1. Egg Donation: Couple’s perspective Gad Lavy, M.D. New England Fertility Institute

2. NEFI Improved Success b Better Diagnostics: fewer cases of unexplained infertility. PCOSPCOS Ovulatory dysfunctionOvulatory dysfunction ImagingImaging Endometrial functionEndometrial function b Better Therapy: Higher overall success. SurgerySurgery Ovulation inductionOvulation induction IVF and related proceduresIVF and related procedures

3. NEFI In Vitro Fertilization

4. NEFI IVF b Intra-cytoplasmic Sperm injection (ICSI) b Assisted zona Hatching (AZH) b Day 4-5 transfer and improved culture media b Cryopreservation of embryos

5. NEFI ICSI Poor sperm quality Zona Pellucida hardening Poor egg-sperm interaction

6. NEFI Assisted Zona Hatching (AZH) Improved Implantation Zona Hardening

7. NEFI Improvements in culture conditions- Blastocyst transfer

8. NEFI PGD b Micromanipulation: remove a single blastomere from an 8-cell embryo without damaging the embryo b Genetic testing FISHFISH PCRPCR

9. NEFI PGD: Fluorescent In Situ Hybridization (FISH)

10. NEFI Age and Fertility

11. NEFI Age and IVF Success IVF success: Effect of age and number of eggs

12. NEFI The aging Ovary (and testicle) b Decreased Ovarian Reserve (DOR) Lower conception ratesLower conception rates Higher rates of pregnancy lossHigher rates of pregnancy loss Higher incidence of Congenital defectsHigher incidence of Congenital defects

13. NEFI Menopausal ovary The Aging Ovary Normal ovary  Fewer eggs  Decreased egg quality

14. NEFI Third Party Reproduction b Egg donation b Surrogacy Gestational carrierGestational carrier Traditional SurrogacyTraditional Surrogacy b Embryo donation

15. NEFI Egg Donation b Process: Involves In Vitro Fertilization b Indications: Who is a candidate b Ethical and Legal considerations

16. NEFI Egg Donation: Indications b Egg Donation Ovarian Failure.Ovarian Failure. Poor egg quality.Poor egg quality. Recurrent IVF failure.Recurrent IVF failure. Recurrent pregnancy lossRecurrent pregnancy loss Genetic defects precluding normal pregnancy.Genetic defects precluding normal pregnancy.

17. NEFI The Egg Donation Process-1 b The process involves IVF. b The resulting offspring will carry genetic material of the donor and the male partner.

18. NEFI The Egg Donation Process II b Donor and recipient cycles are synchronized. b Eggs taken from the donor after ovarian stimulation. b Eggs are fertilized with recipient partner’s sperm. b Embryos transferred to the uterus of a hormonally primed recipient.

19. NEFI Egg Donation: The Process III b Donor Synchronize cycle with recipientSynchronize cycle with recipient Ovarian stimulationOvarian stimulation Egg retrievalEgg retrieval b Recipient Synchronize cycle with donorSynchronize cycle with donor Preparation of the uterusPreparation of the uterus FertilizationFertilization Embryo transferEmbryo transfer

20. NEFI Egg Donation: The donors b Donor recruitment: Who are the donors? b Donor Screening: How are they tested? b Donor matching: How do I pick a donor?

21. NEFI Egg Donation - Screening b Donors b Consultation MD/RN interviewMD/RN interview b Psychological testing InterviewInterview Formal testingFormal testing b Blood tests Infectious diseaseInfectious disease Fertility potential: FSH follicle countFertility potential: FSH follicle count b Recipients b Consultation MDRN interviewMDRN interview b Psychological counseling b Blood tests b Evaluation of uterus Mock cycleMock cycle

22. NEFI Egg Donation: The recipient couple b Medical Screening The Mock cycleThe Mock cycle b Psychological issues b Legal Issues b Ethical concerns: Disclosure

23. NEFI Summary: TPR Egg Donor Embryo donor Gestational Carrier EggDonorDonor Fem ale Partner Sperm Male Partner Donor EmbryoMale/DonorDonor/Donor Female/Male partners

24. NEFI Egg Donation: Success b Number of embryos transferred. b Donor’s age and fertility history. b Recipient's age and history.

25. NEFI Third Party Reproduction NEFI b Gad Lavy, M.D.- Medical director b Angela Buzzeo FNPNurse Practitioner b Judy Calistro R.N.Nurse Manager b Ellen DeGennaro, R.N. Nurse b Sarah ClarkGenetic Counselor b Samantha Tartagila Coordinator/Administrator b Judy Kottick MSW: Counseling and Psych evaluation

26. NEFI TPR at NEFI: Locations b Stamford: 1275 Summer Street b Hamden: 9 Washington Avenue