Egg Donor Program at our WVFC Facility
in Arizona
West Valley Fertility Center's Egg Donor Program is designed to assist women, who for diverse reasons are unable to produce their own healthy eggs for conception. This program gives women the opportunity to carry a pregnancy and deliver a baby. Throughout this overview, the woman donating her eggs is referred to as "the egg donor " and the woman/couple receiving the donated egg is referred to as the Intended Parent(s)". Our goal is to make the egg donation process as positive, simple and stress free as possible. We will coordinate the screening requirements of all parties, synchronize the medical procedure, and if desired, we will assist you in selecting an egg donor compatible with your needs.
Are You A Candidate for Egg Donation?
Egg Donation is indicated if one or more of the following criteria are present:
1. An elevated FSH (Follicle Stimulating Hormone) level (>15MIU) or women who are resistant to stimulation with fertility drugs.
2. Women over 40 years who want to improve their chances of achieving a healthy pregnancy.
3. A history of poor fertilization of eggs in an IVF cycle despite good sperm quality.
4. Women who have been unable to achieve a viable pregnancy despite repeated attempts at IVF.
5. When no ovarian function is present because of previous surgery, radiation or chemotherapy.
6. Women under 40 years of age who are experiencing premature menopause, or who have undergone menopause.
7. Women with a family history of a genetic disorder (usually dominant) that has a high likelihood of being past on to any child through her eggs. Also, for women with frequent miscarriages due to a genetic condition called a "balanced translocation".
If you are a candidate for Egg Donation, you will meet with our Third Party Coordinator to discuss what is involved in an IVF Cycle using an egg donor and the steps in choosing an egg donor.
IVF with Egg Donation requires the following steps:
1. Selecting and Screening an egg donor
2. Screening of the Intended Parents
3. Synchronizing the Intended Mother's and Egg Donor's Cycles using oral contraceptive pills (OCP)
4. Ovulation Induction and Monitoring of the egg donor
5. Preparing the Intended Mother's Uterus for Embryo Transfer
6. The Egg Donor Undergoes Egg Retrieval
9. Transferring the Embryo(s) to the Intended Mother's Uterus
10. Post Embryo Transfer Management and Follow-Up
1. Selecting and Screening an Egg Donor
An egg donor may be someone the Intended Parents know or can be chosen anonymously from either our in-house egg donor registry or from an outside egg donor agency. A known egg donor is often a close relative or friend of the couple. A benefit of having a family member as an egg donor is the genetic link between any resulting child and the woman or Intended Mother. The screening of a known egg donor takes 1 to 2 months.
For most women using an anonymous egg donor is the only option available for them. Anonymous egg donors are usually recruited from colleges, universities, through ads in local newspapers and often by other egg donors. At WVFC we thoroughly screen each prospective egg donor to include detailed medical, social, psychological, and genetic (i.e. cystic fibrosis) evaluations. Laboratory tests are conducted to screen for communicable diseases such as Syphillis, Hepatitis (B and C), HIV, and other sexually transmitted diseases such as Chlamydia and Gonorrhea. The psychological evaluation includes a 600 plus question test (MMPI) and a face-to-face interview with a psychologist. Only egg donors who pass the medical screening and psychological evaluation that meet our high standards are placed in the registry and made available to couples looking for an egg donor. The Intended Parents will select 2-3 egg donor names and these women will be contacted to confirm their availability. The egg donor will then complete any additional testing that is indicated.
Throughout the entire selection and treatment process the egg donor's identity is anonymous. The Intended Parents will know only the age of the egg donor, her egg donor code, and what she looks like and the detailed medical and personal information she provides on the in-depth profile. No name or identifying information will be shared between the egg donor and the Intended Parents.
2. Screening of the Intended Parents
The Intended Parents are also required to undergo evaluation and testing to maximize a successful outcome. This clinical evaluation is called pre-cycle testing.
For the Intended Mother:
1. Cervical cultures are taken for ureaplasma/mycoplasma and aerobic organisms, and a DNA probe for Chlamydia and Gonorrhea is also obtained. Organisms such as ureaplasma have been associated with poor reproductive outcome and poor embryonic growth in the laboratory.
2. Uterine cavity evaluation. This evaluation can be performed by means of a hysterosalpingogram (HSG), an office hysteroscopy, or a "fluid" ultrasound (hysterosonogram). These procedures allow us to evaluate the uterine cavity and make sure there are no fibroids, polyps, or scar tissue that could interfere with implantation. Also, the Intended Mother should have a "Mock Embryo Transfer" to carefully assess length of her uterine cavity, in order to accomplish an atraumatic embryo transfer in the IVF cycle.
For the Intended Father:
1. The male will undergo a complete semen analysis with strict morphology evaluation (Kruger Criteria) at our laboratory. In addition, sperm antibodies are measured in both partners. High levels of sperm antibodies can interfere with fertilization in the laboratory, and special techniques are employed to correct this problem.
For both Intended Parents:
1. They are screened via blood tests for Syphillis, Hepatitis (B and C), CMV, and HIV. The Intended Mother is also screened for German Measles (Rubella) and Varicella. The Intended Father is also screened for HTLV-1/2.
2. A meeting with a psychological counselor is scheduled to discuss issues related to the use of donor eggs.
Often the Intended Mother's pre-cycle testing can occur while the egg donor is being selected and screened to help reduce the time before treatment can begin. Once all the evaluations are complete, the Intended Parents will choose a month to begin the cycle of treatment.
3. Synchronizing the Intended Mother and egg donor's Cycles using oral contraceptive pills (OCP):
Often the Intended Mother and egg donor are not in the same phase of the menstrual cycle when all are ready to begin treatment. WVFC places both the Intended Mother and the egg donor on oral contraceptive pills (OCP) so that the cycles can be synchronized. The birth control pills are usually taken for 3 to 6 weeks. A calendar for both the Intended Mother and egg donor will be provided detailing when each medication is to begin and when appointments are scheduled.
4. Ovulation Induction and Monitoring the Egg Donor:
Once the egg donor has been selected by the Intended Parents, she will be placed on birth control pills (if not already on them) to synchronize her menstrual cycle with the Intended Mother's. The egg donor is instructed in the proper use of all the needed medications during her ovarian stimulation cycle. This teaching includes: medication side effects, possible complications, and the proper injection technique. She will then self-administer ovulation inducing medications to stimulate multiple egg development. When the eggs have developed sufficiently they will be retrieved.
The start of the ovarian stimulation is timed using oral contraceptive pills (OCP). The egg donor takes OCP for two to four weeks prior to the beginning of the stimulation. Within 4 days after the last "active" pill is taken a baseline ultrasound is performed to make sure there are no ovarian cysts, and a blood estradiol level is measured. The fifth day after the last "active" pill is taken the egg donor begins injections of gonadotropins (Follistim, Gonal-F), according to a schedule that is provided by the clinic. We arbitrarily call this first day of gonadotropin administration Stimulation Day 1.
On Stimulation Day 5 the egg donor begins the administration of a GnRH antagonist (Ganarelix or Cetratide) to prevent premature ovulation. In order to monitor an egg donor's response to these drugs, frequent ultrasounds and serum estradiol levels are performed starting Stimulation Day 7. These help us determine when the eggs are ready for collection.
Once the follicles (containing the eggs) are deemed ready or mature, the egg donor stops taking the GnRH antagonist and the gonadotropins. About 35 hours prior to the anticipated egg retrieval, the egg donor takes an injection of human chorionic gonadotropin (hCG). This hormone replaces the woman's normal LH surge, and is necessary for the final maturation of the eggs so that sperm can fertilize them.
5. Preparing the Intended Mother's Uterus for Embryo Transfer:
Since the Intended Mother will be using donor eggs, she will begin a medication called Lupron that temporarily blocks the brain-ovary communication and stops the ovaries from producing the next months' egg. She will then begin hormone injections (estradiol and progesterone) to prepare her uterine lining for implantation of the transferred embryos.
In a natural cycle the uterine lining is built up in response to the hormone estradiol that is produced by the developing follicles within the ovaries. In the Intended Mother, we replace the follicle-derived estradiol with the medication Estradiol Valerate. Estradiol Valerate is injected twice weekly on Tuesdays and Fridays. To monitor the Intended Mother's response to the medication, blood is drawn on Mondays and Thursdays to measure the serum (blood) estradiol concentrations. These blood levels are used to adjust the Estradiol Valerate dosage for the subsequent injection. An ultrasound examination is performed approximately 2 weeks after the estradiol injections begin to evaluate whether optimal endometrial development had occurred.
In the uncommon event of poor endometrial development, the Intended Parents will be given the choice of having the egg donor's eggs retrieved, fertilized, and cryopreserved (frozen) for transfer to the Intended Mother's uterus in another cycle, or to have the procedure cancelled.
Approximately 4-6 days before the anticipated embryo transfer, daily injections of progesterone begin in order to optimize the endometrium for implantation.
6. The egg donor Undergoes Egg Retrieval:
At West Valley Fertility Center, the egg retrieval is accomplished non-surgically using a vaginal ultrasound probe to guide a needle into the ovaries. The procedure is performed with intravenous sedation and does not require general anesthesia. An anesthesiologist administers the sedation to maximize the egg donor's comfort and safety. As a result, the experience is not painful and recovery is rapid.
7. Sperm Processing:
The day of the egg retrieval the Intended Father will provide a fresh semen sample unless prior arrangements are made. Freshly ejaculated sperm must undergo biochemical and structural changes called capacitation before they can fertilize an egg. In an IVF cycle, sperm are capacitated in the laboratory and the motile sperm are isolated prior to inseminating the eggs.
8. In Vitro Fertilization:
In vitro fertilization literally means "fertilization in glass". Follicular fluid removed from the ovaries is examined in our lab for the presence of eggs. These eggs are isolated and placed in culture media where they are allowed to further mature. A few hours later, the processed sperm are placed around each egg. Approximately 50 thousand sperm are needed for each egg. This is why men with low sperm counts can often fertilize eggs in the lab.
The eggs and sperm are left to incubate together in a carefully controlled environment. Approximately 16 hours following insemination, the eggs are inspected under the microscope to determine how many have been successfully fertilized. These embryos will be kept in the incubator as they continue to grow and develop until the moment of transfer.
The Intended Parents receive daily reports keeping them informed of the development of the embryos (fertilization, cell division and quality or grading). Three days after the egg retrieval, a decision is made about when to perform the embryo transfer (Day 3 embryo transfer or a blastocyst transfer). The decision to transfer at Day 3 or 5 (blastocyst) is based on the grading of the embryos.
9.Transferring the Embryo (s) to the Intended Mother's Uterus:
At West Valley Fertility Center all embryo transfers are performed under trans-abdominal ultrasound guidance. We have found that ultrasound-guided transfers are easier to perform and have resulted in higher pregnancy rates. The ultrasound allows for the accurate placement of the embryos approximately 1.5 centimeters from the top of the uterus. The embryos are transferred via a thin plastic tube and this catheter is carefully guided into the upper part of the uterus where the embryos are placed. After 20 seconds the catheter is gently removed. The transfer is generally a painless procedure and the patient remains resting for 1 hour, after which she is sent home. We instruct our patients to rest at home during the next two to three days after the transfer.
When to transfer Day 3 or Day 5 (Blastocyst)?
Depending on the quality of the embryos and the couple's preference, the embryos may be transferred into the Intended Mother's uterus either 3 or 5 days after egg retrieval. Three days after egg retrieval, the embryos have cleaved (divided) and contain 6 to 10 cells each. If an embryo transfer is performed at this time, approximately 1 to 3 embryos are transferred depending on the egg donor's age, the couple's desires and the quality (grading) of the embryos.
Currently, we offer couples that have embryos of exceptional quality the option to transfer their embryos 5 days after egg retrieval when the embryos are at a more advanced stage of development (blastocyst stage). These blastocysts have a higher implantation rate than embryos grown only three days, and as a result, only two blastocysts need to be transferred to have the same pregnancy rate usually seen when 2 or more embryos are transferred into the uterus on Day 3.
10. Post Embryo Transfer Management and Follow-Up:
To ensure an optimal environment for implantation, the Intended Mother continues the hormone injections of Progesterone and Estradiol Valerate during the post-embryo transfer phase. Fifteen days following the egg donor's egg retrieval (12 or 10 days after the Intended Mother's transfer) a pregnancy test is performed. If the test is positive the hormone injections continue for an additional 8 weeks until the placenta is fully functional. A second pregnancy test is obtained approximately 8 days after the first to confirm that the pregnancy is ongoing. Confirmation of a clinical pregnancy is made by ultrasound about 2 to 3 weeks later. If the pregnancy test is negative, all hormonal treatment is discontinued and menstruation will ensue within 3-10 days.
11. Cryopreservation
An option for couples with many embryos is to freeze the "extra embryos". This gives the Intended Parents an additional opportunity to conceive without going through another stimulation cycle and egg retrieval. After a Day 3 embryo transfer, all remaining embryos are cultured for 2 to 3 more days. We then freeze the embryos that reach the blastocyst stage and are of good quality. Our pregnancy rate with the transfer of frozen blastocysts is almost double the expected pregnancy rate with the transfer of frozen Day 3 embryos.
A frozen embryo cycle can be used if the Intended Parents were not successful with the fresh embryo transfer or, if successful, when they wish for another child. Since The Intended Parents already have embryos to transfer, the Intended Mother's uterus needs only to be prepared to receive the embryos. This preparation is very similar to that already discussed for a "fresh" egg donation cycle. When blastocysts are to be transferred daily injections of progesterone are started six days prior to the date of transfer, and the Lupron is stopped. Prior to thawing the embryos, an ultrasound assessment of the uterine lining is performed to make sure an adequate endometrial thickness is present. The embryos are then thawed the morning of the transfer. If successful thawing of the embryo(s) occurs, an embryo transfer will take place as previously described. About half of the frozen embryos survive the defrosting process. Therefore, at least 2 blastocysts should be available for a frozen embryo transfer cycle.
Anticipated Success Rates with Egg Donation
Pregnancy rates using donor eggs are reflective of the age of the egg donor. We anticipate approximately a 55% live birth rate.
The Team Approach
West Valley Fertility Center's overriding objective is to provide an efficient and successful mechanism for helping infertile couples achieve their life's dream of having a baby. Our team is committed to providing the highest quality medical care in a sensitive and caring environment. We are here to assist you on your path to fertility.
If you have any questions please contact our Third Party Coordinator, she will be happy to assist you.
Last updated:
June 4, 2008
Reviewed by Dr. Vladimir Troche and his medical staff