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Egg donation – when is the time to consider it?

Greet Lammens, MD
Gynecologist & Obstetrician at IMER, IMER Instituto de Medicina Reproductiva

Category:
Donor Eggs

When to consider egg donation?
From this video you will find out:
  • about the difference between premature ovarian failure (POF) and primary ovarian insufficiency (POI)
  • risks of an advanced maternal age
  • hereditary disorders
  • multiple miscarries
  • repeated IVF/ICSI failures
 

Egg donation – when is the time to consider it?

When shall I consider egg donation?

Dr Greet Lammens from IMER Valencia, Spain, talks about when it is the best time to consider egg donation and when egg donation treatment is recommended to IVF patients by doctors. Women are born with a finitude number of eggs and the number declines with age as does egg quality, especially after 35. Some women in their late thirties and many in their 40s might need to use egg donation. Women who have already tried IVF without success or women with multiple miscarriages might find this option helpful. Some young women may have fewer eggs and greatly diminished ovarian function related to early ovarian failure or as a result of chemotherapy or ovarian surgery, therefore, donor eggs may be their only option for becoming a mother. Egg donation treatment may also be used by same-sex male couples or single males. Finally, certain rare genetic conditions that may be inherited may call for using donor eggs. When is it time to think of egg donation? Until you are in your mid-30s and you have a regular cycle, there is a 75% chance of a live birth with your own eggs, when that doesn’t happen, you go to a fertility clinic and hopefully with ovulation induction, intrauterine insemination or IVF cycle, you can achieve a live birth using your own eggs. However, if an IVF cycle does not end in a live birth or from the beginning, you know you will need egg donation, at that point, you come to a crossroads. You need to decide what you’re going to do. Egg donation gives you a 50% chance of a live birth per cycle. 3 main causes can lead you to decide to go through egg donation if you want to become a parent. If you do not have any eggs anymore, or your own eggs are deficient, or there is a maternal hereditary disorder, or the fertility road you went down has failed.

Premature Ovarian Failure (POF) = Primary Ovarian Insufficiency(POI)

There can be 2 main reasons for not viable eggs. The first is the condition called Premature Ovarian Failure (POF), also called Primary Ovarian Insufficiency(POI), or you are of advanced maternal age. POI or POF means that the ovaries stop functioning before you turn 40, your estrogen levels go down, and there is no regular ovulation, a woman becomes subfertile. Primary ovarian insufficiency is the main reason for egg donation development in the past. The first birth after egg donation was in 1983-84, which means that the oldest children born from egg donation are now in their late 30s. Premature ovarian failure happens when a woman has irregular or skipped periods, is experiencing hot flashes, night sweats, vagina dryness, dry eyes, irritability, or difficulty concentrating or has a decreased sexual desire. There are some reasons behind this condition, a woman can suffer from Turner syndrome or Fragile X syndrome, where she has no ovaries or bad working ovaries there or has been exposed to toxins that are known to damage the ovaries badly, if there was chemotherapy or radiation in the past, like leukaemia or breast cancer, these chemotherapy radiations are common causes of a toxin-induced ovarian failure, these therapies can damage the genetic material in the cells, cigarette smoking, exposure to chemicals, pesticides, and viruses might hasten ovarian failure. There could also be an autoimmune disease, the immune system produces antibodies against your ovarian tissue harming the egg-containing follicles and damning the egg, what triggers the immune response is not clear, but exposure to a virus is one possibility. In 70% of women confronted with a primary ovarian insufficiency, no cause has been found. The risk of premature ovarian failure increases between the ages 35 and 40, but there are also patients under 30 with primary ovarian insufficiency, when there is a family history of a sister or a mother with primary ovarian insufficiency, a woman’s risk increases as well. Sometimes, ovarian surgery is needed, for example, to treat endometriosis, which can also increase the chance of POI.

Advanced maternal age

A more frequent reason for deficiency of own eggs is advanced maternal age. At IMER, 75% of egg donation patients are older than 40 years old. The fertility decline is similar in all women, in some women, the decline goes quicker than the others. A woman’s fertility peaks in the early and mid-20s, after which it starts to decline. Until your mid-20s, the chances of getting pregnant is 75% within a year, it’s 50 to 40% when you are 40, but it’s only 2% when you’re 43, and it declines very quickly. It’s also important that being pregnant over 40 increases the risk of miscarriage, it’s 35%, in younger patients, it’s 15%, and the miscarriage rate rises to 53% by the age of 45. There are also risks of pregnancy complications, like high blood pressure and gestational diabetes, these risks increase after 35 and continue to rise in your 40s. There is a risk of genetic problems, at 40, your chance of conceiving a child with Down’s syndrome is 1 in 100. At 45, it’s 1 in 30. Another reason is when there is a maternal hereditary disorder. Usually, a woman knows she has a hereditary disorder, so she will not try to conceive spontaneously. Therefore, an IVF/ICSI procedure with PGT might be an option in some cases, depending on the law and the regulations in each country. Hereditary disorders are passed down from parents to their children, women may carry an incurable genetic disease that they do not wish to pass to their future children, such as Thalassemia, Cystic Fibrosis, Tay-Sachs disease, and so on. At IMER, there is a possibility to compare the blood of the donor with the blood of the partner or the sperm donor to see if they could be the carrier of one of the more than 330 diseases that can be detected and that patients can be a carrier. This test can diminish the risk of a child with a disorder.

Egg donation – decision

Before deciding whether to go ahead with egg donation treatment, it’s important to remember about counselling, which could be a very important factor to help you in your decision. The alternative to egg donation is ending the fertility journey, it’s one of the most important decisions you can face in assisted reproduction. Before taking this step, you have to ask yourself this question is egg acceptance good for me and good for us, which challenges are there to face once the child is born, the egg donation implies acceptance, it’s an alternative form of parenthood, it’s an alternative to adoption or foster care. It’s a process that starts before conception grows along with the child that will be born out of it and goes further many years after that egg donation implies acceptance. In Spain, egg donation is anonymous, so before you decide to have treatment there, it is important to consider the future and how your partner and your child will feel about not knowing the true identity of your child. You will receive only the necessary information about the egg donor. However, it’s also important to remember that with sophisticated gene testing and many online ancestries and genetic websites, nowadays, full anonymity cannot be guaranteed. There are now at least 4 big databases that invite people all over the world to send their genetic samples so they can find out if, somewhere in the world, there could be somebody genetically linked to them. 21 million people have done it by now, and in 2 years, it is expected to be 30 million. In Spain, all egg donors are young women between 18 and 30 years old, they must undergo an exhaustive medical, genetic and psychological screening to confirm their good emotional and physical condition, fertility potential and the absence of infectious and hereditary diseases. The selection and matching of the donor are, by law, the exclusive competence of the medical team must ensure the highest possible compatibility of physical and immunological characteristics between the donor and recipient donors.

When shall I consider egg donation? - Questions and Answers

I was advised by another doctor to try ImMap and/or ErMap test before moving to egg donation. Could you tell us more about how helpful those tests are? I was never advised it at my current clinic although I have a history of many failed IVF attempts. 

It sometimes depends on your history. If you have had several embryo transfers without becoming pregnant, it is a possibility to try. We call these tests differently but do these tests to define if the moment when we transfer an embryo is in the right implantation window or not. That is possible with us. It is dependent on the details of your medical history.

I am looking at possibly using an egg donor, but she’s already booked for her next cycle with another intended parent so how soon should we ideally use an egg donor after her last retrieval for best quality and number of eggs. 

In our clinic, it is the donor department in combination with a medical team who defines which donor is appropriate for a patient. When it comes to synchronizing a donor with a recipient, we seldom do that because it gives a lot of stress for the recipient and the results are not so good.

Do you have any experience about the use of Mesenchymal stem cell for ovarian rejuvenation? I mean to establish ovarian reserve? 

The treatments we do and the tests we perform on patients are all tests that are evidence-based and that give the patients a proven better chance for a pregnancy and we do not have any experience with the use of Mesenchymal stem cells for ovarian rejuvenation.

My NK cells have been checked by the immunologist. Results are above the norm, I was advised to do intralipids or immunoglobulin vaccines after a few failed attempts. My IVF doctor suggested quitting those therapies because the cost is quite high because they are not proved to help. How about egg donation with high NK cells? What is your attitude towards this problem and these immunological therapies?

There are a lot of additional treatments along with egg donations, and one of them is intralipid immunoglobulins vaccines. We do not do that. There is not enough evidence that it will make your chances better or greater to conceive.

You said you don’t work with synchronized cycles, so you probably do the most of the cycles from frozen oocytes. What about success rate when using frozen eggs. Are they really on a similar level as from fresh oocytes?

In the beginning, when I joined the clinic I asked that question as well. And I have seen all the figures. Indeed, that way we have a great possibility to match a donor and a recipient because we have a lot of eggs frozen from donors. We do that because the pregnancy rate and the live birth rate is as good as with freshly fertilized eggs these days.

Are there any transfers are done at Imer clinic or this point or everything has been postponed until further notice as well?

Since the middle of March, the transfers that were scheduled after mid-March have been cancelled. The embryos are frozen, so nothing happens with them. They can be frozen for a longer time if needed. At the moment I am working from home, as are my colleagues. A lot of our work is not only seeing patients at a clinic but as well as making treatment plans, filing results the patients are sending, and we are now busy. We are contacting every single patient, and my assistant is scheduling telephone calls, and I have to speak with more than 50 patients one by one, asking how they are, how they are doing, if they are healthy or not, or if they have any questions. We are now waiting what the Spanish government will say about the measures when there is ease down and in what form and also the people in their own countries are subject to the lockdown. In general, the measures everywhere are the same, but there are also other problems. The airlines have to fly so from the moment when we can travel more freely then we will contact each and every one of our patients to inform them that they can begin treatment. I have a lot of video conferences with possible new patients who have a lot of questions. As we always do when somebody is interested in the treatment, we all always offer them a free conversation with me or by videoconference or I often go to Holland and in Belgium in person so that I can listen to their story, listen to their questions and answer them as well as possible. They have time to consider their choices as it is a difficult decision whether to go for an egg donation or to stop your fertility journey.

What is the average number of transfers to achieve pregnancy from a donation?

When we look at our numbers, we see that independent of the age of the patient, of the recipients. When we look at the patients who become pregnant after the first transfer of one embryo, and then the group of patients who are pregnant after the second embryo transfer, we see in our clinic a pregnancy rate of 75%. And in each case, I’m always talking about a single embryo transfer. When we understand that every pregnancy has a risk of 15% of a miscarriage, that means that in 60% of those cases a healthy child is born.

My family advises me to wait with fertility treatments until the vaccine for COVID19 is discovered. I wish to start ASAP after the lockdown is finished. What is your opinion on this? I am 38.

First of all, before answering that question I want to emphasize that any questions I will get on my email address that is through IVF media are very welcome after this webinar, and I will try to answer them to my the best knowledge and to my experience. Now we know about several coronaviruses such as influenza that they do not harm a child in the womb of a mother. You can even have a vaccine for influenza when you’re pregnant. Whether you’re two months pregnant or 6 months pregnant. About COVID 19 we do not know that and as nobody knows. We do not know when there will be a vaccine. I do hope that it will be sooner than later. You are thirty-eight. It’s an age when you’re already in a declining part of fertility. It depends how we all behave shortly if that if it will be a society where we keep our distance when we walk around with masks on. I cannot say exactly you should do this or you can’t do that. I think you can wait a bit longer until we know if the COVID/coronavirus harms the baby in the womb or not.
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Authors
Greet Lammens, MD

Greet Lammens, MD

Dr Greet Lammens is a Doctor in Medicine, Surgery and Obstetrics. She grew up in Flanders, the Netherlands, where she could develop her expertise and passion for reproductive medicine. Dr. Lammens has been a Fertility specialist at IMER Instituto de Medicina Reproductiva. Valencia 2017. She is fluent in Dutch, English, French, German and Spanish.
Event Moderator
Caroline Kulczycka

Caroline Kulczycka

Caroline Kulczycka is managing MyIVFAnswers.com and has been hosting IVFWEBINARS dedicated to patients struggling with infertility since 2020. She's highly motivated and believes that educating patients so that they can make informed decisions is essential in their IVF journey. In the past, she has been working as an International Patient Coordinator, where she was helping and directing patients on their right path. She also worked in the tourism industry, and dealt with international customers on a daily basis, including working abroad. In her free time, you’ll find her travelling, biking, learning new things, or spending time outdoors.
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