EGG DONATION 101

by Tanmoy Mukherjee, M.D.

What is egg donation?

Egg donation is an assisted conception option where one woman (the donor) donates her eggs to a couple (the recipients), to enable them to conceive. Couples who need egg donation cannot use their own eggs for one reason or another.

Using in-vitro fertilization (IVF), two or three embryos are normally transferred to increase the couple's chances of pregnancy. In contrast to non-donor IVF, a high success rate is independent of age and is instead dependent on the overall health of the recipient (especially her uterine function).

Who should consider egg donation?

More than 150,000 women in the United States can't bear children because of ovarian problems. Women who need donated eggs to have a child either do not produce any eggs of their own, or their eggs cannot be used for a healthy pregnancy. A woman might not produce eggs because her ovaries did not develop properly. Women who have premature ovarian failure or who have gone through menopause will also not produce eggs. Sometimes after surgery or chemotherapy a woman is no longer able to produce eggs of her own. All these women will need donated eggs to have a child. Women who are ovulating but approaching menopause might need donated eggs because their eggs are failing to fertilize or are unable to sustain an ongoing pregnancy. Other potential candidates for egg donation include women carrying genetic abnormalities that could be passed on to their offspring.

How do I know if I have problems with my egg supply?

A fertility evaluation will include a blood sample taken on day three of the menstrual cycle to check for evidence of egg quality problems, which would be indicated by elevated levels of follicle-stimulating hormone (FSH) and/or estradiol.

Ultrasonography may also be utilized to evaluate the basal antral follicle count (BAFC). Decreased ovarian volume or a reduced BAFC may also suggest a reduction in ovarian reserve.

Frequent miscarriage in women over 40 may also signal a problem with egg supply. A careful examination of ovarian reserve is a good idea in these cases

Can't I get pregnant even with a diminished egg supply?

A diminished egg supply may make natural conception difficult. In some cases the ability to conceive is severely impaired. In addition, the risk of having a child with a congenital abnormality may also increase. The decision to undertake egg donation is a difficult one, but for women who have undergone extended unsuccessful infertility therapy and recurrent chromosomally abnormal pregnancy loss, egg donation represents a safe and successful treatment option.

Where do the donated eggs come from?

For the anonymous donor program, the identity of the donor and the recipient is maintained in strict confidence. Although anonymous oocyte donation is medically analogous to sperm donation, it is not easy to maintain a large pool of donors because oocytes are not easily accessible, and in the present state of technology, oocytes cannot be as successfully cryopreserved (frozen) as sperm. In our program anonymous donors are 21 to 32 years of age. They are also nonsmokers, with a normal body weight and a healthy medical and genetic history. The donors must test negative for all the infectious disease screening performed according to the standard criteria of New York State (NYS) and American Society of Reproductive Medicine guidelines (ASRM).

For the known donor program, a recipient has to identify a donor who is 21 to 32 years of age. The donor must also be a nonsmoker, with a healthy medical and genetic history. The known donor screening testing for infectious diseases is similar to all oocyte donors and is performed according to the standard criteria of the NYS and ASRM guidelines.

How are candidates for egg donation tested?

Women considering the use of donated eggs should be tested for any abnormalities that could affect the success of IVF with donor eggs. Tests should include:

  • a panel of blood tests that can assess whether the potential recipient has normal thyroid and prolactin levels, whether she carries certain antibodies that may require additional treatment during the cycle, and a general screening panel for infectious diseases;
  • cervical cultures for chlamydia, gonorrhea and mycoplasma;
  • an x-ray (called a hysterosalpingogram), saline sonogram, or hysteroscopy to check for abnormalities in the uterus and fallopian tubes; and a semen analysis of the male partner.

Additionally, some women will need to pass a mock egg donation cycle, also called a ?prep cycle.? In this type of cycle, the potential recipient takes similar medications to those used in an egg donation cycle for a period of 4-6 weeks, and comes to the office routinely for monitoring of hormonal blood levels and endometrial growth. The purpose of a prep cycle is to make sure that the potential recipient's endometrial lining thickens well enough to become pregnant through an egg donation cycle. Prep cycles may be waived for women with adequate uterine lining data from past cycles.

Pretreatment counseling should provide a full explanation of the egg donation process, risks, and likelihood of success. Patients should also be advised on the potential psychological impact of egg donation.

What is the treatment process for egg donation?

Before the transfer, we typically administer hormones to the recipient for two weeks to synchronize her cycle with the donor's cycle. This allows the recipient?s uterine lining to develop as the donor?s follicles and eggs grow, optimizing the implantation environment for the transferred embryos. These hormones include estrogen, which can be taken orally or administered in patches that attach to the skin, and progesterone, administered by injections.

The recipient starts taking progesterone daily on the day before or the day of the donor?s egg retrieval. The embryo transfer takes place two to five days later. Estrogen and progesterone treatments continue until the pregnancy test on the 28th day of her menstrual cycle. If there is a pregnancy, the recipient continues to take estrogen and progesterone to support the development of the placenta until the tenth week of pregnancy.

What are the risks of egg donation?

The main risk is a multiple pregnancy. In the early years of egg donation, triplets, quadruplets, and even quintuplets were not an unusual outcome. Now the process is better understood and only a small number of embryos (two to three) are transferred. According to the CDC?s most recent national data, 36 percent of egg donation pregnancies were twins and more than half were singleton pregnancies. Higher order multiples occur in less than 2 percent of recipient pregnancies in our program at RMA of New York.

Multiple-infant births are associated with greater problems for both mothers and infants, including higher caesarean section rates, prematurity, low birth weight, and infant disability or death. Multiple pregnancies may be reduced to twins or singletons through a procedure called multifetal pregnancy reduction.

Egg donation is an option for couples whose primary cause of infertility is suboptimal egg quality. Current success rates for treatment are exceptional, and the wait list for donors is typically only a few months in large, experienced practices. While adoption is certainly a wonderful alternative, egg donation presents an intimate, successful, and ultimately very satisfying option.

Tanmoy Mukherjee is a board certified reproductive endocrinologist at Reproductive Medicine Associates of New York and is also Associate Director of the Mount Sinai Division of Reproductive Endocrinology.

Reprinted with permission from The American Infertility Association

The American Infertility Association is a national organization dedicated to supporting women, men and families facing infertility and decisions related to family building and reproductive health--from prevention and treatment to social, psychological and financial concerns. Through educational symposia and forums, free publications, interactive media and advocacy for research funding and policy, The American Infertility Association serves as a lifetime resource for men, women and families needing reproductive information and support and to forward the causes of adoption and reproductive health. Contact The American Infertility Association toll free at 888-917-3777 or visit the Web site at www.americaninfertility.org.

Make an appointment with an infertility specialist now
If you are trying to get pregnant and suspect ovulation or infertility problems time is important. Don't wait, see a specialist (reproductive endocrinologist) for a consultation.