Third-Party Reproduction

Third-Party Reproduction by: Jane M. Nani, MD

Oocyte Donation, available since the mid-90s, involves harvesting oocytes from the ovaries of a donor, inseminating them with the sperm of the intended father or donor sperm, and transferring a number of resulting embryos to the Uterus of the intended mother (the recipient). The CDC has been compiling data and statistics on the Assisted Reproductive Technologies (ART) on an annual basis, and the most recent governmental data published is from the year, 2004. Donor eggs were used in approximately 12% of all ART cycles carried out in 2004, totaling 15,175 cycles.

Since Infertility due to advanced maternal age is on the rise, the use of Egg Donation has grown. In general, eggs produced by women in older age groups form embryos that are less likely to implant and more likely to spontaneously abort. Consequently, egg donation is much more common among older women. The percentage of ART cycles using donor eggs increases sharply with age, starting at age 39, such that among women older than age 47, about 91% of all ART cycles used donor eggs.

At FCI, the use of egg donation has steadily increased over the last several years in conjunction with an increase in success. For example, in 2004 at FCI, a total of 68 fresh donor cycles were done with a pregnancy rate of 44%. In 2006, a total of 104 fresh egg donation cycles were completed with a pregnancy rate of approximately 82%.

Sperm donation has long been a popular alternative for couples suffering from male infertility. Donor sperm is readily available and a wide selection of sperm donors is available through several reputable sperm banks throughout the country. This is considered anonymous sperm donation. These sperm banks abide by the recommendations outlined by the ASRM with regard to screening sperm donors. Most often the list of eligible donors is available over the sperm bank's website. Frozen sperm is easily shipped overnight in a liquid nitrogen container and subsequently thawed, counted, and prepared for insemination at the fertility center laboratory. Donated sperm can be used in intrauterine insemination cycles as well as IVF cycles. The pregnancy success, when using donor sperm, is largely dependent on the quality of the eggs that the sperm fertilize.

Similarly, frozen embryos can be easily shipped and subsequently thawed and prepared for uterine transfer. The use of Embryo donation is becoming increasingly popular throughout the country as IVF success has increased in recent years. Couples who undergo IVF and are successful often have extra embryos frozen that they may never intend to use and instead are willing to "give them up for adoption." Currently, many infertility centers offer their own version of embryo adoption. In addition, at least 2 embryo banks exist in the United States, which match recipient couples to an appropriate list of available embryos.

However, unlike frozen sperm and frozen embryos, human oocytes, up until very recently, have not been amenable to the freezing and thawing process that sperm and embryos undergo. In fact, FCI is currently undertaking a study on egg freezing, but this is still in the experimental stage of development. Consequently, the ascertainment of eggs for donation is a much more complicated process.

Anonymous egg donation is exclusively carried out using fresh eggs. This requires that the individual egg donor, although perhaps known to the fertility center, is kept unknown to the recipient couple, except for the screening details, which include history and demographics. The egg donor undergoes a controlled ovarian hyperstimulation protocol very similar to any other young patient undergoing IVF.

Young donors are typically on birth control pills for 21 days, followed by approximately 10 days of daily Gonadotropin injections, during which they are monitored for follicular growth. An Ovulation trigger is then given and the Egg Retrieval is scheduled for 35 hours post ovulation trigger. The donor recovers from the anesthesia for a couple of hours, and is then discharged. The recipient generally has an easier time, because the approach is to suppress the recipient ovary, rather than stimulate it, and instead all attention is aimed toward growing the uterine lining and increasing uterine receptivity. The recipient is typically also on birth control pills, which more easily facilitates coordination with the donor's retrieval. Thereafter, the recipient is on a series of estrogen patches and vaginal estrogen for approximately two weeks, after which Progesterone vaginal cream and/or oral progesterone tablets are added.

Because of the necessity to obtain fresh eggs, which must then be fertilized with the sperm of the recipient father within hours of the donor's retrieval, the cost of egg donation far exceeds that of sperm donation. Fortunately, because Illinois has a state mandate to cover infertility services, many insurance companies cover the cost of egg donation cycles. However, no insurance covers the actual fee that the egg donor receives. Very recently this fee has risen from five thousand dollars per retrieval to seven thousand dollars per retrieval.

Because of the cost of egg donation, many prospective couples choose a known egg donor, such as a sister or other relative. Known donors, as well, must undergo initial screening labs and Ultrasound, very similar to those of anonymous egg donors. At FCI, anonymous donors must be between the ages of 21 and 32; however, greater leniency is afforded known donors.

I hope this has provided you with further insight to this exciting and rapidly expanding aspect of Assisted Reproductive Technologies. A great deal more information on this topic is available through our offices, our website, and our third-party reproduction staff. We welcome any questions by you, your staff or your patients on this or future subjects. Please feel free to contact me or anyone at FCI via e-mail, phone, or fax. Thank you for your attention.