By fertility experts from Spain.
Watch the recording from the Online Patient Meeting with Oksana Babula, MD, gynaecologist-reproductologist at Clinic EGV. Dr. Babula explains when it is recommended to start with egg donation treatment.
The age limit is 52 years but if the recipient is health, if she has no health issues, what we also ask for is mammography, to make sure there are no any risks of breast cancer. Second of all, Pap smear this is for the cervical cancer check, and the diabetes check, so glucose level. So if the recipient is health, if she is not obese, that is more than 35 BMI, if everything is all right, we can consider even older women. So, there are no limits as long as the recipient is absolutely healthy.
So 39 is beautiful age, so I want to see your ovarian reserve, check the ovaries and your AMH level. As for the age, I would say, it’s still worth trying another cycle with your own eggs, and some medication improves AMH level, and improve ovarian reserve and results of the cycle. It’s DHEA, which is adrenal gland hormone in tablets that have to be taken for 2-3 months before treatment, and it improves the results. If you had two failed cycles, I would recommend to resuscitate your ovaries with hormones and then if AMH is not very low, then I would say try once more.
Absolutely, yes. Lesbian couples are welcome in our clinic.
We only have anonymous donors. I know in our neighbour country Sweden, all babies born from donors are allowed to have information about the donor at the age of 18, but not in Latvia. Here, it’s anonymous, even myself as a doctor, do not have access to the donor information. Every donor has its own unique number, and they see only the number. We can provide information like age, height, eye colour, blood type, weight, how many children she had, and what is her background education, hobby. Our patient coordinators, they see all the donors, so we have patient coordinators that communicate with foreign patients. You can fill out the questionnaire, your donor requirements or everything you want your donor to be like, and we will try hard to find a suitable donor. I would recommend relying on our coordinators, usually, they are very helpful and try to find the donor looking exactly like the recipient. We always ask recipients to send their pictures at the age of 20 or 25 to 30 years, this is the age of our donors, so we are very proud when our patient send us emails, letters saying that everybody is saying that your baby looks like mom. This is the highest rating for us, so we are really trying to find the perfect match because our patient coordinators are educated, they will always advise you what to choose. First of all, it’s important whether you’re going to tell your baby that it was conceived from the donor or not. Then if you are going to tell your baby about the donorship, you don’t have to choose the same blood group and everything similar. I mean, it’s up to you, that’s why we have questionnaire where you describe everything you want to see in the donor.
We have 3 steps in screening donors. First of all, we check for sexually transmitted diseases, so it’s HIV, syphilis, hepatitis B and C, even if the donor had a history of hepatitis, even if she’s healthy right now, we don’t accept such donor. So no history of sexually transmitted diseases and of course chlamydia, gonorrhoea also is tested. The second step is a psychiatrist, and we have a very strong psychiatric evaluation, that is checking everything. We check if the donor is prone to alcoholism, drug abuse, depression or any history of psychiatric diseases. Sometimes, I am surprised when there is a beautiful, young girl, everything is alright, so I am asking our psychiatrist, why you’re saying no, and she is answering, even if she has no problems right now, she’s prone to some addictions like alcohol or drugs. We don’t accept her, so this is very important, all our donors are absolutely psychologically health. The third step is genetics, all of our donors are tested for karyotypes, so they are genetically healthy.
The baby will either look like you because we will choose a donor looking like you or like your husband or partner if you’re using your partner’s semen. We will do our best to choose donor phenotypically similar to you. The chances that the baby will look like you, are pretty high, and we are very specific about the face shape, the nose is very important because the nose shape is inherited, and the eye and hair colour, skin colour etc.
We choose the donors according to your donor criteria. We all are different, we have patients that even though the female has white skin, blond hair, blue eyes but she wants a dark-skin donor with brown eyes, some women want a donor that looks like her husband, it is possible, we’ll select a donor based on your criteria. You always have to remember that the baby will be the way you raise the baby, I mean whatever traditions you have, or your family is, it is all in your hands, the way the baby talks and thinks.
First of all, AMH is not a stable value. It’s going up and down, depending on the psychical chase, so it can be up and down even during the day. I would say last recent recommendations to improve AMH level, it’s DHEA that decreases starting from the age of 35, so it’s like a youth hormone. The recommendation is to use it for 2-3 months prior to the cycle. It has very low side effects compared to testosterone because testosterone is also very helpful in improving ovaries and egg quality, coenzyme q10, melatonin, inositol are also working very well, but you have to remember that publications are saying that you need to take it even for 90. If you want to improve your egg quality you need to use them for 2-3 months before stimulation.
I had actually the last donor in our clinic, it was my patient, it was in March. Now, everything is stopped, so we are not allowed to even freeze donor eggs, because everybody is afraid. We still have many frozen eggs from many donors of different phenotypes, all blood groups are available. We have a huge donor database, so hopefully, when it’s all over, we can hold a donor and start stimulating the donors. There are two different types of donor cycles. Egg donation cycles, it’s a fresh cycle when we stimulate donor and do a cycle synchronization of donor and recipient, so everything is done fresh. There is also frozen cycles, so we have frozen eggs, and then we thaw eggs, fertilize with the semen, and do the embryo transfer.
I always recommend changing the donor if there is 1 unsuccessful cycle, so we don’t know, it’s impossible to know everything. There are some small genetic problems that it’s not possible to check. So once you had an unsuccessful cycle with the donor, I would say take another one. Second of all, your age and your AMH level are good, and you get many eggs for your age. I would say take DHEA for 2-3 months and try again with your own eggs and different donor, but if you are tired of trying, if you say I don’t want this anymore, I want a baby right now, then you should proceed with the egg donation and chances with egg donor are much higher than with your own eggs. It’s up to 70% success rate.
I would say try again with your own eggs and check for thrombophilia, this is genetic testing, it’s just a blood test. If you are positive, then you have to start heparin injections. I would say that even if it’s not proof positive, there are some rare cases of thrombophilia that is impossible to find genetically. I would say try with the low molecular weight heparins injections from the day of embryo transfer if you haven’t tried it. It helps to improve the blood circulation in uterus and improves implantation, so you can try it. If if it’s not successful, then you have to proceed with egg donation.
I would say with the donor eggs, you will get a high success rate, but I would try with your own eggs first, and if it doesn’t work well then you can proceed with donor eggs. Depending on what your plans are. If you want a baby this year, then of course with donor eggs, but if you want to give it a try and if you’re ready for the unsuccessful cycle, it can take 2,3 cycles to get the baby, then you can try with your own eggs. Your AMH is not extremely low, and there are 6 follicles, and your age is fine. I mean, for me the age threshold is 43, it’s really difficult to get the pregnancy after the age of 43, but at 41, 42 even 43, you can try. I would say you can try 2 times, it’s time and money consuming, but it is worth trying. I have had many successful cycles until 43, not after. After the age of 43, I had maybe like a couple of patients with a successful result. I don’t recommend to try more than 2 times.
Yes, 100%, it is best to go for egg donation.
Eight eggs collected, that’s a good result and 75 mg DHEA per day is a good dosage. I would say it is up to you, it is 50/50 chances. I would say you can try with your own eggs, but you have to take DHEA at the same dosage, you can also take 50 milligrams twice per day for another 8 weeks, and try again.
That’s a difficult situation, I would say the chances are extremely low that you can get a baby with your own eggs. There are no problems with a single lady, you can get a donor embryo. All donors are anonymous, there is no way your baby will get any information. I would say go for either for donor embryos or you can choose an egg donor, and you choose semen donor, and then we fertilize the eggs and do your custom made embryo. Whatever you choose, but of course no information will be available for your child. You can do the day-3 transfer, if you have 1 or 2 embryos, I would say do day -3, but statistics say that day -5 embryo transfer gives the highest pregnancy and live birth rate. If there are 5 embryos at day-3, then I would say wait for day -5, if you have 1 or 2, go for it, do the transfer.
Talking about my experience, the oldest lady that I got pregnant with the donor eggs, was 56 years old. As long as you’re a health 48- year-old, you’re feeling good and strong, and everything is alright. I have mentioned already we are asking for the breast check mammography and Pap smear, cervix check and if everything is all right, no diabetes, you’re not overweight, no problem, you can have 2,3 children by the age of 56.
Does it mean that you did the TESE procedure or micro TESE? In our clinic, there is micro TESE, which is a procedure we use for complete azoospermia. I would say, you are Young, and with man, this is not fair, but they can have children even at 70 or 80 years of age. I would say you can try, but just to clarify if you need TESE or micro TESE procedure, it’s possible in our clinic. So again, do you take either testosterone or DHEA before the procedure, and try again.
So, azoospermia means zero sperm, no sperm cells. So if you say zero morphology, it means that there are some sperm cells motility. Azoospermia means there is no semen at all, so you have to do the burgery, we do it under the microscope, and our urologist is looking for sperm cells, and if there is one sperm cell, he will find it and fertilize the egg. If you say zero morphology, low motility it’s probably teratozoospermia which is much better. The oldest guy we had, he was from the US that produced a very beautiful, healthy baby with his young wife of 30 years of age, he was 82, he was in bad condition, but he had some sperm cells, so we were able to fertilize. But if a man is older than 60 plus, then preferably his wife should be much younger, or we can use egg donation for that. And to improve the semen quality, there are medications like PROfertil,
most popular. There are many publications about PROfertil, but you have to remember that semen cells are getting ready from zero to the normal semen cells so that is capable of fertilizing eggs, it takes 3 months, so 90 days, so you have to take pills for at least 3 months. Make sure your husband is taking 1 pill twice a day or 2 pills per day. Remember, that he shouldn’t dring beer because beer even with zero alcohol has phytoestrogens that decrease semen quality. All other alcohol is allowed, so beer makes semen less motile and reduces the quality of semen, and the second thing is heat, so no sauna, no heating, male testicles have to be in a cold environment to produce good semen.
Yes, definitely. Last publications say 90 days before the cycle you have to take DHEA because it works for a short period.
The DHEA doesn’t have so many side effects in comparison to testosterone because, in the end, it improves the level of testosterone and estrogens. It works in a very mild manner, so I would say it’s pretty safe, but of course, it’s better to ask your doctor who is a reproductologist. I even give DHEA to women with high testosterone or high testosterone receptor sensitivity, it doesn’t matter, it’s a different hormone, it works differently, so it’s pretty safe. So far, I haven’t seen any side effects.
Just 2 days ago, we had the online international reproductology meeting, and several speakers were talking about DHEA, and all researchers were very positive that it improves egg quality, the number of eggs retrieved, it improves AMH levels, so just ask your consultant to search for recent publications on DHEA. The Americans started it first, and it was interesting as it wasn’t even for the ovaries, in the United States, it’s very popular to stay young and healthy for a long time, so it actually was for like a youth elixir. In all rejuvenation programs, number one was DHEA, for weight loss, for improving libido, for improving life quality, and then it was discovered that it also improves ovarian quality. I would say look for American publications, there are many of them, the name of the professor that was giving a presentation, just 2 days ago on DHEA, and he was the first one who discovered the positive effect of the DHEA on ovaries and the number of eggs retrieved. His name is Professor Norbert Glacier, so look for the publication’s, and there are many of them, and actually, he was telling that there are almost zero side effects, maybe some androgenization, this may be a lower voice.
Yes, you can take DHEA, for sure.
For men, no. That’s interesting you know because DHEA actually produces androgens and those are not good for men semen. They are good for muscles, so sportsmen and the ones that are weight-lifting, and have big muscles, they usually have very low semen count and very low libido. So for men, if it’s necessary to take testosterone or DHEA for sport, then you have to do injections of HCG which is chorionic gonadotropin to reduce the side effects of androgens to semen. So no, testosterone, DHEA, any antigens are contraindicated for men because it reduces semen quality.
If we do pre-implantation genetic testing, but it’s usually done for genetic problems, we can see the sex of the embryo whether it’s a girl or a boy. In case, you have sex-related diseases in your family, f. e. all boys are not health, I mean legally in Latvia it is not allowed, but if we do pre-implantation genetic testing then we can tell where the boys are, where the girls are, so we can see the sex of the embryos. We do it, but not for sex selection, but for genetic testing which is recommended for couples of advanced age, or if there is a family history of genetic problems. I just remember a very interesting story, I had a patient, a Muslim couple that had 8 girls and they needed a boy badly, so we did genetic testing because the lady was already 48 years of age, and that was interesting that all boys, all boys embryos had a genetic problem, so that’s why they only had girls. If you’re ready to accept a healthy baby, it doesn’t matter boy or girl. To check the sex of the baby, we perform a biopsy done when the embryo is five days, or it’s a blastocyst, one cell is taken from the embryo, and we do genetic testing of these cells. It sounds terrible when the embryo has just 30 cells, one of them is taken away, but I mean it’s done when you want to make sure there are no genetic issues, when you have a risk of genetic issues, like age, your family history, but there are publications that anything you do with the embryo, like biopsy or changing media, temperature, that’s why EmbryoScope is better, but you don’t traumatize the embryo. Any trauma to the embryo can lead to some problems later in the baby’s life, like autism etc. I mean if it’s not necessary, it’s better not to do the biopsy. I mean if you have risks, then there is no other way, we should test it.
Low ovarian reserve is 0.4 nanogram per millilitre, and less, at the age of 44. The thing is that you can get pregnant naturally if your tubes are not blocked, and the semen quality is good, at any age, it can be even at 50 years of age. The problem is that our body and cells, the skin and everything are getting fragile. At 40 plus, your eggs may be good, but they cannot survive after all those lab procedures, fertilization and keeping the embryo in the laboratory, and all this kind of changing temperature etc. The problem is that, they are fragile, they just don’t survive, even though we did it, I had patients at the age of 45, 46 where we got eggs, they were fertilized everything was perfect, but at the day 3, 4, 5 they just die, they just don’t grow, they are very very fragile. Maybe in the future, it will be possible. We have special media for advanced age patients, but after 43, it’s almost impossible even if AMH is good.
It’s up to 70 %. Usually, if we use 5-day embryo to transfer with EmbryoScope, it’s around 70%.
Unfortunately, not. Only anonymous sperm donors.
Some researches are saying that you can even take twice more. CoQ10 and melatonin, it’s proven that it improves egg quality, and there is a question about soy product, so again, it contains phytoestrogen, so for women is perfect, but not for men. Melatonin, the dose on the pack, that’s a normal dose, and you should take it multiplied by 3, so 3 times more than normal dose will be ok.
After the transfer, I don’t recommend going to the sauna or hot tubs up for women, no physical exercise, as for swimming in the ocean or pool, I would say, it’s okay, whatever makes you feel relaxed and reduces your stress level, go for it. Also, some publications are saying that having sex after transfer also improves results. About hot tub for men, it’s absolutely contraindicated for men, 3 months before semen donation. For women, after the transfer, I don’t recommend any heat, but the ocean or swimming pool it is ok.
Absolutely, but maybe not only PROfertil, perhaps he needs some more like gonal injections, but I would also say go to the andrologist because even though it’s going to be pretty expensive, the injections work. Our andrologist usually prescribes the same medications we use for women, like gonal, which is a follitropin or hCG, which is ovitrelle, and it works, it improves semen quality. I had one patient, it took him 6 months, and a lot of money, but finally he got his own baby. It’s difficult to say whether it’s going to work or not, but andrologist will tell you what to do, but PROfertil always works. I mean, always start with the simple things, changing your habits, exercise regularly, but not too much, eat healthily, take PROfertil, and don’t drink beer, so sometimes it’s enough to improve semen quality.
Yes, you can start it. Take both melatonin and coenzyme q10.
It improves both egg quality and endometrial quality, so you can do it before the embryo transfer in like egg donation cycle, or you can do it before stimulation cycle with your own eggs. Either way, it works. My colleagues went to China last year, there was a big congress on human reproduction, and there were many studies from Chinese researchers about coenzyme q10 and melatonin. Since then, we started using it in our clinic, and we’ve been getting really good results, so I am actually using both for embryo transfer and for the stimulation cycle, so donor eggs or own eggs, it doesn’t matter. Many women with infertility have problems with depression, with the sleep, have problems with an ovarian regulation. Melatonin improves that, it works on the brain, it improves circulation in your brain, and somehow it improves LH and FSH production, it doesn’t do any harm, you will not get addicted to it. Actually, this is what I do, especially in women after unsuccessful cycles, I prescribe DHEA, I even combine DHEA and testosterone, as well as Coq10 and melatonin. Somehow it works altogether, maybe it’s not 100% clear how it is working, but it really works. If you’re using donor eggs, you need endometrium, and it improves endometrium quality.
Yes, that is correct, so that is an appropriate dose.
We need the menstruation before starting preparing endometrium, so normally, we give short hormonal contraception cycle. For 10 days, we give contraceptive pills, then there is bleeding, and from the second day of bleeding, we give estrogens.