Egg donation is a process in which a fertile woman donates eggs to another woman to help her conceive. It is part of the services available within some assisted conception clinics according to the law in the country where the clinic is based.
For which patients is egg donation indicated?
- Women of advanced reproductive age (typically over the age of 42 years).
- Women with ovarian failure.
- Women with inadequate response to ovarian stimulation in previous treatment cycles.
- Women who are known to be affected by or known to be carrier of a genetic condition that they do not want to pass on to their children.
- Women with poor egg or embryo quality or multiple previous failed IVF attempts.
- Women with no ovaries either as result of surgery or congenitally absent.
What is the process for treatment with egg donation?
- In cycles where fresh embryos are to be transferred, the donor and recipient's cycles must be synchronised, usually by taking the birth control pill, so that the recipient's endometrium (uterine lining) is prepared by the time the donor's eggs are retrieved and fertilised in vitro.
- When the cycles are synchronised, the egg donor takes hormone medications to stimulate the growth of follicles and maturation of the eggs contained within the follicles. The egg donor undergoes monitoring by ultrasound scans and blood tests during a period of 10 to 14 days, after which the eggs are retrieved.
- The egg recipient takes also hormone medications (oestrogen and progesterone) to prepare the uterine lining for embryo implantation.
- Once the donor's follicles reach a certain size, generally greater than 17-18mm, the egg retrieval is scheduled. The partner or sperm donor will provide the sperm sample on the day of the egg retrieval for insemination of the eggs, unless the sperm had been previously frozen.
- The embryo(s) will be transferred to the recipient’s uterus three to five days after fertilisation.
- The first step is to find an egg donor. This can be either someone known to the recipient or unknown, and depending on the law in the country the donor can be anonymous or identified.
- For cycles where the embryo(s) are frozen, the menstrual cycles of the recipient and donor do not need to be synchronised, but the recipient’s endometrium must still be prepared using the hormone medications in advance of performing the embryo transfer.
What are the screening tests done for the egg donor?
- Thorough assessment of the medical, sexual, and family history of the egg donors are carried out to minimise the risk of inherited disorders.
- Donors are tested for blood group, cytomegalovirus (CMV) status, chromosome analysis (ie, karyotype) and certain genetic disease(s) like cystic fibrosis, thalassaemia or sickle cell.
- Screening for infectious diseases is done to all donors including HIV, Hepatitis B, Hepatitis C, Syphilis, Gonorrhoea, and Chlamydia.
- Implications counseling by a fertility counsellor is strongly recommended for all donors to discuss the ethical and psychosocial issues of donating eggs.
How is the egg recipient assessed?
- A thorough review of medical, reproductive, surgical, and mental history is undertaken.
- Laboratory testing includes blood type, antibody screen, thyroid function, and testing for diseases including HIV, Hepatitis B, Hepatitis C, Syphilis, Gonorrhea, Chlamydia, and Cytomegalovirus (CMV).
- The recipient and the partner, if applicable, must receive implications counselling by a fertility counsellor.
- If the recipient is over the age of 45 years, a more thorough evaluation should be done, including assessment of the heart, liver and kidney functions, and the risk of pregnancy-related diseases. Referral to a pre-conception clinic run by an obstetric consultant may also be advised.
- The male partner’s sperm should be assessed, and appropriate genetic screening should be obtained based on the history and ethnic background.
- The male partner should also be tested for blood type and diseases such as HIV, Hepatitis B, Hepatitis C, Syphilis, Gonorrhea, Chlamydia, and Cytomegalovirus (CMV).
How is the egg donor selected?
- Oocyte donation may be undertaken with known or unknown donors.
- Oocyte donors should be of legal age in their state and preferably between the ages of 21 and 35 years.
- Anonymous donors are recruited through egg donation programmes or frozen egg banks, and are not known to the recipient.
- Known donors are generally a close friend or relative of the recipient.
- Recipients are given donors profiles to choose from. These include non-identifying details such as physical characteristics (hair and eye colour, height, weight, build, skin colour), ethnicity, blood group, career, education, and fertility history.
How successful is egg donation?
Success rates with egg donation depends on various factors, including the quality of the sperm, the quality of the donor eggs, the quality of the embryo(s) at the time of transfer, the age of the donor, the recipient’s medical, fertility and obstetric histories.
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