Like IVF cycles, the egg donation cycle commences at the beginning of the woman’s menstrual period. (In the case of egg donation, this is the donor’s cycle.) Prior to synchronization with the egg donor, the intended mother will undergo a practice cycle during which she will take estrogen tablets and progesterone suppositories in order to for us to determine whether the thickness of her uterine lining will be satisfactory for embryo implantation. We will also conduct a practice embryo transfer.
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.
The following is a general guideline for egg donation. The steps are grouped into the three main phases of the IVF process, with additional notes specific to the donor and the intended mother. Details may vary based on the needs of both the egg donor and the intended mother.
Prior to synchronization with the egg donor, the intended mother will undergo a practice cycle during which she will take estrogen tablets and progesterone suppositories in order to for us to determine whether the thickness of her uterine lining will be satisfactory for embryo implantation. We will also conduct a practice embryo transfer.
Donor and intended mother: On day 2 or day 3 following the donor’s and the intended mother’s respective onset of menses, a baseline ultrasound examination and blood test is done in our office.
2 to 4 weeks
Donor and intended mother: The two women’s cycles are synchronized using oral contraceptives and/or Lupron. Oral contraceptives help start the ovarian suppression process and are continued for 2 to 4 weeks.In order to achieve ovarian suppression, Lupron is begun about two weeks before the start of ovarian stimulation and overlaps with the oral contraceptives. To ensure that ovarian suppression has been achieved, another office visit for ultrasound and blood testing is scheduled approximately two weeks after starting Lupron.
8 to 12 days. Once both donor and intended mother have achieved low estrogen levels, treatment continues as follows:Donor: Begins daily dosage of injectable fertility medications, while the Lupron is continued at a lower dose. The medications are usually self-administered subcutaneously (under the skin) using a short needle. Occasionally, we may need to change the dose of medication during the day, therefore, we recommend that patients take their injections in the evening.
Recipient: Begins oral estrogen therapy.
Donor: On day five of stimulation, regular office visits start. These continue every one to two days until egg retrieval takes place. An ultrasound and blood test for estradiol are performed at each visit. The patient must call at the end of the day for results and to receive further medication instructions.
Recipient: Based on the donor’s monitoring, the intended mother’s cycle is adjusted to the donor’s cycle.
Between day 8 and 12
Donor: When the follicles are large enough, final egg maturation is triggered with an injection of human chorionic gonadotropin (hCG). The timing of the hCG dose is very important, as egg retrieval is performed thirty-six hours later.
36 hours following hCG injection
Donor: The egg retrieval procedure takes less than thirty minutes, however, the entire appointment will take approximately two hours.
Recipient: Begins progesterone suppositories on the day of the donor’s egg retrieval.
Day of egg retrieval
Recipient’s male partner: Sperm are obtained from the intended mother’s male partner on the day of retrieval and occasionally the morning after egg retrieval if fertilization was suboptimal.In order to optimize sperm quality, it is recommended that the male partner abstain from ejaculation for two to seven days prior to the first sperm specimen. Typically, this will mean abstinence after the donor’s seventh day on fertility medication.
Day of egg retrieval. Sperm are placed in a dish with the egg or injected directly into the egg (ICSI) to achieve fertilization.The eggs are checked the next day to determine which ones are fertilized. Excess fertilized eggs, now called embryos, can be frozen at this time.
Day of embryo transfer. If indicated, assisted hatching is conducted in order to facilitate hatching and implantation. This is accomplished by making a small hole in the outer shell of the egg.
Preimplantation Genetic Diagnosis – PGD
3-5 days after retrieval. If indicated, Preimplantation Genetic Diagnosis (PGD) is done when the embryo reaches the 8-cell stage (day 3 of development) or the blastocyst stage (day 5-6 of development). PGD can reveal certain genetic conditions and gender with results in one to two days.
3 to 5 days after egg retrieval. The embryo transfer is a simple procedure performed by placing a soft catheter containing the embryos through the cervix under ultrasound guidance. It does not require anesthesia, however, Valium is administered to help relax the pelvic muscles. Therefore, it is important that patients arrange for a ride home. Patients are asked to arrive thirty minutes prior to embryo transfer and must remain in bed for fifteen minutes following the procedure.
Recipient: Since the ovaries are not producing any hormones during the egg donation process, it is important that the intended mother continue estrogen and progesterone until advised to stop.
Day 14 and 21. Blood is drawn on the mornings of day 9 and day 12 following the transfer. The patient will be contacted later in the day with the results.
Donor: The donor should expect her normal period approximately 7-14 days after egg retrieval.