Evaluation Of The Egg Donor
All donors, both anonymous and known, should be screened according to the most recent guidelines recommended by the ASRM. Donors should have attained their state’s age of legal majority and preferably should be between the ages of 21 and 34. The rationale for the lower age limit is to ensure that the donor is mature enough to provide true informed consent. The rationale for the age of less than 34 is that younger women typically respond favorably to ovulation induction, produce more eggs and high-quality embryos with high implantation, and have subsequent higher pregnancy rates than older women. If the donor is over the age of 34, recipients should be informed as to the cytogenetic risk of having a child with a chromosomal abnormality such as Down syndrome and the impact of donor age on pregnancy rates.
Both anonymous and known donors should complete an extensive medical questionnaire that details their personal and family medical history. Included in this questionnaire should be a detailed sexual history, substance abuse history, history of family disease, and psychological history. In the United States, the Food and Drug Administration (FDA) requires that all egg donors be screened for risk factors for, and clinical evidence of, communicable infections and diseases. A donor is ineligible if either screening or testing indicates the presence of a risk factor for, or clinical evidence of, a communicable infection or disease. For anonymous donors, the questionnaire should assess the donor’s motivation for donating her eggs and provide insight into the donor personality, her hobbies, educational background, and life goals. This document ultimately will be shared with the recipient and provides her with insight into a donor she will never meet. A medical professional reviews this history with the donor and conducts a comprehensive physical examination.
Generally, each donor completes a written psychometric test prior to meeting with a mental health professional (MHP). In addition to reviewing the psychometric test, the MHP has the opportunity to further evaluate the donor, discuss the many complex ethical and psychosocial issues she may encounter, and confirm the donor truly is able to provide informed consent for egg donation.
The laboratory testing of all donors should include screening and testing for syphilis, hepatitis B and C, human immunodeficiency virus (HIV)-1 and HIV-2, Neisseria gonorrhoeae, and Chlamydia trachomatis, as well as screening for human transmissible spongiform encephalopathy and testing when risk factors for it exist. All infectious-disease testing must be done and noted to be negative within 30 days before egg donation. Donors also should have documentation of their blood type and Rh status, complete blood count, and rubella titer. Genetic screening of donors should be based on ethnicity. All donors should be tested for the presence of a cystic fibrosis (CF) mutation. Donors of Asian, African, and Mediterranean descent should undergo a hemoglobin electrophoresis as a screen for sickle cell trait and thalassemias. If the donor is of Ashkenazi Jewish origin, CF mutation analysis and screening for Tay-Sachs disease, Canavan disease, familial dysautonomia, Gaucher disease, and other genetic diseases is indicated. Donors who are of French Canadian descent should be screened for CF as well as Tay-Sachs disease. Additional genetic testing and karyotyping of the donor is not required but may be offered by individual programs as part of their standard procedure or upon the request of the recipient couple.