In part one of this helpsheet we looked closely at the facts regarding premature menopause and the chances of pregnancy after your diagnosis. After studying these statistics we went on to look at donor eggs (oocyte donation), the advantages of this method, and how it works.
This article will build on the first by covering the steps involved in egg donation closely.
We will then look at other options, including surrogacy and more experimental methods of maintaining fertility after certain kinds of premature ovarian failure (POF) — specifically ovarian tissue transplant, which is currently under research.
What Will Happen: The Steps Involved In Egg Donation
Here is a quick rundown of what you can expect if you choose to pursue donor eggs as a way of having a child — from choosing a clinic to having donor eggs implanted in your uterus.
Choosing a Reproductive Center
Your first step will be choosing a reproductive center to work with. Depending on where you live, you may have various centers to choose from.
You can find out about different clinics by asking for referrals from your gynecologist or reproductive endocrinologist (RE), checking support groups such as Resolve, searching elsewhere online, and talking with other people who have used fertility clinics.
Here are some questions to ask and points to think about to be sure you’re getting the best possible clinic for your situation:
What were the clinic’s success rates for egg donation over the past year?
It’s useful to know how many donor egg cycles were completed, how many women got pregnant, and most important, how many babies were successfully delivered.
How much will the treatment cost, and what, if any, insurance plans will the clinic accept?
This is an obvious question but one that can get a little confusing. Sometimes the quoted price won’t include elements such as tests, drugs, and even initial consultations.
How often does the clinic perform egg donation for women in your age group and with premature menopause?
Ideally, you want to work with a clinic whose staff have significant experience not only with egg donation patients but with those who are in a similar position to your own.
How long is the waiting list for donor eggs?
If you are supplying your own donor, this question won’t apply. But if you are planning to use an anonymous donor, you need to know approximately how long you can expect to wait for eggs.
Do the staff seem supportive?
Going through a donor egg cycle can be nerve-racking, so it’s important that you feel comfortable, confident, and secure with the clinic and its staff members.
The Initial Screenings
Once you’ve decided upon a center, you and your partner will attend orientation meetings. You’ll usually meet with several people — the medical doctor, a mental health professional, and an administrator to discuss the financial side of things.
The psychological evaluation is important, as the center wants to be sure you and your partner are emotionally ready to go through the egg donation cycle. This part of the process can help you to make an honest decision on your readiness to go through with a sometimes emotionally demanding procedure.
If your husband’s sperm is used for fertilization of the donor egg, your husband will undergo a semen analysis to be sure his sperm is viable. And both you and he will be screened for HIV and other sexually transmitted diseases such as hepatitis.
If you aren’t technically “menopausal” — that is, if you haven’t stopped having periods for at least a year — you will also undergo an ovarian exam. This way, the doctor will determine whether or not you have a risk of getting your period spontaneously and disrupting the donor egg cycle.
Once it looks as though you are both psychologically and physically ready to handle the egg donation, it’s often a waiting game. If you’re not using a known donor, you will have to wait until the center finds an anonymous donor to supply you with eggs. This can take anywhere from a few months to a year or two, depending upon the specific reproductive center. But eventually the call will come — there’s a donor for you! And then it’s on to the actual donor egg cycle.
The Egg Donation Cycle
The egg donation cycle can be broken down into several major elements:
- Getting the eggs — this is a matter of preparing the donor to ovulate, then actually harvesting the eggs.
- Getting you ready to receive the eggs — this entails synchronizing your cycle with the donor’s and preparing your uterus for egg implantation.
- Next, in vitro fertilization is carried out; and finally, the egg implantation is performed.
Here are the steps the reproductive center will take to get both you and the donor ready:
The first step, of course, is screening. Whether she is known or anonymous, the donor is tested for HIV, hepatitis, and other infectious diseases, and she will also undergo both physical and psychological evaluation.
Because ovulation typically produces just one egg per cycle, the donor is given hormones to ripen more than one follicle and so produce more than one egg. This “controlled superovulation,” as it is technically called, is very important because the chances of pregnancy rise with the number of fertilized eggs you receive.
Normally, two or more eggs will then be implanted in your uterus in the hope that at least one will attach to your uterine lining and launch a successful pregnancy. For this reason, your chances of having twins or even triplets are increased!
For about two to three weeks, the donor remains on a combination of hormones, which will make the follicles ripen and the eggs mature. Later, when the eggs are ready to be harvested, the donor gets a shot of human chorionic gonadotropin (hCG). Finally, the eggs are retrieved by “ultrasound aspiration,” which means that an ultrasound-guided needle is inserted, usually through the vagina, to remove the eggs.
Throughout this process, you, the recipient, also take hormones. If you were still getting periods, you might get hormones to be sure your cycle is completely suppressed. Depending upon the particular program, you will be put on estrogen as long as weeks before egg retrieval is due or only days before.
The estradiol, taken as a pill, patch, or injection, will start building your uterine lining. When your donor gets her hCG injection, you begin taking progesterone to prepare your uterine lining for egg implantation. Therefore, by the time your donor is ready to ovulate, your body should be prepared for pregnancy as if you had naturally ovulated.
The next major step is fertilizing the eggs. The eggs retrieved from the donor are taken to a lab, checked and graded for maturity, and prepared for fertilization. The sperm from your partner or donor is then introduced to each egg. By the next day or so, you will usually know how many eggs were successfully fertilized.
Two or three days after the eggs are fertilized, it’s time for implantation of the fertilized eggs (or pre-embryos) in your uterus. This is a simple procedure and typically only takes a matter of minutes.
For approximately two weeks after this, it’s another waiting game; you’ll take both estrogen and progesterone while you wait to see if one or more of the eggs has successfully implanted into your uterine lining. If everything works well, you will be pregnant, and you’ll stay on both estrogen and progesterone for the first trimester of your pregnancy.
The egg donor is given hormones to ripen more than one follicle and so produce more than one egg (as is usually the case). You will also be given hormones to “prepare” your body for pregnancy. Finally, the eggs are fertilized in vitro and later placed in your uterus.
Another option for building a family when you are in premature menopause is for a surrogate mother both to provide an egg and carry the child to term. Since egg donation is the usual choice of women who have uteruses, this option is usually considered primarily by women who are in premature menopause due to a complete hysterectomy and oophorectomy.
Just as with egg donation, using a surrogate mother gives you the opportunity to have a child who is genetically related to your partner. His sperm can be used to artificially inseminate a surrogate who will carry the fertilized egg through the pregnancy. As you might expect, the success rates for surrogacy vary widely, depending on both your partner’s and the surrogate’s fertility.
You can use either a known surrogate, typically a relative, or an anonymous surrogate arranged for either privately or through surrogate programs. If you opt for an anonymous surrogate, you may or may not have contact with her, depending on the program you’re in. In some cases, you’ll be given her personal history, but never meet her; in others, you can interact with her throughout the pregnancy; and others maintain total confidentiality — you know nothing about the surrogate other than the fact that she is carrying your child.
Here are some general guidelines that most surrogacy programs will follow in choosing a surrogate:
A surrogate will be a younger woman (again, typically no older than 35), one who has already successfully gone through at least one full-term pregnancy, and one who passes certain health standards such as no smoking, drinking, or drug use.
The surrogate should be screened for infectious diseases and any other medical disorders, should undergo a thorough physical examination, and — something that is very important in this scenario — should also undergo a psychological evaluation. This is particularly important because, unlike an egg donor, a surrogate mother will carry a child for the entire pregnancy.
By the same token, it’s highly recommended that you and your partner also be sure that surrogacy is a method you can handle. There is a great deal of emotional and psychological hurdles to overcome with this approach — and it’s wise to be sure before you proceed that you fully understand them. There also have been controversies associated with surrogacies including several well-publicized cases in which legal action has resulted. For this reason, it’s vital you also understand any legal ramifications as well.
The specific arrangements surrounding a surrogacy can vary widely. She may be an individual known to you, or completely anonymous depending on the details of your particular case. However, the surrogate mother will always need to undergo physical and psychological screening. After this, artificial insemination is carried out and the surrogate will carry the baby to term.
Research & Future
Ovarian tissue transplant is currently one of the most promising possibilities for maintaining fertility after certain kinds of “menopause-inducing” medical treatments, particularly if your premature menopause can be “pre-empted” (i.e. it is a result of surgery or is related to cancer, for example).
The theory behind ovarian tissue transplantation is relatively straightforward: if you have still-healthy ovarian tissue — that is, the ovarian tissue that is still generating hormones and containing viable eggs — it can be surgically removed and preserved.
Then, later, it can be implanted back into your body to take over from the ovaries that have been damaged because of chemotherapy or other treatments, ovaries that were surgically removed, or ovaries that failed due to premature ovarian failure.
The key, of course, is in having ovarian tissue removed before you undergo ovarian failure, whether naturally, due to surgery or cancer treatments. Of course, since menopause can be anticipated as a direct consequence of some forms of surgery and medical treatment, this method is a particularly exciting possibility for women in this situation.
One recent study found that ovarian tissue can remain functional for up to 10 years in some cases. Amongst the 41 women included in the study, researchers found the chance of a successful pregnancy using this method to be around one in three for those who wish to get pregnant.
A Final Word
In this two part series we looked closely at your chances of a natural pregnancy after an early menopause diagnosis. We also looked at egg donation, surrogacy and ovarian tissue transplant – a newer method under research. We also have a useful, detailed helpsheet available for those interested in pursuing an adoption.