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NEFI
Egg Donation: Couple’s Egg Donation: Couple’s perspectiveperspective
Gad Lavy, M.DGad Lavy, M.D. .
New England Fertility New England Fertility InstituteInstitute
NEFI
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
NEFI
In Vitro FertilizationIn Vitro Fertilization
NEFI
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
NEFI
ICSIICSI
• Poor sperm quality
• Zona Pellucida hardening
• Poor egg-sperm interaction
NEFI
Assisted Zona Hatching Assisted Zona Hatching (AZH)(AZH)
Improved Implantation
Zona Hardening
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NEFI
Improvements in culture Improvements in culture conditions- Blastocyst transferconditions- Blastocyst transfer
NEFI
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
NEFI
PGD: Fluorescent In Situ PGD: Fluorescent In Situ Hybridization (FISH)Hybridization (FISH)
NEFI
Age and FertilityAge and Fertility
NEFI
Age and IVF SuccessAge and IVF SuccessIVF success: Effect of age and number of eggs
NEFI
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
NEFI
Menopausal ovary
The Aging OvaryThe Aging Ovary
QuickTime™ and aTIFF (Uncompressed) decompressorare needed to see this picture.
Normal ovary
Fewer eggs Decreased egg quality
NEFI
Third Party ReproductionThird Party Reproduction
Egg donationEgg donation Surrogacy Surrogacy
• Gestational carrierGestational carrier• Traditional Traditional
SurrogacySurrogacy Embryo donationEmbryo donation
NEFI
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
NEFI
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.
NEFI
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..
NEFI
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..
NEFI
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
NEFI
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?
NEFI
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
NEFI
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
NEFI
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
NEFI
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.
NEFI
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
NEFI
TPR at NEFI: LocationsTPR at NEFI: Locations
Stamford: 1275 Summer StreetStamford: 1275 Summer Street Hamden: 9 Washington AvenueHamden: 9 Washington Avenue