Egg Donation Overview
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The 2002 Guidelines for Gamete and Embryo Donation published by the American Society for Reproductive Medicine (ASRM) were excerpted in this patient handout. Patients are invited to visit the ASRM website for more information on egg donation and reproductive medicine and issues in general.
Egg donation is a fertility treatment which is commonly used in the United States. Many women are unable to conceive due to decline in ovarian function. This most often occurs with advancing age. Egg donation gives them the opportunity to conceive and deliver a child. Pregnancy rates are generally about 60%, given the source of the oocytes.
The donor undergoes ovarian stimulation to produce multiple eggs. Trans-vaginal ultra-sound is used to monitor the follicle growth and the eggs are removed through a small needle passing through the vaginal wall while the donor receives IV sedation. The recipientís cycle is controlled with hormones so that her uterus will be ready for implantation at the correct time. Sample calendars are attached to this handout.
Women with premature ovarian failure, advanced reproductive age, diminished ovarian reserve are good candidates for egg donation. Women known to be affected by or be the carrier of a significant genetic defect or who have a family history of a condition and whose carrier status can not be determined are potential candidates. Women with poor oocyte and/or embryo quality or multiple failures during prior attempts to conceive via one of the assisted reproductive technologies may consider the use of egg donation.
Evaluation of recipient medical history
A routine medical and reproductive history will be obtained. Reproductive abnormalities detected may require more detailed evaluation or treatment before donor cycle is initiated. A physical exam including a pelvic exam should be done. Standard pre-conception testing including blood type and Rh factor, and rubella and varicella titers are done. Recipients should be offered Rubella immunization if they are found to be non-immune. The blood tests also include serologic test for syphilis, serum testing for hepatitis B surface antigen, hepatitis C antibody, cytomegalovirus (CMV) antibody, and human immunodeficiency virus 1 (HIV-1).
Donors may be known to the couple or anonymous. Known donors may be friends, family members (i.e. sister of patient with premature ovarian failure), or others. Anonymous donors are often more expensive due to the cost of recruitment, compensation for time, energy spent, and testing. It can be expensive to maintain an adequate number of donors. Psychological evaluation and counseling by trained mental health professionals (PhD psychologist for testing and MSW for counseling) is recommended to the donor and her partner. Psychological testing should be required for individuals in whom there appears to be factors that warrant further evaluation. In the case of known donors, related issues such as the potential impact of the relationship between donor and recipient should be explored. The donorís age should be between 21 and 34. Donors older than 34 may have lower pregnancy rates and the risk of chromosomal problems related to maternal age (i.e. increased risk of Downís Syndrome after age 35) should be discussed. Proven fertility is desirable but not an absolute requirement. The donor will undergo a standard IVF stimulation protocol which requires administration of medications just under the skin with a small needle for about 3 weeks on a daily basis with 4 or more ultrasound exams and blood draws to assess the stimulation progress. Thus there will be a time commitment on the donorís part. Genetic evaluation, as discussed below, is needed. A detailed family history may reveal the potential for passing on certain diseases to offspring. Patients with genetic illnesses in their families should not be egg donors.
A personal and sexual history should be obtained to exclude donor individuals who might be at high risk for HIV and other sexually transmitted diseases (STDs) as well as transmissible spongiform encephalopathies (TSEs). The risk factors include intravenous drug abuse, exchange sex for money or drugs, having had sex in the past 12 months with any person who uses IV drugs or has sex for money or drugs or any person having or suspected of having HIV or hepatitis. Donors should not be prisoners or should not have had contact with any other person having viral hepatitis within 12 months preceding the donation. Women that have or been treated for gonorrhea or syphilis within the past 12 months should not donate. If a women has had body piercing, acupuncture, and/or tattooing in which sterile procedure were not used or if it is unclear whether sterile procedures were used should not donate eggs. A family history of transmissible spongiform encephalopathy (TSE) such as Cruetzfeld-Jakob disease (CJD), or a history of cognition, speech, or gait problems or exposure to tissues suspected of harboring TSEs should avoid egg donation. Also, any patient that has received human organ or tissue transplants or human extracts should not donate eggs.
Testing for sexually transmitted infections includes syphilis, hepatitis B surface antigen and hepatitis C antibody, HIV-1, HIV-2, and cervical cultures for Neisseria gonorrhea, Chlamydia tachomatis. Rh testing should be done. The implications of Rh incompatibility on pregnancy outcome should be discussed.
Psychological screening and testing play a crucial role in egg donation. It is not un-common for this process to take a couple of months to complete before we proceed further. Assessment of all involved with the process is done by a mental health professional. The psychological history includes family history, educational background, assessment of stability, motivation to donate, current life stressors and coping skills, difficult or traumatic reproductive history, interpersonal relationships, sexual history, history of major psychiatric and personality disorders, substance abuse in donors or first degree relatives, legal history, history of abuse or neglect.
Our Psychologist will evaluate the results of the MMPI test. This is a multiphasic standardized personality test that takes a couple of hours to complete, usually in an office setting. It has several hundred multiple choice questions. When completed, the Psychologist will assess the data and give us a written report. Donors should understand and accept the risks and benefits of the therapy; including allergic reactions to medications, pain and bleeding with injections, ovarian hyperstimulation syndrome, and bleeding and infection with egg retrieval.
Donors will be counseled about infectious disease tests and how that information will be used and shared with others. The assessment should also address the potential psychological risk and should evaluate for evidence of coercion (financial or emotional). It is also important to ascertain if the donor is knowledgeable about the degree of disclosure and whether any plans exist for future contact. The donor must be aware of all aspects of potential embryo management and disposition applicable to that practice. Donors should be informed about how the information will be used, stored, and secured.
The ASRM has suggested relative exclusion criteria for egg donors; significant psychopathology, positive family history of heritable psychiatric disorders, substance abuse, two or more first-degree relatives with substance abuse, current use of psychoactive medications, history of sexual or physical abuse with no professional treatment, excessive stress, marital instability, impaired cognitive functioning, mental incompetence, and high risk sexual practices. Candidates excluded from the donor practice should be counseled regarding the reasons for their exclusion and, if appropriate, offered referral.
The recipient couple will have psychological testing which includes the MMPI test and one-on-one and group sessions with our counselor. Important issues discussed include feelings about the overall situation and outcome if successful, disclosure to child, family, friends, and parenting issues at an advanced age. Should a cycle fail, how will they cope? The stress, emotional and financial, will be discussed.
A detailed genetic family history is obtained. Donorís should be
excluded that have inherited diseases like Huntingtonís Chorea in the
family. The risk of transmission of major malformations like spina bifida
(multi-factorial inheritance) is discussed. The parents, siblings, and
offspring of donors should not have a disease with a genetic component.
The chance of having a balanced translocation is low, about 1/2000 in
healthy people so chromosome analysis (karyotype) testing is optional.
Cystic Fibrosis is the most common inherited disease in Caucasians with
1/20 being carriers of mutations. Guidelines established by the American
College of OB/GYN for testing should be followed.