For Egg Donors - Alta Bates IVF Program

Information For Egg Donors

Introduction
The IVF Team
The Treatment Cycle
Compensation and Long-term Contract
How Do I Apply to Be an Egg Donor?

I. Introduction
Participating in our egg donation program can be a very gratifying and interesting experience. Egg donation offers hope to infertile couples and single women who would otherwise have little or no chance of achieving a pregnancy. Your contribution is genuinely a "gift of life".

The donor screening process includes interviews with the office staff, Anna Metoyer, Donor Coordinator, Dr. Chetkowski and our consulting psychologist, Dr. Madelyn Feingold. In addition there is a complete physical examination, blood tests for exposure to infectious agents and a multiple question personality test. This extensive battery of tests is designed to assure not only that you are suitable for our program but that your participation would not be harmful to you and your health.
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II. The IVF Team
In the course of your treatment you will meet several members of the IVF team. Dr. Richard Chetkowski is the program founder and director. He supervises all aspects of the program. Anna Metoyer, our donor coordinator, is available during business hours to answer and direct any calls or concerns you may have. Barbara McSorley, whom you will meet at the front desk, is our office manager. She is very helpful in directing your questions to the person who can best answer them. Jeananne Moon, R.N. and Catherine Saunders, R.N. are the nurse coordinators. They organize the practical aspects of your treatment cycle: injection instruction, medication needs, scheduling ultrasound times, patient education and support are all part of their role. We welcome your questions and hope that we can work together with you to make your egg donation experience as comfortable as possible. More information about becoming an egg donor is provided to you when you contact our office.
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III. Information on the Treatment Cycle

A. Controlled Ovarian Hyperstimulation
The single most important factor in improving the early success rate of IVF has been the ability to transfer more than one embryo (fertilized dividing egg). To accomplish this we stimulate the ovaries with medications that cause the development of multiple follicles (fluid-filled sacs containing the eggs). A female infant is born with approximately 10 million eggs in her ovaries. During the course of her reproductive years she ovulates only several hundred of these eggs. Therefore, you need not be concerned that "hyperstimulating" your ovaries with medications to recruit multiple follicles will deplete your ovaries of eggs or hasten the onset of menopause.

In order to stimulate development of multiple oocytes (eggs), you receive ovulatory medications (gonadotropins). The primary medication we currently use is Repronex which is a highly purified extract of the FSH and LH natural hormones. Repronex is usually given as deep intramuscular (IM) injection by a member of your household who has been trained in the technique in our office.

Another medication often used before and during stimulation with gonadotropins is leuprolide (Lupron). By using Lupron, we can eliminate the influence of the pituitary gland on ovarian stimulation and achieve recruitment of a larger number of follicles. Lupron is usually started before menses and is given in the form of self-administered subcutaneous injections preferably in the morning.

We recommend that a reliable method of contraception ( birth control pills, condoms, diaphragm or spermicidal jelly) be used during the cycle before egg donation. If your period is more than 2-3 days delayed while on Lupron, you will be instructed to contact our office and schedule a sensitive blood pregnancy test.

Click here for more information on this subject.

An individualized treatment plan will be discussed with you prior to starting and at the baseline ultrasound so you will know what to anticipate. It is of utmost importance that we have your current telephone numbers so that we can always reach you in case there is a change in the treatment plan. Please let us know if your phone has blocking for calls from unidentified numbers because it may make it hard for us to reach you on weekends.
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B. Injection Class
Since Repronex would be digested if given by mouth, it must be given by intramuscular (IM) injection. Shortly before you begin treatment, we will teach your partner or designee how to mix the medicines and how to give injections. This is not at all difficult to master. VHS tapes demonstrating the injection technique are available. The nurse coordinator supervises the first injection at which time additional questions can be answered. Some donors have given IM injections to themselves but it is much easier with another person.
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C. Monitoring of Ovarian Response
Lupron begins 5-6 days before the anticipated onset of menses. If you have regular cycles and are not using birth control pills (BCP), we may measure progesterone level to confirm ovulation before starting Lupron. In other cases birth control pills are used in the cycles before the egg donation cycle. When talking about BCPs we refer only to the first 21 active pills not the 7 placebo pills in most packs. When your period begins to flow, you should call our office in order to schedule a baseline ultrasound. The first day of your period is the first day of regular flow, not just spotting although after BCPs the flow may be light. If your period starts before 5:00 p.m., call our office in order to schedule a baseline ultrasound. If your period starts after 5:00 p.m. call the office the next day. On weekends and holidays, leave a message on the answering machine.

Prior to beginning the gonadotropins, a baseline ultrasound is done to detect any pre-existing ovarian cysts. Simple ovarian cysts are common and they usually resolve on their own. However, if a large cyst is found, the treatment cycle may be delayed. At the baseline ultrasound the nurse will dispense your supplies -- medications, syringes, extra needles, and alcohol wipes. Gonadotropins are usually started 2-5 days after the onset of menses. If there are any days when you will not be able to come to the office, you need to let us know about it on the day of the baseline visit.

After three to four days of gonadotropins, a blood test is usually done to assess your response by measuring hormone estradiol which is secreted by the growing follicles in your ovaries. Blood is drawn in our office between 8:30 and l0 AM on weekdays and Saturdays. In the afternoon after 3 PM on days when you have a blood test, further instructions about your next dose of gonadotropins will be provided.

Once your estradiol reaches 200-300 pg/mL another vaginal ultrasound is scheduled to examine the size and number of the follicles. Ultrasounds are done between 8:30 AM and 10 AM in our office. As a general rule, whenever you are scheduled for an ultrasound, a blood test is also done that day. Early in the course of stimulation blood tests may be done without ultrasounds. Most patients have 4-6 ultrasounds and blood tests. Ultrasound is harmless to you and to the developing eggs. Depending on the growth of the follicles and estradiol levels, variable doses of gonadotropins are given for a total of 9-13 days. Unlike some other programs, we monitor your response closely and frequently adjust the dose of medications in the course of stimulation, so close communication is essential.

When the follicles are mature on the basis of ultrasound and blood tests, you receive a single IM injection of human chorionic gonadotropins (HCG, Pregnyl and Profasi are the brand names). It is a timed injection given in the evening (generally at 8 to 11 PM). HCG provides for the final phase of egg development. HCG is a natural hormone produced by the placenta during pregnancy and is similar to the LH hormone which is released by the pituitary gland to trigger ovulation in spontaneous cycles. HCG has been used for many years and has not been associated with any increase in congenital abnormalities. Since the final decision to administer HCG is not made until the afternoon of the day you get the injection, we must be able to reach you by telephone that day.
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D. Egg Retrieval
Removing the eggs from the ovaries takes place about 36 hours after the injection of HCG, just before ovulation would occur. The night before the procedure, please do not eat or drink anything after midnight. An I.V. line will be started prior to going in for the procedure. Ultrasound-guided retrieval is usually performed with intravenous sedation. There is an anesthesiologist present who will keep you comfortable during the procedure but you might experience some light discomfort. Further instructions will be provided.

After adequate sedation is established, a thin needle is introduced through the vagina into the ovaries and the eggs are aspirated. The procedure takes about 30 minutes. Following the retrieval procedure you may experience discomfort in the abdomen or bladder, have small amount of vaginal spotting or occasionally notice blood in your urine (which usually clears within a short time). Rare but more serious risks of ultrasound-guided aspiration are injury to the bowel, blood vessel or bladder, infection and internal bleeding. Precautions are taken to avoid any complications, and this will be discussed during your visit to the clinic. The eggs are inseminated several hours after the retrieval and the recipient undergoes the embryo transfer two to three days later.

Most women feel well and are ready to go home a couple of hours after the egg retrieval procedure. After intravenous sedation you cannot drive that day. It is wise to plan on spending the remainder of the day resting quietly at home. We provide you with a prescription for a pain-killer which you can fill as needed but many women require nothing more than acetaminophen (Tylenol). We dispense to you oral antibiotics which are to be taken for next few days. You can expect to have a period two weeks later. Shortly after you start your own period, we can tell you whether or not a pregnancy has been achieved. Regardless of the final outcome, your participation is this program is a generous gesture that is greatly appreciated.
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IV. Compensation and Long-term Contract
After the retrieval, you receive your agreed-upon financial compensation. If the planned egg donation cycle cannot be completed and there is no retrieval but ovarian stimulation with gonadotropins has been started, you receive partial compensation the amount of which will be discussed with you at the time of your visit with Dr. Chetkowski. Please note that, since you are not an employee of R.J. Chetkowski, M.D., Inc. or Alta Bates Summit Medical Center, no taxes are withheld from your compensation and you are not entitled to any employee benefits. However, the IRS and Franchise Tax Board of California consider the compensation you receive taxable and you are required to report it as Other Income. Early in the year following the egg donation cycle(s), Form 1099 is issued and mailed to you at the most current address available to us and the compensation is reported to the Internal Revenue Service in accordance with legal requirements for such transactions. However, even if you don’t receive a Form 1099 you are obligated to report this income. If you have any questions regarding the compensation, please do not hesitate to discuss them.

Whereas the egg retrieval procedure marks the end of your active commitment to the program, we request that you keep in touch with our office at least to the extent of informing us of any changes of address and telephone numbers. On rare occasions, we may want to contact you in order to clarify a point in your family health history for the benefit of the offspring. We also request that you keep us informed about any serious illnesses which you or your immediate family may develop in the future, particularly if they are known to be hereditary. Since egg donation is a relatively new procedure, not all of its long-term risks have been defined to date. There may be information in that regard which we would like to provide to you and other donors in years to come. Your continued good health is important to us. We welcome any feedback you might have about the screening process and the treatment cycle so that we can continue to improve and refine our donor egg program.
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V. How Do I Apply to Be an Egg Donor?
If you are interested in becoming an egg donor you may contact our office or download and print the Egg Donor Questionnaire (Adobe Acrobat Reader is required and may be downloaded for free from here). Follow the instructions on the questionnaire and return the completed form to us via mail or confidential fax.

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