Donor Egg IVF
Women who are unable to produce or use their own eggs require donated eggs. The following are some of the reasons why:
- Premature menopause
- Genetic abnormality
- Carriers of a genetic disorder
- Poor ovarian response to hormonal stimulation
- Absence of the ovaries
- Ovarian failure due to chemotherapy and/or radiation treatment
Donor + Recipient Matching
Recipients complete a profile form listing specific attributes they want in their donor. In addition, physical characteristics are also used in matching. There are three options when selecting a donor; internal (our in house program), agency donor, or known donor. We have an in-house donor egg program available to only our patients. If you are working with an agency they will contact us with your match information. Once you have been matched with a donor we will schedule the necessary screening appointments for her.
Ovulation Induction and Monitoring of the Egg Donor
ART (Assisted Reproductive Technology) success rates depend upon the number of eggs or embryos available for transfer. Additionally, the egg retrieval must be carefully timed so as to retrieve mature eggs. To accomplish these 2 goals, ovulation induction medications and careful monitoring are employed.
After the initial screening process is complete and a legal agreement has been reached, the donor starts the stimulation process with her next menses.
The start of the ovarian stimulation is timed using oral contraceptive pills (OCP). The Egg Donor takes OCP for 2-3 weeks prior to the beginning of the stimulation. Then the Egg Donor begins injections of gonadotropins (Follistim, Gonal-F), according to a schedule that is provided by the clinic. We call this first day of gonadotropin administration Stimulation Day 1.
Once the follicles (containing the eggs) are deemed ready or mature, often after 10-12 days of medications, the Egg Donor takes an injection of human chronic gonadotropin (hCG). This hormone replaces the woman’s normal LH surge and is necessary for the final maturation of the eggs so that the sperm can fertilize them.
At Fertility Specialists of Texas, the egg retrieval is accomplished non-surgically using a vaginal ultrasound probe to guide a needle into the ovaries. The procedure is usually performed with IV sedation. An anesthesiologist administers the sedation to maximize comfort and safety.
In Vitro Fertilization
In vitro fertilization (IVF) literally means “fertilization in glass”. Follicular fluid removed from the ovaries is examined in our lab for the presence of eggs. These eggs are isolated and placed in culture media where they are allowed to further mature. A few hours later, the eggs are fertilized. The method of fertilization (conventional versus ICSI) is by the recommendation of the physician based on the spouse/sperm donor’s semen parameters. The embryos are then cultured to day 5 or 6 and frozen. If genetic testing of the embryos is requested by the intended parents, a biopsy is performed just prior to freezing the embryos. Genetic testing results are usually available 5-7 business days following biopsy.
Recipient Testing Prior to Frozen Embryo Tranfer
The recipient starts preparation for the embryo transfer process once the donor’s stimulation has started. The Recipient Mother will be placed on birth control pills in preparation for the embryo transfer and the physician will outline the testing necessary prior to moving forward with the Frozen Embryo Transfer cycle.
Building the Carrier’s Lining with Hormonal Injections
Once the required testing is completed, the Recipient starts a medication called Lupron (GnRH agonist) to suppress ovulation, then begins hormone stimulation with estradiol to prepare her uterine lining for implantation of the transferred embryo. Approximately 4 to 6 days before the embryo transfer, daily injections of progesterone begin in order to optimize the Recipient’s endometrium for implantation.
At Fertility Specialists of Texas, all embryo transfers are performed under trans-abdominal ultrasound guidance. We have found that ultrasound-guided transfers are easier to perform and have resulted in higher pregnancy rates. The ultrasound allows for the accurate placement of the embryo approximately 1.5 centimeters from the top of the uterus. The embryo is transferred via a thin plastic tube called a catheter. The catheter is carefully guided into the upper part of the uterus where the embryo is placed. The transfer is a painless procedure and the patient remains resting for 30 minutes, after which she is sent home.
Post Embryo Transfer Management and Follow-up
To ensure an optimal environment for implantation, the Recipient continues the hormone injections of progesterone and estradiol during the post-embryo transfer phase. Ten days after the embryo transfer a pregnancy test is performed. If the test is positive, the hormone injections continue until 12 weeks gestation, when the placenta is fully functional. A second pregnancy test is obtained approximately 2-4 days after the first to confirm that the pregnancy is ongoing. Confirmation of a clinical pregnancy, indicated by presence of fetal heartbeat, is made by ultrasound at approximately 7.5 weeks gestation. Additional ultrasound monitoring is performed 1-2 weeks later to monitor fetal growth. Once good interval growth is documented by ultrasound, the recipient is referred back to her obstetrician for continued pregnancy care.
The number of embryos transferred depends on the age of the donor and the quality of the embryos on the day of the transfer. The decision on the number of embryos to transfer is an important one with the goal of maximizing the probability of pregnancy without the risk of multiple gestations.
FDA Requirements for the Egg Donor
To comply with Federal Government regulations, the Egg Donor is required to have FDA required labs (an extensive STD panel), FDA required physical exam, and complete a risk assessment questionnaire. These requirements are done at her medical screening appointment. Due to time requirements from egg retrieval, the FDA lab testing will be repeated in conjunction with the IVF, egg retrieval, cycle.
Donors come forward voluntarily. They are well-motivated and usually complete the treatment for egg donation. It is, however, completely within their rights to withdraw from treatment at any given time until egg retrieval.
There may be a rare occasion when the donor does not produce enough follicles or stimulates too quickly. In either of these instances, the treatment cycle may be canceled due to poor donor response or due to high risk of ovarian hyperstimulation syndrome. If the treatment cycle is stopped the physician will discuss the circumstances and plans of another attempt will be considered.