- Oocyte donation has now become an essential part of therapeutic Armamentarium of many infertility clinics.
- Since the time of its introduction it has allowed many couples to overcome infertility secondary to factors like advanced age,diminished ovarian reserve,premature ovarian failure,heritable genetic illnesses and surgical menopause.
Indications For Oocyte Donation :
- Women with non functioning ovaries
- Premature ovarian failure
- Ovarian agenesis
- Surgical removal of bilateral ovaries
- Radiological or chemotherapeutic destruction of the ovary.
- Post menopausal
- Women with functioning ovaries :
- Risk of inheritable genetic disease in children
- failed IVF due to poor oocyte quality
- Inaccessible ovaries
Evaluation Of Oocyte Recipients
- A complete medical & reproductive history is taken.
- Standard preconception testing which includes blood group & rubella antibody titres & serologic tests for syphilis,hepatitis B, Hepatitis C and HIV is done.
- Hormonal profile is performed to evalute the ovulatory status.
- Pelvic sonography is performed to rule out any pelvic pathology.It also helps to evaluate the endometrial appearance, thickness and response to hormonal therapy.
- The donor and recipients cycle are synchronised by putting them on oral
- contraceptive pills in the previous month.
- The standard ovarian stimulation protocol for the donor involves pitutary desensitisation with a GnRH analogue starting in the mid-luteal phase and ovarian stimulation with gonadotrophin.
- The recipients with functioning ovaries undergo pituitary down regulation with GnRH analogue before endometrial preparation with estrogen.
- In non menstruating women,cyclical hormonal therapy is given till the following criteria are fulfilled:
* Minimum 3 months of bleeding
* Uterocervical length > 5-6cm
* Endometrial thickness > 8-9mm
- All recipients then receive exogenous estrogen (estradiol valerate)therapy for endometrial preparation starting from 2 of menses.
- Micronized progesterone is added on the day of donor's pickup.
- Embryo Transfer is done on day3 or day 5.post transfer luteal support is given to all the recipients in the from of estradiol valerate and micronized progesterone.
B-Hcg is done on day 14 post tranfer to confirm pregnancy. If pregenancy is confirmed,luteal support is continued till 12-14 weeks of gestations.