Fertility Program: Egg Donation

What is egg donation?

Egg donation is when a woman volunteers to give her eggs to another woman in the hopes of helping her become pregnant through the in-vitro fertilization process. In other words, egg donation is an infertility therapy that allows women without viable oocytes (eggs) to become pregnant, nourish the pregnancy and deliver a child of her own. There are many reasons why certain women do not have viable oocytes. The most obvious is related to age. Certain couples have simply delayed childbearing too long. Other women may have a genetic trait that they cannot pass on or may have had their oocytes depleted following chemotherapy/radiation treatments.

father and daughterHow successful is egg donation?

Very successful. Elite programs like ours will have delivery rates above 65 percent. That is, for every fresh egg donation cycle you start you would have a greater than 60 percent chance to deliver a baby in our program. The national average delivery rate for egg donation is approximately 50 percent as published by the Society of Assisted Reproductive Technologies.

How do you choose a donor?

Wright State Physicians Obstetrics & Gynecology offers patients and couples the option of known or anonymous egg donation. Known egg donation is reserved for those individuals or couples who select a family member or friend to be their egg donor. Anonymous egg donation is when the donor is initially unknown to the patient or intended couple. Most times, egg donation starts as anonymous but the recipient couples and the donor may choose to meet before final selection. Our donor selection is diverse and all egg donors have been thoroughly screened and educated on the process of egg donation. We follow the guidelines set forth by the American Society of Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART) as well as FDA regulations for egg donation and egg donor compensation. Most young women who choose to apply to become an egg donor are not selected. Donor applicants are between the ages of 21-32 and must be very healthy. We select only those women as donors who truly want to help others have a child and have passed appropriate physical, genetic and psychological screening. We are also open to working with qualified egg donor agencies.

How do most people feel about egg donation?

Egg donation is now widely accepted. Thousands of egg donation cycles are performed each year in the United States and more than 10,000 worldwide. In certain areas in the United States, each kindergarten class has at least one child born through egg donation. Couples have repeatedly told us that they love their child born through egg donation as much as imaginable. Many families have had their first child without infertility therapy and their second child through egg donation.

Why do I need an egg donor?

Some women are unable to conceive because they cannot produce healthy eggs. Our ovum (egg) donor program can help women who otherwise would not be able to conceive by providing this missing link—healthy eggs. Egg donation was started in the 1980’s and over the past 25 years has grown exponentially in popularity because of excellent success rates.

There are a number of indications for a using an egg donor including:

  • Natural menopause
  • Surgically induced menopause
  • Premature ovarian failure
  • Poor quality eggs
  • Women who carry genetic abnormalities

Our team has been involved with egg donation since 1988 and has previously established some of the largest programs in the country. We have helped many women conceive with eggs donated by both identified (known) and anonymous donors.

Who are egg donors?

Known egg donation uses eggs donated by a specific person: a sister, relative or friend.

Anonymous egg donation uses eggs donated anonymously from women recruited specifically for egg donation or from women undergoing an IVF cycle who are willing to donate excess eggs. Donors donate because they want to give this very special gift but are also compensated for each completed cycle.

Before donors are accepted into the program, they undergo various medical and psychological evaluations. We screen all egg donors according to guidelines recommended by the American Society for Reproductive Medicine (ASRM). Potential donors must be between the ages of 19 and 32 and nonsmokers. Candidates fill out a medical questionnaire reviewing their medical history, family history and social habits, all of which are reviewed by us to determine the donor's acceptability and ascertain potential risk for significant medical or genetic disorders.

The potential donor and her partner (if applicable) are then invited to meet with us to learn about why women need an egg donor, the process and the emotional, psychosocial, ethical and legal issues that pertain to egg donation. It is important to evaluate the donor's well-being and level of comfort to cope with the stress of being a donor.

If the egg donor feels comfortable with the process, she will undergo various tests to assure good medical health. These tests include:

  • Sexually transmitted diseases testing
  • Toxicology testing
  • Carrier status testing for genetic disorders

How can we find the right egg donor?

Our Fertility Program team has close relationships with very successful egg donor agencies around the country, particularly, on the west coast. We also have a number of local donors who know of our philosophy and wish to donate. In all, we have access to a tremendous number of donors and an increasing number of frozen donor eggs. We all take a comprehensive approach to the screening process and historically around 40 percent of egg donors who are screened and tested actually become available for you to choose.

A screening process includes a meeting with Dr. Lindheim who reviews with all candidates:

  1. Their medical and family history
  2. Why one is going to be an egg donor
  3. Legal aspects and ethical aspects
  4. What the process entails
  5. Time commitment
  6. Potential risks

Legal and ethical issues are also discussed in great detail. With respect to legal issues, all donors are aware that they have no rights, commitments or obligations attached to the donation process. Ethical issues pertaining to oocyte and embryo disposition are also discussed.

Fresh eggs or frozen?

Until 2005, the process of egg donation required that the recipient’s menstrual cycle be synchronized with the donor’s cycle. This requirement was critical for success because the recipient’s uterine lining needed to be in synchrony with the fresh developing embryos in the laboratory. Otherwise implantation would not occur. This “fresh” embryo transfer is still extremely successful but there is another option. We now have the scientific knowledge to freeze eggs. Eggs are more difficult to freeze and thaw than sperm because they contain a great deal of water which can crystallize and fracture the egg. A technique called vitrification is now used in our laboratory to freeze and thaw eggs with great success. The success rate using frozen eggs is about 10 percent less than the use of fresh eggs but has advantages. The advantages can be not having to wait for the right donor to be found, potentially proven success already with a cohort of eggs and potential cost savings. While this decision may seem daunting, our staff will discuss the pros and cons with you in detail. Either way, you have a choice between two good options.

What does the process entail?

Required screening and testing

Preliminary screening tests are required prior to initiating an egg donation cycle in order to help optimize your outcome. The tests that you may need depend on your overall general health, past health problems and any pertinent family history. The tests are intended to look for problems that could impact your chances of success with egg donation treatment. Your partner will also need to have some testing done as described below. If you have had any of the tests listed below please make sure you have these records forwarded to our office. On occasion some of the tests may need to be repeated. If your medical and/or family history suggests that you may be at risk for certain inherited or autoimmune diseases, additional testing may be ordered.

Female recipient testing

Pre-pregnancy screening

  • Rubella (German measles) and Varicella (chickenpox)
  • A complete blood count (CBC) screen for iron-deficient anemia
  • Blood type and Rh factor
  • Pap smear

Radiologic testing

  • Pelvic ultrasound (U/S): This ultrasound is used to provide us with a picture of the uterus and ovaries. If any abnormalities are identified (fibroids, ovarian cysts) we will decide if they need to be removed prior to your cycle as they could effect the outcome and possibly have an impact on obstetrical outcomes.
  • Sonohystogram: A sonohysterogram is a simple test whereby a small amount of saline is injected into the uterus under ultrasound guidance to view any abnormalities in the uterine cavity.
  • Trial Embryo Transfer: During the actual embryo transfer, the goal is to be able to place the embryos in the appropriate location smoothly and quickly. A trial or ‘mock’ embryo transfer is performed that is identical to an actual embryo transfer except that no embryos are being transferred to your uterus. This trial allows Dr. Lindheim to learn about the anatomy (length and direction) of your cervical canal and uterus and if there are any special issues that may need to be addressed prior to or at the time of your actual embryo transfer. All this is done so that the actual transfer of your embryos is as facile and smooth as possible.

Infectious disease screening

Hormone testing that may affect embryo implantation

  • Prolactin
  • Thyroid Stimulating Hormone (TSH)

Male intended parent testing

  • Semen analysis: A semen analysis is a way of determining sperm count, sperm motility or other abnormalities of the sperm. The sperm analysis allows us to determine the most appropriate way to fertilize the donor eggs at the time of oocyte retrieval.

Oocyte donor testing

Routine screening

  • A complete blood count (CBC) screens for iron-deficient anemia.
  • Blood type and Rh factor
  • Pap smear by her primary physician

Radiologic Testing

  • Pelvic ultrasound (U/S): This ultrasound allows Dr. Lindheim to assess the donor's potential to stimulate eggs and can identify abnormalities that may preclude her from being an egg donor
  • Ovarian function tests (egg quality): These are blood tests and ultrasounds that are markers that help predict the number of eggs a donor may produce in response to stimulation medications
  • Follicle Stimulating Hormone (FSH); Estradiol (E2) — Cycle day 2, 3 or 4
  • AMH – Anti-Mullerian Hormone (AMH) — any day of cycle
  • AF – Ovarian Antral Follicle count by ultrasound — any day of cycle

Hormone testing that may affect oocyte quality

  • Prolactin
  • Thyroid Stimulating Hormone (TSH)

FDA regulated infectious disease screening and testing

The FDA regulates all donated tissue in the United States, including human gametes (sperm and eggs), as well as other organs such as kidneys, eyes and blood. These requirements for donation (non-sexually intimate partners) are strictly adhered to, and must be followed in order to protect patients from unnecessary exposure to disease.

Initial screening, testing and a physical exam is performed on known or directed egg and sperm donors to determine their general health and suitability for donation. This is completed before the start of the IVF Cycle.

Within seven days of the IVF procedure and obtaining sperm, and within 30 days of obtaining oocytes (eggs), the following must again be performed to fulfill FDA Guidelines:

  • Complete a screening questionnaire to rule out risk of exposure to infectious disease
  • Testing for infectious disease.
  • Physical exam by a physician.

Blood testing must be done at an FDA-approved facility using FDA-approved tests. Wright State Physicians Obstetrics & Gynecology requires all intended parents, who are considered egg and sperm donors, even those coming from out of town, to be tested. For the egg donor, this is done at the onset of your stimulation cycle, and for the sperm donor, this can most easily be done on the day of the egg retrieval when the sperm donor needs to provide the specimen to be used for the IVF procedure.

Does this actually work?

Dr. Lindheim has been practicing third party reproduction for more than 20 years and has had nationally recognized success rates at each program he has built. Wright State Physicians Obstetrics & Gynecology is a state-of-the-art program with success rates rivaling any in the country. We currently see patients from all over the world with a specific following from Europe.

How does one prepare the uterus for an embryo?

While your egg donor is undergoing ovarian stimulation to help recruit eggs, you will be taking estrogen by mouth (Estrace) or by patch (Vivelle) for approximately two weeks. At the time you or your egg donor is to undergo oocyte retrieval, you will start progesterone to begin preparing the lining of your uterus for implantation of the embryo(s). This will be given either as an intramuscular injection or as a vaginal suppository/gel. This is critical as progesterone causes the expression of finger-like receptors called pinopods that are short-lived and allow for the embryo to implant. Any premature or delayed expression of these pinopods will prevent pregnancy.

Where do we begin?

While the process may seem overwhelming, we will walk you through each step. We start by performing a complete review of your medical records and a careful assessment to individualize your treatment. While all tests performed are thorough and efficient, we also make sure not to repeat any tests previously done by other physicians as long as they have been done appropriately and within a certain time frame.

How much does this all cost?

The total cost of an egg donation cycle is the sum of those costs associated with the recipient’s medical care and those costs associated with the donor’s medical care and her compensation. There are many variables associated with an Egg Donation Cycle Package. Our Program understands these costs can be significant and tries as much as possible to keep these costs as low as possible.

The costs of an egg donation cycle are somewhat higher than for a regular IVF cycle because there are three patients involved (recipient, male partner and donor). Additionally, the donor receives compensation for her time in the range of $5,000. Please ask our office for the most up to date estimated costs.

How do you get started?

The first step is to meet with Dr. Lindheim to discuss your individual situation. He will answer your questions and perform an ultrasound to do an initial evaluation of your uterus. They will then schedule a water ultrasound or a HSG to further evaluate your uterus. Once your uterus is evaluated to be capable of carrying a pregnancy and your medical examination and blood tests are normal you are all set to look for your donor. We will guide you each step of the way. Many couples start the process of donor selection as they are undergoing their screening tests. From the time you select a donor it is usually two months before your embryo transfer.

How does the egg donation cycle work?

Dr. Lindheim will put you and your donor on birth control pills (OCP’s). These OCP’s will synchronize your menstrual cycle with the donor’s cycle. This is critical because each of you must be in the same phase of your menstrual cycle. Once on the OCP’s you will start a medication called Lupron which will shut off your cycle in preparation for the upcoming embryo transfer. At this point, the donor will start the fertility hormones and you will start estrogen. After 12 days or so, the donor will have her egg retrieval and you will start progesterone. The eggs will be fertilized in the embryology laboratory with your sperm choice. The donor is now recovering and her cycle is complete. She will have a period in two weeks and over time resume her normal daily activities. The donor is specifically counseled not to have intercourse until after her menses in order not to become pregnant.

Once the eggs are fertilized they will begin to develop. The embryo transfer will occur either on Day 3 or Day 5 following the egg retrieval depending on your specific situation. You very well may have additional embryos that can be cryopreserved. You will know whether you are pregnant or not within 12 days after the embryo transfer.

Philosophy

We believe that egg donation is an incredible therapy to allow a couple to have a family even when the female partner has no viable oocytes. Egg donation has revolutionized the treatment of infertility in the last 20 years. We would be honored to help you decide if egg donation is best for you.