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The first oocyte donations were performed in 1982-1983, about 3 years after the birth of first baby from the IVF procedure. Initially, oocyte donation was considered a heroic attempt to allow young women with premature ovarian failure a chance to reproduce. In these individuals, simply put, the ovaries had "run out of eggs", but otherwise the uterus was normal and capable of carrying a pregnancy. Soon, it was shown that the uterus could be "programmed" by use of oral, transdermal, or injectable hormones to accept and carry a pregnancy, normally. It became strikingly obvious that pregnancy rates for recipients were as good, and often even excelled, that of conventional IVF-ET. Now, while the option of donor eggs is not as common as donor sperm, oocyte donation is considered a vital part of many, if not most, of the larger IVF-ET programs.
There are many reasons why a couple might consider oocyte donation. The general indications are:
For the individuals with the above problems, the options for children are very limited and are virtually limited to adoption, or foregoing childbearing.
In many ways egg donation and sperm donation, which has been a long established acceptable therapy, are similar. Obviously the great difference is the number of oocytes available and the physical difficulty in obtaining these eggs. In contrast to millions of sperm in each ejaculation, usually a single mature egg is produced each month. The remaining oocytes in the ovary remain oocytes immature, or degenerate, and not suitable for IVF. The need for ovarian stimulation using injectable medications and requirement of procedure of needle aspiration for harvesting eggs from the ovary, require considerable commitment from the donor. This limits the general availability of donor oocytes from the general population. Also, there are ethical considerations about buying eggs from fertile anonymous donors. An alternative would be to provide "known" donors, such as family members, but this is generally discouraged because of the possible psychosocial implications.
A general requirement in preparation for IVF procedure is ovarian stimulation, which causes the development of multiple follicles (small cysts containing an oocyte) and therefore, oocytes. Young, otherwise healthy individuals undergoing this ovarian stimualtion, often produce a surplus of oocytes and might elect to donate these oocytes instead of cryoperservation (freezing) embryos for later use.
C.A.R.S. advocates the principle of oocyte sharing. The objectives of this approach are to match individuals requiring IVF, in whom it the production surplus eggs is expected, with couples requiring donated oocytes for a chance at fertility. Simply stated, this allows a efficient approach, matching financial and reproductive resources. Most egg donors gain significant satisfaction from egg sharing since they are readily familiar with infertility. In some cases, this sharing allows the donor access to therapy that would otherwise not be available.
With oocyte sharing the donor oocyte is fertilized by the male partner of the oocyte (embryo) recipient. This means that the male partner will be the genetic (natural) father of the child. The embryos are transferred into the recipient whose uterus has been primed with hormones (estrogen and progesterone) to support the pregnancy. Therefore, the recipient will be able to carry and deliver the pregnancy. The recipient is the birth and legal, although not the genetic, mother.
The donor will undergo a standard IVF-ET cycle as outlined in the C.A.R.S. information booklet regarding these procedures for treatment of their infertility. The donors will be less than age 35 , have had children in the past, or have excellent potential for donating oocytes capable of initiating a pregnancy, and be in excellent health and free of medical, or family medical condition of significance. Donors are usually infertile due to tubal disease, often from a previous sterilization procedure. Regardless of the cause of their infertility, they must have the likelihood of producing a surplus of "normal" oocytes. This is a usual finding in the course of treatment for this group of patients. An alternative for the donor would be to freeze these embryos for use in a later attempt at pregnancy. In the sharing program, the surplus oocytes are allotted to the recipient in consideration for payment or to help offset a portion of the cost of the donors IVF-ET cycle.
Recipients who are still having menstrual cycles will be given an injection(s) to suppress ovarian function. This will induce a temporary menopause during which additional pills, injection, skin patches, and/or vaginal suppositories will be used to prepare the uterus to accept the embryo(s) resulting from oocyte donation. This regimen is also used to synchronize the recipient's and donor's cycle. These are all frequently used medications and serious, or lasting, side-effects are uncommon to the recipient, or the fetus. Any sign of an adverse reaction should be reported so that an alternative medication can be used.. Blood testing for hormone levels and vaginal ultrasound scans to monitor response of the uterine lining, will be periodically performed to ensure adequate hormonal stimulation. The recipient will undergo standard embryo transfer with the procedure and risks as explained in the C.A.R.S. IVF-ET booklet. The transfer procedure is usually easy and painless.
When multiple embryos are transferred into either the donor or recipient, multiple pregnancies are possible. The recipient does not have any risk of ovarian hyperstimulation, as is possible in the donor, using the medications for ovarian hyperstimulation. Usually a maximum of 4 healthy embryos will be transferred, either to the donor, or to the recipient. A reasonable estimate, with transfer of 3 embryos is 20% chance of twins and 5% chance of greater than twins.
Pregnancies may be more complicated in older recipients. Some of this increased risk may be due to a higher proportion of women who have known medical problems, such as high blood pressure. Preconceptional counseling is recommended for all patients greater 35. It is known that the incidence of uterine fibroids and the risk of caesarean section increases. Tests to evaluate the receptivity of the uterus, such as hysterosalpingogram (HSG), hysteroscopy, or endometrial biopsy, may be suggested. There is still controversy as to whether the uterus becomes less responsive in women over age 35. Several studies have shown no difference between younger and older recipients. The risk of genetics disorders such as Trisomy 21 (Down's syndrome. mongolism) clearly is increased with maternal age. This is related to the age of the oocyte donor and not the recipient. Recipients do not have a higher incidence of genetic defects because of their own age. Amniocentesis is not necessarily indicated either because of IVF or oocyte donation, but individuals should be counseled by their obstetrician.
The recipient will be informed of the donor's age, whether she has had children, her medical and family histories, her HIV (AIDS) status and infectious disease screen, her blood type, general physical characteristics, and level of education. Donors and recipients will be from different towns, and if possible, over 50 miles apart. Addresses, names or other identifying information will not be given to either donor or recipient. The recipient must approve the selection of the donor. Generally, this is at the initiation of the pretreatment cycle.
Both Donor and recipient must undergo blood screening for transmissible infections and venereal disease including AIDS. Any party that has any contact or is considered high risk for infectious disease must not participate in the sharing program. Unlike sperm, it is not possible to freeze and quarantines eggs prior to fertilization. If desired, embryos for the recipient derived from donor eggs may be frozen, but pregnancy rates using frozen thawed embryos are generally lower. Costs of embryo freezing are in addition to the general fee schedule.
C.A.R.S. will make an honest attempt to insure that the donor is a "good candidate" for oocyte donation. An honest attempt will also be made to ensure that the recipient couple are capable of providing a "good home" for the child born from this procedure. Both donor and recipient have the right to make stipulations about the other but, this must be in writing at the time the matching forms are completed. Both donor couple and recipient couple must have at least one session with the the C.A.R.S. psychological counselor and must be approved for program entry. The cost of this session for the donor couple is included in the program fee.