Donor Egg (Oocyte) Program

Women are candidates for an egg donor in vitro fertilization (IVF) cycle if they are in good health and less than 50 years old. Women needing egg donation include those who have advanced maternal age, premature menopause, premature ovarian failure, surgically removed ovaries, prior poor response with own eggs through IVF and genetic diseases which would be passed on to offspring.

Initial Evaluation:

Generally a couple seeking egg donor IVF needs to have some basic testing performed. These tests include:

Wife

• Blood type, Rh, antibody screening
• Rubella and varicella titers
• RPR
• Hepatitis B and C, CMV, HIV-1
• Uterine cavity study

Husband

• Blood type and Rh
• Semen analysis
• RPR
• Hepatitis B and C, CMV, HIV-1

Although not required, couples may choose to have psychological counseling prior to an egg donor cycle.

If the wife is > 45 years old, then cardiac stress testing and consult with a high risk obstetrician is advised prior to the egg donor cycle.

Egg Donors:

Presently, we use an egg donor match service for anonymous egg donor cycles. X and Y Consulting, Inc. of Phoenix, Arizona finds and screens potential egg donors. These women are screened for genetic and infectious diseases. You can contact X and Y Consulting by logging on to their website at www.EggDonorsNow.com to register and start the selection process or you can phone them at (602) 678-1906. We also are able to do known egg donor cycles that you provide such as a family member or friend.

The egg donor's and the wife's menstrual cycles are synchronized with medication. The egg donor undergoes stimulation in Phoenix under the direction of Drs. Akin, Murray and Muse. The egg donor then flies to Lexington for the egg retrieval procedure. Once the eggs are harvested, they will be combined with the husband's sperm by either standard IVF insemination or by intracytoplasmic sperm injection (ICSI) depending on the indication. Fertilized eggs (embryos) are then transferred 3-5 days later into the wife's uterus that has been hormonally prepared. Any extra viable embryos can be frozen for use at a later time.

A new alternative to using a fresh egg donor is to purchase frozen donor eggs from a donor egg bank. We use Cryo Eggs International for a frozen donor egg bank. For more information, please visit their website at www.cryoeggsintl.com.

Further Preparation for Egg Donor IVF

If the wife's uterus is not hormonally prepared properly, the embryos will not successfully implant. For this reason, all donor egg recipients must undergo a mock donor egg cycle. During the mock donor egg cycle, the wife is placed on daily injections of Lupron starting about 1 week before a period. After the period, she is also started on estrogen patches at varying dosages. A transvaginal sonogram, blood estradiol level and a mock embryo transfer are obtained around cycle day 14 and a repeat transvaginal sonogram and blood progesterone level is obtained around day 23. Progesterone is given daily on cycle days 15 through 28 (Please see Mock Donor Egg Cycle Schedule).

Ready to Start

Once a suitable donor has been selected and all the preliminary work has been completed the date for the egg retrieval can be determined and the process will begin. The stimulations will be at the office of Drs. Akin, Murray and Muse at 1760 Nicholasville Road, Suite 501 , Lexington , KY 40503 . The donor egg retrieval and subsequent embryo transfer will take place at Bluegrass Fertility Center , 2801 Palumbo Dr, Suite 101 , Lexington , KY 40509 . This is at the southwest corner of Man O War and Palumbo Drive . Maps showing the location are available.

Risk Information

1. The donor egg procedure carries with it a small risk of sexually transmitted diseases including but not limited to gonorrhea, syphilis, herpes, hepatitis and acquired immune deficiency syndrome (AIDS). There also is a small risk of infection from an embryo transfer.
2. The risk of miscarriage, Down syndrome and other chromosomal abnormalities increases with the age of the egg donor. The age of the donor is the important one and the age of the recipient is irrelevant. For example, if the wife becoming pregnant is 42 years old and the egg donor is 25 years old, then the risk for Down syndrome is that of a 25 year-old woman.
3. Egg donor recipients have an increased risk of preeclampsia (toxemia) during the pregnancy as high as 25-40%.
4. The background risk for birth defects is 3-4%. IVF may increase the risk of birth defects as high as 6-8%. IVF pregnancies are high risk. There is an increased chance for pre-term delivery, low birth weight, birth defects, chromosomal abnormalities, brain damage and death. There may be an increased risk of genetic diseases. Increased maternal complications can also occur such as placental abruption and need for C-section.
5. The chance for a tubal or ectopic pregnancy is about 1-2%. Embryos circulate within the uterus for a few days prior to implanting and rarely can become lodged in a fallopian tube. Tubal pregnancies require either surgical or medical intervention.

General IVF Information for Egg Donor Recipients

Male Procedures - If the husband has a normal semen analysis, then sperm are simply added to the donor eggs and natural fertilization occurs. However, if the semen analysis is abnormal, then intracytoplasmic sperm injection (ICSI) is indicated. ICSI is a technique where a single sperm is injected directly into the cytoplasm (center) of the egg. 

Risks associated with offspring born from ICSI procedures are still under investigation. While currently available data suggest that the risk of birth defects or major congenital defects in children born from ICSI is approximately that of the general population (approximately 3-4%), it is possible that such defects could occur as a result of the procedure. A higher incidence of abnormalities with the Y chromosome in male offspring (2-3% vs. 0.1-0.5%) from ICSI has been suggested. While the implications of such findings remain unclear, it is possible that male offspring may be at higher risk of fertility problems if such abnormalities occur. There also is a slight increased risk of sex chromosomal abnormalities from the ICSI procedure (0.8% vs. 0.23%) such as Klinefelter's Syndrome and Turner's Syndrome. Because ICSI is still a relatively new procedure, there may be additional risks that cannot be foreseen at present.

Assisted Hatching - Assisted hatching is a technique where a small hole is created in the zona pellucida (shell around the fertilized egg) by a needle or chemical solution to facilitate the embryo's release. Assisted hatching is performed just prior to embryo transfer. Patients who may benefit from this procedure include:

1. Patients that are 38 years or older.
2. Patients that have failed IVF in at least two previous attempts.
3. Patients who are having frozen-thawed embryos transferred.
4. Patients who have embryos with abnormally thick zonae pellucidae (shells).

Risks of the procedure include rarely destruction of the embryo and possibly increased chance for identical (monozygotic) twinning.

Initially, fertilized eggs were transferred back to the uterus after 1 day. Research then showed that transfer on day 2-3 was better. A few years ago, some studies showed that transfer back on day 5-6 was better still. On day 5-6, developing embryos are called blastocysts. However, more recent studies have shown that while blastocyst transfer is better in certain situations, day 2-3 transfer is better for most patients. The optimal day for your embryo transfer will be decided upon by the embryologist and your physician as the embryos develop. Extra viable embryos may be successfully frozen at different stages for later use.

Fact: Multiple gestation is a frequent complication of ART. If a pregnancy is achieved with ART, about 60% of the time there is only 1 baby, however, about 25-30% of the time there are twins, and the other 5-15% of the time triplets or more are present. While many couples are happy to have twins, the complications of pregnancy increase with the number of babies present. The most serious complication of multiple gestation is preterm labor with delivery of premature infants. Severe prematurity can result in the death or brain damage of a child. With proper prenatal care, the risks of premature labor can be lessened but not eliminated. Every effort is made to increase the chances for pregnancy with ART while minimizing the chances for multiple births. Though not offered in Kentucky , selective reduction is an option for some couples with high order multiples. The chance for complete pregnancy loss with selective reduction is between 10-25%.

Success Rates: The overall expected success rate is about 50% per cycle.

When the cycle doesn't work. There are several reasons why conception may not occur during egg donor IVF. The treatment cycle may be canceled prior to egg retrieval if follicular development is unsuitable. Some eggs may not be fertilized and some embryos may not implant when transferred to the uterus. Failures at Egg Donor IVF procedures are frustrating. We share in your success and disappointments. If at any time you feel undue stress or just need to talk, please let us know of your feelings.

If pregnancy does not occur in the first cycle, is there reason to try again? Yes, several studies conclude that IVF pregnancy rates are constant throughout the first 6 attempts. In other words, your chances for pregnancy are not decreased in your third IVF attempt because the first 2 attempts did not work assuming that there were embryos each time to transfer.