Oocyte & Embryo Donation (OD-ED)

Egg donation, first introduced in 1983, has evolved in a relatively short time into a common procedure that addresses a variety of reproductive problems. The popularity of egg and embryo donation is evidenced by the rapidly increasing demand for services. In the USA, 10389 procedures involving fresh or frozen embryos procured through oocyte donation were reported to the CDC in 2000, nearly double from that reported in 1996.

Most of these patients are those with multiple IVF failures, reduced egg reserve, poor egg quality, unexplained implantation failures and other reasons. Also, a number of patients have to avail of egg donation owing to the rising percentage of women who remain childless past the age of 37, a number that has increased sharply over the past 20 years owing to late marriage and delayed child-bearing for numerous reasons.

It would be important at this stage to stress to coming generations the importance of fertility preservation for the future. This is important for young women who desire to pursue career options and delay marriage and child bearing to a later age. It would be worthwhile to check your serum AMH level to estimate your egg reserve and seek cryopreservation of your eggs as a security for the future.

At the present moment, for most of these patients, egg donation remains an extremely successful, cost-effective and popular treatment method for achieving a pregnancy. Of course, the couple has to resolve to the fact that it would not be the wife’s own biological (genetic) child. The technique is simple, quite pain-free and has an exceptionally high success rate.

Our clinic maintains the highest standards for screening of egg donors for genetic disease, repeat checks for sexually transmitted diseases such as HIV, Hepatitis B, C and syphilis and other checks as requested by couples.

Who Needs Egg Donation?

Patients with repeated IVF failures owing to poor egg quality / vacuolated eggs/eggs with thick or dark zona, embryos with moderate to severe fragmentation (these are terms which might have been used in the discharge summary of your previous IVF cycles).

• • Patients above the age of 37 with decreased ovarian / egg reserve.

• • Patients with decreased ovarian / egg reserve at any age indicated by low serum AMH levels, elevated serum FSH levels or decreased antral follicle counts on ultrasound.

• Patients with premature menopause.

• Patients with premature ovarian failure.

• Patients whose one or both ovaries have been removed with poor ovarian stimulation with FSH injections.

Future prospects

The problem of having to accept a foreign DNA in your child might be overcome in the future with the use of enucleated donor oocytes which would allow recipients to use their own genetic material (three-parent IVF) and this is in an active research stage at present.

Improvements in oocyte freezing may soon permit "egg banks" to be set up, reducing the need to synchronize patients while allowing for quarantine for HIV and other diseases.

Also, recent reports of being able to produce eggs in the laboratory from the woman's own skin cells (via stem cell technology) might completely eliminate the need for egg donation and enable every woman to have her own biological child. This technique, however, is still in its infancy and it might be several years before it is permitted for human use.

Who Needs Egg Donation?

Patients with repeated IVF failures owing to poor egg quality / vacuolated eggs/eggs with thick or dark zona, embryos with moderate to severe fragmentation (these are terms which might have been used in the discharge summary of your previous IVF cycles).

Patients above the age of 37 with decreased ovarian / egg reserve.

Patients with decreased ovarian / egg reserve at any age indicated by low serum AMH levels, elevated serum FSH levels or decreased antral follicle counts on ultrasound.

Patients with premature menopause.

Patients with premature ovarian failure.

Patients whose one or both ovaries have been removed with poor ovarian stimulation with FSH injections.

Selection of Egg Donors

Fortunately, most ART banks have a large pool of young, healthy, fertile egg donors from all backgrounds and all walks of life. There are options to select from various ethnicities and all Egg donors are screened as per international standards.

Procedure

There are two categories of patients for egg donation. Those who are menopausal and those who get regular periods. Preparation of the uterus is different in both these categories.

For Menopausal Patients

These patients are required to get one or two menstrual periods before we can perform the IVF using donor eggs. This is to build up the uterus to its full capacity like normal menstruating women. The commonest form of priming is as follows:

Medicine	Time	Day
Tab Progynova 2mg	1 1 1	from day 1 – 25
(Estradiol valerate)	7am 3pm 11pm
Tab ASA 50 mg (called baby aspirin in the USA)	1 after lunch	from day 1 – 25
Tab Regestrone(any norethisterone)	1 1	from day 16 – 25

Starting day of treatment is considered as day 1 of cycle

After completion of 25 day course wait for onset of menses.

From day 4 of that menses start the course again for 25 days

Can do procedure in the second or third month. In the month of treatment just keep taking the first two tablets until arrival in Mumbai (no regesterone in that month).

For Normally Menstruating Patients

For these patients, preparation is required so as to synchronize their cycles with that of the prospective egg donor. This is an easy process. The advantage of following this protocol is that the recipient's cycle is under total control for a period of 30-40 days during which the IVF can be performed.

Sample Instructions

• E mail and inform clinic on day of beginning injections on 21st day of periods.

• Inj Lupride/ Leuprogon/Lupron/ /decapeptyl depot 3.75 mg deep IM on 21st day of periods (only one injection if you have the 3.75 mg depot).

• If the depot preparation is not available you can take daily injections of 0.1 mg decapeptyl/0.5 ml of lupron / busarlin (same hormone) to be continued until arrival in mumbai.

• Inj Gestone (Progesterone) 100 mg deep IM on 21st day of periods (not mandatory if you have regular periods).

Await next menses (periods) - On Day 4 of that menses begin:

Medicine	Time	Day
Tab Progynova 2mg	1 1 1	until arrival in Mumbai
(Estradiol valerate)	7am 3pm 11pm
Tab ASA 50 mg(Baby aspirin)	1 after lunch	Until arrival in Mumbai

Telephone/mail the clinic on day 21 when beginning the protocol to get the arrival dates. Mention on telephone/e-mail that you are for egg donation.

Arrival in Mumbai is after a minimum of 10 to maximum of 45 days of tablet progynova as per availability of suitable donor matching all your given characteristics. Please note that the clinic has up to 45 days to do your procedure once you begin the tablets. During this duration there will be no periods or any adverse effects of the medication. Do not stop any medicines without confirmation from the clinic.E mail your wife's photo and profile to help us make a proper selection

Criteria For Donor Selection

You can request the clinic OR ART Bank to provide a donor which suits all your requirements in terms of Physical appearance, color of hair and eyes, blood group, medical and genetic history, blood work up (including thalassemia, sickle, HIV, Hepatitis B & C, VDRL, Blood counts, Blood sugar and other tests that you might desire).

Embryo Donation

There are some unfortunate couples where both eggs and sperms are either absent or of suboptimal quality. These patients have had repeated failures of IVF and ICSI are at their wit's end for a solution. Often, they are emotionally prepared even for adoption. It is here that the technique of embryo donation comes into play and gives the woman a chance at carrying and delivering a baby (even if it is not genetically their own).

For example, if we have a 42 year old woman with very low AMH levels (indicating a depleted egg reserve) with an azoospermic husband (zero sperm counts with no sperm obtained even with testicular biopsy) they would be ideally suited for embryo donation.

This technique can also be made extremely cost effective for needy and economically backward patients who do not have the resources for repeated IVF trials.

Success rates are as high as 60% if the lining of the uterus is normal. Preparation and the technique is same as described in the section on egg donation.