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Before joining any programme you will need to have an initial consultation with a consultant gynaecologist, during which the consultant will take full medical history and assess your suitability for treatment. All consultations and screening tests will be carried out in the UK.
All patients are requested to undergo blood tests, but if you have had these tests done within six months of the anticipated time of your treatment, some of the tests may not need to be repeated.
An internal ultrasound is necessary to check the pelvic organs, especially the uterus. The uterine cavity may need to be assessed in more detail using special scanning techniques such as aquascan/saline hysterosonography, 3-D scan or keyhole diagnostic surgery, called hysteroscopy.
A mock cycle
Prior to your treatment, a mock/rehearsal treatment cycle may be advised to ensure that the lining of your uterine cavity develops normally whilst you are on the medications to be used in your treatment and also to assess your tolerability of these hormone medications.
The social, ethical, legal and clinical implications of treatment by egg donation will be discussed with a counsellor at a separate appointment. Counselling support is also available at any time during or after treatment.
The drug/medication regime
The details of your drug/medication regime will be fully explained by our Fertility Nurse Co-ordinator.
Egg Donor matching
A donor matching appointment will be held with the assistance of our Nurse Co-ordinator.(see below)
An appointment will be made for your male partner’s sperm to be analysed.
Follow up consultation
The following matters will be discussed with you at the follow-up appointment. Once the pre-treatment screening tests have been completed, your details will be communicated to one of our network clinics abroad likely to have available screened suitable donors. Once matching with the first suitable donor is done then we shall be able to advise when and where the treatment is likely to be performed. You will then be advised of the detailed characteristics of the donor to confirm which, if not all, of your preferred characteristics have been addressed.
At this stage, (Usually) payment in full for the treatment cycle is required to confirm and continue the donor selection process. Once these matters have been addressed, we shall contact the network clinic to determine the possible specific dates for treatment. These dates will be influenced by the cycle of the donor. When your cycle has been synchronised with the donor’s cycle, the proposed dates can be confirmed, your medications will be prescribed and appointments will be arranged for the monitoring in the weeks and days prior to travelling abroad.
Continuity of care will be provided by our specialist team both in Europe and elsewhere abroad.
FREQUENTLY ASKED QUESTIONS ON EGG DONATION
WHAT ARE THE SCREENING TESTS BEFORE TREATMET?
Before a recipient can be matched with an overseas egg donor the following tests must be carried out:
General health check by a physician may be required
These tests should be done within 6 months of the anticipated time of treatment.
Viral conditions: Hepatitis B, C and HIV screens
HOW WILL THE DONORS BE SELECTED?
At your first meeting with our Fertility Nurse Co-ordinator, you will complete a Donor Characteristics Form in which we document the preferred characteristics you would like the donor to have. When you are ready to go for treatment, the nurse will use this information to identify a donor who matches your preferred criterion. A reserve donor may also be identified if available; to avoid delays and problems if a donor withdraws from the programme.
Typically only one donor will be allocated to you and you will be advised of her characteristics for confirmation before commencement of the final stages of treatment.
WILL THE DONATION BE ANONYMOUS?
The rules on anonymity vary in each country and are strict, but are in the interest for all concerned. No identifying information will be available to you about the donor. Similarly no information about you will be given to the donor.
In the UK the legislation is that donors have to consent to the release of their details when an offspring from their donation reaches the age of 18 years. It is then the right of the young adult to contact the HFEA and request this information about their genetic origin (www.hfea.gov.uk)
A strict protocol is in place to assess these requests.
WHO ARE THE DONORS?
The donors are women from diverse backgrounds recruited by word of mouth, newspaper and internet advertising.
Donors are women under the age of 34 years however usually in their mid twenties. They have been accepted into the International Egg Donation Programme screened with a healthy medical and genetic history and negative for all the infectious diseases. All screening performed according to the standard criteria of the HFEA.
WHAT INFORMATION WILL I RECEIVE ABOUT MY DONOR?
Donors will be of European Caucasian origin unless you have a different preference. We will also provide you with information on:
Age – Height – Eye colour – Hair colour – Education – Build – Weight.
HOW WILL I BE ABLE TO ASCERTAIN THAT THE DONATION IS SAFE?
All egg donors have agreed to undergo thorough clinical and psychologically assessment before being accepted as a donor. Extensive blood and some key genetic tests are performed on the intended donor before she is accepted to act as a donor
To have informed choice a donor will be given comprehensive information and counselling and then requested to give their informed consent to egg donation. It is important to note that the law enables the donor to withdraw their consent at any time until the embryos are transferred to the recipient. If your donor withdraws from the programme after embryos have been created and frozen, you will be allocated a new donor immediately at no extra cost.
HOW MANY EGGS WILL BE ALLOCATED TO ME?
You will receive 6 mature eggs (i.e. Metaphase 2 eggs).
HOW WILL THE EGGS BE FERTILISED?
The fertilisation of your eggs will be by the ICSI procedure’ to minimise the risk of low/no fertilisation.
WHICH MEDICATIONS WILL I NEED TO TAKE?
Women who are menopausal (i.e. with no period).
Oral oestradiol valerate tablets (Progynova) are given for 10-14 days, at a prescribed dose daily or as determined in your mock cycle, to thicken the womb lining (endometrium). The endometrium thickness is then checked by ultrasound scan initially after 8 days. The day before the donor’s egg collection, progesterone support will commence in the form of Cyclogest 400m rectal suppositories, twice daily, or Gestone 50m intra-muscular injection, once daily.
Women who are not menopausal (who have regular periods). In order to synchronise both recipient and donor cycles for fresh embryo transfer it is essential to “switch off” the recipients cycle using a long protocol. The recipient will need to take Buserelin or Nafarelin (Synarel) nasal spray daily from day 2 or day 21 of the menstrual cycle, until the day before the donor’s egg collection. The endometrium is prepared by giving oral oestradiol valerate (Progynova) and progesterone support as noted above.
For both groups of patients the drug regime is continued until a pregnancy test is performed. Medication will continue for some months, typically until twelve weeks gestation.
HOW LONG WILL I NEED TO BE ABROAD?
Your stay abroad will be approximately five days. The exact timing depends on your donor’s egg collection.
Proposed travel arrangements should not be confirmed until your donor has commenced ovarian stimulation. This will be approximately two weeks before you will need to travel. It is therefore not advisable to make any arrangements before ovarian stimulation has been started, as your dates for treatment cannot be guaranteed before then.
WHAT WILL HAPPEN ONCE I ARRIVE THERE?
The first contact will be a pre-arranged consultation with your consultant, to which you will take a copy of your medical records. After reviewing your records your doctor will discuss with you specific treatment issues and answer any questions you may have. You may need to make a number of visits:
The first visit will be the initial consultation on arrival
The second appointment will be made for the male partner to provide the semen sample on the day of the donor’s egg collection.
The third visit will be the day of the embryo transfer.
THE EMBRYO TRANSFER
On the day (time) following the donor’s egg collection, telephone the clinic (or you will be contacted) to find out how many of your eggs fertilised. Not all eggs undergo normal fertilisation, and of those which do become fertilised, not all embryos will be viable for transfer into the uterus. Only embryos with a normal growth rate and appearance should be transferred into the uterus.
NUMBER OF EMBRYOS
Typically, two embryos will be transferred, however for women over 40 years of age the consultant may feel there are special circumstances to justify transfer of more than two embryos. The latter would only occur after consultation with your consultant about the possibility and consequences of multiple pregnancy/birth.
WHAT AM I ABLE TO DO AFTER TRANSFER?
Almost anything you like – although prolonged strenuous exercise or activity is not recommended. The embryos are quite safe within the uterus and you can walk, bathe, shower and undertake normal daily activity. Sexual intercourse can be resumed whenever you like.
THE PROCEDURE AFTER EMBRYO TRANSFER
For fourteen days following embryo transfer you should continue to take oestradiol valerate (Progynova) as before, plus daily progesterone (Cyclogest).
On day 14 it is essential to perform a pregnancy test on an early morning urine sample. This is the first opportunity to find out if implantation has been successful or not. It is the only way to make an early diagnosis of a pregnancy; this will be followed by a blood test.
If the result is negative you must continue with your medication for two further days and then repeat the pregnancy test.
If the result is again negative all the medications should be stopped and after the onset of the next period, you should return to your usual hormone replacement therapy, or natural cycle.
If the pregnancy test is positive, you will be asked to continue with the medication for 12 weeks. You should have an ultrasound scan to confirm the location of the pregnancy and fetal heart beat, three weeks after the pregnancy test.
FRESH EMBRYO TRANSFER and any REMAINING EMBRYOS
After the fresh embryo transfer, if there are surplus embryos available of sufficient good quality, they can be frozen with your consent and stored for use in a future treatment cycle.
PREGNANCY SUCCESS RATES
The table below shows the pregnancy rates for egg-recipients following the transfer of embryos for this programme.
Number of transfers…2
Percentage of pregnancies…50%
Percentage of births… 48%
If the pregnancy test is positive, the same drug regime is followed until the 12th week of pregnancy. It is important to continue medication.
A scan will be arranged in order to confirm the number of embryos which have implanted, their location and to monitor the fetal heart beat at seven weeks gestation i.e., three weeks after the positive pregnancy test result.
At week twelve, blood specimen will be taken to measure the levels of progesterone. If this level is acceptable, drug supplementation will be stopped and hormones from the placenta will then continue to support the pregnancy.
We hope that you will have a trouble free pregnancy and be cared for by your chosen hospital and obstetrician.
One should be aware there is a increased risk of pregnancy induced hypertension, pre-eclampsia, premature labour and hospital admission for other reasons as well as for Caesarean Section and Post Partum Haemorrhage.
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