Becoming a Parent: Egg Donors and IVF
Donor Egg Treatment
The following serves as a more detailed review of the process used to stimulate and collect eggs for donation:
OVARIAN STIMULATION
To prepare the body for the advanced reproductive technologies (ART), various hormonal medications are used alone or in combination, to stimulate the development of ovarian follicles. This is known as "superovulation" or "controlled ovarian stimulation" (COS).
These medications are administered for two reasons, (a) to enhance the growth and maturation of as many follicles as possible, thereby improving chances for fertilization and development, and, (b) to control the timing of ovulation so eggs can be retrieved before they are spontaneously released.
Hormonal medications are administered for nine to twelve days; doses may be adjusted during the cycle depending upon follicle growth. The patient is carefully monitored using laboratory tests (estrogen levels), ultrasound, and physical examination. When, in the physician's judgment, follicular development has reached the stage where an optimum number of eggs will be produced without untoward effects, hCG will be administered to trigger ovulation. Egg retrieval will be scheduled within 34 to 36 hours after hCG administration.
These medications have been used for over twenty years to treat women who do not ovulate regularly. As with any medication, side affects are a possibility and should be discussed with your physician. The effects most commonly reported include allergic sensitivity, and pain, irritation, or swelling at the injection site. Occasionally, overstimulation of the ovaries may occur. Ovarian Hyperstimulation Syndrome (OHSS) generally causes enlargement of the ovaries accompanied by abdominal discomfort and/or pain. In severe cases, additional symptoms may require hospitalization of the patient. There appears to be no increased incidence of birth defects, congenital abnormalities or spontaneous miscarriages associated with the use of these medications. There is, however, an increased possibility of multiple births when more than one egg is transferred.
MONITORING
ART cycles are monitored in two ways: by ultrasound and by blood hormone test. Monitoring is necessary in order to assess the growth and development of the follicles and to avoid the possibility of Ovarian Hyperstimulation Syndrome.
Serial ultrasounds are used to follow follicle growth in the ovary beginning at approximately cycle day eight and on a regular basis thereafter. The ultrasound unit sends out high frequency wave signals that reflect or "bounce" off the structure in the pelvis and are translated into images on a TV like monitor. The procedure is essentially painless. The patient may feel the pressure of the transducer on her abdomen or in her vagina, however, she cannot feel or hear the sound waves nor have there been any harmful effects to the developing eggs or early pregnancy demonstrated from ultrasound.
Through ultrasound, the physician can obtain an actual image of a woman's ovaries and can clearly identify, count and even measure the fluid filled follicles as they develop. As the follicles get larger, the ultrasound also provides an indicator of approaching ovulation.
Blood tests to measure hormone levels are performed in conjunction with and on essentially the same regular basis / schedule as ultrasound. As follicles develop, they secrete increasing amounts of the hormone estrogen, specifically estradiol (E2). Concentration of E2 in the blood indicates the degree of response to ovarian stimulation. In general, the higher the E2, the more follicles are developing.
EGG RECOVERY
Egg recovery is accomplished by an ultrasound-directed procedure. This is a minor surgical procedure and can be performed under local anesthesia. The vaginal transducer is placed in the vagina. An aspiration needle is inserted along-side the transducer and through the upper part of the vagina directly into the ovary. The ultrasound image allows the physician to accurately guide the needle into each follicle for aspiration as previously described.
