For many women, including disease and / or diminished ovarian reserve for achieving pregnancy using their own eggs. Since the vast majority of these women otherwise healthy enough and physically capable of having a child are offering egg donation (ED) go with a realistic chance of infertility to parenthood.
Egg donation is associated with some advantages is. First, in many cases more eggs retrieved from a donor younger, as there are normally usedcomplete a cycle of IVF. As a result, there is often an excess (surplus) of embryos for cryopreservation and storage. Secondly, because of aneuploid eggs derived from a young woman is less likely than their older colleagues to produce (chromosomal abnormalities) embryos, the risk of birth defects and miscarriage such as Down syndrome is greatly reduced.
Egg donation-based, fresh and frozen embryo transfer cycles at 10% -15% of in vitro fertilization performed in the United States. Thevast majority of egg donation procedures performed in the U.S. the participation of women with ovarian reserve in decline. While some of these ready to premature ovarian failure, most are performed in women over 40 years. Recurrent IVF failure due to "poor quality" eggs or embryos, a relatively common indication for ED in the United States, increasing evidence for ED in cases of homosexual relationships (predominantly female), in which both partners want to share experiences his parents' throughwhich acts as a supplier of eggs and the other as a receiver.
Ninety percent of egg donation in the United States through the purchase of anonymous donors who are recruited through a state-licensed agency donors did. It is less common for donors known to the receiver get the services of a donor agency, even if it does happen from time to time. It is not easy for donors who are willing to find a place in such an agreement open. Consequently, the vast majority of cases in whichthe services of a known donor is achieved, is through a private agreement. While the services are sought by non-family members sometimes serve is much more common for the receiver as close relatives to donate their eggs approach.
Some of the recipients know the feeling of constriction, or at least met their egg donation in order to acquire first-hand familiarity with their physical, intelligence and character. That said, the United States is much more likely to beseek the services of anonymous donors. (Ren) in relation to the disclosure of their families, friends and children, tend receiver with anonymous donors are much more open than that of donors known about the nature of the child's conception. Most if not all, offer egg donors a detailed profile, photographs, and family medical history of each potential donor for the benefit and information of the recipient. Agencies usually have a website that can be accessed via the receiver in the profiles of donorsthe privacy of your home, choose the ideal donor.
The interaction between the recipient and the donor program can be made in person, by phone or online in the early stages. Once the choice was restricted by a donor to two or three, the recipient will be asked to forward all medical records relating to your doctor chose IVF. Upon receipt of the documents, a detailed medical advice and subsequently maintained a physical examination by the attendingPhysician or a qualified alternate designated party is expected. The entire process is usually neglected, be facilitated and orchestrated by a donor program nurse coordinators to resolve in consultation with the attending physician, all medical problems, financial and logistical, and answer questions. At the same time, the final process of selection of donors and donor-recipient matching has been completed.
Egg donors typically the age limit of donorsWomen under 35 years with normal ovarian reserve to minimize, in an attempt to reduce the risk of resistance to the ovaries and deny the negative influence of the "biological clock" (donor age) on egg quality.
No single factor alone instills more confidence in terms of future reproductive potential of a donor as a story of her first pregnancy achieved alone, or one or more recipients reached their eggs with a live birth. In addition, a track record that makes far moreED likely to have such a "good quality eggs." The fact that light alone and reduces the likelihood of receiving tubal infertility or organic. That said, the current shortage in the supply of donors, it is neither reasonable nor feasible to advertise for donors to those women who could meet these strict criteria to limit the qualification.
It is not unheard of that a donor who is in a certain time after the donation of oocytesno adhesions on their land or tubal disease to their infertility, complications with the status of the surgical removal of oocytes is due to understand guilt. You can also start a lawsuit against the doctor and IVF program. There should be no surprise that there is a measurable degree of comfort, AND the program, when a potential donor is able to demonstrate that they have experienced a relatively new, trouble-free spontaneousPregnancy.
Screening of donors
Genetic Screening: The vast majority of IVF programs in the United States follow the recommendations and guidelines of the American Society of Reproductive Medicine (ASRM) for selective genetic screening of potential donors for diseases such as sickle cell trait or disease, thallasemia, cystic fibrosis and disease Tay-Sachs disease when medically indicated. Consultation with a geneticist is about 90% of the programs available.
Most of the recipientsCouples attach great importance to the emotional, physical compatibility, ethnic, cultural and religious with their donor's choice. There are in fact often insist that the donor is heterosexual.
The psychological screening: Americans tend to place much emphasis on the psychological screening of donors. Since most donors are "anonymous", it is the agency or ED IVF program to determine the level of donor commitment and motivation for the decisionProvide this service. I have occasionally met with donors who gave way under the stress and delay the middle of the river have during their cycle of stimulation with gonadotropins. In one case, a donor gonadotropin administration deliberately stopped without informing anyone. He simply waited for termination, which occurs when the follicles ceased to grow and their plasma E2 concentrations had to be raised.
These concerns mandate donor evaluation, motivation and engagement with appropriatePriority. Most of the recipients in the United States tend to be much influenced by the "character" of the future donor believe that a character defect are probably genetically transmitted to offspring. In fact, unlike some psychosis such as schizophrenia or bipolar disorders, are character flaws and neuroses are usually most likely due to environmental factors associated with education are determined. And 'unlikely to be transmitted genetically. However, donorscounseling and screening should be done and must be directed at the control of a qualified psychologist. If in doubt, should be referred to a psychiatrist for further examination. Targeted use of tests such as the ', Meyers-Briggs, MMPI and NEO-personality indicator used to assess personality disorders. Significant discrepancies, if detected, would lead to automatic disqualification of such potential donors.
When it comes to choosing a donor known, isEqually important is to ensure that they are not obliged to participate. We try to recipients who may consider a close friend or family member named as the donor in respect of the potential always exists that the donor can be durable and serve an unwanted participant in the life of their new family care.
Drug Screening: Due to the prevalence of drug abuse in our society, we have targeted for urine and / or serum drug tests of our vocationDonors.
Screening for sexually transmitted diseases: FDA and ASRM guidelines recommend that all donors for sexually transmitted diseases before they are tested in a cycle of IVF. Although it is highly unlikely that the DNA and RNA viruses, an egg or an embryo through sexual contact or in vitro fertilization may be transferred, women with viruses such as hepatitis B, C, HTLV, HIV, etc., are infected with the participation of in vitro fertilization disqualified from the donation of ova (abeit remote) possibility of transmission, asand possible legal consequences of the process of egg donation is charged for its presence.
It may also have the main evidence of prior infection with chlamydia or existing or gonorrhea, the possibility that the donor could do irreparable damage to the fallopian tubes or adhesions, which made sterile. As already mentioned, such as infertility, then enable the detection of infections that are made have occurred during the egg retrieval process responsible forThe exposure of caregivers to the litigation. Even if a donor or a recipient carrying a pathogenic viral and bacterial sexually transmitted, is willing to give up all legal rights, there is still a potential risk that an affected offspring following in later life may bring an action for wrongful birth.
Screening of the receiver
Medical evaluation: Although age is over 40 years are in fact associated with an increasing incidence of complications during pregnancy, these riskslargely predictable from a careful medical evaluation prior to pregnancy. The fundamental question "is the woman in a position of engagement with a safe pregnancy would end in the safe birth of a healthy baby?" must be asserted before the infertility treatment has begun. For this reason, a careful cardiovascular, liver be made after evaluation of early metabolic and anatomical reproductive in vitro fertilization in all cases.
Infectious screening: the need for carefulinfectious screening for embryo recipients cannot be overemphasized. Aside from tests for debilitating sexually transmittable diseases, there is the important requirement that cervical mucous and semen be free of infection with ureaplasma urealyticum. This organism which rarely causes symptoms frequents the cervical glands of 15-20% of women in the U.S. The introduction of an embryo transfer catheter via a so infected cervix might transmit the organism into an otherwise sterile uterine cavity leading to early implantation failure and/or first trimester miscarriage.
Immunologic Screening: Certain autoimmune and alloimmune disorders (see elsewhere) can be associated with immunologic implantation dysfunction (IID). In order to prevent otherwise avoidable treatment failure, it is advisable to evaluate the recipient for autoimmune IDD and also to test both the recipient and the sperm provider for alloimmune similarities that could compromise implantation.
Disclosure and Consent
Preparation for egg donation requires full disclosure to all participants regarding what each step of the process involves from start to finish, as well as potential medical and psychological risks. This necessitates that significant time be devoted to this task and that there be a willingness to painstakingly address all questions and concerns posed by all parties involved in the process. An important component of full disclosure involves clear interpretation of the medical and psychological components assessed during the evaluation process. All parties should be advised to seek independent legal counsel so as to avoid conflicts of interest that might arise from legal advice given by the same attorney. Appropriate consent forms are then reviewed and signed independently by the donor and the recipient couple.
Most embryo recipients fully expect their chosen donor to yield a large number of mature, good quality eggs, sufficient to provide enough embryos to afford a good chance of pregnancy as well as several for cryopreservation (freezing) and storage. While such expectations ore often met, this is not always the case. Accordingly, to minimize the trauma of unexpected and usually unavoidable disappointment, it is essential that in the process of counseling and of consummating agreements, the respective parties be fully informed that by making best efforts to provide the highest standards of care, the caregivers can only assure optimal intent and performance in keeping with accepted standards of care. No one can ever promise an optimal outcome. All parties should be made aware that no definitive representation can or will be made as to the number or quality of ova and embryos that will or are likely to become available, the number of supernumerary embryos that will be available for cryopreservation or the subsequent outcome of the IVF donor process.
