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Egg Donation: Couple’s Egg Donation: Couple’s perspectiveperspective

Gad Lavy, M.DGad Lavy, M.D. .

New England Fertility New England Fertility InstituteInstitute

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Improved SuccessImproved Success

Better Diagnostics: fewer cases of unexplained Better Diagnostics: fewer cases of unexplained infertility.infertility.• PCOSPCOS• Ovulatory dysfunctionOvulatory dysfunction• Imaging Imaging • Endometrial functionEndometrial function

Better Therapy: Higher overall success.Better Therapy: Higher overall success.• SurgerySurgery• Ovulation inductionOvulation induction• IVF and related proceduresIVF and related procedures

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In Vitro FertilizationIn Vitro Fertilization

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IVFIVF

Intra-cytoplasmic Sperm injection Intra-cytoplasmic Sperm injection (ICSI)(ICSI)

Assisted zona Hatching (AZH)Assisted zona Hatching (AZH) Day 4-5 transfer and improved Day 4-5 transfer and improved

culture mediaculture media Cryopreservation of embryosCryopreservation of embryos

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ICSIICSI

• Poor sperm quality

• Zona Pellucida hardening

• Poor egg-sperm interaction

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Assisted Zona Hatching Assisted Zona Hatching (AZH)(AZH)

Improved Implantation

Zona Hardening

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Improvements in culture Improvements in culture conditions- Blastocyst transferconditions- Blastocyst transfer

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PGDPGD

Micromanipulation: remove a Micromanipulation: remove a single blastomere from an 8-cell single blastomere from an 8-cell embryo without damaging the embryo without damaging the embryoembryo

Genetic testingGenetic testing• FISHFISH• PCRPCR

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PGD: Fluorescent In Situ PGD: Fluorescent In Situ Hybridization (FISH)Hybridization (FISH)

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Age and FertilityAge and Fertility

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Age and IVF SuccessAge and IVF SuccessIVF success: Effect of age and number of eggs

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The aging Ovary (and The aging Ovary (and testicle)testicle)

Decreased Ovarian Reserve (DOR)Decreased Ovarian Reserve (DOR)• Lower conception ratesLower conception rates• Higher rates of pregnancy lossHigher rates of pregnancy loss• Higher incidence of Congenital Higher incidence of Congenital

defectsdefects

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Menopausal ovary

The Aging OvaryThe Aging Ovary

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Normal ovary

Fewer eggs Decreased egg quality

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Third Party ReproductionThird Party Reproduction

Egg donationEgg donation Surrogacy Surrogacy

• Gestational carrierGestational carrier• Traditional Traditional

SurrogacySurrogacy Embryo donationEmbryo donation

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Egg DonationEgg Donation

ProcessProcess: Involves In Vitro : Involves In Vitro FertilizationFertilization

IndicationsIndications: Who is a candidate: Who is a candidate Ethical and LegalEthical and Legal considerations considerations

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Egg Donation: IndicationsEgg Donation: Indications

Egg DonationEgg Donation• Ovarian Failure.Ovarian Failure.• Poor egg quality.Poor egg quality.• Recurrent IVF failure.Recurrent IVF failure.• Recurrent pregnancy lossRecurrent pregnancy loss• Genetic defects precluding normal Genetic defects precluding normal

pregnancy.pregnancy.

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The Egg Donation Process-The Egg Donation Process-11

The process involves IVF.The process involves IVF.

The resulting offspring will The resulting offspring will carry genetic material of the carry genetic material of the donordonor and the and the male partnermale partner..

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The Egg Donation The Egg Donation Process IIProcess II

Donor and recipient cycles are Donor and recipient cycles are synchronizedsynchronized..

Eggs taken from the donor after Eggs taken from the donor after ovarian stimulationovarian stimulation..

Eggs are fertilized with Eggs are fertilized with recipient recipient partner’s spermpartner’s sperm..

Embryos transferred to the uterus Embryos transferred to the uterus of a of a hormonally primed recipienthormonally primed recipient..

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Egg Donation: The Process Egg Donation: The Process IIIIII

DonorDonor• Synchronize cycle Synchronize cycle

with recipientwith recipient• Ovarian Ovarian

stimulationstimulation• Egg retrievalEgg retrieval

RecipientRecipient• Synchronize cycle Synchronize cycle

with donorwith donor• Preparation of the Preparation of the

uterusuterus• FertilizationFertilization• Embryo transferEmbryo transfer

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Egg Donation: The donorsEgg Donation: The donors

Donor recruitment: Who are the Donor recruitment: Who are the donors?donors?

Donor Screening: How are they Donor Screening: How are they tested?tested?

Donor matching: How do I pick a Donor matching: How do I pick a donor?donor?

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Egg Donation - ScreeningEgg Donation - Screening

DonorsDonors ConsultationConsultation

• MD/RN interviewMD/RN interview

Psychological testingPsychological testing• InterviewInterview• Formal testingFormal testing

Blood testsBlood tests • Infectious diseaseInfectious disease• Fertility potential: FSH Fertility potential: FSH

follicle countfollicle count

RecipientsRecipients ConsultationConsultation

• MDRN interviewMDRN interview

Psychological Psychological counselingcounseling

Blood testsBlood tests Evaluation of uterusEvaluation of uterus

• Mock cycleMock cycle

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Egg Donation: The recipient Egg Donation: The recipient couplecouple

Medical ScreeningMedical Screening• The Mock cycleThe Mock cycle

Psychological issuesPsychological issues Legal IssuesLegal Issues Ethical concernsEthical concerns: Disclosure : Disclosure

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Summary: TPRSummary: TPR

Egg Egg DonorDonor

Embryo Embryo donordonor

GestatioGestational nal

CarrierCarrier

EggEgg DonorDonor DonorDonor Fem ale Fem ale PartnerPartner

SperSperm m

Male Male PartnerPartner

DonorDonor Male Male PartnerPartner

EmbrEmbryoyo

Male/Male/DonorDonor

Donor/Donor/DonorDonor

Female/Female/Male Male partnerspartners

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Egg Donation: SuccessEgg Donation: Success

Number of Number of embryos embryos transferred.transferred.

Donor’s age and Donor’s age and fertility history.fertility history.

Recipient's age Recipient's age and history.and history.

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Third Party Reproduction Third Party Reproduction NEFINEFI

Gad Lavy, M.D.- Gad Lavy, M.D.- Medical directorMedical director Angela Buzzeo FNPAngela Buzzeo FNP Nurse PractitionerNurse Practitioner Judy Calistro R.N.Judy Calistro R.N. Nurse ManagerNurse Manager Ellen DeGennaro, R.N.Ellen DeGennaro, R.N. Nurse Nurse Sarah ClarkSarah Clark Genetic CounselorGenetic Counselor Samantha Tartagila Samantha Tartagila

Coordinator/AdministratorCoordinator/Administrator Judy Kottick MSW: Judy Kottick MSW: Counseling and Counseling and

Psych Psych evaluationevaluation

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TPR at NEFI: LocationsTPR at NEFI: Locations

Stamford: 1275 Summer StreetStamford: 1275 Summer Street Hamden: 9 Washington AvenueHamden: 9 Washington Avenue