DONOR OOCYTE PROGRAM
What is the Donor Oocyte Program?
The Donor Oocyte Program (DOP) was established to help women who are unable to produce their own oocytes (eggs) achieve pregnancy. The process is a form of In Vitro Fertilization (IVF) using oocytes donated from another woman which are fertilized by the recipient's husband's sperm. The embryos produced may be transferred to the uterus of a recipient. In Colorado, oocyte and sperm donation is legal.
How is a donor oocyte cycle done?
Donor oocyte cycles use the same technology we use in standard IVF (test tube baby). The oocyte donor undergoes ovulation induction with fertility enhancing medications. The oocytes are retrieved by ultrasound-guided aspiration and then donated to the recipient couple. These oocytes are inseminated with the recipient's husband's sperm (or donor sperm) in order to produce embryos. Some of the embryos are transferred to the recipient's uterus approximately 2-6 days after oocyte retrieval with the intent of producing a pregnancy. The recipient's cycle is synchronized to that of the donor by using a combination of hormonal supplements. Once pregnant, the recipient is maintained on hormones throughout her first three months of pregnancy.
How do I find an oocyte donor?
There are two types of oocyte donors: anonymous and known. Anonymous oocyte donors are screened by the Donor Oocyte Program. A known donor is someone who you know who is willing to donate oocytes for you. Known donors should be between the ages of 18 and 32, they should have at least a high school education, and preferably a history of having achieved pregnancy. All donors, both anonymous and known, must have a medical history of two generations, pass a physical exam including a pelvic exam, and will be screened for sexually transmitted diseases and substance abuse. We require that all oocyte recipients and their partners see a psychologist or counselor. Anonymous oocyte donors are available through our program or at outside organizations which find oocyte donors for couples.
Is there a fee for an oocyte donor?
Anonymous oocyte donors are reimbursed by the recipient couple for their time and expense. Reimbursement for time and expenses for a known donor is left up to the recipient. To help with expenses for the oocyte donor process sharing an oocyte donor with another couple is an option.
What are the requirements for recipients?
At Advance Reproductive Medicine we follow the guidelines for oocyte donation recommended by the American Society for Reproductive Medicine. Women wishing to use donor oocytes should have one of the following indications:
Oocyte recipients should be age 50 or younger, have a normal uterine cavity, and be in good health to enter the program. No women who have reached their 51st birthday by the time of embryo transfer will be accepted into the Donor Oocyte Program.
- Ovarian failure
- Poor ovarian function, failure to respond appropriately to fertility drugs
- Wish to avoid transmission of a significant genetic defect with which the recipient is known to be a carrier of or a condition of which the recipient has a family history
- Individuals with poor oocyte quality or embryo quality during prior IVF attempts
Have women gotten pregnant using donor oocytes?
Yes. In fact, the pregnancy rates for IVF using donated oocytes are typically higher than routine IVF rates. Age of the recipient is not a determining factor for producing a pregnancy with oocyte donation. Naturally, age is considered a risk factor for common obstetrical conditions such as gestational diabetes and hypertension.
What testing is required?
Required testing will include semen analysis on the partner, preconception screening, psychological counseling, evaluation of the uterine cavity with a sonohysterogram (fluid contrast ultrasound), screening for sexually transmitted diseases including HIV and hormonal evaluation.
In view of the concerns of pregnancy in women of advanced reproductive age, it is recommended that potential recipients over the age of 45 undergo a thorough medical evaluation with their primary care physician. In addition, the recipient must undergo testing which includes a pre-pregnancy panel, blood testing for diabetes, hyperlipidemia, and liver disease, in addition to cardiovascular testing with a stress test within the past six months.
D-IVF can be physically and emotionally draining, however, the stress and anxiety associated with D-IVF can be reduced if you and your partner have a clear understanding of the D-IVF procedure. It is important that you and your partner learn as much as possible about the D-IVF process, which includes the following steps after your pre-Donor oocyte IVF lab testing is completed.
How do I get started with an oocyte donor process?
At the University of Colorado we have available pre-screened oocyte donors. The number of available donors and their physical characteristics vary greatly from month to month. We are continually screening new oocyte donors for your use. Once you have decided to use an oocyte donor you will meet with our physicians and our donor oocyte coordinator. Our oocyte donor coordinator will help you with your donor selection process, so you can make an appropriate selection based on your individual needs. All of our oocyte donors are <33 years of age, have an FSH level <8, and have passed medical and psychological screening before getting placed on our list. After you have selected a donor, the donor will be screened for cystic fibrosis, sexually transmitted diseases, Hepatitis, and HIV if these have not been completely previously. If you find that our donors do not meet your needs, you may use an outside agency to help you recruit an oocyte donor.
How do you stimulate the donor?
Every oocyte donor will receive a cycle plan sheet. This sheet will list the protocol medications and dates of the cycle. If the dates of the cycle are okay with the donor and recipient, the cycle will be scheduled. All medications will be ordered by our nursing staff and paid for by the oocyte recipient. The donor's medications will be mailed to our office so we can give these medications to the donor at the start of her menstrual cycle. The purpose of the medications for the oocyte donor is to stimulate the donor's ovaries to form multiple oocytes. We will monitor this stimulatory process with blood tests and ultrasounds, often the donor will be making 10-12 visits to our office during a cycle for the appropriate testing. At the start of the cycle, the donor will receive a drug known as a gonadotropin-releasing hormone agonist (an example is Lupron) or a gonadotropin-releasing hormone antagonist (examples are Antagon and Cetrotide). These drugs prevent the ovaries fr om releasing oocytes too early during the D-IVF cycle. In addition, the donor will be given one or more medications known as human menopausal gonadotropins (hMG), which can stimulate the ovaries to produce many oocytes (eggs). The gonadotropins are given daily as an injection in the oocyte donor's abdomen, thigh, or upper arm. Some hMG and fertility drugs are Bravelle, Fertinex, Follistim, Gonal-F, Novarel, Ovidrel, Pregnyl, Profasi, and Repronex. The nurse at our fertility office will train the oocyte donor to give these injections. While the donor is taking her medications you will be preparing your uterus to accept embryos. This process is described under the oocyte recipient preparation section.
It is important to remember that not all oocyte donors stimulate well. Approximately 5% of donors are cancelled before retrieval.
Oocyte Donor's Oocyte Retrieval and Fertilization
Oocyte retrieval is a surgical procedure performed in the operating room. During the oocyte retrieval procedure, the doctor places a needle into the oocyte donor's ovaries. The fluid from each follicle, along with the oocyte, is drawn through the needle. The oocyte retrieval procedure usually takes about 20 to 30 minutes, depending on the number of mature follicles the donor has.
The oocytes are placed in a special dish in an incubator for a minimum of three hours prior to insemination (exposing the oocytes to sperm).
On the day of the oocyte retrieval, your male partner will need to produce a sperm specimen for the IVF laboratory to use to fertilize the oocytes that are retrieved from the oocyte donor (or a frozen sample must be available). The man providing the semen should abstain from ejaculation for two to five days before the oocyte retrieval. In the case of male factor infertility, standard insemination techniques may not be successful. If the man's sperm counts are very low or fertilization has failed to occur with a prior IVF attempt, special oocyte insemination techniques may be used to help the sperm fertilize the oocytes. We require that all patients undergoing D-IVF have their male partner freeze a backup sperm sample just in case they are unable to produce a good sample the day of the D-IVF procedure. We prefer to use the sample that is collected fresh on the day of the retrieval, however, if difficulties arise we will use this backup specimen.
How do I prepare? (Preparation of the Oocyte Recipient)
The oocyte recipient will initiate the cycle with suppression of ovarian function. Typically, we use Depot Leuprolide acetate to accomplish this. Based on the date of your last menstrual period and the date of cycle initiation, the physicians will determine what date you will receive this injection. Women who are completely menopausal (FSH >50) or have no ovaries will not need the leuprolide injection. Approximately 4 days before your oocyte donor starts her hMG medication, you will start estrogen in the form of estrogen patches. After 12 days of estrogen, we will check the lining of the uterus by ultrasound. If the lining is a "triple line" pattern and measures greater than 8 mm, the uterus lining is considered optimal for implantation. If the lining has not developed adequately, changes in the medication doses will be made to get the uterus prepared. After this ultrasound is performed, you will stay on your estrogen patches every other day until you are told to start your progesterone capsules or injections. Typically, the progesterone injections start the day before the oocyte retrieval. No female oocyte recipients who have reached their 51st birthday will be accepted into our donor oocyte program.
The day after retrieval the inseminated oocytes are studied for evidence of fertilization. To allow further cell division and growth, oocytes are cultured for another 24 to 48 hours before the resulting embryos are considered ready for transfer. We will discuss the condition of your embryos daily during the process and how many embryos will be transferred into your uterus. In general, we may transfer two to three embryos, depending on the embryo quality. The embryos are transferred to your uterus through the cervix using a special IVF catheter.
Following the embryo transfer procedure, we may recommend that you rest in bed for the remainder of the day. Following this, you should avoid strenuous exercise and not engage in sexual intercourse until the day of your pregnancy test.
A pregnancy test is scheduled for about two weeks after the oocyte collection. The nurse will give you the date of the pregnancy test at your embryo transfer.
Frozen Embryo Transfers/Embryo Cryopreservation
Cryopreservation or freezing offers a way to store embryos for a subsequent D-IVF cycle. Couples who have extra embryos available after a D-IVF procedure need to decide what to do with them. The extra embryos may be frozen (cryopreserved) after fertilization. The embryos can be thawed and transferred into your uterus during a future hormone cycle.
Frozen embryos may be stored for five years. To use frozen embryos, they must be thawed and examined to see if they survived freezing. Typically, 10-20% of the embryos do not survive the freezing and thawing process. Pregnancy rates with frozen embryos have been shown to be similar to nonfrozen embryos of equal quality.
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