THE DONATION CYCLE
The first pregnancy through egg donation occurred in 1984. Since that time egg donation has become a popular method to assist couples and individuals suffering from infertility. The recipient mother gives birth to a child with biological connections but non genetic.
Egg donation has been used in cases of female infertility due to medical problems such as ovarian failure, early menopause, absence of ovaries, and cases where the mother has a genetic defect that she does not want to pass onto the child. It has become particularly popular in cases of advanced maternal age where the mother has not responded to fertility medication alone or in combination of IVF.
The Following description of an egg donation cycle is a generality. Different physicians will utilize different medication and protocols of the recipient mother and egg donor. What follows should not be presumed unless substantiated by your fertility physician.
THE WORK-UP PHASE
The initial medical screenings for the recipient mother follows closely with an IVF work-up. The mother will undergo a medical history and physical exam by a fertility physician. Blood tests will be done to evaluate her FSH levels, blood type and RH factor, Rubella titer and exposure to CMV. A pap smear and tests for sexually transmitted diseases will be done. The husband will also have several tests done including a blood and semen test. For mothers of advanced maternal age and EKG, echocardiogram and cardiac stress test, will be done to assess her ability to tolerate the pregnancy. Risk factors for pregnancy induced diabetes and hypertension will be assessed. She may be asked to be evaluated by a mental health professional to assess her response to a child that is not genetically matched. Her husband may be asked to attend this evaluation. The physical exam of the mother will most likely include a HSG (hysterosalipingogram), SHG (sonogysterogram), or hysteroscopy. These tests asses the uterine cavity. A high risk obstetric consultation may be requested if there are complicating medical concerns. A mock transfer of the embryos may included prior to the actual transfer to assess for any problems that may occur during the real transfer.
THE MEDICATION PHASE
Once the screenings have been performed to the satisfaction of the fertility physician, the mother’s menstrual cycle will be synchronized with the egg donor. Lupron is a medication commonly used. This medicine suppresses her menstrual cycle. Side effects of Lupron are similar to symptoms of menopause and can include facial flushing, irritability, and hot flashes. Once the cycles are aligned and the donor starts her stimulation medication, the mother will begin Estrogen to stimulate the uterine lining to develop and receive the implanted embryos. Estrogen may be given as a patch, pill, or injection. The mother will be visiting her physician frequently for blood tests to assess her response to the medication and undergo painless ultrasound exams to assess her developing uterine lining. One the physician determines the donors’ eggs are fully developed the donor will receive a shot of HCG which causes the ovaries to release the eggs. At this time the mother will start on Progesterone as well. This medication causes changes in the uterine lining which allows the embryos to implant. Progesterone is given by suppository, vaginal gel, or most commonly by injection.
FERTILIZATION AND EMBRYO TRANSFER
On the day of the retrieval of the donors’ eggs, the eggs will be fertilized with the husbands’ sperm or donor sperm. A procedure called ICSI (Intracytoplasmic Sperm Injection) may be performed if it is determined that the sperm sample is of poor count or quality. This assists the fertilization of the eggs. The eggs are later inspected for fertilization. Usually multiple eggs are fertilized and they are allowed to mature to 5 days. On day 5 two or three of the best quality embryos are transferred to the mother. This transfer is performed by placing a small catheter through her cervix and into the uterus. Some cramping may occur. The mother is frequently given something to relax her prior the the transfer. She will be on bed rest for one or two days after.
Any extra embryos will be frozen. These embryos will give the mother another chance at pregnancy should the first cycle fail. Frequently these embryos are utilized during later attempts to produce siblings for the child.
The mother will continue on her Estrogen and Progesterone medication after the transfer. At two weeks she will have a pregnancy test. The Estrogen and Progesterone will continue through her early pregnancy.
The success of pregnancy through egg donation varies but the age of the mother is usually not a factor. Each clinic and physician boasts his own success rate. Physicians listed at The Stork Society, LLC have proven success rates based on statistics obtained from the Center for Disease Control and links are provided to check the success rates of the other clinics as well. Numerous factors affect the statistics including the number of embryos implanted and whether the pregnancy is carried to term. Some statistics reflect the number of pregnancies achieved and others report live births. Other factors such as how many procedures the clinic / physician performs each year affect their percentage of success and how many physicians or clinics report together as a unit can skew the data as well. The average success rate for fresh cycle egg donation in the USA is about 70% with approximately a 10% increase or decrease in success based on individual physician or clinic results. A frozen embryo transfer cycle is less successful and depends on the quality of the embryos that were frozen. A higher grade frozen embryo is more likely to survive the thaw and achieve pregnancy for the mother.
The major risk of pregnancy through egg donation is multiple births. The current trend is to reduce the number of embryos transferred to the mother. Most clinics limit the number of fresh embryos transferred to two or three if the donor is less than 34 years of age.