Sample Egg Donor Protocol
Stage One: Selection/Screening
The first step is to complete a detailed application, which will serve as your introduction to prospective parents. The application requires in-depth family health history, and details regarding your personal habits, hobbies, interests, education, employment and fertility. It is important to provide thorough and accurate information, as prospective parents will be using it to gain insight about their future child.
Immediately upon receipt of your application, our coordinator removes all identifying information (name, address, etc.) and assigns your file a confidential donor identification number, thereby securely protecting your anonymity. If accepted into the Future Angels Egg Donor program, your application information and donor ID number are placed in our Donor Registry for prospective parents to review. You may choose to remain completely anonymous throughout the donation process, or you may opt to meet or speak with interested recipients. If you are amenable to meeting in person or participating in a confidential call between parties (where only first-names are exchanged) you may so indicate on the application, however, please understand that both you and the recipient must be in mutual agreement on the matter.
Appointments are scheduled at our agency to allow prospective parents the opportunity to review the Donor Registry. In addition to the copy of your application, the couple will be able to see the photographs you have provided of yourself and your children, which further helps them in making a selection -- especially in cases where a close physical resemblance is important to the prospective parents. In some instances, copies of your file will be sent to prospective parents outside of the United States as our client base extends worldwide. *Your choice of photos is extremely important! Pictures should be clear, focused and uncluttered. Ideally the photos will represent *you* throughout the years. (Photos will be returned to you, if requested, upon closure of your donor file, or following a donor cycle)
Once a recipient selects you as their donor, a Future Angels program coordinator will call you to discuss next steps and schedule you for testing at a selected medical center. Of course, we will arrange the testing and any necessary travel accommodations for you and there will be no cost to you -- just your time and efforts! *Testing will include an in-person psychological consultation; medical evaluation - consisting of a pelvic examination, ultrasound studies, and lab-work (testing for HIV, Hepatitis, Syphilis, and other sexually transmitted diseases as required by law); and consultation with the medical facility's clinical nurse coordinator, whom will be mapping out the cycle of treatment (this is the person telling you the "who, what, when, where and why" of the cycle).
Stage Two: Synchronization and Stimulation
Once all parties are screened, you will customarily be started on low dose oral contraceptives ("the pill"). The purpose of taking the pill is to help get your cycle synchronized with the recipient's cycle. You may spend 14-21 days or longer on the pill after which the clinic will have you begin Lupron (leuprolide acetate) injections or Synarel nasal spray. Lupron is self-administered by needle injection in the abdominal wall or upper thigh, just underneath the skin. This is called a subcutaneous injection. Synarel is taken as a twice-daily nasal spray. You will receive injection instructions from the medical staff at the clinic. If at any time you are not clear on how to give the injection or how much medication to take, you should call the clinic directly. Lupron and Synarel are synthetic hormones, which work to temporarily suppress the pituitary gland so that the stimulation of your ovaries can be more completely controlled. In more basic terms, the Lupron/Synarel will shut down your ovulation, putting you in a short-term menopausal condition, which may cause the following side effects: hot flashes, mild headaches or a sense of fatigue. Of course, you may not have any side effects at all -- hormones can cause different reactions in each person. Your Lupron or Synarel will continue daily for a period of approximately 20-30 days. There are no adverse effects on a pregnancy or any long-term adverse effects for you.
After 14 days injecting Lupron or using the nasal spray Synarel, you will begin a series of injections using a hormone called Gonal-f. At this time you will be using both Lupron or Synarel and Gonal-f. The active ingredient in Gonal-f is known as follicle stimulating hormone (FSH) because it works to increase the number of follicles developing in the ovaries. The follicles are the fluid filled sacs within the ovaries that contain the eggs. These hormones are injected directly under the skin of your abdominal wall or upper thighs (subcutaneous injections). You will be required to give the shots on a daily basis for a period of about 10 days. You will receive the necessary medical instruction from the clinic. Again, if you are unsure of dosage or process of how to give the shot, please contact the clinic directly. A missed injection can have disastrous effects on a cycle outcome. The dose of Gonal-f (or pergonal/repronex/humegon) may be adjusted during the cycle depending upon the response of the ovaries.
Gonal-f (or pergonal/repronex/humegon) has been used extensively for over twenty years and is not clearly associated with any type of cancer, birth defect, or increase in miscarriage. Side effects of Gonal-f are secondary to their action on the ovaries and are related to ovarian stimulation. If you are prone to premenstrual syndrome (PMS) you may feel some of the side effects attributed to the Gonal-f (or pergonal/repronex/humegon) injections. These effects are usually mild and may include allergic sensitivity, breast tenderness, abdominal bloat, headaches and/or mood swings. You may even gain a few pounds, which will only be a temporary weight gain as it is when you have PMS.
In rare cases, over stimulation of the ovaries may occur. Ovarian Hyperstimulation Syndrome (OHSS) generally causes enlargement of the ovaries accompanied by abdominal discomfort and/or pain. In severe cases it could lead to hospitalization. It is anticipated that these symptoms will cease 1-2 weeks following the cycle of treatment. The physician at PFC will discuss any concerns you may have about OHSS at the time of your initial consult.
IVF-ET cycles are monitored in two ways: vaginal ultrasound and by blood hormone tests (blood draws). Monitoring is necessary in order to assess the growth and development of the follicles and to avoid the possibility of Ovarian Hyperstimulation Syndrome (OHSS). At the beginning of injections and after about seven days of Gonal-f, frequent ultrasound monitoring and blood tests begin.
Ultrasounds allow the physician to obtain an image of the follicles as they grow and develop in the ovaries. Both the number and size of the follicles can be determined by ultrasound, which is essentially a painless procedure. You may feel the pressure of the transducer on your abdomen or in your vagina; however, you cannot hear the sound waves nor have there been any harmful effects to the developing eggs.
As follicles develop, the ovaries secrete increasing amounts of the hormone, estradiol. The level of estradiol indicates the degree of ovarian stimulation and is used in conjunction with the ultrasound to adjust the dose of medication and to time the HCG injection (short for "human chorionic gonadotropins"). HCG is a natural hormone and works to stimulate ovulation as in a normal cycle and it has been used safely for many years. HCG is your final injection and this initiates the final stage of maturation and timing of the egg retrieval.
Stage Three: Oocyte Retrieval
Egg retrieval will occur about 36 hours after the injection of HCG. Egg retrieval is usually scheduled early in the morning (between 8:30 a.m. and noon). Typically, the eggs are retrieved under ultrasound-guided needle aspiration. This procedure is performed under anesthesia, so that you will be totally comfortable and pain-free. The ultrasound probe with a needle guide is placed in the vagina, which allows an aspiration needle to be inserted through the upper portion of the vagina directly into the ovary. The ultrasound image allows the physician to accurately guide the needle into each follicle for aspiration or "suction".
The retrieval process takes approximately 15-30 minutes. Following the retrieval you are asked to remain at the clinic for one to two hours to recover from the anesthesia. You must plan on having someone available to drive you home as you have been under the effects of anesthesia and cannot (by law) drive yourself home or take public transportation. You must be accompanied home. When you are released from the clinic you may resume light daily activities. It is very common to experience some cramping and spotting following the process and the clinic will prescribe the appropriate pain medication. You will be scheduled for a care call with the nursing staff 3 days following the retrieval. You should be cautious of increased fertility for several days prior to the egg retrieval and for several days after the egg retrieval and should avoid sexual relations seven days prior to the egg retrieval and for two weeks after the retrieval (until you get your next menstrual period)
****Please remember – this is a sample protocol and it may vary from Clinic to Clinic. Once chosen and you meet with the clinic of the Intended Parents choice, they will give you a more detailed protocol. This is intended for informational purposes only.****