Egg Donation with IVF
Egg donation (also called oocyte donation or ovum donation) can be used as an effective treatment for infertility of all causes except for women with infertility caused by problems with the uterus, such as severe intrauterine adhesions.
Success rates with egg donation are high, particularly as compared to pregnancy rates in women with poor egg quality and quantity.
Donor egg IVF is generally used only in women with significantly diminished egg quantity and quality. This includes women with:
- Failed IVF cycles
- Premature ovarian failure (menopause)
- Very poor egg quality
- Poor response to ovarian stimulation
- Significantly elevated day 3 follicle stimulating hormones (FSH) level
- Very low antral follicle counts
- Advanced female age
In an egg donor IVF cycle, the egg donor (after extensive screening) undergoes controlled ovarian stimulation with fertility medications causing the development of multiple eggs, which are retrieved. Because the egg donor is young, this usually results in the development of healthy eggs.
The donor’s eggs are fertilized with the recipient partner’s sperm in a culture dish and the resultant embryos are placed in an incubator. Donor sperm can also be utilized for single women. The embryos are “cultured” in the incubator until they mature, usually 3-5 days and are then transferred into the female intended parent’s uterus.
By the use of hormonal manipulation, the donor’s and recipient cycles are synchronized so that the recipient’s uterus will be ready to receive the embryos once they are ready for transfer.
Gestational surrogacy is when a woman, the surrogate mother, carries and delivers a child that is not genetically related to her. For medical reasons, the wife of the intended parents cannot carry a child but produces healthy eggs. The intended mother takes fertility medication to produce multiple eggs. At the right time, these eggs are retrieved from the intended mother and fertilized with the husband’s sperm in a Petri dish through the process of in-vitro fertilization/Embryo Transfer (IVF/ET). The resulting embryos are then transferred to the surrogate mother. If a pregnancy results the surrogate mother will carry the child(ren) to term for the intended parents.
- It is usually done for a woman who has had her uterus removed but still has ovaries.
- She can provide the egg to make a baby, but has no womb to carry it.
- Using her eggs and in vitro fertilization technology, IVF, she can utilize a surrogate mother to carry the pregnancy (her own genetic child).
- A surrogate is also sometimes used for cases where a young woman has a medical condition that could result in serious health risks to the mother or the baby
- It is also done sometimes in couples with recurrent IVF implantation failure.
Summary of the surrogacy process
- An appropriate surrogate is chosen and thoroughly screened for infectious diseases.
- Consents are signed by all parties. This is an important step in surrogacy cases. All potential issues need to be carefully clarified, put in writing and signed.
- The patient is stimulated for IVF with medications to develop multiple eggs.
- The surrogate is placed on medications that suppress her own menstrual cycle and stimulate development of a receptive uterine lining.
- When the patient’s follicles are mature, an egg retrieval procedure is performed to remove eggs from her ovaries.
- The eggs are fertilized in the laboratory with her partner’s sperm.
- The embryos develop in the laboratory for 3-5 days.
- Then, an embryo transfer procedure is done which places the embryos in the surrogate mother’s uterus where they will hopefully implant.
A hysterosalpingogram, or HSG is an important test of female fertility potential.
During a hysterosalpingogram, a dye (contrast material) is put through a thin tube that is put through the vagina and into the uterus. Because the uterus and the fallopian tubes are hooked together, the dye will flow into the fallopian tubes. Pictures are taken using a steady beam of X-ray (fluoroscopy) as the dye passes through the uterus and fallopian tubes. The pictures can show problems such as an injury or abnormal structure of the uterus or fallopian tubes, or a blockage that would prevent an egg moving through a fallopian tube to the uterus. A blockage also could prevent sperm from moving into a fallopian tube and joining (fertilizing) an egg. A hysterosalpingogram also may find problems on the inside of the uterus that prevent a fertilized egg from attaching (implanting) to the uterine wall.
Other things that can be seen on a hysterosalpingogram include:
- The uterine cavity is evaluated for the presence of congenital uterine anomalies, polyps, fibroid tumors or uterine scar tissue
- The fallopian tubes are also examined for defects within them, for suggestion of partial blockage, and for evidence of pelvic scar tissue in the abdominal cavity near the tube
Hysteroscopy is a medical procedure that involves insertion of a narrow telescope-like instrument through the vagina and cervix into the cavity of the uterus (endometrial cavity). The uterine cavity is then distended with fluid and visualized.
This procedure allows the physician to see if there are any uterine cavity defects such as fibroid, endometrial polyps, intrauterine scar tissue, or other uterine problems that can cause infertility problems.
In Vitro Fertilization
In Vitro Fertilization is commonly referred to as IVF and is the process of fertilization by manually combining eggs and sperm in a laboratory dish. When the IVF procedure is successful, the process is combined with a procedure known as embryo transfer, which is used to physically place the embryo in the uterus.
There are basically five steps in the IVF and embryo transfer process which include the following:
- Monitor and stimulate the development of healthy egg(s) in the ovaries. Fertility medications are prescribed to control the timing of the egg ripening and to increase the chance of collecting multiple eggs during one of the female partner’s cycles. Multiple eggs are desired because some eggs will not develop or fertilize after retrieval. Egg development is monitored using ultrasound to examine the ovaries and urine or blood test samples to check hormone levels.
- Collect the eggs.
The eggs are retrieved through a minor surgical procedure which uses ultrasound imaging to guide a hollow needle through the pelvic cavity. Sedation and local anesthesia are provided to remove any discomfort that you might experience. The eggs are removed from the ovaries using the hollow needle, which is called follicular aspiration.
- Sperm, usually obtained by ejaculation is prepared for combining with the eggs.
- In a process called insemination, the sperm and eggs are placed in incubators located in the laboratory which enables fertilization to occur. In some cases where fertilization is suspected to be low, intracytoplasmic sperm injection (ICSI) may be used. Through this procedure, a single sperm is injected directly into the egg in an attempt to achieve fertilization. The eggs are monitored to confirm that fertilization and cell division are taking place. Once this occurs, the fertilized eggs are considered embryos.
- The embryos are usually transferred into the woman’s uterus between three to five days after the egg retrieval. The transfer process involves a speculum which is inserted into the vagina to expose the cervix. A predetermined number of embryos are suspended in fluid and gently placed through a catheter into the womb.
Intracytoplasmic Sperm Injection
Intracytoplasmic sperm injection (ICSI) is a technique developed to help achieve fertilization for couples with severe male factor infertility or couples who have had failure to fertilize in a previous in vitro fertilization attempt. The procedure overcomes many of the barriers to fertilization and allows couples with little hope of achieving successful pregnancy to obtain fertilized embryos. ICSI is performed in conjunction with an In Vitro Fertilization cycle.
The technique involves very precise maneuvers to pick up a single live sperm and inject it directly into the center of a human egg. The procedure requires that the female partner undergo an in vitro fertilization cycle. These eggs produced in the IVF cycle are then aspirated through the vagina, using vaginal ultrasound, and incubated under precise conditions in the embryology laboratory. The semen sample is prepared by centrifuging (spinning the sperm cells through a special medium). This solution separates live sperm from debris and most of the dead sperm. The embryologist picks up the single live sperm in a glass needle and injects it directly into the egg.
The IUI(Intrauterine Insemination) procedure is an in-office procedure used to help people who have been unable to conceive on their own become pregnant. IUI procedures are one of the more cost effective fertility treatments available.
Studies have shown that IUI’s can be a useful treatment for some patients who have unexplained case of infertility. IUI also treats couples with some male factor infertility conditions, as well as women with cervical mucous problems and is often done in conjunction with ovulation-stimulating drugs.
During the IUI, sperm is carefully placed in the woman’s uterus, bypassing the cervix and allowing more sperm to reach the egg. The process involves the use of a very thin flexible catheter that facilitates passage of sperm. The procedure takes just a few minutes, and patients are able to return to regular activities immediately after the procedure. IUI may be recommended to increase the probability of pregnancy if a patient has unexplained infertility, male factor infertility (low sperm).
What is laparoscopy? A Laparoscopy may be suggested by your physician to help diagnose causes for infertility. A Laparoscopy is a surgical procedure that involves insertion of a thin telescope-like viewing instrument through a small incision in the belly button. This allows visualization of the abdominal and pelvic organs including the area of the uterus, fallopian tubes and ovaries.
This procedure helps to determine whether there are any defects such as scar tissue, endometriosis, fibroid tumors and other abnormalities of the uterus, fallopian tubes and ovaries.
Ovulation induction (OI) is a safe and effective means of helping infertile women who do not ovulate or who ovulate irregularly. OI involves stimulating the ovary to produce one or more eggs and may be accomplished using a number of different medications that may be helpful in a variety of treatments. Additionally, it may be used to induce the development and release of multiple eggs in ovulatory women undergoing other infertility treatments.
Preimplantation Genetic Diagnosis (PGD)
Preimplantation Genetic Diagnosis (PGD) is a procedure used in conjunction with in vitro fertilization (IVF) to select embryos free of chromosomal abnormalities and specific genetic disorders for transfer to the uterus. These genetic conditions can interfere with embryo implantation, result in pregnancy loss, or in the birth of a child with physical problems, developmental delay or mental retardation.
PGD can significantly reduce the chances a baby to be affected with a specific genetic condition or chromosomal abnormality. We are able to test for many different diseases, including aneuploidy, single gene disorders and chromosome translocations.
Many couples request PGD for aneuploidy such as Down syndrome, trisomy 18, trisomy 13 and Turner syndrome. These disorders do not typically run in families. However, up to 60% of early miscarriages are due to aneuploidy, and the risk for aneuploidy increases with a woman’s age. The purpose of PGD for aneuploidy is to increase a couple’s chance for pregnancy, reduce their risk for miscarriage, and improve their overall chance of bringing home a healthy baby after in vitro fertilization.
Other couples request PGD for a specific genetic condition that may run in their family, such as Tay Sachs disease, cystic fibrosis, muscular dystrophy, Fragile X syndrome or spinal muscular atrophy.
A saline sonohysterogram is a fertility diagnostic study performed to evaluate the uterus and uterine cavity. This test is to determine that the uterine cavity is free of anything that would inhibit the implantation of an embryo.
The test is performed by injecting a small amount of saline into the uterus through a small flexible catheter. Because the saline fills up the uterus, the upper and lower walls of the uterus separate, making it easier to detect uterine abnormalities.
Uterine fibroids are tumors or lumps made of muscle cells and other tissue that grow within the wall of the uterus. Fibroids may grow as a single tumor or in clusters. A single fibroid can be less than 1 inch in size or can grow to 8 inches across or more. A bunch or cluster of fibroids also can vary in size. Most of the time fibroids grow in women of childbearing age. It is estimated that as many as 77 percent of women of childbearing age could have the condition without knowing it.
Doctors put fibroids into three groups based on where they grow, such as just underneath the lining of the uterus, in between the muscles of the uterus, or on the outside of the uterus. Most fibroids grow within the wall of the uterus. Some fibroids grow on stalks (called peduncles) that grow out from the surface of the uterus, or into the cavity of the uterus.
Many women don’t feel any symptoms with uterine fibroids. But fibroids can cause the following:
- heavy or painful periods
- bleeding between periods
- feeling “full” in the lower abdomen – sometimes called “pelvic pressure”
- urinating often (from a fibroid pressing on the bladder)
- pain during sex
- lower back pain
- reproductive problems, such as infertility, multiple miscarriages and early onset of labor during pregnancy
Usually, fibroids are found by abdominal or pelvic examination or pelvic ultrasound. Sometimes the only way to confirm the diagnosis is through surgery (i.e. laparoscopy, hysteroscopy)