Egg Recipient Treatment Overview
The term “egg donation” refers to the use of eggs that have been donated by a third person (donor) to enable an infertile couple (intended recipient) to become parents. The first pregnancy achieved with egg donation was reported in 1984. Since that time there has been increasing utilization of egg donation to help infertile couples conceive. Through the process of IVF, eggs are obtained from the donor’s ovaries and donated to the intended recipient. Sperm obtained from the recipient’s partner is used to fertilize those eggs, and embryos are transferred into the recipient’s uterus. If pregnancy occurs, the recipient will have a biological but not genetic relationship to the child; her partner will be both biologically and genetically related.
Indication for egg donation
Egg donation is indicated for women with ovarian failure, women with multiple IVF failures, women with inadequate response to ovulation induction, women with advanced reproductive age, and women who have an egg factor as the cause of their infertility.
Who are egg donors
There are two ways of obtaining donor oocytes (eggs); anonymous and known or directed donors.
- Anonymous Donors: women who are not known to the recipient. Donors may be recruited through the established egg donation program, donor referrals, or agencies.
- Known or Directed Donors: women who are known to the recipient. The donor is generally a close relative or a friend. There is no age limit for known donors, although women over age 34 have a decreased chance of achieving a successful pregnancy for the recipient.
Evaluation of egg donor
All donors are screened according to the guidelines set forth by the American Society for Reproductive Medicine. Donors are between the ages of 21 and 32 (this age limit only applies to anonymous donors). The rationale for the upper age limit of 32 is that younger women typically respond favorably to ovarian stimulation, produce more eggs and high-quality embryos with high implantation and subsequent high pregnancy rates.
Both anonymous and known donors complete an extensive medical questionnaire that details their personal and family medical history. In the United States, the Food and Drug Administration requires that all egg donors be screened for risk factors for, and clinical evidence of, communicable diseases or infection. The egg donor profile will include insight into the donor’s personality, her hobbies, educational background, and life goals. This document is shared with the egg recipient. A doctor reviews the donor history and conducts a comprehensive physical examination.
Each donor completes a psychological evaluation with a licensed psychologist. The psychologist evaluates the donor and discusses the ethical and psychosocial issues involved in egg donation.
All egg donors complete laboratory testing for communicable diseases based on the guidelines set forth by the FDA. Infectious disease testing is done within 30 days of embryo transfer. Donors are required to undergo drug testing and genetic screening.
Evaluation of Recipient Couple
Evaluation of the recipient couple is similar to that of couples undergoing routine IVF. The physician will obtain a comprehensive medical history from both partners. The female assessment will include a comprehensive gynecological history, physical exam, and any indicated laboratory screening.
The female partner should have an evaluation of her uterine cavity via sonohysterogram or hysteroscopy. Additional screening for cardiac function and diabetes is required for women over the age of 45. The male partner will need to complete a semen analysis.
Preparation of the donor for egg retreival
In order to retrieve multiple eggs from the donor’s ovaries, the donor must be given a combination of hormonal medications to stimulate the development of multiple eggs within the ovary. Development of eggs is monitored by ultrasound and measurement of hormones in the blood. When the eggs are ready to be retrieved the donor takes an injection of HCG. The eggs are harvested approximately 36 hours later via ultrasound guided transvaginal aspiration. A needle is placed through the vaginal wall and into the ovary. The eggs are obtained and inseminated with the male partner’s sperm (donor sperm may also be used) which has been processed in the laboratory.
Preparation of the Recipient for Embryo Transfer
In order for embryos to implant into the recipient’s uterus, the endometrium (uterine lining) must be appropriately prepared and synchronized with the donor IVF cycle. The recipient is given estradiol to stimulate the endometrium to develop. Estradiol is given in the form of an oral pill and transdermal patch. Ultrasound assessment and hormonal blood work is done during this time to evaluated endometrial development.
The recipient will begin progesterone after the donor receives HCG. Progesterone causes specific maturational changes within the endometrium that enable the embryo to implant. Progesterone may be given by vaginal gel, vaginal suppository, or by injection.
Embryos are transferred into the recipient’s uterus usually 3-5 days after eggs are fertilized in the laboratory. The embryo transfer is performed by placing a small catheter with the embryo(s) through the cervix and into the uterus. This procedure is usually done with the aid of abdominal ultrasound.
If the recipient couple has extra embryo(s) , these embryos may be cryopreserved (frozen) for utilization at a later time for additional attempts to achieve a pregnancy.
The regimen of estradiol and progesterone is continued until the recipient pregnancy test. If the pregnancy test is positive, estradiol and progesterone are continued through the first trimester to support the early pregnancy.