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Donor
Egg ( DE ) Program
The Jones Institute donor egg program, founded in 1984,
was one of the first in the United States. The program assists women whose:
- eggs are absent
- eggs are of poor quality
-
eggs are unlikely to produce pregnancies because of disease or age
- eggs might transmit serious
genetic diseases to their offspring
Our Results
The program has provided oocytes to many couples by
anonymous donation and to a few by known ( usually sister - sister ) donation.
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January 2000 - July 2009 ( n =
462 cycles )
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| Clinical pregnancy rate
per transfer* |
51%
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| Number of embryos transferred
per cycle |
2.4
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| Multiple pregnancy rate |
37%
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| Miscarriage rate |
23%
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| Cryopreserved-thawed
embryos pregnancy rate per transfer |
32.5%
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| Total Reproductive Potential |
70%
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* Clinical pregnancy
rate per transfer refers to a conception confirmed by ultrasonography as
demonstrated by the presence of an intrauterine gestational sac.
# Total Reproductive Potential is an important indicator of success. It
refers to the number of pregnancies obtained from only one stimulated cycle,
as the result of a fresh embryo transfer cycle plus at least one additional
cycle of transfer of cryopreserved-thawed embryos derived from that same
stimulation.
Many couples have additional pre - embryos produced
from the initial egg donation that cannot be safely transferred into the
uterus at one time; most couples elect to have the extra pre - embryos
cryopreserved ( frozen ). Since 1992, half of couples receiving donor
eggs have had extra pre - embryos available for cryopreservation;
these have yielded additional pregnancies.
Egg donors are anonymous,
unless the donor is someone chosen by the recipient from outside our program.
All oocyte donors, regardless of type, will undergo extensive donor egg
screening in our best effort to ensure their suitability as egg donors.
Screening begins with a thorough review of personal and family medical
history, with the goal of excluding all whose families include members
with heritable disorders that may produce serious functional or cosmetic
handicaps. A questionnaire and follow - up interview are used to make
this screening as thorough as possible, although we cannot completely
guarantee its accuracy. The physical examination also must be normal,
and a staff psychiatrist must determine that the donor is well adjusted,
without psychopathology, and has a good understanding of the process and
the required anonymity.
Egg donors must have two ovaries, good ovarian
function / reserve, no evidence of drug use ( negative urine drug screen
), no sexually transmitted diseases ( gonorrhea, syphilis, chlamydia,
herpes, ureaplasma, and HIV [types 1 and 2 by an antigen test] ) or prior
hepatitis, and be under the age of 30. Smokers are excluded. In addition, donors are screened for genetic diseases
that occur commonly among members of their ethnic background ( African
Americans - sickle cell disease; Caucasians - cystic fibrosis; Asians,
Greeks, and Italians - thalassemia; European Jews - Tay - Sachs and Gaucher's
disease ).
Qualifying donors are apprised of potential side effects of their treatment,
both known ( for example, ovarian hyperstimulation syndrome ), uncertain
( ovarian cancer ), and unknown. They also are informed that we will not
disclose to them who received their eggs and whether a pregnancy occurred.
Donors sign an anonymity agreement and informed consent outlining these
risks. If married, husbands must grant consent, as well.
Donors are permitted to donate in as many as five cycles. Donors are provided
with a Blanket Special Risk Insurance Policy to cover unanticipated medical
expenses related to any complications of their participation in the donor
egg program.
Though the donation is anonymous, we tell our patients many characteristics
that will enable an informed choice about the appropriateness of the proposed
egg donor. If you, the patient, successfully
conceive, this information will serve as a record of the genetic background
of the child, which may prove important in the future.
When sisters or other "known" donors are involved, the same
screening process is used. If the sister or friend is deemed unsuitable,
you will be advised of our reasons. In some cases, you may elect to proceed
with this donor despite her unsuitability; however, we cannot assume responsibility
for any resulting complications.
During the initial visit, donor egg recipients learn
about the donor egg process, donor availability, and ongoing research protocols.
Fertility specialists will
review the couple's history, conduct a physical, and order diagnostic
tests, including an ultrasound and semen analysis. This appointment
usually requires two to three hours. Donor matching is the second step,
allowing recipients to match physical characteristics and other traits.
Whether or not you are already a patient at the Jones Institute, it is necessary
for you to have an initial consultation at the Jones Institute. This gives
you the opportunity to learn in great detail about the egg donation process,
donor availability, and ongoing research protocols. You will meet with a
doctor and a staff member from the Donor Egg office. If you already have
seen a doctor at the institute, you will continue treatment with your doctor.
Your prior records and hysterosalpingogram
or hydrosonogram
will be reviewed and a physical examination performed. In most cases a vaginal
ultrasound and a semen analysis also will be scheduled for that day. The
entire visit takes about half a day.
Following your successful screening, we will propose
a fully screened egg donor for you based on your physical characteristics
and any additional requirements you communicate to us. We will provide in
writing a summary of this prospective donor, including her age, height,
weight, build, complexion, hair and eye color, and blood type and Rh factor.
We also will disclose the outcome of any of the donor's prior pregnancies,
her marital status, sexual orientation, educational and work history, and
a summary of her ( and her family's ) medical and surgical conditions.
We will FAX, mail, or e - mail these features to you, if possible, to speed
the process. You will review this information and inform us within three
days about the acceptability of the proposed donor. If you would like to
know more about the donor, please call us immediately so we can complete
the matching process expeditiously. If you decline the proposed donor, we
will look for another, but we cannot guarantee when another donor will be
available ( in general, we have been able to secure another donor within
three months ).
Once you accept a donor, we will tell you when we expect the donation to
occur. This depends on synchronizing the menstrual cycles of you ( the recipient
) and the donor to permit a fresh transfer of pre - embryos. In general,
the donation occurs between one to two months after a donor is accepted.
We will indicate when you need to begin taking your estrogen ( and in some
cases, birth control pills / Lupron ) to allow for cycle
synchronization. You will begin this therapy at home and come to the Jones
Institute only when the actual donation occurs.
A $500 non refundable deposit is required once you have accepted a donor.
This will apply towards your total fee.
When you return to the Jones Institute the day
before the donor's egg retrieval, plan to stay in Norfolk for five days
overall, if you are not a resident. Most couples arrive the day before
egg retrieval and stay until the day after the pre - embryo transfer.
The transfer itself is usually performed without anesthesia and lasts
only a few minutes. On occasion, dilatation of the cervical canal may
be required at the time of transfer in order to facilitate the procedure.
Minor side effects include mild cramping and minimal bleeding ( mostly
from the use of a cervical tenaculum to straighten the cervical canal
).
It must be mentioned that occasionally fertilization does not occur despite
the use of donor eggs. In such rare circumstances, your doctor will discuss
the matter with you and appropriate diagnostic and / or therapeutic options
will be offered.
After returning home, you will continue to take hormones. Pregnancy can
be confirmed two weeks after embryo transfer. If you are pregnant, you
will continue taking your hormone medications for a full 10 weeks after
embryo transfer. If you are not pregnant, these medications are discontinued.
If the doctor recommends that you have additional blood tests or ultrasounds
to check on the pregnancy, the costs of these additional tests are extra.
If you would like to try again, we will arrange for another transfer.
Some couples may choose to have pre - embryos transferred after being
cryopreserved and later thawed, rather than being transferred fresh. Reasons
for electing this approach include scheduling conflicts, which would preclude
a fresh transfer, and the desire to quarantine pre - embryos for a period
of time to reduce the risk of HIV infection in the donor. It is entirely
your choice which type of embryo transfer you have.
Note that the chance of pregnancy is somewhat higher for fresh versus
cryo - thaw transfers. Also remember that donors are screened for HIV
before each cycle of donation with an antigen test that detects the infection
weeks rather than months after the exposure; however, research has not
shown that oocytes can harbor this virus successfully.
Couples who have not received donor eggs from our
program before are given priority over those who have. Among those on the
active list, priority is given to those on the list longer. As of this writing,
the waiting list is less than six months.
We typically expect the donor to undergo egg retrieval if she has seven
or more follicles at the time of hCG
administration. If the response is lower, then the cycle may be canceled.
You will be told how many eggs were retrieved, inseminated, and fertilized
the day after the donor's retrieval. At the time of embryo transfer, you
will be given additional information about quality of embryos transferred
and possibility to transfer extra embryos. About 50% of donor egg cycles
result in excess embryos available for freezing.
Immature eggs rarely produce a pregnancy and will
therefore be used in approved research efforts to enhance future clinical
care. They will not be used in your case except in unusual circumstances.
A Blanket Special Risk Insurance Policy is required to cover the costs
of complications of the Donor Egg process. The program, issued by AIG Life
Insurance Company, covers accidental death, paralysis, and accidental medical expense benefits of both donors and
recipients that occur within 30 days of the treatments that are attributable to their participation in the Donor Egg program.
The program excludes costs related to:
- psychological effects of egg donation
-
pregnancy in donor
- sexually transmitted diseases (
including HIV )
In order to minimize and better understand the potential
risks you may face by conceiving with donor eggs, you will need to have
certain screening tests. Some are designed to make your effort more successful.
Most are designed to identify risks, both known and unknown to you, which
we believe you need to know before engaging in this therapy. In some cases,
the risks to your health identified by this process may preclude your participation.
This would be regrettable but certainly preferable to discovering a problem
made life threatening by a pregnancy.
Review the items in the chart below to determine which apply to you. You
will need to review the results of these tests with the appropriate doctors
to ensure you understand the advisability of proceeding with this process.
Since our expertise is in gynecology and not internal or family medicine,
we cannot advise you in these areas. However, for your well being, we require
that you are fully screened and fully informed of any risks before your
donor egg attempt. In the list below, all ages and time intervals refer
to the time of expected embryo transfer.
On average as women age, pregnancies are more
apt to have complications. Some of this increase is due to the higher
proportion of women at these advanced ages who already have known medical
problems such as high blood pressure, diabetes, and obesity. Healthy older
women without overt medical disease are at somewhat decreased risk for
complicated pregnancies, but the level of risk is still above that seen
at younger ages. For this reason, we have stressed preconception counseling
to all prospective recipients over age 35 and a comprehensive medical
evaluation for those above age 45.
The most commonly observed complications have been
an increase in blood pressure ( hypertension and / or pre - eclampsia
in up to 50% of the cases ) and diabetes ( in up to 20% of cases ). Other
complications that may occur more frequently at advancing maternal age
are slowed intrauterine fetal growth, bleeding problems ( placenta previa
), and premature delivery. Cesarean delivery has been necessary in more
than half the cases. There also may be an increased risk of maternal and
/ or fetal death, though the absolute level of this risk is low.
Since the eggs in this program are from young women,
the risk of chromosomal problems is not increased to the level at which
amniocentesis or other invasive evaluations seem necessary.
It is theoretically possible that some of the cases of high blood pressure
stem from dissimilar genetic backgrounds. Though many donor egg recipients
do in fact become ( transiently ) hypertensive during pregnancy, it is
not yet clear whether this is due to age, to the immunologic dissimilarity
of the fetus, or both.
The risks of the development of an abnormal fetus
are not yet fully known but have not exceeded those normally seen to occur
with other sorts of pregnancy. Donors possibly may transmit infections
to you or a fetus via donated eggs. Though not yet demonstrated to occur,
we take all reasonable precautions to reduce this risk.
Donors are screened before each cycle of egg donation for all venereal
diseases ( gonorrhea, chlamydia, syphilis, herpes, and HIV types 1 and
2 ). To reduce the risk of donors having an unrecognized HIV infection,
donors are tested for the presence of the HIV virus itself ( an antigen
test ) rather than the body's response to an HIV infection ( an antibody
test ). This shortens the latent period between infection and detection
from months to weeks ( the precise interval is not known ). Furthermore,
you may elect to quarantine all pre - embryos for a period of time ( usually
six months ) before having any pre - embryos transferred to you. In this
approach, pre - embryos would be used only if the donor is still negative
for HIV at the end of the quarantine period.
Due to the anonymity of the process, it may not
be possible to reliably learn of new medical problems in the donor's family
after the donation has occurred. If we learn of such information however,
we will inform you.
Some religious faiths proscribe egg donation and / or in vitro fertilization.
You may want to consult a clergyperson of your faith before proceeding, if
appropriate.
No other unique pregnancy - related risks of the
donor egg approach are known at this time.
The hormones you will take during this process are naturally produced
and are not known to have ill effects on your system or on a fetus. Some
women experience skin irritation under the estrogen patch; many develop
soreness in the area of progesterone injections or where blood has been
sampled. Rarely, a woman will develop a severe reaction to a component
of the medication, requiring the use of an alternative form. Reactions
resolve upon discontinuation of the preparation.
r
Pelvic infection is a possible but rare complication
of the embryo transfer procedure. In order to minimize it, you will be
asked to take an antibiotic around the time of embryo transfer.
A multiple pregnancy, the majority of which are
twins, account for approximately 20 - 30% of all the pregnancies. In order
to reduce the incidence of triplets and quadruplets, voluntary guidelines
have been established in our clinic. The maximum number of embryos to
be transferred is based on patient age, quality of embryos, ( number of
cells and morphology ) and previous IVF attempts.
Are
you interested in becoming a donor?
For more information contact us:
Telephone: ( 757 ) 446-7446
Contact
Form
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Phone
800-515-6637 or 757-446-7100