EGG AND EMBRYO DONATION IN IRAN: ALL YOU NEED TO KNOW
Egg and embryo donation is among “third-party reproduction” approaches in which the pregnancy involves someone other than the intended parents. The donors may be known to parents in some cases or remained anonymous to them. Disclosed donors are usually one of the parents’ relatives or Acquaintances.
Egg donation is a treatment option for women who can’t get pregnant with their eggs. In these cases, another woman donates her eggs to the intended parents to help them get pregnant through IVF. This method allows the intended mother to get pregnant with the sperm of her own husband.
The basic steps of egg donation can be include:
• Choosing the proper egg donor.
• Ovulation induction through medication by the donor to stimulate the ovaries
• Retrieval eggs
• Collection of sperms from the partner
• Fertilizing the eggs in the laboratory
• Choosing the embryo
• Transferring to the recipient’s uterus
Sometimes the couples, who have undergone IVF and have extra frozen embryos, donate them to the infertile couples. In this situation, embryo donation occurs.
In either case, the intended parents should consult with an infertility counselor and consider the emotional pressures of receiving another person's egg or embryo (biological mothers may not be able to form a connection with a child without a genetic link).
What may cause egg or embryo donation?
Your doctor may suggest egg and embryo donation to you in these cases:
• Low egg count
• Low egg quality
• Improper response to ovulation stimulatory drugs
• Not functioning ovaries due to cancer
• Cessation of ovulation before 40 (primary ovarian insufficiency)
• Natural or induced menopause
• Severe endometriosis spreading to the ovaries
• Age over 40
• Lack of success in other infertility treatment methods
• Probability of congenital disease
• Transgender parents who don’t have eggs
Untreatable infertility in both parents is the cause of using embryo donation.
What are preparations for egg and embryo donation?
Shortly before starting the process (within 30 days before egg donation), the donor and recipients will be tested for possible sexually transmitted diseases, hepatitis B and C, HIV and human transmissible spongiform encephalopathy to remove the chance of passing the diseases to recipient or offspring.
In addition to common tests, the donor’s blood type and RH factor are determined to see if it’s a match to the recipient. Besides, genetic tests are done to be confirmed of being healthy with regard to congenital diseases.
The doctor thoroughly evaluates the donor’s medical, psychological and family history. In psychological screening, the doctor assesses the motivation of the donor and her ability to follow through the process. The psychologist makes sure that the donor is aware of the many ethical and psychological challenges she may encounter. Preferably, the donors should be between 21 and 34 years old. This age is required to assure that the donor fully understands the process and provides truly informed consent. The maximum age is because younger women respond favorably to ovulation-inducing medications and produce more eggs and better embryos, which increases the chances of a successful pregnancy. The recipient should be aware that the chances of having a chromosomally abnormal baby increases if the donor is over 35.
For the recipient, the evaluations are similar to the tests for IVF candidates. Accordingly, the recipient and her partner’s medical and psychological history will be assessed comprehensively. The female blood type and Rh factor are determined then her uterine cavity will be examined with hysteroscopy.
If the intended mother is over 45 years, her cardiac function and the probability of developing pregnancy hypertension and gestational diabetes should be evaluated.
Sperm recipient assessment
The male partner evaluation consists of semen analysis, blood type and Rh factor determination and genetic-carrier screening for inheritable diseases.
What are the possible risks of egg or embryo donation?
The egg donation process may carry some possible risks for the donor and recipient.
Infection: during the egg retrieval process, the normal vaginal bacteria may be transferred into the uterine cavity by the aspiration needle. The bacteria may induce infection of intra-abdominal organs especially the uterus, ovaries and fallopian tubes. The estimated risk of infection is less than 5% which can be cured by taking oral or intravenous antibiotics. Severe cases of infections may need surgery to remove infected tissues. Infections may negatively affect fertility and future pregnancies accordingly.
Bleeding: to get the eggs, the surgeon passes the needle through the vaginal wall and inserts it into the ovary. The needle damages blood vessels in its way and causes minor bleeding. In addition to the vessels of the vagina and ovaries, nearby vessels may be damaged and cause major bleedings. The risk of major bleedings is less than 0.1% which are repaired through surgery.
Trauma: Egg retrieval is done with ultrasound guidance. However, despite using the visual aid, there is a small risk of damaging intra-abdominal organs during procedure. The previous literature has reported damage to bladder, bowel, appendix, uterus, and ovary. The damage may lead to another surgery to repair or remove the affected organs.
Fertility drugs: Ovarian Hyper stimulation Syndrome (OHSS) OHSS happens when the woman responds vigorously to ovulation stimulating medications. The symptoms include gaining weight and swelling in the abdomen area, nausea and vomiting, an increase of ovary size and hematocrit, difficult breathing, kidney, and liver dysfunction. Sever cases leading to kidney failure and blood clots are rare. OHSS may happen at two stages: First in one to five days following egg retrieval as an hCG trigger, and 2nd ten to fifteen days after retrieval because of the hCG if pregnancy occurs
Emotional distress: egg donation and reception could be an emotionally draining experience.
Torsion: enlarged ovaries may twist during exercise and agitating activities and result in sudden onset of severe pain in the abdomen.
Cancer: Many couples are worried that using fertility drugs could increase the risk of breast, ovarian and uterine cancers. These cancers are more common in infertile women. One may associate the incidence of these cancers to using fertility drugs whereas there is no evidence corroborating these claims in epidemiological studies on women taking fertility drugs. More studies are required to assess the long-term effects of fertility drugs on egg donors.
The risks of embryo donation are rare including damaging or destroying the embryos during transfer.
What to expect from an egg or embryo donation procedure?
The first stage of egg donation is similar to IVF. However, instead of the intended mother, it is the donor that should use ovarian stimulatory drugs. The development of eggs is monitored using ultrasound and blood tests for checking hormone concentrations. When the follicles reach the favorable size, the woman is injected with hormones to induce an egg to mature in time for retrieval. 34 to 36 hours after the injection of ovulation-inducing medications, the eggs are retrieved before they are released. In the oocyte retrieval procedure, the surgeon uses a transvaginal ultrasound to see the follicles within the ovaries. Then long aspiration needle is guided to the location and the contents are aspirated. The aspirated content includes follicular fluid, eggs, and granulosa cells. In rare cases that ovaries aren't accessible using a transvaginal ultrasound probe, the doctor performs laparoscopy or trans-abdominal retrieval. In the next step, the mature eggs are separated and fertilized with the sperms.
For fresh eggs and embryos, the donor’s and recipient’s cycles are synchronized so the recipient’s uterus lining is ready to accept the embryo. After 3 to 5 days the embryos are transferred into the uterus using a small catheter through the cervix. The extra embryos will be frozen for future attempts.
The different stages that the donor and recipient go through at the same time points are outlined in the table below:
1.Counseling, testing, and evaluations, giving informed consent
1.Counseling, testing, and evaluations, giving informed consent
2.Taking GnRH-a to regulate the menstrual cycle by nasal spray or injection
2.Injection of ovarian stimulation medication and GnRH agonist or GnRH antagonist to prevent unfavorable spontaneous ovulation
3.Taking Estradiol orally, by injection or transdermal patch
3.Ultrasound to assess the follicles and blood monitoring for hormone levels
4.Ultrasound to assess the follicles and blood monitoring for hormone levels
4.Injection to trigger the Ovulation
5.Taking progesterone through intramuscular injection, using vaginal gel, or taking a tablet
6.2nd Counseling, testing and evaluations, giving informed consent
6.2nd Counseling, testing, informed consent
7.Injecting GnRH-a to regulate the menstrual cycle or using a nasal spray
If the transfer doesn’t lead to pregnancy, estradiol and progesterone administration are stopped. Otherwise, these medications are going on until the end of the first trimester to support the pregnancy in its early stages.
In embryo transfer, the female partner goes through all the listed things to prepare her uterus for embryo implantation. The chance of pregnancy following embryo donation depends on the quality of frozen embryos, the age of the egg donor and the number of embryos.
Egg and Embryo Donation FAQs
1. How much is the success rate of pregnancy using donated eggs?
Approximately 65% to 80% of patients get pregnant in their first attempt using fresh embryos derived from young eggs.
2. Does egg donation hurt donors?
Although you may feel some discomfort temporarily during blood withdraw and injections. The oocyte retrieval is performed under sedation so it is painless. Some women have reported experiencing cramps afterward which subsides gradually within a few days.
3. How many eggs can be aspirated?
Donors can produce 16 or more eggs in every cycle. However, 10 to 15 of them are removed.
4. Is there any risk of becoming infertile after donation?
With every procedure that affects the reproductive system, there is an inherent risk of damage. However, there is no evidence showing that egg donation can cause infertility directly. A woman has thousands of eggs and removing a few of them will not impose any additional risk of them running out. A donor can have a normal pregnancy in the future without any problem.
5. Will I have early menopause due to removing the eggs?
No, every month you can develop many follicles. 1 or 2 follicles reach maturity and ovulate. The medications just induce the other follicles to mature.
6. Will I produce enough mature eggs?
No, if you don’t respond favorably to medications, the doctor stops the medications. A poor response means the eggs are under four follicles.
7. Is intercourse permitted during the cycle?
It is preferred to refrain from intercourse during the cycle and wait for at least one week after the egg retrieval or after your first period.
8. When will I get my first period after aspiration?
10 to 12 days after aspiration you will get your period.
9. How long does the donor cycle take?
The donor cycle takes three weeks to complete.
10. Am I responsible for the child created with my egg?
No, you have no legal and financial responsibilities or parental rights. The recipients are the legal parents of the child created with your egg. Your only responsibility is to give accurate information about yourself so the legal parents can give their child when it is appropriate.