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Donor Egg IVF
Gautam N Allahbadia, Rubina Merchant
SECTION ONE: HISTORICAL ASPECTS
CHAPTER 1:
Gametes and Embryo Donation: An Evolving Medical Contribution to Human Procreation
SUMMARY
INTRODUCTION
SECTION TWO: INDICATIONS
CHAPTER 2:
Can We Define the Indications for Oocyte Donation?
SUMMARY
RATIONALE
INTRODUCTION
CLINICAL DISCUSSION
Outcomes of Oocyte Donation in Women of Advanced Age
Outcomes of Oocyte Donation in Women with Premature Ovarian Failure
Outcomes of Oocyte Donation in Women with Genetic Disorders
Outcomes of Oocyte Donation in Poor Responders to Ovarian Stimulation
Comparison of Oocyte Donation Outcomes for Various Indications
Outcomes of Oocyte Donation following Postradiation Therapy
RECENT ADVANCES
CONCLUSION
CHAPTER 3:
Treatment of Ovarian Failure
SUMMARY
INTRODUCTION
LOW OVARIAN RESPONSE
Identification
Characterization
Cause
Assessment
CLINICAL DISCUSSION
Management
Natural Cycle
High Doses of Gonadotropins
Luteal Initiation of FSH
Flare-up GnRH Agonist Protocols
Luteal Initiation of GnRH Agonist Protocols
GnRH Antagonist Protocols
Adjunctive Use of Growth Hormone
Adjunctive Use of Glucocorticosteroids (Dexamethasone)
Adjunctive Use of Nitric Oxide Donors (L-arginine)
Pretreatment with Oral Contraceptive Pills
Routine Use of ICSI
Assisted Hatching of the Zona Pellucida
CONCLUSION
CHAPTER 4:
Is Donor Egg IVF a Rational Treatment for Genetic Disorders?
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Indications for Donor Egg IVF/ICSI
Premature Ovarian Failure (POF)
Sex Chromosome Aneuploidies—Turner's Syndrome
Carriers of Genetically Transmissible Diseases
Preimplantation Genetic Diagnosis (PGD) in Assisted Conception
The Effects of PGD on Pregnancy
Risk Associated with Assisted Reproductive Techniques (ART)
Counseling1
CONCLUSION
CHAPTER 5:
Reversing the Natural Decline in Human Fertility with Oocyte Donation to Women of Advanced Reproductive Age
SUMMARY
INTRODUCTION
Age and Fertility
The Advent of Oocyte Donation
CLINICAL DISCUSSION
Oocyte Donation in Women of Advanced Reproductive Age
Practical Issues
Ethical Issues
CONCLUSION
SECTION THREE: FACTORS DEFINING SUCCESS
CHAPTER 6:
Do Recipient Age and Infertility Diagnosis Affect Pregnancy and Implantation Rates in a Donor Egg IVF Program?
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Effect of Recipient Age on Success Rates in Egg Donation
Effect of Infertility Diagnosis on Success Rates in Egg Donation
CONCLUSION
FREQUENTLY ASKED QUESTIONS
CHAPTER 7:
Donor Age is Paramount to Success in Oocyte Donation
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Ovarian Response
Fertilization of Donated Oocytes
Embryo Quality
Implantation Rate
Pregnancy Rate
Miscarriage Rate
Can We Estimate the Age from which the Risk is too High?
CONCLUSION
FREQUENTLY ASKED QUESTIONS
CHAPTER 8:
Importance of Transfer and Uterine Factors in a Donor Egg IVF Program
SUMMARY
INTRODUCTION
Indications for Egg Donation
Success Rates in Egg Donation Cycles
CLINICAL DISCUSSION
Influence of Uterine Factors on Embryo Implantation
Window for Implantation
Steroid Hormones
Embryo Apposition and Attachment
Immune System in the Endometrium
Chemokines
Endometrial Preparation for Embryo Implantation
Synchronization of the Donor and Recipient's Cycle
Monitoring Endometrial Proliferation
Impact of Supraphysiological Levels of Estrogen
Implantation Markers
Impact of Pelvic Pathology
Endometriosis
Genitourinary Chlamydial Infection
Salpingectomy or Bipolar Proximal Tubal Occlusion
Fibroids
Endometrial Polyps (Fig. 8.13)
Uterine Malformations (Figs 8.15 and 8.16)
Systemic Problems
Turner's Syndrome
Antisperm Antibodies
Aspirin
Influence of Cancer Therapy on the Genital Tract
Impact of Radiotherapy
Cranial Irradiation
Impact of Chemotherapy
Influence of Embryo Transfer on the Outcome of Egg Donation
Pre-transfer Evaluation
Aseptic Technique
Cervical Mucus
Position for Transfer
Tight Internal Os
Uterine Contractions
Localization of Transfer Site
Confirmation of Transfer
Volume of Air
Injection Speed
Catheter Type
Mock Transfer
Role of Ultrasound
Full Bladder and Mobilization
Difficult Transfers
CONCLUSION
CHAPTER 9:
Do Hydrosalpinges Adversely Affect Implantation in Donor Oocyte Cycles?
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Impact of Hydrosalpinges on Fertility
Mechanism of Action in Infertility
Diagnosis
Significance in Donor Oocyte Cycles
Management
CONCLUSION
CHAPTER 10:
The Effect of Prior Gravidity on the Outcomes of Egg Donation
SUMMARY
INTRODUCTION
EFFECT OF GRAVIDITY
Effect of Aging on the Human Ovary
Our Experience
When Adjusted for Age, there were no Significant Differences
Clinical Discussion
CONCLUSION
CHAPTER 11:
Factors that Determine Discordant Outcomes from Shared Oocytes
SUMMARY
RATIONALE
INTRODUCTION
PATIENTS AND METHODS
RESULTS
CLINICAL DISCUSSION
RECENT ADVANCES
CONCLUSION
CHAPTER 12:
Blastocyst Culture and Transfer in Oocyte Donation
SUMMARY
INTRODUCTION
RATIONALE
CLINICAL DISCUSSION
CONCLUSION
CHAPTER 13:
Endometriosis and Oocyte Donation
SUMMARY
INTRODUCTION
Endometriosis
Endometriosis and Fertility
Endometriosis and IVF
Oocyte and Embryo Quality
Implantation
CLINICAL DISCUSSION
Endometriosis and IVF
Endometriosis and Oocyte Donation
CONCLUSION
CHAPTER 14:
The Best Donor
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
The Age Factor
Age of the Donor
Age of the Recipient
Gravidity and Parity
Infertility Diagnosis
Body Mass Index (BMI)
Repeated Cycles
Synchronization Protocols
The Embryo Transfer Policy
CONCLUSION
CHAPTER 15:
Clinical Factors Interfering with Endometrial Receptivity
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION AND CASE STUDIES
Oocyte Recipient's Age
Body Mass Index (BMI)
Endometrial Preparation Parameters
Endometrial Thickness
Estradiol Levels in Blood
Duration of Endometrial Preparation
Endometrial Preparation Protocol
Estrogen and Progesterone Administration
Progesterone Administration
Pituitary Suppression for Endometrial Preparation
Cigarette Smoking
Hydrosalpinx
Endometriosis
Adenomyosis
CONCLUSION
SECTION FOUR: OOCYTE SHARING PROGRAMS
CHAPTER 16:
The Shared Donor Oocyte Program: Advantages and Insights (Egg Recipients Sharing Oocytes from Single Donor)
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
The Effect of Oocyte Sharing from a Paid Anonymous Donor on Pregnancy Outcome
Sharing Oocytes Between an Infertile Donor and Recipients
Effect of Infertility Etiology of Donor on Subsequent Recipient Outcome
Age of Infertile Donor
The Effect of Sharing of Oocytes on the Pregnancy Outcome of the Infertile Oocyte Donors
The Use of the Shared Infertile Donor Oocyte System to Determine Etiologic Infertility Factors
Male
Progesterone Levels and Infertility
Other Infertility Facts Ascertained from the Shared Infertile Donor Oocyte Recipient Program
CONCLUSION
CHAPTER 17:
Egg Recipients Sharing Oocytes from Patients Undergoing IVF
SUMMARY
INTRODUCTION
Sources of Eggs
CLINICAL DISCUSSION
Advantages of Egg-sharing
Concerns Raised by Egg-sharing
Choice of the Egg Donor
EGG DONATION IN INDIA
Egg-Sharing in India
Our Experience with Egg-sharing
Counseling
Methods
Stimulation Protocol for the Egg-sharers and Standard IVF Patients
Hormone Replacement Protocol for Recipients
Results
Bias During the Allocation of Oocytes
Fewer Eggs Retrieved
Ovarian Hyperstimulation Syndrome and Egg-sharing
Does Sharing make the Treatment more Affordable?
Egg-sharing and Altruism
CONCLUSION
CHAPTER 18:
Does Egg Sharing Compromise the Chances of Donors or Recipients Achieving a Livebirth?
SUMMARY
INTRODUCTION
The Egg Sharing Scheme and UK National Health Service
The Ethics of ‘Egg Giving’
Proven Advantages and Benefits of Egg Shared Treatment
Women Who Share Eggs Have the Same Chance of Conceiving
CLINICAL DISCUSSION
Donor/Shared Egg Program
Criteria for Acceptance into the Egg Share Donor Scheme
Counseling
The Treatment Program
Downregulation and Stimulation
The Egg Collection
Cancellation of Treatment
Fertilization
Embryo Transfer
Side Effects
Legal Parents
Why has Donor Anonymity been Removed?
The Effect of Donor Anonymity on the Future Availability of Donors
Attitudes of Egg Sharing, Egg Donors and Recipients in UK
CONCLUSION
ACKNOWLEDGEMENTS
SECTION FIVE: FINANCIAL CONSIDERATIONS
CHAPTER 19:
Social and Financial Aspects of Egg-sharing versus Professional Egg Donation in a Donor Egg IVF Program
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
CONCLUSION
CHAPTER 20:
Eggs for Sale: How Much is too Much?
SUMMARY
RATIONALE
INTRODUCTION
CLINICAL DISCUSSION
The Nature of the Egg: Altruistic Gift or Free Market Good
The Donated Egg: Setting a Price
The Altruistic Donation
Fixed Fee vs. Variable Reimbursement
Risks of Inadequate Reimbursement
Risks of Excessive Reimbursement
Medical Tourism
Regulation: Global vs. Local
Concerns for the Child
CASE STUDIES
Case 1
Case 2
Case 3
Case 4
Case 5
Case 6
Case 7
RECENT ADVANCES
CONCLUSION
CHAPTER 21:
Subsidized IVF: Egg-sharing as a Source of Donor Eggs
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Egg Donation and Egg Sharing
Egg Sharing – The Research Evidence
Ethical and Psychosocial Issues
CONCLUSION
ACKNOWLEDGEMENTS
FREQUENTLY ASKED QUESTIONS
SECTION SIX: DONOR SCREENING
CHAPTER 22:
Oocyte Donor Screening: The Selection Process and Cost Analysis
SUMMARY
RATIONALE
INTRODUCTION
Indications for Oocyte Donation
Why Select Donors?
Donor Screening
Medical Screening
Genetic Screening
Psychological Screening
Partner Screening
Recipient Screening
The Cost Analysis
Screening Costs
Egg sharing
CLINICAL DISCUSSION
The Selection Process
The Cost Analysis
The Role of Egg Sharing
The Donor Egg IVF Program at Rotunda–The Center for Human Reproduction
Inclusion Criteria
Screening Tests
RECENT ADVANCES
CONCLUSION
CHAPTER 23:
Genetic Screening of Prospective Oocyte Donors
SUMMARY
RATIONALE
INTRODUCTION
Historical Perspective
Laws and Guidelines
CLINICAL DISCUSSION
Ethical and Legal Considerations
RECENT ADVANCES AND FUTURE TRENDS
CONCLUSION
FREQUENTLY ASKED QUESTIONS
CHAPTER 24:
Should Donor Egg IVF Programs Accept PCOS Women as Donors?
SUMMARY
INTRODUCTION
Response to Controlled Ovarian Stimulation
Quality of Oocytes
Genetic Aspects of PCOS
Risk to the Donor
Clinical Discussion
CONCLUSION
SECTION SEVEN: POTENTIAL DONORS
CHAPTER 25:
Family Members as Gamete Donors and Surrogates
SUMMARY
RATIONALE
INTRODUCTION
Types of Familial Ovum Donation and Surrogacy Arrangements
Intragenerational
Intergenerational
Reasons for Choosing Family Members
Analogy to Organ and Tissue Donations
CLINICAL DISCUSSION
Our Experience
Issues
Undue Pressure and Autonomous Decision-Making
Risks to the Gamete Donor and Surrogate
Risks to the Offspring
Social Issues
Secrecy and Openness
Attitude Towards and Acceptability of Family Members as Gamete Donors or Surrogates
Counseling
CONCLUSION
ACKNOWLEDGMENTS
CHAPTER 26:
Sisters of Women with Premature Ovarian Failure may not be Ideal Ovum Donors
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Case Studies
RECENT ADVANCES
CONCLUSION
CHAPTER 27:
Should Nonpatient Volunteers Donate Eggs?
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
CONCLUSION
SECTION EIGHT: ASSESSING ENDOMETRIAL RECEPTIVITY
CHAPTER 28:
Endometrial Receptivity in Oocyte Donation Cycles
SUMMARY
INTRODUCTION
Clinical Evidence for the Importance of Endometrial Quality in Oocyte Donation Programs
Molecular and Morphological Markers for Endometrial Receptivity
Endometrial Receptivity
Markers of Endometrial Receptivity
CLINICAL DISCUSSION
Endometrial Preparation for Oocyte Donation: Clinical and Biological Perspective
CONCLUSION
CHAPTER 29:
Color and Power Doppler for Assessing Endometrial Receptivity
SUMMARY
RATIONALE
INTRODUCTION
CLINICAL DISCUSSION
CONCLUSION
CHAPTER 30:
Endometrial TB-PCR: Transcription-mediated Amplification or Histopathology for Endometrial Evaluation in Donor Egg IVF?
SUMMARY
INTRODUCTION
Clinical Discussion
Incidence of Tuberculosis
Screening Methods
CONCLUSION
SECTION NINE: ENDOMETRIAL PREPARATION
CHAPTER 31:
Preparation of the Endometrium for Egg Donation
SUMMARY
RATIONALE
INTRODUCTION
Regimens for Endometrial Preparation
Factors Influencing Success
CLINICAL DISCUSSION
Estrogen Supplementation
Routes of Hormone Administration
Oral vs Vaginal E2 Administration
Oral vs Transdermal E2 Administration
Progesterone Supplementation
Routes of Hormone Administration
Vaginal Micronized Progesterone vs. Oral Dydrogesterone
Vaginal Micronized Progesterone vs. Intramuscular (IM) Progesterone Injection
Progesterone Vaginal Gel (Crinone 8%) vs. Intramuscular (IM) Progesterone Injection
Progesterone Vaginal Ring vs Progesterone Vaginal Gel
Vaginal Progesterone Capsules (Utrogest 200) vs Progesterone gel (Crinone 8%)
Timing and Duration of Hormone Administration
Adjuvant Therapy
The Role of Preparatory Cycles
RECENT ADVANCES
CONCLUSION
CHAPTER 32:
Long Estradiol Replacement in an Oocyte Donation Program
SUMMARY
INTRODUCTION
Women without Ovarian Function
Primary Ovarian Failure
Premature Ovarian Failure
Menopause
Women with Ovarian Function
Genetic Anomalies
Recurrent IVF Failure
Women Older than 40 Years with Normal Menstruation
Recurrent Miscarriage
Eggs Donors
CLINICAL DISCUSSION
Hormone Therapy for the Recipient
Endometrial Preparation
Hormone Therapy in the Instituto Valenciano de Infertilidad (IVI)
Bleeding and Wait for Egg Donation
Egg Donation Program Outcome
Obstetric Outcome
Oocyte Retrieval in Donors
Ovarian Downregulation
Administration of Estradiol
Risk Factors for Bleeding during Hormone Therapy
Embryo Implantation
Early Pregnancy Loss
Number of Treatment Cycles
CONCLUSION
CHAPTER 33:
Vaginal Progesterone Gel Preparation in a Donor Oocyte Program
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Why is Progesterone Needed?
The Cycle Prior to Embryo Transfer
Estrogen Replacement in the Recipient
Initiation of Progesterone Supplementation in the Recipient (Stage 1)
What Type of Progestin is the Best?
Route of Progesterone Supplementation
CONCLUSION
SECTION TEN: STIMULATION PROTOCOLS FOR OOCYTE DONORS
CHAPTER 34:
Role of GnRH Analog Depot Preparations in Donor Egg IVF
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Recipients with Retained Ovarian Function
NATURAL MONITORED CYCLE
CLINICAL DISCUSSION
Cryopreservation of Donated Embryos
Suppression of Ovarian Function
Our Experience
CONCLUSION
CHAPTER 35:
Long Protocol is the Gold Standard for Ovarian Stimulation of Egg Donors
SUMMARY
RATIONALE
INTRODUCTION
CLINICAL DISCUSSION
The GnRH Agonist
The Flare-up Protocol
Depot vs. Daily Administration of GnRH Agonist
The GnRH Agonist as an Ovulation Trigger
Premature Luteinization
The GnRH Antagonist
The Agonist vs. Antagonist
RECENT ADVANCES
CONCLUSION
CHAPTER 36:
Timing of Placental Competence in Ovum Donation
SUMMARY
INTRODUCTION
Luteoplacental Shift
Present Practice
CLINICAL DISCUSSION
CONCLUSION
SECTION ELEVEN: ULTRASOUND
CHAPTER 37:
Role of TVS in Assessing Endometrial and Ovarian Morphology in a Donor Egg IVF Program: Imaging Aspects–A Perspective
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Etiology of POF
Treatment
Role of 3-D US in Monitoring Treatment Outcome
Role of Color Doppler in Monitoring Treatment Outcome
Role of 3-D Power Doppler Sonography in Monitoring Treatment Outcome
Recipient Endometrial Preparation
CONCLUSION
CHAPTER 38:
Upper Genital Tract Screening with Hysterosonography in Patients Receiving Donated Oocytes
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
CASE STUDIES
RECENT ADVANCES
CONCLUSION
SECTION TWELVE: SURROGACY
CHAPTER 39:
Surrogacy: Ethical, Psychological and Legal Implications
SUMMARY
RATIONALE
INTRODUCTION
Indications for Surrogacy
Types of Surrogacy
CLINICAL DISCUSSION
Ethical and Psychological Issues
Familial Surrogacy
Attitudes and Outcomes of Surrogacy
Surrogacy and Exploitation
Surrogacy and the Law
United States of America (USA)
United Kingdom (UK)
Australia
Europe
Ireland
Canada
Israel
India
FUTURE PROSPECTIVES
CONCLUSION
CHAPTER 40:
Gestational Surrogacy
SUMMARY
INTRODUCTION
History
Types of Surrogacy
CLINICAL DISCUSSION
Gestational Surrogacy
Indications for Gestational Surrogacy
Overview of the Surrogacy Process
What are the Success Rates for Gestational Surrogacy?
Surrogacy and the Law
ICMR Guidelines
Ethical Considerations
Use of Family Members as Surrogates
What are the Costs for the Surrogacy Procedures?
CONCLUSION
SECTION THIRTEEN: ENDOSCOPY
CHAPTER 41:
Role of Hysteroscopy in a Donor Egg IVF Program
SUMMARY
INTRODUCTION
CASE STUDIES
CLINICAL DISCUSSION
RECENT ADVANCES
CONCLUSION
SECTION FOURTEEN: COUNSELING
CHAPTER 42:
Counseling Recipients in a Donor Egg IVF Program
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Infertility—A Disastrous Event?
Empathy, Does it Help?
Grief
Support Group
Donor
Disclosure
Ethics and Egg Donation
CONCLUSION
FREQUENTLY ASKED QUESTIONS
CHAPTER 43:
Potential Psychological Attachments Formed by Egg Donors Involved in Fertility Technology
SUMMARY
INTRODUCTION
Attachment Theory
CLINICAL DISCUSSION
Egg Donors
The Recipient
Disclosure
CONCLUSION
SECTION FIFTEEN: ETHICS AND RELIGION
CHAPTER 44:
Ethical and Religious Considerations in Third Party Reproduction
SUMMARY
RATIONALE
INTRODUCTION
CLINICAL DISCUSSION
Ethical Issues
Donor Insemination
Egg Donation
Familial Egg Donation
Commodification
Egg-sharing
Cross Border Donation
Financial Compensation for Embryonic Stem Cell Research
Postmenopausal Motherhood
Embryo Donation
Related Issues
Surrogacy
Disclosure of Donor Identities
Outcomes for Offspring
Role of Counseling
Religious Considerations
Judaisim
Christianity
Islam
FUTURE PROSPECTIVES
CONCLUSION
SECTION SIXTEEN: OBSTETRICS AND PERINATAL OUTCOMES
CHAPTER 45:
Factors Influencing the Obstetric and Perinatal Outcomes after Oocyte Donation
SUMMARY
INTRODUCTION
Pregnancy Rates with Oocyte Donation
Factors Affecting the Achievement of Pregnancy
Age of the Donor
Age of the Recipient
Parity of the Donor
Number of Embryos Transferred
CLINICAL DISCUSSION
Obstetric Implications of Oocyte Donation Pregnancies
Spontaneous Abortion
First Trimester Bleeding
Second Trimester Bleeding
Pregnancy Induced Hypertension (PIH)
Gestational Diabetes Mellitus (GDM)
Operative Deliveries
Preterm Delivery
Multiple Pregnancies
Promoting Obstetric Well-being
RECENT ADVANCES AND CONCLUSION
CHAPTER 46:
Pregnancy Results and Obstetric Outcomes in Patients 45 Years and Older
SUMMARY
INTRODUCTION
SUBJECTS AND METHODS
Family History and Support
Exclusions
Replacement Protocol
Donors
Recipient Donor Synchronization
IVF and Embryo Transfer
RESULTS
CLINICAL DISCUSSION
CONCLUSION
SECTION SEVENTEEN: LONG-TERM FOLLOW-UP
CHAPTER 47:
Health and Development of Donor Egg IVF Children Compared to IVF Children
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Health and Development of IVF Children
Health and Development of Donor Egg IVF Children
Disclosure
CONCLUSION
SECTION EIGHTEEN: LEGISLATION AND GUIDELINES
CHAPTER 48:
Donor Egg IVF: Its Regulation in India
SUMMARY
RATIONALE
INTRODUCTION
Situation in India So Far
CASE STUDIES
Case 1
Case 2
Case 3
Case 4
CLINICAL DISCUSSION
The Indian Regulatory Framework
The Egg Donor
The Sperm Donor
Semen Banks
The Surrogate Mother
Restrictions (Prohibited Scenarios)
Sex Selection
General Considerations
Other Relevant Considerations
Unresolved Issues
CONCLUSION
ACKNOWLEDGMENT
CHAPTER 49:
Egg Sharing and Policy Making
SUMMARY
RATIONALE
INTRODUCTION
Background
Alternatives to Egg-sharing
Concerns About Patient Autonomy
Concerns about Commodification
CLINICAL DISCUSSION
The Regulatory Framework in the UK
Egg Sharing Arrangements
Question of Information
Donor Anonymity
FUTURE DEVELOPMENTS
CONCLUSION
CHAPTER 50:
Oocyte Donation: The Legislative Framework in Western Europe
SUMMARY
RATIONALE
INTRODUCTION
The EU Tissues and Cells Directive
Why do European Member States Continue to have their Own Laws?
Reproductive Tourism
UK Legislation
CLINICAL DISCUSSION
The HFEA and Oocyte Donation
Consent
Further Legal Considerations
Welfare of the Child
Confidentiality
Screening of Oocyte Donors
Selection of Oocyte Donors
The Number of Families that may be Created Using Oocytes from a Donor
Cross-border Transport of Oocytes
Anonymity
HFEA and Anonymity
Known Unrelated Donors
Known Related Donors
Payment to Donors
Argument for Payment
Argument Against Payment
Payment to Oocyte Donors in the UK and Europe
Egg-sharing
Egg Giving
European Legal Case Studies
Case 1
Case 2
Case 3
CONCLUSION
ACKNOWLEDGMENTS
FREQUENTLY ASKED QUESTIONS
SECTION NINETEEN: WHAT'S NEW?
CHAPTER 51:
Oocyte Donation to Human Immunodeficiency Virus-1 Serodiscordant Couples
SUMMARY
INTRODUCTION
Ethical Considerations
Autonomy
Beneficence
CLINICAL DISCUSSION
Justice
Assisted Reproduction to Prevent Horizontal Infection
Assisted Reproduction in Cases of Infertility
HIV and Infertility
Oocyte Donation
CONCLUSION
CHAPTER 52:
Turner's Syndrome and Oocyte Donation
SUMMARY
RATIONALE
INTRODUCTION
Spontaneous Pregnancy in the Turner's Adult
CLINICAL DISCUSSION
Oocyte Donation
The Donor Egg IVF Cycle
Outcomes from Oocyte Donation in Turner's Adult
Risks of Pregnancy
Long-term Follow-up
CONCLUSION
FREQUENTLY ASKED QUESTIONS
APPENDIX
Rationale
1. Cardiovascular Disease
Congenital Heart Disease
Aortic Dissection
Hypertension
Hyperlipidemia
2. Insulin Resistance
3. Hypothyroidism
4. Osteoporosis
5. Renal Disorders
6. Gastrointestinal Disease
7. Hepatic Disease
8. Hearing
Summary
First Visit to the Gynecologist
Subsequent Visits to the Gynecologist (Every 2 years)
CHAPTER 53:
Cross Border or Reproductive Tourism with Special Emphasis on Donor Oocytes
SUMMARY
INTRODUCTION
Worldwide Incidence
CLINICAL DISCUSSION
OUR EXPERIENCE
RECENT ADVANCES
CONCLUSION
SECTION TWENTY: EPILOGUE
CHAPTER 54:
The Internet and Donor Egg IVF
SUMMARY
RATIONALE
INTRODUCTION
CLINICAL DISCUSSION
RECENT ADVANCES
CONCLUSION
FREQUENTLY ASKED QUESTIONS
CHAPTER 55:
Egg Donor: Once Upon a Time—What Will You Tell Them?
SUMMARY
RATIONALE
INTRODUCTION
CLINICAL DISCUSSION
To Disclose or Not Disclose
Reactions to Disclosure
Disadvantages of Nondisclosure
Disclosing
How and When to Tell?
Help in Storytelling
A Tiny Itsy Bitsy Gift of Life
CONCLUSION
RECOMMENDED READING
FREQUENTLY ASKED QUESTIONS
CHAPTER 56:
Risks of Oocyte Donation
SUMMARY
INTRODUCTION
CLINICAL DISCUSSION
Risks to the Donor (Mainly in Case of Nonpatient Donation)
Risks of COH
Risks of the Surgical Procedure for Ovum Pick-up (OPU)
Potential Risk of Cancer
Effect on Future Fertility and Ovarian Function
Risks Specific to Egg Sharers
Lower Success Rate in the Donor (Egg-sharers)
Stronger Stimulation
Risks to the Recipient
Risks of High Dose Estrogens given to Older Patients
Risks of Death during Pregnancy and Delivery in Older Patients
Special Risks of Turner's Syndrome
Pregnancy Complications
Risks for the Baby
Premature Delivery (PD)
Genetic Problems
Psychological Considerations
Risks for the Doctor
CONCLUSION
INDEX
TOC
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