More on Donor Eggs

It helps to read the instructions…carefully. This afternoon I was helping my son, Aaron, assemble a new baseball pitchback that he received as a birthday present. We read the instructions and quickly assembled the aluminum frame with the little shock cords that would hold the net in place. Suddenly we stood back and noticed that we had completely goobered the thing up and had to pull it apart and start over. The problem was that we were too anxious to get the pitchback pulled together and had not really read the instructions carefully. Couples that jump into egg donor IVF can sometimes experience the same phenomenon.

The decision to use an egg donor is a very profound one and should not be taken lightly. The ASRM recommends that all women and couples using donor gametes (sperm and eggs) undergo psychological counseling. Although this is not a “pass-fail” type of evaluation, sometimes the couple takes stock of their situation and decides to hold off on donor egg or pursue adoption. The good news is that from a biological prospective, there is no rush as the uterus doesn’t lose its ability to carry a pregnancy.

So as we continue this donor egg discussion let’s go to the “Question of the Day.”

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 in 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.