Selecting a donor

Ideal egg donors are young healthy women without a history of in fertility or other reproductive disorders. Egg donors do not necessarily need to have had their own children. An ideal egg donor should also have family history free of significant genetic diseases including no close relatives with breast cancer, alcohol or drug dependency, or serious learning or developmental problems.

Egg donors should be screened for general health issues, sexually transmitted diseases and carrier status of several common genetic defects and have a karyotype for a chromosome analysis. Fertility clinics often do much of this work in coordination with agencies specializing in egg donation.

Egg donors fall into one of two basic categories: known or anonymous. Known donors usually are family members or close acquaintances. However, some patients recruit their own donors and meet them which also qualifies as a known donor situation. Most egg donors are anonymous meaning that the recipients will never meet the egg donors although increasingly, the recipients do see adult pictures of the donors before making their selections.

The amount of information available to the recipients varies by egg donor agency. Individual recipients must determine for themselves whether they are comfortable with the amount of information that they receive. Some recipients contract with egg donor recruiters who specialize in identifying women with specific criteria to act as an egg donor.

Recipients start with a list of potential egg donors, then usually select several candidates to see which are available. The matching process closely relates to the selection process. The staff of the donor agency helps to answer questions regarding the potential donors so that the recipients can rank order their initial list.

Further, the matching process involves determining when the donors are available for a cycle. Some donors may be in school and want to wait for specific times of the year. Others may be in cycle with another recipient and a waiting period is necessary before she can cycle again (assuming that she is willing – another factor to be determined by the staff).

A match occurs when the recipients agree to use a specific donor and the donor agrees to a cycle.

Synchronizing cycles

The medical portion of the cycle requires “synchronizing” the menstrual cycle of the donor and the recipient. We use medications such as oral contraceptive pills (OCP) and GnRH agonists like Lupron to shut off the natural reproductive hormones, which doctors refer to as "down regulation." When both women are down regulated or suppressed then each woman can start her portion of the IVF cycle.

The length of time to down regulate varies from two to four weeks. In some cases, the recipient is already menopausal and on hormone replacement therapy. Synchronization is much quicker in these situations.

The IVF cycle

The egg donor undergoes a very conventional IVF stimulation and egg retrieval process. Please refer to the IVF Fact Sheet for more details. The donor stimulation involves injectable hormones to recruit as many mature eggs as possible. At NCRS, we average about 20 to 24 eggs per retrieval, of which some might be atretic (dead) or immature leaving about 16 to 20 healthy mature eggs.

The stimulation process takes about 10 to 14 days to get to egg retrieval. Once we retrieve the eggs, the donor’s contribution to the cycle is over.

Recipients compensate donors several thousand dollars for each cycle. The donor fee is compensation for the donor's efforts and time away from work, school and home duties required to undergo injections, multiple visits for blood samples and vaginal ultrasound examinations and undergoing conscious sedation and egg retrieval.

The recipient must have an endometrium that is receptive to the embryo to facilitate implantation. Remarkably, fertility specialists can prepare the endometrium of almost all women to receive an embryo and allow implantation and normal pregnancy.

Fertility doctors use estrogen for the initial development to mimic the natural menstrual cycle. The recipient takes the estrogen by a pill most times but may also use transdermal (a skin patch) or injectable estrogen in certain situations.

During treatment, the recipient's clinical team monitors the recipient’s response to estrogen by measuring hormone levels and, more importantly, the thickness of the endometrium by ultrasound.

To increase the odds of success with the donor egg CED cycle, the clinical team usually performs a mock cycle and performs CED to ensure a proper response before the real cycle, when the team would not have the opportunity to correct a poor response before egg retrieval.

Retrieval & embryo transfer

A fertility doctor retrieves the eggs from the donor and combines them with the sperm from the recipient's partner or with donor sperm. Once the embryos form, the doctor transfers some into the endometrial cavity either three or five days after egg retrieval. The embryo transfer process for donor eggs is the same as for conventional IVF.

The success rate with donor eggs is so high that fertility doctors must be very cautious about the number of embryos transferred to avoid the risk of high-order multiple (HOM) births (triplets or more).

We suggest that recipients of donated eggs anticipate transferring only two embryos unless the embryos are unexpectedly lower in quality. Indeed, under selected conditions, transferring a single embryo may be the best treatment decision.

Note that transferring larger number of embryos does not increase the probability of pregnancy but does increase the probability of multiple gestations and HOM pregnancies. This data comes from non-donor IVF when excess embryos are available for transfer which is similar to a donor egg cycle. Unfortunately, the CDC data does not provide the same breakout for donor eggs as for non-donors eggs but this graph illustrates the point well.

After the embryo transfer, the recipient needs to continue her hormone replacement because she does not produce any natural hormones from the ovaries. If she were to stop the hormone replacement, the pregnancy would die because the ovaries produce all the hormones necessary to stimulate the endometrium and sustain a pregnancy for about seven weeks after ovulation.

At about 7 weeks after ovulation or egg retrieval, the pregnancy produces enough hormones itself to be self-sufficient. As a precaution, we continue the hormone replacement until 10 weeks of pregnancy to ensure that the placenta is fully functional.