Egg donation is an option for couples whose primary cause
of infertility is suboptimal egg quality. Egg Donation is an assisted conception
option where one woman (the donor) donates her eggs to a couple (the recipients)
to enable them to conceive. Current success rates for treatment are exceptional,
and in large, experienced practices the wait list for donors is typically only
a few months. While adoption is certainly a wonderful alternative, egg donation
presents an intimate, successful, and ultimately very satisfying option.
More than 150,000 women in the United States cannot bear children
due to ovarian problems. Many women need egg donors to have a child since either
they do not produce any eggs of their own or their eggs cannot be used for a
healthy pregnancy. A woman might not produce eggs for a variety of reasons:
- Poor development of ovaries
- Premature ovarian failure
- Menopause
- Diminished ability to ovulate due to surgery or chemotherapy.
All these women
with the problems above will need donated eggs to have a child. Other women may
be potential candidates for egg donation if they are:
- Ovulating but approaching menopause and their eggs are failing to fertilize
or are unable to sustain an ongoing pregnancy
- Ovulating but carry genetic abnormalities that could be passed on to their
offspring.
There are several ways for a woman to determine if she has problems with
her egg supply. A fertility evaluation can be processed, which will include a
blood sample taken on day three of the menstrual cycle to check for evidence
of egg quality problems. Poor egg quality is indicated by elevated levels of
follicle stimulating hormone (FSH) and/or estradiol. An Ultrasonography may also
be utilized to check for egg quality: the doctor will evaluate the basal antral
follicle count (BAFC) and a decreased ovarian volume or a reduced BAFC may suggest
a reduction in ovarian reserve. A woman may also exhibit signals of poor egg
supply if she is over 40 and frequently miscarrying. A careful examination of
ovarian reserve is recommended in these cases.
The decision to undertake egg donation is a difficult one; however, a diminished
egg supply makes natural conception difficult or almost impossible. The risk
of having a child with congenital abnormality also may increase. For women who
have undergone extensive successful infertility therapy and recurrent chromosomally
abnormal pregnant loss, egg donation represents a safe and successful treatment
option.
There are two types of donor programs: anonymous and known. For the anonymous
donor program, the identity of the donor and the recipient is maintained in strict
confidence. Although anonymous oocyte donation is medically analogous to sperm
donation, it is not easy to maintain a large pool of donors because oocytes are
not easily accessible, and in the present state of technology, oocytes cannot
be successfully cryopreserved (frozen) as sperm. At Reproductive Medicine Associates
of New York, anonymous donors range from 21 to 32 years of age. They are also
nonsmokers, with a normal body weight and a healthy medical and genetic history.
The donors must also test negative for all the infectious disease screening performed
according to the strict standard criteria of New York State (NYS) and American
Society of Reproductive Medicine Guidelines (ASRM).
For the known donor program, a recipient has to identify a donor who is 21
to 32 years of age. The donor must also be a nonsmoker, with a healthy medical
and genetic history. The known donor screening testing for infectious diseases
is similar to all oocyte donors and is performed according to the standard criteria
of the NYS and ASRM guidelines.
If a woman considers using donated eggs, she should be tested for any abnormalities
that could affect the success of IVF with donor eggs. Tests should include: a
panel of blood tests that can assess whether the potential recipient has normal
thyroid and prolactin levels, whether she carries certain antibodies that may
require additional treatment during the cycle, and a general screening panel
for infectious diseases; cervical cultures for Chlamydia, gonorrhea and mycoplasma;
an x-ray (called a hysterosalpingogram), saline sonogram, or hysteroscopy to
check for abnormalities in the uterus and fallopian tubes; and a semen analysis.
Additionally, some women will need to pass a mock egg donation cycle, also
called a "prep cycle." In this type of cycle, the potential recipient
takes similar medications to those used in an egg donation cycle for a period
of 4-6 weeks, and comes to the office routinely for monitoring of hormonal blood
levels and endometrial growth. The purpose of a prep cycle is to make sure that
the potential recipient's endometrial lining thickens well enough to become pregnant
through an egg donation cycle. Prep cycles may be waived for women with adequate
uterine lining data from past cycles.
Pretreatment counseling should provide a full explanation of the egg donation
process, risks, and likelihood of success. In a procedure similar to in-vitro
fertilization (IVF), two or three embryos are normally transferred to increase
the couple's chances of pregnancy. In contrast to IVF, a high success rate is
independent of age and is instead dependent on the overall health of the recipient
(especially her uterine function). Patients should also be advised on the potential
psychological impact of egg donation.
Once the recipient passes all preliminary tests, she must take hormones for
two weeks prior to the transfer to synchronize her cycle with the donor's cycle.
This allows the recipient's uterine lining to develop as the donor's follicles
and eggs grow, optimizing the implantation environment for the transferred embryos.
These hormones include estrogen, which can be taken orally or administered in
patches that attach to the skin and progesterone administered by injections.
The recipient starts taking progesterone daily on the day before or the day
of the donor's egg retrieval. The embryo transfer takes place two to five days
later. Estrogen and progesterone treatments continue until the pregnancy test
on the 28th day of her menstrual cycle. If there is a pregnancy, the recipient
continues to take estrogen and progesterone to support the development of the
placenta until the tenth week of pregnancy.
There are several risks for egg donation. The main risk is a multiple pregnancy.
In the early years of egg donation, triplets, quadruplets, and even quintuplets
were not an unusual outcome. Now the process is better understood and only a
small number of embryos (two to three) are transferred. According to the CDC's
most recent national data, 36% of egg donation pregnancies are twins and more
than half were singleton pregnancies. Higher order multiples occur in less than
2% of recipient pregnancies in our program at Reproductive Medicine Associates
of New York.
Multiple-infant births are associated with greater problems for both mothers
and infants, including higher caesarean section rates, prematurity, low birth
weight, and infant disability or death. Multiple pregnancies may be reduced to
twins or singletons through a procedure called multifetal pregnancy reduction.
Tanmoy Mukherjee, MD is a board certified reproductive endocrinologist at
Reproductive Medicine Associates of New York and is also Associate Director of
the Mount Sinai Division of Reproductive Endocrinology.
© Copyright Tanmoy Mukherjee, MD
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