The Egg Donation Cycle
Like IVF cycles, the egg donation cycle commences at the beginning of
the woman's menstrual period. (In the case of egg donation, this is the
donor's cycle.)
The following is a general guideline for egg donation. The steps are
grouped into the three main phases of the IVF process, with additional
notes specific to the donor and the recipient. Details may
vary based on the needs of both the donor and the recipient.
Prior to synchronization with the donor, the recipient will undergo a
practice cycle during which she will take estrogen tablets and
progesterone suppositories in order to for us to determine whether the
thickness of her uterine lining will be satisfactory for embryo
implantation. We will also conduct a practice embryo transfer.
Ovarian Stimulation and Egg Retrieval
|
| Baseline test |
Donor and recipient: On day 2 or day 3 following the donor's
and the recipient's respective onset of menses, a baseline ultrasound
examination and blood test is done in our office. |
| Ovarian suppression |
2 to 4 weeks
Donor and recipient: The two women's cycles are synchronized
using oral contraceptives and/or Lupron. Oral contraceptives
help start the ovarian suppression process and are continued for 2 to 4
weeks.
In order to achieve ovarian suppression, Lupron is begun about two
weeks before the start of ovarian stimulation and overlaps with the oral
contraceptives. To ensure that ovarian suppression has been achieved,
another office visit for ultrasound and blood testing is scheduled
approximately two weeks after starting Lupron. |
| Ovarian stimulation |
8 to 12 days
Once both donor and recipient have achieved low estrogen levels,
treatment continues as follows:
Donor: Begins daily dosage of injectable fertility
medications, while the Lupron is continued at a lower dose. The
medications are usually self-administered subcutaneously (under the
skin) using a short needle. Occasionally, we may need to change the
dose of medication during the day, therefore, we recommend that
patients take their injections in the evening.
Recipient: Begins oral estrogen therapy. |
| Cycle monitoring |
Day 5
Donor: On day five of stimulation, regular office visits
start. These continue every one to two days until egg retrieval
takes place. An ultrasound and blood test for estradiol are performed at
each visit. The patient must call at the end of the day for results and
to receive further medication instructions.
Recipient: Based on the donor's monitoring, the recipient's
cycle is adjusted to the donor's cycle. |
| Ovulation induction |
Between day 8 and 12
Donor: When the follicles are large enough, final egg
maturation is triggered with an injection of human chorionic
gonadotropin (hCG). The timing of the hCG dose is very important, as
egg retrieval is performed thirty-six hours later. |
| Egg retrieval |
36 hours following hCG injection
Donor: The egg retrieval procedure takes less than thirty
minutes, however, the entire appointment will take approximately two
hours.
Recipient: Begins progesterone suppositories on the day of the
donor's egg retrieval. |
Fertilization and Embryo Culture
|
| Sperm collection |
Day of egg retrieval
Recipient's male partner: Sperm are obtained from the
recipient's male partner on the day of retrieval and occasionally the
morning after egg retrieval if fertilization was suboptimal.
In order to optimize sperm quality, it is recommended that the male
partner abstain from ejaculation for two to seven days prior to the
first sperm specimen. Typically, this will mean abstinence after the
donor's seventh day on fertility medication. |
| Fertilization |
Day of egg retrieval
Sperm are placed in a dish with the egg or injected directly into
the egg (ICSI) to achieve fertilization.
The eggs are checked the next day to determine which ones are
fertilized. Excess fertilized eggs, now called embryos, can be
frozen at this time. |
| Assisted hatching |
Day of embryo transfer
If indicated, assisted hatching is conducted in order to facilitate
hatching and implantation. This is accomplished by making a small hole in the
outer shell of the egg. |
| Preimplantation Genetic Diagnosis - PGD |
3 days after retrieval
If indicated, PGD is done when the embryo reaches the 8-cell
stage—generally three days after fertilization occurs. PGD can
reveal certain genetic conditions and gender with results in one to
two days. |
Embryo Transfer and Progesterone Support
|
| Embryo transfer |
3 to 5 days after egg retrieval
The embryo transfer is a simple procedure performed by placing a
soft catheter containing the embryos through the cervix under
ultrasound guidance. It does not require anesthesia, however, Valium
is administered to help relax the pelvic muscles. Therefore, it is
important that patients arrange for a ride home. Patients are asked
to arrive thirty minutes prior to embryo transfer and must remain in
bed for fifteen minutes following the procedure.
Recipient: For a tubal transfer, the recipient will be
admitted to the operating room to undergo laparoscopic placement of
gametes (GIFT) or embryos (ZIFT) within 24-48 hours of egg
retrieval. The majority of patients will undergo trans-cervical
embryo transfer. |
| Progesterone support |
Recipient: Since the ovaries are not
producing any hormones during the egg donation process, it is
important that the recipient continue estrogen and progesterone
until advised to stop. |
| Pregnancy testing |
Day 14 and 21
Blood is drawn on the mornings of day 9 and day 12 following the
transfer. The patient will be contacted later in the day with the
results.
Donor: The donor should expect her normal period
approximately 7-14 days after egg retrieval. |
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