Egg donation (Oocyte Donation) is the process by which a woman provides several eggs (usually only around 10-20 are mature enough to use) (ova, oocytes) for purposes of assisted reproduction or biomedical research. For assisted reproduction purposes, egg donation typically involves the process of in vitro fertilization as the eggs are fertilized in the laboratory; more rarely, unfertilized eggs are frozen and stored for later use by the intended parents.
Egg donation is part of the process of third party reproduction as part of ART (Assisted Reproductive Technology).
Prior to this, thousands of women who were infertile, had adoption as the only path to parenthood.
As IVF developed, the procedures used in egg donation paralleled that development: the egg donor’s eggs are now harvested from her ovaries in an outpatient surgical procedure and fertilized in the laboratory, the same procedure used on IVF patients, but the resulting embryo or embryos is then transferred into the intended mother instead of into the woman who provided the egg.
Donor oocyte thus give women a mechanism to become pregnant and give birth to a child that will be their biological child (assuming that the recipient woman carries the baby), but not their genetic child.
In cases where the recipient’s womb is absent or unable to carry a pregnancy, a gestational surrogate is used and the embryos are implanted into her per an agreement with the recipients.
Indications for oocyte donation Women with non functioning ovaries:
a. Premature ovarian failure
b. Ovarian agenesis
c. Surgical removal of bilateral ovaries
d. Radiological or chemotherapeutic destruction of the ovary.
e. Post menopausal
Women with functioning ovaries:
a. Risk of inheritable genetic disease in children
b. Failed IVF due to poor oocyte quality
c. Inaccessible ovaries
GUIDING QUESTIONS TO DETERMINE IDEAL CANDIDATES FOR OOCYTE DONATION ASSESSMENT OF THE RECIPIENT
Does the potential recipient have a history of gonadal dysgenesis or an inheritable disorder that would preclude her from using her own eggs for pregnancy?
If the patient desiring pregnancy is over the age of 45, or has already undergone natural menopause, is she free of any major medical illness or condition that would jeopardize her or her fetus during pregnancy?
Does the potential recipient have indications of limited ovarian reserve or premature ovarian failure?
Does the potential recipient have a history of repeated IVF failure?
Are that recipient and her partner psychologically stable with a strong family support system?
SUGGESTED MEDICAL SCREENING OF OOCYTE RECIPIENTS RECIPIENT(S)
Thorough medical history and physical examination CBC, blood Rh, and type
Serum electrolytes, liver and kidney function
Rubella and hepatitis screen
Venereal disease research laboratory slide test VDRL HIV-1, HTLV-1, HIV-2, HTLV-2
Urianalysis and cultures for gonorrhea and Chlamydia Papsmear
Transvaginal ultrasound Uterine cavity evaluation (sonohysterogegram or hysterosalpingogram)
Glucose tolerance testa
Cholesterol and lipid profilea ( a – particularly if the woman’s age is more than 40)
Blood Rh and type Hepatitis screen
HIV-1, HTLV-1, HIV-2, HTLV-2 Semen analysis and culture
Appropriate genetic screening
REQUIREMENTS FOR AN OOCYTE DONOR
The individual must be free of HIV and hepatitis B and C infections, hypertension, diabetes, sexually transmitted diseases, and identifiable and common genetic disorders such as thalassemia.
The blood group and the Rh status of the individual must be determined and placed on record.
Other relevant information in respect of the donor, such as height, weight, age, educational qualifications, profession, colour of the skin and the eyes and the family background in respect of history of any familial disorder, must be recorded in an appropriate proforma. The age of the donor must not be less than 21 or more than 35 years.
The donor and recipients cycle are synchronized by putting them on oral contraceptive pills in the previous month. The standard ovarian stimulation protocol for the donor involves pituitary desensitization with a GnRH analogue starting in the mid-luteal phase and ovarian stimulation with gonadotropins.
The recipients with functioning ovaries undergo pituitary down regulation with GnRH analague before endometrial preparation with estrogen. In non menstruating women, cyclical hormonal therapy is given till the following criteria are fulfilled:
Minimum 3 months of bleeding
Uterocervical length > 5 – 6 cm
Endometrial thickness 8 – 9 mm
All recipients then receive exogenous estrogen (estradiol valerate) therapy for endometrial preparation starting from day 2 of menses.
Micronized Progesterone is added on the day of donor’s pickup. Embryo transfer is done on day 3 or day 5. Post transfer luteal support is given to all the recipients in the form of estradiol valerate and micronized progesterone a’ hcg is done on day 14 post transfer to confirm pregnancy. If pregnancy is confirmed, luteal support is continued till 12 -14 weeks of gestation.
Transfer when retrieved eggs from the donor are immediately fertilized by IVF / ICSI procedure and the resultant embryos are transferred into the recipient
THAWED OOCYTE TRANSFER
When oocytes are retrieved and stored by vitrification and are used later after thawing when required.
The system of oocyte sharing in which an indigent infertile couple that needs to raise resources for ART agrees to donate oocytes to an affluent infertile couple wherein the wife can carry a pregnancy through but cannot produce her own oocyte, for-in-vitro fertilization with the sperm of the make partner of the affluent couple, for a monitory compensation that would take care of the expenses of an ART procedure on the indigent couple, must be encouraged.
There is a secret in our culture, and it’s not that birth is painful it’s that women are strong.