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The Muasher Center
for Fertility and IVF
8501 Arlington Boulevard, Suite 500
Fairfax, Virginia 22031
Ph. 703.542.3610
Fx. 703.876.6317
THE DONOR EGG PROGRAM OVERVIEW
Donor egg is a wonderful option to creating a family. This is a very special gift from a special woman. Our donors are all caring and giving women who have chosen to help you achieve your dream. They complete a strict screening process. This process is regulated by the American Society for Reproductive Medicine (ASRM) and the Federal Drug Administration (FDA). In addition to these guidelines Dr Muasher, the donor coordinator and a psychologist examine and interview all donors prior to admission to the program. We strive to provide quality donors to you. We promise to be open and honest with you, to the best of our knowledge, about these donors while preserving the donor’s and your identity and privacy. We will guide you through this process step by step. The following is an overview of these steps. By the end of this process we hope to have a dream come true.
FIRST STEP: CHOOSING AN EGG DONOR
This is the most important and time-consuming step. You will meet with our donor coordinator to review our donor profiles. These are donors who have completed a strict screening process by our staff and Dr Muasher. These donors are available to cycle when they are matched.
You will be given a summary on donors who are close to your ethnic background and physical characteristics. You will see the donor’s medical history and a 2-generation family medical history. You will see a photo or photos of the donor as a baby or early childhood. Our donors are anonymous. On occasion, we can ask a donor to allow us to show you an adult photo. This will ONLY be done with the permission of the donor. Some donors agree to allow you to see one adult photo and others do not want to disclose this picture. Most donors will also have an audio interview with our staff available for you to hear. They do have the option to not complete this interview but almost all do participate in this interview.
Once you review all the applications you will have an opportunity to discuss the donor(s) with the donor coordinator and ask questions. We will attempt to answer these to the best of our ability and can ask the donor for you.
Sometimes you will not feel that the donors available are what you are looking for. You have the following options. First, you may wish to use an agency to find a donor for you. The disadvantage to this is the cost. It is higher than using one of our donors. The advantage to an agency is they will be able to recruit more aggressively the type of donor you want and they have a larger pool of donors available to cycle. The agency will permit you to begin treatment sooner than waiting for a donor to be admitted to our pool. With agency donors the medical screening and the treatment will all be performed at our center. They are submitted to the same screening criteria as our donors. We will refer you to an agency that we work closely with. Second, you may choose to wait and see what new donors are accepted into our program. The donor coordinator will know about donors who are in the screening process or new applications that come in to begin screening and can give you an idea of what may be available soon. We get an average of 6-8 applications a month of these applications only half qualify or complete the screening process. On average it takes 1-3 months to screen a particular donor.
You can come in as many times as you like to review profiles. We will ask you what you are looking for in a donor and notify you when we think there is a new donor who may fit your criteria.
Selecting the right donor for you needs careful thought. It is not a speedy or easy process. It can take up to several months to a year depending on your criteria. Both you and your partner want to feel good about your choice.
Here are some hints to picking the right donor. You want someone who is close to the same body type and frame as you are. Even if the hair color and eye color is not the same as yours it should match members of your immediate family such as a sibling, cousin, niece or nephew. Do not expect to have a completely negative family medical history. Every family usually will have some disease process present in the family tree. (Cardiovascular disease, arthritis, cancer, migraines etc.) Donors with very strong family histories of disease processes, genetic diseases, or diseases that begin in childhood such as insulin dependant diabetes, mental illness, substance abuse, and cancers at an early age etc. are not accepted into our program.
SECOND STEP: RECIPIENT COUPLE PREPARATION
There are certain medical procedures, testing or results of tests that we must have completed prior to starting treatment. The best time to complete these is now. You must have had a normal pap smear within the last year. If you are over 40, you will need a normal mammogram within the last year. If you are over 45, you must have a letter from your OB/GYN or primary care physician stating you are healthy enough to carry a pregnancy. If you are menopausal, you may need to do a mock cycle to see if you are able to build an adequate uterine lining for an embryo to implant. Dr Muasher will determine if you need to do this. You and your partner will also need to have HIV, Hepatitis and other infectious disease blood testing within the last 6 months. Some women will need a sonohysterogram and/or a hysterosalpingogram (HSG). The sonohysterogram is a sonogram where the doctor will fill the uterine cavity with saline and then look at the cavity with ultrasound. This will determine if the cavity is capable of handling a pregnancy. The hysterosalpingogram (HSG) is a where dye is injected into the uterus and fallopian tubes then X-rays are taken to determine the function of the uterus and tubes. Your partner will need to have a semen analysis within the last year. These tests should be completed prior to matching with a donor.
You will be given consent forms to review and sign. The first is for the treatment. The second is for cryopreservation of embryos. Most donors produce on average 10-12 eggs. Due to the age of the donors we will transfer only 2 embryos on rare occasions 3. This may leave quality embryos left over for freezing. We do encourage you to freeze these embryos for several reasons. The first is not everyone becomes pregnant on the first attempt. It is less costly to transfer these embryos than starting a new donor cycle. Second, if you do achieve a pregnancy you will have these embryos for future use. Most donors are not available to cycle again for you. Third, you will have genetic siblings.
Please read these forms carefully and feel free to ask questions prior to signing the documents. We require these be signed prior to stimulation of your donor.
You also should be preparing for the financial part of the treatment. This is a very costly treatment due to the fact you are paying for the treatment of both you and the donor, the fee for the donor’s time, and you and your donor’s medications. Sometimes we can use your left over medications if they have been stored properly and are not expired. We recommend using one of our fertility specialty pharmacies, since they are the best with pricing. Your donor will use much less medications than a typical IVF patient. Please review the fee structures and contact our practice manager with any questions. You will be expected to pay for the whole treatment cycle on the first day of the donor’s stimulation.
THIRD STEP: MATCHING WITH A DONOR
Once you have decided on a donor, you will sign a Match Agreement. We ask that you be prepared to start treatment within the next two months. The donor will also be asked if she has any restrictions on her time. If the donor is not able to cycle in the next month, you will have the choice of waiting a month or so for the donor or using another donor. It is unusual for a donor not to be able to cycle right away. You will then be given a photocopy of the donor’s childhood/baby picture and her medical history for your records.
FOURTH STEP: SYCHRONIZATION OF MENSTRUAL CYCLES
Depending on where you and your donor are in your cycles you will be asked to begin medications to bring your menstrual cycle to the donor’s cycle. There are several ways Dr Muasher will do this. You may be placed on a birth control pill or a medication called Lupron or sometimes both the pill and Lupron. You will be told when to start and stop each medication and taught how to administer the Lupron. Sometimes you will have a period prior to starting the cycle sometimes you will not have a period. The synchronization usually takes one month to 6 weeks to complete. During this time you will be asked to complete any unfinished testing. You will also have to buy medications for the donor. We will order these medications from a fertility specialty pharmacy that is accustomed to working with donor cycles and keeping the strictest of confidence with you and the donor. Your medications will be shipped to you and the donor’s medications will ship to the donor coordinator so she can monitor them and distribute them to the donor. If you are going to use any left over medications from your previous treatments, please bring them to the donor coordinator so we can know what other medications are needed for the treatment and can distribute them to the donor. On a rare occasion, your insurance may cover some of your medications but NOT your donor’s. You will be billed for the donor’s medications by the pharmacy. They may also set up an account for the donor should we need more medications on short notice they will be able to get them to the donor ASAP.
FIFTH STEP: STIMULATION CYCLE
You will be started on estrogen supplementation (Vivelle Dot Patches) to build the uterine lining approximately one week prior to your donor starting ovarian stimulation. You may be asked to come in for an ultrasound prior to starting the estrogen. Your donor will begin IVF stimulation with her menstrual cycle. The donor coordinator will notify you when the donor begins stimulation. You will receive updates on her progress each time she comes in for monitoring. During this time you will be instructed to increase your dosage of the Vivelle patches. You will be given the estimated date for the retrieval.
When your donor is close to egg retrieval you will come to the office for an ultrasound and hormonal tests to check on the development of the lining and a “mock transfer”. This is a simple process. A speculum is inserted into the vagina and the doctor passes a small soft plastic tube through your cervix. Just prior to the retrieval you will begin Progesterone injections. These are daily intramuscular injections given to you by your partner into your buttocks. You will be instructed on how to do these shots by the nursing staff. The progesterone will prepare the lining for implantation and help support the pregnancy for the first trimester.
On the day of the donor’s egg retrieval your partner will be scheduled to collect the sperm sample. He will be informed about the number of eggs retrieved that morning. We will not know quality at this time. The insemination of the eggs will occur the afternoon of the retrieval. The next day you will be contacted with fertilization results. You will be scheduled for the embryo transfer at this time. Most transfers occur on the third day after retrieval. If there is a decision to go to the next stage of embryo development, blastocyst transfer, you will make this decision with the doctor on the 3rd day of embryo development.
Please note: NO eggs will be retrieved if all infectious disease testing is not completed and results reviewed by the medical director!!!! This is a mandatory FDA regulation. NO EXCEPTIONS WILL BE MADE. You will be informed when the donor’s results are obtained and she is eligible to proceed to egg retrieval. IF any of the test results convert to positive the cycle will be cancelled. The only exception to this rule is for KNOWN donors. You will be informed of the risk of transmission to both you and the fetus so you can make an informed decision with the physician to proceed or cancel the cycle. You will also be informed when you and your partner’s results are obtained.
On rare occasions, despite our best efforts a donor may not respond as expected to the stimulation medications. When this occurs you will be given the opportunity to cancel the cycle. If this occurs you will only be charged for the treatment that has occurred to this point of the cycle. The donor is compensated $50 per visit. The remainder of unused medications will be kept for a future cycle with another donor, should you elect to try again with another donor.
SIXTH STEP: TRANSFER TO PREGNANCY TEST
Prior to the transfer you will be given preparation instructions and the time you are scheduled for the transfer. You are required to have 24 hours of bed rest after the transfer. Then limited activity for the next few days. You will continue on the estrogen and progesterone supplementation.
Twelve days after the transfer you will come to the office for the blood pregnancy test. If positive you will continue to be followed at our center until approximately the 7th week of the pregnancy. At this time you will have an ultrasound to determine the number of fetuses with a heartbeat. Care is then transferred to your OB/GYN who will continue with your care. You will continue the hormonal supplementation during this time. The Vivelle Patches (estrogen) will stop at the 9th week of pregnancy. The progesterone will continue until the end of the first trimester. Once the pregnancy is established and a good blood progesterone level is obtained you will be given the choice of either continuing with the daily injections or switching to a vaginal form of progesterone inserted three times a day.
If the pregnancy test is negative, you will stop all the medications and a menstrual period will then occur. You will meet with the physician again to discuss the next step in treatment. IF you have frozen embryos you can begin another cycle right away.