Donor Embryos - Male/Female Infertility

What is the Procedure of IVF with Donor Embryos?
IVF WITH DONOR EMBRYO:
The transfer of an embryo resulting from male and female gamete, not taken from the recipient and/or her partner is known as IVF with embryo donation. It is also referred to as a type of third party reproduction. (using donor eggs and donor sperms)
INDICATIONS FOR DONOR EMBRYO:

1. Gonadal dysgenesis (Defective embryonic development of gonad in male or female).
2. Women with premature ovarian failure or iatrogenic ovarian failure( due to ovarian surgery or radiation ) or is a poor responder to ovarian stimulation and the man suffers from a severe disturbance in gamete production.
3. Couple who are carriers of a hereditary disease which may cause significant morbidity in the newborn.
4. Women who have attained menopause with male factor infertility.

PROCEDURE
We use donor eggs and donor sperms and create embryos for individual couple with all legal formalities .
The embryos can be frozen or fresh depending on the cycle .
Patients can select donors from ART Bank.
Embryos are created from donor sperm and donor eggs specifically for the purpose of donation and are transferred to recipient in order to achieve pregnancy.
It involves the following steps

Evaluation of the recipient
Evaluation and selection of donor
Counseling of recipient couple and donor
Consents of recipient couple and donor
Controlled ovarian stimulation of egg donor
Oocyte retrieval of egg donor
Endometrial preparation of the recipient
Invitro fertilisation and embryo development
Embryo transfer to the recipient
Pregnancy test
1. EVALUATION OF RECIPIENT
Thorough medical and reproductive history of couple should be evaluated
Complete general physical examination including pelvic examination should be performed to rule out any abnormalities which can affect pregnancy outcome
All relevant testings on couple and donor is done
Relevant laboratory tests including blood type and rh type , hemoglobin etc. and pap smear for cervical screening should be done.
Evaluation of uterine cavity.
3D ultrasonography to rule out the presence of any uterine or ovarian pathology like fibroids, polyps, hydrosalpinx, ovarian cyst, uterine malformations should be done and confirmed.
Hysteroscopy is indicated in case of suspicion of any abnormality and multiple ivf failures or multiple abortions
Endometrial biopsy for histopathological examination, TB-PCR and culture and genetic evaulation of uterus through certain tests may be done if there is any previous history or recurrent implantation failure or persistently thin endometrium or any suspicion on hysteroscopy.
For female age is more than 40 yrs : assessment of cardiac function should be done with ECG , 2DECHO , STRESS TEST . Risk of hypertension during pregnancy and gestational diabetes should be considered couple should be counselled regarding impact of advanced maternal age of pregnancy as well as any medical illness that may affect pregnancy.
Rubella and varicella screening can be done and non immune recipients may be immunised.
Genetic testing depending on history, ethnicity and current recommendations
Special tests like karyotyping and autoimmune screening if needed.
Psychological evaluation of the couple

2. EVALUATION AND SELECTION OF DONOR:
Its one donor : one recipient followed as per law .
Anonymous donor is selected and Screening of gamete donors should be done as per most recent guidelines.
Relevant investigations are be done.
Egg donors should be legal adults and preferably between 21 to 34 years age and with one living child .
Evaluation of personal and medical history.detailed sexual history, substance abuse, history of family disease and psychological history
Donors should be screened for sexually transmitted diseases or any communicable diseases that can endanger health of the recepient
Genetic testing if indicated
Once donor is fit and all relevant compatibility tests are done ,donor is assigned to the specific recipient depending on some phenotypic and blood characteristics etc.
Medical insurance of the donor has to be done with intending couple for period of 12 months .
Affidavit and legal formalities to be done according to law.

3) COUNSELING OF RECIPIENT COUPLE AND DONOR:
Risk and benfits counselling
Legal counselling
The information is kept confidential as its a personal treatment.
Donors are counseled regarding laws related to the procedure, details of the procedure ,need for regular visits and risk of complications due to ovarian stimulation.

4) CONSENTS OF RECIPIENT COUPLE AND DONOR:
Informed Consents are taken from recipient couple and gamete donors as per the recent guidelines
5) OVARIAN STIMULATION OF DONOR:
Egg donor undergoes ovarian stimulation with hormonal treatment as per the Standard protocol.
6) OOCYTE RETRIEVAL OF THE DONOR:
Once ovarian follicles have reached the appropriate size, trigger medication is given to attain final oocyte maturation and ovulation. After trigger oocyte retrieval is done at appropriate time under anaesthesia to obtain oocytes.
Semen sample is obtained from sperm donor for fresh embryo formation . best sperm is selected from the sample and is injected in to the oocyte( obtained from oocyte retrieval of egg donor) .
Lab : all technologies are used to create good grade embryos . No extra charges for the technology .
Embryo is grown upto blastocyst stage to attain maximal implantation and pregnancy rates.
ENDOMETRIAL PREPARATION OF THE RECIPIENT:
This procedure involves hormonal treatment that prepares the endometrium (inner lining of uterine cavity where embryo gets implanted)of the recipient to favor embryo implantation.
Special therapies : AI generated PRP for endometrial enhancement in cases of thin endometrium , multiple IVF failures , multiple abortions
9) EMBRYO TRANSFER TO THE RECIPIENT:
• For this fresh embryos created from donor egg and donor sperm are utilised .
• Embryos are loaded into a catheter and transferred into the uterus of the recipient under ultrasound guidance.
10). PREGNANCY TEST:
A Blood pregnancy test is performed 14 days after transfer to measure HCG levels in the blood to determine if the pregnancy result is positive or negative.
Depending on the value of HCG it might be repeated after two days and patient is then scheduled for an ultrasound at five or six weeks to date and evaluate pregnancy.
The recipient continues to take hormonal supplements as directed by her specialist often until 12th week of pregnancy.