Troché Fertility part of Advanced Fertility Cares’ Egg Donor Program provides women the opportunity to create embryos and carry a pregnancy if they are unable to produce or use their own healthy eggs. Egg Donors may be selected from our extensive Donor Registry of pre-tested donors, or from other sources (agencies, egg bank, or a known donor). Once the donor evaluation process is complete, we will coordinate the cycles and follow you through each step.
Take a look at our Egg Donor Database.
Selecting and Screening an Egg Donor
An egg donor may be someone the intended parents know or can be chosen anonymously from our in-house Egg Donor Registry or from an outside Egg Donor agency. A known egg donor is often a close relative or friend. A benefit of having a family member as a donor is the genetic link between any resulting child and the woman or intended mother. The screening of a known egg donor takes 1 to 2 months.
Anonymous egg donors are recruited from colleges/universities, on-line and from other donors. Most donation cycles involve anonymous donors. At Troché Fertility part of Advanced Fertility Care (TFAFC), we thoroughly screen each prospective egg donor to include detailed medical, social, and psychological histories. The psychological evaluation includes a personality test and an in-person interview with a psychologist. Only egg donors who pass the medical and psychological evaluation and meet our high standards are placed in the registry and made available to persons looking for an egg donor.
The intended parent(s) may review the online Donor Database or our in-office Donor Registry for more information about the donors. Detailed information about the donors is available to the intended parent(s) to ensure a perfect match. Once a donor is selected and her availability confirmed, the donor cycle is planned.
Throughout the entire selection and treatment process the egg donor’s identity is protected. The intended parents will know only the age of the donor, her identifying donor code, what she looks like (from a picture she provides), and detailed medical and personal information she provides on the in-depth profile. No identifying information is shared between the egg donor and the intended parents.
Screening of the Intended Parents
The intended parents also undergo clinical evaluation (called precycle testing) to maximize a successful outcome.
For the Intended Mother:
- Procedures, such as a SIS (Saline Infusion Sonogram) allow us to evaluate the uterine cavity to ensure there are no fibroids, polyps, or scar tissue that could interfere with an embryo implanting. A “Mock Embryo Transfer” is also performed to carefully measure the length of her uterine cavity, in order to facilitate a smoother embryo transfer in the IVF cycle.
- Blood tests to measure prolactin and thyroid hormone levels are performed. These hormones can affect a woman’s ability to become pregnant and maintain an early pregnancy. Rubella (German measles) and Varicella (Chicken Pox) titers are evaluated to confirm protective immunity during pregnancy.
For the Intended Father:
- A semen analysis using Kruger Criteria is performed at our laboratory to determine if the sperm’s ability to fertilize an egg is compromised or normal.
For both Intended Parents:
- Meet with a psychologist. This 1 hour consultation is a discussion of the issues related to using donated eggs. We can provide a list of psychologists for your convenience.
- Infectious disease testing. Tests include: HIV, hepatitis, syphilis, chlamydia, gonorrhea, CMV (cytomegalovirus), and HTLV I/II.
- Once all the evaluations are complete, the cycle can begin.
STEPS IN AN IVF CYCLE WITH DONOR EGGS
Ovarian Stimulation and Monitoring the Egg Donor
Before the stimulation begins, birth control pills are used to quiet the ovaries. An ultrasound exam and blood (estradiol) test confirms this and the donor begins the fertility medications according to a schedule provided by TFAFC. The medications (Follistim, Gonal-F and/or Menopur) are injected subcutaneously (SubQ) daily to stimulate multiple follicles to grow. A follicle is a fluid filled sac in which an egg can develop.
Another medication (Ganirelix or Cetrotide) is added to help prevent premature ovulation (release) of the eggs. The eggs are microscopic and can’t be seen directly, therefore we track their development by measuring the size and number of follicles and measuring the level of hormone (estradiol) produced by the follicles. Together the measurements for follicle sizes and blood tests indicate when the follicles are likely to contain a fully developed egg. A final medication (hCG and/or Lupron) is taken to cause the final maturation of the eggs prior to retrieval.
Building the Intended Mother’s Uterine Lining
The intended mother also takes birth control pills to synchronize her cycle with the donor’s and to quiet the ovaries. When instructed, medication (Estrace or Estradiol valerate) is started to stimulate the lining of the uterus to thicken. After several days of medication, the uterine lining is measured via an ultrasound to ensure an adequate endometrial thickness is developing. When the donor’s egg retrieval date is known, the intended mother begins progesterone supplementation to ready the lining to accept an embryo (implantation).
Egg Retrieval for the Donor
The egg retrieval is performed using ultrasound to guide a needle into the ovaries to obtain the eggs. All eggs that can be retrieved safely are obtained. An anesthesiologist administers IV sedation to maximize the egg donor’s comfort and safety. As a result, the experience is not painful and recovery is rapid.
The day of the egg retrieval the intended father will provide a fresh semen sample unless prior arrangements are made. Freshly ejaculated sperm must undergo biochemical and structural changes called capacitation before they can fertilize an egg. In an IVF cycle, sperm are capacitated in the laboratory, and the motile sperm are isolated, and then used to fertilize the eggs. If donor sperm is used, the sperm is prepared in the same manner.
In Vitro Fertilization
Follicular fluid removed from the ovaries is examined in our lab and the eggs are isolated and placed in culture media where they continue to mature. A few hours after the egg retrieval- the embryologist using a microscope- captures a sperm and inserts it directly into the egg. This technique of injecting an individual sperm into each mature egg is called Intracytoplasmic Sperm Injection (ICSI). All mature eggs are fertilized in this manner to maximize fertilization. ICSI is especially helpful for men with low sperm counts or low numbers of normally shaped sperm.
The injected eggs are incubated in a carefully controlled environment, and after 16 hours are inspected under the microscope to determine how many have successfully fertilized. The embryos will remain in the incubator as they continue to grow and develop until the moment of transfer.
Regular reports of the development of the embryos (fertilization, cell division, and quality or grading) are provided. The decision when to transfer the embryos is based on the embryo development and grading.
Transferring the Embryo(s) into the Intended Mother
At TFAFC, we plan for an embryo transfer on day 5 or at the blastocyst stage of embryo development. Blastocysts have a higher implantation rate than embryos incubated only 3 days.
Three days after ICSI, the embryologist will evaluate the embryos for their quality and provide a grade. If there are at least 2 grade “A” or good quality embryos, blastocyst transfer is confirmed and the embryos remain in culture to develop further. At day 5 the best looking blastocyst stage embryo or embryos are transferred into the woman’s uterus. If there are not 2 grade “A” embryos, a day 3 embryo transfer is planned. Any viable, good quality embryos not transferred into the woman’s uterus may be cryopreserved for future use if the individual/couple wishes.
With the goal of decreasing the incidence of multiple births (twins or triplets) TFAFC utilizes the American Society of Reproductive Medicine (ASRM) guidelines for the number of embryos to transfer. Using the information about the embryo number and quality, and mindful of the ASRM recommendations, the physician and woman/couple will determine the number of embryos to transfer.
All embryo transfers are performed using ultrasound guidance as it allows for accurate placement of the embryos in the optimal location in the uterus. The embryo is transferred via a thin plastic tube (catheter) which is carefully guided into the upper part of the uterus where the embryo is placed. The transfer is a painless procedure and the intended mother remains resting for 30 minutes, after which she goes home. We recommend she rests at home through the next day before resuming her activities.
After the Embryo Transfer
Hormone supplementation (Estrace and progesterone) is continued to enhance implantation of the embryo and support an early pregnancy. Fifteen days after the egg retrieval a pregnancy test is performed. Ultrasound confirmation of a clinical pregnancy (presence of heart beat) is performed about 3 weeks later. Hormone supplementation continues until the pregnancy can sustain itself at 12 weeks.
Cryopreservation of Eggs and Embryos
Occasionally, an egg donor may produce an excessive number (over 25) of mature eggs. To avoid creating a large number of embryos, TFAFC recommends to ICSI (fertilize) 20 mature eggs to create embryos for the intended parent’s immediate use. The remaining mature eggs will be frozen and stored for the intended parent’s use in the future, if necessary. This option avoids the creation of more embryos than will typically be used by the intended parents. When their family is complete, the intended parent(s) can donate or discard the stored cryopreserved eggs.
An option for individuals/couples with remaining embryos that are not immediately transferred into the uterus is to freeze (or cryopreserve) the embryos. After the embryo transfer, any untransferred embryos are placed in culture until they progress to the blastocyst stage. All good quality blastocyst stage embryos are then frozen. Cryopreserved embryos can be used in the event the woman doesn’t conceive in the “fresh” IVF cycle or for later use to attempt for a sibling. Most patients (approximately 75%) will have 1 or more embryos to cryopreserve. Approximately 80-90% of cryopreserved embryos survive the thawing process.
Anticipated Success Rates with Egg Donation
Pregnancy rates using donor eggs are reflective of the age of the Egg Donor. We anticipate approximately a 60% live birth rate.
Are You A Candidate for Egg Donation?
Egg Donation is recommended if:
- A woman has poor ovarian reserve, defined by an elevated FSH (Follicle Stimulating Hormone) level, and/or low AMH (Anti-Mullerian Hormone) level. Poor ovarian reserve may occur also from premature menopause, prior surgery, radiation or chemotherapy.
- Women over 40 years who want to improve their chances of achieving a healthy pregnancy.
- Poor fertilization of eggs occurred in a prior IVF cycle, despite good sperm quality.
- Unsuccessful IVF cycles despite repeated attempts.
- There is a family history of a genetic disorder that is likely passed through her eggs to affect her child; or a genetic condition (balanced translocation) that causes frequent miscarriages.