Egg donation, unlike sperm donation which has been a routine clinical treatment for male infertility for many years, has recently become widespread since the introduction of invitro fertilization.
Egg donation has now become a widely used treatment modality for infertility due to premature menopause.
Indications for Egg Donation Women requiring egg donation can be divided into 2 main group
1. Women with failed Ovaries
a. Premature ovarian failure
b. Ovarian agenesis
c. Bilateral removal of ovaries during surgery
d. Menopause
2. Women with functioning ovaries
a. Risk of inheritable genetic disease in children
b. Failed IVF due to poor quality eggs
c. Inaccessible ovaries.
Female fertility begins to decline years before the onset of menopause, despite continued regular ovulatory cycles. The age-associated decline in female fertility and increased risk of spontaneous abortions are largely attributable to abnormalities in the egg. Recent data’s suggest that women after 40 years of age have better pregnancy rate with donor eggs. Pregnancy rate in post-menopausal women who uses donor egg is comparable to the age of the donor they use.
EVALUATING OF EGG RECIPIENTS
Apart from the routine medical and reproductive history along with general physical examination standard testing for Rh factor, rubella, Hepatitis and HIV are done.
All egg recipients couples should undergo a counselling session to check for possible psychological factors. It is important to rule out possible repercussions on the child by either the counselling should also stress the confidentiality of the egg donor.
Anonymity is maintained between the donor and the recipient couples, although non-identifying information is available to both on request. Psychological counselling of the partner is also essential.
SELECTION OF DONOR
Because of the shortage of egg donor, some recipients seek their own donor, either a close friend or relative. This is usually done for altruistic motive. Issues such as the potential impact of the relationship between donor and recipient should be explored.
Sharing of eggs from an assisted reproductive cycle where a patient undergoing IVF treatment donates her excess eggs is also a means of getting donated eggs.
Nowadays, professional egg donors are always available for a price. This is getting quite common in Nigeria because of the economic issues in the country. Generally speaking, known donors to the couples, should be discouraged, and only professional donors or shared egg donation is to be considered. An ideal egg donor is a woman between the ages
of 21 to 25, with previous successful pregnancies in a stable relationship and has complete her family.
All this may not necessarily be found but age is the most critical factor.
SCREENING AND TESTING OF EGG DONORS
A person and sexual history of the donor should be obtained to exclude donors who may be at a high risk of HIV or other sexually transmitted diseases.
Testing for syphilis, Hepatitis B, Hepatitis C, and HIV is mandatory. A family history is an effective screening tool for many genetic disorders and should be used routinely to exclude certain genetic disorders.
Vaginal scan to confirm ovulation, ovaries size and morphology and accessibility for egg collection should be performed. Hormonal profile to confirm ovulatory cycle.
SUCCESS OF EGG DONATION
The success of egg donation is influenced by multiple factors including the age of the egg donor and the recipient, the embryo quality, and the reproductive status and endometrial receptivity of the Donor’s age is one of the most significant factors as the egg age is one of the primary contributors to IVF outcome. The recipient age is also inversely proportional to the success of the egg donor, but not always by some other studies. Endometrial thickness and pattern have been implicated as predictors of success in egg donor. The most reliable predictive factor for pregnancy however is the quality of the embryo transferred and the recipient’s endometrial thickness.
REASONS FOR HIGH PREGNANCY RATES IN EGG DONATION
-Lack of endometrial hyperstimulation
-No risk of excessive oestrogenism
-No premature luteinisation
-Better control of endometrial receptivity
IN DONOR EGGS PROGRAMME THERE ARE 3 MAIN PRINCIPLES
-Preparation of recipient’s endometrium
-Window of embryo transfer
-Early pregnancy management with hormones.
In egg donation programme, significantly higher pregnancy rate have been reported when endometrial thickness is more than 10mm.
Most egg donor programmer employ oestrogen replacement therapy in the form of oestrodial valerate 4 to 8mg daily. Progesterone replacement is usually in the form of either progesterone pessary 200mg daily or injectable 50-100mg daily.
In women still ovulating, it is important to down regulate the cycle with GnRH before the HRT. The window for embryo transfer in egg donation is wide. Pregnancy rate of egg donation is slightly higher than in routine IVF. The age of the donor is of significant factor in success. The age of the recipient is of little significant since endometrial receptivity can be overcome by increasing HRT dosages. Pregnancy rate is directly related to the number of embryo transferred.
Donor egg has revolutionized thinking in human reproduction. There is no longer a definite age for women to become pregnant. (The oldest IVF mother in Nigeria was 57 years old)
In several countries, it is accepted legally that the recipients are the legal parents and the egg donor has no legal rights or responsibilities towards the resulting child.
