April 24, 2020
Author Name: Dr. Shipra Nigam || Mentor Name: Dr. Amol Lunkad on April 24, 2020
Infertility as a problem has plagued the society for ages. The advent of in-vitro fertilization (IVF) and with manifolds of developments in the field of reproductive medicine, many infertile couples are nowadays able to fulfill the dream of having a child. For those females in whom eggs have finished due to menopause or those females where the egg quality is very poor or in those females where they are unable to conceive with one owns egg than egg donation has come up as a boon for such infertile couple. So, it becomes imperative to understand the egg donation process and how is it useful…!
The first pregnancy resulting from egg donation was reported in 1984. Ever since, egg donation has assumed significant importance in reproductive medicine. Egg donation is required when the cause of infertility in a couple is diagnosed to be due to inadequate egg production or poor quality of eggs in the female. Egg donation involves obtaining eggs from another woman (donor). These donor eggs are fertilized with the sperms of the recipient’s husband (male counterpart of the infertile couple) in laboratory by the process of IVF [in vitro fertilization]. Finally, the embryo formed after fertilization is transferred to the uterus of the female counterpart of the infertile couple.
The various reasons for which egg donation is required can be broadly grouped into two categories which are as follows:-
1. Non-functional ovaries:-
• Premature ovarian failure- Menopause starts earlier than usual, before 40 yrs of age
• Ovarian agenesis—Ovaries are not formed
• Bilateral oophorectomy
• As a consequence of cancer chemotherapy
2. Functional ovaries:-
• Inherited genetic diseases
• Poor quality eggs
• Inability to conceive repeatedly with IVF with self-eggs (recurrent IVF failure)
• Inaccessible ovaries
Egg donors are anonymous, that is, the identity of the donor is never revealed to the recipient(s). Prospective donors are found through egg donation programmes or through certain agencies. In an Egg donation IVF program donor eggs can be taken by various ways that is-
1) Frozen eggs from egg banks (stored eggs).
2) Egg sharing with ongoing young IVF patients in the same IVF center.
3) Getting Fresh eggs from a medically fit young donor (best option as better success – this is how it is done in INDIRA IVF)
The first step is to find an egg donor. The recipient woman is treated with hormones to prepare her for accepting the embryo. If the ovaries of recipient are functional, her menstrual cycle is coincided with that of donor’s cycle with the help of certain treatment. Meanwhile, the donor is also treated with hormonal injections to produce superovulation. Once donor eggs are ready, they are retrieved and fertilized with the sperm of husband of recipient. After a few days, the embryo/s is/are implanted in the recipient’s uterus. Some donor eggs can be frozen so that they can be used later for some other needy couple.
The success of egg donation IVF cycle depends upon number of factors some of them can be as follows-
1) Age of donor – Young and healthy egg donors are preferred for egg donation programs. It is because it has been observed that chance of pregnancy is nearly the same in young and old recipients if the donor chosen is young. That’s why at INDIRA IVF we use only fresh donor eggs from a young female donor.
2) Egg quality – egg quality is an important factor which in turn determines the embryo quality and thus it determines the outcome of IVF (pregnancy and birth outcomes).
3) Endometrial preparation – Most important factor determining the success of Egg donation cycle is the preparation of the endometrium that is the place where the embryo is going to be implanted (soil preparation) and also the endometrial receptivity when the embryos prepared by donor eggs are implanted. In INDIRA IVF the process of fertilization of donor eggs by husband’s sperm is done in CLOSED Working Chambers so the eggs and sperms during fertilization get the best environment (similar to as they should have got in the womb) so embryos formed are better and so the success would be better.
4) Embryo transfer process – the process of placement of embryos in the womb is also important which is done under sonography guidance.
One advantage offered by use of donor eggs, especially in older recipients, is reduced risk of miscarriages and reduced risk of chromosomal abnormalities. This is because older the age of the parents; more are the chances of conceiving a child with chromosomal abnormalities. Use of an egg of a young donor reduces the chances of conceiving a child with chromosomal abnormalities.
A risk among egg donation cases is multiple gestations. So, in order to reduce chances of multiple gestations it is advisable to limit the number of embryos transferred to one or two. Single high-quality embryo transfer, also known as elective Single Embryo Transfer (eSET), helps to reduce the risk of multiple gestations to less than 1 percent.
To conclude, egg donation can be an answer to the problem of infertility in those couples where the female has decreased eggs/ poor egg quality. However, egg donation should be preferably from a young healthy donor. Good success rates in terms of achieving pregnancy and in terms of favourable pregnancy outcomes have been observed with carefully chosen donor eggs.
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