The establishment of an ovum donation program using a simple fixed-dose estrogen-progesterone replacement regimen

Abstract

Most ovum donation (OD) programs involve cycle synchronization between recipient and donor for normally cycling recipients and a complex estrogen-progesterone replacement regimen for recipients with ovarian failure. In 1987, Serhal and Craft (1) suggested the use of a fixed-dose estrogen-progesterone regimen for recipients who were normally ovulatory and to those with ovarian failure. Following this protocol, and simplifying it still, the authors administered 6 mg estradiol valerate (E2) daily orally starting on day 2-6 of induced withdrawal bleeding, augmented with 100 mg progesterone in ethyl oleate (P) intramuscularly daily, starting any time between 4 days prior to and the day of oocyte pickup. All recipients underwent embryo transfer at a 2-pronuclei (2PN)-10-cell stage. A group of 21 patients underwent 26 treatment cycles, resulting in 16 pregnancies. Twelve of the patients gave birth, one to triplets, two to twins, and nine to singletons. Four patients miscarried in the first trimester of pregnancy.

The Impact of Endometrial Preparation on Implantation following Cryopreserved-Thawed-Embryo Transfer

“…Nevertheless, it requires close monitoring, carries a risk of ovarian hyperstimula tion syndrome, is sometimes inefficient and might even have a detrimental effect upon the endometrium-reduc ing uterine receptivity [2,3]. Artificial preparation of the endometrium by hormonal replacement has produced satisfactory pregnancy rates in recipients of donated ova [4], This method has led to a virtual elimination of the cancellation of ET cycles due to ovarian dysfunction and/ or the risk of ovarian hyperstimulation syndrome. It allows flexibility with exact planning, offering maximal convenience for both patients and the medical staff.…”

Surrogate Pregnancies in Patients With Mayer?rokitansky?kustner?hauser Syndrome and Severe Teratozoospermia

“…Surrogacy is a fairly new concept in South Africa and in our approach we were led by the guidelines set by the South African Law Commission [2]. The gestational carrier was sent for full psychological evaluation to establish her motives for surrogacy.…”

“…It was clearly established that the motive in this instance was humanistic. It was also stated that reasonable costs of the gestational carrier should be carried by the genetic parents as outlined by the Law Commission guidelines [2]. This, along with other relevant issues, were incorporated in the contract between the two parties.…”

“…Teratozoospermia in the husband as diagnosed by the Tygerberg strict criteria [3] complicated the case further. Success rates for GIFT procedures with sperm morphology below 14% (this case 6%) vary between 9% (metaphase I oocytes) and 15% (metaphase II oocytes) [2] compared to 33% success rate in normal morphology above 14%. In the first 2 cycles GIFT procedures were done and in all cases metaphase II oocytes were selected to maximize success rates.…”

Gestational Surrogacy

“…Most often, egg donation is utilized with infertile couples as a result of either ovarian failure or advanced age of the woman who has decreased odds of the ART procedure producing a successful outcome. [1][2][3][4][5][6][7][8][9][10][11] Reproductive failure can still persist in cases where gamete production is normal, but uterine function is either abnormal or absent. To treat these disorders, the use of surrogate gestational carriers has become a helpful clinical tool in assisting couples in having their genetic offspring when the female has no uterine function.…”