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BACKGROUND

While cancer survival has significantly improved, treatment-related premature ovarian insufficiency (POI) and sterility are devastating consequences faced by many survivors. In such cases ‘third party’ reproduction can be useful.1 The American Society for Reproductive Medicine defines this as ‘involving someone other than the individual or couple that plans to raise the child in the process of reproduction. This includes using donated eggs, sperm, or embryos and surrogacy’.

IN-VITRO FERTILIZATION (IVF) USING DONOR EGGS

IVF using donated eggs can be highly successful for women with POI. Since the first pregnancy using donor eggs in 1984, it has helped countless couples conceive.2,3

Outline of a typical donor-recipient IVF cycle

The typical donor-recipient IVF cycle requires both the preparation of the donor and the recipient as well as a screening procedure for the donors. This is described below (see Figure 9.1).

Figure 9.1

Summary of typical donor recipient cycles

Pre-treatment preparation of donor and recipient

As mandated by the Human Fertilisation and Embryology Authority (HFEA), before starting any treatment, all potential egg donors and recipients receive extensive counselling regarding the implications and legalities involved and are consented using the relevant specific HFEA consent forms. If an egg recipient is using an unknown donor they will go through the donor selection process where they will be matched to a suitable donor. Both donors and recipients are also medically screened for suitability before starting treatment.

Screening donors

Donor screening follows national UK guidance, including a detailed family history, testing for blood borne viruses (HIV, Hepatitis B/C, HTLV), karyotype and genetic screening for common conditions, for example cystic fibrosis.4

Exclusion criteria for egg donors4:

  • Inheritable conditions

  • Risk of prion disease

  • <18 years

  • >35 years (success declines with age and eggs from older women have higher risks of chromosomal issues)

  • Poor ovarian reserve (unlikely to produce adequate number of oocytes)

Donor treatment

The donor receives follicle-stimulating hormone (FSH) to induce development of multiple ovarian follicles. Gonadotrophin-releasing hormone (GnRH) antagonist is used to prevent a spontaneous gonadotropin surge which would otherwise lead to ovulation. When there are adequate follicles of >17 mm, a trigger injection (usually GnRH agonist) is administered to release oocytes from the follicle wall and allow their aspiration during ultrasound guided transvaginal oocyte retrieval 36 h later. Oocytes are either vitrified and banked for future use, or fertilized immediately with sperm from recipient’s male partner, and embryos cryopreserved or transferred to the recipient.

Recipient treatment

If oocytes are used to create embryos for immediate transfer (fresh cycle), the donor’s ...

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