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Contemporary and effective alternatives after failed IVF with donor eggs

Uliana Dorofeyeva, MD
Director of International Cooperations at IVMED, Medical Director at OVOGENE Egg Donor Bank, IVMED

Category:
Donor Eggs, Failed IVF Cycles

Effective alternatives after failed IVF attempts
From this video you will find out:
  • What are the age-related changes in oocyte mitochondria?
  • Why egg donation needs an alternative?
  • What is spindle transfer and pronuclear transfer?
  • What are the advantages?
  • How to prepare for an IVF treatment in Ukraine?
  • Why is it important to genetically screen the oocytes?
  • What is the advantage of polar body NGS testing?
  • When to stop egg donation treatments after failures?
   

What is spindle transfer and pronuclear transfer?

In this webinar, Dr. Uliana Dorofeyeva, Director of International Cooperations at IVMED, Ukraine, and a Medical Director at OVOGENE Egg Donor Bank who has talked about some alternative procedures like Spindle or Pronuclear Transfer.

What is spindle transfer and pronuclear transfer? - Questions and Answers

Is it possible to ship biological material (donor oocytes) to Germany?

The regulations in Germany are limiting oocyte donation, so it is impossible to transfer those materials to Germany. You can consider coming to Austria, which is closer, or to some countries where oocyte donation is legal. If you are talking about, for example, NGS testing for your own oocytes and transfer your own embryos back to Germany, this can be done, but with donor materials, it is not possible.

Regarding spindle transfers. Is there an age limit for this treatment?

I would not say an age limit but the limit of being able to provide the materials. After we access the patient, and we know the FSH, AMH, AFC level, we are checking the previous outcomes for the stimulation cycles. We are selecting an optimized stimulation protocol, and we expect to receive at least 2-3 zygotes from that patient – this is a good candidate to go ahead with the spindle transfer. The average age we are talking about will be 40 years old, but sometimes we may accept patients if they’re 42. Sometimes, patients who are 39 cannot be accepted for this option due to the ovarian reserve and the previous simulation failures.

For a patient over 45 who has irregular ovulation, would it be possible to use own eggs and spindle egg donation in the UK?

Irregular cycles already mean that the patient is in her pre-menopausal period, so it’s better to check the AMH level and AFC, also if there were previous stimulation cycles, what was the outcome, and if the patient was responsive to the gonadotropins. For some patients, we can consider the option of several stimulation cycles and getting all the oocytes or fertilized zygotes together. With an AMH of 0.2, it is unlikely that we would consider that patient into the spindle transfer. For such patients, we are trying to offer also so-called combined oocyte donation. We go ahead with the stimulation of the patient, and then if we are receiving biological material from the patient like 1 or 2 oocytes, we are also fertilizing them with the male partner sperm and cultivate them, own oocytes and donor oocytes. If we are getting embryos, we decide which embryos, we are going to transfer. With 0.2 and being 43 years old considering the spindle, the transfer is unlikely, but we can consider receiving more medical tests and the results, so then it can be possible.

If I want to try the spindle transfer, how many eggs will I need to provide?

We are expecting at least 2-3 zygotes to start working and scheduling the spindle transfer. 2-3 zygotes if we are expecting a fertilization rate of 80%, we should have 3 4, or even better 5 oocytes collected and for them to be mature.

The spindle transfer is an option to consider after using own oocytes is exhausted? How will I be related to my baby? I am using a sperm donor, so it is important to be related to the baby.

In spindle transfer, we call a baby being a three-parent baby. There is no opportunity right now to provide a specific percentage of how much you will be related to the baby. The spindle transfer is involved in the cell division, it also consists of your genetic materials, so that baby will be related to you, but also the donor. The donor is providing the genetic material and to the sperm donor as well. That’s why we call those babies three parents baby.

Is it easy to get to Ukraine for treatment these days?

Yes, it is quite easy, and as I said, patients are arriving in Ukraine for their treatments. What we are recommending is to consider international insurance that will cover COVID-19 as well, but we had some time where the borders were closed for foreigners, but now it’s ended. There is no limit for anybody to come into Ukraine.

There is a recommendation of being tested, and probably this is the recommendation from your home country, but there is no need to be quarantined if you have any symptoms, etc., or and there are no requirements for providing any medical confirmation letters or something like this. If the borders will be closed again because it’s been mentioned that maybe this will happen soon for the Christmas period. When the borders were closed before, it was resolved by providing a certificate or the official letter from the clinic that your reason for visiting Ukraine is medical treatment, and this was an exception. For medical treatment, anyone was able to visit Ukraine, even when the borders were closed.

Can the eggs be collected over several cycles, and those can be vitrified, for example, like 2+1+2 to get 5?

Yes, this is something that is offered for some patients, but we need to understand also the time frames. We are explaining to the patient that one stimulation cycle is one month and then for the second cycle, usually we recommend resting, or we are checking the antral follicle count, and then we are stimulating only after one month break. To perform 3 treatment cycles, we need to have 3 visits to Ukraine, we need to have about 6 months, but yes, it is possible.

Do you have partner clinics in the UK that will treat a patient over 45 in combination with your clinic?

In the UK, clinics are having an age limit, they will not accept a patient for IVF treatment if they’re overage. If a patient is coming to the clinic to receive ultrasound diagnostics or hormonal levels measurements, this is possible, and this can be performed. The responsibility for the treatment cycles is totally on us, on the Ukrainian clinic.

I am ok with collecting oocytes over several cycles and coming to Ukraine. How much time do I need to reserve for this?

We need to coordinate your menstrual periods initially, we need to have all your blood work and the screenings which we are requesting in Ukraine to be done and sent to us. We will check all of those. If everything is fine, also we need to have a GP clarification and confirmation that there are no risks for carrying the pregnancy or the contraindications for IVF. If this is all available, we will be able to assist in preparing the stimulation protocol. The protocol will be given to the patient, and if the patient has a treating physician who is ready to assist, we will be in touch with our doctor, our coordinator, and the doctor of the patient, and the patient herself. Four of us are coordinating the whole process, and we need to see how long we can coordinate this.

What can be performed in the facility in the home country, we decide when patients should come to Ukraine, for example, we also had a practice when clinics performed even egg retrievals for the patients, they fertilized their oocytes, they created zygotes, and those were transferred to Ukraine for further pronuclear transfers. When we are talking about a pronuclear transfer, you need to remember the scheme. We need to work with the pronuclear stage embryos to take the pronuclear from one oocyte and to put it into the cytoplasm of the donor oocyte, so this was done with some clinics by sending zygotes to Ukraine.

Authors
Uliana Dorofeyeva, MD

Uliana Dorofeyeva, MD

Dr Uliana Dorofeyeva is a Director of International Cooperation at IVMED, Ukraine, and a Medical Director at OVOGENE Egg Donor Bank. She is a multi-talented, engaging and results-oriented fertility specialist with significant experience in ART. She is trained in all aspects of andrology and reproductive endocrinology with exceptional knowledge in the areas of laboratory quality control, vitrification of oocytes, cryopreservation of gametes, embryos and unique ovarian tissue, micromanipulation of gametes including Intracytoplasmic Sperm Injection and Assisted Hatching. Worth mentioning that Dr Uliana is a member of ASRM and ESHRE (American and European Society of Reproductive Medicine).
Event Moderator
Caroline Kulczycka

Caroline Kulczycka

Caroline Kulczycka is an International Patient Coordinator who has been supporting IVF patients for over 2 years. Always eager to help and provide comprehensive information based on her thorough knowledge and experience whether you are just starting or are in the middle of your IVF journey. She’s a customer care specialist with +10 years of experience, worked also in the tourism industry, and dealt with international customers on a daily basis, including working abroad. When she’s not taking care of her customers and patients, you’ll find her traveling, biking, learning new things, or spending time outdoors.

Disclaimer:

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