Oocytes may be obtained from an anonymous donor or a designated donor. Anonymous donors are more commonly chosen because of availability, the option of keeping the procedure confidential, and security against a third person interfering with the parent-child relationship. A designated donor may be chosen in order for the couple to have more information about the donor and her characteristics or for genetic reasons, as in the case of a sister-to-sister donation. The donor should be young, fertile, and able to make a well-informed decision about the procedure. Her medical and family history should be carefully screened and her physical examination should be normal. Psychological screening and counseling should be mandatory.
Although some programs routinely perform karyotyping, it is not considered essential in a woman with no family or personal history suggestive of a familial disorder. The donor should be advised of the medical, legal, financial, and psychological risks of oocyte donation.
A hormone replacement evaluation ("sham") cycle is usually performed in which the donor is placed on a GnRH agonist to suppress the normal ovarian cycle, then given estrogen and progesterone in order to develop an appropriately secretory endometrium. Most centers perform an endometrial biopsy in this cycle to evaluate the endometrium in the mid luteal phase. If normal, this is the protocol that will be used in the IVF cycle.
A routine IVF stimulation protocol is used for the donor, with the recipient starting her estrogen replacement at the onset of the donor's cycle. At the time hCG is given to the donor, the recipient adds progesterone to her treatment regimen. The oocyte retrieval and embryo transfer are performed as usual.
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