This technique of Assisted Reproduction (ART) consists in anonimous women that meet the criteria (age, proved health,…) that give oocytes to patients who are not able to get a pregnancy, and this way they can reach the maternity. The main causes that leads to oocyte donation are:
If after the treatments of Assisted Reproductive Technologies, either for Artificial insemination or IVF cycles, the ovarian response is low it is advisable the inclusión of the patient in a oocyte donation cycle.
In the cases in which there was ovarian response with production of more then three mature oocytes but there was no pregnancy although there was enough number of IVF cycles (generally 3 or 4) is recommended to choose oocyte donation.
Despite having ovarian response and getting apt embryos for the transfer, it has been previously described that almost all women over 45 do not get pregnant with IVF.
This grupo incluyes cases that for a genetic exam o any other motive, serious genetic alterations are identified in a woman and that can be thensmitted to the progeny.
The possibility of modify the proper development and maturing of the oocyte by external agents must be considered as a cause for oocyte donation.
Women with physical or important aesthetic problems or other circumstances difficult to stablish, but that means a beneficial situation for the woman or for the couple.
Oocyte donors must be, following the Spanish law, adult women under 35 years old with a proper physical and mental health state, with no risky genetic disorder background and must be tested for infectious diseases.
Besides these requirements, oocyte donors must do a gynaecological checkup and a full hormonal study in order to undergo a subsequent follicular stimulation out of risks.
The donor follow follicular stimulation protocols and oocyte recovery process according to a conventional IVF process. Keeping in mind that donors are good responder patients and exists a risk of having Hyper Stimulation Syndrome (HSS), it is important to take the adequate steps and give a complete information to the donor.
GENERAL ASPECTS A OOCYTE RECIPIENT PATIENT MUST KNOW
OVODON is the usual name for the egg donation program. This is a procedure inwhich oocytes are received from a donor with reproductive purposes. These oocytes are inseminated with the sperm of the recipient´s couple or with sperm of a donor. The generated embryos are transferred to the recipient´s uterus in order to get pregnant.
The diagnosis that lay down that a woman does not have or have few oocytes in her ovaries can be done by:
a) Blood determination of the following values:
b) Dynamic tests, blood determination of FSH and E2 after ovarian stimulation:Clomiphene Test (TCC): consists in the administration of 0100 mg/d from the 4th-8th day of the menstrual cycle, doing a blood determination before beginning, on the third day an after finishing, the ninth day. When the basal levels of FSH on the ninth day are over 26 mUI/ml it is considered pathological.
2) Ultrasound scan tests: Verify the Lumber of astral follicles smaller than 10 mm (between 5-10). It is accepted that a number between 5 and 10 antral follicles in the first days of the cycle is a sign of good follicle reserve. The ovarian volume diminishes with the reproductive and menopause age. In any case the ovary must have a volume higher then 3 cm3. Ovarian Vascular Flow:
Lies on the evaluation of the blood flow of the ovarian stroma by means of Doppler technology. The low responder patients present a low ovarian artery flow in the early follicular phase, as in a natural cycles as after hypophysiary inhibition with GnRH analogous.
3) Test cycle: It is the more reliable diagnostic test. It lies in starting ovarian stimulation with FSH administration and, if the response is good invalidates all the other tests, although in most of the cases they agree. All things considered, the recipient women are that whose ovaries, having high levels of FSH, do not manage follicles or even very few in the test cycles, as it happens with the early ovarian failure and the early menopause. Also patients with a ovariectomy or a important reduction surgery as endometriosis. Besides, women with repeated abortion with findings of genetic alterations who does not want to do a PGD are recommended for egg donation program, as well as women with recurrent abortions. Also can be added the patients with repeated in vitro fertilisation failures with their own oocytes. To undergo one cycle like this entails an endometrial preparation with a estrogenic treatment with pills with a crescent or fixed dose in order to make the endometrium grow.
To check that the endometrium develops ultrasound arranged serially are made. In the last step, this treatment is supplemented with Progesterone which role is to induce the endometrial glands secretion and to make the endometrium meet the conditions needed for embryo implantation. In case of getting pregnant, the estrogens and progesterone intake will continue untill 8-12 week of pregnancy.
The success of egg donantion is determined in a good part by the correct synchronization between donor and recipient by the medical team in the centre.
It is importat to adjust both menstrual cycles, so the endometrium and the hormonal levels are adequate to make sure the receptivity to the embryos at the moment they are generated from the oocytes and are transferred to the recipient´s uterus.