Oocyte donation is fundamentally different from other assisted reproductive technologies in that it has a precedent in the animal world. Embryo donation, resulting from artificial insemination of the donor and subsequent recovery of the fertilized embryo from the uterus of the donor, has been practiced by veterinarians for many years. This method was initially attempted as a way of accomplishing oocyte donation in humans. The donor monitored her ovulation in a spontaneous ovulatory cycle, then was inseminated with the sperm of the infertile woman’s husband at the time of ovulation. Approximately 5 days later, the uterus was lavaged and if a conceptus was retrieved, it was transferred to the uterus of the recipient. This method resulted in the first livebirth after oocyte donation in the United States in 1983, shortly after the world’s first birth achieved in Australia in 1982. However, uterine lavage proved to be very inefficient and attempts at ovarian stimulation of donors were unsuccessful in increasing the number of embryos retrieved. Furthermore, concerns about infectious disease transmission and potential retained pregnancy in the donor caused the abandonment of this process.

At its inception, IVF utilized laparoscopy for oocyte retrieval. Whereas laparoscopy was less traumatic than laparotomy, it nevertheless required general anesthesia and an operating room environment, and was prohibitively complex for utilization on oocyte donors. Therefore, early attempts at oocyte donation via IVF typically used excess oocytes donated by infertile women themselves undergoing IVF. When embryo cryopreservation became a reality, IVF patients now had the option of preserving their own embryos for future use and “excess oocytes” were no longer available. The development of the transvaginal ultrasound-guided method for follicle aspiration dramatically changed IVF and made oocyte donation a reality. Oocytes could now be retrieved under conscious sedation in an office setting and donors could now be recruited explicitly for the purpose of donating all their oocytes to a potential recipient.

All recipients at the beginning were women with premature ovarian failure or those with genetic diseases who did not wish to pass them along to their offspring. As experience grew, it became apparent that the pregnancy rate after oocyte donation was not influenced by the age of the recipient. Thus, it became clear that oocyte donation could be used to circumvent the age-related decline in fertility. Oocyte donation then became the treatment of choice for women in their mid-40s and for those who failed standard IVF.

Oocyte donors may be anonymous or known and in many instances may be female relatives of the infertile patient. Since pregnancy rates are related to the age of the oocyte provider, the ideal age for oocyte donors is between 21 and 35. Older donors may be utilized but pregnancy rates are lower.

Donors are screened for infectious diseases according to FDA regulations with a questionnaire and serum testing. Their reproductive potential is assessed with a day 3 follicle-stimulating hormone measurement and an antral follicle count by ultrasound. They need to be carefully counseled regarding the psychologic and emotional ramifications of donating their gametes, and should receive informed consent information regarding the physical risks of the procedure. Fortunately, there are very few risks associated with controlled ovarian hyperstimulation and follicle aspiration (see Chapter 103), and these are thought to be even less among young healthy oocyte donors.

Oocyte donation is achieved with what is essentially a cycle of IVF, which is divided into two portions: the donor undergoes controlled ovarian hyperstimulation and follicle aspiration, and the recipient undergoes embryo transfer. Ovarian hyperstimulation in oocyte donors utilizes standard regimens and medications. Because the donors are generally good responders, lower doses of gonadotropins are utilized. There is a risk of ovarian hyperstimulation syndrome (OHSS) associated with the good response to stimulation and careful monitoring of donors is required. Fortunately, since the donors do not became pregnant after the procedure, cases of OHSS tend to be mild and self-limited.