Poor Ovarian Reserve & Egg Donation

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.

At 37 years of age, a woman will only have 25,000 eggs and at menopause less than 1000.

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.