DONOR INSEMINATION

Donor insemination (DI) uses sperm from a donor to help the woman become pregnant.
Sperm donors are screened for sexually transmitted diseases and some genetic disorders. In DI, sperm from the donor is placed into the neck of the womb (cervix) at the time when the woman ovulates.
DI - IUI uses intrauterine insemination with donor sperm.
Donor sperm can also be used for in vitro fertilisation (IVF).

• In vitro fertilisation (IVF)
• Intrauterine insemination (IUI)

A clinic is likely to recommend donor conception if:

• you are not producing eggs or sperm of your own
• your own sperm or eggs are unlikely to result in conception
• you have a high risk of passing on an inherited disease
• you are in a same sex relationship, or
• you are single.

If you are considering using donated sperm, eggs or embryos, you will need to think about some complex issues before starting treatment. For this reason, you will be offered counselling; many clinics regard it as essential and will not offer donor conception treatment without it. Try to also talk to people who already have donor-conceived children.

How does DI work?

Using donated eggs

Donated eggs can be used in either in vitro fertilisation (IVF) or intra-cytoplasmic sperm injection (ICSI). Read more about these treatments in the previous sections.
The procedure for using donated eggs varies depending on your clinic and the fertility treatment you are undergoing. A typical procedure may involve the following steps:

 

For women:

1. You and your donor will be given medication to synchronise your menstrual cycles. You will also be given medication to prepare the endometrium lining of your womb for embryo transfer.
2. The donated eggs will be fertilised using IVF or ICSI. 
3. When the embryos begin to develop, they will be transferred to your womb as in conventional IVF. As the eggs will be from donors aged 35 or younger, no more than two embryos will be transferred.

Alternatively, the embryos may be frozen after they have been fertilised. This avoids the need to synchronise your menstrual cycle with that of the donor and may reduce the stress of the treatment.

For men:

1. Unless you are using donor sperm, before treatment takes place you will give a sperm sample to check that your sperm are healthy and active.
2. On the day that the eggs are collected, you will give another sperm sample.
3. The sperm sample is mixed with the donor eggs in vitro to fertilise them, or fertilised by ICSI and then transferred to the womb.

Using your eggs in your partner’s treatment

If you are in a same sex female couple and you want to use your eggs and your partner carry the baby, the process for collecting your eggs will be as follows:

1. After being screened for sexually transmitted diseases and some genetic disorders, you will be given a series of hormone injections to help develop and mature the eggs within the ovaries.
2. Once the eggs are matured, they are collected while you are sedated by inserting a needle into the ovaries through the vagina.

The eggs will then be fertilised, usually using IVF.

Donor insemination (DI) - chance of success

Female fertility diminishes with age, so if you are using your own eggs, on average, the younger you are, the higher your chances of success.
Some women receive fertility drugs to boost egg production before the sperm is transferred. We now present the stimulated and unstimulated cycles seperately.
In 2010 (the year for which the most recent data is available) women receiving unstimulated donor insemination (DI) - including intrauterine insemination (IUI) and GIFT - the percentage of cycles started that resulted in a live birth was:

• 14.6% for women aged under 35
• 11.4% for women aged 35-37
• 9.4% for women agend 38-39 
• 4.7% for women aged 40 and over

In 2010 (the year for which the most recent data is available) women receiving stimulated donor insemination (DI) - including intrauterine insemination (IUI) and GIFT - the percentage of cycles started that resulted in a live birth was:

• 20.7% for women aged under 35
• 17.1% for women aged 35-37
• 11.9% for women agend 38-39
• 5.3% for women aged 40 and over

EMBRYO TRANSFER

So you've had an embryo transplant, but still do not conceive. It is normal to blame yourself for something you may or may not have done during this time. Therefore, try not to do anything for which you will blame yourself if you do not get pregnant. In general practice the following guidelines:
 

• No tub baths or swimming for 48 hours after embryo transfer.
• No douching or wearing tampons. 
• No intercourse or orgasms until the fetal heartbeat is seen on ultrasound, or the pregnancy test is negative.
• No excessive physical activity such as jogging, aerobics, or tennis.
• No non-prescription medications or other prescribed medications without the approval of your doctor.
• No heavy lifting.
• You may return to "work" after 24 hours of bed rest (getting up for bathroom and meals only) and one to two days of light activity.

Doctors used to advise "strict bed rest" after an embryo transfer. However, remember that physical activity does not affect your chances of getting pregnant. Resting when you are well can be very emotionally taxing, and we encourage patients to lead as normal a life as possible. 

After a transplant, there are numerous stages which must be reached and completed before conception.

• More than one egg should develop.
• Eggs should mature.
• Ovulation should not occur before the eggs can be collected.
• Eggs must be retrieved during the "pick-up".
• Sperm must fertilize at least one egg
• Fertilized eggs must divide and grow healthily.

The embryos might get implanted in the uterus.

Think of it as a series of hurdles, all of which have to be cleared, in order to win the race!

 

Maximizing Chances for Success

Women:

• Avoid all medications. If you are taking other prescription medications check with your doctor prior to beginning your treatment cycle. 
• No smoking or alcohol use. Studies show both can result in lower pregnancy rates and a greater risk of miscarriage. Why put yourself through this if you are not doing everything YOU can to insure your success.
• No more than two caffeinated beverages per day.
• Avoid change in diet or weight loss or fad diets during IVF cycle. A healthy well balanced diet works best.
• Refrain from intercourse three to four days prior to egg retrieval and following embryo replacement until the pregnancy test has been done. 
• Normal exercise may continue unless enlargement of your ovaries produces discomfort.
• Avoid hot tubs or saunas.

Men:

• Fever greater than 100.4o one to two months prior to IVF treatment may adversely affect sperm quality. Be sure to let your doctor know. If you are sick, please take your temperature and report any febrile illnesses. 
• Sitting in hot tubs and saunas is not recommended. Even a single episode in a hot tub can adversely affect sperm function. Please refrain from this for at least three months prior to treatment.
• Drugs, alcohol, and cigarette smoking should be avoided for three months prior to treatment and at all times during the ongoing IVF treatment cycle to get the best results.

Abstain from intercourse for at least three days, but not more than seven days prior to collection of semen for egg collection and during treatment.

Intra-cytoplasmic sperm injection (ICSI)

Intra-cytoplasmic sperm injection (ICSI) differs from conventional in vitro fertilisation (IVF) in that the embryologist selects a single sperm to be injected directly into an egg, instead of fertilisation taking place in a dish where many sperm are placed near an egg.  

ICSI enables fertilisation to happen when there are very few sperm available.

Your clinic may recommend ICSI if:

·         you have a very low sperm count

·         other problems with the sperm have been identified, such as poor morphology (abnormal shape) or poor motility (not moving normally)

·         during previous attempts at IVF there was failure of fertilisation or an unexpectedly low fertilisation rate

·         you need sperm to be collected surgically from the testicles or epididymis (a narrow tube inside the scrotum, where sperm are stored and matured); for example because you have had a vasectomy, you do not ejaculate sperm, or because you have extremely low sperm production

·         you are using frozen sperm in your treatment which is not of optimum quality

·         you are using embryo testing.

How does ICSI work?

Before your treatment starts you will need to complete various consent forms and you, and if applicable your partner, may need to have blood tests to screen for HIV, hepatitis B and C and human T cell lymphotropic virus (HTLV) I and II.

Treatment then typically involves the following:

For women

You take fertility drugs to stimulate your ovaries to produce more eggs, as for IVF, and your progress will be monitored through vaginal ultrasound scans and possibly blood tests.

The eggs are then collected using the same procedure as IVF and each egg is injected with a single sperm from your partner or donor. The rest of the process is also the same as IVF.

You are more likely to become pregnant with twins or triplets if more than one embryo is transferred so your clinic will recommend single embryo transfer (SET) if they feel it is the best option for you. An embryologist will examine your sperm under a microscope and decide whether ICSI could increase your chances of fathering a baby.

The next step depends on whether you are able to provide sperm without a medical procedure:

·         If you can, you produce a fresh sperm sample on the same day as your partner’s eggs are collected.

Or:

·         Sperm can be collected directly from the epididymis using a type of fine syringe. This is known as ‘percutaneous epididymal sperm aspiration’ or PESA.

·         Sperm can also be retrieved from the testicles, a process known as ‘testicular sperm aspiration’ or TESA.

·         It is also possible to remove tiny quantities of testicular tissue from which sperm can be extracted. This procedure is called ‘testicular sperm extraction’ or TESE. For more information about PESA, TESA and TESE, speak to your doctor.

·         If you have stored sperm, it will be removed from frozen storage, thawed and prepared for treatment.

A single sperm is then injected into each egg. ICSI provides the opportunity for fertilisation to happen, but it is not guaranteed to succeed.

Finally, if fertilisation does take place, the embryos will be cultured in the laboratory for up to six days and then between one and three of the best-quality embryos will be transferred to the womb.

Zero sperm count

If you have a zero sperm count (other than caused by vasectomy), the chances of retrieving sperm surgically by PESA, TESA or TESE may be very low.

In this situation, you might consider having a surgical retrieval as a ‘dummy run’ and storing any sperm that are obtained. If no sperm are retrieved, you may want to consider donor insemination (DI) or IVF with donor sperm instead.

Egg Donation Process

Being selected as a donor by one of our recipients leads to a very exciting and rewarding journey to help make a dream of becoming parents come true. We hope that you have carefully evaluated your decision to become an egg donor. It is a serious commitment when you choose to participate in an egg donor cycle, and the results are gratifying. We appreciate your generosity and compassion for these infertile couples.
The length of your commitment once you are selected for an egg donor cycle can be as few as six weeks and as long as four months. Egg Donation, Inc. is not a medical facility, but we have relationships and work with the best Reproductive Endocrinologists across the nation who will work to ensure your safety and well being and can explain the full medical procedure of egg donation. A goal of our staff is to make your journey as enjoyable and fulfilling as possible. We know the time and effort it takes to be an egg donor and we treat all our donors with the care and the respect they deserve.

How Egg Donation Works

Step 0: Egg Donor Application and Screening

Before everything else can happen, egg donors must apply to our egg donation program, go through an initial screening www.pfrcivf.com and two rounds of interviews (one with our clinical coordinators and another with our physicians) as well as some testing. Only the donor applicants who pass all these screening steps will be added to our egg donor program, and can be matched with a recipient couple. CHR's egg donor program is very selective: on average, we accept only about 1-3% of applicants to our donor program.

Step 1: Egg Donor Matching

When a couple decides to use donor eggs, they can view the pre-screened pool of egg donors online, and select a candidate from the pool. A tentative donor egg match is made when a recipient decides to move forward with a specific donor. Our IVF coordinator will contact the egg donor to confirm her availability. If the egg donor is available for the recipient's desired time frame, and passes an FDA-required round of testing, an official match is made. Some donors are selected and matched to a recipient very quickly after they apply; others may take months or years before they are selected; still others may never be selected.

Step 2: Suppression and Ovarian Stimulation for the Egg Donor

The egg donor will self-administer daily injections of a medication called Lupron to suppress her natural cycle, so that her and the recipient's cycles are synchronized. During the ovarian stimulation phase, the egg donor uses daily injections of gonadotropin to stimulate her ovaries. In a natural cycle, only one egg matures; gonadotropins injections encourage more than one egg to mature for retrieval.
During ovarian stimulation, the egg donors are monitored closely through blood tests and ultrasound, ensuring that the ovaries are responding well and not going into hyperstimulation. This means that egg donors need to visit our center in the Upper East Side of Manhattan frequently during this phase. (Long-distance donors go to collaborating IVF centers that are local to them.) These monitoring sessions are scheduled in early morning in order to avoid interfering with the donors' daily schedule of school and work.

Step 3: Endometrial Lining Development for the Donor Recipient

On the recipient's side, a favorable uterine environment, especially an endometrium of at least 7 mm, is crucial in the success of a donor egg cycle. While the egg donor develops eggs for retrieval, the recipient takes estrogen and progesterone to prepare her endometrial lining for implantation. Developing the endometrium for embryo transfer is usually not a problem.
In rare cases, some patients have difficulties in reaching minimal endometrial thickness and may require special treatments. Fortunately, www.pfrcivf.com CHR has demonstrated special expertise in this area. Some patients with autoimmune abnormalities may use additional medications to improve the chance of implantation.

Step 4: Triggering Ovulation and Egg Retrieval for the Egg Donor

When the ultrasound imaging shows that the donor's eggs have sufficiently developed, the donor will be instructed to trigger ovulation with an injection of hCG. Two days later, her eggs are retrieved in a short in-office procedure, called egg retrieval. While the donor is asleep (under I.V. sedation), one of our physicians will use aspiration needle, guided by ultrasound, to transvaginally retrieve the eggs. The donor will be required to take the rest of the day off to recover.

Step 5: Fertilization and Embryo Transfer for the Recipient

The retrieved eggs are fertilized with partner's or a donor's sperm. If using fresh sperm, the partner will need to visit CHR to produce a sample at this time. The embryos that result from this fertilization are incubated and graded. Normally, embryos are transferred into the recipient's uterus on day 3 after donor egg retrieval (on rare occasions on day 5). For our recipients working with our center's egg donor program from outside the NYC metro area, this is the only time they need to be in NYC for the entire cycle. The rest can be managed locally.

Step 6: Post-Retrieval Checkup for the Donor and Pregnancy Tests for the Recipient

The donor will be required to return to our center for a post-retrieval checkup, so that we can make sure that the donor is recovering properly from both the ovarian stimulation and retrieval. In most cases, donors have no problem returning to normal in a day or two after egg retrieval, and if this is not the case, our clinical team closely monitor the donor's progress and stay in touch with her until the donor fully recovers. From the start of the Lupron injections to egg retrieval, egg donation is a 3-5 week process for most of the egg donors.
Recipients will have a pregnancy test two weeks after the embryo transfer, via a blood test that measures the level of hCG. After two normally rising hCG tests and an ultrasound demonstrating a pregnancy, recipients are "discharged" to their obstetricians for prenatal care.

 Frozen Donor Egg Program (EcoDEP)

CHR also offers a frozen donor egg program called Eco Donor Egg Program (EcoDEP), in which a recipient receives eggs from a donor who has already undergone ovarian stimulation and egg retrieval by the time the recipient chooses her donor. This means that EcoDEP has a different "workflow" from the standard egg donor program described here.