Bay IVF - Advanced Reproductive Care Palo Alto 650-322-0500
Donor Egg In Vitro Fertilization
Donor Egg IVF is a highly successful treatment widely used for patients who no longer have high-quality eggs within their ovaries.
Probability of Success
Donor Egg IVF is the most effective fertility treatment available. The likelihood of a successful outcome depends primarily on the fertility potential of the egg donor, and you should expect over 50% probability of a successful outcome with a highly fertile egg donor.
We performed our first Donor Egg IVF treatment in 1988. Since that time, Donor Egg IVF has become a mainstream treatment for infertility. Over the years, we have streamlined and simplified the process of Donor Egg IVF to minimize interference with your lifestyle. A cycle of Donor Egg IVF treatment can take as little as two months and only requires 3 to 4 brief visits to the clinic.
Donor Egg IVF Offspring
Children conceived with the help of Donor Egg IVF are genetically linked to the male partner and the egg donor, but the female partner is the one who becomes pregnant, nourishes the baby throughout the pregnancy, and experiences the childbirth.
Selecting an Egg Donor
Your egg donor can be someone blood related to you (female partner) to preserve the genetic link, or you could choose a donor from one of the many egg donor agencies. Most (but not all) donor agency Donor Egg IVF treatments are anonymous.
Once your Donor Egg IVF treatment at Bay IVF is completed (approximately 6-8 weeks into your pregnancy), the pregnancy becomes indistinguishable from a conception through intercourse, and your obstetrical care should be no different than if you conceived without any treatment.
Once you select your egg donor, she will become a patient at our center and will be medically and genetically screened by us.
Donor Egg IVF Procedure
Donor Egg IVF treatment consists of:
Ovarian stimulation of egg donor
Egg retrieval procedure
Fertilization of eggs
Culture of embryos
Assisted hatching of embryos (when indicated)
Preparation of recipient mother’s uterus
This is an example of a Donor Egg IVF treatment protocol. Your treatment is always individualized and may take less or more time to complete:
Donor Egg IVF treatment begins with the onset of the egg donor’s menstrual period. Oral contraceptives are started within the first four days of the menstrual cycle. They prime the ovaries for optimal response.
Seven days before the estimated onset of her next menstrual period, Lupron injections begin. Lupron prevents premature release of the eggs from the ovaries prior to the egg retrieval procedure and decreases the level of male hormones (beneficial for egg quality). The Lupron injections are given subcutaneously (just under the skin).
After approximately seven days of taking Lupron, the donor will start her menstrual period. Shortly after the onset of the period, follicle stimulating hormone (FSH) injections will begin. FSH stimulates production of multiple eggs in the ovaries. FSH injections are given subcutaneously with tiny needles. FSH injections are administered daily for approximately ten days.
During this time, the egg donor’s progress is monitored by estradiol (estrogen, E2) and progesterone blood levels and ultrasound examinations. Once the follicles (grape-like structures within the ovaries containing eggs) are at the appropriate size, Lupron and FSH are stopped, and she will take a single injection of Human Chorionic Gonadotropin (HCG). This is also a subcutaneous injection. This medication triggers the final stages of egg maturation. Thirty-six hours after the HCG injection, the eggs are aspirated from the ovaries.
The ultrasound image below shows a stimulated ovary. Each of the several follicles (dark circles) contains a microscopic egg.
Egg Retrieval Procedure
The egg retrieval procedure is performed at our center. The procedure only takes a few minutes, and we use very comfortable conscious sedation for analgesia.
Under ultrasound guidance, the tip of a thin needle is passed through the top of the vagina into the cul-de-sac (a space behind the uterus). The ovaries are located near the bottom of the cul-de-sac allowing the tip of the aspirating needle to enter the ovarian follicles and aspirate the follicular fluid from them. The fluid is examined under a microscope to identify the eggs.
The egg retrieval procedure is the last step in the donor’s participation. She will have her normal menstrual period within two weeks of the egg retrieval.
Fertilization of Eggs
On average, twelve to sixteen eggs are aspirated during the donor egg retrieval procedure. The eggs are identified under the microscope and placed in petri dishes filled with culture medium. The composition of the medium resembles the fluid secreted by the Fallopian tubes. This allows the eggs and embryos (fertilized eggs) to develop in our laboratory environment at the same rate as inside the Fallopian tubes.
The male partner collects a semen specimen by masturbation the day of the egg retrieval. The highest quality sperm are extracted from the semen and combined with the eggs six hours after the egg retrieval. This process of in vitro fertilization takes place over several hours during the evening after the egg retrieval.
If the male partner has never caused pregnancy, or if your test results indicate a possibility of significant male infertility, Intracytoplasmic Sperm Injection (ICSI) is performed. In ICSI, a single sperm is inserted into an egg. This can significantly increase the probability of normal fertilization for selected patients.
Culture of Embryos
Evidence of fertilization can be seen the next day, 16 hours after insemination. The fertilized eggs are transferred into a growth medium and continue to be cultured in our laboratory.
A normally fertilized egg (zygote) will show two pronuclei representing the genetic material from the egg and sperm.
The following day, embryos should divide into 4 cells, the day after into 8 cells.
This picture shows a morphologically exquisite, day three, 8-cell embryo. At this stage, human embryos are still microscopic and invisible to the naked eye.
By the fifth to seventh day after the insemination, embryos should reach the blastocyst stage (80 or more cells).
This picture shows an advanced stage of blastocyst development. Notice the central fluid-filled cavity. The cells within the blastocyst have already differentiated into the inner cell mass (at seven o’clock) that will give rise to the fetus and the trophectoderm cells that will form the future placenta.
Assisted Hatching is a laboratory procedure used to create a "weak spot" in the egg shell of an embryo. For selected embryos, this increases the likelihood of the embryo being able to hatch out of its egg shell, implant, and result in a baby.
This picture shows an embryo after assisted embryo hatching with an opening breaching the egg shell at 12 o´clock position.
Preparation of Recipient’s Uterus
The lining of the recipient mother’s uterus must be prepared to support implantation and growth of the embryos. The development of the uterine lining must be accurately synchronized with the development of the embryos. This is achieved by taking estrogen and progesterone.
The treatment begins with taking oral contraceptives. They are used to suppress the recipient mother’s ovarian function and to initiate the process of synchronization.
Seven days before the estimated onset of the next menstrual period, Lupron injections begin. Oral contraceptives and Lupron "put the ovaries to sleep" and temporarily stop their production of estrogen and progesterone. This estrogen and progesterone secretion by the ovaries would interfere with the development of the endometrial lining. The volume of the Lupron injections is very small, and they are given just under the skin. Women who do not have spontaneous menstrual periods typically do not have to take the Lupron injections.
After approximately seven days of taking Lupron, you will start your menstrual period. Within one to three weeks of the onset of the period, you will begin taking estrogen in the form of skin patches. The progress of the development of your uterine lining is monitored with ultrasound and your blood level of estrogen.
Once the egg donor is ready for her egg retrieval, you will start taking progesterone. The addition of progesterone opens the "window of receptivity" of your uterus and synchronizes development of its lining with the development of the embryos. Progesterone is given as vaginal capsules.
The embryo transfer is performed two, three, or five days after the egg retrieval depending on the number and development of your embryos. The gamete embryologists assess the embryos prior to the embryo transfer to determine their likelihood of implantation.
This probability of success is one of the factors determining the number of embryos to transfer. Dr. Polansky will help you with your decision, but you will have the "last say." Most partners select one or two embryos for the transfer.
Just prior to the embryo transfer, the embryos are placed into the tip of a very thin embryo transfer catheter. The catheter is then passed through the cervical canal to within 15 mm of the top of the uterine cavity, and the embryos are gently released. The length of your uterus was assessed during your pre-treatment evaluation.
Having done thousands of embryo transfer procedures, Dr. Polansky will precisely place your embryo(s) within the endometrial cavity. The embryo transfer usually takes only a few seconds to complete, and no resting is required afterward.
There may be more embryos than the future parents wish to have transferred. It is possible to vitrify (freeze) these embryos and store them in liquid nitrogen. A large majority of the embryos will survive the vitrification and thawing process. The implantation rate of the thawed embryos is equal to the "fresh" embryo implantation rate.
After the embryo transfer, the endometrial lining gently holds the embryos within the top of the uterus. There is no restriction of your physical activity.
This picture shows a healthy blastocyst in the process of "squeezing out" of its eggshell. Once fully hatched, it will stay in the uterus unattached for one to two days and then implant.
A blood pregnancy test is done two weeks after the embryo transfer. If the pregnancy test is positive, an ultrasound examination is scheduled two weeks later to visualize the implantation site and to look for a heartbeat within the embryo. Once a heartbeat is seen, there is a 95% probability that the pregnancy will continue to a baby.
This ultrasound picture shows a six-week pregnancy. The pregnancy sac is 25 mm in diameter. The baby inside the sac is only 13 mm long. It is already possible to distinguish the baby's head and body and to see the cardiac activity.
Supplementation of estrogen and progesterone must continue until the placenta produces enough of its own estrogen and progesterone to sustain the pregnancy. You will be closely monitored for 6 to 8 weeks as this transition takes place. Once all medications are discontinued, you will be referred to your OB doctor for the remainder of your obstetrical care.
Please use the following links for financial information about Donor Egg IVF and to schedule a consultation.