What Happens During a Donor Cycle?
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An egg donation cycle is similar to a regular IVF cycle. There are two different types of cycles that can be undertaken (antagonist/long down regulation). Both cycles include injecting a follicle stimulating hormone (FSH) into your stomach once a day, and may also include a second injection to suppress ovulation. During cycling you will need to attend blood tests, and intra-vaginal ultrasounds to monitor your follicle progress. When follicles are ready, a trigger injection is given and egg pick-up (EPU) occurs 36 hours later and is completed under local or general anaesthetic.
The First Appointment
Prior to the appointment you will need to get a basic referral from your GP. Your recipients will book in an appointment with their fertility specialist. Some clinics may book in all appointments on one day, particularly for interstate donations, or these may be spread out. You will be asked to provide the clinic with some basic information on your medical and family health history.
The fertility specialist will order a number of blood tests, and possibly an intra-vaginal ultrasound to be completed. Scheduling for counselling sessions may also be completed at this time.
The fertility specialist will order a number of blood tests, and possibly an intra-vaginal ultrasound to be completed. Scheduling for counselling sessions may also be completed at this time.
What About Blood Tests?
A number of blood tests will be ordered to medically clear you for donation. These may include but not limited to: genetic testing (karyotyping), infectious disease testing (HIV, hepatitis, syphilis, etc.), cystic fibrosis, and Fragile X
Some of these tests may take up to six weeks to be returned.
What if I’m positive for______?
Even if you are a carrier for a certain condition this will not necessarily exclude you from donation. The intended father (IF) or sperm donor will also need to be tested for any of the same conditions that you may have tested positive for, if he is not also a carrier then the donation can proceed.
Some of these tests may take up to six weeks to be returned.
What if I’m positive for______?
Even if you are a carrier for a certain condition this will not necessarily exclude you from donation. The intended father (IF) or sperm donor will also need to be tested for any of the same conditions that you may have tested positive for, if he is not also a carrier then the donation can proceed.
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What to Expect at the Counselling Session?
- The way counselling sessions are conducted vary greatly by clinic. Some clinics require the sessions to be spread out over a number of days or weeks, and some allow them to be completed in one day. Generally three sessions are conducted: a session with recipients only, a session with the donor (and her partner), and then a group session with everyone.
- Some clinics allow these sessions to be completed via Skype or telephone - especially for interstate donations.
- The sessions cover a wide range of topics including, but not limited to:
- Your expectations of the donation - What do you want out of the donation?
- The legal aspects of donation - Your rights as a donor
- Your partner - How they feel about the donation?
- You are donating genetic material to assist a couple to create a life that will be carried, birthed, and brought up by another couple - this child will not be yours.
- You are providing your own children with genetic half siblings - how and when will you tell them?
- You are providing your parents with genetic grandchildren, your brothers and sisters with genetic nephews/nieces - how and when will you tell them?
- Who else will you tell? Do you have someone in your support network who can support you through this?
- Even in a known donation, with the child knowing how they were conceived and how they are genetically related to them, they may not want to contact or meet you or your children - how would that make you feel?
- The recipient couple decides what happens to any embryos they do not use - let them thaw, leave to research or donate on to another couple - how do you feel about this, given these embryos will have genetic links to you and your children?
- If you wish to have more children in the future and are unable to, how will you feel about this donation?
- If you have not yet started your family, how do you feel about your future children having genetic half siblings?
- How will the recipients treat/love the child/ren I help them conceive?
- Will I still be happy with this decision in 20 years' time?
What Happens at the Nurse Appointment?
The nurse will go over the details of the cycle with you. They will have a plan of when you will do your injections and when you will have your blood tests and scans throughout the cycle. The nurse will also take this time to instruct you how to do the injections properly.
What Happens During the Cycle?
If a recipient is going to do a fresh transfer, both the donor and recipient will be in sync (coming off the pill at a similar time), the donor will be set in time with the recipient after a natural period and a holding pattern set in place for the recipient so that they are synchronised at the same time. The idea is to synchronise the donor cycle and the recipient’s cycle so that when the eggs are ready for pick-up, the recipient's body is ready to accept the embryo.
Types of Cycles
The Antagonist cycle- On the first day of your period, you will start injections of Gonal f, Puregon, or Menopur to stimulate your ovaries into producing more than one egg. About a week into the cycle, you will begin a second injection of Orgalutran or Cetrotide to suppress ovulation. The cycle will take about 14 days depending on your body’s response.
The Down Regulation cycle- You will start by sniffing a nasal spray (Synarel) twice a day, this drug prevents your body from ovulating. After about a week on Synarel, a blood test is taken to ensure that your body is not ovulating and you’ll then begin the stimulation phase, injecting a drug called Puregon or Gonal F, where your ovaries are over stimulated to produce more than one egg. You will continue injections for 14-21 days depending on your body’s response.
The Down Regulation cycle- You will start by sniffing a nasal spray (Synarel) twice a day, this drug prevents your body from ovulating. After about a week on Synarel, a blood test is taken to ensure that your body is not ovulating and you’ll then begin the stimulation phase, injecting a drug called Puregon or Gonal F, where your ovaries are over stimulated to produce more than one egg. You will continue injections for 14-21 days depending on your body’s response.
How Am I Monitored Through the Cycle?
Your clinic will tell you how often you will need to attend blood tests and intra-vaginal ultrasounds to monitor the progress of your follicles. Usually the first scan is approximately 6 days after you’ve started the follicle stimulating hormone (FSH). Most clinics open early and you can be seen before normal work hours.
What is the Trigger Injection?
Once most of the follicles have grown to a certain length (this varies by clinic) but approximately 18mm or greater. The ‘trigger’ injection is given at a specific time and tells the body to release any eggs, this will happen approximately 36 hours later when the egg pick-up (EPU) is scheduled.
What Happens at Egg Pick-Up (EPU)?
Some clinics have their own facilities, but generally EPU is conducted at a day surgery. You will need to fast from food and drink prior to your scheduled pickup time from about 12 hours prior. You will be checked in, the anaesthesiologist will discuss everything with you, and then they will give you a light anaesthetic. You will be asleep for about 30-60 minutes while the fertility specialist collects your eggs. This is done using a needle and needle guide through a vaginal transducer, a tube inserted to collect the eggs from the follicles. The fluid in the follicles is drained, and the eggs are then taken for fertilisation
What happens if I don't have Private Health Insurance?
If you don't have health insurance, recipients will pay for all of the gap that is not covered by Medicare. If you are an anonymous donor, your recipients will be made aware of this. Be aware that if you experience any complications after EPU, you will have to cover your hospital costs and associated care, unless this is something you have discussed with your recipients.
How long do I need to wait between donations?
Fertility specialists vary on their opinions but most will want at least 1 month between donations though some will approve ‘back to back’ cycles. Many fertility specialists recommend 3-4 months between donations to allow a donor’s body to recover from each donation.
What are the side effects of the IVF drugs?
The job of the suppressant drugs, such as synarel, is to force your body into a temporary menopausal state where you will not ovulate. As such you may experience some menopausal symptoms such as spotting, hot flushes, headaches, breast tenderness, discomfort in lower back and abdomen due to increased ovarian activity. A full list of symptoms and what to be aware of is available from the clinic.
Stimulation drugs, such as Puregon and Gonal F, ask your ovaries to produce many more eggs than their usual one. The worst side effect of these drugs is Ovarian Hyper Stimulation Syndrome (OHSS) where the ovaries are so overstimulated that fluid leaks from the ovaries... in very rare cases some patients require hospitalisation. However, most women get some minor signs of OHSS during their treatment - swelling, tenderness - which is all treatable at home. Clinics are very careful to monitor anyone who may be prone to overstimulation, usually women who produce 15-20 eggs plus. Although rare, OHSS is a very real risk and must be taken seriously - please make sure you consult your clinic for a list of symptoms to watch out for.
General Anesthetic - although a light anesthetic is used, the usual side effects of a general anesthetic apply and some people may experience drowsiness, nausea etc.
There have been no long term studies conducted on the effects of IVF/donating for egg donors.
Stimulation drugs, such as Puregon and Gonal F, ask your ovaries to produce many more eggs than their usual one. The worst side effect of these drugs is Ovarian Hyper Stimulation Syndrome (OHSS) where the ovaries are so overstimulated that fluid leaks from the ovaries... in very rare cases some patients require hospitalisation. However, most women get some minor signs of OHSS during their treatment - swelling, tenderness - which is all treatable at home. Clinics are very careful to monitor anyone who may be prone to overstimulation, usually women who produce 15-20 eggs plus. Although rare, OHSS is a very real risk and must be taken seriously - please make sure you consult your clinic for a list of symptoms to watch out for.
General Anesthetic - although a light anesthetic is used, the usual side effects of a general anesthetic apply and some people may experience drowsiness, nausea etc.
There have been no long term studies conducted on the effects of IVF/donating for egg donors.
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How many eggs will I produce?
There are so many factors that impact on the number of eggs produced and as yet no one clear method to foretell how many eggs will be picked up... age, health, BMI, smoker or non-smoker are some of the things that might make a difference. Most donors are given the minimum dosage of drugs necessary and then it is up to how their bodies respond to these drugs. A woman doing an IVF cycle may produce anywhere from 0 to 30 plus eggs, with the average being between 5-15. It is the quality of the eggs that is important as well, the ability of an egg to become fertilised and divide into two cells, and then four so on. Any left over eggs will be frozen for future attempts of FET or Frozen Embryo Transfers.
What happens after EPU? What will I be told about any pregnancies?
Depending on what relationship you have with your recipients, your journey may end here. You can contact the clinic to find out how many eggs were successful, and by law the clinic must tell you if there is a successful birth, the sex of the child and if there are any disabilities. However, clinics in general do not appear to be very apt at taking care of their donors, so you may have to remain in contact with them. Down the track, if you or family members contract any hereditary diseases, it would be prudent to contact the clinic so they can alert the family. Likewise keep them informed of any address changes in case the family or children conceived would like to contact you when the time comes if you have agreed to this.
For known donors, your recipient will probably keep you informed of the outcomes up to pregnancy and hopefully beyond.
For known donors, your recipient will probably keep you informed of the outcomes up to pregnancy and hopefully beyond.