Why do some couples need egg donation?
There are a variety of reasons why some women may not be able to produce their own eggs or produce enough good quality eggs during IVF (in vitro fertilisation).
The most common reasons are: –
- Women who were born without ovaries or with under-developed ovaries
- Women whose ovaries stopped working prematurely
- Women whose ovaries have stopped working due to radiotherapy, chemotherapy or after surgery
- Women undergoing infertility treatment but whose ovaries consistently produce poor quality eggs when stimulated
- Women undergoing infertility treatment but whose ovaries do not respond to traditional fertility drugs
- Some women may not wish to use their own eggs as they may be carriers of genetic a disease such as haemophilia. (NB Preimplantation Genetic Diagnosis is an option for some patients with a genetic disease as an alternative to egg donation, please contact the unit for more information).
Who can become an egg donor?
Women who are considering becoming egg donors should be in a stable relationship, have already had children and have preferably completed their own family. Egg donors should ideally be less than 36 years old.
Egg donation may be on an anonymous basis where the egg donor and recipient will not know each other, however at this unit we are offering egg donation on a known’ donor basis. Donors may be a friend or relative of the woman who needs egg donation.
All egg donors will go through a series of screening procedures, this will include a detailed medical and family history. Blood tests will also be performed including AMH (which is a measure of how the ovaries may respond) and to screen for infectious diseases. These include Hepatitis, HIV, Syphilis, Gonorrhoea and Chlamydia screening. A blood test will also be carried out to check if the donor is immune to a virus called cytomegalovirus (CMV). This virus produces a mild flu like illness in adults but if caught when pregnant it can cause abnormalities in the developing baby. If the donor has previously been infected with CMV they should only be matched with recipients who are immune to CMV.
Donors are also tested for genetic disorders such as cystic fibrosis and karyotype.
Patients from different population groups may need to be screened for other genetic conditions such as Tay-Sach’s diseases, Sickle Cell Anaemia and Thalassaemia.
As the recipient please be aware that the tests are limited. This will be discussed with you at your consultation.
Blood tests will be carried out on the recipient to check CMV status and Rubella immunity.
Donor Anonymity
The law changed in April 2005 to require that egg and sperm donors must be identifiable. This means that any children born as a result of donation will be able to access the information about the identity of their donor at the age of 18. This new regulation will not apply retrospectively to anonymous donors from before April 2005.
The law was changed as it was felt that children born from donations should have access to information about their genetic origins.
The change in the law may dissuade some donors from coming forwards to offer their eggs and sperm.
How does egg donation work?
The egg donor will undergo a cycle of treatment that is very similar to IVF. In an egg donation cycle the donor is given a course of drugs to stimulate the ovaries into producing eggs. The eggs are then taken out of the body and fertilised in the laboratory with the sperm from your partner. Normally two fertilised eggs (which are called embryos) are then replaced in your uterus (womb).
There are three primary aims:
- To achieve two or more embryos from eggs collected from the donor
- To achieve (by hormone treatment) good development of your uterine lining (endometrium) to receive the embryos, and subsequently favourable hormone levels to support the first few weeks of pregnancy
- To synchronise the donor and recipient cycles
What Are The Procedures, Drugs And Side Effects?
The treatment involves the synchronisation of the donor’s menstrual cycle with your own. If you have periods your cycle will be suppressed by using drugs:
- Nafarelin (Synarel)
- This is a nasal spray. The usual dose is two sniffs in the morning and two sniffs in the evening
- Buserelin (Suprafact)
- This is a daily injection, which we can teach you how to give yourself
These drugs stop your ovaries from producing hormones for the duration of the treatment this is called downregulation. They are started either on day one or day 21 of your cycle. It may be necessary for you to take the downregulation drugs for a more prolonged period of time to fit in with the donor’s cycle and allow synchronisation.
Risks & Side Effects Of Downregulation
Because the downregulation drugs switch off your hormones, you may experience a number of menopausal-like symptoms, such as hot flushes, irritability, and headaches.
By using downregulation, we can co-ordinate your treatment cycle with that of the donor. To confirm that your hormones have been switched off and that you are adequately downregulated we will need to do a scan. All scans done during your treatment cycle will be performed by an internal scan. This involves inserting a thin ultrasound probe a short way into the vagina. This allows us to see the uterus and the ovaries much easier than with the normal tummy scan. If your hormones have been switched off the lining of your uterus should be thin, and your ovaries should be inactive.
We will also scan your donor at the same time and, if both of you are downregulated, we will be able to proceed with the next stage of treatment.(If you have gone through an early menopause and no longer have periods, you will not need to undergo downregulation and may proceed straight to the womb preparation stage, however in order to co-ordinate with the donor cycle we may ask you to discontinue your usual HRT for a short while).
In order to prepare the lining of the womb you will need to take tablets containing a hormone called oestrogen (given in the form of Progynova tablets). This will cause thickening of the lining of the womb. You will need to continue to take these tablets for about 2 weeks. We will then check a scan to measure the thickness of the womb lining. Depending on the thickness we may ask you to adjust the dose of the oestrogen tablets.
We will also be scanning the donor at this time. When we know how the donor is responding we will be able to work out when the egg collection and the embryo transfer will be. On the evening of egg collection (three to five days before embryo transfer) we will ask you to start a different hormone called progesterone. This is given in the form of a vaginal pessary or injection. You will need to continue this combination of oestrogen and progesterone for at least two weeks after the embryo transfer and if you become pregnant you will need to continue the medication until 12 weeks of pregnancy
Egg Collection And Fertilisation
Your partner will be asked to produce a sperm sample on the day of the donor’s egg collection, this normally needs to be produced in the unit.
The prepared sperm sample is added to the eggs roughly five hours after egg collection. The sperm is prepared in such a way so as to inseminate the eggs with only the most active sperm. The dishes are then returned to the incubator and hopefully fertilisation will occur three to four hours later.
Fertilisation can depend on a number of factors such as egg maturity and sperm function. Very occasionally the eggs can fail to fertilise. The eggs are checked the following morning by our embryologist, and you will be telephoned that morning to inform you of the result. The fertilised eggs are then left in the incubator overnight and should hopefully start to develop. A fertilised egg is one cell but should begin to divide to become an embryo.
Embryo Transfer
The embryo transfer may take place three days or five days after the egg collection. The number and quality of your embryos will be discussed with you and together we will decide how many embryos to replace in the womb. The risk of a multiple pregnancy depends on the number of embryos transferred and this will be discussed in full of you.
The embryo transfer procedure is similar to a smear. A fine catheter with the embryos in is passed through the cervix and the embryos are replaced in the womb.
We suggest that you take things easy after the embryo transfer and avoid strenuous activities for at least one week. Following the embryo transfer you will need to take progesterone in the form of pessaries or injection and the progesterone tablets (oestrogen) for a fortnight, which keep the womb lining healthy and receptive for an early pregnancy.
You will need to attend the unit 14 days after the embryo transfer if you have had a day three transfer, or 12 days if you have had a day five transfer for a pregnancy test. If pregnancy fails to occur you would stop your hormone treatment and menstruation occurs two to three days later. An appointment will also be arranged to discuss your treatment and advice on future treatment as appropriate.
Success rates for IVF and ICSI can be found on our results sheet.
Embryo Freezing
It is not unusual to have spare embryos at the end of treatment. If the embryos are of good quality we may be able to freeze them for you to use in the future.
If you are having NHS treatment this will be funded and we will discuss this on an individual basis. If not there is a cost implication.
Embryos can be frozen for ten years. If you have the opportunity to store your spare embryos we will counsel you fully on the risks and benefits of this procedure.
It is important to be aware that there is a remote possibility of loss of stored material during the process of freezing, storing, and thawing.
The decision to allow embryo freezing is made by the donors of the sperm and the eggs. In egg donation the donor has to give consent that embryos resulting from fertilisation of her eggs may be frozen. In practice this consent is given prior to the egg collection. It is also important to realize that the donor can withdraw her consent to use her embryos at any time until they have been replaced.
Problems With Egg Donation / IVF
Unsuccessful Treatment:
IVF with donor eggs may not work for a number of reasons:
- Failure to respond to the fertility drugs
- Technical difficulty in collecting the eggs (very rare)
- Failure of the eggs to fertilise
- The embryos do not develop normally
- Failure of the embryos to implant in the womb following transfer – this is the commonest reason that treatment fails
In many ways egg donation treatment can be thought of as a series of hurdles. Every patient is different with a unique response. Unfortunately, there will always be unsuccessful treatments, and this is obviously very distressing and can be difficult to cope with. Our staff are always available to discuss any concerns you may have so please do not hesitate to contact us.
Counselling is available at any stage of the treatment and is free of charge (up to six sessions) We have an independent counsellor who you may wish to talk to – all details about counselling can be found in the unit booklet and separate counselling sheet.
A Multiple Pregnancy:
The risk of multiple pregnancies depends on various factors. It is more common in younger women and if the embryos are of good quality. Previous IVF history may assist us in deciding how many embryos to replace and the HFEA limits the number of embryos replaced to a maximum of two in women under 40 years. If we have a day five blastocyst embryo to replace we will normally replace one embryo only.
The complications of pregnancy increase with multiple pregnancies. There is an increased risk of miscarriage and complications including raised blood pressure.
There is a higher incidence of premature birth. Babies born prematurely may have low birth weight and are at increased risk of still birth and perinatal mortality and if they do live they may have serious disabilities, such as cerebral palsy and learning problems.
Multiple pregnancy can create the need for extended hospital stay both before and after birth.
Multiple pregnancy and birth can also have a potential strain not only physically but also emotionally, practically, and financially on a couple and any existing children.
This decision will be discussed with you at various stages of treatment by the clinicians and embryologists.
Miscarriage:
Once pregnancy occurs, it continues in the natural way. It is subject to the usual risks, but they are unrelated to the original treatment. The risk of miscarriage appears to be no higher than usual, after allowing for the pregnancies that fail at a much earlier stage than would usually be recognised.
Ectopic Pregnancy:
Up to 2% of IVF pregnancies implant in the fallopian tubes. This is called an ectopic pregnancy and if left untreated can become life threatening. If you become pregnant following your treatment we will perform an ultrasound scan to confirm that the pregnancy is in the right place.
What is The Legal Situation?
The person donating the eggs will not be the legal parent of any resulting offspring. The Human Fertilisation and Embryology Act passed by Parliament (1990) defines the mother as the woman who carries or gives birth to a child and her husband or partner as the father or legal parent. At the time of the donation the donor relinquishes all legal rights and claims over any offspring that may result from the donated eggs and all duties towards the child or children.
If a child born from donation is disabled in anyway the donor will not be held responsible, however, it is their responsibility to inform us of any genetic or inheritable diseases which present themselves in their immediate family (section 35, 1990 HFEA). The Congenital Disabilities (Civil Liability) Act 1976 enables a child to bring a civil claim for damages against another person whose wrongful act caused that disability. The legislation does not impose criminal liability.
Will I Be Given Counselling?
The guidelines issued by the HFEA states thatskilled and independent counselling by someone other than the medical practitioner involved in the procedure must be available to the donor.
The independent counsellor attached to the unit will conduct the sessions.
We require that implications’ counselling be provided for a minimum of four sessions, these sessions are compulsory:
- Recipient couple together
- Donor alone
- Donor with partner (if applicable)
- All parties concerned
At this unit we offer free independent counselling. You should ensure that you are given and have understood sufficient information to make an informed decision. The counselling sessions take place via video link at a time arranged between yourself and the counsellor.
What is the cost of egg donation?
Egg donation will usually be performed on a private basis, however under exceptional circumstances it may be available within the NHS. This will be discussed with you in more detail at your consultation. Please contact the unit for a more detailed breakdown of costs.
Contact Us
If you are in doubt about any part of the procedure, before, during or after your donation and the ethical aspects involved, please feel free to ask questions or call us on:
Telephone: 0191 445 2768 (Direct Line)
Email: [email protected]
Please read our unit booklet for information on the following.
- Legal Parenthood
- The HFEA
- Witnessing laboratory procedures
- Welfare of the Child
- Pregnancy and Success
- General advice prior to conception
- Ethics Committee
- Counselling
- Complaint and Contacts