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Egg Donors

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Message from the IPGO Team – “Blessed is the fruit of thy womb”

Many causes of infertility exist and practically all are treatable. Medications stimulate ovulation when a woman is unable to ovulate; surgical procedures repair the anatomical problems in the reproductive system, such as pelvic adhesions or tubal obstructions; endometriosis is treatable by video laparoscopy; spermatozoa, when not present in the semen, can be retrieved from the testicle by microsurgical procedures; All these difficulties cause some major or minor emotional pain in a woman, and the available treatments for these problems alleviate the distress with some ease. Of all these diagnoses, the most difficult for a woman to accept is the absence of eggs capable of being fertilized, i.e., the ovary is no longer able to produce eggs capable of reproducing. It is a moment of disappointment, because she believes it is no longer possible to be a mother. This occurrence can happen in young women with premature ovarian failure called premature menopause; in cases of damaging surgical procedures, in which both ovaries are removed; in advanced age, when the eggs produced do not develop into good embryos; or in menopause itself at a certain age (about 50 years old), when eggs no longer exist. Nowadays, more and more women delay marriage or having a child in order to give priority to their professional development and career or to their financial goals. Others, around 50 years old, find again a happily devoted life in a second marriage with a man without children and who desires a family. For others, their destiny is to get married at a later time. Cases of transmittable genetic and chromosomal diseases exist when Pre-implantation Genetic Diagnosis (PGD) may not be possible (http://www.ipgo.com.br/pgde.html). The cause does not matter. The solution is egg donation. These women can be mothers and carry their own children in their own uterus, having an offspring from her husband’s spermatozoa and an egg from a donor.

The initial reaction to the proposal of this treatment for these patients is always of resentment, accompanied with comments such as: “No way does this interest me”, “So this child will not be mine”, “This child will not have my characteristics nor my DNA”, and others. These assertions are made by almost every woman in an initial phase. Even when we provide them with a vast quantity of necessary information for the comprehension of this process, they leave the clinic frustrated swearing that they will quit trying to have children forever. However, after taking time to reflect and understand, they return accepting this option to have their children. It is very rewarding to attend to these couples, because the sadness of their fertility that they had considered irreversible turns into an unexpected happiness. The egg donation is a very confidential treatment with exclusive knowledge by the doctor, by the couple, and sometimes, depending on them, by someone very close (a mother or a sister). The donors must be anonymous, i.e., they cannot be from within the family, not even acquaintances of the couple. They must have physical similarities, compatible blood type, and physical and mental health attestations through exams. The embodiment of a mother’s emotion and the fatherhood spirit after the confirmation of a successful pregnancy test is so great. After the bad moment, all couples remember that the pregnancy was achieved through donated eggs. What matters to these mothers is that the baby came from her own womb. She gave birth, and from this moment forward and for the rest of her life, this will be HER CHILD! For this reason, the chapter of the book “Pregnancy: alternatives, obstacles, and triumphs” that deals with this subject, written by Dr. Arnaldo Schizzi Cambiaghi, has the title “Blessed is the fruit of thy womb”.

“Although nobody can return back and make a new start, anyone can start now and make a new ending.”
(Chico Xavier)

Evaluating The Recipient Patient

The evaluation includes a detailed medical history, physical exam, and specific lab exams (table 1). The decision to start an egg donation treatment is not always easy; therefore, a psychological evaluation is essential.

There must be a frank conversation about the related subjects: producing a non-biological child, emotions pertaining to the failures of previous treatments, pregnancy in advanced age, advantages and disadvantages of telling or not telling the child who is to be born.

In general, the pregnancy rates in egg donation cycles are high, around 50%. Nonetheless, it is important to stress the possibility of it not working, in order for the patient to know how to cope with this and to not create high expectations for a successful treatment on the first attempt.

The evaluation of the recipient’s uterus is essential. Various methods exist that can be used for this, such as transvaginal ultrasound, hysteroscopy, and sometimes hysterosalpingogram or hysterosonogram. A recent Pap smear test (less than 6 months) must be done. In addition, the couple must be screened with serological tests, such as HIV, HTLV, syphilis, and hepatitis. The husband will need to have a recent spermogram and blood type test. When the recipients are around 40 years or older, they also must be requested to take some general exams, such as a mammogram, chest x-ray, glycemia, cardiovascular evaluation, insulin resistance, cholesterol, and other tests for a thorough medical examination of the woman.

Evaluating the medical conditions

A detailed evaluation of the woman’s physical health must be completed in order to know if, at the age that she finds herself, her body will be capable of supporting a pregnancy without placing her in risk, mainly in cases of a multiple pregnancy. All these details must be thoroughly analyzed by the responsible doctor and discussed together with the couple. Besides medical and cardiological exams, the recipient will be requested the following exams:

  • Ultrasound
  • Hysteroscopy
  • Pap smear
  • Mammogram (over 40 years old)
  • Blood exams – hormones and infectious diseases (HIV, Hepatitis, HTLV, etc.)
  • Complementary exams for medical evaluation
  • Chest x-ray
  • Electrocardiogram
  • General blood exams (glycemia, cholesterol, etc.)
  • Others, if necessary
  • Psychological evaluation

Advanced Age Recipient

A woman, in the splendor of her fifties, when attended by specialized professionals, upholds the privilege of her femininity, taking pride of her age, her knowledge, and her physical appearance. Nevertheless, at this moment, many of them never have experienced the emotion of maternity, or if they already had, they might have the desires and reasons to experience it again.

There are many factors that motivate a woman to want a child at this age. Some compelled by destiny, others by the will of achieving a professional status, they put off marriage and pregnancy. For others already with children, but in a new relationship after a dissolved marriage, they desire to give birth to another child. When a girl reaches puberty and begins menstruation (12-13 years old), she has three hundred thousand “available” eggs which, under a hormonal stimulation, can reach to ovulation, fertilization, and pregnancy. The group of these eggs that is capable of responding to a hormonal stimulation, being fertilized, and developing into embryos with a chance to implant inside the uterus is called the ovarian reserve, which corresponds to the “supply” of viable eggs. During the reproductive life, in each menstrual cycle, for each egg that reaches maturity, a great number is “lost”. Making it so that, around 50 years old, practically no more capable eggs are available to be fertilized. It is the end of the “ovarian reserve”, the end of the “supply”: menopause. The only way to achieve pregnancy in this phase of life is by means of egg donation.

When Science allows and we are within the ethical, legal, and moral principles, a woman who meets the basic requirements of good physical condition and has a solid marriage, who is emotionally balanced and is no more than 55 years old, deserves this rare opportunity to conceive.

Evaluating And Selecting The Donor Patients

In Brazil, egg donation is mandatorily anonymous, that is, neither the donor nor the recipient knows the identity of one another, unlike in the United States where the recipient can select a donor whom she knows. Also Brazil does not allow any kind of business transaction for this kind of treatment. The donation must be voluntary, not for profit-making. In IPGO, the donor candidate, besides taking rigorous medical and lab exams, must complete a detailed questionnaire about her personal life and medical history including details about family background and characteristics. Physical details, such as hair type and color, eye color, weight, and height, are included in this questionnaire. A photo of when she was a child is also accompanied which gives the recipient an idea of the features of the patient who will be donating the eggs.

Thus she will feel reassured of not having any risk of future recognition. We also ask that they write a short text which reflects their sentiments and personality putting emphasis on their personal characteristics. Habits such as smoking and use of alcohol and drugs must be questioned. The donors are not selected at random. Most of the time, they are also doing a treatment to become pregnant (shared donation) as a result of the husband’s fertility problems (few spermatozoa or the absence of them). Nevertheless, they are subjected to fertility exams for investigation. All serological tests such as syphilis, HIV, hepatitis, and HTLV must be no more than 6 months old and a karyotype must be requested to check for balanced translocations.

How The Recipient Selects The Donor

IPGO is accustomed to having various donors available to be selected. The recipient will have access to the questionnaire with all the physical characteristics of the donor and a photo of when she was a child. The blood type must be compatible in cases where the parents do not wish to tell the child the manner in which he or she was conceived.

Although many of the donor’s characteristics might not be transmitted to the child, the recipient feels more comfortable with selecting someone who resembles herself in various aspects, as much physique as well as personality.

The donors must be between 18 and 32 years of age. Over 35 years old, normally the ovarian response is not sufficient to share the eggs; however, they can donate in special cases. The older the donor, the smaller the chance of pregnancy for the recipient due to the natural decline in pregnancy rate in older women. The waiting time to find a compatible donor varies a lot since some ethnic groups are very rare depending on the region of the country, like for example, Blacks and Asians. Depending on the blood type also, the time to find a compatible donor can be long.

The General Rules For Egg Donation

In Brazil, the donation will never have a profit-making or commercial characteristic. Eggs cannot be sold (nor spermatozoa). The donors cannot know the identity of the recipients and vice-versa. Mandatorily, they will be maintained under confidentiality and anonymity. The legislation does not allow donation between family members.

The specialized clinics maintain on permanent file a register of donors, medical records with a general description of the phenotypical characteristics (physical resemblance), and lab exams that attest their physical health. The donor selection is based on physical and immunological resemblance and maximum compatibility between the donor and the recipient (blood type, etc.).

Who Can Donate Eggs

The donors must have the following characteristics:

  • Good intellectual level;
  • No family history of transmittable genetic diseases;
  • Negative test result for sexually transmittable diseases (hepatitis, syphilis, Aids, etc);
  • Compatible blood type with the recipient.

The Donor Patients Are:

  • Fertile women who wish to have tubal ligation can be encouraged to do ovarian stimulation and egg donation.
  • Patients of in vitro fertilization or artificial insemination programs with high response to ovarian stimulation sometimes wish to donate part of their retrieved eggs voluntarily and anonymously. They are patients who do not wish to freeze their embryos and are very fearful of multiple pregnancy.
  • Shared donation: It is a more common situation. In this case, the recipient would pay part of the costs to be incurred by the donor, who has decided for a test tube baby; however, this cannot be done for financial motives. In exchange, the recipient receives half of the eggs produced by the donor. Under this program, we are helping two women and giving them the right to be mothers. This position can be considered ethically disputable once the donor is being benefited economically, although she would not be receiving any money for this.
  • Frozen eggs originating from women who conceived and had children through in vitro fertilization. In a way, the success of the treatment already performed indicates good quality of those eggs. These patients, when they no longer wish to have any more children, many times donate the remaining eggs. The chance of pregnancy, in these cases, is between 25 to 30%. It is worth pointing out that the donation of eggs is much easier to be accepted by the patient in relation to the donation of embryos. While the chance of pregnancy with frozen eggs becomes closer to frozen embryos, it is worth the incentive for freezing eggs of young women who produce in great quantity.
  • Sisters, family members, and others who want to help the recipient can be donors when they do a cross donation, i.e., the eggs from a family member of a donor will be donated to another recipient who has no relation to her family, who also will have a family member donate to the first recipient. A hypothetical example: The recipient patient “A” has a sister who is called “X” and another recipient patient “B” has a sister who is called “Y”. In this case, patient “A” can receive eggs from donor “Y” and the recipient “B” can receive eggs from donor “X”. In this manner, the anonymity will be preserved.
  • Donation by pure generosity: It is very rare. Some women of altruistic manner or who already benefited from prior in vitro fertilization treatments, wanting to have no more children and moved by the sentiment of gratitude, offer to donate their eggs without anything in return.

How Is Egg Donation Treatment Done

The cycle of the egg donation is performed by an in vitro fertilization technique in which the female gametes (eggs) of a woman (donor) are donated to another (recipient) for them to be fertilized. The fertilization is performed in the laboratory with the spermatozoa of the recipient’s husband. The donor will be stimulated with injectable hormones to increase the production of eggs in that month. After collection, when the process is performed under the shared donation program, half of the eggs will be fertilized with the spermatozoa of the donor’s husband and the other half with the spermatozoa of the recipient’s husband.

Twenty-four hours after fertilization, we know how many embryos form. They remain in the laboratory for 2 to 5 days. After they are selected, they are placed in the uterus by a catheter through the vagina. Sedation is not necessary.

In this way, the embryo(s) is transferred to the recipient’s uterus, which will be developed by her own husband’s spermatozoa and the egg from the donor. The recipient receives only two hormones (estrogênio and progesterone) to prepare the endometrium in order to receive the embryos, since there is no ovulation induction. The success rate of pregnancy is the same for the donor patient who is around 30 years old (50%).

“Mix” Of Eggs

It is an extreme measure in which the donor’s eggs are mixed with those of the patient, in a single transfer of the embryos. It is an alternative that can be offered to couples whose wife, in previous treatments of fertilization, did not develop embryos of satisfactory quality, as a result of undesirable quality eggs. In these cases, the patient has bad quality eggs; therefore, they have minimum chances for fertilization. The donated eggs are considered a good alternative for pregnancy success. Therefore, the “mix” of eggs can be recommended. In this manner, the psychological impact of “pure” egg donation, i.e., without the use of her own eggs, can be softened, in case the woman or the couple still has insecurities about this procedure. The embryos will be transferred all at once and will be derived from the eggs of the patient herself and from the donated eggs. Therefore, the born child will have unknown genetic origin, unless the couple wants to know in the future, by a DNA exam, which egg conceived this baby. The financial cost of this procedure can be a drawback.

Ethical And Legal Aspects

The donors must be informed about the risks of ovarian hyperstimulation as well as other possible complications of in vitro fertilization such as multiple pregnancy, bleeding, infection, and anesthesia. In Brazil, it is not necessary to hire an attorney for the treatment, unless for specific cases, as for example, a surrogate mothers (also known as a gestational carrier).

The recipient must know that, although the donors are women at an age of minimum chances for chromosomal malformations, this possibility cannot be excluded. The couple who decides on egg donation must be open to asking questions to the medical assistant.

 

Evaluation Of Donors And Recipients Summary Table

DONOR RECIPIENT
Initial medical consultation – explanations about the egg donation process Initial medical consultation – explanations about the egg donation process
Exams to evaluate the ovarian reserve (hormones and ultrasound) as well as thyroid, prolactin, CA-125, androgens, and others If the patient is over 45 years old, a general medical evaluation is done, as well as a gynecological exam and dosages of some hormones
Investigation of endometriosis Investigation of endometriosis, if necessary
Karyotype test to rule out chromosomal problems and balanced translocations Unnecessary evaluation
Psychological evaluation and comprehension of the egg donation process Psychological evaluation and comprehension of the egg donation process
Evaluation of the uterine cavity by hysteroscopy, hysterosalpingogram, or hysterosonogram (in the first phase of the menstrual cycle) Evaluation of the uterine cavity by hysteroscopy or hysterosonogram in the first phase of the menstrual cycle (it is not necessary for a hysterosalpingogram)
Exams for cancer prevention Exams for cancer prevention
Blood type Blood type
Screen for infectious diseases and STD’s:  Serologies for Rubella, Toxoplasmosis, Cytomegalovirus, Syphilis, HIV I & II, HTLV, Hepatitis B & C and other necessary tests.  And also screen for Chlamydia and Neisseria in the vaginal discharge Screen for infectious diseases and STD’s: Serologies for Rubella, Toxoplasmosis, Cytomegalovirus, Syphilis, HIV I & II, HTLV, Hepatitis B & C and other necessary tests. And also screen for Chlamydia and Neisseria in the vaginal discharge
Questionnaire completed by the patient and verified by IPGO, that describes her physical, personal, and intellectual characteristics, professional background, personal and family history on physical and mental health, prior illnesses, and other relevant details.  The patient also provides a childhood photo to be viewed by the recipient, but without the risk of being recognized Questionnaire completed by the donor available for review
Signed consent form Signed consent form
Screen for infectious diseases and STD’s:  Serologies for Syphilis, HIV I & II, HTLV, Hepatits B & C, and other necessary tests Screen for infectious diseases and STD’s: Serologies for Syphilis, HIV I & II, HTLV, Hepatits B & C, and other necessary tests
Karyotype test to rule out chromosomal problems and balanced translocations Karyotype test to rule out chromosomal problems and balanced translocation
A complete spermogram A complete spermogram
Blood Type Blood Type
Psychological evaluation and comprehension of the egg donor process Psychological evaluation and comprehension of the egg donor process
Signed consent form Signed consent form

FOR MORE INFORMATION:

Email: mariana@ipgo.com.br
Phone: +55-11-3885-4333

 

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