Guide for Egg Donors
Welcome to F.I.R.S.T.’s Donor Egg
Program! This information is designed to provide you with an introduction to the
procedures which will be performed during your participation cycle. During the
course of your treatment, please refer to these instructions. At each step of
the procedure, we will provide you with instructions and
information tailored to your specific needs. Each of us holds a deep commitment
to making egg (oocyte) donation a positive experience for you. Do not hesitate
to ask questions at any time!
Overview
Prescreening
Ovulation
Induction
Egg
Retrieval
The procedures of In Vitro Fertilization
(IVF)
and Zygote Intra-Fallopian Transfer (Z.I.F.T.) may be thought of in four stages:
1. Ovulation Induction - the use of
fertility drugs to stimulate the ovary to produce large numbers of eggs. This
period is divided into two parts -- the “suppression phase” and the
“stimulation phase.”
2. Egg
Retrieval - the surgical
procedure in which the mature eggs are collected for fertilization.
3. Fertilization of mature
eggs in
the laboratory to obtain embryos.
4. Uterine Embryo Transfer - a minor
procedure (basically a pelvic exam) to replace the fertilized eggs (embryos)
into the uterus (in IVF)
OR Tubal Embryo Transfer - placement
of fertilized eggs (embryos) into the fallopian tube(s) during a laparoscopy (in
Z.I.F.T.).
The procedures of Gamete Intra-Fallopian
Transfer (G.I.F.T.) may be thought of in two stages:
1. Ovulation Induction - the use of
fertility drugs to stimulate the ovary to produce large numbers of eggs. This
period is divided into two parts -- the “suppression phase” and the
“stimulation phase.”
2. Egg
Retrieval and Gamete Transfer
into the Fallopian Tubes - surgical procedure (laparoscopy) in which the
mature eggs are collected, combined with the male’s sperm and, together,
replaced into the fallopian tube(s).
When donor eggs are used during these
procedures, the egg donor participates in stages 1 & 2 only. While the
recipient of donor eggs is given medication to prepare her uterus to accept a
pregnancy, the egg donor undergoes ovulation induction followed by
egg retrieval, after which she has completed her participation. The participation
period may last from about 3-5 weeks (usually closer to 3), depending on how
long it takes to synchronize the donor’s cycle with that of the recipient’s,
and how the donor responds to the medication.
IMPORTANT POINTS - During the course
of your participation cycle, the drugs which are used for ovulation induction
take control of your hormonal system. As a result, you may notice vaginal
bleeding or other menstrual symptoms at unexpected times. Sexual intercourse may
become uncomfortable as the ovaries enlarge during the stimulation phase of your
ovulation induction. This is an intended and expected part of your treatment. Do
not be alarmed by unusual symptoms! Check with the A.R.T.
Coordinator or your
physician.
At your first visit, your physician, Dr.
Selub, will explain the procedures of egg donation for
IVF, Z.I.F.T. and
G.I.F.T. in
detail and help you decide whether, in fact, you wish to participate. You will
be asked to complete a Donor Genetic History Screening Form before this initial
interview. If you do not know your blood type, and think you may want to
participate, blood will be drawn during this visit to obtain this information.
Donors are matched to recipients mainly on the basis of blood type and physical characteristics.
Once you are matched to a recipient (which
may range between a few weeks from your initial interview to more than a year),
we will contact you to arrange a second visit with the
physician. She will inquire whether you still wish to participate, since we
anticipate that the plans of many donors will change over time. If you are still
available, during the next visit a complete physical exam will be performed.
This will include a pelvic exam during which a Pap smear will be done (for your
benefit only), as well as various cervical (internal) tests (performed in a
similar fashion to a Pap smear) to check for infectious diseases. Blood tests to
check for infectious diseases (including HIV or AIDS screening) will also be
drawn. You will be asked to sign a consent form for HIV screening at this time.
Donors will receive consent forms at this visit to review at home.
Potential donors with positive results
found during infectious disease screening will be offered treatment, but will
not be selected to participate in the program. Once you are accepted, we will call you to arrange a third appointment. This will
probably be around the third week of your menstrual cycle. At this time, she
will review the consent forms. She and the physician will give specific
instructions on how to administer your medications and a schedule for the
monitoring visits that follow.
Suppression Phase:
This is the first part of the treatment
designed to produce a maximal number of eggs for fertilization. Lupron, a drug
similar to the hormone which controls the ovarian cycle, is used to suppress the
brain’s pituitary gland and the ovaries prior to stimulation with Metrodin and
Pergonal. The goal of this therapy is to shut down the ovary so that a large
number of eggs will be at the “starting line” and will be ready to
respond to stimulation, in contrast to a single egg responding and
preparing for ovulation, which is the case in a natural menstrual cycle.
A vaginal ultrasound scan of the ovaries
and a urine test for progesterone will be performed to ensure that you are ready
to start treatment with Lupron. We will give you instructions
regarding proper Lupron administration technique and a supply of medication.
Please refer to the detailed “Suppression Therapy with Lupron” included with
this packet. You will be instructed to start the injection of Lupron on that day
and continue for at least seven days before returning to the office. We will give you a precise date before you leave, usually within 12
days of starting Lupron.
Since Lupron acts to turn off the ovaries
and the hormones they supply, the side effects of Lupron are similar to the
symptoms of women beginning the menopause. These symptoms are usually mild,
consisting of hot flashes, vaginal dryness and vaginal bleeding.
Frequently, they begin seven to ten days after the start of treatment. These
symptoms are a sign that the treatment is working and that you will soon be
ready for the next phase of stimulation.
Stimulation Phase:
In this part of the process, you will
receive injections of Pergonal and Metrodin to stimulate your ovaries to produce
large numbers of eggs. We designate the first day of Pergonal treatment as
“stimulation day 1.’
Stimulation Day 1:
You will return to the office approximately
10 days after starting Lupron. Usually, vaginal bleeding will have begun by this
time. At this visit, we will draw a blood sample for estradiol and perform a
vaginal ultrasound scan to assess your response to the Lupron treatment. If your
ovaries are sufficiently suppressed, you will be started on gonadotropin
injections. We will give you precise medication instructions.
Usual treatment will include decreasing the Lupron to 0.1 cc per day and
starting intramuscular injections for five days. Precise instructions for
therapy will be reviewed by us.
IMPORTANT POINTS - To prevent
unintended pregnancy, if you have vaginal sexual intercourse (and you or your
partner have not undergone a sterilization procedure) after this point, USE
A BARRIER CONTRACEPTIVE (condom with foam or diaphragm with
contraceptive jelly). Continue using a barrier method of contraception to
prevent unintended pregnancy for four days following the ooctye (egg) retrieval
procedure!
Stimulation Day 6:
On stimulation day 6, we will draw a blood
sample for estradiol and perform a vaginal ultrasound scan to follow the
response of the ovaries to the stimulation regimen. The dose of your medication
will be adjusted as appropriate.
Stimulation Days 7 and Beyond:
You will need to return to the office every
one to two days for a serum estradiol and a vaginal ultrasound scan to follow
your response to stimulation.
When the estradiol and pelvic ultrasound
scans demonstrate that the eggs are mature and ready for harvest, you will be
instructed to discontinue both the Pergonal and Lupron injections. Most patients
are given at least a total of nine days of stimulation.
We will instruct you on
the administration of hCG (a hormone used to ensure final maturation of the eggs), 10,000 international Units intramuscularly, 34 hours prior to the
scheduled egg retrieval procedure (e.g., at 2:00 a.m. for a 12:00 noon scheduled
aspiration procedure). Please check with us for any
questions.
Post-hCG Day 1:
You will not need to return to the office
this day. We may contact you for final
instructions for your egg retrieval which is scheduled for the next day.
Please remember not to eat or drink
anything after midnight prior to the egg retrieval procedure.
The method your physicians will use to
harvest the stimulated eggs is identical for the
IVF, Z.I.F.T. or
G.I.F.T. procedure.
You will receive
light sedation. The vaginal ultrasound will be utilized to visualize the ovaries
and a thin needle will then be passed through the vagina and used to aspirate
the eggs from the ovarian follicles. This is a very safe and painless procedure.
You may not remember anything about the procedure due to the medication
administered. You may plan to go home after about two hours of observation with
someone to accompany you.
After your procedure, we advise you to
use good common sense in returning to all of your usual activities. You should
initially plan to rest at home, avoiding strenuous activities. You will probably
be instructed to discontinue all medication after this point. Some donors may be
advised by the physician to restart treatment with Lupron for about one week, or
until vaginal bleeding (a menstrual period) begins. The purpose of restarting
Lupron in some donors is to help avoid uncomfortable ovarian swelling that may
occur in the few days following a retrieval if an exceptionally large number of
eggs are produced. Ordinarily, without further medication, you will have a
period one to three weeks following the retrieval. There will probably be some
light vaginal bleeding for one or two days after the procedure, which is a
result of the instrumentation and not a menstrual period. Please avoid alcohol
and cigarettes and any other medications around the time of egg retrieval. Do
not hesitate to contact our office with questions.
After your period, your normal menstrual
cycle should resume. If you wish, and you are matched with another recipient,
you may participate in another cycle as soon as one to two months following the
retrieval. Theoretically, an individual egg donor may participate in as many as
four or five cycles a year. Following each egg retrieval, you will receive a
stipend.
We hope that this information will assist
you on your journey through egg donation. The entire team thanks you for your
participation and wishes you a pleasant, exciting experience.
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