Finding the right donor when donation is anonymous

Laura Garcia de Miguel, MD
Medical Director at Clinica Tambre, Clinica Tambre
Joshua Rackstraw

Category:
Donor Eggs, Sperm donation

From this video you will find out:

What is Fenomatch and how it works?
What features can be matched (hair colour, eye colour, ethnicity, etc.)?
How to make this important decision of choosing the right donor?
At which clinics can I find Fenomatch services?
How anonymous donor selection works at Clinica Tambre in Spain?
What are the donor recruitment criteria at the clinic?

Finding the right donor when donation is anonymous

How to find the perfect egg/sperm donor?

In this webinar, Joshua Rackstraw, Former Product Owner at Fenomatch together with Dr Laura Garcia, MD, Medical Director at Clinica Tambre, Madrid, Spain have been explaining how the phenotype matching algorithm works and how it can help with finding the best match in anonymous egg donation.

Fenomatch

Fenomach is a company that has been operating in clinics since 2018, and the first Fenomatch babies were born around May 2019. As of this moment, around 100 clinics use facial matching software to find a donor for patients, and they helped more than 7 000 families so far. Fenomatch offers a platform that allows clinics to find egg donors and sperm donors thanks to facial matching technology. It allows searching for facial features, which are inherited through DNA, and the objective is to have donor-assisted children that have a greater facial resemblance to their parents. Fenomatch was designed to give more information to the doctors who are choosing donors. Firstly you can search by the industry standard criteria, so for example, you can search for things like eye colour, hair colour, hair type, ethnicity, skin tone, height, and body type but not weight because body type is something phenotypic and weight is something that can vary throughout your life depending on factors that are not genetic. This technique allows us to analyse a map of the patient’s face and compare it with the potential donors, it works with egg or sperm donors, it’s possible to use photographs of men or women, and it works with heterosexual and homosexual couples, so it doesn’t matter if you are a male or a female or you’re looking for an egg or a sperm donor. The doctors can use that alongside the other criteria, which might include things like genetic testing, etc. A photograph of your face is needed where the phenotype is visible so that we can see the structure of the face, and we’re looking for some degree of facial similarity.

Donor selection

Dr Laura de Garcia described the general selection of donors in Spain, where egg donation is anonymous. Regarding the law, the physical characteristics of the recipient, the blood type, the facial resemblance carried out with Fenomatch technology and doctor-patient communication is taken into consideration. Based on that, the best donor is not only regarding physical characteristics but also in a general aspect to make the recipient feel sure that the best donor is chosen. If it is necessary because of implantation failure or repetitive miscarriages, sometimes it is necessary to perform immunological matching (KIR AA/ HLA C1C1), it is also possible to do genetic compatibility testing for the status of recessive mutations for more than 300 genetic tests. Patients are given a questionnaire, it is also consent for egg donation or sperm donation treatments, and patients need to fill it out. They also need to provide a photograph, this can be taken at the clinic to perform the facial matching, or if someone is living abroad, they can just send it via email for the most accurate results. The patient needs to look straight into the camera, without a smile and make sure the hairline is visible, without glasses, or jewellery and have the minimum makeup, only one photograph is required. The patients can also share photos of their children, also grandmothers, and mothers so that the doctors can see them.

Egg donor selection

The selection criteria for egg donors are as follows:

women less than 35 years old
minimum height: 1 meter 55
maximum body mass index (BMI) is 30

The first step is a visit with the nurse to exclude medical conditions, and that there are no hereditary diseases within their families, and that is when the process of egg donation is also explained. If all is okay and accepted by the recipients, the next step can start. It is an interview with the psychologist, which usually takes around 1 hour and 30 minutes to confirm that everything is okay, there are no mental pathologies, there are no abnormalities in personality, and that the lifestyle is normal. The last step is a medical test where a general health checkup is done with complete blood count, blood type, biochemistry, and serology, such as Cytomegalovirus (CMV) infection, HIV, Syphilis, Hepatitis B and C and others. An ultrasound with the count of antral follicles, smear tests, and vaginal cultures for chlamydia and other pathologies are also checked. Then, also the genetic tests, including karyotype and 15 important recessive mutations are screened to confirm that they are not carriers, for example, Fragile X syndrome, cystic fibrosis, Muscular Dystrophy, etc. The carrier status test of the more than 300 genes is also screened.

Sperm donor selection

The selection criteria for sperm donors are as follows:

less than 35
minimum height 1.70
maximum body mass index 30

The first step is a consultation with the andrology team, carried out by an andrologist. During this consultation, any medical conditions should be excluded, no background of diseases in their families, and the process is explained. Then, there is again an interview with a psychologist. The last step is the medical test and again general health check-up, such as complete blood count, blood type, biochemistry, serology, etc. Sperm count will be reviewed altogether with urine culture and PCR for Chlamydia, if all is okay, the last part will be the genetic test including Karyotype, cystic fibrosis and other basic recessive mutations. Then, the Carrier status test on more than 300 genes is performed. At Clinica Tambre, there are more than 2 500 samples available in the bank, including a wide range of phenotypes, not only Caucasian or Spanish, European donors, but also Asian, and Black donors, and we always use facial matching provided by Fenomatch because this gives tranquillity to confirm that the process regarding physical characteristics and physiology is going to be perfectly matched. There is no waiting list for treatment with donations.

How to find the perfect egg/sperm donor? - Questions and Answers

Why is there a selection criterion of 1.55m minimum for an egg donor?

It’s just to confirm a limit in regards to height. It’s extremely rare, to have a recipient who is shorter than this height and, of course, if we have a recipient that it’s really shorter than 1.55m, we will select another donor if necessary, but the majority of women in Europe that are applying for treatments close to our clinic, they are at least 1.55m. If they are sorter, it could be because of some genetic conditions, but of course, it also could lead to any medical problems, so that’s the reason why.

As with regards to Fenomatch, how do I, as a patient, know which clinics use your technology?

Basically, the best thing to do is ask. If you go to a clinic, they’ll be able to tell you what methods and what techniques they use for donor selection. Another option that you can do is if you go to EggDonationFriends.com, you can search for clinics there, and it will tell you if Fenomatch is available or not.

What kind of photo do you request from an intended mother? Does it have to be a current photo or a photo of me when I was young?

For the Fenomatch process, we need a photograph of you as an adult because that is when we can see the fully developed facial features, so that works best when we’re doing the matching with the artificial intelligence. However, as Dr. Garcia said, if you’re at the Tambre clinic, you can send them as many photos as you want. You can send them photographs of yourself as a child, you can send photographs of other children that you already have, and all of that can be taken into account as criteria.

Is the treatment done with fresh donor eggs? Or frozen at the Tambre clinic?

The majority of our treatments are done with fresh eggs, but we also have our own egg bank, so people that really need to organize their treatment, organize the exact day of the embryo transfer can do it with frozen eggs.

I am Filipino/Caucasian. I am between considering a clinic in Spain and one in Ukraine. There seems to be a little more liberty in sperm donor selection in Ukraine. Am I able to request a Spanish Caucasian sperm donation given my multi-racial background, provided the phenotypes do match at the clinic in Spain?

It’s not a rare case, I have lots of patients, especially from France and also the UK that is mixed, that are from different ethnicities. Our law considers that we really need to give the best candidate, not only in terms of ethnicity but also in terms of physical characteristics. As I’ve said before, we are flexible, and we really enjoy talking and communicating with our patients. In the past, I had black recipients asking for white as a donor, and I was always explaining that it was not permitted in Spain, as long as I had black donors in the clinic. In your case, which is more specific, I’m always very honest with my patients, and it’s extremely rare to have a Filipino/Caucasian donor in a donor sperm bank. We will be flexible, and we will select the best candidate. If’s a Caucasian and not a Filipino or Asian, that’s something that really can be taken into consideration, so it’s not the only ethnicity, but as I’ve said before, we match the color of eyes, hair, the physiology done by Fenomatch, so it’s really a global process, it’s not only regarding ethnicity.

Does it take longer to find an egg donor if you use Fenomatch? What happens if the match fails?

The short answer is no. The Fenomatch is done with artificial intelligence, which is much quicker, as Dr Garcia said. At Tambre, I think there are over 2 000 samples, so for a doctor to go through that many donors would take a very long time. With Fenomatch, a lot of that process can be done very quickly, so the answer is no. It’s not really a failure or a success. This is important to be aware of, all Fenomatch does is give a score based on facia resemblance, and then the doctor decides to decide if that score is good enough or not, or if the facial resemblance is good enough or not. Like with all the other factors essentially, this is something your doctor can help you with, and you should be able to speak to your doctor about it.

Is Fenomatch also considering intellectual matching?

You can search by education level, which is not exactly the same as intelligence or intellect, but it’s definitely a good way of measuring that, and I believe Dr. Garcia, you also do some psychological tests. At this point, it’s not matching, it’s the confirmation if the candidate is good to be a donor or not, so it’s not really a question of intellectual matching in terms of likes, etc. It’s more confirmation for each candidate if they have a normal personality and a minimum intelligence, so that will be carried out, with our psychologists.

Is the criminal background for donors also checked?

Let me explain that the majority of our donors are extremely honest, and they just come to our clinic, they really want to help people, they know via Facebook or via other ways that this is really a problem for some people to have children with their own sperm or eggs, so that’s something that it’s not really related with the compensation in terms of financial issues. It’s more to do with helping other people. If they have some problems, our psychologists will reveal that. The majority of them are just telling the truth, and they are just reporting they had some problems, not only criminal problems but also other issues such as disorders, etc. The psychologist will confirm 100% that everything is all right, and we can work and go ahead with the donation with that candidate.

Can Fenomatch technology be used also with non-anonymous donors?

Yes, of course. Fenomatch technology was designed in Spain to solve a very specific problem because in Spain as the patients can’t see the photographs of the donors. However, as you say, Fenomatch technology can be used as long as we have a photograph of the adult face of the donor, we can use it.

I am interested to know what has the best IVF rates: frozen or fresh egg donation?

When we look at the literature, it’s not 100% clear about that. Usually, the best success rates are with fresh eggs, but it’s more to do also with the egg donor, we have extremely good donors that work very well with a fresh donation, and by contrast, when we work with their frozen eggs, they do not work correctly at all in terms of the development of the embryos. With the frozen eggs, you really need to confirm with your clinic that the thawing of the eggs will be guaranteed, the number of a minimum of eggs because this is very important. With frozen eggs, there is a slight tendency for a chemical miscarriage. If we need to do the genetic screening of the embryos, we definitely need to use fresh eggs from a donor.

Would the doctor share the Fenomatch resemblance score of the chosen egg donor?

Doctors can share as much information as they think is relevant for you because it’s not identifying data. One of the reasons that patients have to be careful when knowing the Fenomatch resemblance score is that everybody wants 100 and if not 100, then they want 99. In fact, if you have a score of 99, you’re likely looking at two photographs of the same person, and if you have a score, which is between 80 and 90, you could well be looking at twins. If you have a score that’s between 70 and 80, you could be likely looking at a photograph of your brother and sister, and you don’t want to have children with those people for various reasons related to genetics, essentially. That’s one of the reasons why we tend not to talk about the precise mechanics of the score because a doctor would tell you that a score of between 60 and 70 is a very good score, but for a patient, 60 to 70 sounds not good enough. My advice would be that you speak to your doctor about the specific case and make sure you’re getting enough information. The thing is that without me knowing enough about your situation, your doctor, your history, your Leeds, what your face looks like, I can’t really tell you properly and communicate exactly how the Fenomatch score works. In summary, my answer is you should talk to your doctor about that.

Do you also offer an embryo donation? If yes, do you have Asian embryos?

Yes, we do have embryo donation, and once you apply for embryo donation, we ask you to send your physical characteristics, and we confirm if embryos that are already created are available in your bank. I think there are embryos in our bank that are mixed as the patient were half- Asian and half-Caucasian, but I would need to confirm that in my data.

How about the success rate with making an embryo, is there a difference between making an embryo with fresh or frozen sperm?

At this point, if the sperm is absolutely normal, there is no difference if it is fresh or frozen, and our recommendation is to work with frozen, and that will confirm that everything is alright, we will not have problems if there is a problem with the sample. It is also helping the clinic to be more flexible with the donor. By contrast, if there is the Oligoasthenoteratozoospermia, if we need to use a specific technique in our laboratory such as Chip Fertile, then fresh sperm is necessary, so what we always recommend is the first consultation with the advanced tests and freezing that sample, and if everything is all right, we will work with the frozen, and we will confirm that everything is absolutely fine. If there are some problems, then we will just confirm what type of vitamins and pre-treatments you need to take, and we will ask you to come for the fresh sample the day of the egg retrieval.

Is Fenomatch an additional cost, or is it included?

What we do in our practice and it’s always important in our treatment, there are no extra costs for this. It’s up to the clinic whether they want to include it or not. Most clinics do tend to include, it just because it’s quite an important service.

Where are the donated embryos coming from? Donors?

The majority of embryos are coming from egg donation, but also, it could be embryos that come from patients that used their own eggs, but if they are coming from own eggs, the woman must be younger than 35 years old. Usually, a patient having IVF they try to do as many transfers as they can without the donation. A lot of patients are a little bit older, they are in their 40s or 45s, so perhaps they want to transfer and have 1 or 2 children, and if they have extra embryos, normally they donate to other people, so that’s usually the origin egg donation with sperm of the partner or double donation.

If the clinic doesn’t offer Fenomatch, what’s another way to match the recipient with the egg donor?

If the clinic doesn’t have a Fenomatch, there’ll be a couple of things that most clinics do, so that will be things like they are checking ethnicity, skin tone, eye color, hair color, hair type, height, body type, and a few other features like that. Fenomatch is different because instead of just selecting the eye color, you can do the whole facial matching thing like the jawline, the size and shape of the eyes, and this kind of feature. Some clinics don’t use Fenomatch, and they do that manually, but the advantage of Fenomatch is that if you have many donors or many samples, it’s a way to get objective, scientifically verified results, and it often saves time.

How can a clinic get access to Fenomatch?

We already work with around 100 clinics around the world, and I should say the majority of them are in Europe, although we’re also in Argentina, Peru, Brazil. You can send me an email, and that is probably the quickest way for a clinic to get access to Fenomatch. If the contracts are signed, it just takes something like 24 hours to get the clinic signed up.

In the case of choosing an egg donor, is it possible for a patient to choose as other clinics will be showing examples of donors? Is it good to make my own choice, or the clinic has to select an egg donor for me?

In Spain, it is absolutely necessary to select an anonymous donor, so if eventually, you want to do egg donation treatment with eggs from another bank, I can accept that as long as you have no idea of the resemblance and all this image and selection of the donor. If it is 100% anonymous, we can accept that, but it’s not worth it because I cannot guarantee the success rates of our treatments with eggs that are not coming from our bank.

Given that Fenomatch is only 2 years old – how do you define successful matching given that most live births would still be infants? Could this change as they become adults?

We have not yet been able to do any testing of the Fenomatch babies because babies tend to have those lovely chubby cheeks because their phenotype hasn’t fully developed, so how do we know that it works that’s a good question. We trained the algorithm on photographs of members of the same family. In the initial training, and I’m talking about 2017, we used around 600 photos of individuals, and they were from 108 different families, so what we defined as a successful match is if the algorithm is able to identify members of the same family. Members of the same family have the same phenotype, and that’s what our algorithm is looking for. A couple of weeks ago, this was at the beginning of this month, I did a test where I gave the algorithm 600 random photographs, and one of those photographs was of my brother. Then, I compared them to my own face, and I personally think my brother and I look very different, he’s I have to say, is a lot skinnier than I am, but the algorithm was able to identify from a sample of 600 people, the phenotype which was shared between us. It takes a couple of seconds to do. That’s how we know that it works.

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Authors

Laura Garcia de Miguel, MD

Dr Laura García de Miguel has worked in the field of gynaecology and obstetrics since 2008. At present, she is a medical director of Clínica Tambre in Madrid, Spain. Dr García de Miguel has extensive experience in IVF and provides a highly personalized approach to each and every patient and custom-tailored treatments to meet the needs of various patients. Dr García de Miguel specializes in treating patients who have had previous IVF failures or who respond poorly to hormonal or IVF treatment. Dr Laura speaks fluent Spanish, English, and French and treats patients from all over the world.

Joshua Rackstraw

Joshua Rackstraw, Former Product Owner of Fenomatch, an algorithm that helps doctors find the donor with the greatest facial resemblance to each patient. A native Englishman, Joshua has been living and working in Spain for the last 10 years.

Event Moderator

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.

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