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

Dr Manuel Izquierdo
Director of Medical Quality & Consultant Gynaecologist

Donor Eggs, Embryo donation

From this video you will find out:
  • What do embryo and double donation mean?
  • For whom are those treatments indicated?
  • What does the process of embryo donation look like?
  • What does the process of selection of donated embryos look like?
  • What are the advantages of embryo donation?

Where do the donated embryos come from?

In this webinar session, Dr Manuel Izquierdo, Director of Medical Quality & Consultant Gynaecologist at IVF-Life Madrid, has discussed the pros and cons and options of embryo donation.

Embryo donation & double donation

Dr Izquierdo started his presentation by explaining the definition of embryo donation, which is the adoption of embryos coming mostly from the patients who have already fulfilled their dream of having a family. Sometimes we have more available embryos than the couple, or the woman is going to use. One of the options by the Spanish Regulation is donating these embryos to any other couples or women. At this moment, there are 80 000 embryos stored in the IVF Life clinics in Spain from many years of treatments being performed. Most of these embryos are coming from couples that are not allowed to donate these embryos. The alternative is double donation embryos coming from fertilization with donated sperm and eggs.

Embryo donation – main indications

  • heterosexual couples in which both have fertility problems
  • a single woman with insufficient or poor ovarian reserve
  • female couples when oocytes of neither woman can be used
  • in cases of implantation failures or repeated miscarriages

Once we have these embryos, we need to do the endometrial preparation, which is very easily most of the time. Sometimes, we even take the advantage of the woman’s natural cycle, every woman with a regular period is ready most of the time for the embryo implantation every month, so sometimes, we take advantage of this endometrial uterine cavity preparation promoted by the natural cycle. However, most of the time, we take control of the endometrial preparation, if we want to perform the preparation in advance and we want to set a day in the future for the day of the embryo transfer, we can set up the use of hormonal preparation. This is a very light hormonal treatment because we try to get a similar preparation like the body is producing in the natural cycle. The basis of this preparation is mainly oestrogens, and they will promote endometrial preparation. We can measure this preparation after 2 weeks of taking estrogen pills most of the time, we have available estradiol patches as well. These oestrogens are taken orally or through patches will make the endometrium grow and have a good lining, we will measure it by ultrasound scan, we will check blood hormonal levels, and if confirmed, we are ready to implant these embryos once we start with progesterone supplementation.

The key is having a good lining, but at the same time to set the best moment to start progesterone supplementation and taking this progesterone at least for the same days the embryo is, this is the general rule. Sometimes we need to adjust the starting of progesterone in terms of very narrow windows of implantation, but the main rule is more or less to take progesterone the same days the embryo is. Most of the time, we need to supplement for 5 days with progesterone before embryo transfer. Embryo transfer is a regular procedure, it’s very easy to transfer the embryo and place it with the ultrasound scan guidance most of the time, and there’s no problem.

Embryo donors – requirements

  • embryo donors must meet the same requirements as gamete donors
    • age:
      • female: 18-35
      • male: 18-50
  • successful screening testing negative for infectious, genetic and hereditary diseases

Phenotype matching is mandatory in Spain, we always need to match race, size, hair, and eye colour), blood type doesn’t have to be matched, but it is considered if the couple wants to make sure that their future child will have the same blood type.

According to the Spanish law from 2006, 4 options can be done with the remaining embryos that are not going to be used, destroying the embryos, donating the embryos for research, keeping these embryos for the woman or the couple just in case and the alternative of donating these embryos to other couples, but the woman must be under 35, and the male is under 50 years old. The nature of donating such embryos must be anonymous, voluntary, and altruistic, as the Spanish law requires.

Sometimes we recommend the patients perform PGT-A on those embryos to check the aneuploidies, hereditary diseases or other alterations that may affect the viability of the embryo. However, the main thing is if we consider the egg donor or embryo donation is needed in a woman being under 35 years old having all these genetic testing, most of the time, there’s no need to consider genetic testing.

Embryo donation – advantages

  • high-quality embryos from patients whose fertility has been proven
  • an easier and faster process
  • the total cost is significantly reduced
  • no prior hormonal stimulation to obtain oocytes
  • possibility of transferring in a natural cycle
  • total anonymity of the donation, stipulated by Spanish legislation

The pregnancy rate of embryo donation is about 60-70%, this is the same pregnancy rate as with double donation. The prognosis of the statistics of embryo implantation depends mainly on the woman’s age, and women donating eggs or embryos must be under 35 years old, therefore, the pregnancy rates are the same.

- Questions and Answers

Are there couples in your clinic willing to give up some of their embryos for adoption to other couples? Are there any waiting lists?

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.

What is the pregnancy rate with embryo donation?

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.

Are you able to tell us about live birth rates?

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.

In what stage of embryonic development are the donated embryos?

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).

I had the first FET with donated embryos, but it did not take. I’m thinking of a 2nd attempt but was advised to do a myomectomy for 6.5 centimetres sub-serosal fibroid first. How long to wait after surgery before trying again? How many attempts, on average, lead to a successful pregnancy, in your opinion?

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 had a laparoscopy for removal of endometriosis 3 months ago, how long should I wait to attempt to try embryo donation?

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.

How long do you store the frozen embryos?

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.

When the patients don’t want their embryos, what percentage discharge them or donate them?

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.

What fertility drugs will you recommend for someone who had a miscarriage and has been trying to conceive for over 2 years?

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.

Is it possible/recommended to have more than 1 embryo from the same donor to have siblings in 2 separate pregnancies?

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.

Is embryo donation success affected by menopause?

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.

I had an ectopic pregnancy after a transfer of egg donation. I’m very worried that it may happen again since one of my tubes was removed. I would like to try again, but what are your recommendations?

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.
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Dr Manuel Izquierdo

Dr Manuel Izquierdo

Dr Manuel Izquierdo is part of the IVF-Life group as Director of Medical Quality & Consultant Gynaecologist at IVF Life Madrid. Graduated in Medicine and Surgery from the University of Salamanca, specialising in Gynaecology and Obstetrics, from the Hospital Universitario Fundación Jiménez Díaz. Dr Izquierdo also holds an MSc in Human Reproduction from the Complutense University of Madrid. Dedicated to the field of fertility for more than 25 years, he has developed his profession in different centres, always projecting his vocation of help and service to patients until today.
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Caroline Kulczycka

Caroline Kulczycka

Caroline Kulczycka is managing MyIVFAnswers.com and has been hosting IVFWEBINARS dedicated to patients struggling with infertility since 2020. She's highly motivated and believes that educating patients so that they can make informed decisions is essential in their IVF journey. In the past, she has been working as an International Patient Coordinator, where she was helping and directing patients on their right path. She also worked in the tourism industry, and dealt with international customers on a daily basis, including working abroad. In her free time, you’ll find her travelling, biking, learning new things, or spending time outdoors.