By fertility experts from Spain.
Egg donation may not be an easy choice for everyone. There are questions and concerns that need to be addressed before you begin your treatment. During this online meeting, two experts answered patients’ questions live – Sławomir Sobkiewicz, PhD, gynecologist, obstetrician and endocrinologist and the co-founder of Salve Medica in Poland and Bogna Sobkiewicz, MD, Gynecologist & Obstetrician at Salve Medica.
We always have to act as the law says. In Poland, we cannot perform an IVF treatment for same-sex couples or single women. Surrogacy is also not allowed. There is also an age limit in Poland, and we do not conduct tests on the embryos, only if there is a medical reason for it.
In Poland, the law does not say that there is an age limit, but in general, most of the clinics have an age limit which is 50.
It is difficult to say, but of course, it will be better if the BMI is in the normal range, so no more than 30. Although BMI at 35 is, in my opinion, a maximum BMI. When it is over 35, we advise to either try to go on a diet or do the operation before proceeding with egg donation. We know that high BMI can influence the success rate, so we do not advise patients to go ahead with egg donation when they have a very high BMI. We encourage such patients to, first lose some weight and then evaluate their options.
In Poland, there is a limited amount of embryos that can be transferred. It is a maximum of 2 embryos that we can transfer. In Europe, it is recommended to transfer one embryo. Transferring two embryos may increase your chances, but it can also cause a higher rate of miscarriages. In patients that are going for egg donation and are over 40, the twin pregnancy can be riskier. The preterm live birth rate is higher. So you always need to think about those things, in the end, we want to ensure you’ll be able to take your baby home.
Egg donation in Poland is anonymous. We can say the age of the egg donor, or if they have children or not, if they already took part in any previous egg donation programs, blond group, phenotype features. We do not reveal the details of the donor social status. The donors are thoroughly checked, we evaluate their physical and mental health.
We always ask our donors about their health status but also about their families health status, it is not allowed for us to see the family, so we always ask about it. It’s their free will to tell us everything, but most of the time donors are open, and there are no problems with that. They do not allow us to share their photo. Not all women that come to our clinic are becoming egg donors. We always evaluate all the things, so even though a young woman is healthy, she might not be accepted as a donor. All of our donors are of Polish nationality.
We have some features which we evaluate when we try to take eggs from a donor for egg donation programs. We check the blood group and other features, but it is difficult to say that the child will look like the future recipients. You should know that when we’re mixing eggs and sperm, it is still possible that the children will not look exactly like their parents. I always say to my patients, that f.e. in my family, I’m the only one who is blonde, and I’m very similar to my parents, but nobody has blond hair like me. So even if you are the biological child, it doesn’t mean you will look like your parents.
In my opinion, there is no difference because we are working 12 years with vitrified eggs and our embryologists are very experienced. When vitrification was introduced in Europe in 2008, we learned this procedure in Spain, and we collaborated with people from Japan. So our embryologists are very experienced. I know that future recipients prefer using fresh eggs, and we also organize it and perform such donor programs, and the frozen sperm. In our experience though, with our frozen eggs, we have from another IVF program, we receive the same success rate as in the fresh cycle. It depends on the experience of embryologists, and it’s always easier to conduct the process with the frozen eggs, for patients who live abroad, it’s also easier to organize everything. Vitrification of embryos is not damaging the embryos, and it is the way we perform a frozen donor cycle, in the majority.
In Polish law, there is a limited number of oocytes that can be inseminated. Therefore, we give recipients six eggs, and in this program, on average we receive two – four to five embryos. This way we can choose the best embryos that will be transferred in the first cycle.
We guarantee the number of oocytes because the number of embryos depends on the status of semen as well. We can perform our procedure regularly, and as always, but we can not know how many embryos will be created. When we inseminate six eggs, it is the maximum eggs we can offer in the egg donation program, the average number of embryos we receive is 3-4, they can be of different quality.
When women are over 35, the quality of the eggs is diminishing faster every year. The miscarriage rate is higher and higher every year. The miscarriage rate is much lower with the egg donation programs, I would like to say that a lot of patients that come to us, they already have some history of miscarriage, and it’s crucial to diagnose other problems that caused the miscarriage in the past before they come to us. The IVF procedure is not a solution for the miscarriage history I need to emphasize that.
There should be performed more thorough tests of semen because, in the majority of clinics, they only performed standard semen analysis, and we know that there are some other things that should be looked into, so extended tests will be required. Another aspect is the quality of embryos which were transferred, in those previous 3 cycles. As well as, the number of eggs the recipient received, how many of them were inseminated, and what was the quality of semen. Also, the genetic status of both man and woman should be checked, as sometimes it could be a reason for miscarriage, another reason could be immunology. When it comes to the retroverted uterus, and as long as it is a normal uterus, it is not a problem. Hypothyroidism, if it is well treated, again that won’t be a problem. It is very difficult to find the one reason for something going wrong, and it requires to perform a lot more tests to be able to find the solution.
For our donors, it is not necessary to have a child of their own, but a lot of them already do have them. You can request a donor with proven fertility at our clinic. Some of our donors, about 50% do have children, but the most important is to have younger donors who are in good health and have a good quality of oocytes.
We do not have Asian donors in our clinic. Most of the polish clinic have only Caucasian egg donors.
Unfortunately, we don’t have Spanish donors available. We don’t import the donor eggs from Spain as well. We always try to match the phenotype with the recipient as much as possible, but as I’ve mentioned, we only have Caucasian egg donors available.
It is difficult, to give a 100% guarantee in the egg donation program. We can guarantee the number of embryos in our programs, but we do not have a money-back guarantee program and are not able to guarantee a pregnancy. Successful IVF does not only depend on the state of embryos but also the status of the recipient.
OHSS (Ovarian Hyperstimulation Syndrome) can happen when you are stimulated for the egg collection, and it won’t be a problem in the donor program. When we are talking about egg donors, you should know that we do care about them, so we do not overstimulate the donors. We take care of all donors the same way as with our other patients. It may be hard at times to adjust the number of hormones, of course, but it can happen with any other patient.
We try to select a donor with the same blood group as the recipient. We take into consideration the blood group of male and female. We try to find the best solution because if the blood group is not matched, it can be problematic for our patients in the future.
No, it’s impossible, when we transfer only one or two embryos and the recipient doesn’t have any health problems, that won’t cause any issues. Even if the health problem occurs during pregnancy, it’s not because of the eggs received, it’s just because of the whole health status of the woman and the pregnancy. Egg donation is not the reason.
In our clinic, first, we are in touch with the patients via email, and we talk with the patient, ask for the detail and adjust the program. The patient can choose an egg donation program, they need to pay in advance, we look for the donor for them, after that we encourage our patients to come to the clinic during their cycle, before the transfer to provide them with medication, we do the embryo scratching because we believe it helps us to introduce the catheter inside the uterus, and we will see if we will have any problems during the embryo transfer. The patient then comes in about 10th – 9th day of the cycle and needs to stay in Poland for about one week or ten days. We do the ultrasound, and we conduct the embryo transfer. When we use husband’s sperm, he also needs to come before starting the egg donation treatment because we need to evaluate the semen sample, not only a basic test, but we perform the more detailed tests as it is important for us. We vitrify semen which will be used in the donor program. We always want to meet the woman as well, at this time because we need to evaluate the uterus we can talk about previous programs and problems. Sometimes we find that this will help with improving success.