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Couples who have problems in conceiving & infertile intending to become parents, third party recipients play an important part with regards to sperm,eggs or embryos, that have been donated for couples. If it is necessary the donors may be known or they could be anonymous to the intended recipient. In third-party reproduction ,there are certain steps involved in the process,ie legalities,ethics and social issues . Since this new methodology is in vogue , and has impacted a lot of parents , their offspring and egg donor themselves . This third-party reproduction has made ethical, social & legal,issues mandatory.
Though egg donation , the first pregnancy was achieved in 1984, since that time , egg donation has been one of the life boats, to help couples with infertility/individual to conceive. Egg donor's have been identified through the process of IVF, eggs are obtained from the donor's ovaries and donated to the respective recipient. The sperm obtained from the recipient's partner is used to fertilize the eggs, and then implanted in the uterus of the recipient.. If the pregnancy matures, the recipient will have a biological, connection to the fetus , but not a genetic relationship, nevertheless if the sperm has been donated by the partner, then the recipient will have a connection biologically and genetically.
Indications For Egg Donation
Women who had problems with their ovaries. Women became prematurely menopausal, because of certain sickness, like a disease , chemotherapy, radiation therapy,or removal of the ovaries through surgery. Women born without ovaries, egg donation was the only thing that could help them. The success of IVF technology, and egg donation this process expanded. Women found to have a significant genetic disease, egg donation was offered to them, so that this disease is not passed on to the child, this indicates that women who have a serious family condition where this cannot be determined. Women with normal-ovulation problems usually become susceptible to egg donation. This also considers women with problems to conceive and has already tried IVF which has failed, women with an age , women with no response to ovulation induction.
WHO ARE EGG DONORS?
There are different ways of becoming egg donors.
Anonymous donors: It is not necessary that the donor needs to meet or know the recipient , donors can be arranged & established through the hospital ARC Center or reputed agencies.
Known or directed donors: Known donors are usually know to the recipient, it could be close family friend or a relative , in certain cases recipient's generally go to various agencies or get in touch with a donor program affiliated to a specific hospital , or other advertise. There are different ways now, if the recipient is anxious, they advertise through the newspapers or even on the Internet. In certain circumstances the recipient and the donor become known to each other. Recipient's knowing donors through their own way, should be cautious as their could be untoward circumstances, it is always best to consider going through a hospital program or otherwise a donor agency , where there are legalities and the donors are screened.
Evaluation of the Egg Donor
It is important that donors whether known or anonymous , should go through the legal system and be screened,according to the guidelines of the donor program , or by the respective hospital. The donor's should be eligible to be a donor , and meet all the legal guidelines also be of a certain age primarily between the age of 21-34. If the donor's are between he age that is 18 years and below 34 is authentic and provides relevant information. If the donor's are of a matured age but, below 34 , they are considered to be more favorable to ovulation induction, and can produce more eggs, which are of high quality,after the embryos are implanted, and they are successful in higher pregnancy rates than older woman.
Recipients are to be informed if the donor is above the age of34, due to the cytogenetic risk, of giving birth to a child with chromosomal abnormalities, such as down syndrome. Considerably the impact on donor age with pregnancy rates.
It is mandatory that anonymous and known donors, need to fill in a questionnaire, with there past medical history and personal questionnaire on family history. In this form all details of family history, substance of abuse, genetic history , if there is any family disease, and psychological history captured accurately. As per ICMR (Indian Council for Medical Research)the council requires all egg donors to be screened thoroughly, for risk factors, and clinical evidence of communicable infections and diseases.
If the tests or screening indicates that there is presence of a risk factor,or clinical evidence of a communicable disease or infection, the donor becomes ineligible.
Anonymous donors, all information provided should be accurate, the questionnaire, should also asses, the donors interests hobbies, the donors background personality, and her motivation goals. This information will be shared with the recipient, as the recipient based on the information provided has the insight to make a decision , as she will never meet the donor. After the decision is made the donor will go through a complete medical and physical examination.
In general donors go through to a psychometric test, with the a mental health care professional. This test is done in order to check if the donor is mentally stable , also discuss many complex and ethical issues , discusses about past family history as well, If the mental heath care professional is fully satisfied with the results of the psychometric test, only then he will confirm the donor fit to donate her eggs, to the recipient.
The donors go through a series of test including screening of certain tests, like yphilis, hepatitis B and C, human immunodeficiency virus (HIV)-1 6 and HIV-2, Neisseria gonorrhoeae, and Chlamydia trachomatis, as well as screening for human transmissible spongiform encephalopathy and testing when risk factors for it exist. This is a normal procedure, that all donors undergo. Testing for infectious diseases, must be done done and noted within 30 days and prove negative, before the eggs are donated.
It is important that all donors should have their blood type and RH status documented, with complete blood count, and rubella titer. Genetic screening of donors. Is a must and should be based on the ethnicity. Donors should also be test for cystic fibrosis,(CF) mutation. Depending on which part of the country the donor is from either internationally or locally , the donor needs to go through a hemoglobin electrophoresis, screening to check for sickle cell trait and thalassemias.
If the donor is of Ashkenazi Jewish origin, CF mutation analysis and screening for Tay-Sachs disease, Canavan disease, familial dysautonomia, Gaucher disease, and other genetic diseases is indicated. Donors who are of French Canadian descent should be screened for CF as well as Tay-Sachs disease. Additional genetic testing and karyotyping of the donor is not required,however if it is standard procedure , or upon the request if the recipient.
Evaluation of the Recipient Couple
As donors also undergo screening , and evaluation, so do recipient couples as well who are in the program of IVF. Bother partners, would need to provide their background of medical history. The female partner who go through a physical exam and also a comprehensive gynecologic history. The female partner should also do an assessment of ovarian reserve, together with a blood test RH, rubella and cytomegalovirus (CMV) testing. A pap smear is also conducted for cultures of Neisseria gonorrhoeae and Chlamydia trachomatis should be obtained.
The woman needs to go through an evaluation of her uterine cavity, with a hysterosalpingogram (HSG), sonohysterogram (SHG), or hysteroscopy. If the recipient is over the age of 45, a thorough assessment, and evaluation should be conducted, with a cardiac function , risk for pregnancy-induced, hypertension and gestational diabetes. Consultation is recommended considering a high risk involved , and the impact because of the maternal age on the pregnancy, medical conditions and the impact it may have on the pregnancy. An assessment is also conducted on male partner which includes a semen analysis , blood type RH factor and genetic testing . This is part of the procedure. It is also important that the recipient, should be screen for syphilis, hepatitis B &C, HIV-1&HIV-2.
Preparation of the Donor for Egg Retrieval
In order to retrieve multiple eggs from the donor;s ovaries ,hormonal medications are given to the donor to stimulate the development of multiple eggs within the ovaries. This procedure is called ovulation induction. Hormonal medications like gonadotropin-releasing hormone agonist(GnRH-a)or gonadotripin hormone antagonist(GNRH-ant), from keeping the donor from ovulating, spontaneously,human menopausal gonadotropin(hmg) or a combination of follicle-stimulating hormone (r-FSH), both of hormonal medications are able to induce egg development. The developments of eggs by these hormonal medications are monitored by an ultrasound and measurement of hormones in the blood. Ovulation is triggered by an injection of human chorionic gonadotropin(hcg) when the eggs have developed to a normal size.
After 34-36 when the eggs are harvested from the ovary ,after the hormonal medication HCG is administered through a process called trasnvaginal ultrasound aspiration, this is carried out by paving an ultrasound probe, which is a needle guide into the vagina, the needle is placed into this guide through the vaginal wall and into the ovary. The eggs are then obtained , evaluated for maturity and then inseminated with the male's partner sperm (donor sperm may also be use) this is processed in the laboratory. For any further information on ovulation induction please get in touch with ARC Center, to help you know more at ART techniques.
Preparation of the Recipient for Embryo Transfer
In order to transfer or implant the embryos into the recipient's uterus(the endometrium/uterine lining)the embryos must be ready and well synchronized with the donors reproductive cycle. Women with an ovarian function are given hormonal medications like, GnRH-a to suppress their menstrual cycle temporarily .When the donor starts her hormonal medications to stimulate the ovaries the recipient is given estradiol, to stimulate the endometrium to form & develop. Estradiol can be given in the form of a pill, a trans dermal patch, or an injection. An assessment of the edometrium is done by an ultrasound assessment, blood test . The process of the recipient begins when progesterone is given one day after HCG is administered to the donor. When progesterone is given , there specific changes that takes place within the endometrium, which enable the embryo to be implanted, this drug may be administered to the patient in different ways , either an intramuscular injection ,vaginal gel or a tablet.
Embryos are planted in the uterus of the recipient , between 3-5 days after the eggs are fertilized in the laboratory. With the help of a small catheter with the embryos through the cervix and into the uterus are transferred. If there are any extra embryos , these embryos are frozen by cyropreserve(frozen) and use at a later stage to achieve pregnancy.
Hormonal medications are continually administered , like estradiol and progesterone until the recipient achieves pregnancy. If the pregnancy test is positive then hormonal medication is continued to keep & support the pregnancy safe for the first trimester .
Pregnancy Rates with Egg Donation
Pregnancy rates with egg donation is consider to be relatively a successful, but it depends on many factors the main factor being age of the recipient. With the advanced technology many pregnancies rates with egg donation has achieved in live birth. It depends on the percentage of these pregnancies some being triplets or grater, most of the pregnancies miscarry so it is difficult to say pregnancy rates. Mostly the number of embryos transferred ,in the effect and the effort to reduce the risks of multiple gestation's. Relatively the number embryos transferred are two if the donor is between the age of 21-34.