Shared Egg Donor Program
The Shared Egg Donor Program is offered to SRM patients to provide a more affordable treatment cycle with egg donation. Many egg donors produce more eggs than a single recipient needs, and as a result, many frozen embryos are never used or are discarded. The cost of an egg donor cycle is high, making it less available to many couples who would otherwise choose egg donation. The costs continue to rise due to increases in the cost to screen egg donors as required by the FDA and due to the increasing competition for donor reimbursement from agencies that are unregulated.
Donor Selection
Only donors who meet stringent requirements are accepted as SRM donors. For the Shared Donor Program, only egg donors who have completed a prior cycle and have proven themselves to be a good candidate for a shared cycle are included. Their prior cycle is evaluated for good egg number, fertilization rate, and embryo quality. The prior performance of a donor is an excellent predictor of her future response; however, egg number can vary somewhat cycle to cycle. Shared cycles will be split between two SRM recipients. By using our selection criteria, it is anticipated that each recipient should receive a minimum of 5 mature eggs.
Recipient Assignment
Recipients who choose to participate in the Shared Egg Donor Program will select from donors designated for the Shared Egg Donor Program. The recipient who selects the donor first is given first priority and thus is the primary recipient. If a donor is selected and SRM is not able to find another recipient within six weeks, the primary recipient will have the option to proceed with a cycle at full cost or release the egg donor.
Cycle Stimulation
The egg donor receives medications to stimulate her ovaries to produce multiple eggs. The donor's response is monitored by closely by ultrasound. The number of eggs to be retrieved can be estimated by the monitoring ultrasounds leading up to the donor's egg retrieval. If it appears that fewer than 12 eggs may be retrieved, the secondary recipient will be notified of a possible cycle cancellation.
The donor's eggs will be split between two recipients equally; with each recipient will receive at least 5 mature eggs. If there are an odd number of mature eggs, the primary recipient will receive the extra egg. If there are insufficient mature eggs to allow for 5 mature eggs to each recipient, the primary recipient has the priority to receive the total number of eggs. The secondary recipient's cycle would then be cancelled. In this situation, the secondary recipient will be responsible for only the cost incurred for their cycle medications up until cycle cancelation.
Insemination
Intracytoplasmic Sperm Injection (ICSI) will be used as the insemination method for shared donor cycles. Assessment of egg maturity is essential in the setting of a shared donor cycle, to ensure that each recipient receives a minimum of 5 mature eggs. To determine egg maturity, the surrounding cells around each egg much be gently removed. Once these cells are removed, ICSI is required for fertilization.
Embryo Transfer
During the cycle, the Embryology lab will determine whether the transfer will be on day 3 or day 5. This is based on set criteria for embryo quality and quantity, just as it would be for a non-shared donor cycle. The number of embryos to transfer will depend on embryo quality. In donor recipient cycles, we strongly encourage consideration of a single embryo transfer.
Expected Outcomes
The Shared Egg Donor Program is new to SRM so we are unable to provide our own success rates specific to this type of cycle. Based on the data we have reviewed from other shared donor programs, the success rate is may be 5%-10% less than a non-shared cycle. The cancellation rate for the second recipient is estimated to be about 5%.
Potential Benefits
The primary advantage for the Shared Egg Donor Program is the reduced price for a donor IVF cycle. For recipients who are hoping to have one or two children through egg donation, the Shared Egg Donor Program offers a great chance to achieve this goal at a much lower cost than a traditional donor IVF cycle. In turn, for recipients who wish to have one child through egg donation, another advantage is the lower probability of having many embryos cryopreserved. This would reduce the number of recipients faced with the sometimes difficult decision regarding disposition of any remaining embryos.
