance into the program, and ongoing emotional support is available throughout the process if it is necessary. You will be made aware of the requirements and implications of the procedure. You also will have the opportunity to discuss the personal, moral and ethical issues associated with egg donation, as well as practical considerations, such as the wait for an appropriate egg donor.
Although we actively recruit egg donors, the number of egg donors is limited and you may have to wait several months for an appropriate match from our team or consider an outside egg donor agency. The process of donor screening is very selective and we have a high rejection rate during the screening process. The process may be further delayed if the recipient couple has special requests such as a particular ethnic background or other specific characteristics in the donor.
Cryopreservation and Disposition of Embryos
At the end of a cycle, you may end up with more embryos than are required for transfer, and you will need to consider what to do with them. If those remaining are of high enough quality, you can consider cryopreservation – embryo freezing. Approximately 40% of donor cycles will have extra embryos for freezing. Many couples wonder what happens in the 60% of cycles that do not have excess embryos for cryopreservation. In these cycles, excess embryos may be abnormal or stop growing prior to day 3. Only normal, viable embryos will be frozen. This will allow you to undergo a subsequent transfer without stimulation, a process known as a Frozen Embryo Transfer (FET). However, if they cannot be frozen, they can be donated for research or destroyed.