Even sophisticated, 21st-century medical technology has its limitations. When the best science has to offer is not enough for other medical problems, we may be forced to turn to donation of sperm and eggs to achieve a healthy pregnancy.
Donation of semen has been practiced for more than a century, while the use of egg donation has only been used in the past three decades. Initially it was applied only to women with ovarian failure who were unable to produce any eggs. Its use has further expanded with the realization that egg quality and number are critical to IVF outcome. Egg donation will yield much higher success in:
• Poor responders to stimulation or women who produce poor-quality eggs or embryos, or both
• Those who have a markedly reduced prognosis due to an elevated Day 3 FSH
• Women who are of advanced age
WHEN IS EGG DONATION APPROPRIATE?
Prime candidates for utilizing donor eggs are patients when the female partner:
• Has laboratory evidence of premature ovarian failure, usually manifested in elevated gonadotropin levels (FSH and LH)
• Has demonstrated poor follicle development with stimulation due to reduced ovarian tissue because of previous surgery, damage to the ovaries by chemotherapy or radiation during successful therapy for a malignancy, or for unknown reasons
• Carries a genetic disease or chromosomal defect likely to be passed on to her offspring, resulting in miscarriage or an abnormal baby and does not want to do PGD or PGS Or in which the couple:
• May have had multiple failed IVF procedures, particularly with poor egg quality being found
• May be over 40 and may choose egg donation because of a dramatically higher rate of success
MAKING THE DECISION
The decision to utilize donor eggs can be made in two ways.
• It seems to be an easier decision to make if the patient has a relative or friend who wishes to donate eggs for her. However relatives or friends may not make the best donors as they are being selected because of their relationship, not characteristics which would make them most likely to succeed.
• Therefore we usually recommend obtaining eggs from an anonymous donor who is selected because of physical characteristics similar to the intended parent, her young age and her excellent ovarian reserve. The characteristics used to match a donor to a recipient are usually primarily ethnicity, hair and eye color, and, in some cases, education. The recipient couple can ask for any set of criteria, but the stricter their criteria, the less chance that they will find a suitable donor. The anonymous donor is fully vetted for her background, health history, habits, psychological and genetic profile and screened according to FDA rules for infectious diseases.
HOW DO WE FIND A DONOR?
Until recently all egg donation was done in a fresh IVF cycle which required both the donor and recipient to have their cycles suppressed over a lengthy period of time so that they will be in synch. Fresh donors are available at some IVF centers or egg donation agencies which recruit and initially screen the donors and charge a fee for their services.
Now, thanks to technology that allows eggs to be frozen, frozen eggs are available which can be used in a much quicker and easier process for the recipient couple. Reproductive Partners is fortunate to have PARTNERED with Donor Egg Bank USA which has frozen eggs from prescreened donors available immediately. The lack of a need to suppress the recipient's cycle and coordinate with the donor's cycle and schedule makes the process much quicker, often completing the embryo transfer within three weeks of the recipient's last menstrual period. The efficiency of being able to use one donor's frozen eggs for several potential recipients makes the process much less expensive.
Until recently all egg donation was done in a fresh IVF cycle which required both the donor and recipient to have their cycles suppressed over a lengthy period of time so that they will be in sync. Fresh donors are available at some IVF centers or egg donation agencies which recruit and initially screen the donors and charge a fee for their services.
Now, thanks to technology that allows eggs to be frozen, frozen eggs are available which can be used in a much quicker and easier process for the recipient couple. Reproductive Partners is fortunate to have Partnered with Donor Egg Bank USA which has frozen eggs from prescreened donors available immediately. The lack of a need to suppress the recipient's cycle and coordinate with the donor's cycle and schedule makes the process much quicker, often completing the embryo transfer within three weeks of the recipient's last menstrual period. The efficiency of being able to use one donor's frozen eggs for several potential recipients makes the process much less expensive.
There is no one right way to choose a donor. Choosing a donor is an individual journey and each person or couple will make choices based on their family building goals. You are likely to have physical, mental and emotional preferences in choosing a donor. Do speak with your doctor or donor coordinator if you have questions or feel strongly about a preference. Our advice to you is to make the time in choosing a donor a positive experience. You are in control. There are few times during the treatment process that you have an opportunity to have control. This is one of those times, so embrace it.
You will forever remember making such a big decision. You are choosing the DNA of your future child. If you choose to tell your child, you will want to share how you looked for the right donor to provide you a perfect gift. Your positive recount of the experience will instill upon your child self-esteem and a sense of being perfectly chosen.
HERE ARE FEW ITEMS TO CONTEMPLATE WHEN CHOOSING A DONOR:
• There is no perfect donor. There is no mini‐you in a database. You are unique and have qualities and idiosyncrasies that only you possess. You can expect to match most of the items that are important to you, However there are very few donors who may meet every criteria you may have.
• Current psychological research recommends that children of donor egg be told of their origins while young and in an age appropriate way. Matching a blood type is not medically necessary or important if you plan to divulge your baby's genetic source. As the parent of your child, to tell or not to tell will be your personal decision. You may wish to consult with your physician for more information on blood type.
• Consider choosing a donor that looks like you or complements some of your characteristics. People are inherently nosy and occasionally make insensitive comments. Many people will share with you their unsolicited thoughts as to who they think your baby looks like. While looking at the donor's characteristics also review her entire family. Is she the short one in an otherwise tall family or perhaps, the only brunette amongst all blonde siblings?
• Even in cases in which a child is not the mirror image of a parent, the child will take on the parent’s characteristics. You may want to watch the story of Allegra – an Egg Donor Child who tells her story on http://www.youtube.com/watch?v=hTgHRV8g1Fg
• Choosing a donor is an opportunity to play to your strengths or weaknesses. You may be very athletic, enjoy sports and want children that may have a genetic aptitude to the same. You can look for these qualities in your donor. Or you may not be able to carry a tune or dance a step in rhythm; this is a perfect opportunity to give your child a genetic edge in musicality.
• Review the medical history of the donor closely if you want to off‐set any genetic history of your partner providing the sperm. If your partner has a history of skin cancer in his family, you may want to look specifically for a donor with an absence of skin cancer in her history. Talk to your doctor if you have any concerns or for advice.
• Level of formal education will vary widely amongst donors. Some donors have had greater access to a formal education while others may have found the endeavor financially challenging or perhaps pursued other goals. While a higher level of education may afford some recipients peace of mind, it doesn't necessarily point to the level of intelligence of the donor.
• Once you narrow your choices based on the traits you desire, take time to read the personal statements. Perhaps one donor’s statement will connect with you more than another. Your donor, through her gracious gift, will forever become connected with you. Her personal comments will give you a glimpse into the heart of your donor and her desire to help you become a parent.
Choosing your donor is a wonderful step in your journey to parenthood; a step that will move you down the path to treatment and hopefully on to parenthood. While each person's experience in choosing a donor is different, we hope this helps guide you in the selection of your donor.
Q. What type of screening is done on the donor?
A. First, she must fill out extensive personal health as well as family health and genetic history questionnaires. If deemed suitable, she is invited for a consultation where her medical history is reviewed and a physical exam is done to detect any medical problems and assess her egg reserve. The entire donation process is explained in detail so that the donor candidate knows exactly what is expected of her including her time commitment, injections required, the details of the retrieval, and the potential risks. She will also receive genetic, psychological, drug and infectious disease testing.
Q. What is the mock cycle, if required, and how do I get started?
A. A mock cycle is necessary only if you are using fresh donor eggs or the 100% Assured Refund Plan™ for frozen eggs. It consists of taking all of the medications prior to your actual egg donation cycle. During this time, there will be blood tests to determine hormone levels. You will be on birth control pills for a short time, Lupron injections, then estrogen, followed by progesterone injections and possibly an endometrial biopsy.
There are two critical times during the mock cycle. One is the ultrasound to be sure the endometrial lining of the uterus is thick enough to sustain a pregnancy. The second critical time is the endometrial biopsy, if needed. A small sample of tissue is taken and analyzed to be sure you are taking the right dose of medications.
Q. Why do I have to do so many tests if I am 45 or older?
A. The "Over 45 Checklist" Is a series of basic medical tests required because with each advancing year a woman is more likely to develop medical problems during pregnancy. Pregnancy can be a tremendous strain on a woman and we want to be sure that there are no underlying physical problems to jeopardize your health or your baby's well-being.
Q. When should I get the IVF pre-cycle tests done?
A. Some can be done any time (as long as you are not on your period), such as the trial transfer and sonohysterogram to assure there is nothing in your uterine cavity to prevent implantation. Others like genetic screening for your partner may be needed if the donor you are using has not been screened for important conditions related to his ethnicity. Others like infectious disease screening can wait until you are matched with a donor and ready to begin the egg donation cycle.
Q. Will the donor be able to find out who I am or contact me in any way? ?
A. If your donor is anonymous, you or she does not have any way of identifying you under USA current law.