Egg Donation Program
Women are candidates for an egg donor in vitro fertilization (IVF) cycle if they are in good health and less than 50 years old. Women needing egg donation include those who have advanced maternal age, premature menopause, premature ovarian failure, surgically removed ovaries, prior poor response with own eggs through IVF and genetic diseases which would be passed on to offspring.
Initial Evaluation:
Generally a couple seeking donor egg IVF needs to have some basic testing performed. These tests may include:
| Wife | Husband |
|---|---|
| Blood type, Rh, antibody screening | Blood type and Rh |
| Rubella and varicella titers | Semen analysis |
| RPR | RPR |
| Hepatitis B and C, CMV, HIV-1&2 | Hepatitis B and C, CMV, HIV-1&2 |
| Uterine cavity study |
Although not required, couples themselves may choose to have psychological counseling prior to an egg donor cycle.
If the wife is > 45 years old, consultation with a high-risk obstetrician (perinatologist) is advised prior to the egg donor cycle. Also, cardiac stress testing should be considered.
Egg Donor Options:
Egg donors may be anonymous or known (directed). Anonymous egg donors are acquired through a donor egg match service. Known or directed donors are persons you bring to us to do the donor egg cycle which may be a friend or a relative. An advantage of using a known donor is that the cycle is less expensive. A disadvantage of using a known donor is that your donor knows your child was conceived with her egg.
For anonymous donor cycles, several egg donor match agencies can be found on the Internet. One that we recommend is Compassionate Beginnings of Cincinnati, Ohio. The egg donor match agencies have many donors to choose from and photographs of the donors are available. The egg donor agencies find and screen potential egg donors. You can contact Compassionate Beginnings at www.CompassionateBeginnings.com or phone them at (513) 490-0333.
Compassionate Beginnings has a selection of donors available for a fresh donor cycle where the donor undergoes hormonal stimulation wherever she lives, then travels to Lexington for the egg retrieval, subsequent fertilization and embryo transfer. Some egg donor match agencies have eggs available for purchase that have been previously harvested and are now frozen.
Fresh donor egg cycles have been performed since the 1980s. The use of frozen donor eggs to achieve a pregnancy is still relatively new and was considered investigational until 2012. Advantages of using fresh eggs are 1) pregnancy rates are currently higher and 2) some donors will make extra eggs that may be fertilized and frozen as embryos (fertilized eggs) for future use. Disadvantages of using fresh donor eggs are 1) fresh donor cycles can be more expensive, 2) some donors do not stimulate well producing fewer eggs than expected, 3) occasionally donors drop out for various reasons and 4) the donor you want may not be immediately available.
Preparation for Egg Donor IVF
Semen Analysis – All male partners should have a semen analysis performed
Uterine cavity study – Usually a sonohysterogram (SHG) is performed to measure the depth and curve of the uterine cavity. Sterile saline is injected via a plastic catheter under ultrasound visualization to make sure no abnormalities are present such as polyps or intracavitary fibroids which may reduce pregnancy chances.
Hormonal Preparation – If the wife’s uterus is not hormonally prepared properly, the embryos will not successfully implant. For this reason, all fresh donor egg recipients must undergo a mock donor egg cycle. During the mock donor egg cycle, the wife is placed on estrogen patches after her period starts at varying dosages. A transvaginal sonogram and blood estradiol level are obtained around cycle day 12-14 and a repeat transvaginal sonogram is obtained around day 21-23. Progesterone is given daily on cycle days 15 through 28 (Please see Mock Donor Egg Cycle Schedule). Couples undergoing a frozen donor egg cycle do not have to complete the Mock Donor Cycle because when doing the estrogen patches for the actual frozen donor egg cycle, the lining will be evaluated around day 14 and if abnormal then the eggs simply will not be thawed.
Ready to Start
Once a suitable donor has been selected and all the preliminary work has been completed the date for the egg retrieval or thaw can be determined and the process will begin. The stimulations will be at the office of Dr. Akin at 1760 Nicholasville Road, Suite 501, Lexington, KY 40503. The donor egg retrieval and subsequent embryo transfer will take place at Bluegrass Fertility Center IVF Lab, 2716 Old Rosebud Road, Suite 210, Lexington, KY 40509. This is located in the Hamburg Pavilion Shopping Center. Maps showing the location are available.
Risk Information
- The donor egg procedure carries with it a small risk of sexually transmitted diseases including but not limited to gonorrhea, syphilis, herpes, hepatitis and acquired immune deficiency syndrome (AIDS). There also is a small risk of infection from an embryo transfer.
- The risk of miscarriage, Down syndrome and other chromosomal abnormalities increases with the age of the egg donor. The age of the donor is the important one and the age of the recipient is irrelevant. For example, if the wife becoming pregnant is 42 years old and the egg donor is 25 years old, then the risk for Down syndrome is that of a 25 year-old woman.
- Egg donor recipients have an increased risk of preeclampsia (toxemia) during the pregnancy as high as 25-40%.
- The background risk for birth defects is 3-4%. IVF may increase the risk of birth defects as high as 6-8%. IVF pregnancies are high risk. There is an increased chance for pre-term delivery, low birth weight, birth defects, chromosomal abnormalities, brain damage and death. There may be an increased risk of genetic diseases. Increased maternal complications can also occur such as placental abruption and need for C-section.
- The chance for a tubal or ectopic pregnancy is about 1-2%. Embryos circulate within the uterus for a few days prior to implanting and rarely can become lodged in a fallopian tube. Tubal pregnancies require either surgical or medical intervention.
General IVF Information for Egg Donor Recipients
Male Procedures – If the husband has a normal semen analysis, then sperm are simply added to the donor eggs and natural fertilization occurs. However, if the semen analysis is abnormal, then intracytoplasmic sperm injection (ICSI) is indicated. ICSI is a technique where a single sperm is injected directly into the cytoplasm (center) of the egg. ICSI is needed to fertilize thawed eggs.
Risks associated with offspring born from ICSI procedures are still under investigation. While currently available data suggest that the risk of birth defects or major congenital defects in children born from ICSI is approximately that of the general population (approximately 3-4%), it is possible that such defects could occur as a result of the procedure. A higher incidence of abnormalities with the Y chromosome in male offspring (2-3% vs. 0.1-0.5%) from ICSI has been suggested. While the implications of such findings remain unclear, it is possible that male offspring may be at higher risk of fertility problems if such abnormalities occur. There also is a slight increased risk of sex chromosomal abnormalities associated with the ICSI procedure (0.8% vs. 0.23%) such as Klinefelter’s Syndrome and Turner’s Syndrome. Because ICSI is still a relatively new procedure, there may be additional risks that cannot be foreseen at present.
Assisted Hatching
Assisted hatching is a technique where a small hole is created in the zona pellucida (shell around the fertilized egg) by a needle, laser or chemical solution to facilitate the embryo’s release. Assisted hatching is performed just prior to embryo transfer. Patients who may benefit from this procedure include:
- Patients with egg donors that are 38 years or older.
- Patients that have failed IVF in at least two previous attempts.
- Patients who are having frozen-thawed embryos transferred.
- Patients who have embryos with abnormally thick zonae pellucidae (shells).
Risks of the procedure include rarely destruction of the embryo and possibly increased chance for identical (monozygotic) twinning. Assisted hatching has been around since the 1980s and some studies show it helps while other studies do not. Our recommendation for assisted hatching is still evolving and changes from time to time.
Which day should the embryos be placed back into the uterus?
Initially, fertilized eggs were transferred back to the uterus after 1 day. Research then showed that transfer on day 2-3 was better. A few years ago, some studies showed that transfer back on day 5-6 was better still. On day 5-6, developing embryos are called blastocysts. However, more recent studies have shown that while blastocyst transfer is better in certain situations, day 2-3 transfer is better for many patients. The optimal day for your embryo transfer will be decided upon by the embryologist and your physician as the embryos develop. Extra viable embryos may be successfully frozen at different stages for later use.
Multiple gestation is a complication of ART. The risk of multiple gestation is related to how many embryos are transferred to the uterus. Further, an individual embryo can split into identical twins (1 chance in 300). The number of embryos to transfer is dependent on several factors, but the most important one is the age of the eggs. Usually only 2 embryos are transferred to donor egg recipients.
While many couples are happy to have twins, the complications of pregnancy increase with the number of babies present. The most serious complication of multiple gestation is preterm labor with delivery of premature infants. Severe prematurity can result in the death or brain damage of a child. With proper prenatal care, the risks of premature labor can be lessened but not eliminated. Every effort is made to increase the chances for pregnancy with ART while minimizing the chances for multiple births. Though not offered in Kentucky, selective reduction is an option for some couples with high order multiples. The chance for complete pregnancy loss with selective reduction is between 10-25%.
When the cycle doesn’t work. There are several reasons why conception may not occur during egg donor IVF. The treatment cycle may be canceled prior to egg retrieval if follicular development is unsuitable. Some eggs may not be fertilized and some embryos may not implant when transferred to the uterus. Failures at Egg Donor IVF procedures are frustrating. We share in your success and disappointments. If at any time you feel undue stress or just need to talk, please let us know of your feelings.
If pregnancy does not occur in the first cycle, is there reason to try again? Yes, several studies conclude that IVF pregnancy rates are constant throughout the first 6 attempts. In other words, your chances for pregnancy are not decreased in your third IVF attempt because the first 2 attempts did not work assuming that there was embryos each time to transfer.