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Information for the Recipient of eggs in an - Latest IVF_ ICSI

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					Information for the Recipient of eggs in an Egg Sharing Scheme
Egg donation has been a standard form of fertility treatment since 1984. It is used for women whose ovaries have lost the ability to produce eggs of a in sufficient quantity and/or of suitable quality, or in some cases have lost the ability to produce eggs at all, e.g. premature ovarian failure. In these women there is usually nothing wrong with the uterus itself and they can successfully become pregnant using donated eggs with no increased risk to the pregnancy. In fact, in egg donation treatment the chance of pregnancy is higher than in normal IVF treatment mainly because donors tend to be younger and more fertile than women seeking IVF treatment with their own eggs and possibly because of reduced physical stress associated with this treatment. As egg donation has become more available, so also has the need to find suitable egg donors. Although most women today have heard of egg donation, there is still a great lack of knowledge surrounding treatment using donated eggs. Our team has been very active in our attempts to raise awareness of the need for egg donors over recent years and we are very conscious of the enormous gift that donors are making to an infertile couple. This has prompted us at the Herts & Essex Fertility Centre to embark on our Egg Sharing scheme whereby a woman needing IVF treatment for herself is willing to share her eggs with an anonymous recipient in return for having her treatment paid for. 1 SELECTION OF EGG SHARING DONOR Although there is a great need for donors we have to make sure as far as we can that we are not passing any disease or abnormality to a potential recipient through donor eggs and that both the donor and recipient are given a fair chance of receiving good quality eggs. For this reason there are certain criteria which the donor has to fulfil before being accepted as a donor.           Less than 36 years of age (this a HFEA regulation) Satisfactory AMH level Complete donor screening No previous evidence of poor ovarian response to stimulation with fertility drugs Informed consent Free independent counselling No genetic disorder or history of recurrent miscarriage No evidence of adverse embryology in previous cycles No evidence of severe endometriosis. (Chocolate cysts) Normal pathology of ovaries following an ultrasound scan.

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We ask for a detailed medical and family history to exclude any hereditary diseases that could be passed through the eggs. There is a legal obligation for donors to reply truthfully to these questions. Once donors have thought carefully about donation and decided that they wish to be an egg donor we need to do blood tests. We would test for the following: Blood group. This is important information for the recipient’s pregnancy AMH hormone. If AMH level is low the donor would probably not respond well to the drug stimulation we use HIV, Hepatitis B, Hepatitis C, Syphilis. To exclude viral infection Chlamydia and Gonorrhoea (urine test). To exclude sexually transmitted diseases Chromosome analysis. To make sure the donor does not have an unknown genetic problem Cystic fibrosis screen. 1 in 25 people in this Country carry a mutant or abnormal gene for cystic fibrosis. If an egg donor happens to be a carrier she should not have any symptoms associated with Cystic Fibrosis but if the egg recipient’s partner carries the same abnormal gene, a resulting offspring will have a 1 in 4 chance of developing full blown Cystic Fibrosis. This means that we cannot fertilise this particular donor’s eggs with the sperm of a man who is also a Cystic fibrosis carrier. Eggs can still be donated to a couple where the man is not a carrier, which will mean that the offspring cannot have Cystic Fibrosis but can be a carrier. CMV (Cytomegalovirus). This is a very common minor viral infection like rubella. Well over half of the population have had this infection in the past. If the donor is found to have had the infection there is a theoretical risk of her transmitting it to a recipient. Therefore priority will be given to a recipient who is also positive for CMV. However many women choose to accept a positive donor even if they themselves are negative as the risk is very minimal, as long as they are prepared to take that risk and consent to it. The tests are carried out in the strictest confidence.

2 DONOR MATCHING It can take up to 3 weeks for the results of all tests to be available and matching with a recipient can only begin when all the results have been received After this we try to match the physical characteristics of the donor with those of the recipient. The information we use includes: Ethnic origin (e.g. Caucasian, Black, Asian), height, build, skin complexion, hair colour and eye colour. The treatment is performed anonymously and no information will be given to any individual or parties
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other than the Human Fertilisation & Embryology Authority, (HFEA). We also ask for permission to contact the recipient’s GP so that he/she is aware of the treatment

2.1 Egg sharing arrangement The egg share agreement will only be triggered if 6 or more eggs are collected. In the event of less than 6 eggs being produced all the eggs will go to the egg sharer/donor and the egg share arrangement will not proceed. The recipient will then pay the abandoned cycle fee and will go to the top of the waiting list for the next available suitable donor The egg sharer can cancel the arrangement up until the time of embryo transfer but would be liable for the full cost of the treatment and any drugs used, and the recipient would be fully reimbursed.

3 STARTING TREATMENT Before starting treatment it is mandatory that as recipients the following requirements have been met     Arrangements must be agreed before either the donor or recipient enters a treatment cycle A signed consent of the agreed arrangements is obtained from both parties Both partners must have been screened for HIV 1 & 2 Hepatitis B &C Both partners must have had implications counselling.

3.1 Down regulation   The recipient should start taking folic acid either on its own or as a pre-pregnancy supplement. If the recipient is still having periods they start down regulation one week before their period. There are two types of down regulation drugs Suprecur or Prostap. If the recipient has been prescribed Suprecur she takes 0.5ml by subcutaneous injection once daily. Needles and syringes will be provided.

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If periods are very irregular the Suprecur should be started on the second day of the period. If Prostap 3.75mg is prescribed a Nurse at the centre will administer it. It is a once only injection i.e. it normally lasts until the end of treatment. If periods have ceased and standard HRT (hormone replacement therapy) is not being used, please do not use any hormone supplements until instructed to do so. If the recipient is on HRT she will be instructed to stop the drug in the cycle just prior to the one scheduled for the egg donation treatment.

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3.2 Stimulation   The recipient will be asked to start Progynova tablets on the same day that the donor starts her ovarian stimulation drugs. Instructions will be given on the dose of Progynova at the appropriate time. These tablets contain the hormone Oestrogen, designed to build up the womb lining. We recommend that the tablet is left underneath the tongue to dissolve, instead of being swallowed. The recipient should also start taking Aspirin 75mg daily with food. The evening prior to, or the morning of the donor’s egg collection the recipient will be asked to start daily progesterone. This will be in the form of Cyclogest pessaries which will be used 3 times daily.

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3.3 Egg Collection  On the day of egg collection your partner will be asked to attend the clinic in order to produce the sperm sample. When ready the sample will be taken to the laboratory for the necessary preparation. On the day of the egg collection, half of the donor’s eggs will be fertilised with the sperm of your husband/partner. Hopefully some eggs will fertilise, now called embryos and continue to develop further over the next 3 – 5 days in readiness for embryo transfer The male partner will be asked to check the details on labeled sample pot and the transport envelope. He will then be asked to sign a form confirming that the details are correct.

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Please note that it is essential that the recipient continues both the progesterone (Cyclogest) and oestrogen (Progynova) until the pregnancy test, fourteen days from egg collection. We strongly recommend coming to the clinic for a blood pregnancy test rather than using a home test. The reason for this is the fact that at this stage of treatment your body cannot produce its own supply of progesterone and oestrogen. Stopping medications prematurely if you were pregnant would lead to certain miscarriage. Clear instructions will be given when it is safe to stop all medications If the test is positive, instructions will be given to continue both medications until further notice. 4 SIDE EFFECTS OF THE DRUGS 4.1 Progynova This is an HRT and the dose used in egg donation treatment is normally significantly higher than that used to relieve menopausal symptoms. In the standard HRT dose there is a slightly increased risk of blood clots (Thromboembolism) forming in the circulation than that of the normal population. With the increased dose used in egg donation treatment, that risk is also proportionally increased and on rare occasions could be very serious, especially when clots form in the lungs. The risk is further increased if there is a personal or family history of thrombo-embolism and a weight problem. Aspirin 75mg taken daily thins the blood slightly therefore reducing the risk of clot formation Other known side effects of progynova include nausea, headaches, dizziness and mood swings. It is not advisable to take Progynova if you suffer from any of the following: Severe diabetes, sickle cell anemia, high cholesterol and a past history of jaundice. Please inform us if any of these conditions exist. 4.2 Suprecur/Prostap The most common side effects of Suprecur/Prostap include headaches, hot flushes, nausea, tiredness, drowsiness and mood swings. Paracetamol and other pain relief tablets may be used for treating headaches. Increased intake of water will also help to reduce the symptoms. 4.3 Cyclogest Occasionally skin rashes may occur

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5 EMBRYO TRANSFER Embryo transfer is performed in the treatment room that is adjacent to the IVF laboratory where the embryos are stored. Your partner may accompany you into the treatment room where you will be met by an embryologist. A name verification check will be made with both parties and the embryos cam be viewed on a TV monitor. No anaesthetic is required, so when your ID has been verified the theatre staff will get you ready. The procedure is very similar to having a cervical smear test. You will be asked to relax on the theatre table whilst your legs are placed in special supports. You will remain covered until the transfer is ready to begin. A speculum (instrument) will be gently placed into the vagina to allow the doctor to see the neck of the womb. The vagina and cervix are then cleaned with cotton wool dipped in a warm sterile solution. The embryos are drawn up into a special tube that will be inserted through the cervix. This is carefully positioned before the embryos are then injected in to the womb. This completes the transfer. You will then be able to go home and resume normal activities, avoiding heavy lifting and strenuous exercise. 6 PREGNANCY TEST It is advisable to attend the centre for a blood pregnancy test For all routine enquiries please contact the centre Monday – Friday 9.00am – 5.00pm on 01992 78 50 60 There is an on-call service provided after 5pm and at weekends. Tel: 079 403 146 84 THIS IS FOR EMERGENCIES ONLY For general non-urgent enquires and appointment, please call the Herts and Essex Fertility Centre during regular office hours. The nurse on-call will not have access to your medical records, as she will be in her own home

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