By fertility experts from Spain.
Dr Diana Obidniak, Head of International Cooperation Department at AVA-Peter is talking about pros and cons of egg donation IVF programmes.
It is definitely possible. There is no difference for sure. It doesn’t play any significance.
Unfortunately, we don’t have donors from Africa or India, it is very hard to find such donors in Russia.
I would like to clarify what you mean about multiple transfers, it’s never a difference in price, but it doesn’t make sense for medical issues. Our aim is to get one pregnancy, one delivery. Ideally, if it’s one embryo transfer we want one pregnancy with one child because multiple pregnancies provoke many risks associated with OB.-GYN practice, not with IVF cycle. Multiple pregnancies cause a greater risk of some problems with health or babies, that’s why we have implemented selective embryo transfer, which doesn’t play a bad impact on the success rate because it’s quite the same. The percentage of twins is much lower, it’s just minimal, and so consequently there are very few complications during the pregnancy. We do not recommend it, we can do it technically, but we don’t do it because it’s evident that it will be bad and not a good thing. It can provide harm to your organism.
To tell you the truth, there is no correlation between the number of IVF cycles with your own eggs because we expect that using egg donation as a solution because egg donation will prevent the course of your previous implantation failures. That’s why we should expect that if the donor is good, and we expect that all clinics share responsibility and improve the quality of their egg donors. If your physician pays much attention to the other factors, you can call it pathology to the endometrium, and if there are some defects in sperm of your husband, it’s better to implement pre-implantation genetic testing so for sure if we pay attention to all the factors, we expect to have a pregnancy from the first attempt. In any situation, our aim is to shorten your time to pregnancy and do one but successful IVF cycle especially when we talk about egg donation program.
It is 50 years old.
Unfortunately, it is restricted but we should take into the account that it is restricted, not in terms of the law system but also according to all the medical recommendations, according to a World Health Organization, the reproductive age for a woman is under 50 years old. After that, we can discuss the implementation of an examination program only if we talk about surrogacy program, also because it’s just not safe to bring the pregnancy after 50 years old. It’s very risky, and it’s a great stress for the organism, that’s why we should be sure that your health and your organism is ready for this. Unfortunately, over 50 years old it’s very risky so you can consider egg donation cycle with examination only in the context of the surrogacy program.
The success rate of 65-70% is the clinical pregnancy rate, but as we make a selective embryo transfer and we implement in most cases pre-implantation genetic testing, the miscarriage rate is very low, so it’s not more than 8%, it’s considered to be very low. We have great statistics, and the live-birth rate is more than 55%.
Surrogacy is maybe even the third line of our recommendations. Only when we have understood that there is no opportunity for women to bring the pregnancy herself. I would like to share my opinion, which is rather common for many experts that unexplained implantation failure is in most cases just the lack of tests provided. In many cases, it’s just associated with not performing tests of implantation window, not great quality of hysteroscopy provided. Unexplained implantation failure usually it’s just the diagnosis which is a diagnosis of our desperation, that we have by this moment no evidence-based tools to verify the reason for your problem. For sure for us, it’s also a problem, in many cases, if we talk about surrogacy program usually we have the certain diagnosis, which can be associated with the competence of uterus or there can be contraindications for childbearing. For example, there is a heart disease or lung disease or autoimmune problems or kidney problems because our centre is affiliated with the centre treating the disease of kidneys and treating the disease of intestines, so we work with rather difficult patients. That’s why we have extensive experience of a surrogacy program, but it’s not such a common thing to move to surrogacy because we have unexplained implantation failure, we move to the surrogacy only when we understand that there is a great problem with the uterus, which cannot be fixed by this time, at this stage of development of medicine. To tell you the truth, it’s a very rare situation when we talk about unexplained implantation failure, I can’t even remember when we moved to surrogacy because of unexplained implantation failure. We always try to find the reason and fix it, so usually, we find the reason.
Yes, we have for such a program. We guarantee that if after three embryo transfers, the pregnancy is not achieved, you can take your money back, you can take the refund of 50%, or you can continue your treatment till the pregnancy comes without additional expenses. We have such program, they are rather popular to tell you the truth because for sure patients need this information that we share the responsibility, not only providing emotional support and being in touch and just doing our best but also in terms of financial relationships between the clinic and the patients.
For sure, it depends on the country but nowadays, the European Society of Human Reproduction and Embryology and American and Russian Society for Reproductive Medicine have established the protocol of safe practice especially if we are talking about both vitrified egg donor and sperm donor, so if the clinic follows this strict, standardized protocol, it is considered to be very healthy, but for sure it’s better to ask this question your physician who knows the internal information in this clinic and I can talk to you sincerely about the situation in the country. If we’re talking about Russia we perform such cycles when we do not mean that the patient will come to the clinic, so if we start cycles, we only mean that we will do a freeze all cycle, so we will not make any embryo transfers, and we are freezing the embryos. According to the available data, there is a minimal risk of making the embryo cells infected. It’s considered to be rather safe, but it’s better to discuss with your local physician.
In Russia, the donation is generally anonymous, but it means that the donor can provide their pictures if she is ready so our base of donors consists of donors who are ready to share their Picture. They are ready to make a video call with intended parents, some of them are ready to meet you but if we talk about disclosure of their personality f.e.20 years later, after your baby grows up, unfortunately in Russia it’s not ethically approved, so we cannot guarantee that 20 years later the donor will be ready to meet your baby, but we have all the details of all the information concerning the donor, and we are still in touch with them but now what we can provide are the pictures of the donor, we can make an appointment for the meeting if you want, we can schedule a video call and provide many other opportunities. The manager will ask you about what features are significant for you, what do you expect from the donor and then send you the profiles of the donor which can match your preferences. The database is very large and is rather dynamic by this moment we have limited access to the electronic database so the managers can send their portfolios for you via email for sure.
We do not consider the donors over 32 years old Usually, the average age is 25 – 28 years old but not more than 32.
Unfortunately, maybe the intervention, the medical prescription was a little bit tougher than it should be in your case, as you are gaining weight after every transfer. You should do a consultation or provide your hormonal test and discuss it with endocrinologists or with the fertility specialist. If your specialist has such competence but for sure in any situation, if we have a problem we should find the reason why you have this problem just after that. We can make an individualized treatment plan. In your situation for sure, it’s also an abnormal reaction to this fertility treatment maybe it’s associated with emotional unsatisfaction because of that result, maybe it’s the result of some abnormalities after hormonal medication. So to answer your question, for sure, it’s better to lose some weight, it’s comfortable for you, that’s why it’s better to verify the reason why you had started putting on weight. Try to fix this problem before transfer.
The implantation or window is identified with these two methods we have mentioned previously, so-called ERA test and BeReady test, so both methods require remodelling of an artificial cycle or natural cycle. We just make the same preparation of the endometrium as we are planning to do during the embryo transfer cycle and just at the day when we would do the embryo transfer, we are taking the biopsy from the endometrium, and then according to the genetic testing, we analyze the expression of the genes and then I have the conclusion what time if there is a replacement of an implantation window, so there is no correlation with an endometrial thickness between implantation window and the thickness. For sure, the thickness of the endometrium also plays an important role, there are data, and it’s already well known that we need at least seven millimetres for successful embryo transfer.
If we talk about enhancing the result for sure not. We always try to find the egg donor with the same blood type as the woman has or her partner has. It’s not associated with good or bad outcomes, it’s just in case the couple doesn’t want to disclose their status to everybody. Just to prevent the risk of disclosure this information for some reasons, the baby can have indications for example for blood tests, and if there will be different blood types with the parents for sure it would be Rather obvious that egg donation program was implemented, so we just want to prevent such social risks.
As we have mentioned during the presentation recurrent implantation failure and if unfortunately, you have 3 failed embryo transfers for sure it’s considered to be recurrent implantation failure. The chances of finding chronic endometritis also depend on the quality of the embryos. If the quality of embryos was good according to their available data, the prevalence of chronic endometritis will be close to 60%. If the embryo was not so good their prevalence will be lower but still very high close to 45%. After 3 failed embryo transfers, according to all the guidelines and according to the experience, I should recommend you to pay attention and to do proactive diagnosis of the status of your endometrium. So the golden standard of evaluation of the endometrium is hysteroscopy, which is the method of visualization when we insert a thin camera into your uterus, so it’s minimally invasive, but by inserting the camera inside the uterus we can assess the status of the endometrium. In the golden standard, we also can perform the first stage of the treatment, so if we see some polyps because sometimes the location of polyps doesn’t allow to notice them by ultrasound. That’s why hysteroscopy gives much more objective information, but during hysteroscopy, we can not only detect the pathology, but we can also start to fix this problem and initiate the surgical stage of the treatment.
There are approved protocols when the treatment of endometriosis should be combined. I would like to have more information on how the endometriosis was verified in your case. To make a certain diagnosis, it is important to know if there were any surgeries like laparoscopy or hysteroscopy or it was a suggestion by ultrasound. The quality of your eggs is not the basis to have the diagnosis of endometriosis, there should be at least several ultrasounds performed. If we are talking about endometriosis of uterus, or about the endometriosis, a so-called external genital disease, endometriosis in ovaries or your abdomen, we cannot see it by ultrasound or by egg quality, we can make a suggestion, but we have to prove it, at least make blood tests called CA125, it’s a blood test, it’s better to make it twice during one menstrual cycle, one time during your menstrual bleeding and the second time during the middle phase of when we can expect the ovulation. If you have endometriosis, no doubt you need to have treatment. At this moment we have approved tools, they are Rather easy for intake, so first-line treatment is the pills, which you have to take once a day at the same time constantly, for at least three months. Endometriosis requires to be staged because there are four stages and the tactics, that treatment plan will differ depending on the stage of the disease. If you have endometriosis, it’s better to be examined. When it comes to treatment, we don’t talk about cortisol or injection. Endometriosis has autoimmune nature, but that pathogenic treatment is not associated with injections of cortisol in the treatment. At this moment you haven’t had the diagnosis yet, you have for the uh suspicion that you may have endometriosis, but it’s better to prove it and do treatment prescriptions only after verification of this diagnosis.
I recommend doing everything safely. At this moment, we have a standardized protocol on how to act during the pandemic. It is the same protocol in all the countries, the indications and the tools of prevention of the risks are the same. I bet that even Rusing fresh donors are the safe option when it is allowed because if it’s not safe, your clinic, your physician will never recommend it or will never make this possible to do. We already have a protocol to perform fresh cycles, and I know that in some countries, they have already started to do a simulation of the donors. In Russia, at this point, we do not do any ovarian stimulation, neither for donors nor for patients but we expect that we will start it not later than in a month because in two weeks we expect, that it will be totally safe, so we will wait a bit more. I expect, that in other countries it can be already safe because the process was a little bit earlier so in those countries the process is already at the stage of recovery. I’m sure that you should ask this question to your physician at your clinic. I bet that he will answer very sincerely because each physician wants just to make nothing but good.
It’s just the normal, standardized form for everybody, so we have recommendations from the medical committee in Russia, Medical Society for Reproductive Medicine, so we need to do all the examination you have mentioned, in each situation. The pregnancy is a very long journey so we should be sure that it’s safe to do the embryo transfer. That your uterus is capable of bringing the baby, there are no defects in different organs, that it can get worse during the pregnancy because pregnancy is a stress for the whole organism. It’s a physiological process, but it’s still great stress for the organism, that’s why you should be in good form. No person is in perfect form, for pregnancy but some of such problems can be treated before as some of the problems can be treated even during the IVF cycles, but some of them can be risky and can be considered as a contraindication for IVF or for carrying a pregnancy. We should assess it before planning treatment for the patient.
Unfortunately, I should tell you that the chance of having a successful program with your own egg is not high for sure, and it is not associated with your AMH but is mostly associated with your age because we know that there is a strong correlation between the prevalence of abnormal embryos in population and the age of women after 35 years old, the general risk of abnormal embryos increases. After 39 years old we see an extreme elevation of such risk and we see that about 80% of the embryos will be abnormal among those, which reach the stage of the blastocyst. Unfortunately, not many women after 33 years old produce eggs which can develop till the stage of the blastocyst. We obtain the eggs, there is no doubt because we have 19 modes of ovarian stimulation, so we have a lot of feasible methods of deletion of your treatment, so we will obtain the eggs, but unfortunately the quality of those eggs will be very bad just because of the age. We have to tell the truth, I had a woman who had her own baby with her own eggs at the age of 48. It’s the record in our clinic, but she should be considered as an exclusion. You have provided FSH and AMH which demonstrates very physiological changes, so you have normal physiology of a woman. Unfortunately, we expect that the quality of embryos will be very bad that there is a great risk that we will have no normal embryo for embryo transfer.
Yes, for sure, we have even our own shipping company, but I think that during the following months, it will be just impossible to do the shipping because I think that in the following one or two months, all the countries will be a bit worried of some transportations or some active movements. If you’re ready to wait for a month, it’s okay, but I’m not sure that we can manage to do this shopping during the following months.
We perform ERA test in Russia, and BeReady test, we send to Estonia. It’s very close to St. Petersburg, so it’s not a problem, but BeReady test is cheaper, so it’s more affordable, even with including the expenses for shipping to Estonia. Their effectiveness and their objectiveness all the data are comparable, it is comparable, that’s why we always discuss with the patients those two alternatives because in terms of effectiveness and providing reliable data they both are good. Sometimes if it can be made cheaper for sure, we want to minimize financial expenses.
Well, the child will have DNA from the husband if we use an egg donor. The child will have DNA from your partner or your husband, so there will be no genetic connection between a woman and the child. Actual data provides certain information that a woman during the pregnancy has like a trophic function for the baby, so her blood circulates also inside the embryo. It provokes, and it regulates all the expression of all the genes, that’s why even by appearance, even by the character, the child will be very similar to the woman, though genetically there will be no connection.
We can verify endometritis using so-called immunohistochemistry by detecting CD 138 or CD56. It requires special staining of the samples for the endometrium. If the doctor has removed the polyps, it’s a sign that you had chronic endometritis but removing the polyps is just the first stage of treatment. You have to prolong the treatment using medications, what kind of medications, usually it is identified depending on the pattern which was observed during the hysteroscopy. According to the conclusion from pathology, we should assess not only the morphological process but also accept the activity of inflammation. If the inflammation is rather active, if there is a need for antibacterial therapy, sometimes there are also in some mode micro polyps in other areas of the uterus. There are connections, adhesions, they can be very slight, but we still need to implement some ferment activity or PRP therapy. You have to complete the therapy, as prevention of regression of endometritis and the polyps. Unfortunately, I cannot give you just the standard protocol because we are stating that the treatment should be individualized and should be evidence-based. The presence of polyps doesn’t provide enough information concerning the activity of the process and the stage of the process, that’s why I just can recommend having a complete therapy to prevent the residue.
It should be performed in a parallel model. If you have disrupted period, you should check your hormones and your physician should normalize your period, it’s just the first line. On the other hand, if you already had problems and your physician have removed the polyp, sometimes after removing the polyps if it was a hard intervention, it wasn’t so delicate, or your resources do not allow to make a great recovery. Naturally, sometimes we recommend PRP therapy as a tool of regenerative medicine to help your lining to recover and to start growing. First of all, you should find the reason why the lining isn’t growing. We call it resistant thin endometrium, we should find the reason and there are usually 2 reasons, dysregulated menstrual cycle and the presence of inflammation and you should work in both directions. 6.5 millimetres is very close to our aim, it’s always better to have more than 7 millimetres, but it’s much better, trust me, I have patients with the endometrium not more than 4 millimetres, and we have treated her till the normal size. Don’t be desperate, it’s really not a bad thing, you have to just take everything into the account, listen to a physician, and I’m sure that your physician will find the key to your endometrium and prepare it properly.
EmbryoGlue was suggested several years ago, and we tried it as we always try everything to enhance the results but unfortunately this supplement disappointed most clinics and most physicians. EmbryoGlue means that we add something which will help the embryo to implant. At this time, we can consider granulocyte colony-stimulating growth factor in the form of injections, subcutaneously in the abdomen, and it for sure will help because it’s the systematic activity which fixes the problem of deficits of GCSF in our organism and this growth factor plays a role of this natural glue for implantation, so that is the reason we do not implement EmbryoGlue anymore because it doesn’t work to tell you the truth. We have implemented a kind of glue, embryo glue but we administered it not during the practice of embryo cultivation but just from the day of embryo transfer.
Yes, for sure but we should follow the instructions of preparation to BeReady test, so we will make hysteroscopy from day 19 to 22 during your menstrual cycle and 5 days before hysteroscopy, you should start to take progesterone usually, we administer it in the form of vaginal gel because it’s so-called micronized, so it’s very similar to the natural ones. It’s considered more similar to our organism, but for sure, we can do it just at the same time.