All donors, regardless of whether they are known or anonymous, will undergo a thorough evaluation. This evaluation is done to protect everyone involved, including the donor, the recipient, and the potential offspring.
In general, the donor should ideally be younger than 35 years old, have normal ovarian reserve, and have no signs of impaired fertility. On average, most egg donors are between the ages of 21 and 34 years old. Having a donor in this age group will increase the likelihood that she will respond favorably to ovulation induction, produce many eggs, and develop high-quality eggs. If the donor is over the age of 34, there is a higher risk for chromosomal abnormality, such as Down syndrome
, and the rates of a successful pregnancy decline.
The donor must also be tested for communicable infectious diseases, such as syphilis
, hepatitis, and HIV
. She should also have genetic screening done, both by obtaining a detailed family history and specific blood tests, to rule out diseases like cystic fibrosis
, Tay-Sachs disease
, sickle cell disease, and thalassemia
. A psychological evaluation is also usually required.
What's Involved When Using "Fresh" Eggs and Embryos?
The key to the success of egg and embryo donation is to effectively synchronize the development of the uterine lining (endometrium) in the recipient with the growth of the donor's follicles and eggs. The donor and recipient will both need to take certain medications at precise times to make sure the cycles are synchronized, to prevent inadvertent ovulation in the recipient, and to ensure a hormonal situation conducive to pregnancy in the recipient.
If time or distance makes the usual fresh egg synchronization process difficult or inconvenient, some fertility centers offer a staggered process, where the donor eggs are retrieved and fertilized (using donor or partner frozen sperm) and then the embryos are frozen to be later transferred into the recipient. The process (for the recipient) is quite similar to using frozen donor embryos.
For the traditional synchronization process, recipients will need to take estrogen to prepare the uterus. Recipients who have good ovarian function will usually also have to take certain medications, such as Lupron®
, to help suppress the ovaries prior to starting estrogen. Recipients typically take estrogen (most commonly estradiol by mouth, injection, or a transdermal skin patch) for two weeks. This helps to mimic the natural cycle.
Recipients must also take progesterone daily, usually starting the day before or the day of the donor's egg retrieval. The embryo transfer will usually occur two to five days after the egg retrieval. Progesterone can be used in various ways, such as by intramuscular injection, vaginal suppositories, and vaginal gel.
Once the donor's eggs are mature, the healthcare provider will give her an anesthetic and remove her eggs from the follicles using a type of aspiration needle (see The Ins and Outs of In Vitro Fertilization (IVF) for more information on the process).
From here on, the procedure you will go through is similar to in vitro fertilization. Your partner's sperm or a donor's sperm is mixed with your donor's eggs in a dish in the laboratory and allowed to fertilize (see Considering Donor Sperm for more details on what's involved with finding a sperm donor)
After a few days of development, the embryos are evaluated to determine their appearance and quality. The best-appearing embryos are chosen to be transferred into the uterus. The number of embryos chosen to transfer will depend on a number of factors, including the donor's age, how many days into development the embryo has reached (i.e., a day-3 or day-5 embryo), and certain other conditions.
When you go in for the embryo transfer, your healthcare provider will discuss how many embryos there are, the grade of each, and which embryos should be transferred and how many. Determining whether an embryo has a good chance of becoming a successful pregnancy will be made by taking all of the components of the embryo into account.
The embryo transfer is done by passing a catheter through the cervix into the uterus. An ultrasound is used as well so your healthcare provider can see the proper placement to deposit the embryos. The embryos are then deposited into the uterine cavity along with a small amount of fluid.
This transfer is usually a quick process and no anesthesia is required. Your healthcare provider may have you remain lying down for a few minutes after the procedure. You will also receive instructions for the following two weeks until it's time for the pregnancy test
Although it can vary, your instructions for the next few days after the transfer may include lots of couch time. In many cases, you'll be asked to spend the first 24 hours after the embryo transfer with your feet up and resting as much as possible.
After the first 24 hours, women are usually encouraged to take it easy for another three or four days. Although you can return to work and go back to a fairly normal routine, you should avoid strenuous exercise, chores, and sexual intercourse -- anything that may cause uterine contractions
and could interfere with the implantation process.
Following the embryo transfer, the recipient will continue treatment with both estrogen and progesterone until she can take a pregnancy test on day 28 of the cycle. If a pregnancy is confirmed, the woman will continue taking estrogen and progesterone until her blood work shows that the placenta is sufficiently established (usually by around the tenth week of pregnancy). After this occurs, the estrogen and progesterone can be stopped, since the placenta, and not the ovaries, is now the main source of pregnancy hormones.
If you have any embryos left, they can be frozen and used in another cycle.