Although there might be a slight variance from clinic to clinic, in general, the donor egg process is as follows:

• Select a donor.

Complete medical screening for the recipient, the spouse of the recipient and the donor:

• Psychological: This typically includes a PAI for the egg donor, a psychological examination for the donor. A psycho-educational session for the recipient couple, individually and jointly. If the donor is a known or directed egg donor a meeting, or a session with the donor and the recipients to talk about possible continuing contact or registration with a donor sibling registry.

• Physical - includes semen analysis, blood work to test the donor and the recipient for infection and sexually transmitted diseases, hysterosalpingogram (HSG), for the recipient to allow the doctor to view the uterine lining to detect uterine polyps or other defects which could affect implantation or pregnancy, "mock transfer" to determine the best type and size of catheter for the embryo transfer, etc.

• Some clinics require a "mock cycle" for the recipient, where the recipient takes medications (generally Lupron, followed by Estrace and then progesterone), followed by ultrasounds and blood work to ensure that the medication is effective and the uterine lining is appropriate to support a pregnancy.

• Coordinate cycles of donor and recipient. For pre-menopausal recipients this is accomplished by both the recipient and the donor taking medications such as Lupron (shots), Synarel (nasal spray), and/or birth control pills. For recipients past menopause only the donor will be down-regulated using Lupron or Synarel.

• Some clinics prescribe antibiotics for the donor, recipient and recipient's spouse early in the cycle (often a 10-day treatment) in order to treat any undiagnosed infections that may exist.

• Once both the donor and the recipient are down-regulated the recipient begins to take estrogen supplements in some form - either oral, patches or shots. The dosage may be adjusted based on blood tests (measuring E2 levels) and ultrasounds measuring the uterine lining.

• While the recipient is taking estrogen supplements to build a thick uterine lining the donor begins her fertility medications. These medications are often taken for 8-10 days. Her progress is measured through blood work and ultrasounds.

• The date of the egg retrieval will be determined based on the size of the donor's follicles, as measured by ultrasounds. At the appropriate time she will be given a trigger shot of hCG, and the retrieval is generally performed approximately 33-35 hours thereafter.

• On the date of the retrieval the recipient's partner will provide a semen sample. Or donor semen will be provided. The semen is processed, and the sperm added to the eggs that same day. In some cases ICSI will be performed (a process where a single sperm is injected into each egg).

• The day after retrieval the lab will provide a fertilization report. The embryos remain in the laboratory until the date of the transfer, which can be between two and five days after the retrieval date. Periodic progress reports are provided to the recipient to keep her informed about number, size and quality of embryos.

• On or just before the date of the donor's egg retrieval the recipient will begin taking progesterone supplements available as injections, vaginal gel, vaginal or rectal suppositories, or administered in oral form. • Based on embryo quality and other factors the recipient couple determines how many embryos to transfer to the recipient's uterus. The rest may be frozen at that time or kept in the laboratory for several more days before freezing. Often clinics will freeze only high quality embryos.

• Some clinics will prescribe a steroid (often medrol or prednisone) and another round of antibiotics for the recipient to take for several days preceding the embryo transfer.

• The embryo transfer is performed either at a hospital or in the clinic's office. The embryos are placed into a catheter and transferred through the cervix into the uterus of the recipient under ultrasound guidance. Some clinics prescribe valium for the recipient to take prior to embryo transfer, although the procedure is generally not any more painful than a pap smear or insemination.

• Following the embryo transfer the recipient will remain in the hospital clinic for 30 minutes to several hours, depending on the clinic's protocol. The recipient then remains on bed rest for several hours to several days, depending on the clinic's protocol.

• Several restrictions may be imposed for the period between transfer and the pregnancy test, including limitations on exercise, heavy lifting (over ten pounds), sex, caffeine, etc. Again, this varies from clinic to clinic. • A blood pregnancy test may be performed 9-14 days from a day 3 embryo transfer (or sooner for a day 5 transfer). The hCG level in the blood is measured; if the test is positive it is repeated two days later. hCG levels should double every 48-72 hours.

• If the repeat beta test double like it should the patient is then scheduled for an ultrasound at the five or six week mark of pregnancy to date and measure the pregnancy. The patient continues to take progesterone and estrogen supplements as directed by her physician, often until the end of week 10 or 12 of pregnancy.