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 embyros 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 the wife’s own biological (genetic) child. The technique is simple, quite pain-free and has an exceptionally high success rate.

The ICMR guidelines for IVF clinics in India permits egg donation and the use of commercial egg donors for this purpose. Our clinic maintains the highest standards for selection of egg donors, screening for disease, repeat checks for sexually transmitted diseases such as HIV, Hepatitis B, C and syphilis and other checks as requested by couples.

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 groups (such as Caucasian, Indian, African, Chinese, Russian and so on) 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 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:

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:

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). Please note that Indian law does not permit revealing the identity or showing the photograph of the donor.

Success Rates of Egg Donation

You can expect a pregnancy rate of @ 50% - 60% per cycle. We normally recommend 2-3 cycles before opting for other methods such as surrogacy.

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 me 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 technique is same as described in the section on egg donation.

Frequently Asked Questions

The ICMR guidelines do not permit the use of known (friends or relatives) donors. They clearly state that there can be "no exchange of genetic material between siblings".

Most egg donors are recruited donors - usually young women with excellent reproductive potential who are paid for their time and efforts. Recruited donors may be found through egg donor agencies or through the Clinic in-house donor pool.

We have a highly selective and comprehensive screening process. Prospective donors complete a detailed questionnaire that's reviewed by our team. Those who meet specific criteria will be invited to complete the additional screening, which involves meetings with our coordinator, IVF doctor (for ultrasound and assessment of egg reserve) and finance manager.

The Counsellor screens her for a family history of birth defects or hereditary diseases by taking a comprehensive family history. You may request a report of these findings.

The prospective donor also undergoes a physical exam, cultures and blood test to rule out infectious diseases such as HIV, hepatitis B, hepatitis C and syphilis. In addition, our donors are tested for their blood type and are screened inherited disorders related to hemoglobin, such as sickle cell anemia or thalassemia, depending on ethnicity.

In most cases, donors become available only after their screening is complete and they are designated eligible according to all our guidelines. In recruiting and screening donors, we adhere to guidelines from the Indian Council of Medical Research.

We also work with many outside ovum donor agencies especially for recruiting foreign donors such as Caucasian (Georgian or Russian), South African, African, Thai, etc. Outside agencies recruit and partially screen donors. The agency then assists couples in identifying possible donor matches from within their pool. We're happy to help coordinate a donor ovum cycle with a donor from an outside agency. We are also in touch with Indian agencies providing premium egg donors.

A list of external egg donor agencies is available on request. We recommend that you ask about their recruitment and screening policies and procedures directly. Donors from outside agencies must meet specific criteria for eligibility, such as all the tests listed above and recent infectious disease screening, to proceed with a cycle at our clinic.

To maximize the likelihood of success, we recommend a donor under the age of 34. Most egg donors are between the ages 21 and 30. Other factors that increase the chances of success are having previously carried a pregnancy to term, or having previously donated eggs with good results.

Other factors that many patients consider are physical characteristics, ethnic background, family and medical history, educational background and personality characteristics.

The ICMR guidelines insist that the egg donor should be anonymous and meeting between the two parties is not encouraged.

Your donor will sign a consent form in which she relinquishes all rights and responsibilities regarding her donated eggs. You will sign an undertaking that you will not try and find out the identity of the egg donor. For women using egg donation to conceive, there's no need to file any legal documents to establish the parentage of the child.

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