There are many difficult decisions when it comes to infertility treatment and – especially – IVF with donor eggs. Many patients cannot get rid of questions popping into their heads, like: ‘How are the egg donor and the egg recipient matched?’, ‘What about genetic inheritance?’, ‘Will the baby look like me?’ and probably the most important one: ‘Will the baby be healthy?’ In this webinar, Dr Stavros Natsis from the reputable GENNIMA IVF clinic in Athens
provides a clear explanation of these terms.
Dr Natsis starts by explaining that among all factors affecting fertility, woman’s age is the most important. Women are born with a certain amount of eggs and they grow older with them. A 22-year-old girl is at the highest level of her fertility, which is still only 25%. Three out of her four eggs have chromosomal abnormalities. At the age of 35, there is only one good egg out of five. Then there is a significant drop and at the age of 42, fertility level is only 4%, meaning one good egg every 20 eggs. Additionally, the miscarriage rate at the age of 44 skyrockets up to 50%. However, one has to remember that in the case of egg donation, a female patient’s age is not an issue.
Dr Natsis states that patients coming for consultation often wonder if egg donation is a right decision for them. It is probably one of the toughest decision they have to make in their life. It is generally difficult to convince a woman that the quality of her eggs are not good and that egg donation is the only suitable solution. In this case it’s highly important to find a professional IVF clinic that has a lot of experience with the egg donation procedure and has high success rates. Then, there is the choice of an ideal egg donor
. The donor is understood as a person who looks phenotypically like the female patient. It is also crucial that this person is healthy and has similar social, educational and religious background.
How donors are chosen?
Dr Natsis explains how donors are chosen. In Greece, egg donation is completely anonymous and a couple cannot find out the identity of the donor or see her present picture. In the same way, the donor has no idea where her eggs have gone. The procedure of choosing a donor starts with phenotype matching during which doctors have to make sure that the donor looks similar to the female patient. They choose donors out of a large database, focusing on those who have matching body type, hair and eyes colour as well as the smile. The clinic also conducts a thorough medical history including donor’s personal and family history. According to Dr Natsis, the donors usually are honest when they answer the questionnaire. However, if they tried to hide things, the questionnaire is made in a certain way that allows to pick up answers that are not true. Additionally, there are all the necessary blood tests for genetic conditions performed, like cystic fibrosis or muscular dystrophy, as well as for transmitted diseases like hepatitis, syphilis or HIV. Prenatal testing is also obligatory. If the couple is afraid of a certain genetic disorder, an additional genetic test can also be performed to the donor. Similarly, a donor can undergo a proper psychiatric evaluation conducted by psychiatrists. Of course, every donor needs to be screened for their fertility. The medical team will do all the necessary hormonological tests and the ultrasound scans. It would be good if a donor had already one child of her own as well.
HLA typing of donor
Dr Stavros Natsis refers to the HLA (Human leukocyte antigen) typing of a donor that many clinics offer today. It is a way to see if the donor and the recipient are matching immunologically. Although it’s not medically proven, some clinics use that in case they have recurrent failures with egg donation. Intended parents can also consider selecting a donor with a matching blood group – especially if they do not want to reveal the method of conception to their children.
When the clinic finds the ideal donor, they inform the couple immediately. There are two ways of embryo donation: the first is a fresh cycle and the second is to a thawed embryos transfer. If doctors go ahead with the fresh cycle, they try to synchronize the cycle between the donor and the recipient. The donor receives injections of GnRH analogues in order to start the hormonal stimulation. At the same time, the recipient starts a substituted cycle where she is given mild hormone replacement treatment (oestrogen) that helps to build up the lining of the womb. The donor always undergoes a tailor-made stimulation according to their fertility assessment in order to take the maximum amount of mature eggs. Dr Natsis says it would be ideally to take more than 10-12 eggs. Then the eggs get fertilised with IVF or ICSI, depending on sperm characteristics.
At Dr Natsis’s clinic, the embryos are put into the incubator where they start to develop. Clinics that have excellent results use new generation incubators which have time-lapse technology. Such incubators have slots for each embryo. After the embryo is inserted inside, the incubator will not open until the embryo transfer day. It has built-in cameras that monitor the way the embryo is developing. A big advantage of these new generation incubators is the fact that they do not open and they keep the stable microenvironment for the embryo development. Dr Natsis admits that they have seen quite a big improvement in the success rate by the time lapse technology.
When the embryos reach day 5, they have to be transferred back to their mother. The Greek law allows clinics to transfer up to two embryos. In case there are additional embryos/blastocysts, they can be cryopreserved for a future embryo transfer or for a second attempt or another baby in the future. According to Dr Natsis, if the clinic transfers two good quality blastocysts, the suggested success rate will be of 70 to 75 %, irrespectively of a mother’s age. Eight out of ten times that two embryos are transferred, the pregnancy will be a singleton but two out of ten will be a twin pregnancy. If it is not possible for a patient to undergo a fresh cycle, the blastocysts are cryopreserved and the transfer is done later, with similarly excellent success rates.
Pregnancy after egg donation
A pregnancy following egg donation treatment is the same as all other pregnancies, either natural or IVF. The mother is advised to have all the necessary pregnancy scans and tests. According to Dr Natsis, the possibility for Down syndrome and other chromosome abnormalities is much lower as they are calculated on the basis of the donor’s age and not the maternal age. The general health status of children under 5 conceived with egg donation is the same as the one of kids conceived with standard IVF.
Egg donation – will the baby look like the recipient?
Dr Natsis goes on to answer the most important question asked by most intended mothers: Will the baby look like me? The answer is: yes. There are a few reasons for that.
- Firstly, the clinics do their best when matching the donor with the recipient, both in case of phenotype and psychological preferences.
- Secondly the role of Epigenetics is now at the centre of egg donation research. Epigenetics has demonstrated that normal development does not depend only on a healthy genome but also on a healthy environment that the baby’s growing in.
Dr Natsis gives a beautiful metaphor, comparing genetics and DNA to a musical composition.
Genetics is a score of a musical composition whilst epigenetic is how the orchestra interprets the score.
So summing up, although donor egg recipients cannot pass on DNA to their children, they can strongly affect their children’s genes. In fact, there are several data supporting beneficial effects of a healthy lifestyle during pregnancy on the developing fetus.
Should I tell my children how they were conceived?
Another very difficult question asked by couples is that whether they should tell their children how they were conceived. According to Dr Natsis, there is no right or wrong answer. It depends on various factors, including couple’s social status, their needs and how open they want to be about it. Dr Natsis also highlights that if for some reason the family needs to track down the donor, they can contact their IVF clinic. Clinics keep a database and they can easily find the donor, especially for medical reasons.
You may be interested in reading: Telling kids they were conceived via egg donation
In conclusion, Dr Natsis gives some tips on how to find an ideal IVF clinic. Most couples usually know from the first visit to a clinic whether they like and trust the team there. Additionally, all good and reputable IVF clinics should work under strict regulations and follow strict protocols. There are some organizations that can ensure the correct functioning of an IVF clinic, like ISO or ESHRE (the European Society of Human Reproduction). Other important things patients should pay attention to include whether there is easy access to the clinic, a dedicated egg donation team that speaks fluent English and tailor-made treatments guaranteeing that each patient is treated individually. According to Dr Natsis, Greece is an ideal solution for egg donation. It is not only a perfect holiday destination where one can prepare for their IVF treatment in a beautiful and relaxing environment but also a country with a lot of benefits (e.g. clear laws, experienced medical teams) and reasonably low treatment costs as compared to the UK and the USA.