Print

IVF

Written by dr- zhila abedi asl. Posted in Infertility

IVF

In vitro fertilisation (IVF) is a process by which an egg is fertilised by sperm outside the body: in vitro ("in glass"). The process involves monitoring and stimulating a woman's ovulatory process, removing ovum or ova (egg or eggs) from the woman's ovaries and letting sperm fertilise them in a fluid medium in a laboratory. The fertilised egg (zygote) is cultured for 2–6 days in a growth medium and is then implanted in the same or another woman's uterus, with the intention of establishing a successful pregnancy.
IVF techniques can be employed in a variety of situations. It is a method of assisted reproductive technology for treatment of infertility. IVF techniques are also employed in gestational surrogacy, in which case the fertilised egg is implanted into a surrogate's uterus, and the resulting child is genetically unrelated to the surrogate. In some cases, donated eggs or sperms may be used. Some countries ban or otherwise regulate the availability of IVF treatment, giving raise to fertility tourism. Restrictions on availability of IVF include to single females, to lesbians and to surrogacy arrangements. Due to the costs of the procedure, IVF is generally attempted only after less expensive options have failed.
Indications
IVF may be used to overcome female infertility where it is due to problems with the fallopian tubes, making fertilisation in vivo difficult. It can also assist in male infertility, in those cases where there is a defect in sperm quality; in such cases intracytoplasmic sperm injection (ICSI) may be used, where a sperm cell is injected directly into the egg cell. This is used when sperm have difficulty penetrating the egg, and in these cases the partner's or a donor's sperm may be used. ICSI is also used when sperm numbers are very low. When indicated, the use of ICSI has been found to increase the success rates of IVF.
According to the British NICE guidelines, IVF treatment is appropriate in cases of unexplained infertility for women that have not conceived after 2 years of regular unprotected sexual intercourse.
 IVF is also considered appropriate in cases where any of its expansions is of interest, that is, a procedure that is usually not necessary for the IVF procedure itself, but would be virtually impossible or technically difficult to perform without concomitantly performing methods of IVF. Such expansions include preimplantation genetic diagnosis (PGD) to rule out presence of genetic disorders, as well as egg donation or surrogacy where the woman providing the egg isn't the same who will carry the pregnancy to term.
Method
Theoretically, in vitro fertilisation could be performed by collecting the contents from a woman's fallopian tubes or uterus after natural ovulation, mixing it with sperm, and reinserting the fertilised ova into the uterus. However, without additional techniques, the chances of pregnancy would be extremely small. The additional techniques that are routinely used in IVF include ovarian hyperstimulation to generate multiple eggs or ultrasound-guided transvaginal oocyte retrieval directly from the ovaries; after which the ova and sperm are prepared, as well as culture and selection of resultant embryos before embryo transfer into a uterus.
Ovarian hyperstimulation
Ovarian hyperstimulation is the stimulation to induce development of multiple follicles of the ovaries. It should start with response prediction by e.g. age, antral follicle count and level of anti-Müllerian hormone. The resulting prediction of e.g. poor or hyper-response to ovarian hyperstimulation determines the protocol and dosage for ovarian hyperstimulation.
Ovarian hyperstimulation also includes suppression of spontaneous ovulation, for which two main methods are available: Using a (usually longer) GnRH agonist protocol or a (usually shorter) GnRH antagonist protocol. In a standard long GnRH agonist protocol the day when hyperstimulation treatment is started and the expected day of later oocyte retrieval can be chosen to conform to personal choice, while in a GnRH antagonist protocol it must be adapted to the spontaneous onset of the previous menstruation. On the other hand, the GnRH antagonist protocol has a lower (or even eliminated) risk of ovarian hyperstimulation syndrome (OHSS), which is a life-threatening complication.
For the ovarian hyperstimulation in itself, injectable gonadotropins (usually FSH analogues) are generally used under close monitoring. Such monitoring frequently checks the estradiol level and, by means of gynecologic ultrasonography, follicular growth. Typically approximately 10 days of injections will be necessary.
Final maturation induction
When the ovarian follicles have reached a certain degree of development, induction of final oocyte maturation is performed, generally by an injection of human chorionic gonadotropin (hCG). Commonly, this is known as the "trigger shot." hCG acts as an analogue of luteinising hormone, and ovulation would occur between 38 and 40 hours after a single HCG injection, but the egg retrieval is performed at a time usually between 34 and 36 hours after hCG injection, that is, just prior to when the follicles would rupture. This avails for scheduling the egg retrieval procedure at a time where the eggs are fully mature. HCG injection confers a risk of ovarian hyperstimulation syndrome. Using a GnRH agonist instead of hCG eliminates the risk of ovarian hyperstimulation syndrome, but with a delivery rate of approximately 6% less than with hCG.
Egg retrieval
The eggs are retrieved from the patient using a transvaginal technique called transvaginal oocyte retrieval, involving an ultrasound-guided needle piercing the vaginal wall to reach the ovaries. Through this needle follicles can be aspirated, and the follicular fluid is passed to an embryologist to identify ova. It is common to remove between ten and thirty eggs. The retrieval procedure usually takes between 20 to 40 minutes, depending on the number of mature follicles, and is usually done under conscious sedation or general anaesthesia.
Egg and sperm preparation]
In the laboratory, the identified eggs are stripped of surrounding cells and prepared for fertilisation. An oocyte selection may be performed prior to fertilisation to select eggs with optimal chances of successful pregnancy. In the meantime, semen is prepared for fertilisation by removing inactive cells and seminal fluid in a process called sperm washing. If semen is being provided by a sperm donor, it will usually have been prepared for treatment before being frozen and quarantined, and it will be thawed ready for use.
Co-incubation
The sperm and the egg are incubated together at a ratio of about 75,000:1 in a culture media in order for the actual fertilisation to take place. A review in 2013 came to the result that a duration of this co-incubation of about 1 to 4 hours results in significantly higher pregnancy rates than 16 to 24 hours. In most cases, the egg will be fertilised during co-incubation and will show two pronuclei. In certain situations, such as low sperm count or motility, a single sperm may be injected directly into the egg using intracytoplasmic sperm injection (ICSI). The fertilised egg is passed to a special growth medium and left for about 48 hours until the egg consists of six to eight cells.
In gamete intrafallopian transfer, eggs are removed from the woman and placed in one of the fallopian tubes, along with the man's sperm. This allows fertilisation to take place inside the woman's body. Therefore, this variation is actually an in vivo fertilisation, not an in vitro fertilisation.
Embryo culture
The main durations of embryo culture are until cleavage stage (day 2 to 4 after co-incubation) or the blastocyst stage (day 5 or 6 after co-incubation). Embryo culture until the blastocyst stage confers a significant increase in live birth rate per embryo transfer, but also confers a decreased number of embryos available for transfer and embryo cryopreservation, so the cumulative clinical pregnancy rates are increased with cleavage stage transfer. Transfer day 2 instead of day 3 after fertilization has no differences in live birth rate. There are significantly higher odds of preterm birth (odds ratio 1.3) and congenital anomalies (odds ratio 1.3) among births having from embryos cultured until the blastocyst stage compared with cleavage stage.
Embryo selection
Laboratories have developed grading methods to judge oocyte and embryo quality. In order to optimise pregnancy rates, there is significant evidence that a morphological scoring system is the best strategy for the selection of embryos. Since 2009 where the first time-lapse microscopy system for IVF was approved for clinical use, morphokinetic scoring systems has shown to improve to pregnancy rates further.
Embryo transfer
Embryos are failed by the embryologist based on the amount of cells, evenness of growth and degree of fragmentation. The number to be transferred depends on the number available, the age of the woman and other health and diagnostic factors. In countries such as Canada, the UK, Australia and New Zealand, a maximum of two embryos are transferred except in unusual circumstances. In the UK and according to HFEA regulations, a woman over 40 may have up to three embryos transferred, whereas in the USA, younger women may have many embryos transferred based on individual fertility diagnosis. Most clinics and country regulatory bodies seek to minimise the risk of pregnancies carrying multiples, as it is not uncommon for more implantations to take than desired. The embryos judged to be the "best" are transferred to the patient's uterus through a thin, plastic catheter, which goes through her vagina and cervix. Several embryos may be passed into the uterus to improve chances of implantation and pregnancy.
Adjunctive medication
Luteal support is the administration of medication, generally progesterone, progestins or GnRH agonists, to increase the success rate of implantation and early embryogenesis, thereby complementing and/or supporting the function of the corpus luteum. The live birth rate is significantly higher with progesterone for luteal support in IVF cycles with or without intracytoplasmic sperm injection (ICSI). Co-treatment with GnRH agonists further improves outcomes, by a live birth rate RD of +16% (95% confidence interval +10 to +22%).[19]
On the other hand, growth hormone or aspirin as adjunctive medication in IVF have no evidence of overall benefit.[14]

Print

Preimplantation genetic diagnosis(PGD)

Written by dr- zhila abedi asl. Posted in Infertility

Preimplantation genetic diagnosis
Pre-implantation genetic diagnosis (PGD or PIGD) refers to genetic profiling of embryos prior to implantation (as a form of embryo profiling), and sometimes even of oocytes prior to fertilization. PGD is considered in a similar fashion to prenatal diagnosis. When used to screen for a specific genetic disease, its main advantage is that it avoids selective pregnancy termination as the method makes it highly likely that the baby will be free of the disease under consideration. PGD thus is an adjunct to assisted reproductive technology, and requires in vitro fertilization (IVF) to obtain oocytes or embryos for evaluation. The term preimplantation genetic screening (PGS) is used to denote procedures that do not look for a specific disease but use PGD techniques to identify embryos at risk.
The procedures may also be called preimplantation genetic profiling to adapt to the fact that they are sometimes used on oocytes or embryos prior to implantation for other reasons than diagnosis or screening.
 Procedures performed on sex cells before fertilization may instead be referred to as methods of oocyte selection or sperm selection, although the methods and aims partly overlap with PGD.
Indications and applications
PGD can potentially be used to select embryos to be without a genetic disorder, to have increased chances of successful pregnancy, to match a sibling in HLA type in order to be a donor, to have less cancer predisposition, and for sex selection.
Monogenic disorders
PGD is available for a large number of monogenic disorders — that is, disorders due to a single gene only (autosomal recessive, autosomal dominant or X-linked)— or of chromosomal structural aberrations (such as a balanced translocation). PGD helps these couples identify embryos carrying a genetic disease or a chromosome abnormality, thus avoiding diseased offspring. The most frequently diagnosed autosomal recessive disorders are cystic fibrosis, Beta-thalassemia, sickle cell disease and spinal muscular atrophy type 1. The most common dominant diseases are myotonic dystrophy, Huntington's disease and Charcot-Marie-Tooth disease; and in the case of the X-linked diseases, most of the cycles are performed for fragile X syndrome, haemophilia A and Duchenne muscular dystrophy. Though it is quite infrequent, some centers report PGD for mitochondrial disorders or two indications simultaneously.
PGD is also now being performed in a disease called Hereditary multiple exostoses (MHE/MO/HME).
In addition, there are infertile couples who carry an inherited condition and who opt for PGD as it can be easily combined with their IVF treatment.
Pregnancy chances
Preimplantation genetic profiling (PGP) has been suggested as a method to determine embryo quality in in vitro fertilization, in order to select an embryo that appears to have the greatest chances for successful pregnancy. However, as the results of PGP rely on the assessment of a single cell, PGP has inherent limitations as the tested cell may not be representative of the embryo because of mosaicism.
A systematic review and meta-analysis of existing randomized controlled trials came to the result that there is no evidence of a beneficial effect of PGP as measured by live birth rate. On the contrary, for women of advanced maternal age, PGP significantly lowers the live birth rate. Technical drawbacks, such as the invasiveness of the biopsy, and chromosomal mosaicism are the major underlying factors for inefficacy of PGP.
Alternative methods to determine embryo quality for prediction of pregnancy rates include microscopy as well as profiling of RNA and protein expression.
Sex discernment
Preimplantation genetic diagnosis provides a method of prenatal sex discernment even before implantation, and may therefore be termed preimplantation sex discernment. Potential applications of preimplantation sex discernment include:
•    A complement to specific gene testing for monogenic disorders, which can be very useful for genetic diseases whose presentation is linked to the sex, such as, for example, X-linked diseases.
•    Ability to prepare for any sex-dependent aspects of parenting.
•    Sex selection. A 2006 survey [1] found that 42 per cent of clinics that offer PGD have provided it for sex selection for non-medical reasons. Nearly half of these clinics perform it only for “family balancing”, which is where a couple with two or more children of one sex desire a child of the other, but half do not restrict sex selection to family balancing. In India, this practice has been used to select only male embryos although this practice is illegal {{PNDT ACT NO. 57 OF 1994}}. Opinions on whether sex selection for non-medical reasons is ethically acceptable differ widely, as exemplified by the fact that the ESHRE Task Force could not formulate a uniform recommendation.
In the case of families at risk of X-linked diseases, patients are provided with a single PGD assay of gender identification. Gender selection offers a solution to individuals with X-linked diseases who are in the process of getting pregnant. The selection of a female embryo offspring is used in order to prevent the transmission of X-linked Mendelian recessive diseases. Such X-linked Mendelian diseases include Duchenne muscular dystrophy (DMD), and hemophilia A and B, which are rarely seen in females because the offspring is unlikely to inherit two copies of the recessive allele. Since two copies of the mutant X allele are required for the disease to be passed on to the female offspring, females will at worst be carriers for the disease but may not necessarily have a dominant gene for the disease. Males on the other hand only require one copy of the mutant X allele for the disease to occur in one's phenotype and therefore, the male offspring of a carrier mother has a 50% chance of having the disease. Reasons may include the rarity of the condition or because affected males are reproductively disadvantaged. Therefore, medical uses of PGD for selection of a female offspring to prevent the transmission of X-linked Mendelian recessive disorders are often applied. Preimplantation genetic diagnosis applied for gender selection can be used for non-Mendelian disorders that are significantly more prevalent in one sex. Three assessments are made prior to the initiation of the PGD process for the prevention of these inherited disorders. In order to validate the use of PGD, gender selection is based on the seriousness of the inherited condition, the risk ratio in either sex, or the options for disease treatment.
Minor disabilities
A 2006 survey reveals that PGD has occasionally been used to select an embryo for the presence of a particular disease or disability, such as deafness, in order that the child would share that characteristic with the parents
Technical aspects[edit]
PGD is a form of genetic diagnosis performed prior to implantation. This implies that the patient’s oocytes should be fertilized in vitro and the embryos kept in culture until the diagnosis is established. It is also necessary to perform a biopsy on these embryos in order to obtain material on which to perform the diagnosis. The diagnosis itself can be carried out using several techniques, depending on the nature of the studied condition. Generally, PCR-based methods are used for monogenic disorders and FISH for chromosomal abnormalities and for sexing those cases in which no PCR protocol is available for an X-linked disease. These techniques need to be adapted to be performed on blastomeres and need to be thoroughly tested on single-cell models prior to clinical use. Finally, after embryo replacement, surplus good quality unaffected embryos can be cryopreserved, to be thawed and transferred back in a next cycle.
Obtaining embryos for preimplantation genetic diagnosis
Currently, all PGD embryos are obtained by assisted reproductive technology, although the use of natural cycles and in vivo fertilization followed by uterine lavage was attempted in the past and is now largely abandoned. In order to obtain a large group of oocytes, the patients undergo controlled ovarian stimulation (COH). COH is carried out either in an agonist protocol, using gonadotrophin-releasing hormone (GnRH) analogues for pituitary desensitisation, combined with human menopausal gonadotrophins (hMG) or recombinant follicle stimulating hormone (FSH), or an antagonist protocol using recombinant FSH combined with a GnRH antagonist according to clinical assessment of the patient’s profile (age, body mass index (BMI), endocrine parameters). hCG is administered when at least three follicles of more than 17 mm mean diameter are seen at transvaginal ultrasound scan. Transvaginal ultrasound-guided oocyte retrieval is scheduled 36 hours after hCG administration. Luteal phase supplementation consists of daily intravaginal administration of 600 µg of natural micronized progesterone.
Oocytes are carefully denudated from the cumulus cells, as these cells can be a source of contamination during the PGD if PCR-based technology is used. In the majority of the reported cycles, intracytoplasmic sperm injection (ICSI) is used instead of IVF. The main reasons are to prevent contamination with residual sperm adhered to the zona pellucida and to avoid unexpected fertilization failure. The ICSI procedure is carried out on mature metaphase-II oocytes and fertilization is assessed 16–18 hours after. The embryo development is further evaluated every day prior to biopsy and until transfer to the woman’s uterus. During the cleavage stage, embryo evaluation is performed daily on the basis of the number, size, cell-shape and fragmentation rate of the blastomeres. On day 4, embryos were scored in function of their degree of compaction and blastocysts were evaluated according to the quality of the throphectoderm and inner cell mass, and their degree of expansion.
Biopsy procedures
As PGD can be performed on cells from different developmental stages, the biopsy procedures vary accordingly. Theoretically, the biopsy can be performed at all preimplantation stages, but only three have been suggested: on unfertilised and fertilised oocytes (for polar bodies, PBs), on day three cleavage-stage embryos (for blastomeres) and on blastocysts (for trophectoderm cells).
The biopsy procedure always involves two steps: the opening of the zona pellucida and the removal of the cell(s). There are different approaches to both steps, including mechanical, chemical, and physical (Tyrode’s acidic solution) and laser technology for the breaching of the zona pellucida, extrusion or aspiration for the removal of PBs and blastomeres, and herniation of the trophectoderm cells.
Embryo transfer and cryopreservation of surplus embryos
Embryo transfer is usually performed on day three or day five post-fertilization, the timing depending on the techniques used for PGD and the standard procedures of the IVF centre where it is performed.
With the introduction in Europe of the single-embryo transfer policy, which aims at the reduction of the incidence of multiple pregnancies after ART, usually one embryo or early blastocyst is replaced in the uterus. Serum hCG is determined at day 12. If a pregnancy is established, an ultrasound examination at 7 weeks is performed to confirm the presence of a fetal heartbeat. Couples are generally advised to undergo PND because of the, albeit low, risk of misdiagnosis.
It is not unusual that after the PGD, there are more embryos suitable for transferring back to the woman than necessary. For the couples undergoing PGD, those embryos are very valuable, as the couple's current cycle may not lead to an ongoing pregnancy. Embryo cryopreservation and later thawing and replacement can give them a second chance to pregnancy without having to redo the cumbersome and expensive ART and PGD procedures.

Print

Intracytoplasmic sperm injection( ICSI

Written by dr- zhila abedi asl. Posted in Infertility


ICSI
Schematic image of intracytoplasmic sperm injection in the context of IVF.
This procedure is most commonly used to overcome male infertility problems, although it may also be used where eggs cannot easily be penetrated by sperm, and occasionally in addition to sperm donation.
It can be used in teratozoospermia, because once the egg is fertilized, abnormal sperm morphology does not appear to influence blastocyst development or blastocyst morphology. Even with severe teratozoospermia, microscopy can still detect the few sperm cells that have a "normal" morphology, allowing for optimal success rate.
Procedure
ICSI is generally performed following an in vitro fertilization procedure to extract one to several oocytes from a woman.
The procedure is done under a microscope using multiple micromanipulation devices (micromanipulator, microinjectors and micropipettes). A holding pipette stabilizes the mature oocyte with gentle suction applied by a microinjector. From the opposite side a thin, hollow glass micropipette is used to collect a single sperm, having immobilised it by cutting its tail with the point of the micropipette. The oocyte is pierced through the oolemma and directed to the inner part of the oocyte (cytoplasm). The sperm is then released into the oocyte. The pictured oocyte has an extruded polar body at about 12 o'clock indicating its maturity. The polar body is positioned at the 12 or 6 o'clock position, to ensure that the inserted micropipette does not disrupt the spindle inside the egg. After the procedure, the oocyte will be placed into cell culture and checked on the following day for signs of fertilization.
'Washed' or 'unwashed' sperm may be used in the process.
Live birth rate are significantly higher with progesterone for luteal support in ICSI cycles.[6] Also, addition of a GNRH agonist for luteal support in ICSI cycles has been estimated to increase success rates,[6] by a live birth rate RD of +16% (95% confidence interval +10 to +22%).[7]
Success or failure factors
Potential factors that may influence pregnancy rates (and live birth rates) in ICSI include level of DNA fragmentation] as measured e.g. by Comet assay, advanced maternal age and semen quality.

Print

Egg donation

Written by dr- zhila abedi asl. Posted in Infertility

Egg donation
Egg donation is the process by which a woman donates eggs for purposes of assisted reproduction or biomedical research. For assisted reproduction purposes, egg donation typically involves in vitro fertilization technology, with the eggs being fertilized in the laboratory; more rarely, unfertilized eggs may be frozen and stored for later use. Egg donation is a third party reproduction as part of assisted reproductive technology (ART).
In the United States, ASRM (American Society of Reproductive Medicine) has issued guidelines for these procedures, and the FDA has a number of guidelines as well. There are boards in countries outside of the US who have the same regulations. However, egg donation agencies in the U.S. can legally choose whether to abide by ASRM regulations or not.
History
The first child born from egg donation was reported in Australia in 1983 at the Monash IVF clinic.[1] In July 1983, a clinic in Southern California reported a pregnancy using egg donation, which led to the birth of the first American child born from egg donation on February 3, 1984.[2] This procedure was performed at the Harbor UCLA Medical Center and the University of California at Los Angeles School of Medicine.[3] In the procedure, which is no longer used today, a fertilized egg that was just beginning to develop was transferred from one woman in whom it had been conceived by artificial insemination to another woman who gave birth to the infant 38 weeks later. The sperm used in the artificial insemination came from the husband of the woman who bore the baby.[4][5]
Prior to this, thousands of infertile women, single men and gay male couples had adoption as the only path to parenthood. Advances in IVF and egg donation set the stage to allow open and candid discussion of oocyte and embryo donation as a common practice.[4][5] This breakthrough has given way to the donation of human oocytes and embryos as a common practice similar to other donations such as blood and major organ donations. At the time of this announcement the event was captured by major news carriers and fueled healthy debate and discussion on this practice which impacted the future of reproductive medicine by creating a platform for further advancements in woman's health.
This scientific breakthrough changed the outlook for those who were unable to have children due to female infertility and for women who are at high risk for passing on genetic disorders. As IVF developed, the procedures used in egg donation paralleled that development: the egg donor's eggs are now harvested from her ovaries in an outpatient surgical procedure and fertilized in the laboratory, the same procedure used on IVF patients, but the resulting embryo or embryos is then transferred into the intended mother instead of into the woman who provided the egg. Donor oocytes thus give women a mechanism to become pregnant and give birth to a child that will be their biological child (assuming that the recipient woman carries the baby), but not their genetic child. In cases where the recipient's womb is absent or unable to carry a pregnancy, or in cases involving gay male couples, a gestational surrogate is used and the embryos are implanted into her per an agreement with the recipients. The combination of egg donation and surrogacy has enabled gay men, including singer Elton John and his partner, to have biological children.[6] Oocyte and embryo donation now account for approximately 18% of in vitro fertilization recorded births in the US.[7][8]
This work established the technical foundation and legal-ethical framework surrounding the clinical use of human oocyte and embryo donation, a mainstream clinical practice, which has evolved over the past 25 years.[4][9] Building upon this groundbreaking research and since the initial birth announcement in 1984, well over 47,000 live births resulting from donor oocyte embryo transfer have been and continue to be recorded by the Centers for Disease Control (CDC)[10][11] in the United States to infertile women, who otherwise would not have had children by any other existing method.
The legal status and cost/compensation models of egg donation vary significantly by country. It may be totally illegal (e.g., Italy, Germany, Austria);[12][13] legal only if anonymous and gratuitous—that is, without any compensation for the egg donor (e.g., France);[14] legal only if non-anonymous and gratuitous (e.g., Canada); legal only if anonymous, but egg donors may be compensated (the compensation is often described as being to offset her inconvenience and expenses) (e.g., Spain, Czech Republic, South Africa, Greece);[15][16][17][18] legal only if non-anonymous, but egg donors may be compensated (e.g., the UK);[19] or legal whether or not it is anonymous, and egg donors may be compensated (e.g., the US).
Since this process is so invasive (much more so than its counterpart, sperm donation), in countries that prohibit compensation there is an extreme dearth of young women willing to go through this procedure. Additionally, in most countries where it is legal and compensated, the law places a cap on the compensation and that cap tends to be in the vicinity of $1000–$2000. In the US, no law caps the compensation but the American Society for Reproductive Medicine (ASRM) requires member clinics to abide by ASRM standards, which provide that "sums of $5,000 or more require justification and sums above $10,000 are not appropriate."[20] The "justification" for payments over $5000 may include previous successful donations, unusually good family health history, or membership in minority ethnicities for which it is more difficult to find donors.
As a result of these legal and financial differences around the world, egg donation in the US is far more expensive than it is in other countries. For instance, at one top US clinic it costs more than $26,000 plus the donor's medications (another several thousand dollars).[21] In contrast, at a top Czech clinic it costs 4500 Euros (approximately $6000) including the donor's medication.[22] However, in the US the recipient's ability to choose donors with the desired characteristics (e.g., strong physical resemblance to recipient; same ethnicity and/or religion as recipient; excellent academic background; musical or athletic talent; etc.) is unparalleled. Thus, many patients come to the US in order to benefit from that range of options. In contrast, many US patients travel abroad for egg donation, sacrificing their ability to hand-pick a donor in exchange for significantly lower costs.
Indication
A need for egg donation may arise for a number of reasons. Infertile couples may resort to egg donation when the female partner cannot have genetic children because her own eggs cannot generate a viable pregnancy, or because they could generate a viable pregnancy but the chances are so low that it is not advisable or not financially feasible to do IVF with her own eggs. This situation is often, but not always based on advanced reproductive age. It can also be due to early onset of menopause, which can occur as early as their 20s. In addition, some women are born without ovaries, while some women's reproductive organs have been damaged or surgically removed due to disease or other circumstances. Another indication would be a genetic disorder on part of the woman that either renders her infertile or would be dangerous for any offspring, problems that can be circumvented by using eggs from another woman. Many women have none of these issues, but continue to be unsuccessful using their own eggs—in other words, they have undiagnosed infertility—and thus turn to donor eggs or donor embryos. As stated above, egg donation is also helpful for gay male couples using surrogacy (see LGBT parenting).
In the US and UK, if desired (and if the egg donor agrees), the couple can meet and get acquainted with the egg donor, her children and family members. More often, egg donations are anonymous or semi-anonymous (i.e. the egg donor may provide personal and medical information, photographs of herself and/or family members, and an email or third party willing to convey communications between the donor and recipients). In some countries, the law requires non-anonymity (e.g., the UK). In other countries, the law requires anonymity (e.g., France, Spain, the Czech Republic, South Africa). In the US the choice between anonymity, semi-anonymity and non-anonymity is made by the donor and recipient, although some IVF clinics that maintain their own databases of egg donors strongly encourage or require anonymity.
•    Congenital absence of eggs
o    Turner syndrome
o    Gonadal dysgenesis
•    Acquired reduced egg quantity / quality
o    Oophorectomy
o    Premature menopause
o    Chemotherapy
o    Radiation therapy
o    Autoimmunity
o    Advanced maternal age
o    Compromised ovarian reserve
•    Other
o    Diseases of X-Sex linkage
o    Repetitive fertilization or pregnancy failure
o    Ovaries inaccessible for egg retrieval
Types of donors
Donors includes the following types:
•    Donors unrelated to the recipients who do it for altruistic and/or monetary reasons. In the US they are anonymous donors or semi-anonymous donors recruited by egg donor agencies or IVF clinics. Such donors may also be non-anonymous donors, i.e., they may exchange identifying and contact information with the recipients. In most countries other than the US and UK, the law requires such donors to remain anonymous.
•    Designated donors, e.g. a friend or relative brought by the patients to serve as a donor specifically to help them. In Sweden and France, couples who can bring such a donor still get another person as a donor, but instead get advanced on the waiting list for the procedure, and that donor rather becomes a "cross donor".[23] In other words, the couple brings a designated donor, she donates anonymously to another couple, and the couple that brought her receives eggs from another anonymous donor much more quickly than they would have if they had not been able to provide a designated donor.
•    Patients taking part in shared oocyte programmes. Women who go through in vitro fertilization may be willing to donate unused eggs to such a program, where the egg recipients together help paying the cost of the In Vitro Fertilisation (IVF) procedure.[24] It is very cost-effective compared to other alternatives.[25] The pregnancy rate with use of shared oocytes is similar to that with altruistic donors.[26]
Procedure
    This article needs attention from an expert in Medicine. Please add a reason or a talk parameter to this template to explain the issue with the article. WikiProject Medicine (or its Portal) may be able to help recruit an expert. (November 2008)

Egg donors are first recruited, screened, and give consent prior to participation in the IVF process. Once the egg donor is recruited, she undergoes IVF stimulation therapy, followed by the egg retrieval procedure. After retrieval, the ova are fertilized by the sperm of the male partner (or sperm donor) in the laboratory, and, after several days, the best resulting embryo(s) is/are placed in the uterus of the recipient, whose uterine lining has been appropriately prepared for embryo transfer beforehand. The recipient is usually, but not always, the person who requested the service and then will carry and deliver the pregnancy and keep the baby.
Why people proceed with egg donation?
Some women whose own eggs do not result in a viable pregnancy choose to proceed with egg donation. Some of the reasons why a woman’s own eggs cannot be used and lot more information about this procedure explained here. Some women whose own eggs do not result in a viable pregnancy choose this treatment. There are various reasons why a woman’s own eggs cannot be used:
Premature ovarian failure is a leading cause where women stop producing eggs at an early age. There are cases where women go into early menopause in their early 20s. Women suffering from premature ovarian failure can no longer produce healthy eggs that can lead to pregnancy. Some women are born without ovaries, in which case the only possibility of having a baby is through egg donation. Women who go through chemotherapy or radiotherapy whose ovaries may have been damaged by the treatment may also need this procedure Women who produce eggs but have genetic diseases could also choose egg donation to ensure healthy children. Older women with diminished ovarian reserves or older women who are going through menopause could also become pregnant with egg donation.[27]
The egg donor's process in detail
Before any intensive medical, psychological, or genetic testing is done on a donor, they must first be chosen by a recipient from the profiles on agency or clinic databases (or, in countries where donors are required to remain anonymous, they are chosen by the recipient's doctor based on their physical and temperamental resemblance to the recipient woman). This is due to the fact that all of the mentioned examinations are expensive and the agencies must first confirm that a match is possible or guaranteed before investing in the process.[28] Each egg donor is first referred to a psychologist who will evaluate if she is mentally prepared to undertake and complete the donation process. These evaluations are necessary to ensure that the donor is fully prepared and capable of completing the donation cycle safely and successfully.[29] The donor is then required to undergo a thorough medical examination, including a pelvic exam, blood draw to check hormone levels and to test for infectious diseases, Rh factor, blood type, and drugs and an ultrasound to examine her ovaries, uterus and other pelvic organs. A family history of approximately the past three generations is also required, meaning that adoptees are usually not accepted because of the lack of past health knowledge.[28] Genetic testing is also usually done on donors to ensure that they do not carry mutations (e.g., cystic fibrosis) that could harm the resulting children; however, not all clinics automatically perform such testing and thus recipients must clarify with their clinics whether such testing will be done.
Once the screening is complete and a legal contract signed, the donor will begin the donation cycle, which typically takes between three and six weeks. An egg retrieval procedure comprises both the Egg Donor's Cycle and the Recipient's Cycle. Birth control pills are administered during the first few weeks of the egg donation[30] process to synchronize the donor's cycle with the recipient's, followed by a series of injections which halt the normal functioning of the donor's ovaries. These injections may be self-administered on a daily basis for a period of one to three weeks. Next, follicle-stimulating hormones (FSH) are given to the donor to stimulate egg production and increases the number of mature eggs produced by the ovaries. Throughout the cycle the donor is monitored often by a physician using blood tests and ultrasound exams to determine the donor's reaction to the hormones and the progress of follicle growth.[29]
Once the doctor decides the follicles are mature, he/she will establish the date and time for the egg retrieval procedure. Approximately 36 hours before retrieval, the donor must administer one last injection of HCG hormone to ensure that her eggs are ready to be harvested. The egg retrieval itself is a minimally invasive surgical procedure lasting 20–30 minutes, performed under sedation. A small ultrasound-guided needle is inserted through the vagina to aspirate the follicles in both ovaries, which extracts the eggs. After resting in a recovery room for an hour or two, the donor is released. Most donors resume regular activities by the next day.[29]
Results
In the United States, egg donor cycles have a success rate of over 60%. (See SART statistics at http://www.sart.org.) When a "fresh cycle" is followed by a "frozen cycle", the success rate with donor eggs is approximately 80%.
With egg donation, women who are past their reproductive years or menopause can still become pregnant. Adriana Iliescu held the record as the oldest woman to give birth using IVF and donated egg, when she gave birth in 2004 at the age of 66, a record passed in 2006.
Donor motivation and compensation
An egg donor may be motivated by a number of reasons to provide eggs. Some egg donors may be altruistic and feel that participation in the reproductive process provides a benefit for another person, sometimes a person they know or are related to. A survey of 80 American women showed that 30% were motivated by altruism alone. Others, 20%, were attracted only by monetary compensation, while 40% of donors were motivated by both reasons. The same study reported that 45% of egg donors were students the first time they donated and averaged $4,000 for each donation.[31] Although the donors may be motivated by both monetary and altruistic reasons, egg agencies desire and prefer to choose donors that are strictly providing eggs for altruistic reasons, as it portrays the traditional gendered definitions of females in a more positive light.[28] In the European Union the standard for reimbursement is based on compensation, not payment limiting egg donation to, at most, $1500. In some countries, most notably Spain and Cyprus this has limited donors to the poorest segments of society.[32] In the United States, the donors are paid regardless of how many eggs she produces and for each additional cycle, especially if it results in the recipient's pregnancy, the fee that the donors are paid will increase.[28]
Egg-broker agencies are known for advertising to college students in publications such-as campus newspapers and on Craigslist. Although by the terms of use posting ads recruiting for egg donors on the message forums and other areas of the Craigslist site are not permitted paid advertisements on Craigslist do allow the posting of Donor Egg Recruitment.
Risks
Egg donor
The procedures for the donor and the medication given to her are identical to the procedures and medications used in autologous IVF (i.e., IVF on patients who are using their own eggs). The egg donor thus has the same low risk of complications from IVF as an autologous IVF patient would, such as bleeding from the oocyte recovery procedure and reaction to the hormones used to induce hyperovulation (producing more than one egg), including ovarian hyperstimulation syndrome (OHSS) and, rarely, liver failure.[33]
According to Jansen and Tucker, writing in the same ART (assisted reproductive technologies) textbook referenced above,[33] the risk of OHSS varies with the clinic administering the hormones, from 6.6 to 8.4% of cycles, half of them "severe." The most severe form of OHSS is life-threatening. Recent studies have found that donors were at less risk of OHSS when the final maturation of oocytes was induced by GnRH agonist than with recombinant hCG. Both hormones were comparable in the number of mature oocytes produced and fertilization rates.[34][35] A larger study in the Netherlands found 10 documented cases of deaths from IVF, with a rate of 1:10,000. "All of these patients were treated with GnRH agonists and none of these cases have been published in the scientific literature."
The long-term impact of egg donation on donors has not been well studied, but because the same medications and procedures are used, it should be essentially the same as the long-term impact (if any) of IVF on patients using their own eggs. The evidence of increased cancer risk is equivocal; some studies have pointed to a slightly increased risk while other studies have found no such risk or even a slightly reduced risk in most patients (women with a family history of breast cancer, however, may have a higher risk).[36][37] 1 in 5 women report psychological effects—which may be positive or negative—from donating their eggs, and two-thirds of egg donors were happy with the decision to donate their eggs. The same study found that 20% of women did not recall being aware of any physical risks.[31] In accordance with the ASRM (American Society for Reproductive Medicine) guidelines, female donors are given a limit of 6 cycles that they may donate in order to minimize the possible health risks.[28]
However, it appears that repetitive oocyte donation cycles does not cause accelerated ovarian aging, evidenced by absence of decreased anti-Müllerian hormone (AMH) in such women.[38]
Recipient
The recipient has a minimal risk of contracting a transmittable disease. While the donor may test negative for HIV, such testing does not exclude the possibility that the donor has contracted HIV very recently, so the recipient faces a residual risk of exposure. However, the FDA governs this and requires full infectious disease testing no more than 30 days prior to retrieval and/or transfer. Most clinics now require, however, that donors be retested a few days prior to retrieval so the risk to the recipient is minimal. Intimate partners of both the egg donor and the recipient are also tested.
The recipient also trusts that the medical history of the donor and her family is accurate. This factor of trust should not be underestimated in importance. Donors in the US are paid thousands of dollars; such compensation may attract unscrupulous individuals inclined to conceal their true motivations. However, a full psychological evaluation is required by most IVF clinics, giving an indication if the donor is trustworthy or not.
In more cases than not, there is no ongoing relationship between the donor and recipient following the cycle. Both the donor and recipient agree in formal legal documents that the donation of the eggs is final at the time of retrieval, and typically both parties would like any "relationship" to conclude at that point; if they prefer continued contact, they may provide for that in the contract. Even if they prefer anonymity, however, it remains theoretically possible that in the future, some children may be able to identify their donor(s)using DNA databanks and/or registries (e.g., if the donor submits her DNA to a genealogy site and a child born from her donation later submits its DNA to the same site).
Multiple birth is a common complication. Incidence of twin births is very high. At the present time, the ASRM recommends that no more than 1 or 2 embryos be transferred in any given cycle. Remaining embryos are frozen, whether for future transfers if the first one fails, for siblings, or for eventual embryo donation.
There appears to be a slightly higher risk of pregnancy-induced hypertension in pregnancies of egg donation.[39]
Fetus
Pregnancies with egg donation are associated with a slightly increased risk of placental pathology.[39] The local and systemic immunologic changes are also more pronounced than in natural pregnancies, so it has been suggested that the association is caused by reduced maternal immune tolerance towards the fetus, as the genetic similarity between the carrier and fetus from an egg donation is less than in a natural pregnancy.[39] In contrast, the incidence of other perinatal complications, such as intrauterine growth restriction, preterm birth and congenital malformations, is comparable to conventional IVF without egg donation.[39]
Custody
Generally legal documents are signed renouncing rights and responsibilities of custody on the part of the donor. Most IVF doctors will not proceed with administering medication to any donor until these documents are in place and a legal "clearance letter" confirming this understanding is provided to the doctor.
Legality and financial issues
The legal status and cost/compensation models of egg donation vary significantly by country. It may be totally illegal (e.g., Italy, Germany, Austria);[12][13] legal only if anonymous and gratuitous—that is, without any compensation for the egg donor (e.g., France);[14] legal only if non-anonymous and gratuitous (e.g., Canada);[40] legal only if anonymous, but egg donors may be compensated (the compensation is often described as being to offset her inconvenience and expenses) (e.g., Spain, Czech Republic, South Africa);[15][16][17] legal only if non-anonymous, but egg donors may be compensated (e.g., the UK);[19] or legal whether or not it is anonymous, and egg donors may be compensated (e.g., the US). Because most countries prohibit the sale of body parts, egg donors generally are paid for undergoing the necessary medical procedures rather than for their eggs. In other words, if they complete the cycle, they will be paid the agreed price regardless of how many (or how few) eggs are retrieved.
Since this process is so invasive (much more so than its counterpart, sperm donation), in countries that prohibit compensation there is an extreme dearth of young women willing to go through this procedure. Additionally, in most countries where it is legal and compensated, the law places a cap on the compensation and that cap tends to be in the vicinity of $1000–$2000. In the US, no law caps the compensation but the American Society for Reproductive Medicine (ASRM) requires member clinics to abide by ASRM standards, which provide that "sums of $5,000 or more require justification and sums above $10,000 are not appropriate."[20] The "justification" for payments over $5000 may include previous successful donations, unusually good family health history, or membership in minority ethnicities for which it is more difficult to find donors.
As a result of these legal and financial differences around the world, egg donation in the US is far more expensive than it is in other countries. For instance, at one top US clinic it costs more than $26,000 plus the donor's medications (another several thousand dollars).[21] In contrast, at a top Czech clinic it costs 4500 Euros (approximately $6000) including the donor's medication.[22] However, in the US the recipient's ability to choose donors with the desired characteristics (e.g., strong physical resemblance to recipient; same ethnicity and/or religion as recipient; excellent academic background; musical or athletic talent; etc.) is unparalleled. Thus, many patients come to the US in order to benefit from that range of options. In contrast, many US patients travel abroad for egg donation, sacrificing their ability to hand-pick a donor in exchange for significantly lower costs.
Having an attorney draft a contract is recommended in order to ensure that the donor has no possible legal rights or responsibilities over the child or any frozen embryos. Hiring an attorney who specializes in reproductive law is thus strongly recommended, at least in the United States; other countries may have other procedures for clarifying the parties' rights, or may simply have legislation that defines the parties' rights. In the US, before the egg donor's IVF cycle begins she typically must sign the Egg Donor Contract, which specifies the rights of the donor and the recipient(s) with respect to the retrieved eggs, the embryos, and any children conceived from the donation. Such contracts should specify that the recipients are the legal parents of the child and the legal owners of any eggs or embryos resulting from the cycle; in other words, while the donor has the right to cancel the cycle at any time prior to egg donation (although if she does so the contract generally provides that she will not be paid), once the eggs are retrieved they belong to the recipient(s). In individual cases the donors and parents may also wish to negotiate terms relating to any unused embryos (e.g., some donors would prefer that unused embryos be destroyed or donated to science, while others would prefer or allow them to be donated to another infertile couple). Some states have also adopted the Uniform Parentage Act, which provides that the recipient or recipients have complete parental responsibility of the conceived child.
In Buzzanca v. Buzzanca, 72 Cal. Rptr.2d 280 (Cal. Ct. App. 1998), the court held that both the recipient and the father of a child conceived through anonymous sperm and egg donation and carried by a surrogate were the legal parents of the child by virtue of their procreative intent. Therefore, the father was required to pay child support even though he sought a divorce before the child was born.[41]
Donor registries
A donor registry is a registry to facilitate donor conceived people, sperm donors and egg donors to establish contact with genetic kindred. They are mostly used by donor conceived people to find genetic half-siblings from the same egg- or sperm donor.
Some donors are non-anonymous, but most are anonymous, i.e. the donor conceived person doesn't know the true identity of the donor. Still, he/she may get the donor number from the fertility clinic. If that donor had donated before, then other donor conceived people with the same donor number are thus genetic half-siblings. In short, donor registries match people who type in the same donor number.
Alternatively, if the donor number isn't available, then known donor characteristics, e.g. hair, eye and skin color may be used in matching.
Donors may also register, and therefore, donor registries may also match donors with their genetic children.
The largest registry is the Donor Sibling Registry- with more than 25,000 members, the DSR has matched almost 7,000 donor conceived people with their egg and sperm donors, as well as with their half siblings. Alternate methods of providing an information link between the donor and recipient (both agreeing to stay registered on the DSR) are often provided for in the legal document (referred to as the "Egg Donor Agreement".)
Embryo donation
An alternative to egg donation in some couples, especially those in whom the male partner cannot provide viable sperm, is embryo donation, sometimes called "embryo adoption". Embryo donation is, as its name implies, the donation of embryos remaining after one couple’s IVF treatments have been completed, to another individual or couple, followed by the placement of those embryos into the recipient woman’s uterus, to facilitate pregnancy and childbirth. Embryo donation has been shown in a recent study to be more cost-effective than egg donation on a "per live birth" basis.[42] Another study has found that embryos created for one couple, using an egg donor, are often made available for donation to another couple if the first couple chooses not to use them.[43]
Psychological and social issues
Common reasons to donate are to help childless couples and receive monetary compensation. Reluctance to donate may be caused by a sense of ownership and responsibility for the well-being of the offspring.[44]
Most psychological and social issues of egg donation are likely comparable to those of sperm donation.
Telling the child
Most psychologists recommend being open and honest with children from an early age. Groups for donor conceived children make a strong case for the rights of children to have access to information about their genetic background. For donor conceived children who find out after a long period of secrecy, their main grief is usually not the fact that they are not the genetic child of the mother who raised (and, usually, gave birth to) them, but the fact that their parents lied to them, causing loss of trust.[45] Furthermore, assuming that egg-donor conceived children have essentially the same reaction as sperm-donor conceived children, the overturning of one's lifelong understanding of who one's genetic parents were may cause a lasting sense of imbalance and loss of control.[46]
Telling the children that they were donor conceived is recommended, based on decades of experience with adoption (and more recent feedback from donor-conceived children) showing that not telling children is harmful to the parent-child relationship and to the child psychologically.[47][48] Even parents who would normally be extremely reluctant to tell the child should consider telling if any of the following scenarios applies:
•    When anyone other than the parents know about the donation, such that the child might find it out from somebody else.[45]
•    When the recipient carries a significant genetic disease, since telling the child will reassure the child that he or she does not carry the disease.[45]
•    Where the child is found to suffer from a genetically-transmitted disorder and it is necessary to take legal action which then identifies the donor.
Conversely, when the child is being raised in a religion or a culture that strongly disapproves of donor conception (e.g., a Catholic country where egg donation is illegal), that may counsel against telling the child, at least until the child is much older and clearly capable of understanding why he or she was not told earlier and of keeping that information to him or herself.
The parents' decision-making process of telling the child is influenced by many intrapersonal factors (e.g., some mothers feel ashamed that they were not able to use their own eggs), interpersonal factors (e.g., approving or disapproving family members), as well as social and family life cycle factors.[49] Health care staff and support groups have been demonstrated to have an impact on the decision to disclose the procedure.[49] It is generally recommended that parents who disclose should do so in age-appropriate ways, ideally starting well before the age of five with a discussion of the fact that their parents needed help to have a child because certain things are needed to make a child—namely, sperm and eggs—and because the parents did not have one of those things, a nice woman gave it to them.
Families sharing same donor
Having contact and meeting among families sharing the same donor generally has positive effects.[51][52] It gives the child an additional extended family and may help give the child a sense of identity[52] by answering questions about the donor.[51] It is more common among open identity-families headed by single men/women.[51] Less than 1% of those seeking donor-siblings find it a negative experience, and in such cases it is mostly where the parents disagree with each other about how the relationship should proceed.[53]
Other family members
Grandparents of donors may regard the donated eggs as a family asset and may regard the donor conceived people as grandchildren.[54]
Sociological perspectives on the donor
Although an embryo is created by equal shares of an egg and sperm, these bodily goods are seen and respectfully treated differently in the social process of donation. These separate treatments are based on the cultural norms credited to the biological differences between males and females.[28] "Women, love, altruism and the family are, as a group, [viewed as] radically separate and opposite from men, self-interested rationality, work and market exchange" (Nelson and England, 2002).[55] Women donors with altruistic motives are preferred. In some cases, staff identify the donor's responsibilities as being like those in a job, but in the case of egg donation, it is understood to be much more meaningful than any regular job. Women who try to make careers out of egg donations “disgust” the staff by going against the altruistic and caring frame of donation.[28] In accordance with the culturally expected norms of women, egg donors that are highly educated and physically attractive or are caring and have motherly instincts are the most vied for. It stems from cultural validation that is anticipated from motherhood.[28]
Donor marketing
For a donor to be accepted by an agency and repeatedly used she must be marketable and appealing to the recipients. Although egg donation is a significant, life-giving act, the companies participating in this industry still have to operate with an economical mind-set. Matches between egg recipients and egg donors are what make the profit for the company and achievable to continue these processes for others. The most sought-after donors tend to be those who are (1) proven (i.e., have donated before and produced a pregnancy from it, proving themselves both fertile and reliable); (2) conventionally attractive; (3) healthy, with good family health histories; and (4) smart, well educated.
Donor profiles presented on agency websites are their primary marketing tool to find recipients and learn what these future consumers want. On the donor profiles listed on the agency website for recipients, or "clients", to peruse for their desired egg match, "physical characteristics, family health history, educational attainment (in some cases, standardized test scores, GPA, and IQ scores are requested), as well as open-ended questions about hobbies, likes and dislikes, and motivations for donating" (Almeling) are included. Donors are encouraged to submit attractive photos and are advised of what the recipient finds as desirable. Profiles that are at some point deemed unacceptable are deleted, whether it be because their personalities did not stand out or their portrayals were viewed as negative in some way. Overweight volunteers for donation are also most often not accepted, not just because of conventional views on physical attractiveness but also because women with a higher body-mass index tend to respond differently (less well) to ovarian stimulation drugs and IVF clinics thus generally recommend that patients not use donors with higher BMIs.[56] Egg donors also have a higher standard of physical appearance than sperm donors; many sperm donors are not required to provide adult photographs of themselves, or in some cases, any photographs.
Religious views
Some Christian leaders indicate that IVF is acceptable (but they should ensure that no fertilized embryos are discarded in the process). Many Christian couples who cannot have children thus can go for IVF, with both the husband's sperm and the wife's egg and this is in line with the church's teaching.
However the question gets trickier with donor eggs.
There are also some Christian leaders (especially Catholic) who are concerned about all in vitro fertility therapies because they disrupt the natural act of conceiving a child where gamete donations, both egg and sperm donations, are seen to "compromise the marital bond and family integrity".[57] and they encourage infertile couples to consider adoption instead.
In the Muslim community, Sunnis are allowed fertility treatments that do not involve third parties. This rule does not allow for the donation of gametes. Shi’ite Muslims on the other hand are allowed to accept egg donations, although there are some details that prevent egg donation in some countries and regions.[58]
In the Jewish community there is no consensus as to whether an egg donor needs to be Jewish in order for the child to be considered Jewish from birth.[59] This is not an issue in the reform community for two reasons. First, only one parent must be Jewish for the child to be considered Jewish; thus, if the father is Jewish, the mother's religion is irrelevant. Second, if the mother who carries the pregnancy and gives birth is Jewish, reform Jews will generally consider that child to be Jewish from birth because it was born of a Jewish mother. In the Orthodox community the situation is different because the mother must be Jewish for the child to be Jewish—a father married to a non-Jew cannot transmit Judaism—and most Orthodox Jewish rabbis consider that the child must be genetically Jewish in order to be Jewish. Thus, among Orthodox Jews, not only the mother but also the egg donor must be Jewish.

Print

Iui

Written by dr- zhila abedi asl. Posted in Infertility

The loading new masege.....