Introduction

          Assisted reproduction using donated sperm is not a new practice. Such donations occurred in biblical times and sperm donation has been a common practice for many years.  However, it has only been in the last decade that the practice of donating oocytes (eggs) has become a technological reality.  Our practice first offered the option of egg donation in 1991.  The results were so encouraging that the program has grown yearly and the success rates continue to be above the national average.  As you consider this exciting reproductive option, we would like to introduce you to our program at The Institute For Reproductive Health.

          The process of egg donation, although originally expected to be utilized by women who had no  ovaries or who were carriers of genetically transmissible diseases, has proven to serve many women who have been unable to conceive using their own eggs. The procedure makes it possible for the recipient couple to experience the entire gestational process and birth experience.  Egg donation allows us to circumvent the age-related decline in egg quality that is now widely recognized.

          We have found that patient preparation is of the utmost importance prior to beginning a donor egg cycle.  Almost all couples have both physical and psychological issues and concerns that must be addressed in order to begin the cycle with confidence.  Special attention is paid in providing couples with written material, as well as face-to-face contact, in order to assist them in information gathering and preparation for egg donation.  This pamphlet is intended to acquaint you with the process of egg donation and to provide basic information. If after reading it you have any questions, please contact our office and ask to speak to an IVF nurse.  We will be happy to answer any questions you might have.

Preparation For the Recipients

          Before proceeding with the recruitment or selection of a donor, recipient couples will meet with their physician and a nurse.  You will have these two consultations whether or not you are already an IRH patient. Your physician will discuss what is required of you prior to participation.   During these meetings you will receive information about how the program works, what the costs are, the medical risks and the chances of success.

         We also include at least one visit to our psychosocial consultant for the recipients as well.  We believe that it is important to ensure that you are prepared emotionally as well as medically and that this meeting improves the care we give you.  At this time the couple may inquire about issues such as bonding, disclosure, or any other topics they want addressed.  It is an opportunity to talk about what infertility has been like, get help with decision making, and help looking beyond the cycle in the event that you are not successful.  Additionally, in this meeting, couples have the opportunity to learn from the experience of the many recipients who have gone before them.  Questions and discussion are highly encouraged before, during, and after the procedure. Our goal is to minimize stress and optimize your understanding and peace of mind throughout all phases of your treatment.

 Donor Selection

Recruitment

          There are two types of donor cycles. In an anonymous cycle the donor and recipient do not meet, nor do they have access to identifying information about each other. However, there are some recipient couples who are uncomfortable with the use of eggs from an anonymous donor. These couples will recruit a close friend or family member to be their oocyte donor, and proceed using a directed donor. The screening process is the same for both types of donations and follows the guidelines set forth by the American Fertility Society. The screening is extensive but is designed to optimize safety for donor, recipient and offspring.

Donor criteria

In our program donors are required to be between the ages of 21 and 33. They must give informed consent prior to beginning therapy and if married, the husband's consent is also required. They must have regular menstrual cycles and have no history of genetically transmissible diseases, sexually transmissible diseases or cancer. They must also have no history of alcohol or substance abuse. They must be willing to undergo extensive screening and be willing to use barrier contraception for at least two complete menstrual cycles.

Screening

          When a potential donor has been identified, she is first asked to complete a detailed questionnaire which gives us general information about her personal and family health history. The questionnaire gives us information regarding all members of the donor's family from her grandparents' generation to that of her children, if applicable. 

          When the completed questionnaire is received an RN, and a physician review it.

If the health history is negative for genetically transmissible diseases and the reproductive history is acceptable, the donor is contacted and an initial interview is scheduled. During this interview an RN outlines the donor cycle in detail and discusses all medications, side effects, risks and precautions. All procedures are reviewed.  If, after talking with the RN, the potential donor wishes to participate, she is referred to a psychosocial consultant.

          During this interview the donors may ask any questions regarding the psychological ramifications of ovum donation.  Virtually every donor we see envisions this process as a compassionate, altruistic act and her portion of the donation merely the donation of a few cells, much like blood donation.  After thorough psychological screening, each donor is required to complete the Minnesota Multiphasic Personality Inventory.  This series of simple true/false questions provides us with information about the donor's personality traits.  All of this information is very helpful when matching donors and recipients.  The final step in the screening process is a meeting with one of the physicians.  At this time the potential donor is counseled regarding possible risks and side-effects, and any final questions about the procedure are answered.  A physical exam is completed, the donor is tested for sexually transmissible diseases, and blood type is determined.

 Matching

          When all of the results of the screening have been received and found to be in order, the approved donor is ready to be matched with a recipient!   Matching donors and recipients is a very exciting part of the egg donation process.  It is especially important to us that recipients are completely comfortable with the donor they chose.

          Every couple has a different set of criteria for making this extremely personal choice. Importance may or may not be placed on any number of things, ranging from physical characteristics to blood type to personality traits.   You will work closely with the psychosocial consultant prior to making the decision.  You will also have the opportunity to discuss your wishes with an IVF nurse and we will work closely with you to help you find the right donor to meet your needs. 

     Potential recipients will be provided with information about the donors as they become approved.  All non-identifying information regarding a donor's age, physical characteristics, educational background, occupation, fertility history is shared with the recipient couple. After reviewing the information carefully, the

couple has the option of accepting the donor, or waiting for the very next available candidate.

Donor/Recipient Cycle

          Once the match has been made, it is time for the cycle to begin.   Treatment is usually individualized, depending on the diagnosis of the recipient and on her response to the medications involved.   The goal of treatment is to carefully synchronize the menstrual cycles of the donor and recipient so that when the

donor's eggs are retrieved and fertilized, the lining of the recipient's uterus is ready to receive and nourish them.  A typical treatment plan will be reviewed here. 

          We begin by synchronizing the menstrual cycles of the donor and recipient.  This is accomplished by pretreatment of the donor with a drug called Lupron that quiets, or down-regulates, the ovaries completely.  If the recipient has ovarian function, she is also treated with Lupron.  Once down-regulation of both donor and recipient has been confirmed, an artificial common menstrual cycle is established.  On the first day of this "artificial" menstrual cycle, the recipient begins taking medication that will prepare the lining of her uterus.  Six days later the donor begins medications that will cause multiple egg-containing follicles to develop within her ovaries.  The donor comes to our office for frequent blood tests and ultrasound examinations of her ovaries so the follicle development can be monitored and medications adjusted, if necessary.  The recipient is contacted with updates as to how the donor is progressing during the course of the donor cycle .  When the follicles have reached the right point of maturity, one last injection causes the eggs to complete their preparation for harvest, and the egg retrieval is scheduled. 

Egg Retrieval

          The egg retrieval generally takes place in the IVF Lab area of our Rookwook office.  The donor will be greeted by the IVF staff, admitted and transported to the procedure room.  She is given intravenous medications that will keep her comfortable during the egg retrieval. 

          Using a thin needle and ultrasound guidance, the physician removes the fluid from each follicle.  In the IVF Lab, highly trained technologists search through the fluid to find the eggs, which are transferred into dishes containing nutrient growth medium.  It is not unusual to have 10 to 12 eggs retrieved from one donor.  When the procedure is over, the donor rests for approximately one hour, and then she can go home.  Two weeks later she has a final check up.  On the morning of egg retrieval, the recipient's husband will provide a semen specimen so that the eggs can be inseminated.  Most often the husband will come to the ART Lab at the Rookwook office to collect the specimen so that no harm from temperature changes or delay in processing occurs.  The specimen is then prepared to provide the best chances for the fertilization of the eggs.  If your doctor has recommended Intracytoplasmic Sperm Injection (ICSI), that procedure is

performed early in the afternoon on the day of egg retrieval.  Fertilization is confirmed on the morning following the retrieval.   Typically 50% of the eggs will fertilize.   Several fertilized eggs are selected for transfer and will remain in the incubator for two more days.  The remaining fertilized eggs can be cryopreserved (frozen) for later transfer

procedures.

Embryo Transfer

          On the day of embryo transfer, the recipient couple should arrive at the Rookwood office about one-half hour before the transfer takes place.   The transfer involves placing the embryos in a narrow tube or catheter, which the physician inserts into the uterus through the cervical opening.  Following the transfer, the recipient rests for approximately one hour. She is then free to go home and maintain her normal daily routine.  Fourteen days later, a blood test will determine whether or not a pregnancy has begun.  Pregnancy rates will average 40-60% per fresh cycle.

Monitoring Your Pregnancy

          A positive blood test-how wonderful!-but that is just the beginning.  Other tests are also run to check on the levels of estradiol and progesterone in the blood, an indication of the health of the uterine lining.  Adjustments to the medications may be made to create the best environment for the embryo to continue its

development.  Two weeks after the positive pregnancy test, the first ultrasound examination is done to see the developing fetal sac and the fetal heartbeat.  A second examination two weeks later will show appropriate growth and development.  Bi-weekly blood tests are conducted to monitor hormone levels until

the supplemental medications are no longer required, otherwise the recipient continues in the care of an obstetrician. 

Conclusion

          The use of donor eggs has created many families, and we hope that the information provided in this brochure helps you in your own quest.  Please feel free to contact our program by calling 513-924-5550 for additional information.