Embryo Donation

Some religiously based organizations have used the term embryo donation rather than the accepted term embryo adoption. There is essentially no difference between the two concepts. At least in Illinois, couples who wish to attempt pregnancy with embryos donated from another couple do not have to go through a legal adoption process. Some agencies that provide donated embryos may have their own requirements, however. The agency requirements may be as stringent as adoption requirements. In some cases, these requirements exist because the couples who have donated these embryos requested them in order to make their embryos available. At IVF1, we do not have any of these requirements.

Couples can donate their embryos anonymously or make their identities known to potential recipient couples. Couples who are potential recipients of donated embryos can make their identities known or remain anonymous. Thus, there are several different combinations possible. At IVF 1, embryo donation is performed so that both the donor couple and the recipient couple maintain anonymity. As stated above, some agencies may require that a couple remain known. In some cases, the donating couple may require the potential recipients to meet with them and be “interviewed” before they will release their embryos to them. They may also request that they be allowed to maintain a relationship with any children born using their embryos.

As of May 25, 2005, new regulations from the Food and Drug Administration are going to make embryo donation much more difficult and expensive. At that time, if a couple wants to donate their embryos or even if they think they might want to donate their embryos at some point in the future, each partner who contributes to the formation of the embryos is going to be required to:

• Provide additional extensive medical history
• Undergo a detailed physical exam
• Undergo additional testing for transmissible diseases.

This includes blood tests, vaginal cultures for females and semen cultures for men.

These rules do not apply to embryos that were produced before May 25, 2005.

The treatment used in embryo donation is the same that is used for women receiving their own frozen embryos. The uterus is prepared using hormones to mimic the natural menstrual cycle. These are the same hormones produced by the ovaries: estrogen and progesterone. One additional medication is also frequently used: Lupron. Lupron is used to suppress the pituitary gland to prevent the patient from ovulating during the preparation of the uterus. One the pituitary gland is suppressed, the estrogen begins. Estrogen thickens the uterine lining. Estrogen can be given as pills, patches, or even injections. The uterine lining is monitored with transvaginal ultrasound. Once the thickness of the lining reaches 7 mm or more, progesterone supplementation can begin. Progesterone can be given as a vaginal suppository or gel or as injections. Oral progesterone is not recommended. The number of days progesterone is given before the transfer must match the stage of embryo development. This “synchronization” is very important in embryo donation cycles.

Unlike other types of “transplants” the recipient of donor embryos does NOT need to take medications to suppress her immune system.

Once the uterine lining has been prepared, the frozen embryos are thawed and placed into the uterus. The embryo donation recipient continues to take estrogen and progesterone until a pregnancy test is done. If she is pregnant, she continues both the estrogen and progesterone until the 11th week of pregnancy.

Embryo donation is less costly than IVF or IVF with donor eggs. Many of the most expensive parts of an IVF cycle: the fertility medications, the egg retrieval and the fertilization and culture of the embryos does not need to be performed.

Embryo donation is an option that is open to our IVF patients who have embryos that they do not wish to use themselves. They can “donate” or make their embryos available to other couples who are attempting pregnancy. The “recipient” couple uses the donated embryos instead of their own to attempt pregnancy. Embryo donation can be accomplished in two ways:


• At the time of the original IVF cycle
• At a later time using embryos previously frozen for a couple’s own use
  

Cytomegalovirus (CMV) is a virus that can be transmitted to a developing fetus before birth. CMV is a member of the herpes family of viruses that also includes chickenpox and mono. Primary CMV infection occurs in people who have never been exposed to the CMV virus before. Once a person becomes infected with CMV, the virus remains alive but dormant inside that person’s body for the rest of their lives. Recurrent CMV infection is when a dormant virus become active again. This can occur if a person’s immune system becomes weakened such as in the elderly or in people who have AIDS. CMV infection is usually harmless and rarely causes illness. However, for pregnant women, primary CMV infection can cause more serious problems than recurrent CMV infection.

Most women who are infected with CMV whether pregnant or not, will not develop any symptoms of the infection. Those that do experience symptoms may see fever, swollen glands or lethargy (feeling tired or rundown).

About 50 to 85% of the adults in the United States will become infected with CMV by the time they turn 40. About half of expectant mothers have never been infected with CMV. About 1% to 4% of uninfected mothers have primary CMV infection during their pregnancy. If a pregnant woman has never been exposed to CMV and has her first infection during pregnancy, there is a chance that the fetus could become infected before the mother’s body can eliminate the virus. About one third of women who become infected with CMV for the first time during pregnancy pass the virus to their unborn babies. Thus, CMV is the most common cause of congenital viral infection in the United States.

On average, about 40% of the babies born to mothers who had a primary CMV infection during pregnancy will become infected themselves. Of the 40% of babies who become infected, twenty percent of babies born with an infection develop medical complications over the first few years of life. Those symptoms can include low birth weight, deafness, blindness, mental retardation, small head, seizures, jaundice, brittle teeth and damage to the liver and spleen. While a child may develop some of the above symptoms, no baby develops all the symptoms and some infants have no symptoms at all. Each year in the United States, about 1 in 750 children are born with or develop disabilities as a result of CMV infection.

For women who have been infected at least 6 months prior to conception, the rate of newborn CMV infection is about 1%, and these infants appear to have no significant illness or abnormalities.

Most CMV infections are rarely diagnosed because the virus usually produces few, if any, symptoms. However, people who have had CMV develop antibodies to the virus which remain in their body for the rest of their life. Two types of CMV antibodies may be found in the blood: IgM and IgG.

IgM antibodies are the first to be produced by the body in response to a CMV infection. They are present in most individuals within a week or two after the initial exposure. Eventually, after several months, the level of CMV IgM antibody usually falls below detectable levels. IgG antibodies are produced by the body several weeks after the initial CMV infection to provide long-term protection. Levels of IgG rise during the active infection, then stabilize as the CMV infection resolves and the virus becomes inactive. Once a person has been exposed to CMV, they will have some measurable amount of CMV IgG antibody in their blood for the rest of their life. CMV IgG antibody testing can be used, along with IgM testing, to help confirm the presence of a recent or previous CMV infection.

If both CMV IgG and IgM are present in a symptomatic patient, then it is likely that he or she has either recently been exposed to CMV for the first time or that a previous CMV infection has been reactivated. This can be confirmed by measuring IgG levels again 2 or 3 weeks later. A high level of IgG is not as important as a rising level. If there is a 4-fold increase in IgG between the first and second sample, then the patient has an active CMV infection (primary or reactivated).

The FDA requires that CMV testing be performed on all men who intend to donate sperm or embryos which they have fertilized. A positive result however, doesn’t necessarily mean that a man will be ineligible to donate. In many cases, couples may have decided to donate embryos months or years after they were frozen. Men who undergo the required testing at that point might test positive for some previous exposure. Since the testing can’t tell us about the timing of the infection, it is possible that a man

• might have been infected and immune prior to fertilization of the eggs. There would be no risk of transmission in this case.
• might have contracted the CMV virus after fertilization of the eggs. There would be no risk of transmission in this case.
• might have had an active infection with CMV at the time of fertilization. There is a theoretical risk of transmission in this case. However, there have never been a case of CMV known to have been transmitted to a woman or a fetus from embryo donation.

Women who are considering attempting pregnancy with donor sperm should have CMV antibody testing. Those women who have had a past infection are at very low risk of transmitting CMV infection to as fetus. They are at little to no risk from using a CMV positive donor. women who have never been exposed to CMV however, should consider using a CMV negative sperm donor. Although the risk from CMV positive donors may be small, it is impossible to determine with certainty whether there might be some risk for infection. Therefore for the CMV negative woman, these specimens are best avoided.