Preparation for the Egg Donor Cycle
Preparation for ovum donation begins with full disclosure to all participants regarding what each step of the process involves from start to finish, as well as potential medical and psychological risks. This requires that a significant amount of time be devoted to this task and that there be a willingness to painstakingly address all questions and concerns posed by all parties involved in the process. An important component of full disclosure involves clear interpretation of the medical and psychological components assessed during the evaluation process. All parties should be advised to seek independent legal counsel so as to avoid conflict of interest that might arise from legal advice given by the same attorney. Appropriate consent forms are then reviewed and signed independently by the donor and the recipient couple.
Most embryo recipients fully expect their chosen donor to yield a large number of mature, good quality eggs, sufficient to provide enough embryos to afford a good chance of pregnancy as well as several for cryopreservation (freezing) and storage. While such expectations ore often met, this is not always the case. Accordingly, to minimize the trauma of unexpected and usually unavoidable disappointment, it is essential that in the process of counseling and of consummating agreements, the respective parties be fully informed that by making best efforts to provide the highest standards of care, the caregivers can only assure optimal intent and performance in keeping with accepted standards of care. No one can ever promise an optimal outcome. All parties should be made aware that no definitive representation can or will be made as to the number or quality of ova and embryos that will or are likely to become available, the number of supernumerary embryos that will be available for cryopreservation or the subsequent outcome of the IVF-OD process.
The Cycle of Treatment
The basic format used by most ovum donor programs is as follows. First, the menstrual cycles of both the recipient and the donor must be synchronized. In some cases where the recipient is anovulatory or post menopausal, this requires establishing cyclicity through hormone replacement therapy, using sequential estrogen – progesterone therapy or through by way of a birth control pill. By placing the donor and the recipient on such hormone replacement and then selectively lengthening or shortening the duration of such therapy, both parties start with gonadotropin releasing hormone agonist (Lupron) together and both can be expected to initiate a subsequent withdrawal bleed following pituitary down regulation, on or around the same time. The donor thereupon receives gonadotropins at a prescribed dosage while the recipient receives sequential estrogen therapy. There are many different ways to administer estrogen to develop the uterine lining. This will be discussed with you by the clinical team prior to the commencement of your cycle. Typically, we administer twice weekly injections of estradiol valerate at a dosage that usually ranges between 4 and 8 mg and is determined by the resultant plasma estradiol concentration, which ideally should range between 500 and 800 pg/ml.
As soon as at least 50% of the donor’s follicles have attained a mean diameter of greater than 15 mm, and at least 2 are 18 to 22 mm and her plasma estradiol concentration exceeds the number of follicles multiplied 125 pg/ml, she is given 10,000 units of hCG. The egg retrieval is scheduled for 34 to 36 hours later. Following the egg retrieval the donor receives an injection with 100 mg of progesterone and is scheduled for a follow up examination following ensuing menstruation. The recipient starts receiving progesterone injections one day prior to the donor’s egg retrieval and continues with such daily injections until the 8th week of pregnancy or evidence of a negative outcome, whichever occurs sooner. On the day of the egg retrieval the eggs are fertilized with the partner’s sperm and an embryo transfer is performed 3 or 5 days post egg retrieval, depending upon whether 3 cleaved embryos or 2 expanded blastocysts are transferred. Two beta hCG pregnancy tests are performed two days apart, on the 11th and 13th day post egg retrieval, respectively. Hormonal replacement therapy is continued throughout the first trimester.
The vast majority of OD cycles are performed in cases where the recipients are over 40 years of age. Anticipated results are around 55% per fresh embryo transfer (2-3 embryos transferred) and 70-75% per egg retrieval. This implies that there would be enough embryos left over for freezing at the blastocyst stage, and then the pregnancies that would result from the frozen cycle, are added to the 55% PR from the fresh cycle for a cumulative success rate of around 70-75%