Ovarian
reserve is the pool of eggs present in the ovaries at any given time. Low ovarian reserve is when there is a
physiological decrease in the number of eggs, resulting
in insufficient number to ensure a
reasonable chance of pregnancy. Generally, it is caused by aging ovaries.
Patients can have diminished ovarian reserve but intact ovarian function.
Where Did All the Eggs Go?
Females
begin life at one of the earliest stages of development with millions of eggs.
Unfortunately, nature plays a cruel trick by letting the vast majority of them
decay before they are ever needed for
reproduction.
In utero, there is a rapid
multiplication of germ cells starting at six to eight weeks. By the time the
female fetus is at 16-20 weeks, she has a peak of six to seven million eggs.
This number declines to one to two million eggs at birth, falling even further
to 250,000 to 500,000 eggs at puberty.
There are three types of eggs
in the ovary: a pool of immature eggs, eggs that are selected to mature and
prepare for ovulation in a particular cycle, and a pool of atrophic or dead
eggs. The eggs are encased in follicles that support and nourish them until
they mature, though the vast majority never do so. Every month, a certain
number or percentage of immature eggs are selected for maturation. One of these
eggs will ovulate and the rest will regress, die and be reabsorbed into the
ovary through atresia. The number of eggs selected is dependent on the number
of immature eggs in the pool.
Causes of Poor Ovarian
Reserve
Low ovarian reserve is a premature decrease in the number of eggs and can be caused by chromosomal anomalies such as Turner Syndrome, where there the woman does not have two X chromosomes, or gene abnormalities such as Fragile X.
Also ovarian tissue can be
destroyed through torsion, surgical removal of part or all of the ovary,
ovarian cysts caused by endometriosis, benign or malignant ovarian tumors,
radiation or chemotherapy, immunological conditions, pelvic adhesions, or a
high body mass index.
Egg Donation
Egg donation is the process by
which a woman provides eggs to another woman and / or women for purposes of
assisted reproduction. The need for women to donate eggs may arise for any
number of reasons including:
1.
Women who are born
without ovaries.
2.
Women who are younger
but have premature ovarian failure.
3.
Women whose own eggs
are of poor quality and who have failed multiple IVF cycles.
4.
Women who are older
and whose FSH is elevated and whose chances of achieving a pregnancy with their
own eggs is negligible.
5.
Women whose ovaries
and eggs are damaged from disease and/or chemotherapy or who have been forced
to have their ovaries surgically removed.
6.
Women with chromosomal
translocations or genetic diseases that they do not want to pass on to their
children.
7.
An egg donor is also
required for gay couples using gestational surrogacy in order to have children.
Finding an egg donor:
Our clinic has egg donors listed with us to
help our patients find an egg donor unless the patient(s) are able to use
family members or friends who are willing to help them out. We at IVF-ICSI
CENTER want to do the best we can for patients and what we do best is the
medical side of these complicated cycles. We certainly will help patients screen
egg donors once they have been matched and in many instances we help patients
actually select their egg donor by evaluating several different donor profiles
and giving feedback as to who we think would be the most appropriate egg donor
for that particular patient.
If you have an
interest in contacting us to obtain a list of egg donors please email our
Patient Coordinator progenyivficsi@gmail.com
Donor Screening:
Any potential egg donor will be screened for the
following:
1.
Questionnaire
regarding history of birth defects or hereditary diseases
2.
Medical and social
history
3.
Psychological
screening
4.
An additional medical
and social history performed by IVF-ICSI CENTER
5.
Physical examination
performed by Dr. Ruby Sehra
6.
Infectiousdiseasetesting
as per international protocols
Over and above these
screenings, most patients who are going to use an egg donor will also look at
many personal issues of importance such as:
1.
Physical appearance
2.
Ethnicity
3.
Interests and talents
4.
Reason for donating.
There should be some indication that a donor has some interest in donating
beyond simply the money. In our opinion when a donor has some altruistic
motivation in addition to the money, they seem to be more compliant in terms of
their treatment protocol.
One additional issue
that we counsel patients to be aware of is that there is a difference between a
“proven donor” and one who has never donated before. A “proven donor” is a
donor who has donated before and whose donation has resulted in a pregnancy.
Such donors obviously remove much of the guess work in an egg donor cycle.
Their genetic and infectious disease screening from their previous cycle(s) are
useful information and we also will know in advance how they respond to the
medication that stimulates their ovaries to produce eggs as well as knowing
whether their eggs have produced a pregnancy. We have seen a higher pregnancy
rate with “proven donors” as opposed to young ladies who have not donated
before. Having said that however, this does not preclude patients from using
donors who have not donated before if they fulfill other criteria that are of
importance to the patient. It is just an additional element for patients who
are looking at egg donation to be aware of in their decision process.
Egg Donors
IVF-ICSI CENTER, being
located in Delhi, has the options of
having donors from different parts of India. These donors come from:
Punjab – Punjabi, Sikh tall good looking girls
North India
North Eastern India – Asian looking beautiful girls
Himalayas – Cute girls with sharp features
West and South India – Wheatish looking girls
We do also provide egg
donors from abroad for white girls with Caucasian origin andAfrican origin
girls.
Many of the Indian
donors are belongs to very good families and are post graduates working in good
companies and are tall and very good looking. These girls / women come under
our A list Donors.
Out of state and out of country patients:
Many of the patients that come to our PROGENY IVF-ICSI CENTER for egg
donation come from great distances. In fact approximately 70% of the patients
who are being treated at our facility for egg donation come from other states
or from foreign countries for this treatment. Many countries simply do not
allow egg donation which for some older women may be the only method available
to achieve a pregnancy. Among those that do allow it such as the United
Kingdom, Canada and Australia, nearly all prohibit compensation for the donor.
This greatly limits the pool of available donors and has created long waiting
lists. In Australia, for example, waiting lists for altruistic donors can be
upwards of five years. By then the intended mother herself may even be too old
to carry a pregnancy. In contrast, in the United States and particularly in
California, egg donation is a recognized treatment modality and the fact egg
donors are compensated for their time, inconvenience and going through the
treatment is acceptable practice. All patients using an egg donor are provided
with a nursing coordinator who will help arrange all the treatment protocols
for the patient and the egg donor and who will be the contact at the clinic. Dr. Ruby Sehra is very
experienced at treating patients from “out-of-town” and coordinating the
patients’ cycles with those of their egg donors. Our goal is to eliminate any
concerns or anxieties that long distance treatments and traveling out of state
or country for medical care can elicit.
