Learn about In Vitro Fertilization (IVF) with donor egg at our Dallas, Texas fertility center. please visit: https://dallasfertilitycenter.com/treatment-options/donor-egg-ivf/

1. The Egg Donation Process
The egg donation process works in 7 steps:
 Indications
 Selecting an Egg Donor
 Matching the Egg Donor with the Recipient
 Egg Donor Recruitment
 Evaluating Prospective Egg Donor Candidates
 Preparation for the Egg Donor IVF Process
 The Cycle of Treatment
Indications
1. Advancing age (beyond 40 years) is by far the most common reason why
American women elect to work with an egg donor.
2. The second most common indication for OD – and one that usually ties in
with advancing age beyond 40 years – is declining ovarian function.
3. In a select, but nevertheless, significant percentage of cases, the indication
for OD falls into one of the following categories:
1. Premature ovarian failure in women under 40 years due to genetic
cause
2. Exposure to chemotherapy and/or excessive radiation as part of
cancer therapy
3. Aneuploidy (e.g. ovarian dysgenesis or Turner’s syndrome)
4. Surgical removal of the ovaries (oophorectomy)
4. Recurrent IVF failure due to “poor quality” eggs or embryos is relatively
common and one of the most rapidly growing indications for OD in the
United States.

2. 5. Another social reason for American women electing to undergo OD is in
cases of same-sex relationships (predominantly female) where both
partners wish to share in the parenting experience by having one serve as
egg provider and the other as the recipient.
Selecting an Egg Donor
Ninety percent of egg donation in the United States is accomplished by soliciting
the services of anonymous donors. There are typically state-licensed agencies
used to handle the legal and financial aspects of such arrangements. It is less
common for recipients to solicit donors that are known to them. However, this
too can be accomplished ethically through the services of an OD agency. It is also
not easy to find donors who are willing to enter into such an open arrangement.
Accordingly, in the vast majority of cases where the services of a known donor are
solicited, it is often done by virtue of a private arrangement. While the services of
non-family-member, known donors are sometimes sought, it is much more
common for recipients to approach close family members in an attempt to retain
as much of the family gene pool as possible. Many recipients feel the compulsion
to know or at least to have met the egg donor so as to gain first-hand familiarity
with their physical characteristics, intellect, and character. It is of interest that in
the United States, the decision to use a known donor is rarely based solely on the
desire to reduce or eliminate the donor fee.
In America, embryo recipients who use known donors, while often sharing similar
demographic characteristics with them, tend to differ significantly when it comes
to issues of disclosure. Recipients using anonymous donors tend to be far more
open about the issue of their undergoing egg donation and are more willing to tell
others as well as inform the child about the nature of his or her conception.
At the Center for Reproductive Endocrinology, we can advise patients on the process,
however, we do not facilitate selection – the process will go through an external agency.
One of the outside agencies we work with is The World Egg Bank.
Matching the Egg Donor with the Recipient
Egg donor agencies usually prepare rather extensive donor profiles. Some, aside
from offering direct personal and telephone-based access to both donors and
recipients, also offer copious information and online services via a dedicated

3. website. Through such a website, a recipient and her partner can for a nominal
fee, select or narrow down their selection of the most suitable egg donor in the
privacy of their home…a growing number of candidates take full advantage of this
service.
Once the choice of a donor has been narrowed down, to two or three, the
recipient(s) is/are asked to forward all relevant medical records to their chosen
ART physician. Upon receipt of such information, an in-person or telephone-based
detailed, medical consultation will subsequently be held. Thereupon a physical
examination by the treating physician or by a designated alternative qualified
counterpart is scheduled. This entire process is overseen, and orchestrated by
one of the OD program’s nurse coordinators. As a result, all clinical, financial and
logistical issues can be managed effectively.
Egg Donor Recruitment
Donor agencies usually limit the age of egg donors to under 35 years in an
attempt to minimize the risk of ovarian resistance and negate the adverse
influence of the “biological clock” (donor age) on egg quality. In fact, some OD
agencies go so far as to set their age limits below 30 years.
Another factor involved in selecting an egg donor is the need to accurately assess
ovarian reserve. We use various tests to assess ovarian reserve in order to
optimally screen the most fertile egg donors. For instance, we recently reported
on an excellent correlation between such a pre-antral/antral follicle count and the
number of mature eggs subsequently retrieved from the donor following ovarian
stimulation with an appropriate dosage of gonadotropins. A total pre-
antral/antral count of less than ten (10) will often lead to the recommendation
that the woman be disqualified from serving as an egg donor.
No single factor instills more confidence regarding the reproductive potential of a
prospective egg donor than a history of her previously having achieved a
pregnancy on her own, or of one or more recipients of embryos derived from her
eggs having achieved a live birth. Moreover, such a track record makes it far more
likely that such an OD will have “good quality eggs.” Furthermore, the fact that an
OD readily conceived on her own lessens the likelihood that she herself has tubal
or organic infertility. It should therefore come as no surprise that it provides a
measurable degree of comfort to OD programs when a prospective donor is able

4. to provide evidence of having experienced a relatively recent, trouble-free,
spontaneous pregnancy. However, the current shortage in the supply of egg
donors makes it both impractical and unfeasible to confine donor recruitment to
those women who could fulfill such stringent criteria for qualification.
Evaluating Prospective Egg Donor Candidates
1. Donor History
Appropriate and careful history taking is essential in order to identify any personal
or family history that might point towards potential medical problems that might
arise during or after the cycle of stimulation and egg retrieval. Systemic disease,
allergies to known medications, hemorrhagic diatheses, and mental disease are
but a few significant examples. It is also extremely important to try and rule out
potentially debilitating hereditary and chromosomal disorders that could affect
the quality of any offspring arising out of the egg donation.
Most programs in the United States follow the American Society of Reproductive
Medicine’s (ASRM) recommendations and guidelines for selective genetic
screening of prospective egg donors for conditions such as sickle cell trait or
disease, thalassemia, cystic fibrosis, and Tay Sachs disease when medically
indicated. Consultation with a geneticist is available in about 90% of programs.
There are, however, still a significant number of OD ART-programs in the United
States that do not follow all ASRM guidelines.
Most American recipient couples place a great deal of importance on emotional,
physical, ethnic, cultural, and religious compatibility with their chosen egg donor.
In fact, they will often insist that the egg donor’s sexual orientation be
heterosexual.
2. Psychological Screening
Americans tend to place great emphasis on the psychological screening of egg
donors. Since most donors are “anonymous”, it is incumbent upon the OD agency
or ART program to determine the donor’s degree of commitment as well as her
motivation for deciding to provide this service. We have on occasions
encountered donors who have buckled under the stress and defaulted mid-
stream during their cycle of stimulation with gonadotropins. In one case, a donor
knowingly stopped administering gonadotropins without informing anyone. She

5. simply awaited cancellation, which was affected when follicles stopped growing
and her plasma E2 concentration failed to rise.
Such concerns mandate that assessment of donor motivation and commitment be
given appropriate priority. Most recipients in this country tend to be very much
influenced by the “character” of the prospective egg donor, believing that a
flawed character is likely to be carried over genetically to the offspring. In reality,
unlike certain psychoses such as schizophrenia or bipolar disorders, character
flaws are usually neuroses and are most likely determined by environmental
factors associated with upbringing. As a result, they are unlikely to be genetically
transmitted. Nevertheless, all donors should be subjected to counseling and
screening and should be selectively tested by a qualified psychologist. When in
doubt they should be referred to a psychiatrist for a definitive diagnosis. Selective
use of tests such as the MMPI, Meyers-Briggs, and NEO-Personality Indicator is
used to help screen for personality disorders. Significant abnormalities, once
detected, should lead to the automatic disqualification of such prospective
donors.
When it comes to choosing a known donor, it is equally important to make sure
that she was not coerced into participating. We try to caution recipients who are
considering having a close friend or family member serve as their designated egg
donor that in doing so, the potential always exists that the donor might become a
permanent and unwanted participant in the lives of their new family.
3. Assessing for Substance Abuse
We typically use urine and/or serum drug testing of egg donors. This is to
minimize the risk to our recipients of an undiagnosed but significant risk factor.
4. Assessing the Donor’s Ovarian Responsiveness
Assessing an individual’s follicle recruitment potential is accomplished by
measuring FSH and E2 on the 3rd day of a spontaneous menstrual cycle. In
addition to these tests, we also measure the woman’s serum Inhibin-B levels. An
FSH of less than 8.0 mIU/ml in association with a plasma estradiol concentration
between 20 and 60 pg/ml and an Inhibin-B level above 45 ng/ml on CD3 usually
points to the woman being a potentially good responder to gonadotropin
stimulation. However, recipients must be made aware of the possibility of a
suboptimal ovarian response in spite of these tests all being within normal limits.

6. Other measurable hormonal parameters include Thyroid Stimulating Hormone
(TSH), free T4 and prolactin, which if present in a high concentration, can
competitively bind with granulosa cell FSH receptors, reducing ovarian response
to gonadotropins.
5. Testing for Sexually Transmittable Diseases
FDA guidelines require that all egg donors be tested for sexually transmittable
diseases before entering into a cycle of IVF. It is highly improbable that DNA and
RNA viruses are vertically transmitted to an egg or an embryo through sexual
intercourse or IVF. Nevertheless, the albeit remote possibility of transmission and
the associated legal ramifications demand that potential donors so infected be
disqualified from participating in IVF with egg donation. For example, it is easily
conceivable that the egg donation process could be blamed for an unrelated
occurrence of disease states such as hepatitis b, c or HIV. In addition, evidence of
prior or existing infection with Chlamydia or gonorrhea introduces the possibility
that the egg donor so affected might have pelvic adhesions or even irreparably
damaged fallopian tubes that might have rendered her infertile. Even if an egg
donor or recipient who carries a sexually transmittable viral or bacterial agent is
willing to waive all rights of legal recourse, a potential risk still exists that a
subsequently affected offspring might in later life sue for wrongful birth.
6. Medical Evaluation
While advancing age beyond 40 years is indeed associated with an escalating
incidence of pregnancy complications, such risks are largely predicable through
careful medical assessment prior to pregnancy. The fundamental goal is to
determine that the recipient is capable of safely carrying a pregnancy that would
culminate in the safe birth of a healthy baby. For this reason, a thorough
evaluation must be done prior to initiating IVF in all cases.
7. Infectious Screening
The need for careful infectious screening for embryo recipients cannot be
overemphasized. Aside from tests for debilitating and life-threatening sexually
transmittable diseases, there is the important requirement that cervical mucus
and semen be free of infection with ureaplasmaurealyticum. This organism, which
rarely causes symptoms, frequents the cervical glands of 15-20% of women in the
United States. The introduction of an embryo transfer catheter via an infected

7. cervix might easily transmit the organism into an otherwise sterile uterine cavity.
Ureaplasma and Mycoplasma induce apoptosis of trophoblast cells, leading to
early implantation failure and/or first-trimester miscarriage.
8. Preparation for the Egg Donor IVF Process
Preparation for egg donation begins with full disclosure to all participants as to
what each step of the process involves from start to finish, as well as potential
medical and psychological risks. This requires that a significant amount of time be
devoted to this task and that there be a willingness to painstakingly address all
questions and concerns posed by all parties involved in the process. An important
component of full disclosure involves clear interpretation of the medical and
psychological components assessed during the evaluation process. All parties
should be advised to seek independent legal counsel so as to avoid conflict of
interest that might arise from legal advice given by the same attorney.
Appropriate consent forms are then reviewed and signed independently by the
donor and the recipient couple.
Most embryo recipients fully expect their chosen donor to yield a large number of
mature, good quality eggs, sufficient to provide enough embryos to afford a good
chance of pregnancy, as well as several for cryopreservation (freezing) and
storage. While such expectations are often met, this is not always the case.
Accordingly, to minimize the trauma of unexpected disappointment, it is essential
that in the process of counseling and of consummating agreements, the
respective parties be fully informed that there are no specific guarantees of
outcome. By making best efforts to provide the highest standards of care, the
caregivers can only assure optimal intent and performance in keeping with
accepted standards of care. All parties should be made aware that no definitive
representation can or will be made as to the number or quality of ova and
embryos that will or are likely to become available.
Please visit: https://dallasfertilitycenter.com/treatment-options/donor-egg-ivf/