Stimulation for Egg Donation
Different types of medications are used to increase the number of eggs which develop to maturity before retrieval. The specific medications, the dose of those medications, the times at which they are administered and the duration of treatment may vary from patient to patient and are based upon their individual needs. The following contains a general discussion of a typical protocol, a brief description of the medications being used and a general summary of what you will be doing in your cycle.
In your case, the egg donor team has planned a cycle which consists of six phases – screening, synchronization, suppression, stimulation, retrieval and follow-up.
The screening process consists of the nursing consultation, the Personality Assessment Inventory (PAI), day 3 baselines (ultrasound and blood work), meeting with the psychologist, and finally, a complete physical (with blood tests and urine drug screen). Only after all screenings have been completed and results obtained, may a donor be matched with a recipient and be permitted to begin synchronization. A medication teaching class will be scheduled with you sometime before you are to begin your injections.
After you have been matched and have your blood analyzed on day 3 of your menstrual cycle, you will be instructed to begin an oral contraceptive. The purpose of the pill is to keep your hormones and consequently, your ovaries, in a uniform, non-ovulatory state while waiting to begin suppression. Depending on when the recipient’s menstrual cycle falls in relation to yours, the egg donor team will assign you a date to begin suppression and to stop taking the pill.
Based on the date given to you, you will begin suppression by taking Lupron injections. There will be a medication teaching consult prior to the time you begin Lupron. Remember, you will be instructed specifically when to stop the pill. Usually, you take both the pill and Lupron for several days together before you discontinue the pill. This is called an overlap. Lupron is a medication used to turn off your body’s natural stimulation of your ovaries. A week to ten days after beginning Lupron and about three to five days after stopping the pill, you may have a menstrual cycle. This indicates that the ovaries are inactive. Contact your nurse coordinator on day 1 of your cycle in order to begin stimulation. You will have an ultrasound and blood draw. Stimulation with gonadotropin injections begins within a few days of starting your menstrual cycle.
Suppression provides several advantages during an egg donation cycle. Once the ovaries become quiescent, all stimulation will be provided by the injectable gonadotropins (Gonal-F, menopur and Repronex). This allows for a very precise and uniform stimulation that results in the increased production of better quality, mature eggs.
Once you are suppressed, a number of small follicles are available at all times in the ovary, which are capable of being stimulated. Since you are not producing appreciable amounts of your own LH and FSH, stimulation will be provided by the injection of exogenous gonadotropins. These medications, which are taken twice daily, require close monitoring. Ultrasounds to document the number and size of your follicles and blood work to determine how much estrogen they are producing will be done at 1-4 day intervals.
Retrieval involves aspirating the fluid in the follicles with a special needle to obtain the eggs. The procedure is done using ultrasound guidance, which does not require an incision. You will have IV sedation and will feel no pain during the procedure.
You will be asked to return following your next period to have a final ultrasound and to make sure that you are doing well. However, if you need to be seen before that time, you may call the office to schedule an appointment.