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Tanmoy Mukherjee, MD
Reproductive Medicine Associates of New York
Visit our Web Site www.rmany.com
Egg donation is an option for couples whose primary
cause of infertility is suboptimal egg quality. Egg
Donation is an assisted conception option where one
woman (the donor) donates her eggs to a couple (the
recipients) to enable them to conceive. Current success
rates for treatment are exceptional, and in large, experienced
practices the wait list for donors is typically only
a few months. While adoption is certainly a wonderful
alternative, egg donation presents an intimate, successful,
and ultimately very satisfying option.
More
than 150,000 women in the United States cannot bear
children due to ovarian problems. Many women need egg
donors to have a child since either they do not produce
any eggs of their own or their eggs cannot be used for
a healthy pregnancy. A woman might not produce eggs
for a variety of reasons:
- Poor development of ovaries
- Premature ovarian failure
- Menopause
- Diminished ability to ovulate due to surgery
or chemotherapy.
All these women with the problems above will need donated
eggs to have a child. Other women may be potential candidates
for egg donation if they are:
- Ovulating but approaching menopause and their
eggs are failing to fertilize or are unable to sustain
an ongoing pregnancy
-
Ovulating but carry genetic abnormalities that
could be passed on to their offspring.
There
are several ways for a woman to determine if she has
problems with her egg supply. A fertility evaluation
can be processed, which will include a blood sample
taken on day three of the menstrual cycle to check for
evidence of egg quality problems. Poor egg quality is
indicated by elevated levels of follicle stimulating
hormone (FSH) and/or estradiol. An Ultrasonography may
also be utilized to check for egg quality: the doctor
will evaluate the basal antral follicle count (BAFC)
and a decreased ovarian volume or a reduced BAFC may
suggest a reduction in ovarian reserve. A woman may
also exhibit signals of poor egg supply if she is over
40 and frequently miscarrying. A careful examination
of ovarian reserve is recommended in these cases.
The decision to undertake egg donation is a difficult
one; however, a diminished egg supply makes natural
conception difficult or almost impossible. The risk
of having a child with congenital abnormality also may
increase. For women who have undergone extensive successful
infertility therapy and recurrent chromosomally abnormal
pregnant loss, egg donation represents a safe and successful
treatment option.
There are two types of donor programs: anonymous and
known. For the anonymous donor program, the identity
of the donor and the recipient is maintained in strict
confidence. Although anonymous oocyte donation is medically
analogous to sperm donation, it is not easy to maintain
a large pool of donors because oocytes are not easily
accessible, and in the present state of technology,
oocytes cannot be successfully cryopreserved (frozen)
as sperm. At Reproductive Medicine Associates of New
York, anonymous donors range from 21 to 32 years of
age. They are also nonsmokers, with a normal body weight
and a healthy medical and genetic history. The donors
must also test negative for all the infectious disease
screening performed according to the strict standard
criteria of New York State (NYS) and American Society
of Reproductive Medicine Guidelines (ASRM).
For the known donor program, a recipient has to identify
a donor who is 21 to 32 years of age. The donor must
also be a nonsmoker, with a healthy medical and genetic
history. The known donor screening testing for infectious
diseases is similar to all oocyte donors and is performed
according to the standard criteria of the NYS and ASRM
guidelines.
If a woman considers using donated eggs, she should
be tested for any abnormalities that could affect the
success of IVF with donor eggs. Tests should include:
a panel of blood tests that can assess whether the potential
recipient has normal thyroid and prolactin levels, whether
she carries certain antibodies that may require additional
treatment during the cycle, and a general screening
panel for infectious diseases; cervical cultures for
Chlamydia, gonorrhea and mycoplasma; an x-ray (called
a hysterosalpingogram), saline sonogram, or hysteroscopy
to check for abnormalities in the uterus and fallopian
tubes; and a semen analysis.
Additionally, some women will need to pass a mock egg
donation cycle, also called a "prep cycle."
In this type of cycle, the potential recipient takes
similar medications to those used in an egg donation
cycle for a period of 4-6 weeks, and comes to the office
routinely for monitoring of hormonal blood levels and
endometrial growth. The purpose of a prep cycle is to
make sure that the potential recipient's endometrial
lining thickens well enough to become pregnant through
an egg donation cycle. Prep cycles may be waived for
women with adequate uterine lining data from past cycles.
Pretreatment counseling should provide a full explanation
of the egg donation process, risks, and likelihood of
success. In a procedure similar to in-vitro fertilization
(IVF), two or three embryos are normally transferred
to increase the couple's chances of pregnancy. In contrast
to IVF, a high success rate is independent of age and
is instead dependent on the overall health of the recipient
(especially her uterine function). Patients should also
be advised on the potential psychological impact of
egg donation.
Once the recipient passes all preliminary tests, she
must take hormones for two weeks prior to the transfer
to synchronize her cycle with the donor's cycle. This
allows the recipient's uterine lining to develop as
the donor's follicles and eggs grow, optimizing the
implantation environment for the transferred embryos.
These hormones include estrogen, which can be taken
orally or administered in patches that attach to the
skin and progesterone administered by injections.
The recipient starts taking progesterone daily on the
day before or the day of the donor's egg retrieval.
The embryo transfer takes place two to five days later.
Estrogen and progesterone treatments continue until
the pregnancy test on the 28th day of her menstrual
cycle. If there is a pregnancy, the recipient continues
to take estrogen and progesterone to support the development
of the placenta until the tenth week of pregnancy.
There are several risks for egg donation. The main risk
is a multiple pregnancy. In the early years of egg donation,
triplets, quadruplets, and even quintuplets were not
an unusual outcome. Now the process is better understood
and only a small number of embryos (two to three) are
transferred. According to the CDC's most recent national
data, 36% of egg donation pregnancies are twins and
more than half were singleton pregnancies. Higher order
multiples occur in less than 2% of recipient pregnancies
in our program at Reproductive Medicine Associates of
New York.
Multiple-infant births are associated with greater problems
for both mothers and infants, including higher caesarean
section rates, prematurity, low birth weight, and infant
disability or death. Multiple pregnancies may be reduced
to twins or singletons through a procedure called multifetal
pregnancy reduction.
Tanmoy Mukherjee, MD is a board certified reproductive
endocrinologist at Reproductive Medicine Associates
of New York and is also Associate Director of the Mount
Sinai Division of Reproductive Endocrinology. You can
find out more about Dr. Mukherjee and RMA of NY's Egg
Donation program by calling (212) 756-5777 or going
to their web site www.rmany.com.
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