By fertility experts from Spain.
Watch the Online Patient Meeting with Dr. Anna Galindo Trias, Medical Director at Gravida Clinic and learn more about egg and sperm donation, embryo adoption and ROPA method for same-sex female couples.
Essentially it is the same because the embryo comes from a donated egg and donated sperm, but the difference is these embryos that are donated come from a group of embryos that were already created in the past and out of the same this group of embryos, the main one has been transferred already, so these are the remaining embryos when these couples or patients have gone through a few transfers usually, they have one or two kids, and they have the remaining embryos frozen. They are not the first ones that we would choose, they’re not bad embryos, they’re good quality embryos, but out of this group, some have been used already. The double donation means that we create a group of embryos for the patient or the couple. The double donation has a slightly better pregnancy rate compared to embryo donation because of these characteristics, it is 55-58% implantation rate in a double donation, in embryo donation, it is 45-48% up to 50% of implantation rate, so it’s a little lower.
On the other hand, the physical characteristics are more accurate when we create these embryos for a couple or a patient when we take into account the colour of skin, characteristics of the face, height, weight of the recipient to better match the phenotype. The embryos that were already created the matching is more general.
In Spain, the law says that donation has to be anonymous. We can know the age of the egg because of the age of the egg during the pregnancy if we have to go through some tests the age of the egg is important as a marker for risk of Down syndrome and other little markers that could be important for the obstetrician that follows up the patient. If a couple or a patient wants to know the age of the sperm donor, it is also possible, and some general characteristics of the donors meaning colour skin, the colour of eyes, the colour of hair and general height and weight, complexion of the donors and also they have the certificate of all these tests that we performed in the donors so everything matches with the frame of egg donation and sperm donation.
It depends, in our clinic embryos keep coming little by little so there are some months that we have a lot of embryos coming in meaning that the couples that have these embryos already signed these consent that they want to give the embryos, we tested partners and everything, and there are some months that we have just a few, so it depends, there might not be a waiting time at all or 2-3 months at the most. We usually don’t have a longer waiting list than this. This also depends on the phenotype of the patient and the partner. If it’s the Mediterranean type, most of our patients are these types, so it wouldn’t be a problem, but if it’s another phenotype like Asian phenotype or others that are more unusual in our area, this probably would take a little more waiting time.
As I’ve said, there’s a slight difference between the adopted embryos and the embryos created for the patients. The concept is that the first ones are the supernumerary embryos and the other ones are created specifically for the patients, so in terms of the group of embryos, this percentage defers in around 10% difference. That also depends on the stage when they have been frozen, the day-3 embryos we barely have this type of embryos because we do a lot of blastocyst age, so most of the embryos that are given to adoption right now are day-5 embryos. They give us more information about themselves, so there are embryos that have a little higher implantation rate, day-3 embryos are tested less. They could be good embryos, but it’s not quite the same, so depends on the stage of freezing, depends on many factors that could be a little difference between both.
It’s a treatment for most of the couples. The pregnancy rate in this treatment depends very much on the age of both members of the couple. If both moms are over 40, the success of these treatments will be lower because of their ovarian ageing. It depends on the ovarian reserve, but also on which mom wants to be the donor and which one wants to be the carrier because sometimes when we have interviews with the couples, and sometimes one of them that is 32 f.e. wants to be the carrier and the one who is 42 wants to be the donor, and in this case, it is quite difficult because the rates are going to be much lower compared with another way around. We can plan ROPA, in any case, depending on the age or on the circumstances the success can be higher or lower, but it’s variable for most of the couples.
In terms of ROPA, the interpretation of the law is very tricky sometimes. ROPA is the only exception for anonymity in the donation of gametes, so it’s kind of tricky and depends on the areas of Spain. Specifically, in Catalonia and Barcelona, we have a local regulation where couples are considered couples if they can demonstrate that they live together or they just say they are together, they are considered a pair. In other areas of Spain, they have to be married to be considered a couple, so this legality depends on the area, even then we are all in the same law Frome, the local regulations are slightly different. In Catalonia, they don’t have to be married to go through ROPA, but they have to be a couple, they both have the rights of maternity, so when you go for a ROPA, it’s doesn’t mean you are donating your eggs to me, it means I’m going to be a mum with you, so the rights of the donor and the recipient are the same, they are legal mothers of this child, which is not the idea of an egg donation. In the egg donation, the donor gives cells, and the mother and father are the ones that go for treatment. In ROPA, it is a different concept as both moms are going together through this treatment.
We know that every individual is a mix of genetics and the environment. What does this mean, from all the cells of the body we come from one cell but it’s the result of the combination of the egg and the sperm, this cell is going to give the full genetic information to these cells that come from the first one, so all the cells in our body are going to have the same genetic information but the genes that are expressed out of every cell depend on many environmental themes. This means that the final individual is going to be a mix of what the genetic issue says and its environment. This depends on the environment where this cell is developing, the embryo is developing and these genes that are going to be expressed can be a little different. The final individual will have this expression of the genes depending on the mother and this can be sometimes those little physical characteristics that can come from the mother that carries the pregnancy, sometimes can be risk factors for some sicknesses that turn on or off depending on the environment of the uterus, many many things are not related by the intrauterine environment. Both mothers give genetics, and the mother who carries the pregnancy is going to give this child the final inputs.
If a couple goes through ROPA that means they are legally both mothers of the child but also any remaining embryos belong to both mothers, so if the couple breaks apart, these embryos can’t be used except for the situation in which both ex-partners agree to sign a consent to go for treatment and also be legal mothers again for this child. We need the consent from both mothers, even though one is the genetically related and the other one have gone through the transfer, but the legal rights of these two mothers are the same, they both have the same rights on these embryos independently of the genetics.
The law says it has to be anonymous. Our concept of anonymity depends on each clinic interpretation of the law. Unfortunately, there are no Basic guidelines on what we should communicate about the games to the recipients, so there are some clinics that are more open about it, some clinics are more restrictive. We usually have many inspections, and it also depends on the person that comes to the clinic and can decide if we do it in a too restrictive way or to open, so we are kind of a little tight in these subjects. In our clinic, we inform our patients about general phenotypic characteristics, age, blood group. Other clinics only provide information on age and blood group. They are more restrictive, and you are completely right, the law is not applied in the same way, the law is very generic, it says it has to be anonymous but what’s considered anonymous, who knows.
We don’t really give this educational information because we have this feeling that, as I said, the individuals are genetics, environmental issues. I’ve been working for 20 years in the egg donation process, and there are two main profiles of donors, at least in our clinic. There are the donors that are university students, and they want to get some money for travelling or something, they know that they can help, they’re young, and they come to the clinic to donate. There’s the other profile which is the person who Works maybe in a supermarket, and they haven’t had the opportunities of becoming a university student, and they are young, they had their kids very young, and they are not going to use their eggs anymore, they know that they can help and say well why not. If I had to compare these students with this other group, sometimes these other group donors are survivors of society, they’re really smart, but they didn’t have these opportunities, and sometimes we have social issues about it. What we’re testing or trying to give is not to define the donors only because of their capacity of education or the stores, we don’t want to select these donors like super first-class donors, and whatever the rest is because of these kinds of social issues we don’t provide information on the hobbies or education because those are more environmental of course there’s a genetical basis, but there’s a lot of epigenetics going on in here and what we want to give is an unequal right for all the eggs.
Single patients or monoparental families are the ones that mostly ask for embryo adoption. To give you an example: I’m single, maybe I’m a little older, I tried several techniques, it didn’t go through, I might get an embryo as a concept is I’m helping these embryos not to be lost and also is more economically beneficial. Monoparental families start with an embryo donation, it’s the most common type of embryo donation that we have. The waiting times depend on the phenotype. For Caucasian phenotype, it can be from no waiting time at all to 2-3 months. For other ethnicities, waiting is longer because they are less common in our area.
Some couples have really defined what they want to do, who is going to be the donor and who is going to be the recipient. Sometimes, it’s not as specified, and we’ve built a lot of families of all kinds. We have many families that one of the partners give the eggs to the other mother, and they have a child out of this. Then for the second child, we do it the other way around, so the one who was the carrier gives the eggs to the other mother, so in concept, they both share genetics and epigenetics for all of their children. There are other couples when there’s an age difference, what we recommend is for the younger one to give the eggs, for the older one to carry the pregnancy, and sometimes if we can’t do it all the way around, then these embryos of the couple can be transferred, also to the one that gave her eggs previously. All the combinations, we’ve done it, and those can be planned, the limitations are the medical issues that the partners can have like the age, ovarian reserve and all the other issues can change the way of the ROPA method.
The risks of receiving any gamete or an embryo are related to the age of the mother that is going to carry and all the medical diseases that could be concomitant to this person. Also because with a given gamete there’s a little increased risk because of the technique of preeclampsia which is the high blood pressure at the end of the pregnancy. It is because of some immunological issues that we are still trying to understand, but it’s low, and usually, it’s not that severe. Apart from this risk of preeclampsia, the chance of pregnancy depends on the age of the egg that generated this embryo. In Spain, the law says we can’t transfer embryos over the age that we consider adequate, and every centre makes their own interpretation according to what we consider would be the maximum age that we would accept. With ageing comes diabetes, the high blood, the overweight etc ., so we have to decide what is the age where we wouldn’t transfer an embryo. In our centre, it is 50, which is the main physiological age for menopause. In some centre, it’s 55 in Spain. In most centres in Barcelona, it is 50, but some of them accept 55.
A couple can give all of the embryos that they have remaining. The problem with this is that we usually don’t have that many embryos remaining, the supernumerary embryos, especially when we talk about day-5 embryos, there are not that many of them. If we are talking about a standard patient or a couple who gives their embryos, those are the patients that already used some of the embryos. Usually, these groups are 1-3 embryos at the most, but the patients that want to donate these embryos can give in donation as many embryos as they have.