The Shared Egg Donor Program is offered to RSC patients to provide a more affordable treatment cycle with egg donation.  Many egg donors produce more eggs than a single recipient needs.  As a result,  many frozen embryos are never used or are discarded.  In addition, the cost of an egg donor cycle is high, making it less available to many couples who would otherwise choose egg donation.  The costs of egg donation continue to rise due to increase costs of donor screening as required by the FDA and due to increasing competition for donor reimbursement from agencies that are unregulated.

In our experience, most egg donors produce enough eggs to share between two recipients.  The average number of eggs recovered is about 20.  Excellent pregnancy rates are achieved with 5-8 eggs.  Therefore, the most efficient use of egg donors would be to split the eggs between two recipients.

Donor Selection

Only donors who meet stringent screening requirements are accepted as RSC donors.  For the Shared Egg Donor Program, egg donors that are RSC Program donors who have had a previous successful cycle at RSC are reviewed for their clinical response and the appropriateness for a shared cycle.  Only donors whose donation resulted in an ongoing pregnancy would be selected for a shared cycle.  Their past cycle is evaluated for normal ovarian response, normal fertilization rate, good egg quality and good embryo quality.  The past performance of a donor is a good predictor of her response in a future cycle.  Most donors who have a high response in their first cycle will have consistency in their response in future cycles.  

Shared cycles will be split between two recipients. By using these criteria for selection, it is anticipated that each recipient should receive a minimum of 4 mature eggs.

A few select donors who have previously produced a large number of good quality embryos will be available only for the Shared Egg Donor Program. 

Recipient assignment

Recipients who choose to participate in the Shared Egg Donor Program will select from the donors designated for the Shared Egg Donor Program.   The recipient who selects the donor first is given first priority.  If a donor is selected and RSC is not able to find another recipient within three months, the recipient will have the option to proceed with a cycle at full cost or may continue to wait for another recipient.

Cycle stimulation

The egg donor receives medications to stimulate the ovaries to produce multiple eggs.  The donor’s response is monitored by ultrasound in which the follicles, each of which contains an egg, can be visualized.  Prior to the egg retrieval, the number of eggs to be recovered can be anticipated by the ultrasound image.  If it appears that less than 10 follicles are present, the second priority recipient will be notified of possible cancellation.

The eggs will be split between the two recipients equally.  Each recipient will receive at least four mature eggs. If there is an odd-number of mature eggs, then the first priority recipient will receive the additional egg.  If there are insufficient mature eggs to allow 4 mature eggs to each recipient, then the first recipient has the priority to receive the eggs over the second recipient.  The second recipient’s cycle would then be cancelled.   In this situation, the second recipient will be responsible only for the costs incurred for the recipient’s procedures and the recipient’s medications.  

Our estimation that the cycle would be cancelled is less than 10 %.

Insemination

At the time of the egg retrieval, cells surrounding the eggs, called granulose cells, must be teased away to clearly inspect the egg to see if it is mature.  Egg maturity can only be assessed when the eggs can be viewed directly.  Only fully mature eggs will fertilize.   Typically, 80% of eggs are mature.  Of those eggs that are mature, about 75% will fertilize. Once eggs are stripped of the granulose cells, the safest way to inseminate them is through Inctracytoplasmic Sperm Injection or ICSI.  While ICSI is not performed routinely in all IVF cycles, it is required in this situation.  The advantage of ICSI is that avoids any risk of unexpected fertilization failure.

Expected Outcomes

The Shared Egg Donor Program is new to RSC, just initiated in January of 2008.  Data from other Intergramed IVF programs that have shared egg donor cycles show that the pregnancy rate with a shared cycle is about ten percent less  than a traditional cycle when the donor eggs are shared between two recipients.  The average cancellation rate is 10%, pregnancy rates about  50%, and the ability to have embryos to freeze in 25% of cycles.  The smaller number of eggs available to the recipient in the Shared Egg Donor Program will result in fewer embryos and may result in a slightly lower pregnancy rate and fewer embryos for freeze.  By selecting donors with previously demonstrated high response, it is hoped to maintain the high pregnancy rate seen in traditional treatment cycles.

Embryo Transfer

Typically one or two embryos are transferred in an egg donor cycle.  The day of the embryo transfer will be determined by embryo development on day 3.  If there are three or more excellent quality embryos on day three, RSC will recommend waiting until day 5 for embryo transfer.  If there is a day 5 transfer, there is an option to transfer one embryo minimizing the risk of a twin pregnancy.  In a Shared Egg Donor Cycle, it may be more likely to have a transfer on day 3 as there may be fewer embryos.

Financial Considerations

The main advantage for a Shared Egg Donor Cycle is the reduced cost.  A Shared egg donor cycle is approximately $8,000 less than a traditional cycle where one donor is matched to one recipient.  For couples who are hoping to have only one or two children through egg donation, the Shared Egg Donor Program offers them a realistic chance to achieve their goal at a much lower cost than the traditional cycle.