Donor Eggs and Sperm: IVF and IUI Options for Couples Facing Female and Male Infertility
Donor Oocytes
Oocyte donation is often
recommended for couples when the female partner is a
poor responder to ovulation induction medications,
has evidence of diminished ovarian reserve, or is
the carrier of a genetic condition. For some
infertile couples, egg donation represents the only
real chance for parenthood and the ability to
experience the entire pregnancy process from
conception to delivery. Oocyte donors can either be
designated (known to the intended parents) or
anonymous. In general, the donor oocyte process is
very similar to in vitro fertilization. The major
difference is that the egg donor undergoes the
ovulation induction and egg retrieval, while the
oocyte recipient undergoes simultaneous preparation
of her uterus for embryo implantation.
Once the eggs have been
retrieved from the donor, they are fertilized with
the recipient’s partner’s sperm. The embryos then
develop in the IVF laboratory until 3-5 days after
the retrieval, at which time the 1-2 healthiest
embryos are transferred into the recipient’s
uterus. Following the embryo transfer, the
recipient continues on her replacement hormones
(estrogen and progesterone) until the pregnancy test
is performed. In general, pregnancy rates resulting
from the use of donor oocytes exceed those seen with
IVF. Although this is primarily due to the young
age of the donors, there are also several other
factors that lead to higher pregnancy rates.
Before treatment with donor
oocytes is begun, all parties involved are required
by the Federal Drug Administration (FDA) to undergo
medical, psychological, and legal counseling. Texas
Fertility Center donors undergo a rigorous
prescreening process for genetic, psychological and
physical health abnormalities, sexually transmitted
diseases, and we also exclude potential donors with
a history of smoking, alcohol, and/or drug use.
Only those women who have passed the complete
screening process including preliminary ultrasound
and hormonal fertility screening become candidates
to be oocyte donors for a prospective recipient
couple.
Donor Insemination
(Donor Sperm)
Donor insemination is the use
of artificial insemination – typically intrauterine
insemination (IUI) - using donor sperm. Natural
conception is dependent on having a certain number
of moving sperm. If the numbers are too low to even
consider insemination using your partner’s sperm,
then we will typically recommend in vitro
fertilization (IVF), possibly with intracytoplasmic
sperm injection (ICSI). If, however, your partner
has essentially no sperm or if IVF is not a
financially viable option, donor insemination may be
offered as an alternative.
Other scenarios in which donor
insemination might be used include: treatment for a
single woman or same-sex couple, treatment if a male
partner is undergoing radiation or chemotherapy for
cancer or as an alternative if the male carries a
genetic defect that he would not want to pass on to
his children.
Sperm donors are typically less
than 40 years of age to minimize the potential risk
of genetic abnormalities associated with aging.
Usually donors are anonymous (unknown), though
occasionally a known donor might be used. A sperm
donor has to undergo rigorous blood testing to
minimize the risk of transmitting a communicable
disease. Also, the Federal Food and Drug
Administration (FDA) requires that all donor sperm
must be quarantined for a minimum of 6 months prior
to use.
Sperm banks (where donor sperm
are stored) typically obtain an extensive medical
history on the donor as well as his family. They
will provide you with detailed information about his
education, appearance, hobbies, and interests upon
request.
The sperm donor will undergo an
initial semen analysis to confirm that the sperm are
of good enough quality to undergo freezing and
thawing. If selected, the donor will produce
further samples which are washed, concentrated, and
frozen for at least 6 months. At this time the
donor is retested for communicable diseases, and the
sperm are then only available for release if all
repeat testing is negative.
Preparation for donor
insemination includes ruling out other possible
causes of infertility. Therefore a history,
physical exam, blood work, and a hysterosalpingogram
(HSG) will usually be performed.
The timing of insemination
depends on the regularity of the recipient woman’s
menstrual cycle. If she is young and has regular,
predictable menstrual cycles, than donor
insemination can be performed the day after a
positive ovulation predictor kit (OPK)
reading. If the menstrual cycles are irregular,
and/or if the woman is older, then other medications
(i.e. Clomid or gonadotropins) may be
added with additional monitoring to increase the
chance of
success.
The actual donor insemination
is a quick, simple procedure that is performed in
the office. The woman is positioned on the
examination table for a pelvic examination. A
speculum is inserted into the vagina to visualize
the cervix. The washed semen specimen is placed
through the cervix and into the uterine cavity
through a flexible narrow catheter. Some people may
experience mild cramping or spotting with this; more
significant symptoms are rare.
The success rate of donor
insemination varies according to the patient’s age
as well as the presence of other factors influencing
fertility (i.e. endometriosis or tubal disease). In
an appropriately selected population, the chance of
pregnancy simply using donor insemination ranges
from 8-15%. The success rate may be higher if other
medications are used to stimulate the ovaries.
Donor insemination does not increase the risk of
birth defects.
