Egg donation is a fertility treatment used by women who cannot use their own eggs to have a child. Choosing this solution is probably one of the hardest steps of one’s own fertility journey.
During this #IVFWEBINARS, Dr Maria Arqué [International Medical Director at Fertty International
] considers the subject of IVF & egg donation; the process, risks and limitations. Equipped with this information it is hoped that your decision regarding this type of treatment will be made easier.
What is an egg donation IVF
Before we can start talking about any subject, we must define it. Dr Arqué starts by describing egg donation as the process by which a woman donates eggs to enable another woman to conceive as a part of an assisted reproduction treatment. It is basically offered to patients who have early menopause, have low quality eggs or have had previous chemo- or radiotherapy (and as a result, they’re not producing eggs anymore). Egg donation is also recommended for those who underwent previous unsuccessful fertility treatment (failed ART) as well as to those affected with genetic diseases that cannot be diagnosed on the embryo. Finally, it is the only solution in cases where ovaries are not accessible for egg collection.
Dr Arqué explains how the legislation on egg donation works in Spain. There are a few important issues to take into consideration when deciding on the treatment in that country. Firstly, egg donation in Spain
is anonymous. It means that neither a donor nor recipient can know each other’s identities. Secondly, egg donation is a truly altruistic act – donors do not receive compensation for it. The only costs that are refunded are those of travel, accommodation, medical tests, etc. Finally, under the Spanish legislation, it is the medical team that selects the donor based on phenotypical and immunological characteristics of the patient. In practice, it means that they are looking for a donor who looks much like a patient.
The donor selection
According to Dr Arqué, one of the most frequently asked questions is how egg donors are selected. In the light of the law, egg donors must be healthy women between 18 and 34 years old. The upper age limit is dictated by the fact that over the age of 35, there is a decline in the quality and quantity of eggs. To diminish the risk of problems with eggs’ quality, doctors have to prepare a thorough medical and family history of the patient and the donor. The egg donor undergoes psychological tests and an extensive assessment including tests such as blood group and Rhesus, virals (HIV, hepatitis B and C, syphilis) and sexually transmitted diseases (STD). Additionally, there are different genetic tests conducted – karyotype (being ‘a map of chromosomes’) and a panel of recessive diseases (called also ‘the genetic carrier screening’). The latter includes e.g. cystic fibrosis mutation, muscular spinal atrophy, X-fragile syndrome testing, sickle cell and thalassaemia and is used to match the donor not only according to the physical characteristics, but also according to the genetic information and, as a result, to minimise the risk of having a baby with genetic diseases. Apart from the genetic tests, there are also gynaecological tests (AMH and scan) included in the egg donor selection process to make sure that there are no factors possible to affect the ovarian stimulation and the egg collection process.
As egg donation is anonymous in Spain, the only information on donors that can be accessed by patients is age, race/ethnicity, blood group and Rh as well as general phenotype characteristics (hair, eyes and skin colour, height and weight).
The recipient screening
Patients choosing egg donation treatment must undergo a detailed assessment as well. There are mandatory examinations, necessary in the European legislation on infertility treatment, as well as tests required on the basis of each patient’s individual case. The list consists of tests for virals (HIV, HBsAg, anti-HB core, HCV, RPR/VDRL), Rubella IgG, blood group and RH, full blood count (hemiogram), TSH and vitamin D. Dr Arqué says that doctors also have to screen the patient to see if there are no pap smear test abnormalities and do an ultrasound examination just to make sure that the uterus is normal and free of fibroids or polyps that could interfere with the implantation. Depending on the patient’s age, doctors could ask for a mammogram and a clearance letter from a patient’s GP stating that there are no contradictions for pregnancy.
When a woman is undergoing egg donation treatment with her male partner, he is required to have some tests done as well. These most frequently include virals, blood group and RH, karyotype and semen analysis.
The egg donation IVF treatment timeline
In order for us to grasp the timeline of the egg donation treatment, Dr Arqué goes on to present a full treatment cycle. It starts with an initial consultation – first online, and then usually a presential one at the clinic. During the latter, all the required tests are done and a patient’s male partner is asked to leave his sperm sample to be frozen. In this way, it will not be necessary for him to come to the clinic on the day of the egg collection from the donor. The results of all the tests will be available after 2-3 weeks and then another (preferably online) consultation takes place. When all the treatment issues are discussed and set with a patient, the clinic goes on to select the egg donor. The egg donor is then required to undergo ovarian stimulation (lasting for approximately 2 weeks) prior to the egg collection. On the day of the egg collection, the frozen sperm is thawed and afterwards, the eggs and the sperm are put together for fertilisation. Fertilized eggs (embryos) are left in the lab to grow until they reach the stage of a blastocyst (day 5 or day 6 embryo). If the embryos are of good quality, they are frozen. At that point, the patient starts her endometrial preparation. The endometrial preparation usually begins one week before the patient’s period, together with the injection of a GnRH antagonist – just to make sure that the ovulation is done and it does not interfere with the preparation. Once a patient gets her period, she starts the hormonal treatment (with patches or pills) to prepare the lining of the uterus for the embryo implantation. The response of the lining is then checked with a scan and a blood test. If the results are ok, the patient is told when to start a progesterone therapy. After 5 days of progesterone use, the embryo transfer is conducted. After 2 weeks have elapsed since the transfer, the pregnancy test is done and the pregnancy is confirmed. Dr Arqué explains that generally the full treatment process takes around 3 months (counting from the initial consultation to the moment of the embryo transfer).
Dr Arqué also mentions the possibility of synchronising the patient’s cycle with the cycle of the donor and conducting the so-called fresh embryo transfer. However, it happens that the cycle of the egg donor might not go as well as expected – meaning there are no good embryos available for transfer on time. This might be highly risky when one realises that most patients come for the embryo transfer from abroad and have to travel long distances for that one procedure. Taking it into account, doctors prefer to proceed with frozen transfers, especially as the chances of success are pretty much the same in case of fresh and frozen embryos.
The programmes on offer
Clinics nowadays make different egg donation programmes available. The patients can choose among options with various guarantees, tailored especially to their needs. Dr Arqué says that the standard programme at her clinic offers minimum 8 mature eggs from the door and 3-4 blastocysts for each egg donation cycle on average. There are also options such as Exclusive Egg Donor (guaranteeing all the eggs from the donor’s stimulation cycle) and Baby Guarantee Programme
(including 3 cycles of egg donation).
The egg donation success rates and limitations
Generally, egg donation treatments can boast high success rates. The pregnancy rate per transfer is more or less 55-60% and cumulative pregnancy rate (out of the cycles conducted at Dr Arqué’s clinic) comes up to 80-85%. However, even though this type of infertility treatment is a great way to overcome obstacles such as patients’ advanced age and the decline of eggs’ quality and quantity, it is not free of risks and limitations. There are infertility problems that cannot be addressed even with egg donation and these include coexisting female infertility factors (e.g. uterine fibroids, malformations or thrombophilia) and male infertility.
Finally, Dr Arqué stresses one very important thing to remember: biology is not mathematics. One must remember that even when using egg donor, cycles might not go as we have expect. For example, egg donation is not a guarantee of euploid embryos – the only solution for that is preimplantation genetic testing (PGT). Unfortunately, the latter is not medically indicated in all the cases.