Egg donation – all you need to know before you go abroad

Veronica Legidos Lopez, MD
Gynecologist at IVI Clinic Alicante, IVI Clinic Alicante

From this video you will find out:

How long is the procedure?
With an egg donation treatment, are we avoiding all the inherited diseases?
Can I perform an egg donation treatment without any hormonal treatment?
Fresh eggs or frozen eggs, have they the same results?
It is no easy to travel for me, can we Schedule the donation in a fixed week?

Egg donation – all you need to know before you go abroad

What should I know about egg donation before I fly abroad?

In this video, Dr Veronica Legidos Lopez, Gynaecologist at IVI Clinic, Alicante, has answered patients’ questions about the egg donation process abroad. Dr Lopez started by explaining that many times the egg donation treatment is the only option for some couples to achieve pregnancy or the easiest option as sometimes it is very hard to have a successful IVF outcome with own eggs. It’s important to mention that egg donation treatment has the highest pregnancy rate in all clinics worldwide. Although the success rates can vary from clinic to clinic, it’s more or less 65% within 1 attempt. The first step is to be sure that the egg donation is for you, the psychological aspect is very important and it is always a difficult decision. Once the couple decides to move forward with egg donation, the process itself is easy. First, the donor is matched with the recipient according to the physical characteristics, the blood group is also matched with the recipient or male partner. There is no waiting time. All egg donors are thoroughly screened to make sure they are healthy, Karyotype is checked, and blood test is also performed to rule out infectious diseases such as HIV, hepatitis B, hepatitis C, gonorrhoea and chlamydia. Dr Lopez mentioned that at IVI clinic, they always guarantee 8 oocytes from the egg donor, but most of the time more eggs are retrieved, and two day 5 embryos (blastocyst stage) are also guaranteed. When the eggs are collected, they are fertilized with the partner’s sperm or donor sperm, after they are fertilized, we wait until the embryos are developed till day 5 and then the best ones are selected. The top-quality embryo is selected and transferred to the recipient’s uterus. Any surplus embryos are frozen and can be used for another IVF attempt and another child, or in case, it doesn’t work the first time, for the second attempt. When the donor is matched, the next step is performing an ovarian stimulation for the egg donor and the recipient is prepared for the embryo transfer. Nowadays, single embryo transfer is recommended in most cases as multiple embryo transfer increase the chance of twin pregnancy, which can result in complications for the mother and future child. The last thing that Dr Lopez added was that it is crucial to do a personalized treatment to each patient and provide all necessary details before starting the treatment.

What should I know about egg donation before I fly abroad? - Questions and Answers

How long is the egg donation IVF procedure?

In general, the procedure of egg donation lasts about 1.5- 2 months, and this is the time we need to have everything done from the beginning (the recipient’s first menstruation) to the embryo transfer.

With an egg donation treatment, are we avoiding all the inherited diseases?

This is a very good and frequent question patients ask because with egg donation treatment we avoid probability of chromosomal abnormalities that is increasing in women who are over 38 years old. Our donors are between 18 and 35 years old. In those ages the probability of chromosomal abnormalities is very low, so we are avoiding passing Down or Turner syndromes, and other the most important syndromes that are related to maternal age. But we are not avoiding all inherited diseases because there are thousands of them. We avoid the most common syndromes, and there is an optional test that we can perform, the genetic compatibility test. When we select donors, we look into mutations as about 18% of population can have mutations in their genes. If there is a coincidence and the mutation is in the egg and the same mutation is in the sperm, we have a risk of a newborn with an inherited disease. So we can filter our donors to select the donor who will be compatible with a male partner. So, we can select the donor who does not have the same mutation as a male partner. We study 550 genes related to inherited diseases, but not all inherited disease can be avoided.

Can I perform an egg donation treatment without any hormonal treatment?

Yes, we can do it, but only in some cases, e.g. when a woman has regular natural cycles. If a woman does not have regular cycles, we cannot do a natural treatment.

Fresh or frozen eggs? Do they have the same result?

We have two options, and both have the same pregnancy rates and results. It does not matter whether we use fresh or frozen eggs, because donors are young, and the eggs quality is very good. The only nuance is the survival rate for frozen eggs. 95% of eggs survive correctly. So if we take 10 eggs, we can lose maximum one egg in the thawing procedure, and it is very low. For international patients it’s easier to have treatment with frozen eggs because we have more flexibility to plan the trip and treatment, and a couple have more time to decide when they want to visit the clinic.

It is not easy for me to travel. Can we schedule the donation in the fixed week?

Yes, of course. We have holidays in the 1st week of August, We can plan everything 2 months before to perform the embryo transfer. But we need to start 2 months earlier, e.g. you want to have the transfer in September, so we have to start in July – treatment, synchronization, the schedule of embryo transfer.

How do you try to get a match in terms of interest and education?

This is a very common question. We select donors according to physical characteristics, blood group and maximum similarity to patients. It is very difficult to select regarding interests and education, because only a few topics related to interests are associated with genetics. Spanish law says nothing about it, so we select only according to physical characteristics. We ask patients to provide their pictures to see all characteristics, and we use our database to select the best match. In terms of education it’s very difficult to select, also because the majority of our donors are students

Do you transfer 2 embryos in older women to increase chances?

No, it’s the opposite. The maternal age is not important, as we use high quality eggs, so the chances are the same in case of women who are 35 or 42. We do not transfer 2 embryos in older women, we transfer one. Only if a couple wants to transfer 2, then we perform that. Transferring one embryo, our pregnancy rate is 55%. With 2 embryos, the pregnancy rate is 70%, but we increase the complications at the same time. So we also see that the chances of complications are high in women who are over 40- 42 years old. It’s contradicted to transfer two embryos in women over 44, and our medical team does not recommend transferring 2 embryos, but we can do it when a woman is young.

I am in London and after attending a webinar with IVI London we learned that IVI London can liaise with an IVF clinic in Spain. How would payment for that work? Can I pay the Spanish payment package or would it be paid as you go?

We have a clinic in London, and patients from London also visit Alicante, and all clinics do the same, but the law is different. Patients need to go there to perform the egg donation because in their countries egg donation is not allowed. IVI London works with us, so you can prepare everything in London, but you need to visit Spain for the embryo transfer. The patient only prepares in their country, then comes to the clinic in Spain for the embryo transfer or provides us material to fertilize eggs. IVF with egg donation takes maximum 6 days in Alicante. The payment depends on where you undergo the treatment. However I cannot answer this question in detail, as I am not responsible for the administration.

Do you have a clinic in France?

No, we do not have a clinic in France. We have the clinic in London, Rome, and several clinics in Spain.

If you are synchronizing the donor and the recipient, that means you only work in fresh cycles?

If we work in fresh cycles, we need to synchronize the donor and recipient. If we are using frozen eggs, we use the treatment to synchronize the days according to the preferences of patients. But we do not always use fresh cycles. Both treatments have the same results.

If we accept the risk of twins (or, in fact, prefer twins), would it be possible to request 2 embryos to be transferred?

Yes, of course. But only in situations when a woman does not have any complications, any chronic illnesses or pathologies, and is young.

Which clinic in London do you work with?

We work with IVI clinic in London. But if you want to go to other clinics because you have insurance there, or your gynecologist works in it, we can do all the treatment there. You do not need to do scans in IVI London, we can work with all clinics and gynecologists that help us perform scans. You only need 2 (max 3) scans during the procedure and one blood test to understand if you are prepared.

How do you look after recipient if they are travelling from abroad?

After the transfer, the patient can fly and they do not need to rest. Patients cannot make any efforts or exercise during three days after the transfer. If patients want to go home at the same day of embryo transfer, they can fly. Once they are in their home country, patients can do a pregnancy (blood) test ten days after the transfer, and send their results by email or by phone. Later they need to do the scan to check whether everything is OK. We are waiting for this information to give recommendations on what they need to do when women are pregnant. We are waiting to first scan to control everything, and the patients need to visit their hospital or gynecologist to do pregnancy check-ups. But we are always in contact with our patients, we do not stop our contact after the embryo transfer and keep in touch during the pregnancy.

Would you require fibroids to be removed (multiple but intramural) and endometriosis to be treated?

If endometriosis is not symptomatic, we do not need to treat it. Endometriosis needs to be treated only when a woman experiences pain every day or majority of days during her cycle, but not because of egg donation. Referring to fibroids, it depends on quantity, their size, and location. If fibroids are inside the uterus, they need to be removed. If they are intramural, it depends on the size. We recommend removing if they are more than 4 cm to improve results. We also need to make scans to understand the situation. Some fibroids can be removed, and some do not need to be removed to start egg donation. But initially, if fibroids are over 5 cm, it’s always recommended to remove to improve results.

Can we request the age bracket of our donor?

All our donors are between 18 and 34 years old, and a majority of them are aged 18-29. We select donors according to the physical characteristics, medical background and reproductive history, their history as a couple. All eggs are high quality.

If you are struggling to find a good match in terms of physical characteristics do you just go with the closest match or is there a benchmark that needs to be met? Do you need to wait for a closer match?

Nowadays, we do not have a waiting list because we have a bank and our donors are waiting to be stimulated. We can begin in a very short time. Physical characteristics are sometimes unique, e.g. here in Spain we do not have many donors of Chinese origin, and we have to wait for a closer match. But in general, if a patient is Caucasian (lives in Europe), we have enough donors to select from and find the best match. Here, in Alicante, we have donors from all over the world. In case of unique characteristic, if a patient needs a very close match, they need to wait.

Do you have black donors available?

Yes, we have black donors.

Can you specify a nationality of donor?

We are not allowed to reveal the nationality, because donation is anonymous. We can give you the form that tells about the physical characteristics, but we cannot mention the nationality.

How do donors benefit from donating their eggs? Do they get paid or is it purely altruistic?

The most of them are altruistic, because donation in Spain is very common. Some of them are young mothers who want to help others. We can also compensate them because women need to visit the clinic several times to have some tests done, take medications for the stimulation. They also take a day off to visit the clinic, to pass psychological and blood tests, scans, so they get the compensation.

Are donors matched for anything other than appearance? Do you do a basic personality test? Height or other characteristics?

Yes, we match according to the height, but we don’t match according to the weight. Like I mentioned before, we do not do personality tests. According to Spanish law it is not allowed.

What is the best guarantee for a 44 y/o with donor eggs: 8 mature eggs, or 2 blastocysts, or 4 embryos. I have a few small fibroids.

We usually get more than 8 eggs and more than 2 embryos. The number of blastocysts is important. When a woman is over 40, it’s likely she will need egg donation as the quality of eggs is decreasing. When a woman is 44, the recommended treatment is egg donation because it is very difficult to achieve pregnancy with own eggs. When transferring one blastocyst, 35% of our patients get pregnant. If we think about the accumulated, there are more protocols and probability is high. About 70% of patients get pregnant with two attempts. But it is not related to the age, here good quality of eggs are important as they are from young donors.

When do you think that donors in Spain will become non anonymous?

I don’t know, I think it will always be anonymous and any changes are not being considered now. It depends on a government and other cases. If the donation will be allowed to be non anonymous in the future, it will be all the time then. If you used anonymous egg donation, then donors cannot know whether their eggs were used, and patients and children cannot know who their donors are. And they cannot contact in the future.

What clinic in the UK do you work with? Do you have many donors with blond hair and blue eyes?

Yes, we have many. We select donors to have a lot of characteristics, as we have many patients from the UK, Ireland or Denmark, who usually have blond hair and blue eyes.

If the transfer is unsuccessful, when can you try again?

Egg donation treatment is a long process and usually takes about 2 months. But if we speak about frozen eggs, the process is very quick, we only need to wait for the next period. Unfortunately, when egg donation unsuccessful, then we wait for the menstruation, and three weeks after we can do another transfer of frozen eggs. If everything is normal in the control scans, during the second attempt we use frozen embryos, so it’s only three weeks from the menstruation.

What is your intake on the mock cycle? I was advised to do so to see how well the endometrial lining respond due to small fibroids.

We can sometimes do a mock cycle, although it’s not too often. In case of menopause it’s difficult to grow the lining, so we need to do a mock cycle to see whether the uterus is prepared accordingly. Because of fibroids, when the lining is very thin, we cannot see if fibroids will affect the embryo transfer. When we do a mock cycle, preparing the uterus is the same as for embryo transfer- you take hormones and drugs to prepare the lining. When the lining has a good thickness, we can see and decide if we need to remove fibroids. If they are very small, fibroids do not need to be removed, and when they are inside the lining, fibroids need to be removed. So, this is the only way to see the lining.

What do you consider when you say “pregnancy rate”? “Live births”

When we talk about pregnancy rate we mean positive pregnancy test, the lab test to know whether or not you are pregnant. Live birth is another rate, in egg donation it is very high because the probability of miscarriages is very low. But the live birth rate is lower than the pregnancy rate, and is around 45%.

I’m 32 and also got PCOS, so I was reassured that only minimal stimulation would be used. What are the chances of OHSS and how does it affect my health?

A woman who has PCOS has a good ovarian reserve and does not need egg donation, so we mean stimulation of own eggs here. We usually use the minimal stimulation because we do not need to use a high dose of hormones and medication, when a woman has a good ovarian reserve. PCOS is very specific condition because the response is sometimes very high or low to the stimulation. This pathology of the ovaries is very difficult to manage, and the risk of hype stimulation syndrome is, but we can avoid it as we do scans and blood tests during the stimulation to control the risk. When the ovaries respond high, to avoid hyperstimulation syndrome, we fertilize eggs and freeze embryos for another cycle as we need to wait when ovaries and levels of hormones return to normal. We wait one month till the next period to perform the embryo transfer and let ovaries return to normal. Nowadays, it’s very unlikely to have hyperstimulation and visit the hospital, that happened 20 years ago, we control levels of hormones during the cycle and know whether we risk.

How do you test all donors on COVID-19? Do you accept donors if they have positive results (antibodies)?

We are not talking about COVID-19, as the situation is improving. Since the pandemic, we test all donors, we test antibodies before they start stimulation. If they are positive, they cannot donate. A few days before when we know exactly when egg donation will take place, we perform PCR test to see whether they are positive or negative. If PCR is negative, we can proceed with egg donation, if the result is positive, we do not start the process. You need to know that COVID is not transmitted by eggs. There is no scientific evidence that coronavirus is transmitted by eggs.

I am 47 and worried that I do not fall pregnant with natural plan. Worried my uterus will not have the correct thickness to hold embryo with receiving hormonal drugs. Can you advise?

In a natural cycle when a woman has regular periods, the lining is well prepared. We control everything with scans, if the thickness of lining is not correct, we do not proceed with egg donation or embryo transfer. The uterus needs to have a good lining (7.5 mm), there is no difference if that is a natural cycle or with hormonal treatment, and the pregnancy rate is the same. But in many cases, when a woman is 47, her cycles are not regular and she does not always ovulate correctly, there are more cancellations, and if we need to wait for natural periods, we lose time. In natural cycles we sometimes do not have good thickness and ovulation, and need to wait for the next month.

If I do a frozen cycle, how many eggs would I expect to have?

In a frozen cycle, we know exactly how many eggs we have from the donor. We always get more than 8, only 5% of eggs won’t survive during the thawing procedure. We guarantee that you will have min 2 embryos. It’s very difficult but it might sometimes happen that we do not have 2 embryos as something did not work correctly, but we have one very good embryo, and we did the transfer. If we do not have 2 embryos and the patient does not achieve pregnancy during the 1st attempt with this embryo, we repeat the egg donation and guarantee that you will have min 2 embryos and more. And if we do not have, we repeat the egg donation without no cost.

What is IVI’s policy on a negative pregnancy – do you try again or is it classified as a new treatment including new fees?

The fees depend on the 2nd cycle. If we perform donation with frozen embryos, costs are lower, because all preparation is done and we do not need to select donors. We need to prepare the uterus, one frozen embryo and perform the transfer. Egg donation and frozen egg transfer are different procedures. If you have any doubts, you can contact with our team.

What is the average number of day 5 blastocysts of good quality that you get from donor eggs?

The average number is from 10-12 donated eggs, we have 2-3 good quality embryos in average, perhaps 4 embryos, and it’s not often we have more. As humans are not very fertile, eggs need to be fertilized, this is the stage one. Then not all the eggs fertilize correctly, and when they reach day 5, some embryos might stop their development, this is the natural selection of embryos. We need to have many eggs to have a few embryos. Good embryos mean high chances of pregnancy.

Don’t fibroids grow with all the hormones, that’s what happened to me and they were much bigger that the doctor thought?

It can happen. Fibroids depend on hormones, and they can grow when a woman takes drugs for donation. In case of treatment with hormones, fibroids can grow, but it’s a slow process. Fibroids can grow, and only in some women they can grow very fast.

My potential donor has a corpus luteum and hasn’t started an IVF cycle yet, will this be a problem when she starts?

No, this is not a problem. Corpus luteum is normal to have in ovaries after the ovulation. After ovulation the empty follicle left and forms the corpus luteum. It sometimes stays longer than usual, and then we cannot start the stimulation in donors. It’s very common and normal, and it does not affect the stimulation.

How successful is a live birth doing a natural preparation plan with donor eggs at 47 years old? I have regular periods.

The live birth is 40- 45%

Can you get a contract with a guaranteed live birth and not just a pregnancy?

This is a good question because I forgot to mention, that we have a contract that includes two guarantee: you will have a newborn after performing maximum 3 egg donation and if we do not achieve a pregnancy after 3 egg donations, we will refund all the costs of the treatment.

How do the live birth rates compared with the use of two embryos vs one?

Live birth rates when we transfer two embryos are a bit lower except situations with twin pregnancies. Such pregnancy might have complications, also for a mother such as diabetes, cesarean section, miscarriages, and others. Babies might also have complications, they are often premature. So, the live birth rates for two embryos are lower. Only half of our patients who transfer two embryos have twins.

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Authors

Veronica Legidos Lopez, MD

Veronica Legidos Lopez, MD is a gynecologist at IVI Alicante in Spain. She has a degree in medicine from Miguel Hernández University, Elche (Alicante, Spain) from 2006 and she did her PhD courses in 2009 Level III: ultrasound in obstetrics and gynaecology. In 2011 Dr. Legidos did her Obstetrics and Gynecology specialty. In 2020, she has started developing a clinical trial in Alicante IVI Clinic, for her doctoral thesis, that started in 2019.

Event Moderator

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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