The egg donation process includes selecting an egg donor, monitoring and synchronizing cycles
The donor egg coordinator matches anonymous egg donors with potential donor egg recipients. Healthy and thoroughly screened donors are first anonymously “matched” with women who desire to be recipients of donor eggs.
The match is often based upon genetic and ethnic backgrounds, as well as upon other characteristics such as height, eye color, hair type, etc. Once the matching process is completed, the process of preparation of the donor egg recipient followed by stimulation of the egg donor ensues.
Preparing the egg donor recipient
Preparation of the donor egg recipient involves a series of processes that act to prepare the recipient’s uterus for eventual embryo transfer and subsequent embryo implantation. This hormonal preparation seeks to mimic the physiologic events that occur in a normal menstrual cycle, i.e., a period of estrogen stimulation of the uterine lining followed by a period of concomitant progesterone stimulation prior to embryo implantation.
In women who have ovarian function, a gonadotropin-releasing hormone (GnRH) agonist is typically used to prevent the recipient’s hypothalamus and pituitary gland (in the brain) from stimulating ovarian follicular development and subsequent endometrial maturation.
In this way, the recipient’s uterine lining can be stimulated in a controlled manner and a predictable “window” for implantation created; when performed in a natural menstrual cycle, this window of opportunity can be missed for a variety of physiologic reasons. Thus, the use of a GnRH agonist allows the physician to control the physiologic events necessary to ensure an optimal outcome.
Once the communication between the recipient’s brain and ovary has been hormonally suppressed by the GnRH agonist, the recipient takes estrogen, which stimulates the uterine lining, paralleling the endometrial development seen prior to ovulation. Estrogen can be administered orally, vaginally, transdermally, or by injection with equal success.
“What if I have no ovarian function?”
In patients who have complete cessation of ovarian function, a GnRH agonist is not necessary; typically, recipients without ovarian function can begin a course of estrogen without concern for hypothalamic-pituitary interaction. In either case, response to the administered estrogen is measured in most cases by both serum estrogen levels as well as by endometrial thickness and differentiation as visualized by transvaginal ultrasound.
When the recipient’s uterine lining appears well-differentiated and amenable to implantation and pregnancy, the egg donor begins a regimen of injectable gonadotropins for controlled ovarian stimulation in preparation for egg retrieval.
The donor egg recipient remains on estrogen until her embryo transfer. Studies suggest that the donor egg recipient can remain on estrogen for up to 6-8 weeks prior to her transfer, although the period of time spent on estrogen is typically closer to 4-5 weeks.
Preparation and monitoring before egg retrieval
The egg donor can only be successful in making multiple follicles if the drive for the recruitment of a single dominant ovulatory follicle is prevented. Like the case of the donor egg recipient, a GnRH agonist can block this hypothalamic drive; in addition, a GnRH antagonist can be utilized (typically following a short suppressive course of birth control pills) to achieve this same goal. Once the egg donor’s hypothalamic-pituitary-ovarian axis is suppressed (as typified by low estrogen levels), the egg donor begins a course of injectable gonadotropins, which usually consists of recombinant or urinary-derived follicle stimulating hormone (FSH) with or without human menopausal gonadotropins (hMG, a combination of FSH and luteinizing hormone [LH]).
The egg donor’s progress is monitored every few days by ultrasound and blood work (just as a patient using her own eggs undergoing IVF would). Thirty four to thirty six hours after an appropriately-timed injection of hCG, the egg retrieval is performed, and the eggs are inseminated with the sperm from the recipient’s partner; after the egg donor is deemed stable post-retrieval, her job is done.
Coincidentally, the recipient begins progesterone (administered intramuscularly and/or vaginally) the day before the egg retrieval to assure appropriate synchrony between the cleaving embryo and endometrium development. Typically, an embryo transfer is performed three or five days after retrieval. Extra embryos can be cryopreserved in most cases, if desired.
The donor egg recipient continues taking estrogen and progesterone through 8-10 weeks of gestation. The donor egg recipient transitions her care to her obstetrician at the end of her first trimester of pregnancy, and as a rule can expect a “normal” pregnancy.
Throughout the entire process of anonymous egg donation cycles, all office visits, testing, and procedures are performed discretely, and anonymity between the donor and recipient is preserved.
Want more information?
This is an exciting era in the treatment of infertility, as now almost all women who desire to have children can do so. With the advent of the use of donor eggs, women who once could not bear children are now able to conceive and deliver healthy babies.
Recipients of donor eggs can be assured that their chances of having a healthy child are excellent and that the entire process can be performed in a discrete and confidential manner if anonymous egg donation is desired.
If you’d like more information on how this option could work for you, or if you want to get started as an egg donor, please contact us.