Egg Donation Process for Recipients

Candidates for IVF with Egg Donation Include:

1. Women whose ovaries have a low chance of responding to fertility medication (decreased ovarian reserve) due to increased age, premature menopause, past exposure to chemotherapy medications, or for unexplained reasons.
2. Women over age 40 who still have eggs that can be retrieved from their ovaries but have a high chance of a having chromosomally abnormal embryos due to the age of their eggs. Embryos can be tested for chromosomal abnormalities by PGT-A (preimplantation genetic testing for aneuploidy).  However, if all of the embryos are abnormal such that there are no chromosomally normal embryos for transfer, a woman may choose egg donation rather than continue to proceed with successive cycles of IVF using her own eggs.
3. Women who are carriers of a severe genetic condition which has a high chance of being passed to their biological children.
4. Men who do not have a female partner who wish to have a genetically related child.  The man’s sperm would be used to fertilize donor eggs, and a resulting embryo or embryos would be placed into the uterus of a gestational surrogate, who would carry and deliver the child for them.

Preparation of the Recipient for the Treatment Cycle Includes:

1. Documentation of a current normal mammogram for all women 40 years of age or older.
2. Documentation of a current normal Pap smear.
3. Consultation with the woman’s primary care physician or obstetrician if she is 45 to 51 years of age, to be sure she does not have a medical condition that could potentially make carrying a pregnancy too dangerous for her or the fetus. This would also include documentation of a normal electrocardiogram and normal chest X-ray.  In our practice, women must be no more than 51 years of age at the time of embryo transfer to proceed with an in vitro fertilization cycle with the use of donor egg.
4. Pelvic ultrasound.
5. Office hysteroscopy or 3D saline sonogram to check that the uterine cavity is normal.
6. Semen analysis of the male partner to be sure he has adequate numbers of sperm to fertilize eggs.
7. Infectious disease screening for both recipient partners or for the potential single parent.
8. A consultation for both partners (and for the potential single parent) with a clinical psychologist/counselor to discuss emotional aspects of using donor eggs, prior to initiation of the cycle.

Selection of an Egg Donor

The egg donor may be a person known to the recipients, including a family member (such as a sibling), a friend, or may be a known donor from an egg donor agency.

Alternatively, the donor may be an anonymous donor from the donor pool of Northern California Fertility Center or from another agency. Egg donation with an anonymous egg donor is more common than a known donor. The recipient(s) would know much about the donor, but not her identity. An anonymous donor does not know anything about the recipient(s).

The choice of obtaining eggs from a known donor vs from an anonymous donor would be made by the recipient(s).

Screening of the Egg Donor Includes:

1. Medical and genetic history questionnaire reviewed by a nurse coordinator and a physician.
2. A physical examination and pelvic ultrasound performed by a physician
3. Genetic consult with a genetic counselor and blood draw for recommended genetic carrier screening.
4. Evaluation by a clinical psychologist/counselor as well as psychological testing.
5. Baseline hormone screening, drug testing, including alcohol and tobacco, and infectious disease screening as required by the FDA.

Medications and Monitoring for Egg Donor for the IVF Stimulation

The egg donor will be started on oral contraceptives at the start of a natural menses to lead into the IVF stimulation.  She will be on birth control pills for approximately 2 ½ weeks.  A few days after the end of the birth control pills, the egg donor will begin a series of daily injections to stimulate the growth of her eggs.  She will also be an injectable medication to prevent ovulation during the stimulation.  She will be monitored by ultrasounds and estrogen blood levels every few days while on the injections.  When the eggs are considered ready, she will receive a final injection to prepare the eggs for ovulation.  The egg retrieval will be performed approximately 36 hours after the final injection (prior to when ovulation would be occurring). The egg retrieval will be accomplished under light anesthesia in the operating room at Northern California Fertility Center and takes approximately 15 minutes to complete.  She will stay in the recovery room for about 45 minutes and will be discharged home in the care of a family member or friend.

The morning of the egg retrieval, the male partner of the recipient couple will provide a sperm specimen which will be used to fertilize the eggs (unless previously frozen/thawed sperm is to be used).   The sperm and egg will be combined in the lab the day of the egg retrieval.  The next day we will be able to identify which eggs fertilized and became embryos.   Embryos will be cultured in the lab for 5 to 6 days.  Embryos that progress to the blastocyst stage by day 5 and 6 after fertilization will be frozen and saved for future transfer into the recipient woman (or gestational carrier).  If the recipient(s) have elected for embryo biopsy and genetic testing, the biopsy of the embryo is performed prior to the embryo being frozen.  The biopsied cells will be frozen and shipped to an outside testing facility for the genetic testing.

Medications and Monitoring for the Recipient for Frozen Embryo Transfer

There are different medication protocols used to prepare the recipient woman (or surrogate) for the frozen embryo transfer.  The physician will determine which protocol is best for the individual patient, depending on their ovarian function, among other factors.  One commonly used protocol involves birth control pills for 3 weeks and a daily injection of a medication called Lupron to suppress the recipient’s normal ovarian function.  This is then followed by estrogen (usually an injection 2 times a week) for about a week and a half to grow the uterine lining. Ultrasound and blood work are done to assess if the uterine lining looks appropriate.  When the uterine lining looks appropriate, the recipient would be started on progesterone injections and a vaginal suppository.  Embryo transfer occurs on the 6^th day of progesterone administration.  A pregnancy test would be performed 10 days after embryo transfer.  In this protocol, the estrogen and progesterone medication would be continued until 11 weeks of pregnancy.

We recommend the transfer of a single embryo at a time.  If there are multiple embryos to work with, one embryo would be thawed and transferred and the rest would remain frozen.