What is an Egg Donation?
For donation cycles, hormone treatment stimulates the egg donors during the preparation for an egg collection. First our expert team collects the eggs from a donor, and the eggs are injected with sperm from the father. The fertilized embryos are then transferred to the recipient mother after they have been prepared in synchronization with the donor. This method of IVF has been used widely for 30 years.
History of Egg Donation
Dr. Jon Buste carried out the first egg donation transfer in America during the 1980’s. It resulted in a successful pregnancy and a live birth on the 3rd of February, 1984 in California.
Egg donation was a new way for women who had no eggs or poor quality eggs to have children, when they previously could not even with IVF. It is widely used in many European countries and few Muslim countries such as Iran, Lebanon and Egypt.
Egg Donations are forbidden in some European countries. However, the laws in Greece, England, Spain and Belgium allow it. North and South America, Africa, Australia and in many Asian countries this method is also accepted. In North Cyprus, egg donations are allowed, though forbidden in specific circumstances according to the Turkish law.
How Does Egg Donation Work?
Finding The Donor
There are two choices when choosing an egg donor.
- Anonymous Donor: the intended parents do not know the donor and only have access to limited information during the treatment process, i.e. blood group, hair and eye colour, height, skin tone, country born, etc.
- Non-Anonymous Donor: the couple know the donor, and the child may possibly have the right to contact them in the future.
Egg Donation Procedure Steps
The donor goes through a stimulation process to increase the possibilities of the number of eggs produced. In turn, we make the female recipient start on separate medication to not stimulate their eggs, but to prepare their body for transfer and pregnancy. When females undergo egg donation, the main focus for development is the thickening of the endometrium lining in synchronization with the donor, while they undergo egg stimulation. It is the same preparation method that we use for women undergoing a frozen embryo cycle. The statistics at our clinic have showed that there is no difference in the percentage of women becoming pregnant via a fresh or frozen donation cycle.
Fresh Donation Cycle
When there is a a fresh donation cycle, we collect the sperm from the intended father on the same day of the donor’s egg collection and conduct a Microinjection (ICSI) procedure, with which we inject the sperm that we collected into the healthy egg. The gamete (egg and sperm) fertilize. Once fertilization takes place, the embryo develops for 3 or 5 days before the transfer to the recipient. Sometimes, we also freeze embryo at these stages as well. Once two weeks have passed after the transfer, our patients run the pregnancy blood test.
Who is Eligible for Egg Donation?
Egg Donation is the most effective treatment for women who are at an age where they are unable to produce eggs or have poor egg quality.
The following are the situations that we assess before commencing treatment for the women:
- For those who have a womb but have entered menopause early and are unable to produce eggs are candidates for egg donation
- Those suffering from hereditary disorders like Turners Syndrome
- Those suffering from Premature Ovarian Failure
- Those who have undergone chemotherapy or radiotherapy for cancer treatment
- Those who’s ovaries are poorly stimulated or cannot be stimulated once hormone treatment has begun
- Those with Hemophilia, Duchenne’s Muscular Dystrophy, and Huntington’s Chorea, in which the transporter gene may be passed to the child from the mother may also prefer egg donation to prevent the risk of having children with inherited diseases
- Those who have continuous unsuccessful IVF cycles
- Those who are of advanced aged with poor egg reserve or no eggs to conceive (check out our blog post about menopause!)
- Those who have genetically inherited diseases passed by the mother
Necessary Preparation and Procedure Outline for Donors
When choosing the donors among the applications, we consider a number of requirements, such as:
- Psychological assessments in which Preliminary tests assess the mental wellbeing of the donor candidate
- General information
- Depression and anxiety tests
- Detailed medical analyses
- Depressive personality disorder. Those with psychosis and neurotic individuals are disqualified
- Serological Evaluation; Infectious diseases (HBsAg, HCV, HIV, syphilis, chlamydia, CMV) and thalassemia test which is legally mandatory, as well as Cystic Fibrosis
“All mentioned tests are completed in a trusted laboratory that has all the necessary ISO certificates with valid ID control.”
We have donor candidates complete Gynaecological Reviews, in which they assess their egg reserve and antral follicle counts to see if they are suitable to become a donor.
Without exceptions, donors have blood tests done, including LH, FSH, and AMH, which show whether the candidate is fertile. Trans-vaginal scans are carried out to determine whether the donor candidate is suitable for the stimulation process.
Hematologic tests are done due to risk of bleeding during the egg collection. We identify the adequacy of the potential donor’s blood cells and clotting potential.
“This procedure is also same for men who will have a surgical intervention for sperm collection.”
If the recipient’s partner is a genetic carrier of a specific gene that can affect any offspring’s health, we also screen the donor for this, to reduce the risk of the baby being born with the same gene. The routine tests on donors for chromosome analysis are for Thalassemia and Cystic Fibrosis. At Crown IVF clinic, we can screen up to 1800 genetic disorder tests, and can also negotiate with centers abroad to fulfill other test requests. There are many new techniques that scientists are creating to thoroughly screen and test genetic disorders. However, the results are not 100%, and we recommend all our patients that they should keep screening during any pregnancy.
A donor receives a certificate once the conclusion of all the additional tests come out. This certificate includes all the physical and medical details along with their psychological profile.
Choosing Donors For Egg Donation
For couples who intend to have an egg donation, we offer a choice of the most suitable donors, who not only match their blood group, but also their visual characteristics. Once the couple make the selection, we inform the donor to begin preparation. The egg stimulation begins on the 2nd or 3rd day of menstruation. Once the eggs are mature enough, we administer HCG or GnRh analogue injection. This enables us to have around 35–36 hours to collect the eggs under general anesthesia.
Once we collect the eggs, our medical team in the laboratory prepare them for ICSI, and they are left to become fertilized. The embryos that have developed are then prepared for transfer.
The donors and the recipient do not interact at any point of the egg donation process. Our team keeps all personal information private and confidential. Misusage or mishandling the information cannot be a matter of discussion.
Information and Guidance for Egg Donation Donors
The donors first sign a consent form at the beginning of the procedure, so that they are legally consenting to begin treatment. Any child born via donated eggs legally has no connection to the donor, and the intended mother receiving the eggs is the legal guardian. Families can get some physical information about the donor, but their name and similar information that can reveal the identity of the donor is strictly not provided.
Confidentiality in Egg Donations
The information for both the couple and donor is confidential, and kept between the doctor and patient. The only way this may be exposed is if the information is required in legal circumstances. The donor has the right to cancel treatment at any time from the date the egg development begins to the point of egg collection. Sometimes things may not go according to plan, and the donor has to pull out of their commitment to the cycle. Treatment may need cancellation. If there is a secondary donor, then treatment is completed with them instead.
We explain the complications associated with the egg donation treatment in detail before and after the procedure. We also provide them in a written form that the donor signs; a consent form stating that they are fully aware of the process. After Dr. HIT has obtained the donor’s full awareness and consent, the medical team proceed with stimulation.
Procedure Outline of Egg Donations for Egg Donor Recipients
It is necessary that we also prepare the receiving couple properly, and we thoroughly inform them about the stages of the procedure. For the mother, it begins with an ultrasound. It is very important that the male has a sperm analysis. Afterwards, the couple get blood tests to rule out contagious illnesses such as HBsAg, HIV, AND HCV. We file the test results for the couple. The key to success comes from the proper examination of the couple. The list of necessary steps are below according to importance:
HSG is the most important and easiest way to analyze the state of the fallopian tubes. The doctor inserts fluid containing radiopaque via the entrance of the uterine cavity through to the fallopian tubes. It allows the x-ray to see where the liquid has travelled, and also enables us to see growths like myomas and polyps more clearly. We can also see hydrosalpinx, where tubes are swollen due to liquid retention. These conditions may fail the pregnancy and may also cause an ectopic pregnancy. Hydrosalpinx are treatable by tying the fallopian tubes or by surgically removing them. In the case of the existence of polyps and myomas, we need to remove them surgically before commencing treatment.
USI (Ultrasound Contrast Imaging)
A USI is the easiest and most effective way to examine the tissue that lines the inside of the uterus. This layer is called the endometrium, and we measure the thickness of it. Finding issues with this lining and treating them are very important for patients undergoing IVF treatment, and careful examination may increase the patient’s chance of pregnancy.
The hormone estradiol is found within the tissues that surround the egg during development. The progesterone hormone is also around the same place. Towards the end of a period, the amount of this hormone decreases. Due to this withdrawal, bleeding may occur. When women become pregnant, this hormone will continue to increase in the blood, and the endometrium will not shed. Throughout the pregnancy, the placenta will be keeping this hormone and a withdrawal bleeding will not occur.
For the endometrium to accept an embryo and for pregnancy to happen, it needs to produce enough estradiol for 10 days. Only afterwards, the progesterone hormone can work best.
Important Points for the Preparation of the Endometrium
For pregnancy to happen:
- The endometrium must take the estradiol hormone for at least 10 days. The receptors found in the endometrium should be saturated. From this, the endometrium will thicken by around 8mm-14mm. Studies showed recently that at least 7mm and above are suitable.
- Estradiol needs to be present in the blood for about 24 days, so that a withdrawal bleeding does not occur. There is no pre-agreed period about the duration of estradiol after embryo transfer.
- About 5 days after transfer, the placenta starts to secrete estradiol and progesterone.
- The patients take supplements externally of estradiol and progesterone for egg donation, embryo donation and frozen embryo transfer cycles.
- The levels of progesterone and the following of natural cycles are very important. In the case of an explosion of progesterone to endometrium for more than 7 days, the patient’s failing pregnancy is unlikely. The limit of saturation of progesterone is 1.85. For the preparation of the patient’s endometrium, they must use 10 days of estradiol. After that, by checking the development of embryos, we decide for how long more we should supply progesterone. This may go up to 17 days.
Factors that Affect the Endometrium
Theoretically, tuberculosis and pre-cancerous pathologies (where tissues are different before the cancer diagnosis) are problems that aid doctors in confirming the identification of problems. When the endometrium sheds every month, it rarely catches microbial infections. Tuberculosis is the only microbial illness that causes damage to the endometrium. This illness can occur when a droplet which comes through the airway sticks to the endometrium. Dr. HIT has seen this once throughout his medical career, and the patient was able to get pregnant and gave birth to a healthy child.
Here are some other factors that can affect a female’s endometrium:
Hysteroscopy is the most common surgery that can cause endometrium damage. It has become a very common procedure, and some doctors may perform it unnecessarily. They do not do it for diagnosis, and instead view it as if it is a routine check-up. They believe that this procedure is easy and harmless, though really it is one that is time consuming and can damage surrounding tissue. At Crown IVF, without causing any damage, we cut out and burn the septum inside the uterus. We use the same procedure for heart shaped uteruses. Afterwards, we find polyps and myomas via ultrasound and HSG.
“Taking out large myomas in one operation may cause endometrium damage. The endometrium, afterwards, does not thicken the same way anymore.”
- Myoma operations
- Women who have undergone abortions are not at risk of damage to the endometrium, as long as the procedure was carried out properly. It is not recommended to have an abortion with the vacuum method.
- Damage inside of the uterus due to frequent injections to the uterus, frequent IVF treatments and use of a coil.
- Myomas that grow towards the gap of the womb, and can cause a pregnancy to not be able to continue. Myomas that are on the wall of the womb or grow towards the empty part of the belly do not harm a fetus, as long as they are not too big in size. There is not a certain number on the limit of size.
“In my personal experience, it is best to proceed with treatment and see. 15cm is the largest myoma I have ever seen. I have seen many patients with large myomas who have given birth with no problems.”
- Hyperplasia and pre-cancerous conditions. In these situations, patients need to get the treatment for cancer or illness.
- Chronic endometriosis that goes away with thickening reasons.
- Endometrium cancer
- Uterine tuberculosis
Patients who go through the treatment of breast cancer use drugs like tamoxifene and femara. Those drugs may also help with the thickening of the endometrium. There is no need to panic as they are harmless.
Analyzing and Recognizing Endometrium Damage
The best method to observe the endometrium is by vaginal ultrasound. It is also medically known as Transvaginal USI.
The endometrium sheds and thins when the menstruation period starts. On the first 6-7 days of it, it is thin. Later, the endometrium thickens with the increase of the estradiol hormone that the body produces when the egg cells begin development, and it could also be increased with medication. When the egg reaches 20 mm, or when the female uses the medication for 10 days, the thickness of the endometrium should ideally be a minimum of 8mm. Women in menopause may require a longer medication process (about 20 days). If the endometrium does not reach 8mm despite the correct use of the medication and the occurrence of ovulation, it shows that there is a problem with the endometrium lining. We also examine the shape and layer of the endometrium in order to make sure that there are no abnormalities.