In vitro fertilisation enables women who cannot produce a healthy ovum (egg) and male couples to enjoy parenthood. The eggs can be obtained from a willing donor. The donated eggs are used at a later date for various in vitro fertilisation (IVF) techniques.
The Egg donor cycle is a process during egg donation wherein the woman who is donating the eggs undergoes a planned cycle of six phases. These phases are- personal screening, synchronisation with the recipient cycle, suppression of the cycle, stimulation of follicles, retrieval of eggs and follow-up.
The donor is screened via ultrasound, blood tests and urine drug screen tests along with psychological analysis to rule out the possibility of any genetic, mental or physical diseases. Once results are obtained, and the reports are clear, only then is a donor matched with the recipient and asked to start the process of synchronising the cycle. This is the first and a crucial step in egg donation.
Synchronisation of the cycle
During this phase, the female donor is given oral contraceptive pills on day 3 of her menstrual cycle to maintain the hormones and the ovaries in a uniform, non-ovulatory state before the suppression starts. Based on the recipient’s menstrual cycle dates, the egg donor is given a date to start and stop the contraceptive pill, so that their periods are in synchrony.
Suppression of the cycle
The donor is initiated on Lupron injections on that specific day. Lupron works by switching off the body’s mechanism to stimulate ovaries naturally. Both the oral contraceptive pill and Lupron are taken together for several days before the pill is discontinued. The donor gets her periods in about a week to ten days of starting Lupron and about three to five days after the pill is stopped. This is an indication that the ovaries are now inactive. Due to this suppression of the donor’s periods, many small follicles in the ovary become available for stimulation.
The follicles in the ovary are stimulated by injecting external hormones called gonadotropins since the donor is not producing enough LH and FSH on her own. Gonadotropins are given twice a day, and serial ultrasounds are done to monitor the number and size of follicles that are developing. A blood test is done to determine the amount of oestrogen that is being produced at 1-4 day intervals. Once the donor’s follicles are optimally stimulated, she is given a Human Chorionic Gonadotropin (HCG) injection, which separates the eggs from the follicular wall and allows them to float freely in the follicular fluid. This happens around 35 hours after the HCG injection and eggs are released from the ovary after 39 hours. The egg retrieval procedure is planned between 34.5 to 39 hours after the injection. Final blood tests are performed the next morning.
Retrieval of eggs
This is done under sedation so that the donor does not feel any pain during the procedure. With the help of a special needle, under the guidance of ultrasound, eggs that are floating in the follicular fluid of the ovaries are retrieved.
The donor is followed up after she completes her next period. An ultrasound is performed to make sure that she is doing well.
Completion of all the six phases successfully leads to the production of viable eggs that can be then used for IVF.