Egg Donation: Couple

1
Egg Donation Couples perspective

• Gad Lavy, M.D.
• New England Fertility Institute

2
Improved Success

• Better Diagnostics fewer cases of unexplained
  infertility.
• PCOS
• Ovulatory dysfunction
• Imaging
• Endometrial function
• Better Therapy Higher overall success.
• Surgery
• Ovulation induction
• IVF and related procedures

3
In Vitro Fertilization
4
IVF

• Intra-cytoplasmic Sperm injection (ICSI)
• Assisted zona Hatching (AZH)
• Day 4-5 transfer and improved culture media
• Cryopreservation of embryos

5
ICSI

• Poor sperm quality
• Zona Pellucida hardening
• Poor egg-sperm interaction

6
Assisted Zona Hatching (AZH)
Zona Hardening
Improved Implantation
7
Improvements in culture conditions- Blastocyst
transfer
8
PGD

• Micromanipulation remove a single blastomere
  from an 8-cell embryo without damaging the embryo
• Genetic testing
• FISH
• PCR

9
PGD Fluorescent In Situ Hybridization (FISH)
10
Age and Fertility
11
Age and IVF Success
IVF success Effect of age and number of eggs
12
The aging Ovary (and testicle)

• Decreased Ovarian Reserve (DOR)
• Lower conception rates
• Higher rates of pregnancy loss
• Higher incidence of Congenital defects

13
The Aging Ovary
Normal ovary
Menopausal ovary

• Fewer eggs
• Decreased egg quality

14
Third Party Reproduction

• Egg donation
• Surrogacy
• Gestational carrier
• Traditional Surrogacy
• Embryo donation

15
Egg Donation

• Process Involves In Vitro Fertilization
• Indications Who is a candidate
• Ethical and Legal considerations

16
Egg Donation Indications

• Egg Donation
• Ovarian Failure.
• Poor egg quality.
• Recurrent IVF failure.
• Recurrent pregnancy loss
• Genetic defects precluding normal pregnancy.

17
The Egg Donation Process-1

• The process involves IVF.
• The resulting offspring will carry genetic
  material of the donor and the male partner.

18
The Egg Donation Process II

• Donor and recipient cycles are synchronized.
• Eggs taken from the donor after ovarian
  stimulation.
• Eggs are fertilized with recipient partners
  sperm.
• Embryos transferred to the uterus of a hormonally
  primed recipient.

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Egg Donation The Process III

• Donor
• Synchronize cycle with recipient
• Ovarian stimulation
• Egg retrieval

• Recipient
• Synchronize cycle with donor
• Preparation of the uterus
• Fertilization
• Embryo transfer

20
Egg Donation The donors

• Donor recruitment Who are the donors?
• Donor Screening How are they tested?
• Donor matching How do I pick a donor?

21
Egg Donation - Screening

• Recipients
• Consultation
• MDRN interview
• Psychological counseling
• Blood tests
• Evaluation of uterus
• Mock cycle

• Donors
• Consultation
• MD/RN interview
• Psychological testing
• Interview
• Formal testing
• Blood tests
• Infectious disease
• Fertility potential FSH follicle count

22
Egg Donation The recipient couple

• Medical Screening
• The Mock cycle
• Psychological issues
• Legal Issues
• Ethical concerns Disclosure

23
Summary TPR
Egg Donor Embryo donor Gestational Carrier
Egg Donor Donor Fem ale Partner
Sperm Male Partner Donor Male Partner
Embryo Male/Donor Donor/Donor Female/Male partners
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Egg Donation Success

• Number of embryos transferred.
• Donors age and fertility history.
• Recipient's age and history.

25
Third Party Reproduction NEFI

• Gad Lavy, M.D.- Medical director
• Angela Buzzeo FNP Nurse Practitioner
• Judy Calistro R.N. Nurse Manager
• Ellen DeGennaro, R.N. Nurse
• Sarah Clark Genetic Counselor
• Samantha Tartagila Coordinator/Administrator
• Judy Kottick MSW Counseling and Psych
  evaluation

26
TPR at NEFI Locations

• Stamford 1275 Summer Street
• Hamden 9 Washington Avenue