Third Party Reproduction
For many of our patients and couples, not being able to conceive is a challenging obstacle. At the Indiana Fertility Institute, we offer third party reproduction solutions for those who may benefit from donor assistance.
According to the American Society for Reproductive Medicine, third party reproduction refers to the use of eggs, sperm or embryos that have been donated by a third person (donor) to enable an infertile individual or couple to become parents. The use of donor eggs, sperm or embryos can then be used in procedures such as IUI and IVF. Third party reproduction also includes surrogacy with a gestational carrier.
What is egg donation?
Egg donation is when a woman volunteers to give her eggs to another woman in the hopes of helping her become pregnant through the in vitro fertilization process. In other words, egg donation is an infertility therapy that allows women without viable oocytes (eggs) to become pregnant, nourish the pregnancy and deliver a child of her own. There are many reasons why certain women do not have viable oocytes. The most obvious is related to age. Certain couples have simply delayed childbearing too long. Other women may have a genetic trait that they cannot pass on or may have had their oocytes depleted following chemotherapy/radiation treatments.
How successful is egg donation?
Very successful. Elite programs like ours have delivery rates above 65 percent. The national average delivery rate for egg donation is approximately 50 percent, as published by the Society for Assisted Reproductive Technologies.
How do you choose a donor?
The Indiana Fertility Institute offers patients and couples the options of known or anonymous egg donation. Known egg donation is when individuals or couples select a family member or friend to be their egg donor. Anonymous egg donation is when the donor is unknown to the patient or intended couple. Most times, egg donation starts as anonymous but the recipient couples and the donor may choose to meet before final selection.
Our donor selection is diverse. All egg donors are thoroughly screened and educated on the process of egg donation. We follow the guidelines set forth by the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology as well as FDA regulations for egg donation and egg donor compensation.
Most young women who apply to become egg donors are not selected. Donor applicants are between the ages of 21 and 31 and must be very healthy. We select only those women as donors who truly want to help others have a child and have passed appropriate physical, genetic and psychological screening. We are also open to working with qualified egg donor agencies.
How do most people feel about egg donation?
Egg donation is now widely accepted. Thousands of egg donation cycles are performed each year in the U.S. and more than 10,000 worldwide. In certain areas of the country, every kindergarten class has at least one child born through egg donation. Couples routinely tell us that they love their child born through egg donation as much as imaginable. Many families have had their first child without infertility therapy and their second child through egg donation.
How do you get started?
The first step is to meet with Dr. Jarrett. He will discuss your individual situation, answer your questions and perform an ultrasound to evaluate your uterus. Next, he will schedule a water ultrasound or an HSG to further evaluate your uterus.
Once we determine that your uterus is capable of carrying a pregnancy and your medical examination and blood tests are normal, you are all set to look for your donor. We will guide you each step of the way.
Many couples start the process of donor selection as they undergo screening tests. From the time you select a donor, it is usually two months before your embryo transfer.
How does the egg donation cycle work?
Dr. Jarrett will put you and your donor on birth control pills (OCPs) to synchronize your menstrual cycle with the donor’s cycle. It is critical that both of you are in the same phase of your menstrual cycle. Once on the OCPs, you will start a medication called Lupron, which will shut off your cycle in preparation for the upcoming embryo transfer.
At this point, the donor starts fertility hormones and you start taking estrogen. After 12 days or so, the donor undergoes retrieval and you start taking progesterone. The eggs are fertilized with your sperm choice in the embryology laboratory. The donor recovers and her cycle is complete. She will have a period in two weeks and, over time, resume her normal daily activities. The donor is specifically counseled not to have intercourse until after her menses in order to not become pregnant.
Once the eggs are fertilized, they begin to develop. The embryo transfer occurs either on Day 3 or Day 5 following the egg retrieval, depending on the specific situation. You very well may have additional embryos that can be cryopreserved. You will know whether you are pregnant or not within 12 days after the embryo transfer.
The costs of an egg donation cycle are somewhat higher than for a regular IVF cycle because there are three patients involved (recipient, male partner and donor). Additionally, the donor receives compensation for her time in the range of $5,000. Please ask our office for the most up-to-date estimated costs.
We believe that egg donation is an incredible therapy to allow a couple to have a family even when the female partner has no viable oocytes. Egg donation has revolutionized the treatment of infertility in the last 20 years. We would be honored to help you decide if egg donation is best for you.
Sperm donation is when a male voluntarily gives his sperm in the hopes of helping a woman or couple to become pregnant with IUI or IVF. Just as in egg donation, sperm donation can be done anonymously or as a directed (known) donor.
Anonymous Sperm Donation
The Indiana Fertility Institute assists couples with selecting anonymous donor sperm from sperm banks that are accredited by the American Association of Tissue Banks. Such accreditation assures that these banks meet specific minimal standards for disease screening and semen quality.
Known Sperm Donation
Known or directed sperm donation is when individuals or couples select a family member or friend to be their sperm donor. We follow the guidelines of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology as well as FDA regulations for directed sperm donation. We select only those men who pass appropriate physical, genetic and psychological screenings.
A surrogate is a woman who agrees to carry a pregnancy for another woman or couple.
One of the most generous gifts a woman can give to another is to carry a baby for nine months. New advances in reproductive medicine make it possible for a woman without a healthy uterus to have her own genetic child.
When is surrogacy needed? The most common use of surrogacy is for a woman who does not have a healthy uterus. There can be many reasons for this, including infection, small size, scar tissue or poor endometrial development. Additionally, some women are born with ovaries but no uterus.
How successful is surrogacy? The success of surrogacy depends on many factors—the most important being the age of the egg provider. For women or donors younger than age 32, the success is above 60 percent per cycle.
Who becomes a surrogate? Many educated women very much enjoy being pregnant. In addition, they enjoy helping another woman have a child. Before becoming a surrogate, a woman must meet a number of requirements, including having a child of her own and being at least 21 years old.
How are surrogates chosen? Surrogate agencies provide a great deal of information on prospective surrogates, including pictures and personal information. The surrogate/egg provider relationship is often non-anonymous, but that is decided by each case.
Once a surrogate is selected, medical and psychological screening tests are done to ensure her general, hormonal and psychological health are satisfactory. These tests include a careful medical history, pelvic examination (including a pelvic ultrasound), blood tests to look for infectious diseases (HIV, hepatitis B, hepatitis C, syphilis and HTLV-1), and cervical cultures for gonorrhea and chlamydia. The psychological screening includes an interview with a therapist experienced in this area.
How is surrogacy accomplished?
Surrogacy is an IVF cycle split between two women. Both women take birth control pills for a few weeks before starting the medication Lupron. This synchronizes the menstrual cycles of the women—getting both of them to the “starting gate” at the same time.
The surrogate then receives estrogen in the form of an estradiol valerate injection, twice a week. This is the same estrogen normally produced by the ovaries. Meanwhile, the egg provider receives daily injections of fertility drugs (such as Gonal-F, Follistim, Menopur and Repronex), which help to mature a group of eggs in her ovaries. Usually, eight to 12 days of fertility hormones are required before the eggs mature. Soon after, the recipient begins progesterone, the other hormone necessary to maintain pregnancy. This can be in the form of a vaginal gel or a daily injection. It has long been our custom to teach a spouse, relative, friend or neighbor to give injections so frequent trips to our office are not needed.
The eggs are gathered at the egg retrieval. A few hours later, the eggs are usually inseminated with sperm from the recipient’s partner. This is done by our embryologist. He will culture the fertilized eggs (now called embryos) until they are transferred to the recipient’s uterus, usually three to five days after egg retrieval.
What are the risks of being a surrogate?
Pregnancy, which is the goal of surrogacy, is also a risk to the surrogate. Any singleton pregnancy comes with the possibility of complications, which are increased in multiple pregnancies. We strive to limit the number of multiple pregnancies because of the added potential risks to the surrogate and unborn babies—premature delivery, respiratory issues and infections, to name a few. Although we limit the number of embryos transferred, we maximize success rates.
Can surrogacy reduce the future fertility of the surrogate?
There is no evidence that surrogacy reduces the future fertility of the surrogate, unless there is a complication with the pregnancy or the delivery.
Also known as a gestational carrier, this is the most common type of surrogacy. It refers to a woman who agrees to have another individual’s or couple’s embryo(s) transferred into her uterus with the IVF process. The surrogate has no genetic link to the pregnancy she carries.
This term refers to a woman who is artificially inseminated with sperm (typically from the male partner of the couple seeking surrogacy) for the purpose of conceiving. The surrogate’s eggs are fertilized with the sperm, giving the surrogate both a genetic and biological link to the pregnancy she carries. Currently, the Indiana Fertility Institute does not offer traditional surrogacy.