Using Egg Donation with IVF

With the recent trend to postpone childbearing until their mid to upper 30s, many women find it difficult to conceive using their own eggs. They are experiencing the natural tendency of the ovaries to have fewer and poorer quality eggs with advancing maternal age, resulting in an increased risk of developing genetically abnormal embryos. With limited successful treatment options, many women are resorting to donor eggs, which involves in vitro fertilization (IVF).

Donor eggs can actually benefit a broader group of individuals beyond those affected by advancing maternal age. These groups include the following:

  1. Carriers of a genetic disorder that could be passed on to a baby or result in a failed pregnancy.
  2. Previous history of failed IVF.
  3. Premature ovarian insufficiency (formerly known as premature ovarian failure).
  4. Individuals at any age with diminished ovarian reserve testing results.
  5. Gay men who require donor eggs and a gestational surrogate.

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Treatment options for donor egg recipients: fresh vs. frozen donor eggs

Fresh egg donation with IVF

More popular in the past, in this scenario, a couple would commission or hire an egg donor either from a donor agency or directly from an IVF clinic. The egg donor is then treated with daily fertility injections resulting in growth of multiple eggs. The eggs are then harvested transvaginally under intravenous sedation in an outpatient procedure that takes approximately 20-30 minutes.

Most fresh egg donation cycles initially required the IVF center to synchronize the menstrual cycles of the donor and recipient to allow for an embryo transfer when the uterine lining was most receptive to implantation. Alternatively, embryos derived from fresh donor eggs could be frozen for subsequent embryo transfer. A planned frozen embryo transfer involves thawing the embryo at a time convenient for the couple, thus avoiding the time-consuming task of synchronizing menstrual cycles for the donor and recipient.

Frozen egg donation with IVF

Because of the convenience of the frozen transfer, many infertile couples are purchasing frozen donor eggs from registered egg bank centers. These egg banks store frozen eggs from young egg donors who have completed the egg retrieval process as noted above.

Using frozen donor eggs simplifies the entire treatment scenario since the infertile couple avoids the often lengthy process of choosing an egg donor and then waiting for her to complete the egg harvest procedure. Additionally, there is no need for the recipient and donor to synchronize their menstrual cycles when using frozen donor eggs.

Recent advances in freezing gametes (eggs) and embryos have dramatically improved survival rates and overall pregnancy rates. The rapid freeze process, known as vitrification, enables the specimen(s) to quickly enter a “glass-like” state, thus avoiding the formation of ice crystals that can damage the egg, enabling greatly improved survival rates.

 What the research says

Research from the University of Colorado and Duke University concludes that using fresh donor eggs during in vitro fertilization (IVF) provides a higher chance of implantation when compared with using donor eggs that have been cryopreserved (frozen).

Choosing an egg donor

Selecting an egg donor can be a daunting process, but there are many reputable donor egg agencies, locally and nationally, that actively recruit egg donors. While CU Advanced Reproductive Medicine is not a donor egg agency, we work only with high quality agencies to secure the best possible egg donors for our patients. Additionally, some individuals choose to have a friend or family member be the egg donor.

The egg banks will recruit donors and screen them in advance, allowing infertile couples to select “ready to go” donors. The screening process consists of a detailed history and physical, psychological testing, assessment of the potential donor’s egg reserve, genetic testing, and screening for infectious diseases.

Egg donation process

How are donor eggs obtained?

This process is identical, whether a couple uses a fresh egg donor or purchases frozen eggs from an agency. The egg donor, once carefully screened, receives daily fertility medications by injection, stimulating the growth of multiple eggs. This process requires frequent monitoring, consisting of transvaginal ultrasounds and lab work, enabling the safe retrieval of many eggs. Egg donors may receive up to 2 or 3 injections per day during active stimulation, which typically occurs over 10-12 days.

When egg growth is complete, the donor receives a final series of injections to mature the eggs, which is followed by the transvaginal egg retrieval 35-36 hours later. This is a minor surgical procedure during which a hollow needle, guided by ultrasound imaging, is inserted into the ovary to collect the eggs.

This timing is critical, as any significant deviation may result in ovulation (release of the eggs) prior to the planned egg retrieval procedure. As previously noted, egg retrieval is always performed using IV sedation by the anesthesia department. The egg donor rests in the recovery room until she is ready for discharge, approximately 1-2 hours after the egg retrieval.

The role of the male partner in egg donation with IVF

Donor eggs (fresh or frozen) must be combined with sperm to create embryos. Fresh donor eggs are inseminated on the day of retrieval, whereas frozen donor eggs must be thawed prior to insemination. The male partner would typically produce a semen specimen on the day of egg retrieval (fresh egg donation) or on the day that the frozen eggs are thawed (frozen donor eggs).

He should abstain from ejaculation for 3-5 days prior to the collection date in order to increase sperm count, thereby increasing the chances of fertilization. The actual insemination method(s) are described in the following section.

The magic that happens in the embryology lab

With fresh donor eggs, insemination involves placing the eggs in a petri dish with sperm. Frozen donor eggs must be thawed before insemination. But since vitrification (freezing) alters the egg’s protective covering (known as the zona pellucida), the traditional insemination method does not always result in fertilization of the egg. Fertilization, in this scenario, is best accomplished by injecting a single sperm into each egg in a process known as intracytoplasmic sperm injection (ICSI). The targeted introduction of sperm into the cystoplasma section of the egg where fertilization occurs results in an embryo in approximately 70 percent of cases.

Once fertilization is documented, the embryos are kept in “climate-controlled” incubators for the next few days until they develop to the stage (blastocyst) appropriate for embryo transfer into a host uterus. Not uncommonly, less than half of those initial embryos fully develop into a blastocyst.

Transferring donor eggs to the uterus

Embryos derived from frozen donor eggs

As the process from thawing and insemination transitions into embryo development in the lab, the recipient’s uterus will be readied to accept the embryo. The transfer must occur when the lining of the uterus (endometrium) is primed and matches the uterine lining typically found within the normal “window of implantation.” This occurs approximately one week after ovulation in a natural conception cycle. Synchronization is vital so a blastocyst stage embryo capable of implanting arrives in a fully prepared and receptive uterus.

Women with normal ovulatory menstrual cycles have the option of receiving the embryo during this natural window of implantation, which is called a natural cycle embryo transfer. Or their uterine lining can be artificially developed by taking hormonal therapy, called an artificial cycle.

When using frozen donor eggs, the preparation of the uterine lining is matched against the development of the embryo that arose from use of donor eggs. The donor egg derived embryo can be placed into a receptive uterus during the natural menstrual cycle of the recipient or into a uterus that is hormonally regulated and prepared.

An artificial cycle requires less ultrasound monitoring but is more regulated and often takes longer than the natural cycle regimen. The patient will typically receive about 2 weeks of estrogen hormones (administered via transdermal route, intramuscular injections or orally) to build up the uterine lining.

Many physicians will actually suppress any ovarian activity during this process by administering a daily injection of Lupron (leuprolide acetate). Lupron is used to prevent development of any growing ovarian follicles, which could derail the entire process if the uterine lining is prematurely exposed to progesterone through the ovulation process.

The Lupron would typically be administered prior to starting any estrogen and continue until the uterine lining is ready for the final hormone known as progesterone. The progesterone is started when the ultrasound and lab monitoring demonstrate a uterine lining that has achieved the desired thickness and growth pattern. The embryo transfer occurs on the sixth day of progesterone administration.

Embryos derived from fresh donor eggs

This scenario occurs much less frequently since the advent of frozen donor egg banking. Much like an artificial frozen egg donor cycle, the recipient will take Lupron to suppress ovarian activity, unless she is already menopausal. She will also take estrogen well in advance of the egg retrieval to allow for complete development of the uterine lining.

It is essential that the recipient’s uterine lining be receptive for an embryo when the eggs are retrieved. Failure to achieve a receptive uterus would mandate that all embryos be frozen for a subsequent frozen embryo transfer. The recipient will start a regime of progesterone supplements in conjunction with the egg retrieval to allow for proper development of the uterine lining. The progesterone can be initiated on the day of egg retrieval or one day prior, depending on the particular IVF center.

What happens after the embryo transfer?

The donor egg recipient will continue the hormonal regimen of estrogen and progesterone until at least a pregnancy test is obtained, about 9 or 10 days after the embryo transfer. The hormones may be discontinued if the pregnancy test is negative. If pregnant, the patient should continue this hormonal regimen until about 10-11 weeks gestation. The placenta typically produces enough progesterone to maintain an on-going pregnancy after 8 weeks gestation. We allow for a slight overlap of hormone administration resulting in continued hormone use, as noted above, to 10 or 11 weeks of pregnancy.