You’ve Matched with an Egg Donor for a Fresh Cycle: Here are the 5 Steps to Embryo Creation

Here are the 5 Steps:

1. Completing Your Egg Donor’s Medical Screening & Final Clearance
2. Sperm & Uterine Evaluations prior to Embryo Creation
3. Financial Clearance & Legal Contracts
4. Egg Donor’s Ovarian Stimulation Cycle & Egg Retrieval
5. Fertilization and PGT Testing

Step 1: Completing Your Egg Donor’s Medical Screening & Final Clearance:

Depending on the level of screening your ideal Egg Donor has already completed, the most critical step is to assess where she currently resides in her medical approval process.

If you are working with an in-house egg donor program, and/or a repeat donor, she may have undertaken all the preliminary screening necessary to give her the green light, potentially shortening the timeline from initial match to embryo creation.

However, there may be some additional testing required before the donor is approved. This screening is essential to ensure the donor’s suitability for the procedure. It typically involves a comprehensive evaluation process including, but not limited to, the following tests:

• Psychological assessment
• Genetic carrier screening & genetic risk review with a genetic counselor
• Drug & nicotine toxicology analysis
• Physical examination
• Ultrasound of ovaries & uterus
• Routine blood tests including infectious panel

Lastly, examining the genetic carrier screening outcomes of your egg donor and sperm provider(s) is another essential factor to help ensure compatibility. Your fertility clinic and a genetic counselor will serve as valuable resources in this process.

Assuming everything is normal, the donor is considered “officially medically cleared” and is ready to proceed with treatment!

Step 2: Sperm & Uterine Evaluations prior to Embryo Creation:

Either in advance of, or following, your fertility clinic’s donor approval, you also have a series of tests and evaluations of your own to complete.

From the embryo transfer side of things, regardless of whether you plan to carry the baby, or are working with a Gestational Carrier, a thorough uterine evaluation will be required in preparation for the culmination of your treatment. Each clinic has their own protocol for assessing the uterine health and lining development. However, this will be done in advance and as part of your approval to proceed with next steps.

At some point, relatively early in your journey, your fertility clinic will make arrangements for a semen analysis and perhaps cryopreserve the sperm for storage purposes.

There are a few options for completing this step. Firstly, you can opt to test and freeze a sample in advance of the donor’s egg retrieval. This allows for greater flexibility in timing and guarantees the sperm is readily available for when needed. In those cases where you are unable to travel to your clinic in person, they can even assist with the shipping of frozen sperm to ensure everything goes smoothly. Alternatively, you can choose to produce a fresh sample on the day of the egg retrieval, but there is no difference in fresh vs/frozen sperm so it might be nice to “take the pressure off” by completing this in advance.

If a gestational carrier is involved in your journey, infectious disease blood work and an FDA physical exam will also be executed in conjunction with your frozen sample, or in advance of your blood work.

It should go without saying that uterine evaluations and sperm testing are performed along with a battery of other medical diagnostics, such as genetic carrier screening, psychological assessments, family health history analysis to make certain all is good to proceed.

In a follow-up article, we will dive deeper into IP and GC screening for a greater understanding.

Step 3: Financial Clearance & Legal Contracts:

Financial clearance, on the part of your fertility clinic, authorizes you to proceed to the next phase of your upcoming cycle. Once you have the green light that your cycle is paid in full, legal contracts are often initiated.

Regardless of whether you are working with an in-house program or an egg donor agency, these contracts are an important component of the process. Agreements, between Intended Parents & Egg Donor, are typically drafted by attorneys who specialize in reproductive law and outline the rights and responsibilities of all parties involved, presently and going forward. These documents are separate from medical consents that are also signed by patients, both the IPs & egg donors, on behalf of the fertility clinic.

The timeline for this step can vary from a few weeks to a few months, depending upon the legal requirements and stipulations of everyone involved, but most are considered “standard agreements” that may vary slightly to moderately from case to case. However, there are some instances where contracts may be waived as per your fertility clinic's procedures, for example: de-identified arrangements.

Step 4: Egg Donor’s Ovarian Stimulation Cycle & Egg Retrieval:

Now you’re getting close to the really exciting part – the donor’s egg retrieval! While the overall preparation for an egg donor cycle may take months (and your entire journey to this point may span the course of years), the average length of time the donor is on stimulation medication ranges from about 10-14 days. Your clinic’s nurse or coordinator will work with the egg donor to schedule her cycle dates, so in turn they may be able to provide you with estimations on the cycle timeframe. However, it’s important to note that each case can vary depending upon the donor and the clinic.

Prior to starting stimulation medications, the egg donor may be placed on birth control pills to suppress any possibility of ovulation (amounting to loss of eggs). Once ready to start the cycle, most egg donors will take a combination of medications to grow and develop the resting follicles, which will become eggs. The donor is monitored through a series of ultrasounds (to measure the growth of her follicles) and blood work (to measure the hormone levels in her system) every few days.

While the specific type of stimulation medication prescribed depends upon the doctor’s protocol, and your donor’s response – you will typically hear the following names (or have seen them on your pharmacy receipt on behalf of your donor): Gonal-F and Follistim are given as daily injections to stimulate the ovaries and help multiple follicles grown. Alongside these medications, you may also hear about Menopur which also supports the maturation of the eggs. And to prevent eggs from being released too early, she may be using Ganirelix or Cetrotide also.

36 hours prior to scheduled egg retrieval, your donor will give herself the final injection known as a “trigger shot” as the last step in maturing follicles. By carefully orchestrating this process, these medications ensure that eggs are collected when they are mature and ready for fertilization.

Step 5: Fertilization and PGT Testing:

Once the eggs are retrieved, it’s time for fertilization. If you are electing to conduct PGT (pre-implantation genetic testing), as soon as fertilization takes place and the embryo starts cell multiplication.

Your embryology lab will typically inform you about the fertilization process of the day after the eggs are fertilized. This is considered “Day 1”, with the day of retrieval labeled “Day 0.” The fertilized embryos will be cultured for five to seven days, allowing cells to divide and develop.

If PGT is in the plan, a biopsy will be performed on the embryos during this time, and samples sent for testing to determine the chromosomal health of the embryos. Additionally, for those Intended Parents that wish to know the sex of the embryos, PGT reveals which embryos are male and which embryos are female based upon the analysis. The final results of PGT generally take one to two weeks before you learn which embryos are considered “normal” and appropriate for transfer.

In an upcoming post, we will explore embryo development and PGT testing in greater detail.

There you have it! A step-by-step overview of the events that follow the matching of an egg donor for a fresh cycle. Each stair along this journey is important and brings you closer to your dream of building your family. While there may be twists and turns in the road, it’s important to stay positive, communicate openly with your fertility clinic, and take care of yourselves throughout the process. We wish you the best of luck and great success on your path to parenthood!

Jenna Lake

Jenna Lake is co-founder of EDC Nexus, a unique registry developed to support Intended Parents, Egg Donors and Donor-Conceived Offspring — identified or de-identified — through a private online database providing medical updates and a mode of communication.

First and foremost, Jenna is the proud mother to a teenage, egg donor-conceived son. Her journey through third party reproduction directly launched a 15+ year career overseeing one of the largest clinic-led egg donor programs in the United States. After matching more than 3,000 cycles, and witnessing the ever-increasing demand for donor-conceived families to connect with their genetic and biological stories (and donors to stay informed of their contribution), Jenna helped to create a secure means of exchanging vital information and ensuring greater peace-of-mind on many fronts.

Currently, Jenna also serves as Operations Manager at Egg Donor Connect. She is a past board member of Parents via Egg Donation, former consultant for a surrogate agency, and the author of several articles focusing on Egg Donors and Intended Parents. Jenna can be reached through her LinkedIn profile, or via email at jenna@eggdonorconnect.com or coordinators@edcnexus.com.

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