Oocyte (Egg) Donation (Fresh cycle)
NOVA IVF has been performing oocyte (egg) donation treatment since 1988. Oocyte donation is the most effective treatment available to help infertile couples achieve pregnancy. The probability of a live birth depends greatly on the fertility potential of the oocyte donor and with selection of the right donor the success rate is 50-80% at NOVA.
The egg donation is indicated for women who cannot or should not for genetic reasons get pregnant with their own eggs. Oocyte donation has become a mainstream treatment for infertility.
Finding an oocyte donor is the first step in initiating the oocyte donation treatment. She can be a relative, a friend, or you may use one of the many oocyte donor agencies nationwide. These agencies have a number of pre-selected young oocyte donors. The above document lists egg donor agencies that NOVA IVF has been working most closely with. Your donor does not have to live locally or even in California.
Usually the agency provides an anonymous match. Depending on the oocyte donor agency, you may be able to decide whether or not you contact the donor.
All potential egg donors are screened at Nova for over 100 genetic diseases. Blood type determination and screening for sexually transmitted diseases will also be performed at NOVA. An important part of the screening is to be sure that the egg donor has great fertility potential. NOVA has recommendations that can help you choose a fertile donor.
Even though the child is genetically linked to your partner and the oocyte donor, you are the one getting pregnant, nourishing the baby throughout the pregnancy and delivering the child.
Pre-implantation genetic diagnosis (PGD) or screening (PGS) can be added to the oocyte donation treatment.
If sperm cannot be obtained by masturbation, it can be aspirated from the testes or epididymis.
Process of Oocyte Donation
The oocyte donation procedure is similar to in vitro fertilization: after the egg donor’s ovaries have been stimulated, the eggs are aspirated, inseminated with sperm from the recipient’s partner, incubated and one or more of the resulting embryos are transferred into the recipient’s uterus.
Below is an example of an egg donation treatment sequence. Actual treatment is individualized. All stages of this treatment take place in our clinic. All medications are given as pills, skin patches, vaginal capsules or small subcutaneous injections just under the skin. The recipient also takes one intramuscular injection a day for four days.
1. Ovarian Stimulation
To maximize the probability of a live birth, the egg donor takes FSH (follicle stimulating hormone) and LH (luteinizing hormone) to stimulate production of as many high quality eggs as possible (usually 8-20 eggs).
During the 7 to 12 day ovarian stimulation, several examinations and blood estrogen determinations are used to follow the development of the eggs. When the eggs are ready for retrieval, your donor will take a trigger shot to prepare the follicles for ovulation. This injection completes the maturation process of the eggs.
The ultrasound image on the left shows fully stimulated ovaries. Each of the grape-like follicles (15 to 25 millimeters in diameter) contains a practically microscopic egg.
2. Egg Retrieval
Thirty-six hours after the trigger shot, a non-surgical oocyte retrieval is performed at NOVA. This is typically a 3 to 7 minute procedure. Using ultrasound guidance, a thin aspiration needle is passed through the top of the vagina into the follicles. Only the tip of the aspiration needle enters the pelvic area. Since the ovaries are located just above the top of the vagina, the tip of the needle is passed into the follicles without penetrating the uterus, cervix or the fallopian tubes.
The recipient’s partner collects a semen sample by masturbation either at home or at our office and the highest quality sperm are added to the eggs several hours after the egg retrieval. If your infertility history suggests the possibility of a male factor significant enough to keep the eggs from being fertilized using regular laboratory methods, the ICSI procedure will be recommended. ICSI or Intracytoplasmic Sperm Injection, is a micromanipulation technique in which a single sperm is inserted directly into an egg.
The next day, NOVA’s embryologist will examine the eggs for signs of fertilization. A normally fertilized egg (zygote) will show two pronuclei representing the genetic material from the egg and sperm (first image below).
The following day, embryos reach 4 cells, the day after, 8 cells and by day 5 after egg retrieval, they should reach the blastocyst stage.
4. Embryo Transfer
Two to five days after the egg retrieval, one or two embryos (sometimes more if the donor is older) are transferred into the recipient’s uterus by passing a thin embryo transfer catheter through the cervix to the top of the uterus. This procedure is always done under ultrasound guidance. This dramatically increases the chance of the embryo(s) implanting and causing a pregnancy. Sometimes the ultrasound will be transabdominal and other times it is better to be transvaginal. Regardless of the ultrasound method, the embryos are never “blindly” placed into the uterus. The embryos can implant because the uterine lining has already been prepared to support the embryos by the use of estrogen and progesterone supplements.
Extra embryos that are not transferred at this time can be cryopreserved and stored in liquid nitrogen.
5. Establishment of Pregnancy
A blood pregnancy test is scheduled approximately two weeks after the embryo transfer. A fetal heartbeat ultrasound is done two weeks after a positive pregnancy test. This ultrasound picture shows an eight week pregnancy. The baby inside the sac is about an inch long, yet it is possible to already distinguish the head and the bottom portion of the baby’s body.
Estrogen and progesterone supplementation of the pregnancy continues for 6 to 8 weeks. By that time, the placenta produces enough of its own estrogen and progesterone so that the supplementation can stop. At that point, your pregnancy becomes indistinguishable from a conception through intercourse and it is up to you whether to let your OB doctor know that you conceived through egg donation.