In order to become pregnant, women should produce healthy eggs.
During ovulation a set number of eggs are released but sometimes the number of eggs is less than what it should be, or the quality is poor.
Egg quality is determined by how ready the eggs are to develop into embryos after being fertilized. For eggs to be healthy, they should have the right chromosomes, and the ability to combine the chromosomes with a sperm. Sometimes a woman’s eggs do not have the proper chromosomes that are needed to have a successful pregnancy.
The number of eggs produced and the quality of these eggs have a huge impact on fertility. As women age, they tend to produce fewer eggs of poorer quality. Poor quality eggs either do not implant themselves properly in the uterus after fertilization or they are not healthy enough to grow and divide which could result in a miscarriage.
More and more women who face infertility due to these reasons are opting for egg donation. Let us look at this process in more detail. Through assisted reproductive technology, doctors surgically remove eggs from a woman’s ovaries and combine them with a sperm in a laboratory, after which the egg and the sperm are returned either to the woman’s uterus or donated to another woman. The egg donation process starts with basic medical tests such as blood tests, cultures, uterine evaluation and a pap smear. It is important for egg recipients to have a normal and conducive uterus for it to work. Apart physiological tests, women also go through psychological evaluations, and legal and financial counseling.
Egg donation and ART is an expensive ordeal, the prices ranges between 15,000 to 50,000 US dollars, excluding medical fees. The cost includes pre-screening, tests, donor fees, IVF, medications, embryo transfer and embryo preservation. A legal contract is needed in an egg donation process, which should clearly state the egg recipient’s responsibility to bear all financial costs incurred, have transparent privacy and confidentiality clauses, have specific responsibilities for both parties as well as clear establishment of parental rights. With the legality procedures in place, recipients now move on to the next part of the process.
Egg recipients work to select potential donors with the help of their fertility clinic or an egg donor. The selection is done by browsing through anonymous egg donor databases, which are available based on race, origin, eye color, hair, height and education. A personal profile of the egg recipient will also be need to be created. It would contain details that are non –identifying about the recipient, the recipient couple, and the reason or struggle with infertility. After the recipient has selected potential candidates, the donor or clinic contacts the donors to share the recipient’s profile as well as to confirm availability. If the donor and recipient are in agreement, it is considered a match.
There are specific conditions and testing that an egg donor must also go through. Most clinics or programs accept eggs that are from women above 21 and not more than 32 to 33 years of age. They will also need to state their education level, body weight, lifestyle choices (smoking and alcohol use), previous family medical history, ability to be available for donation requirements, and the proximity to the fertility center. Donors should not have any psychological disorders, be treated for any sexual or physical abuse, use any psychoactive medication, be in an unstable relationship or marriage, and be mentally unstable to consent to the donation.
After meeting all the criteria, egg donors then undergo a series of tests and exams like a physical exam, genetic screening, psychological evaluation, and infectious disease testing. The donors address all the factors surrounding the egg donation process like donor compensation, financial and legal responsibilities of both parties, and parental and confidentiality rights. Donors will have to waive all parental rights to any child resulting from the donation process.
After the donor and recipient are matched, and all legal and preliminary medical tests are conducted, both women are prepared for the egg-harvesting process. First, the donor and recipient’s menstrual cycles are synchronized. Donors are taught the synchronization process with the administration of pills and injections. A physician will assess the donor’s ovarian functioning on the first day of her period by conducting a vaginal ultrasound and blood tests, post which the donor will start to take birth control pills. Daily GnRH injections will be given to suppress the donor’s natural ovulation. This whole cycle takes about 4 weeks, and routine blood tests and vaginal ultrasounds are carried out to chart progress. The cycle is then brought to an end by stopping the intake of birth control pills, and eventually getting her menstrual cycle synched with the recipient’s cycle.
For the next stage, which is the ovarian stimulation process, the donor needs to be injected with hormones to encourage the release of many eggs, as compared to the one egg that is released each month in normal women. In the meanwhile, the recipient also takes medication to thicken the lining of the uterus for embryo implantation, and to repress ovulation. During this process, the donor has to undergo regular ultrasounds and blood tests for monitoring of egg follicle development. Once the eggs have been fully developed, she will then have to be injected with hCG (Human Chorionic Gonadotropin) to help the eggs separate from the follicle walls for collection, which is done 34 to 35 hours after the hCG injection is administered. The recipient takes progesterone injections in addition to the rest of the medication in preparation for the transfer of the embryo.
Once this is done, the eggs that are harvested are combined with sperm either from a sperm donor or the recipient’s partner or husband. After a few days in incubation, 2 to 4 embryos are transferred and placed in the recipient’s uterus via in vitro fertilization (IVF). Usually all harvested eggs are inserted in the recipient’s uterus but if there any remaining, they legally belong to the recipient and can be preserved through cryopreservation to be used in future pregnancy attempts.
The egg donation process is not without its risks. Medications that are used to synchronize menstrual cycles can bring about breast tenderness, mood swings, and hot flashes. This can also be held true for medication taken during the ovulation stimulation process, which has a possibility to cause fluid retention, ovary swelling, and ovarian hyperstimulation syndrome (OHSS). The symptoms that accompany OHSS can vary from non-serious abdominal pains to fatal clots, which is why careful monitoring of the donor is required to avoid development of any severe or fatal conditions.
Egg donation is mutually beneficial to both parties. Egg recipients get an opportunity to start or add to their family while egg donors are either motivated by financial gain or just from the pleasure of helping people create families. According to a survey done, about 30 percent of egg donors say that altruism was the motivation while the rest 20 percent said it was for the money. And the rest, a combination of both altruism and money were motivating factors.
