In vitro fertilization or IVF stands for a fertility treatment which consists of removing both the eggs and the sperm from each member of a couple and then join them together in a laboratory dish. The aim is to create an embryo that will be later transferred into the woman’s uterus so that pregnancy can be achieved. Despite using the intended parents’ gametes (i.e. eggs and sperm) is advisable, unluckily it is not always possible.
In case the eggs and/or sperm of the future parents are non-viable, that is to say, unable to produce a healthy embryo, or in case there is no partner or it is a same-sex couple, there is an opportunity to use donor eggs or sperm.
Here we shall focus on those cases of egg donation where the woman is unable to use her own eggs for IVF. Main causes why resorting to donor eggs is necessary are the following:
- Depletion of ovarian reserve (menopause, premature ovarian failure or POF…)
- Recurrent miscarriage
- Advanced maternal age
- Genetic disorders
- Recurrent failed IVF cycles with own eggs
In the US, IVF using donor eggs is regulated by law nationally, although legislation varies from state to state.
Egg donor profiles
As stated hereunder, each US state establishes its own regulations when it comes to make provision in respect of egg donation. Among these requirements, the identity of the egg donor is considered to be a very important step within the process. Accordingly, two main egg donor options are incorporated:
- Anonymous egg donation: intended parents do not get to know the donor or learn which her features are. Choosing the potential donor is a matter of the egg donor agency or the fertility clinic, which will do so by matching her with the physical and immunological characteristics (blood type) of the intended parents. However, the intended parents can inform about which their preferences are.
- Known egg donation: in this case, two arrangements are available:
- The intended parents choose the egg donor. Typical egg donor profiles chosen by parents include friends, relatives or acquaintances.
- The egg donor agency (egg bank) or the fertility clinic offers a series of potential donors so that intended parents choose the one that best fits their requirements according to their physical characteristics, ethnic group, education level and social status, medical history, etc. In this arrangement, the selection can be done by just using an egg donor database or, conversely, the intended parents and the donor can meet in person and get to know each other.
In cases where intended parents prefer to choose the donor by themselves or even where there is a relationship between them and the potential egg donor, signing an agreement concerning the safeguarding of confidentiality of all parties involved is recommended. The confines of confidentiality between the donor and the intended parents shall be established before the donation process starts. Having legal representation for drawing up the contract and supervising the contract’s fulfillment is recommended for both parties.
Likewise, the donor and the recipient, together with their partners, must have a legal document explaining which are the limits regarding their rights and obligations concerning the baby.
Finally, it should be clear that the donor, whether she is selected by the intended parents or chosen from an egg donor database, must undergo a series of strict physical and psychological check-ups and medical tests in order to validate she meets the requirements to become an egg donor.
Egg donation implies a variation in the IVF process, not regarding the lab procedure itself but in in relation to the patient, since follicular puncture is not required.
Since the eggs that are going to be used are donor eggs, the recipient does not have to take any medication for ovarian hyperstimulation. Conversely, preparing the endometrium to receive the embryos is necessary by taking a series of medications such as progestagenic drugs.
Once the embryos from donor eggs and husband or donor sperm are adequately developed and the recipient’s endometrium is ready, that is to say, when it presents a trilaminar appearance and a 7-10 mm thickness, the embryo transfer will be performed. The sole purpose of this process is to achieve embryo implantation and therefore pregnancy.
Another aspect to be looked at is whether the eggs used are going to be fresh or frozen eggs (vitrified). In case fresh eggs are used, synchronization between the donor and the recipient must be scheduled. In contrast, when frozen eggs are used, no synchronization is required.