A rigorous evaluation procedure is maintained in the egg donation process for both donors and recipients for a successful outcome.
Screening tests for an egg donor
Legally women under the age group between 21 years to 34 years are eligible for the egg donation process. An egg donor is enough mature to understand the whole procedure and able to give true consent to pursue the procedure at the minimum permissible age selected for egg donation. The upper age limit for egg donation is also fixed. Within 35 years of age, the donor's response to ovarian stimulation is favorable and produces a maximum number of eggs. This provides a high quality of embryos, a better rate of implantation with higher pregnancy rates than older women.
If the donor's age is more than 35 years, then recipients should be informed. The age factor of the donor interferes with the health of the fetus. Experts should explain the risk of genetic abnormality such as Down syndrome can occur as the eggs are collected from an aged donor.
An extensive medical questionnaire related to the medical history of the donor and her family has to fill up in both anonymous and non- anonymous egg donation processes. The detail information acquires from this questionnaire includes sexual history, drugs used and abused history, hereditary disease history, psychological state of each member of the family of an egg donor, etc. An egg donor is thoroughly screened for diseases, which tend to pass either to recipients or to offspring. Detection of any such disease cancels the participation of women from the egg donation program. Medical experts thoroughly review all the screening test reports and also check through a complete physical exam.
An additional screening test is also performed in an anonymous egg donation process to assess the motive of an egg donor for participation in an egg donation program. Other factors like personality, educational background, the goal of life, hobbies of an egg donor are also thoroughly documented. Medical health professional evaluates all these aspects by assessing the written psychometric test performed by the egg donor. After evaluating all the screening tests, medical professionals explain ethical and psychosocial issues associated with egg donation to obtain the genuine informed consent from the egg donor.
Certain laboratory screening process including both HIV -1 and HIV-2, hepatitis B and C, rubella titer, sexually transmitted diseases, such as syphilis, gonorrhea, and chlamydia infections tests are performed. Human transmissible spongiform encephalopathy also tested. Experts also recommended the Zika virus test in case of an endemic condition or association with the higher risk condition.
The blood group detection of egg donors along with Rh status, blood cell count have also checked in screening tests of an egg donor. In some cases, the donor acts as a carrier of any heritable diseases. Medical experts also preformed genetic-carrier screening to avoid such conditions, so that the disease germ cannot pass through to the fetus. A cystic fibrosis (CF) mutation and spinal muscular atrophy tests are performed and negative test results can only pursue further.
Besides these, some screening tests are performed in the egg donation process based on the ethnicity of the donors. For example, Asian, African, and Mediterranean donors have a high incidence of sickle-cell trait and thalassemias. Hemoglobin electrophoresis test specially performed to avoid such health issues. Donors belong to Ashkenazi Jewish origin must evaluate some additional disease conditions including CF mutation, Tay-Sachs disease, familial dysautonomia, Canavan disease, Gaucher disease, etc. Donors belong to French Canadian descent also screen for CF mutation and Tay-Sachs disease. Some clinics also prefer to evaluate karyotyping and Fragile X premutation screening through additional genetic tests.
Screening tests for Recipient(s)
The screening tests for recipients are quite similar to routine IVF. A thorough medical evaluation is conducted by assessing the medical history of the recipient and her partner. The recipient has to undergo a physical examination and disclose detail gynecologic history to a medical professional. Blood group, Rh status, cytomegalovirus, and rubella virus detection tests are also performed. In certain cases, medical professionals also evaluate ovarian reserve. Hysterosalpingogram, sonohysterogram, or hysteroscopy are different available detection procedures that may be conducted to evaluate the uterine cavity of the recipient.
In the case of the recipient has exceeded 45 years of age, then additional tests are performed to evaluate the safety of the pregnancy. The cardiac dysfunction, gestational diabetes, and hypertension risks are higher with increasing age. An obstetrical specialist should explain the risk associated with increase age-related pregnancy.
Semen analysis, blood group and Rh status, and genetic-carrier screening tests have performed with a male partner for better pregnancy outcomes. Intended parents must be screened for hepatitis B and C, HIV-1 and HIV-2, syphilis, West Nile virus, and Zika virus.