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The Process of Egg Donation Explained
a blog by David Tourgeman, M.D., HRC Fertility, August 11, 2011
To read more Discussing Fertility with HRC blogs, CLICK HERE.
The most important initial step is identifying an egg donor that meets your “wish list." In addition to the physical and medical attributes that were discussed in an earlier blog, it is paramount to have the egg donor evaluated by a psychologist and a geneticist. In general, the psychologist will administer a mental health examination to verify that the egg donor is emotionally stable and that her motives are genuine. Additionally, a geneticist will conduct a personal and family history to assess if there are any genetic predispositions or concerns.
Once the egg donor has psychological and genetic clearance, she will be tested for infectious diseases according to the FDA guidelines. This is usually done by your physician, who will also evaluate her for any other medical issues. At this point, the only thing that is left is signing the dotted lines. In addition to completing the contract with the egg donor agency, an attorney is provided to protect both the egg donor and recipients.
Before the process can begin, there will need to be an evaluation of the intended mother’s uterus. This is usually done by having a water-instilled ultrasound known as a hydrosonography or a dye-based X-ray called a hysterosalpingogram. In either case, the idea is to have a perfect womb — free of fibroids, polyps or other problems that may decrease the pregnancy rate.
It is also common to perform a practice embryo transfer in which a small soft catheter is guided through the cervix into the uterus. The practice of performing a “mock cycle” in which the uterus is stimulated with hormones to test the response, followed by an uterine biopsy is rarely done, but will depend on the practice of your physician.
Ready, Set, Go
Believe it or not, the actual cycle synchronization begins now. Typically both the egg donor and the recipient call with their periods, and they are then started on birth control pills. Dependent on the stimulation protocol, the recipient and donor are converted to an injection called lupron. This is done so that both the recipient and egg donor are at the same starting point. Once the egg donor is started on the stimulation medications, the recipient will begin estrogen supplementation, which will thicken the uterine lining and continue the synchronization process. Estrogen is usually administered orally, by patch, injection, or via vaginal suppository.
The egg donor will typically stimulate her eggs to grow for about 10 to 12 days and will then take the last shot to trigger maturation of the eggs to prepare her for egg harvesting.
Based on the time of the trigger shot, the egg donor will be scheduled for the egg retrieval. In the cases where the egg donation is anonymous, the intended father will come at a different time (usually after the egg extraction) to produce a sample. The intended mother will then stop the lupron and begin progesterone supplementation. Progesterone is usually administered via vaginal suppository or injection. The progesterone and estrogen will continue through the end of the first trimester.
The embryologists will then combine the eggs and sperm, and the final steps begin. Your fertility doctor’s office will call you the next morning with the fertilization report. This will give you the information of the number of eggs extracted and the number of embryos that were achieved after fertilization. The embryos are then grown in the laboratory for three to five days. In most cases, there will be many embryos, and most fertility doctors will opt to grow them out to the fifth day when the embryos reach the blastocyst stage in which they have 60 to 100 cells.
The time has come ... the embryo transfer! Your doctor will review the number of embryos that are transferable and then make a recommendation of the number that should be placed that day, usually one to two. The embryos that are not transferred will be frozen for future use.
The embryos will be placed into the uterus with the same soft catheter that was previously used. This is often done under ultrasound guidance, so that the embryos can be placed in the perfect spot. The procedure is painless, other than the discomfort of the speculum that is placed. The embryologist that handed your doctor the catheter will double check that the embryos did not stick to catheter.
The process is done! In eight to 12 days your blood will be tested to see if pregnancy has occurred. About two weeks after the first blood test, you will have your first ultrasound to confirm the viability of the pregnancy. Best of luck!!!