Dr. Jain is truly an expert in the field of egg donation. He completed his training in the Division of Reproductive Endocrinology and Infertility at the University of Southern California, the location of the first successful egg donation cycle in 1987. He remained at USC for almost a decade as a tenured professor of Obstetrics and Gynecology during which time he published a landmark article in the Journal of the American Medical Association on egg donation in women over fifty years of age. More significantly, he helped to pioneer the next generation of egg donation utilizing frozen donor eggs. He was instrumental in creating one of the first frozen donor egg banks in the world.
Video transcript →
Egg donation offers a real chance for a couple to have a child. It’s associated with the highest pregnancy rates in all of fertility care, its also associated with one of the most difficult decision making processes because that woman is giving up her genetic legacy. It’s usually a decision that takes time to reach, usually a decision that is made after trying IVF and other fertility treatments and it’s definitely not a decision that should be taken lightly. So egg donation is often sought by women who have reached a certain age and no longer have viable eggs or for gay men who need an egg donor to have a child.So once a couple decides they would like to pursue egg donation they seek an egg donor from an egg donor agency and they usually look for ethnic matches, maybe physical characteristics that match the intended mother, also family history, maybe proclivity toward athletics or academics. Interestingly a woman doesn’t have to choose an egg donor based on her blood type it doesn’t matter, it doesn’t impact the outcome at all.
Egg donors are typically women in their twenties who are in college or post-college or just working. It should be known that egg donor agencies are typically run by non-medical personnel so when seeking an egg donor it is important to work with a reputable and good agency that provides you know honest and transparent information.
So once a couple choses a donor the donor has to go through a battery of screening tests. They have to see a psychologist and undergo psychological screening, talk to a genetic counselor and have genetic tests, they have to see the medical doctor – the fertility specialist and have a battery of tests for infectious disease screenings. That’s mandatory put up by the food and drug administration and it has to be done within thirty days of egg retrieval and then the donor is represented by an attorney so that the decision is binding. Once all of that is done then the donor can proceed to egg donation.
Most egg donation cases in United States are done anonymously. There is also an opportunity for the intended parents to have their child meet the donor when that child is eighteen again that is not in all cases but in most cases and its at the pure discretion or sole discretion of the intended parents not of the donor.
In traditional egg donation after a couple chooses an egg donor from the agency and that donor is qualified medically she begins the process of in-vitro fertilization, so the donor takes injections of hormones to help recruit multiple eggs, now interestingly those eggs are only good for one month, that donor would lose the eggs anyway. So very importantly the donor is not affected by the process as it relates to her future fertility.
We then retrieve the egg from the egg follicles in the operating room under anesthesia, the eggs are then provided to the intended parents where sperm is injected into the eggs. The embryo is allowed to develop for five days, and on the fifth day we transfer one embryo to the intended mother. Additional embryos can be frozen and there is no shelf life on those embryos.
A common question I have from intended mothers using an egg donation is what is my role with the baby? And it is true that the hardwiring the DNA of the sperm and egg do influence things like the characteristics of the child but we are learning more about something called epigenetics whereby the womb is a place where that woman, that mother starts to influence the DNA of the actual fetus. Actually putting molecules on the DNA of the fetus and those molecules influence things like personality intellect, nerve developmental issues and probably many more phenomena of human existence, we are just learning about. So really motherhood begins in the womb.
Now we are seeing pregnancy rates from frozen embryos comparable to those of fresh embryos almost identical so whether a couple chooses to have a fresh embryo transfer or a frozen embryo transfer it doesn’t matter, we see the same pregnancy rate. The good news about having frozen embryos is if the first embryo transfer doesn’t work they have an immediate backup. And of course if the first embryo transfer works and it works sixty-six percent of the time then the frozen embryos could be a second child in years to come.
At Santa Monica Fertility we really specialize in shared egg donation and this is based on my observation that couples have a very hard time navigating egg donation agencies and all the moving parts so we find donors that are excellent donors, proven donors and provide those donors to our intended parents. So with shared egg donation donors go through the same screening process as they would with traditional egg donation but when we get the eggs more than one couple uses those eggs. So for example a good donor will make about sixteen eggs, one couple will get eight eggs and from those eight eggs because it’s a proven good donor we often get three or more of the advanced embryos we call them Blastocyst. Each one has a chance of sixty-six percent in giving rise to a birth. So we transfer one embryo and we freeze the rest. If the couple does not achieve a pregnancy with the first transfer then the second and the third transfers are free. So our program is really built in partnering with patients and donors getting good donors proven donors that make great eggs proven eggs and then assigning a lot of the eggs. And then assigning a portion of the eggs that allows the couple to have multiple chances at a baby. And of course one of the biggest benefits is because more than one couple is sharing the eggs the costs are much less than with traditional egg donation. And we found this program to be very effective, patients like the idea that the doctor is intimately involved in selecting the donor.
There has been a recent increase in frozen donor egg banks and frozen donor eggs are basically eggs that are not used at the time of egg retrieval and frozen for future use. Of course the benefit is they are readily available so couple can obtain the eggs and very quickly thaw those eggs and have a chance at a pregnancy but there are some down sides. Whereas fresh embryos or even frozen embryos have birth rates of about sixty-six percent, the rate we see with frozen eggs is about fifty five percent.
So it’s not bad but it is less than the rate with fresh. We also don’t get as many embryos from frozen eggs as we do with fresh eggs, it’s more variable because the egg were frozen and thawed they are more vulnerable that way. So couples who seek frozen eggs should really work with a clinic that has treated the donor and a clinic where the embryologist themselves have frozen the egg. And with the recent advent of donor egg banks or egg banks that offer donor eggs I caution patients to be careful with that because freezing the egg and caring for the donor somewhere else and then shipping them to a clinic or lab that never worked with these eggs really leads to lower pregnancy rates. And so in seeking frozen eggs which are good option a couple should seek centers where the donor has her care and where the eggs are frozen by the same embryologist who is going to be thawing the eggs for best success rates.
Egg donation allows women to become pregnant even when they lack eggs of their own, or their eggs are of poor quality. The technique is most commonly used in women who are unsuccessful after undergoing multiple cycles of in vitro fertilization (IVF), those with premature ovarian failure or elevated FSH levels, and those over the age of forty-three. The combination of young eggs and optimal preparation of both donor and intended mother makes egg donation a very successful fertility procedure.
The process of egg donation requires that the components of a single IVF cycle be divided between the donor and the intended mother. The donor undergoes the initial steps of IVF, including ovarian stimulation and egg retrieval, and the intended mother undergoes the embryo transfer.
Traditionally both women’s cycles must be synchronized using a combination of birth control pills and Lupron. When the cycle begins, the donor is administered the medications required for a standard IVF cycle, while the intended mother takes a combination of estrogen and progesterone to prepare the uterine lining for implantation. However, with recent improvements in embryo freezing, comparable pregnancy rates are now being observed between fresh and frozen donor egg embryos allowing much greater flexibility in scheduling. Once the donor’s eggs are mature, they are retrieved using the standard trans-vaginal ultrasound-guided method of follicle aspiration. The sperm is provided by the intended mother’s partner (or by a donor) and fertilization takes place in the laboratory.
Alternatively, sperm can be shipped to Santa Monica Fertility Center, embryos are created from donor eggs and frozen. The intended mother can then undergo the embryo transfer at a later time convenient to her with minimal hormonal treatment.
Typically the embryo transfer is scheduled 3 or 5 days later. The intended mother continues to take estrogen and progesterone through the end of the first trimester to mimic the hormones produced by the ovary in natural conception. At the end of the first trimester (twelve weeks gestational age, or approximately ten weeks after embryo transfer), the placenta produces the necessary hormones, and the estrogen and progesterone supplementation is no longer required.
Alternatively, the embryo can be frozen and prepared for transfer at a later date.