Donor Egg/Embryo Program

ACFS has a lot of experience using donor eggs, and probably has one of the longest standing donor egg programs in the country. As early as the mid to late 80's, ACFS was anonymously transferring extra donated eggs from young women undergoing the GIFT procedure, without financial compensation, to women with premature ovarian failure and age-related infertility. Freezing of embryos was not readily available then, and some couples were willing to donate their extra eggs anonymously to another woman. These "recipients" were on a first come, first serve basis; and when they were number one or two on the list, they were temporarily made menopausal, put on oral estrogen to prepare their uterus for implantation, and hoped that some young woman with similar characteristics who was having egg recovery, had "extra" eggs that she was willing to donate, before her "window of opportunity" passed because she had been on estrogen too long. Although, in those days, there were many successful pregnancies, it was extremely frustrating for so many women who were prepared and "waiting for eggs". Many times numerous cycles were cancelled because no extra eggs were available to be donated.

As the demand for donor eggs increased, and because of the cancellation of many cycles because of the "window of transferability" had passed with no extra donated eggs available, ACFS looked at ways to improve its donor egg program. Our current program is an evolution of those changes. Today, ACFS has a busy and very successful donor egg program. With the advances in cryopreservation, women are no longer donating their extra eggs. As a result, ACFS was the first program in Arizona to begin recruiting young women who were willing to anonymously donate their eggs for financial compensation; to make "a profound difference in another couple's life and alter their own lives forever".

Become an Egg Donor at ACFS - Click Here to download the Application (PDF)

Imagine being able to profoundly impact another individual's life. To give the gift of life and love... a gift that would alter another's life forever. Becoming an egg donor allows you to do that. Many of us are "opportunities" waiting to happen. Becoming an egg donor can be that opportunity. You have that power. The donor egg program at ACFS, with your help, has helped hundreds of couples achieve their dreams.

Letter to an egg donor from one of our patients

"As I cannot contact you directly and talk to you face to face, I'm writing this letter anonymously to let you know just how important and significant your decision is to others. My arms have ached waiting for that special child to arrive that would bring new meaning and significance to my life, and create the family I have always wanted. Even as you read this, you are getting very close to having that dream of creating life come true for us. You have put your body through daily injections. My eggs could not be used. This means that the chance of creating a life that is most wanted and would be most cherished cannot happen without your help. It is the gift of hope and life itself. Your gift could be the most loving and gracious gift that you will ever give to a fellow human being. I assure you that the child that could develop will be loved and cherished. They will be raised with true social consciousness and environmental awareness. By their very presence, they will make the world a better place, having been given a rare and special chance to be here. Although I cannot thank you directly, please know that my grateful thoughts and prayers will be with you all of the rest of the days of my life".

All ACFS donors are between 19-30 years old. Initially, an interested young woman will fill out an donor egg application and mail it back to the office. ACFS donor egg coordinator will then call her up for an interview; at which time, the entire ACFS donor egg program will be explained to her in detail and she will have plenty of time to have all her questions answered and/or any concerns addressed. Once she is determined to be a suitable candidate, she will see the doctor; as well as, undergo full psychological, genetic and medical testing, and once chosen all required FDA testing. Having passed all these, she will then be put on our list of available egg donors for patients to choose from. Although ACFS donor egg program is completely anonymous, couples will have the opportunity to be able to see a perspective donor's pictures and review her medical, psychological and genetic information, identifiable by a number unique to that donor.

Egg donation involves the deliberate use of oocytes (eggs) provided by a donor for IVF and subsequent embryo transfer to a matched and synchronized recipient. Today, egg donation has expanded to include:

1. Premature ovarian failure secondary to chemotherapy or radiation
2. Gonadal Dysgenesis- where a woman is born without eggs
3. Certain chromosome abnormalities like Turner's Syndrome
4. Carriers for chromosome/genetic defects- cystic fibrosis, Tay-Sachs, sickle-cell anemia, Huntington Chorea and many others where PGD is not an option or the couple does not want to have to deal with the difficult choices of deciding on termination of affected embryos.
5. Peri-menopausal women with decreased ovarian reserve
6. Premature menopause - menopause before the age of 40
7. Women of any age who fail to respond to gonadotropin stimulation
8. Woman who respond to gonadotropins but want to increase their "odds" of being successful, generally based on their ages.
9. Multiple attempts of IVF without success
10. Repeated pregnancy loss in spite of treatment
11. Women of any age with repeated poor egg quality and/or poor fertilization rates and/or poor embryo development, all without resulting pregnancy
12. Elevated FSH levels
13. Loss of ovaries secondary to surgery

ACFS clearly recognizes that for some women, the decision to use donor eggs is an easy and straightforward one based on their medical history; for many, it is a difficult and, many times, life-altering decision. A frank discussion of issues related to non-genetic parenting, past infertility problems, feelings regarding prior failed IVF treatments, parenting at an older age and positive and negative aspects of disclosure to family and the potential offspring of using donor eggs needs to be thought through. If a known donor is used, the "recipients" need to consider how the pregnancy might impact on any future relationship with the donor, as well as, defining future interaction between the donor and the potential offspring. Although success is quite high using donor eggs, the couple must address the possibility of being unsuccessful and determine how they might deal with that outcome.

For some, after much thought and prayer, they make the decision to proceed, for others, it is the most difficult decision of their life, and sometimes impossible to make. Donor eggs is not right for all women. To give up your own "genetic material" in exchange for an others, is many times, one of the most difficult and thought out question of a woman's life. It depends on so many factors including believe systems, religious values, spiritual, psychological and a long list of emotional thoughts and feelings. A big part of the decision is what a woman thinks most influences the outcome of a child. Is it nature or nurture, environment or hereditary? For those women that believe that the way a child turns out is due mainly to how he/she is raised; to include the values, beliefs, experience, traditions and the personality of the parents, then making the choice to proceed with donor eggs is "easier". If a woman believes that hereditary is the main guiding factor in how a child turns out, then deciding to use donor eggs will be extremely difficult. Some will not be able to make that choice, and would rather adopt or go childless. But once the decision is made to use donor eggs, in ACFS experience, that woman "never looks back" and once the baby is born and she holds it in her arms, she "wonders why she waited so long to make the decision".

There are many pros and cons for deciding to proceed with donor eggs versus adoption or going childless. For some women, they feel strongly about adoption and being able to give a loving and nurturing home to a less fortunate child. But adoption is not for everyone and donor eggs offers a great alternative. In ACFS experience, we have noticed some differences between adoption and donor eggs:

1. With adoption, it is neither parent's genetic (chromosomes) material, nor are they the biological (birth) parents
2. With donor eggs, the male's role is unchanged and he gets to contribute his own sperm; whereas the woman is still the "main player" because she will carry the baby to term.
3. Donor sperm is a lot harder for men than donor eggs is for women. That's because the male ego has a much harder time dealing with the thought of "someone else's sperm"; whereas, typically, the female ego deals with donor eggs much better. Maybe part of that has to do with the fact that she will be carrying the baby and is able to bond with the child during those 9 months. Men already have such a small role in the reproductive process and once you use donor sperm, he "is taken out of the picture".
4. Don't under-estimate the importance of the "couple" being pregnant and the sharing "the baby" experience for the next 9 months. If is hard to be "instant parents", one day getting a call to "pick up your child". Those 9 months shared "preparing" for your new baby is very significant. The woman is a pregnant woman, a future mother, the mother of her partner/husband's child, a pregnant sister, colleague, friend or co-worker, and together, for the next 9 months they prepare to be the future parents of that child.
5. Adoption is difficult and 3 out of 4 adoptions do not go through and results, many times, in frustration and disappointment.
6. Adoption in Arizona takes an average of 2-5 years, unless you know someone who knows someone that will be giving up a baby for adoption; or the couple goes with an international adoption, which generally takes about 18-24months.
7. Adoption is expensive and can cost upwards of $50,000+. Donor eggs is considerably less and you usually can freeze extra embryos to have "genetic "siblings in the future (at a fraction of the cost of the original donor egg cycle).
8. Adopted children can have psychological problems. Although adoption is a wonderful option for some and many children grow up just fine and well adjusted, others have a hard time coping and adjusting to the fact that they were "given up for adoption"; because at sometime they need to be told that they were adopted. The underlying psychology of adopted children is "abandonment and lack of self-worth" and on some level they want to know "what was wrong with them" for their mother to "give them up". From experience, whether you agree with it or not, most parents choose not to tell their children that they were from donor eggs. With adoption, there is a set of genetic and biological parents out there, but when a couple decides on using donor eggs, they are the biological parents (and the father is also the genetic parent).

From the many differences seen above, the decision to proceed with donor eggs is a very personal and, sometimes one of the most difficult decisions in a woman's life; but once she makes that decision, in ACFS experience, she "never looks back" and when the baby is born and she gets to hold it in her arms, she "wonders why it was so difficult to decide".

Once the decision has been made to proceed with donor eggs and the couple has selected a donor, the process of synchronizing both donor and recipient's cycles will begin. ACFS does not match recipients with egg donors and strongly believes it is the decision of the recipient couple to "choose" the egg donor that is "best" for them. Donors receive medication that will stimulate her ovaries to produce multiple egg follicles. The patient (recipient) prepares her uterus by taking estrogen, and later, progesterone; once ovulation is triggered in the donor. Egg donors are either anonymous or known to the couple. In the United States, anonymous donors are compensated for their services.

At ACFS, donors are compensated $3800 per donation.

Many think that young women donate for the money. In ACFS experience, that is so far from the truth and if that was the case we would have a line of potential egg donors a block long waiting to sign up. Young women donate because it is their way of "making a difference", and what a profound difference it is in the life of the recipient, and in theirs. What better gift can one person give to another? Although, she will "never be thanked", it will alter her life and the life of the people around her in so many positive ways. It is what the East Indians call AGAPE or "selflessness". ACFS gets its egg donors by word of mouth and by advertising in local media sources. All ACFS donors are between 19-30 and can donate for a total of 6 times and are covered with donor health insurance. For every 100 calls we get and send out applications, we are lucky to put 5 donors on the list. The following steps is what an egg donor needs to do:

1. Fill out the application and mail it back to ACFS. Then she will be called in for an interview and all her questions will be answered and the entire process explained to her in detail and a complete medical history and physical examination will be done.
2. The next step is that she sees a genetic counselor to review her genetic history of, at least, her parents and grandparents to rule-out any genetic problems that would disqualify her as an egg donor.
3. She also will have a complete psychological evaluation that includes the MMPI(Minnesota Multi-Phasi Personality Index) which consists of 454 multiple-choice questions that tells everything about her personality. The controversy is whether personality is learned or inherited. ACFS believes, that it is probably learned behavior. The consultation also consists of about a one hour visit with the psychologist discussing the reasons why she wants to be an egg donor, to make sure that there isn't any "psychological" reason why she may not be an appropriate candidate.
4. Once she "passes" the medical, genetic and psychological parts of the process, she is put on a list with her physical characteristics, educational background and pictures and is assigned a donor number that is unique other. Although the process is 100% anonymous, the recipient has access to seeing any donor's psychological and genetic profiles by using her donor number.
5. Once she is "picked" by a recipient couple, she signs all the appropriate informed consents and she undergoes screening tests based on FDA guidelines , outlined for all third-party tissue donation (see screening list below). These are mainly screening tests for STD's and hormonal abnormalities that can interfere with egg production, like thyroid and prolactin levels.
6. The recipient will also go through her appropriate screening tests based on FDA guidelines and a complete work-up to make sure that nothing is overlooked that may affect her ability to be successful.
7. Both the recipient and the donor's cycles are synchronized by starting Lupron on the first day of bright red bleeding of their cycles. They are continued on Lupron until the person whose cycle started last is on it for 4 weeks. At that point they are both temporarily menopausal and the recipient is started on oral estrogen to begin to prepare her uterus for implantation, and the donor is started on gonadotropins to stimulate her ovaries for multiple egg production and monitored with frequent ultrasounds.
8. Once the donor's lead follicles are at 18 mm in size, she is given 10,000 IU of hCG to trigger ovulation. In 36 hours, under conscious sedation by anesthesia, she undergoes transvaginal ultrasound guided egg aspiration and all her eggs are recovered and placed in the incubator. She is in the recovery room for about 30 minutes and then discharged home. She is seen in 2 weeks at the onset of her menses to do an ultrasound to make sure she has no residual simple cysts from the stimulation cycle. If she does, she is put on birth control pills which will cause them to go away. Many egg donors will stay of the pill. At that point, if the experience was a good one and she would like to be a donor again, she will let us know, and she will be put back on the list. ACFS feels strongly that if the donor requests to know if the recipient got pregnant, it is her right to know and she is told.
9. About 5 hours after egg recovery, all the mature eggs undergo ICSI to maximize fertilization and are checked in 17-18 hours for the number that have fertilized. The morning after the egg recovery, the recipient starts either IM progesterone or progesterone gel (Crinone) and continues on her estrogen.
10. Because the eggs are so young, ACFS recommends blastocyst transfer and the embryos are left in culture till day 5. Based on ASRM guidelines, 1-2 blastocysts are transferred into the uterus on day 5.
11. Pregnancy test is done in 9 days, and if positive, the recipient will stay on her estrogen and progesterone until the end of 12 weeks. At that time the placenta is fully functional and making all the hormones required to sustain the pregnancy until delivery. Ultra sound monitoring will be done to track the development and progress of the developing fetus every 1-2weeks.

The reason that donor eggs is so successful is two-fold. One is that the eggs are so young, and the "younger a woman's eggs are the better the success". And secondly, the age of the uterus is a zero factor. That is why you can put 24 year old eggs in a 49 year old woman, and she will have the success rate of a 24 year old.

The couple acknowledges that any child/children born as a result of IVF-donor eggs will be considered in all respects their natural child.

How old is too old to receive donor eggs? ACFS feels strongly that a woman has the right to choose whether or not she would like to have a baby regardless of her age; and, therefore, any woman 50 or older is considered on an individual basis and not automatically turned down. As long as she has medical clearance to proceed, no significant medical problems, has seen a psychologist and perinatologist (high-risk baby doctor) and is cleared, then ACFS respects her right to choose, will support her decision and passes no judgment on whether or not it is a good idea. What is better, 25-30+ years of unconditional love and nurturing or 60+ years of maybe not knowing one or both of your genetic parents?

ACFS checklist and FDA guidelines required for all egg donors prior to egg recovery (PDF)

EMBRYO DONATION PROGRAM

ACFS has a busy, successful and demanding donor embryo program and, at times, has trouble keeping up with the request for donor embryos. The donor embryo program at Arizona Center for Fertility Studies offers infertile couples the chance to successfully achieve a pregnancy. Generally a couple will choose donor embryos because the donor egg program is too costly, the woman needs donor eggs and her partner has no sperm, or the couple "feels better" that neither one is using their genetic material. Using a donor embryo is a great alternative treatment for couples that have been unsuccessful in achieving a pregnancy either on their own or through assisted reproductive technologies (IVF) with their own eggs, and for those who have experienced multiple pregnancy losses.

Donor embryos at ACFS are donated cryopreserved embryos from generally younger patients who have gone through IVF, been successful and have completed their family. At ACFS, all patients with "extra" embryos, are given the opportunity to anonymously donate their unused frozen embryos, rather than discarding them, to couples that have made the decision to use donor embryos.

ACFS encourage anonymous donation of a couple's extra unused embryos but supports their decision to discard their extra embryos rather than donate them.

ACFS does not match donor embryos to the recipient couples. Couples wanting donor embryos are put on a list and when they become number one on the list, they are anonymously given the complete profiles of available donor embryos. The couple views the profiles of donated embryos and selects the embryos they would like to use. ACFS believes the donor embryo selection is an important decision that should be made by the recipient couple. There is generally not as much information on donor embryos as there is on donor eggs, since the embryos are from ACFS patients; and thus, did not have to undergo psychological and genetic testing, although, they have had a complete medical work-up and FDA testing. ACFS staff is very familiar with the personalities and the backgrounds of "these donor embryos" because they are so familiar with the couple, and therefore, can help in the selection process, if asked.

Donor Embryo Recipient Consent For Uterine Transfer

I/we consent to receive donor embryos from Arizona Center for Fertility Studies to be used for uterine transfer. I/we have had the screening tests for receiving donor embryos as set by the American Society of Reproductive Medicine and the FDA. I/we are aware the embryo donors have been screened also, according to ASRM and the FDA. All reasonable measures have been taken to ensure that the donor remain anonymous. It is understood that ACFS cannot be responsible for the physical or mental characteristics of any child or children produced. Any child born of this procedure will be regarded as my/our natural child in all respects including the laws of descent and distribution of property. I/we waive all rights to challenge the legitimacy of any child/children born from this procedure, and to provide all reasonable support to said child/children. All records and agreements remain confidential, and cannot be released without my/our permission.

I/we consent to the following general steps involved in uterine embryo transfer.

1. Administration of hormone injections to time the thaw and prepare the uterine lining.
2. Monitoring of the uterine lining with vaginal ultrasound.
3. A pre-determined number of embryos will be thawed in the laboratory under microscopic examination to assess viability based on ASRM guidelines.
4. Once viability is confirmed, a pre-determined number of embryos will be transferred into the uterus by a small catheter inserted through the cervix.

I/we have been informed of the following procedures, risks and limitations and have had the opportunity to discuss these with my physician.

1. Transferring the embryos into the uterus may cause slight discomfort, cramping, spotting, or infection, although these side-effects are quite uncommon.
2. There is a possibility of ectopic pregnancy with any attempt at pregnancy. This would require treatment by MTX (methotrexate) or surgery to remove the ectopic pregnancy.
3. The transfer of multiple embryos may result in multiple gestation. The risks of prematurity and other complications have been explained.
4. It is possible, although extremely unlikely, that infection could be introduced into the patient by this procedure.

I/we understand that any of the following may occur to prevent pregnancy.

1. Medical emergencies may make the transfer unavailable.
2. The embryo(s) may not survive the thaw process.
3. The embryo(s) may not develop normally and therefore would not be transferred.
4. Implantation may not occur.
5. A laboratory accident may result in loss or damage to the embryo(s), although this has never happened at ACFS.

The goal of this procedure is to achieve a normal pregnancy. Once a pregnancy is established, miscarriage, ectopic pregnancy, stillbirth and/or congenital abnormalities may occur. There is no evidence to date that the occurrence of these is increased or decreased by this procedure. I/we understand that several attempt may be necessary to achieve a pregnancy.

I/we understand that if I or any of my off spring should require medical treatment as a result of physical injury arising from participation in this process, the financial responsibility will be mine. I/we understand the financial responsibility associated with this procedure.

Data from this procedure will be provided to the Centers for Disease Control and Prevention(CDC). The 1992 Fertility Clinic Success Rate and Certification Act requires the CDC to collect data on all assisted reproductive technology cycles in the US. SART (Society for Reproductive Technologies) uses this information to confirm and report success rates. Because this is sensitive information, the CDC and SART applied for and received an "assurance of confidentiality" for this project under the provisions of the Public Health Service Act, Section 308D. This means that any information that CDC has that identifies you cannot be disclosed to anyone without your consent.