We are having far fewer children than heterosexual couples, and as a result our Gay DNA is not being passed on at a competitive rate.
We must sell our gametes to egg and sperm banks. These clinics are the location where our reproductive objectives can be achieved.
Common Candidates for Egg Donation Program:
Candidates for egg donation/IVF generally fulfill one or more of the following criteria:
1. Women with ovarian resistance to stimulation by fertility drugs, or with an elevated level of Follicle Stimulating Hormone (FSH) greater then 15 MIU.
2. Poor fertilization of eggs in spite of good quality sperm
3. Failure to achieve a viable pregnancy following repeated attempts at IVF.
4. Absent ovarian function due to previous surgery, radiation, or chemotherapy.
5. Premature menopause (under the age of 40 years).
7. The presence of genetic disorders (usually dominant) that have a high likelihood of being transmitted via the woman's eggs to the offspring.
8. Women over the age of 40 who want to improve their chances of achieving a healthy pregnancy.
Success Rates with Egg Donation:
The national IVF/egg donation success rates are approximately 30% per embryo transfer. Many clinics claim to have a 50% or greater ongoing pregnancy rate per embryo transfer procedure (with fresh embryos).
Evaluation of the recipient and her partner will include the following:
1. The recipient will have cervical cultures to check for the presence of organisms such as chlamydia or ureaplasma that might interfere with a successful outcome. She will also have blood drawn for prolactin and thyroid stimulating hormone measurements and antisperm antibody testing.
2. The male partner will undergo a semen analysis, semen cultures to screen for the presence of organisms such as chlamydia and ureaplasma that might interfere with a successful outcome.
3. The recipient will undergo an ultrasound examination of the uterus as well as a hysteroscopy (where a thin telescope-like instrument is introduced through the cervix into the uterus) to look for the presence of lesions that might interfere with implantation, such as fibroid tumors, polyps, or scarring. This procedure is performed in the office under local anesthesia. If the recipient has had a recent HSG (dye test) and the films or report specifically state the normal appearance of the uterine cavity, then the hysteroscopy is often be waived.
4. The recipient will also undergo a thorough clinical evaluation and blood tests to screen for hepatitis, HIV, sexually transmitted diseases, and the presence of antibodies which might interfere with implantation.
5. The recipient couple will meet with a designated counselor to discuss important psychological and social issues related to the use of donor eggs..
6. The recipient and her partner will visit with the clinical coordinator to outline the exact process in a step-by-step fashion.
Once all the evaluations have been completed, the clinic, the recipient and her partner will select an appropriate month to begin the cycle of treatment.
Most clinics follow the official ASRM and FDA guidelines for egg donation. You can access these documents by clicking on the links above. An anonymous egg donor is usually recruited through an egg donation agency. These agencies obtain their donors from colleges, universities, or through ads in local newspapers or magazines. Once you pass the initial screening phase of the application process and are determined to be a good egg donor candidate, you will undergo a full medical and laboratory evaluation. Childhood, family and adult photos are often required. Genetic, family, personality, and medical histories are taken. A thorough clinical examination is performed, as well as specific blood tests to exclude HIV, hepatitis, and other sexually transmitted diseases. You will have blood drawn on the second or third day of a spontaneous menstrual cycle for measurement of Follicle Stimulating Hormone (FSH), and estradiol. A measure of your intelligence is determined through interviews, SAT scores and/or GPA (grade point average,) and educational background. A degree from an accredited university, or current enrollment in a degree program is preferred. Sometimes the Weschler Adult Intelligence Scale IQ test is also administered. Most Clinics ask for medical and genetic history going back three generations. A brief profile of your family members, their careers and lifestyles may also be asked for. Donors are also often chosen on a basis of their motivations to help infertile couples.
Additional Screening May Often Include:
1. Blood tests: HIV, HTLV 1, HEPATITIS, RPR PR VDRL, ABO TYPE and RH, Rubella
2. Pelvic Exam: Pap smear, GC, Chlamydia (DNA probe),
3. Urine: Urine drug screen
As screening for sexual partners may often be required, if you are currently involved in a homosexual relationship it is best to state that you are single. Homosexual applicants are in most cases automatically excluded from donor programs.
Synchronizing the Recipient's and the Donor's Cycles:
Both the donor and the recipient will usually be placed on birth control pills and Lupron in order to synchronize their cycles. In natural cycles, women will usually ovulate only one egg. In order to increase the chances of pregnancy occurring in an egg donation cycle, the goal is to stimulate the donor's ovaries to produce multiple eggs so that more than one embryo will be available for transfer to the recipient' uterus. This stimulation is accomplished with medications known as gonadotropins (Gonal-f, Follistim, Fertinex).
Instead of medication to stimulate egg development, the recipient requires hormone injections of estradiol and progesterone (via a progesterone vaginal gel preparation known as Crinone) to prepare her uterine lining for implantation of the transferred embryo(s). Some recipients are menopausal and accordingly have inactive ovaries. The administration of preparatory hormonal therapy, is such cases, is initiated without Lupron. For those recipients with functioning ovaries (generally manifested by menstruation), Lupron therapy will be necessary to avoid potential interference by the "natural" hormones produced by the ovaries. The duration of Lupron therapy is adjusted to synchronize the recipient's cycle with that of the donor's ovarian stimulation cycle.
Process for the Egg Donor:
In the cycle immediately preceding the treatment cycle, you will be asked to use barrier contraception or to abstain from sexual intercourse (being a lesbian, this should not be an issue for you, as the intent is to prevent pregnancy). Beginning approximately seven days before your period is due, treatment with Lupron is initiated. This medication is administered daily by subcutaneous injection and prevents the occurrence of premature ovulation later in the cycle. With the onset of menstruation, your ovaries and uterus are evaluated by ultrasound to confirm that it is safe to begin treatment with the gonadotropins.
The first day of gonadotropin injections is arbitrarily referred to as Cycle Day 2. Five days after beginning treatment (Cycle Day 7), a blood estradiol level is obtained. Two days later (Cycle Day 9), daily ultrasounds and blood estradiol examinations begin. Beyond that day, it commonly requires one to three additional days of treatment before optimal follicular (egg) development is achieved. At that point, the ovulatory trigger, hCG (Chorionic Gonadotropin, Profasi, Pregnyl) is given. In order to capture eggs prior to ovulation, they are harvested 36 hours after the hCG injection by transvaginal ultrasound-guided needle aspiration.
The month prior to follicular stimulation, the donor will use birth control pills for approximately 3-5 weeks. Lupron is started the last 5 days of the pill. Lupron is administered daily to desensitize the ovaries, or quiet the brain-ovary communication. When the pill is stopped and the menstruation begins, the donor comes to the Center for a baseline ultrasound examination and blood test to confirm the quieting of the brain-ovary communication and to exclude the presence of ovarian cysts.
The gonadotropin medication (Follistim, Gonal-F, Fertinex, Pergonal or Repronex) is started on a specified day, and is referred to as Cycle Day 2 (CD2). After 5 days of medication the blood test and ultrasound examination are repeated to assess the number of follicles or eggs developing. Daily ultrasound examinations and hormone measurements begin on CD9. Once monitoring confirms optimum follicular development, the ovulatory trigger, hCG or Profasi, is given. The eggs are retrieved 36 hours after this injection by transvaginal ultrasound needle-guided aspiration.
Eggs are retrieved by transvaginal ultrasound needle-guided aspiration. This procedure is performed using intravenous (IV) sedation administered by an anesthesiologist to ensure complete patient comfort and safety. The egg retrieval involves the passage of a needle through the upper vagina, and into the ovary(ies) for the purpose of extracting the eggs. By means of a suction device connected to the needle, the egg and fluid within each follicle are aspirated. The egg retrieval takes about 30 minutes to accomplish and requires approximately 1-4 hours of post-operative recovery. The woman can usually return to normal activity within 6-12 hours. Any discomfort after the procedure is generally adequately relieved with acetaminophen.
Building the Recipient's Lining with Hormonal Injections:
In a monthly cycle the uterine lining is built up in response to the hormone estradiol which is produced by the growing eggs. In the recipient, we replace the egg derived estradiol with the medication Estradiol Valerate. Estradiol valerate is the principal hormone used to stimulate growth of the uterine lining and is injected twice weekly. After initiationof these injections, blood is drawn to measure serum estradiol concentrations which determine any changes in dosing that may be necessary.
Approximately three days prior to anticipated embryo transfer, twice daily vaginal application of Crinone (progesterone gel) begins in order to optimize the endometrium for implantation. Ultrasound examinations are performed beginning 10 days to two weeks after initiating the injections to evaluate whether optimal endometrial development has taken place. Approximately 4 days before the anticipated embryo transfer, daily injections of progesterone begin in order to optimize the endometrium for implantation. In the uncommon event of poor endometrial development, the couple will be given the choice of having the donor's eggs harvested, fertilized, and stored in the frozen state (cryopreserved) for transfer to the recipient's uterus in a subsequent cycle, or alternatively to have the procedure canceled.
Fertilization and Implantation:
Eggs removed from the ovaries are immediately examined and graded. They are placed in a specialized culture medium in preparation for fertilization with sperm. The sperm is specially prepared and enhanced through washing and centrifugation. A quantity of sperm is added to each egg. In this environment, fertilization occurs naturally. The incubation process begins. Approximately 16-24 hours later, the eggs are inspected microscopically to detect fertilization.
Transferring the Embryo(s) to the Recipient's Uterus:
Some clinics allow donation three to five days after egg retrieval. Many clinics freeze and store embryos for a minimum six-month quarantine period. This is primarily to insure that diseases such as HIV and Hepititis are not carried by the embryo or given to the recipient. In this situation, it is often a requirement that the donor must have repeat negative infection blood screens before the embryos can be released from quarantine for use by the recipient couple.
The embryos are transferred via a thin plastic tube through the cervix into the uterine cavity. They are then deposited in the upper part of the uterus and the catheter is withdrawn. This is generally a painless procedure and the patient remains immobile for 1.5 hours, after which she is sent home. As implantation will occur in the following two or three days, patients are often instructed to rest at home during the time after the transfer.
Depending on the quality of the embryos and the couple's preference, the embryos may be transferred into the woman's uterus 3 or 5 days after egg retrieval. Three days after egg retrieval, the embryos have cleaved and contain 6 to 10 cells each. If embryo transfer is performed at this time, approximately 3 to 5 embryos are transferred depending on the couple's desires and the quality (grading) of the embryos. 5 days after egg retrieval at a more advanced stage of development (blastocyst stage), the blastocysts have a higher implantation rate than embryos grown only three days, and are more likely to succeed in initiating a pregnancy. As result, only two blastocysts need to be transferred to have the same pregnancy rate usually seen when 3 or more embryos that have been grown for only 3 days are transferred into the uterus. As a result, fewer embryos are needed to achieve the same or higher pregnancy rate, with a lower incidence of multiple gestation.
Post Embryo Transfer Management and Follow-up:
After the transfer, the recipient continues the hormone injections of Progesterone and Estradiol (or Estradiol and the Crinone) in order to sustain an optimal uterine environment for implantation and subsequent pregnancy sustenance. Valerate is also often used during the post-embryo transfer phase. Eight and ten days after the transfer a pregnancy test is performed. If the test is positive, it indicates that implantation is taking place. In such an event, the hormone injections will continue for an additional 6-8 weeks until the placenta is fully functional. In the interim an additional blood pregnancy test will be done to confirm all is well with the pregnancy. An ultrasound to clinically confirm the pregnancy and identify the number of embryos, which implanted is performed approximately 4 weeks later. If the pregnancy test is negative, all hormonal treatment is discontinued and menstruation will ensue within 3-10 days.
If the recipient does not conceive, she may have any frozen embryos thawed and transferred to her uterus in a subsequent cycle.
If in spite of both the initial attempt and the subsequent transfer of thawed embryos, the recipient does not conceive, she may schedule a new cycle of treatment.