Embryo donation explained – where do donor embryos come from & what are the prospects for patients?

Yes, we have couples who are donating embryos and most of the time we have no waiting list. We have a huge amount of embryos here in Spain, coming from all the years of fertility treatments. Usually, that would take more or less 2-3 weeks if we need to find some other ethnicity like Asian or Black. We always inform the patients about these circumstances, so it is not even more than 1 month.

The main message is that it is related to a woman’s age and the conditions for egg donation and embryo donation are the same in terms of woman’s age. Egg donation and embryo donation have the highest pregnancy rates of all. The answer is very clear, it’s 60-70% with the transfer of 1 day-5 embryo. It’s also important to mention that 30-40% of the patients don’t get pregnant after the first embryo transfer, most of the time, we offer to transfer a new embryo, second embryo and even a third embryo, we talk about this as a cumulative pregnancy rate, this means if we add all the pregnancies coming from the first embryo transfer, the second, and third embryo transfer. Cumulative rates are showing that more than 93- 95% of the patients are pregnant, and only 5-7% of the patients are not getting pregnant.

We have 10% of miscarriages, so we are not free of miscarriages. The mean number you need to think about is this 50-60% of the live birth rate.

I cannot tell 100% of the patients are getting day-5 embryos because we have donated embryos from some years before. Around 5-10 years ago, we performed day-3 embryo transfer most of the time, today we perform almost all transfers on day-5, and so most of the donated embryos are blastocysts (Day-5).

This embryo is big enough for a possible condition that will prevent the embryo implantation, and when it comes to removing this fibroid, there’s no general rule. Our protocol usually tells about waiting for 6 months after the surgery to try to get pregnant. The thing is that the uterine wall needs to recover after this removal and be strong enough for the pregnancy to go ahead. The cumulative pregnancy rate going to egg donation or embryo donation is very high, and most patients get pregnant in the first embryo transfer.

I want the patients to know that our body inside recovers very quickly. In my opinion, there’s no problem if the surgery for endometriosis is not touching the uterus and endometriosis, by definition, is not inside the uterus, it’s outside. There’s no issue to try to get pregnant starting from the first period after the surgery. In my opinion, there’s no issue at all.

I’ve been working in fertility treatments for 25 years, and I remember the time when the Spanish regulation did not allow using embryos longer than 5 years after being frozen. This limitation was removed in the last regulation because we know that the time of the embryo being frozen is not important for embryo viability. There’s no limitation for storing frozen embryos. I always tell the patients that our embryos could survive us, and the limitation for using this embryo is the health condition of the woman, not the years the embryos are stored for. Less than 1% of the embryos do not survive thawing. If they survive freezing, they are as if they’ve never been frozen.

I have no clear statistics regarding this. We inform the patients about their options, and sometimes they do tell us that they would like to help some other patients with the same difficulties. Possibly half of the patients are thinking about donating, and another half are on the other side, but it’s hard to tell the exact numbers.

It depends on if we find any condition that could tell us what caused this miscarriage. We have a lot of things that we could check including thrombophilia factors, immunological factors, endometrial receptivity factors and anatomical conditions in the uterus, so it depends on if you find any alteration or not. If there is a problem with thrombophilia, we could suggest anticoagulants, low-dose aspirin, and heparin. If there is some uterine condition like fibroids, we would need to look into everything, so it’s hard to answer this.

Sometimes patients are asking for this, but we cannot guarantee several embryos, we are guaranteeing 1 embryo. Sometimes we have more than 1 embryo, and if you succeed with this embryo and you are thinking of increasing your family if we have more embryos coming from the same egg donor etc., we can do it, it’s easy for us and it’s more natural.

At the same time, we need to remember we don’t know if we are going to get pregnant in the first attempt, if you have 2 embryos, maybe you will succeed with the first and the second one, but sometimes you might get pregnant with the second embryo transfer, and you start it with 1 embryo. We never know how many embryos we need for having 1 or 2 children etc., so it depends on the personal response. Even though we have 2 embryos doesn’t mean we will have 2 children. We have an opportunity of having 2 children, but we are looking for the first one.

I always tell my patients that the ovaries get older, but the uterus doesn’t, most of the time. This means that even if a woman is in menopause, we can prepare the uterus with hormonal supplementation to be ready for embryo implantation. Here in Spain, we consider performing these treatments up to 50 years old, a woman who has demonstrated to be in good health. We can perform embryo transfer, and we know a woman in menopause or with premature ovarian reserve can get pregnant because we know how to prepare the uterus even though there is no ovarian function.

Ectopic pregnancy is not so frequent, it is about under 2-3% of the embryo transfers and it doesn’t depend on where you’re placing the embryo because we check the embryo by ultrasound scan at the time of embryo transfer. Sometimes the embryo gets inside the tubes by itself and implants there. Sometimes the treatment of ectopic pregnancy implies removing the tubes, sometimes 1 of the tubes. I remember my gynaecological reproductive fertility treatment manual was saying that if a woman is having an ectopic pregnancy and is involved in IVF treatment and is going to be removed from the tube because of an ectopic pregnancy, you must consider removing the other tube as well.

I know few people acting like this, they sometimes remove the 2 with ectopic pregnancy, and the probability of having a new ectopic pregnancy in your remaining tube is very low. At this point, it could happen, you can have a new ectopic pregnancy in the other tube, but then the frequency of ectopic pregnancy is very low, so I would not be scared about this embryo transfer, and I would act as a usual.