RMA at Jefferson offers gestational carrier and donor programs to help women and men conceive.
The American Society for Reproductive Medicine (ASRM) defines third-party reproduction as “the use of eggs, sperm, or embryos that have been donated by a third person (donor) to enable an infertile individual or couple (intended recipient) to become parents.” Third-party reproduction may also include the use of a gestational carrier. A gestational carrier is an individual who carriers a pregnancy for an infertile individual or couple. Gestational carriers are not biologically or genetically related to the intended parent/s or child.
Using Donor Eggs
Egg donors are an option for many patients. It is recommended for women who have age-related infertility, reduced egg quality, premature menopause, or diminished ovarian reserve. Women who have certain genetic diseases are also candidates for using donor eggs. Eggs can come from a fresh donor cycle or from an egg bank.
Choosing a Donor
Patients may identify their own donor, often a close friend or relative. More commonly, however, the egg recipient does not know the egg donor’s identity. Anonymous donors are between 21 and 30 years of age, in good health, with normal ovarian reserve. Each prospective donor undergoes screening for genetic diseases and infectious diseases, hormonal testing, a physical exam, and an ultrasound. Each donor also has a psychological consult and a consult with a genetic counselor.
For anonymous egg donors, we maintain strict confidentiality of the donor’s and the recipient’s identity; however, the egg recipient will have access to all of the donor’s extensive medical and family history.
RMA at Jefferson also works with various national egg banks that offer pre-screened eggs which have already been retrieved and frozen. These eggs may be purchased and shipped to RMA. We are then able to store the eggs until the patient is ready to thaw them. This option may decrease wait time and removes the need to synchronize a woman’s cycle with a present egg donor. The recipient for a frozen donor egg cycle is given estrogen and progesterone to ready her uterus, similar to what takes place in a fresh donor egg cycle.
What to Expect
We synchronize the cycles for both the recipient and donor, so that the recipient’s uterus is fully prepared for the embryos created with the donor’s eggs. The recipient is treated with estrogen and progesterone, to prepare her uterus. The donor is stimulated with medication that will help her body to produce multiple eggs. Typically, this takes between nine and 12 days. The donor will then have a transvaginal egg retrieval to remove the eggs. During a frozen egg donor cycle, the eggs are thawed and fertilized at the appropriate time and the woman’s uterus undergoes uterine preparation with estrogen and progesterone to mimic a natural cycle.
On the day of the egg retrieval or thaw of cryopreserved eggs, the recipient’s partner (if applicable) will produce a fresh semen sample, typically by masturbation either on-site or at home. If semen is collected at home it should be brought into the office within about an hour. Donor sperm is available, if needed. The sperm is then combined with the donor eggs. Intracytoplasmic sperm injection (ICSI) may be indicated if the semen analysis is abnormal.
Embryo transfer is typically performed five days after donor egg retrieval. Because donated eggs come from young women, we typically transfer one embryo.
There are a number of indications for the use of donor sperm. For example, donor insemination can be used when the male has severe semen abnormalities. The use of donor sperm for severe male factor infertility has decreased significantly over the past several years with the increased use of intracytoplasmic sperm injection (ICSI).
Donor sperm can also be used if the male is a carrier of or is affected with a significant genetic abnormality and the patient wishes to avoid passing this on to his/her children. More commonly, donor sperm are used by single women or same sex female couples who wish to become pregnant.
Choosing a Donor
Patients may identify their own donor, often a close friend or relative, or use an anonymous sperm donor. All donors require screening as established by the Food and Drug Administration (FDA).
RMA at Jefferson works with various national sperm banks that offer pre-screened eggs which have already been retrieved and frozen. The sperm may be purchased and shipped to RMA. We are then able to store the sperm until the patient is ready to use it.
What to Expect
Insemination is timed to occur at ovulation. Blood work and ultrasound are often done to pinpoint the opportune time for insemination. Insemination can be done during a woman’s natural cycle or in conjunction with medications. The procedure, known as an intrauterine insemination (IUI), is brief and painless, and is performed in our offices. A very thin, flexible catheter containing the prepared semen sample is placed through the woman’s cervix into her uterine cavity. This procedure places all of the motile sperm in the uterus, close to the fallopian tubes, where fertilization typically occurs.
A gestational carrier is a woman who carries a pregnancy for another couple or individual. This process begins when one or more embryos created with the sperm and egg of the intended parent/s (donor sperm and/or donor eggs may be used) is transferred into the gestational carrier.
Use of a gestational carrier is indicated for a woman who has normally functioning ovaries but who lacks a uterus or has uterine abnormalities. Gestational carriers are also an appropriate option for women with a medical contraindication to pregnancy such as heart disease, diabetes, or kidney disease. Gestational carriers have also been used to help women with poor obstetrical outcomes or recurrent miscarriage as well as same sex male couples.
Gestational carriers can be relatives or friends of the intended parent/s who volunteer to carry a pregnancy. Alternatively, gestational carriers can be identified through agencies that specialize in this process. The gestational carrier undergoes extensive medical testing as well as a thorough medical history and physical exam. Each prospective carrier also undergoes a full series of psychological screening tests and an interview with a psychologist.
RMA at Jefferson synchronizes the cycles of the gestational carrier and genetic mother or egg donor. The genetic mother or egg donor undergoes ovarian stimulation and egg retrieval. On the day of egg retrieval, the recipient’s partner (if applicable) will produce a fresh semen sample. Donor sperm may also be used. The sperm is then combined with the eggs. Intracytoplasmic sperm injection (ICSI) may be indicated if the semen analysis is abnormal or if cryopreserved eggs are being used. Typically, one or two of the resulting embryos are then transferred into the carrier’s uterus, which has already been prepared with estrogen and progesterone.
Embryo Donation Program
The use of donor embryos provides individuals and couples the opportunity to become pregnant with embryos donated by patients who have previously undergone in vitro fertilization (IVF) at RMA at Jefferson. Typically, embryo donors have finished building their family and have cryopreserved embryos that they wish to donate to others experiencing infertility. Embryo donors are screened for sexually transmitted infections. The identities of both the donor and recipient will remain strictly confidential; however, the embryo recipient will have access to all of the donor’s extensive medical and family history.
In order to prepare for embryo donation, the recipient undergoes an evaluation of her uterine cavity. She is then treated with estrogen and progesterone in order to ready her uterus to receive the embryos.