Watch the recording of the Online Patient Meeting with Gad Lavy, M.D
., F.A.C.O.G, the medical director and founder of New England Fertility (NEF), USA. He answered patients’ questions on egg, embryo & sperm donation in the USA – availability, legal aspects & costs.
Dr Lavy started his presentation by explaining the process of IVF. He began by explaining how ovarian stimulation works, where the woman would get medications to increase her egg production, which then will be retrieved and fertilised. Created embryos will be then cultivated, and when they are ready, one of them, most of the time, will be transferred.
Dr Lavy emphasised that nowadays, medications are much better, not only are they more effective, but also much safer than they used to be. The fact that the embryos are growing in the laboratory for 5 or 6 days until the blastocyst stage before the embryos are placed back into the uterus had made a huge impact on success. Just by watching the embryos grow, it’s possible to quickly tell the difference between viable or not-so-viable embryos. Nowadays, it’s easier to pick the embryo that will give you success. The sperm injection (ICSI) procedure is a way of fertilizing the egg by inserting a single sperm into each egg. It has been a big step in IVF as it allows using sperm that is not always of the best quality and still gets the same results for fertilization and embryo development. Embryo freezing allows the freezing of the embryo at any given point and then expects the embryo to retain its viability when it’s thawed whether it’s a week later, a month later, or a year later, the embryos are the same.
Another big development was genetic testing on embryos. There is a significant improvement, almost double the success in embryos that have been genetically screened compared to embryos that have not been screened. Genetic screening of embryos has become very standard, initially, it was done on older women where a higher percentage of abnormal embryos was expected, but in the last few years, in the USA also donors are doing this test, even in these young, healthy women there is still about 30 or 40% of the abnormal embryos. For a woman who’s 40, maybe 90% or more of her embryos can be abnormal.
If a partner’s sperm is used, a semen analysis is required, sperm is usually frozen, and then it is used for fertilization before the sperm is used, genetic carrier screening is performed to make sure that we know if a patient is a carrier of any kind of genetic conditions, and if he is a carrier, we need to make sure that the egg donor is not a carrier of the same genes. That is listed as FDA testing, which is standardized testing, which is more extensive in the case of using a surrogate. If a donor sperm needs to be used, one of the commercial sperm banks the clinic works with. Those are three of the largest sperm banks in the US. The sperm donors go through the same screening process that is used for egg donors, so you can be assured that you’re not going to have any genetic issues, infectious disease issues and so forth.
Egg donation is usually offered to older women or women that have poor egg quality, which usually relates to age. For women, the reproductive window is much narrower than it is in men. By the time women get to their late 30s or early 40s, their fertility declines dramatically. Therefore, most of the patients who require an egg donor are those who are too old to have good eggs or have tried IVF without success and had genetically abnormal embryos. There are also cases where a woman carries certain genetic conditions that make it impossible to have a normal child and some cases where there have been environmental exposures that affected the egg to radiation and chemicals and so forth.
Same-sex couples and single men require an egg donor to have their biological child, it will be their sperm and an egg donor and a carrier to hold the pregnancy. In the U.S., the entry criteria for becoming an egg donor are being a young woman under the age of 30, they have to be a healthy, non-smoker, and with no significant family history, any donor who is adopted is not accepted because their family history won’t be known.
Once the donor is accepted at this first stage, the screening takes place starting with the medical screening, where the medical history and the medical records are reviewed, there are also a lot of psychological evaluations, and an interview with a donor is done in person with a counsellor, and then such donor will have a written personality assessment test and needs to do more genetic testing, also genetic testing is performed including extensive carrier screening, and then infectious disease, such as Hepatitis, HIV, CMV Syphilis, Chlamydia and so forth. The donor profile is created, which is a compilation of all the information available about the donor and her family, her occupation, hobbies, and what books she likes, and there are also some pictures of the donor available. For many people, deciding to use an egg donor is a very big emotional step, and some people never get past that.
You have to be comfortable not only with the fact that you’ll be using a donor, in other words, you’re not going to be using your own genetics, but once you’ve made that decision, once you’ve crossed that hurdle, the next is to find a donor that meets your requirement whatever your requirements are.
You will get some information on the physical characteristics, background education as well as ethnic background of the donor. You will also have the option to choose whether you want to have any connection, any contact with the donor, or not. In the U.S., there is no restriction on having a connection with a donor, so for some couples, it’s important to establish that connection, some prefer to have a relationship, meet in person or online speak, while others don’t want to meet the donor, but that option would be available for the child when the child reaches an age where they can decide if they want to know who the egg donor was and the meeting can be arranged.
The whole process of selecting an egg donor usually takes one to two months, the clinic’s staff helps with your list of requirements, and they also help with deciding the best donor for you. If you live in Europe, the sperm can be shipped to the USA, or if you’re using a sperm donor, you can look for one in American sperm banks. When it comes to the embryo transfer and if you’re going to be carrying the pregnancy, it takes about a month to be ready, you can prepare for the transfer in your home country, and then you’ll be able to come to the USA and spend there less than a week, typically 4–5 days. You need to come a day or two before the transfer to get yourself acclimated, the day before an ultrasound will be performed to make sure all is okay. Then you have the procedure, and you rest for the day, and then the next day or the day after you can go home.