Treatment

Become a Parent Through Egg Donation

Realize your dream of building a family.

Pacific Fertility Center understands there are times when a gift from another person is needed to create a family. We are proud to have been an integral part of over 2,000 donor/recipient cycles. Let us assist you along this sensitive journey.

Learn more about the various steps involved in egg donation and the responsibilities of both donor and recipient below.

• Recipient/Gestational Carrier Screening
• Egg Donor Selection and Screening
• Synchronization of Donor and Recipient/Gestational Carrier Cycles
• Ovarian and Endometrial Stimulation
• Egg Retrieval
• Fertilization and Embryo Transfer
• Post Embryo Transfer Management and Follow-up

Recipient/Gestational Carrier Screening

Before the process of selecting a donor can begin, the egg recipient (either the intended mother carrying the pregnancy or the gestational carrier in cases of patients needing a "surrogate") is required to complete the following clinical and psychological evaluations:

Mid-cycle ultrasound, post-menstrual hysteroscopy or hysterosonogram in order to assess the uterus, cervical canal and ovaries
Uterine cavity measurement to prepare for placement of embryos at the time of embryo transfer (also known as a "trial transfer" or "mock embryo transfer")
Male partner sperm sample to verify adequate sperm parameters
Infectious disease screening for all parties
Genetic screening for male partners, if ethnicity indicates increased risks
One counseling session on egg donation with PFC's Marriage and Family Therapist
Meeting with PFC's Clinical Coordinator to discuss medical procedures
Meeting with PFC's Financial Coordinator to discuss fees and potential financial options
Meeting with PFC's Egg Donor Agency to discuss potential egg donor candidates

In addition, PFC strongly recommends the following exams:

• Screening mammogram for all women prior to treatment; and documentation of a normal mammogram for women 40 years and older
• Pap smear (screening for cervical cancer) within a year of treatment
• Primary care evaluation and letter of clearance from the patient's obstetrician or primary care physician for women 45 and older

Egg Donor Selection and Screening

Intended parents may select a known donor, such as a family member or friend, or use a third party egg donor program that provides anonymous donors in an egg donor database. Patients have the option of using PFC's Egg Donor Agency or an independent donor agency. If our patients choose to work outside of our agency, PFC can coordinate the care of the recipient or gestational carrier and that of the outside-agency egg donor.

Agencies may differ in their donor evaluation processes. Below is an overview of PFC's selection and screening process. PFC's egg donor program follows a rigorous donor screening protocol involving the following steps:

Preliminary Screening

PFC Egg Donors undergo a Preliminary Screening at our center before they are accepted into our program and added to our egg donor database. Our preliminary screening includes an extensive medical and genetic history questionnaire, a vaginal ultrasound, initial psychological assessment and testing performed by a licensed Marriage and Family Therapist, genetic counseling performed by a Certified Genetic Counselor, and appropriate indicated genetic testing.

Pre-cycle Screening

Once selected by a patient, the donor will be scheduled for Pre-cycle Screening. During this process, the donor will undergo testing required by the Food and Drug Administration (FDA) as well as additional comprehensive psychological and medical evaluations.

These pre-cycle evaluations are conducted by Pacific Fertility Center and include:

• Thorough psychological evaluation. This follow-up to initial psychological assessment ensures that the donor continues to be thoughtful about her choice to donate her eggs and that she has the maturity to manage and follow through with this significant commitment
• Thorough medical history and ultrasound evaluation
• Comprehensive infectious disease testing, drug and nicotine toxicology testing

Synchronization of the Donor and Recipient/Gestational Carrier Cycles

The next steps in the egg donation process involve careful coordination of donor and recipient or gestational carrier (GC), so that the recipient/GC is ready to receive donor eggs at the designated time.

When screening for both donor and recipient or gestational carrier is complete, each will begin a low dose oral contraceptive. After two to three weeks, each will be asked to take Lupron, a synthetic hormone that 'turns off' the normal menstrual cycle and prevents ovulation.

Ovarian and Endometrial Stimulation

Both donor and recipient or gestational carrier will continue with Lupron hormones. These hormones are injected subcutaneously or just beneath the skin, with a very fine needle. The recipient/GC will begin injections of the hormone 17 beta-estradiol (Del-Estrogen) in order to prepare her uterine lining for embryo implantation. At the same time, the donor will begin injections of ovulation-stimulating hormones to stimulate the growth of numerous egg-containing sacs called follicles. Throughout this process, both donor and recipient/GC will receive regular monitoring. The egg donor will receive regular blood tests and ultrasounds so that physicians may monitor her rate of follicular growth and hormone levels. The egg recipient/GC will be monitored through periodic testing of estradiol levels and ultrasounds to ensure that her uterus is ready for embryo implantation.

When the physician determines the optimal time for the egg retrieval, the donor receives a final injection of hCG, a hormone which will help the eggs to mature and detach for retrieval.

Egg Retrieval

The donor's eggs are retrieved in a minor surgical procedure, performed under mild anesthesia. An ultrasound image enables the physician to accurately guide a small needle through the vagina directly into the ovaries, where follicles are collected into a test tube and sent to our IVF lab. The whole procedure takes about 30 minutes, and discomfort is generally minimal. Following the retrieval, the donor recuperates under the care of our nurses for 1 – 2 hours and is then discharged into the care of a guardian for 12 hours of supervision. During this time it is okay to resume light daily activities.

The male will collect a sperm sample by masturbation the day of the egg retrieval (occasionally a second sample is needed as well). If donor sperm is being used, this will be thawed and prepared for insemination of the eggs on the day of the egg retrieval.

Fertilization and Embryo Transfer

Fertilization. Eggs mature for several hours in the Petri dish, and sperm are added – a process called insemination. Insemination is followed several hours later by fertilization, when the sperm enters the egg. On the first day after the egg retrieval, the eggs are inspected by embryologists in the laboratory to determine how many have successfully fertilized. The recipient is notified by PFC staff on this day, usually by telephone call.

The transfer of an embryo(s) to the uterus is typically performed 3 to 5 days after the egg retrieval, depending on how many embryos are available for transfer and/or freezing.

Transfer. The embryo transfer is a brief and painless procedure, requiring no anesthesia. A catheter is inserted through the cervix into the uterus. The embryos are then gently released into the uterine cavity. The recipient or gestational carrier is maintained in a recumbent position for approximately fifteen minutes, at which point she is free to go home. Learn more about recovery from embryo transfer.

If there are embryos of sufficient quality remaining, they may be frozen for subsequent transfers. Learn more about frozen embryo storage and transfer.

Post Embryo Transfer Management and Follow-up

Beginning after the transfer, the recipient or gestational carrier will receive daily injections of the hormone Progesterone (or in some cases, vaginal progesterone suppositories) in order to support the lining of the uterus so that embryos may implant. Progesterone is taken for two weeks following transfer and through early pregnancy. It is typically discontinued at 10 weeks of pregnancy, or about 8 weeks following the egg retrieval. We will usually change from progesterone injections to progesterone vaginal suppositories following the 7 week OB ultrasound, if all appears to be going well.

Approximately two weeks after the embryo transfer, the recipient receives two pregnancy tests to determine whether embryos have implanted. If the test is positive, hormone injections are continued until 10 weeks of gestation at which time the placenta will supply all the hormones necessary to sustain the pregnancy. During this time, ultrasound examination(s) will be performed to definitively diagnose pregnancy between 5 to 6 weeks after the embryo transfer.

If the recipient/GC does not conceive

In the event of a negative pregnancy test, we encourage our patients to follow up with their physician as soon as they are ready, so we can review the cycle and possible next steps. While emotionally difficult, this follow-up visit is very important to all of us. If the pregnancy test is negative, all hormonal treatments will be discontinued and menstruation will usually ensue within two weeks.