Women with egg quality issues may still have options for enjoying a pregnancy, with the help of other women who are willing to donate eggs.
If you do not have functioning ovaries or usable eggs, but you do have a uterus that responds to hormonal signals and can support a pregnancy, you may be able to use donated eggs. This means that a fertile woman would supply eggs that can be fertilized in the laboratory with your partner's sperm, using the techniques of in vitro fertilization (IVF). The resulting embryos would then be implanted into your uterus, for you to carry the pregnancy.
Most fertility clinics in the United States offer the option of using donor eggs to women up to the age of natural menopause, about age 50. Egg donation may be suggested in cases such as these:
- You no longer have ovaries, but do have a hormonally responsive uterus.
- Your eggs have been determined to be unsuitable or abnormal, as typically occurs with age, ovarian resistance, ovarian failure, and poor ovarian reserve.
- You have poor embryo quality that has brought about repeated failures with IVF.
- You carry a genetic disorder.
Most egg donors are between 21 and 32 years of age and are screened according to the FDA guidelines.
The donor may be anonymous or someone you know. Most recipients use an anonymous egg donor and rely on their fertility clinic to aid in the search for a donor. Anonymous donors are paid for their services. Regardless of whether the donor is known or anonymous, she is thoroughly screened for her personal, medical, surgical, psychiatric, and genetic (family) history.
The egg donation procedure involves the following steps after appropriate counseling:
- Donor selection and examinations. Donors are examined and screened for medical and genetic disorders. A donor will be selected by you based on desired qualities, such as hair color, eye color, and height. You will be examined, too, to rule out health problems and to ensure you have a normal uterus.
- Synchronization of your menstrual cycle with the donor's. This step occurs if you have ovaries and a cycle of your own. Both you and the donor will receive oral contraceptives; this allows you to start the medications at any time. About two weeks later, both you and the donor will be evaluated with ultrasound and a blood test to ensure your ovaries are suppressed.
- The donor cycle. Your donor will undergo ovulation induction to stimulate her ovaries so that eggs can be retrieved. Meanwhile, you will need to take estrogen hormone replacement to prepare your uterus to receive an embryo. You may be given estrogen as a pill, skin patch, or injection, either in a fixed daily dose or a steadily increasing dose over 12 to 21 days. We will use ultrasound to see whether your uterine lining has reached the necessary thickness of 6 mm to 14 mm.
- Egg retrieval. Once the donor is scheduled for egg retrieval, you will be started on progesterone replacement as well as estrogen replacement.
- Insemination and fertilization. On the day of egg retrieval, your partner will be asked to provide a semen sample, or a sample from a licensed sperm bank will be thawed and processed for egg insemination. This is done as with any IVF procedure.
- Embryo transfer. Once the eggs are fertilized, the resulting embryos will be assessed and chosen for transfer as with any IVF procedure. Timing of the transfer depends on the office procedures, but it is generally between two and six days after fertilization (most commonly 5 days).
- Hormonal supplementation during early pregnancy. You should have a positive pregnancy test about 14 to 18 days after transfer. You will continue the estrogen and progesterone supplementation until about 10 weeks of pregnancy.