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
- female: 18-35
- male: 18-50
- successful screening testing negative for infectious, genetic and hereditary diseases
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.