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Dr. Abayomi Ajayi
All infertility courses are not exactly the same. Each trip is personal and based on family building options specifically tailored to individual situations. The exploration of options such as donor sperm, donor egg and donor embryo may not be on the list of early options, but it is preferable to approach the reality of building your family with an open mind.
On this column, the importance of Invitro fertilization has always been emphasized, but before the development of IVF, there was no option other than egg donation for women with complications such as premature ovarian failure. , decreased ovarian reserve or genetically transmitted diseases.
What is the gift of eggs? Who needs it, why and how successful is it? It is quite natural to ask these questions as much as it is necessary to emphasize the indications, screening and assessment, procedures, statistics and known risks. Are you a good candidate for the egg of a donor? You can easily find.
First and foremost, keep in mind that the main indication of oocyte donation was originally for women with premature ovarian failure, defined as a menopause occurring before birth. 40 years old. This condition indicates the exhaustion of the woman's eggs and the cessation of ovarian function. The causes are varied and a thorough medical assessment to look for an underlying or associated process is important before treatment.
In recent years, the predominant indication of egg donation has been in women with diminished ovarian reserve but intact ovarian function. Women over 40 typically have reduced fertility and a lower chance of success after IVF. This gradual decline in age-related fertility is a direct consequence of egg aging.
Fertility assessment may also reveal signs of decreased ovarian reserve, even in women younger than 40 years of age, as evidenced by elevated levels of FSH (follicle-stimulating hormone) and / or estradiol at baseline. of the menstrual cycle, determined by a blood sample taken on the day of the cycle. 2 or 3.
Other potential candidates for egg donation are women who have already failed several attempts at IVF, especially if there is suspicion of poor egg quality, and women with severe pain. transmissible genetic abnormalities that may affect their children.
If you are a woman who plans to use egg donation, you must first be the subject of a medical assessment including a complete history and a physical examination, so to make sure that you are in good health for the pregnancy. It is important to research and correct any abnormalities that may compromise the success of IVF with donor eggs (ie factors that may affect fertilization, implantation, or pregnancy).
An in-depth evaluation or selection of each potential egg donor is of crucial importance, whether the donor is known to you (for example, a sister) or anonymous. This selection protects all parties involved (donor, recipient and offspring resulting). We often stress that the donor must generally be under 35 years of age, with laboratory evidence of normal ovarian reserve and no indication of loss of fertility. It must be screened for communicable infectious diseases and tested genetically, both through detailed family history and specific blood tests.
The egg donor test requires a thorough evaluation or the selection of each potential donor is of critical importance, whether the donor is known to the recipient (eg, a sister) or whether it is anonymous. This selection should serve to protect all parties concerned (the donor, the recipient and the offspring resulting).
Since the recipient does not undergo ovarian stimulation or egg extraction, she is not exposed to potential risks. The main risk is multiple pregnancy because the egg donors are young (usually under 35) and pregnancy rates are high for this reason. The age of the recipient, even if he is over 40, does not affect the pregnancy rate. It is important that the number of embryos transferred be limited, usually to a maximum of two or three embryos for a day or two to three transfers or to one or two embryos, if any, at the fifth day, at the blastocyst stage .
The argument in favor of donor sperm (donor insemination or IVF) is similar, especially when the husband / partner does not have sperm or has very poor sperm analysis (azoospermia, oligospermia, low motility), or in case of genetic problem inherited from the male.
It is generally recommended for couples or people considering using sperm from a donor to see a competent counselor to clarify their feelings regarding infertility. You and your spouse must be comfortable with the decision. Couples or individuals usually have the right to decide which sperm bank and which donor to use. Most of the time, only frozen semen is used. The donor is thoroughly examined before the frozen sample is used.
All donors must be tested for certain infections such as HIV, syphilis, hepatitis B, gonorrhea, chlamydia, etc. The sperm of the donor must also be checked for the presence of white blood cells that may indicate an infection of the reproductive system.
The procedure of donor insemination involves inseminating the woman as close as possible to the time of ovulation. Many women monitor their ovulatory cycles by analyzing their urine to find out when ovulation will likely occur.
Cervical insemination is a simple procedure. A soft catheter is passed through the speculum until the cervical opening and sperm is released from the catheter. The woman can be asked to lie down for 15 to 20 minutes, then insert a small plastic covered sponge and tied with a string to keep the sperm as close to the cervix as possible.
The woman is responsible for removing the sponge in 2-3 hours. With cervical insemination, the nurse can take a cervical swab several hours after insemination, which will determine the extent to which sperm survive in cervical mucus. Intrauterine insemination is often used to increase the success rates of frozen spermatozoa. Once the sperm is treated, it is injected into the uterus using a syringe and a thin catheter, via the cervix. Insemination is usually painless.
The highest success rates were reported in women with no infertility problem, under the age of 35 and whose partner / husband had azoospermia (no sperm). ). Lower success rates are reported when there is a female factor (ovulation problem, endometriosis, etc.) or the woman is over 35 years old.
Success rates vary between 15 and 20%, but getting a pregnancy can take several cycles. If no pregnancy occurs after several cycles, IVF may need to be considered.
Ovulation stimulating drugs such as clomiphene or injectable gonadotropins can be given to the woman. Carefully monitored ovulation and IUI can help increase the chances of success for some women.
Couples struggling to start a family may consider donating embryos as a viable option. If you are trying to have a family and things are not going as planned, embryo donation could be a good option. When a couple or a person undergoes IVF sterility treatment, it is possible to cryopreserve all non-transferred embryos during this cycle for use in a subsequent cycle.
And while the majority of frozen embryos are intended for your own use in IVF treatment cycles, they are also potentially available for donating embryos to other infertile couples.
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