Monday, 1 October 2018

EGG SHARING -DONOR

RECRUITMENT
Patients will be recruited through standard referral by their GP or Consultant, alternatively current patients can be recruited into the scheme if they fulfill the following criteria:

·        < 3 6 years
·        FSH < 8
·        Greater than 25 day cycle.
·        Completed donor screening
·        No previous evidence of poor ovarian response to stimulation with gonadotrophin drugs
·        Informed consent
·        Independent counselling
·        No genetic disorder or history of recurrent miscarriage
·        No evidence of adverse embryology in previous cycle (e.g. poor embryo or oocyte quality)

Each potential donor will receive the HFEA leaflets entitled "Egg Donation" and "Sperm and Egg Donors and the Law" plus our unit's information leaflet “Egg Sharing”.  Interested women will contact us for an appointment to discuss the programme in greater detail.

CONSULTATION
Ensure, at initial contact, that the woman is between 18-35 years old.  The woman should not have participated in more than 2 previous egg-sharing schemes.

On arrival, the woman is seen by the nurse co-coordinator who takes details of her name, date of birth, address, telephone numbers and the name and address of her G.P.

The woman then sees the clinician for a full consultation.

Please record her past obstetric and gynaecological history, whether she had any problem conceiving and if any children then are her children physically and mentally normal.

Ensure that there is no family or personal history of inheritable disorders, which could potentially be passed on to any offspring as a result of the donation.  Emphasise that it is illegal to donate eggs if such a history is known and that she may be sued for damages by the child if he or she is born handicapped as a result of deliberate misleading information.

Determine the woman's general health.  Make sure that there are no contraindications for the patient undergoing this treatment i.e. cardiac problems or hypertension etc.

Enquire if she is on any medication that she will need to stop during the treatment.

Discuss the need for HIV test plus other tests such as hepatitis B and C, plus other sexually transmitted disease tests.  Discuss the implications of any of those tests being positive.

Discuss fully the clinical aspects of egg donation i.e. the ovarian stimulation drugs used and their potential side effects, method of egg collection, anaesthetic used, in the same way as one would counsel ordinary IVF patients.  Emphasise the potential risks of OHSS and other complications.

Discuss fully the arrangements of the egg share scheme as follows:

Make the patients aware that arrangements must be agreed before either donor or recipient enters treatment cycle.

The arrangements should be signed in the relevant consent form.

Discuss the following principles:

·        For the purposes of this treatment an egg is defined as that structure judged to be an egg by the embryologist at the time of egg collection.
·        The donor will receive all the eggs if 7 or less eggs are collected.
·        The egg share arrangement will only be triggered if 8 or more eggs are produced.  In the event of less than eight eggs being produced all the eggs will go to the donor and the egg share arrangement will not proceed.
·        The recipient will bear the major part of the cost of the treatment.
·        The donor can cancel the arrangement up until the time of embryo transfer but if they do so they will be liable for the full cost of the treatment and any drugs used.
·        In the event of the donor receiving eggs and the recipient receiving none, the recipient will be allocated the next available donor cycle at no extra cost

Distribution of eggs

Number of oocytes
Destination.of oocytes

1 – 7
Donor
> 8
Split equally to donor and recipient with odd number eggs to the recipient.

Discuss what will happen if the recipient is left with no eggs? 
This unfortunately is a possibility.  In this case the    recipient will be offered the next available donor at no extra cost


Discuss how much treatment will cost?

a)        The donor will pay a reduced price for her IVF (£1000.00)
b)       The donor and recipient will pay for their own consultation fees.
c)        The recipient will pay at least the full cost of an egg donation cycle plus the cost of the screening required for the donor and counseling fees.
d)       If ICSI is required by either donor or recipient they will pay half the normal additional cost of ICSI.
e)        The donor will pay for the cost of drugs used after her egg collection unless supplied by her GP (~£30.00).
f)         The recipient will pay for all hormone drugs used to prepare the endometrium for embryo replacement and those drugs used to support the embryos after they are replaced in the uterus.
g)        If less than 8 eggs are produced the donor will pay the price quoted for the egg share arrangement.
h)       If the recipient withdraws at any stage, the recipient will pay the full cost of the drugs used by the donor.  No others fees will be levied.
i)          If the Donor withdraws from the egg share agreement then the donor will pay full treatment costs plus the costs of the drugs.
j)          If embryos are frozen for the recipient the normal freezing fee will be applicable. 
k)        If embryos are frozen for the Donor no fee will  be applicable.

Discuss the reduced possibility of having  embryos frozen.  As eggs are being shared there is a reduced chance of either donor or recipient having spare embryos to freeze.  If there are spare embryos of good enough quality from either donor or recipient, freezing will be offered in the normal way.

ANONYMITY
The donor will not, under any circumstances, be informed of the outcome of the recipient’s treatment.  The Donor  will also not be informed about fertilisation and embryo quality of the recipient’s cycle.

The Donor will always be seen by a different nurse co-ordinator to that of the Recipient.

COUNSELLING

Both the donor and recipient will receive independent counselling in addition to the implications information session and written information provided by the clinic.

Fill in a "Green Form" (91)4