The Donor Egg Process - Step by Step
Although there might be a slight variance from clinic to clinic, in general, the donor egg process is as follows:
1. Locate a donor see ( How To Select an Egg Donor )
2. Complete medical screening for the recipient, the spouse of the
recipient, and the donor: psychological (includes MMPI for donor,
counseling for the donor and the recipient couple, individually and
jointly, if the donor is a known donor) and physical (includes semen
analysis, blood work to test the donor and the recipient for infection
and sexually transmitted diseases, hysterosalpinogram for the recipient
to allow the doctor to view the uterine lining to detect uterine polyps
or other defects which could affect implantation or pregnancy, "mock
transfer" to determine the best type and size of catheter for the embryo
transfer, etc.).
3. Some clinics require a "mock cycle" for the recipient, where the
recipient takes medications (generally Lupron, followed by Estrace and
then progesterone) and has ultrasounds and bloodworm to ensure that the
medication is effective and the uterine lining is appropriate to support
a pregnancy.
4. Coordinate cycles of donor and recipient. For pre-menopausal
recipients, this is accomplished by both the recipient and the donor
taking medications such as Lupron (shots), Synarel (nasal spray), and/or
birth control pills. For recipients past menopause, only the donor will
be down-regulated using Lupron or Synarel.
5. Some clinics prescribe antibiotics for the donor, recipient, and
recipient's spouse early in the cycle (often a 10-day treatment) in
order to treat any undiagnosed infections that may exist.
6. Once both the donor and the recipient are down-regulated, the
recipient begins to take estrogen supplements in some form - oral,
patches, or shots. The dosage may be adjusted based on blood tests
(measuring E2 levels) and ultrasounds to measure the uterine lining.
7. While the recipient is taking estrogen supplements to build a thick
uterine lining, the donor begins her fertility medications. These
medications are often taken for 8-10 days. Her progress is measured
through blood work and ultrasounds.
8. The date of the egg retrieval will be determined based on the size of
the donor's follicles, as measured by ultrasounds. At an appropriate
time, she will be given a shot of hCG and the retrieval is generally
performed approximately 33-35 hours thereafter.
9. On the date of the retrieval, the recipient's partner will provide a
semen sample. The semen is processed and sperm are added to the eggs
that same day. In some cases, ICSI will be performed. This is a process
where a single sperm is injected into each egg.
10. The day after retrieval the lab will provide a fertilization report.
The embryos remain in the laboratory until the date of the transfer,
which can be between two and five days after the retrieval date.
Periodic progress reports are provided to the recipient to keep her
informed about number, size, and quality of embryos.
11. On or just before the date of the donor's egg retrieval, the
recipient will begin taking progesterone supplements, available as
injections, vaginal gel, vaginal or rectal suppositories, or in oral
form.
12. Based on embryo quality and other factors, the recipient couple
determines how many embryos to transfer to the recipient's uterus. The
rest may be frozen at that time or kept in the laboratory for several
more days before freezing. Often clinics will freeze only high quality
embryos.
13. Some clinics will prescribe a steroid (often Medrol or prednisone)
and another round of antibiotics for the recipient to take for several
days preceding the embryo transfer.
14. The embryo transfer is performed either at a hospital or in the
clinic's office. The embryos are placed into a catheter and transferred
through the cervix into the uterus of the recipient under ultrasound
guidance. Some clinics prescribe valium for the recipient to take prior
to embryo transfer, although the procedure is generally not any more
painful than a pap smear or insemination.
15. Following the embryo transfer, the recipient will remain in the
hospital clinic for 30 minutes to several hours, depending on the
clinic's protocol. Then the recipient remains on bed rest for several
hours to several days, depending on the clinic's protocol.
16. Several restrictions may be imposed for the period between transfer
and the pregnancy test: limitations on exercise, heavy lifting (over ten
pounds), sex, caffeine, etc. Again, this varies from clinic to clinic.
17. A blood pregnancy test may be performed 9-14 days from a day 3
embryo transfer (or sooner for a day 5 transfer). The hCG level in the
blood is measured; if the test is positive, it is repeated two days
later. hCG levels should double every 48-72 hours.
18. If the test is positive, the recipient continues to take
progesterone and estrogen supplements as directed by her physician -
often until the end of week 10 or 12 of pregnancy.
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