Wanted: Egg Donor

So here I am sitting in Logan International Airport trying to kill some time before heading back to DC and hoping that I don’t catch Swine Flu. I was in Boston all day to attend a special ceremony honoring my father, Dr. Edward Gordon, who just retired from active clinical practice at the age of 86 and ending 60 years of continual practice as a general surgeon. All three of his sons were in attendance as he received several commendations for his contributions to medicine. Following these presentations, Dr. Pauline Chen gave a very emotional presentation including a reading from her NYTimes best-selling book Final Exam. I asked her for some hints as to how to get our book higher up the best-seller list but she was at a loss….Oh well.

What does all this have to do with infertility? Nothing. Just thought my patients may want to know where I was on a rainy Friday in Virginia. If you don’t care where I was then please accept my apologies but no one’s forcing you to read this blog anyway (although I pay my kids 5 cents per click to help my Google ranking).

This has been a week full of third-party reproduction questions. Egg donation, sperm donation, embryo donation, gestational carrier, gestational carrier with egg donation vs. embryo donation….etc, etc. If you can think of an usual way to have a child, chances are that someone has already tried that. Every year I get a couple of questions regarding daughter to mother egg donation. Adult daughter from first marriage wants to help mom have a baby with 2nd husband. If successful this makes husband #1 the grandfather of baby born to patient and husband #2. This is not as newsworthy as Octomom but most clinics will not perform this type of egg donation. The reason usually given (and I concur) is that children wish to please their parents and that makes Informed Consent without coercion impossible. Plus it just seems “yucky.”

So how do we even do egg donor IVF in the first place? This is the topic of today’s excerpt from 100 Questions and Answers about Infertility (which could use some more positive reviews on Amazon.com BTW!).

82. What are egg donors, and how is donor egg­ IVF performed?

Donor egg-IVF involves the use of healthy female egg donors who are usually in their twenties. Most donor arrangements are anonymous, although known donor egg IVF is possible. In the latter case, the known donors are usually family members or friends. In our experience, most of our patients prefer to use an anonymous egg donor to avoid family and interpersonal conflicts. Most medical practices recruit egg donors for their patients, but third-party agencies are also available that act as brokers. The American Society of Reproductive Medicine (ASRM) has developed a set of egg-donor screening guidelines, which most practices utilize for screening donors. The guidelines encompass comprehensive screening for infectious and genetic diseases, physical examination, and psychological testing.

Since May 2005, the U.S. Food and Drug Administration (FDA) has mandated extensive infectious disease testing while screening all anonymous egg and sperm donors. The actual treatment cycle for donor-egg IVF essentially combines a fresh IVF cycle (the donor) and a medicated FET cycle (the recipient). The two treatment cycles are synchronized by using GnRH analogs. Usually, the recipient begins estrogen therapy 5 days prior to the start of the egg donor’s stimulation so as to provide an adequate time frame for the recipient’s endometrium to grow and thicken. After 10 to 14 days of stimulation, the donor receives an injection of HCG (Pregnyl, Profasi, Ovidrel) to mature her eggs. On the same day, the recipient starts progesterone therapy to create a receptive endometrium.

Because most egg donors are young, they tend to respond very well to the ovarian stimulation drugs, producing many high-quality eggs and embryos. Implantation rates with these embryos are also very high, so that usually only one or two embryos are transferred to the recipient. Pregnancy rates usually exceed 50% per initiated cycle, making donor-egg IVF the most successful therapy currently available for infertile couples. Usually, extra embryos that were not transferred can be frozen and stored for later transfer, with excellent pregnancy rates achieved in subsequent conception attempts.