Egg Donor Recipients
Egg donors can be found through a variety of methods. Many couples decide to use egg donation agencies to find an egg donor. A reputable agency can simplify the process by offering a wide selection of donors who have been fully screened, who will remain anonymous, and who have signed the necessary release forms. Egg donation clinics often partner with egg donation agencies or maintain their own databases of donors to facilitate the process.
Egg Donor Databases
Some fertility clinics work with egg donation agencies to obtain eggs, while others maintain their own registry of donors and offer a complete, in-house egg donation process. Egg donation clinics provide psychological and medical screening of donors, and administer the necessary treatments and procedures to the recipient. The clinics have full medical facilities for performing in vitro fertilization, and the doctors at egg donation clinics have specialized training in the egg donation procedure and implantation of the embryo. Professional, reputable egg donation agencies and clinics will thoroughly discuss their procedures, the rights and responsibilities of donors and recipients, and the risks of the egg donation process to both egg donors and recipients. Regardless of an agency's or clinic's standing, donors and recipients should read all contracts carefully before signing.
Each clinic has different guidelines for screening potential egg donors to ensure that they are good candidates. In general, potential egg donors will undergo several tests and screenings, including:
- Fertility Test and Physical Exam: These exams ensure the donor's overall health and her ability to produce healthy eggs, as well as determine her blood type and RH incompatibility.
- Medical and Psychological History: The donor must provide the medical and psychological histories of herself and close family members.
- Drug Screening: The donor must disclose current or previous use of alcohol, cigarettes, and prescription or street drugs. Some clinics also conduct random drug tests of donors to ensure that they aren't using drugs during the donation process.
- Infectious Disease Screening: This screening typically consists of a series of blood tests to detect diseases such as hepatitis B and C, HIV, Chlamydia, Gonorrhea, Syphilis, and HTLV.
- Genetic Screening: This screening looks for genetic abnormalities that could be passed on to offspring.
- Psychological Evaluation: Generally completed after the potential donor has passed all other screenings, this evaluation is performed by a licensed psychologist or psychiatrist to ensure the donor's emotional and mental health.
Most clinics provide couples with the medical and family history of potential egg donors; a description of physical traits such as eye color, hair color, ethnicity, skin tone, height, and weight; educational background; results of the psychological screening; and personality traits. Some clinics will provide genetic screening, if requested. Most clinics require that the donors remain anonymous; however, some will set up a meeting if both parties agree.
Sometimes a family member or friend is willing to donate eggs. This can work well because a more complete medical, genetic, and psychological history and profile can usually be obtained. However, future complications involving the donor can arise, so careful thought and consideration should be used before choosing this option. If the recipient chooses to use the eggs of a relative or acquaintance, the recipient will arrange with an egg donation center or clinic to have the donor properly screened and prepared.
Women with these infertility problems may benefit from the help of an egg donor:
- Premature menopause occurring before the age of 40
- Diminished ovarian reserve - an age-related decline in fertility that typical occurs after the age of 40, but may occur in younger women
- Inability to produce eggs or production of poor-quality eggs
- Failure to become pregnant after other infertility treatments, such as fertility drugs
- Carrier of genetic abnormalities
Cost of Donor Eggs
Infertility treatment with donor eggs includes acquiring eggs from a donor and having them placed through the in vitro fertilization (IVF) procedure, making it more expensive than IVF alone or other types of infertility treatments. The total cost of a treatment with donor eggs and IVF can cost from $24,000 to $30,000 for a single cycle.
In general, fertility clinics include the fees listed below in the cost of IVF with donor eggs:
- Fertility clinic or program fee
- Egg donor fee
- Administration fee
- Short-term medical insurance and legal fees
In addition to these fees, some clinics charge extra for medications, which can cost from $2,000 to $4,000 for the donor and from $500 to $1,000 for the recipient. Since fertility clinics vary in what they include in the base cost of treatment, it is important to find out which services are included in the prices offered by any infertility program you are considering.
Depending on the state in which you live and the type of health plan you have, your insurance may cover part of the cost of fertility treatment. Some states have mandated coverage for such treatments. In addition, certain diagnostic infertility procedures may be covered by some policies.
Most fertility clinics offer financing options to help offset the egg donor and/or in vitro fertilization costs. The financing companies often offer plans with low interest rates and low monthly payments. You can also find information online about companies that offer financing programs for elective medical procedures such as infertility treatment.
The Egg Donor Process
Step 1: Selecting an Egg Donor
Egg donor selection is often an emotionally laden decision, since it affects the recipients, donor, and, potentially, the child. While donor screening assures that a potential donor is physically and psychologically able to donate viable eggs, a couple must make the final choice. The following guidelines may provide a framework for choosing a donor and help make the decision more manageable.
- Anonymous Donors: In anonymous donation, the only information typically exchanged is the donor's medical, genetic, psychological, educational, and professional profile. Her identity may be kept confidential, although she may allow the child or couple to contact her in the future for additional information. Many couples prefer this degree of privacy and feel that it helps make their adjustment to pregnancy and parenthood less complicated.
- Designated Donors: Some couples prefer designated donation by a woman they already know. Couples who choose designated donors sometimes choose a close family member so that the child is more closely linked to them genetically. One of the main advantages of designated donation is the open exchange of information. In addition, many couples appreciate the feeling of candidness designated donation provides. Since neither anonymous nor designated donors have a legal link to a child born as a result of egg donation, the choice is more a matter of personal preference of the recipient.
- Donor Characteristics: A couple must also consider characteristics of a donor they find appealing. Primary considerations are ethnicity, race, IQ, physical appearance, and predisposition to certain mental or physical conditions. These are personal preferences entirely up to the couple.
Step 2: Donor Egg Retrieval Process
Once a donor is chosen, the recipient and donor begin the egg retrieval process. Hormone therapy is used to precisely synchronize each woman's hormone levels so that, when the donor produces eggs, the recipient's body is likely to implant those eggs once they are fertilized. The hormones cause the recipient's body to closely mimic that of a pregnant woman, which increases her chances of successful implantation after in vitro fertilization (IVF).
- Synchronization: The egg retrieval process begins with synchronization, in which the donor's natural menstrual cycle is temporarily halted to synchronize it with the recipient's. This allows a fertility specialist to synchronize the donor's egg production with the ripening of the recipient's uterus - the ideal time for implantation. Synchronization also prevents premature ovulation by the donor.
- Hormone Therapy: While the donor's natural menstrual cycle is temporarily halted, the recipient undergoes estrogen replacement therapy. This mimics the body's natural ovulation cycle, in which the ovaries make hormones (primarily estrogen) that thicken the uterus in preparation for implantation of the fertilized egg. The recipient takes hormone supplements for about 7 to 10 days, during which time her fertility specialist carefully observes her uterine lining and blood hormone levels. When the recipient's uterus has thickened sufficiently, the donor is given hormones that cause her ovaries to produce several eggs at a time (donor stimulation). By the time her eggs are ready for retrieval, the recipient's uterus is in an ideal condition for implantation.
- Egg Retrieval: When the donor's ovaries have produced several eggs, she is scheduled for egg retrieval surgery, and the recipient begins taking progesterone, the final hormone the ovaries would naturally produce to complete thickening of the uterus. The donor's eggs are retrieved and fertilized shortly afterward in preparation for IVF.
Step 3: In Vitro Fertilization
IVF, or In Vitro Fertilization, is one of the most common Assisted Reproductive Technology procedures; according to a report by the Society for Assisted Reproductive Technology (SART). In IVF, the most viable sperm and eggs are selected to promote successful fertilization.
- Collection of the Eggs and Sperm: The eggs used in IVF are retrieved from the recipient's ovaries or from an egg donor in egg retrieval surgery. The eggs can be used within a few days of retrieval or frozen for future use. If the eggs are to be used right away, on or near the day of egg retrieval surgery, the recipient's partner (or a sperm donor) provides a semen sample at the laboratory. Fertility specialists closely examine the egg and sperm and choose the healthiest of each for the next step, insemination.
- Insemination: Once the sperm and egg are collected, the sperm is combined with a viable egg outside the body. This is done either in a Petri dish or using Intracytoplasmic Sperm Injection (injection of a single sperm into an egg with a thin needle). The inseminated egg is incubated and monitored closely for about 40 hours to see if it becomes fertilized.
- Fertilization: If the sperm fertilizes the egg, the resulting cell (the embryo) is monitored closely for several days to follow its cellular division. An embryo that divides properly (first into two cells, then into four, and finally into eight) can be transferred to the recipient's uterus. Many couples choose to freeze some embryos for future use in case of unsuccessful impregnation in the first IVF treatment.
Embryo transfer is the final step in the IVF process. By this point, the recipient has undergone extensive hormone therapy to prepare her uterus for implantation. When the eggs have been fertilized, the resulting embryos are placed in the recipient's uterus. Typically, multiple embryos (two to four) are transferred in order to increase the chances of one of them implanting into the uterus.
- Timing of Embryo Transfer: An embryologist will work with a couple and their physician in order to time the embryo transfer to increase the chances of pregnancy. The transfer of embryos can occur between one and five days after fertilization, depending on factors such as low sperm count and embryo development. Same-day embryo transfer, in which embryos are transferred about four hours after retrieval, is becoming more common, since it allows recipients to undergo treatment on an outpatient basis.
- Activated Oocyte Transfer (AOT): Another option is Activated Oocyte Transfer (AOT), in which the embryos are transferred to the uterus about one hour after they are fertilized. According to a study reported by the Oxford University Press, the AOT procedure may be more effective than others when the male has an extremely low sperm count.
- The Embryo Transfer Procedure: The embryo transfer procedure, which is much like a pap smear, is usually painless and does not require anesthesia. The embryos are placed in a small amount of fluid, which is then placed in a thin tube (catheter) and passed into the uterus through the cervix. While the procedure is usually successful, it is possible for the embryos to be displaced in the cervix (resulting in loss of the embryos) or in the fallopian tubes (potentially resulting in ectopic pregnancy). The procedure may cause mild bleeding and/or cramping. The recipient can return home shortly after the procedure and should relax for the rest of the day.
Step 5: After Embryo Transfer
The period after embryo transfer is a suspenseful time for couples. It takes about 11 to 16 days for pregnancy to be confirmed, during which time complications can arise. Although embryo transfer can be highly successful (resulting in live births in 54 percent of fresh embryo transfers, according to a report by the Society for Assisted Reproductive Technology), couples can expect to encounter several issues during the weeks following embryo transfer.
- Symptoms During Weeks One and Two: A woman may experience minor vaginal bleeding and infection in the days immediately following the procedure. During the first two weeks after embryo transfer - during which implantation can occur - a woman should avoid alcohol consumption, limit caffeine consumption, avoid strenuous or jarring activities, and abstain from sexual intercourse. She will probably be prescribed progesterone to keep her uterine lining in prime condition.
- The Pregnancy Test: In the middle of the second week (around day 11), the woman will be given a pregnancy test. If the test is negative, the couple typically has the option of trying again during the next menstrual cycle, using frozen eggs or embryos. If the pregnancy test is positive, a second test will be administered to confirm the pregnancy.
- After Implantation: When an embryo is successfully implanted into the uterus and pregnancy is achieved, it is a very exciting time for the couple. The couple's fertility specialist will advise them on how to protect the pregnancy through every means possible, including abstaining from alcohol and substance use and certain physical activities. Couples should also be aware of potential risks still ahead, which can include:
- Increased chance of pregnancy with multiples - This increases a woman's risk of miscarriage(s), birth defects, premature labor and birth, heightened blood pressure, gestational diabetes, and other problems
- Premature birth
- Lack of development, or incorrect development, of the embryo
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