Late motherhood and IVF with donor eggs in Poland
What does IVF process in Poland look like? What is the maximum IVF patient’s age allowed? Can I become a mother after 40 or 50 through IVF with donor eggs in Poland? What are the success rates? If you are interested in answers to these questions, this webinar is for you.
Have you considered Poland as a destination for your IVF treatment?
Watch the webinar recording to find out about the laws and regulations for egg donation treatment in Poland, possible side effects of late motherhood and medical requirements that need to be met before you’ll be able to start the treatment.
Dr. Katarzyna Olszak-Wąsik, the presenter, discussed the webinar topic and answered the questions from the webinar attendees during the Q&A session. If you missed the event live, watch it here.
IVF, donor eggs and woman over 45
It’s a frustrating and disheartening fact of life but female age can, and does, play an important role when trying to conceive. In today’s world, it’s becoming more common, within developed countries, for women to delay starting a family. Whilst there are many sociocultural reasons for this including financial stability, education and/or career, our bodies aren’t keeping up to date with modern preferences and female fertility can become an issue. It’s widely known that oocyte quality and quantity do, unfortunately, diminish with age, yet more women are choosing to embark upon motherhood later in life. Egg donation programs offer a chance for older women to become pregnant and carry a baby to term, but what is the process and are there any risks?
In this webinar, Dr Katarzyna Olszak-Wasik a specialist gynaecologist and obstetrician at Gyncentrum clinic, Katowice, discusses the side effects of pregnancy, with increased female age, and outlines egg donation treatment protocols and legalities within Poland.
Becoming pregnant and creating a family is an emotional journey and, for many, can lead to disappointment and heartbreak. With improvements in medical science and procedures, egg donation now offers a realistic solution for women wishing to start a family in later life, or for those who have experienced repeated failure to conceive due to female factor infertility.
It’s understood that increased maternal age can act against a healthy pregnancy and for women over 45 years of age there is a greater chance of developing high risk pregnancy conditions and obstetrical complications. Stillbirth and miscarriage rates are also known to be related to age and, alongside general health and maternal weight, increase with maternal age. Older mothers are more likely to suffer from pregnancy complications such as gestational diabetes, pre-eclampsia, placenta prevaria (where the placenta covers the cervix) and chronic hypertension (high blood pressure), there is also a higher Caesarean Section rate in women who are, again, over 45.
Before continuing to outline the donor egg procedures, used by Gyncentrum clinic, it’s important to note that the legalities mentioned are specific to Poland; differing legislation could apply when seeking treatment in different countries. Procedures may also vary, from clinic to clinic.
In Poland there is currently no maximum female age or BMI level for female patients and donors are anonymous. Whilst age isn’t a factor, Polish law does not allow single women to undergo egg donation treatments. Although women must be in a relationship, marriage isn’t a stipulation; those with a long-term partner are eligible for egg donation treatment programs.
In order to start egg donation IVF, in Poland, a specific medical reason is required. This includes previous failed IVF procedures when using own oocytes (eggs), premature menopause or low ovarian reserve, which could be due to an advanced maternal age.
Once couples have been accepted and approved for IVF with donated oocytes, donor matching can begin; in Poland, there is currently no waiting list for Caucasian donors. In order to donate, women must be between the ages of 20-32 and in good health, they are then required to undergo a strict recruitment process which includes rigorous screening and testing. Dr Olszak-Wasik advises that circa 65% of ladies who apply to become donors are rejected; only the best are selected.
Donors and recipients are matched using basic phenotypes (hair and eye colour, ethnicity and body shape), blood type and, where possible, also on education, personality and shared interests or hobbies.
Treatment timelines can vary as each case and patient are individual, however, couples would typically spend an initial 2-3 days at the clinic, undergoing uterine screening and the various other fertility testing recommended for both partners. Patients would then go back to Gyncentrum for the egg retrieval and spend circa 7-10 days, in Poland, whilst the eggs are fertilised, embryo culture takes place and the embryo is transferred. The recipient’s hormone levels and uterine lining would also be monitored during this time. Please be advised that the timeframe for egg donation IVF is different when using frozen oocytes.
Patients, at Gyncentrum clinic come from all over the world with the most popular visitors coming from the UK (37%), Germany (17%) and the U.S.A (8%). During treatment clients are assigned a personal coordinator to provide all the information and support required during the medical processes and visit to Poland.
Questions and Answers from the event
I would like to know if the doctor does consultations via skype?
Yes, this kind of consultation is available. All you have to do is to make contact with our coordinators and we can do this kind of consultation We’ve already done it. If you would like this, please just get back to us.
Why do you only have Caucasian donors?
We only have Caucasian donors because all our donors are Polish women, who are Caucasian.
Do you perform fresh or frozen cycles? (I mean frozen eggs from the donor)
We have two possibilities. We can perform a frozen cycle and also a fresh cycle. This depends on your timeline, so if the vitrified oocytes are available from the chosen donor, we can do this, and if you wish to have fresh eggs, this is also possible.
I wonder how many times I’d have to come to Poland for the process to proceed? As I am 3,000 kilometres from Poland, I’m thinking about the minimum number of visits.
The minimum number of visits would be not less than two because at the beginning we should meet to perform a gynaecological examination to look at all test results and to perform an ultrasonography scan. If everything is fine, and we decide to prescribe medicines, and the medicines are taken at home, then the next visit should be around seven days of preparing the endometrium. You should go to Poland the second time, which will last for a couple of days when we’ve got the decision that the endometrium is appropriate to prepare the transfer. So two visits, not less than two.
Do you guarantee four good quality embryos on day 3 or 5?
We guarantee four good quality embryos, and whether it is day 3 or 5 depends on their development, which is checked by our embryologist.
Is there a charge for Skype consultation with the doctor? if so, how much does this cost?
Yes, the consultation is available and it’s about one hundred Euros for a consultation. Of course, if you are interested, then you can get back to us and we can ask the doctor to contact you and we can schedule such a consultation.
What is the price for the egg donation programme?
The egg donation programme costs EUR3,090, but this is a promotional price. The price of the normal package is EUR4,900.
What effect does the age of the patient or donor have on the success or failure of egg donation?
Both have an effect. The age of a donor is between twenty to thirty-two, and we know that the older the recipient and the older the patient the worse the results. However, the final result depends on the patient’s maximum age.
What maximum age are the donors and what is the average age of most donors?
The maximum age of the donor is 32, and most of them are about 25 years old, because most of them have already finished higher education, or are just finishing studies, so these are all young women.
Which is more successful, fresh or frozen embryos? What is the cost of embryo donation?
Frozen embryos have a success rate of about 60% in our programmes. We do both frozen and fresh embryos transfers, and but usually start with a fresh embryo transfer.
Are the donors mothers with proven fertility?
Yes, these are women with proven fertility.
Can you influence the DNA of the egg? I have read some reports from Spain that the female carrying the baby can influence the DNA of the egg?
There are studies on epigenetics, and studies have been made around the world. But, for the time being, we aren’t sure.
Is there a difference between the success of fresh and frozen cycles? Recently, I have heard that it is better to do frozen cycle as there is a better chance to prepare the patient for transfer.
Yes, I agree that in the frozen cycle it is much easier for the patient to prepare an endometrium to achieve the appropriate endometrial thickness, which tells us whether the endometrium is ready to be given the embryo.
Is it possible to prepare myself for an embryo transfer remotely with my OBGYN?
Theoretically, it is possible, but your gynaecologist should be in contact with us, and if he or she is a specialist in reproductive medicine and does these things every day and has enough experience, then it is possible. However, if the doctor is not that familiar with reproductive medicine, there might be some problems with the endometrial thickness or changing the dosage of the drugs. But, yes, it is possible under several circumstances.
Do you require hormone blood tests before embryo transfer?
Generally, we check estradiol and progesterone, but not always. I don’t know here what hormone blood tests you mean. We want to have all the hormone blood test before our first visit, so it is possible to send them to our coordinators via email.
What do you mean by ‘a good embryo’ at the blastocyst stage? We mean the fifth day. Are the embryos guaranteed on day 3 or day 5?
The embryo is guaranteed on day 3 or day 5. Generally, this is day 5, but sometimes, when we see the development of the embryo, it can also be day 3.
There is a significant difference in 3 and 5 day embryos. Do you have a programme where you guarantee a certain number of day 5 blastocysts, good quality embryos?
It is possible in our programme, four embryos are guaranteed, but there’s also a program with two embryos guaranteed, and all the information is available on our website.
Do you accept blood tests done abroad in a European Union country such as Spain or Italy?
Yes, we do.
Why is it easy to prepare the endometrium with a frozen embryo? Surely the endometrium preparation is the same.
When we want to prepare endometrium, or when we have the frozen embryo, we can start preparing endometrium in a timeline that is good for the patient, and if we want to perform the fresh transfer, then we have to prepare the donor and the recipient at the same time.
Do you have semen donors?
Yes, we have semen donors in our clinic.
Is what you call good embryo the same quality as a top quality embryo?
Yes, this is the same.
How many fresh oocytes will I get for fertilization? Is there any guarantee of the number of oocytes?
We can use four or two embryos because from one donor we can have more oocytes. We do not guarantee all oocytes from one donor. Therefore, the oocytes of one donor can be shared with a few patients.
Are your semen donors only Caucasian?
Yes, because these are only Polish men. Therefore, it’s exactly the same as with women donors.
Are donors exclusive donors? That means all the oocytes from the stimulation will not be shared?
It is possible that you can have all the oocytes from one donor for yourself, but this is an extra cost and it is not guaranteed in every programme.
With fresh embryo donation, you synchronize the donor cycle with the recipient. Does this make the endometrial lining more difficult to prepare?
It is the matter of the doctor who is preparing the endometrium of the patient, so it is maybe a little bit more difficult, but we do it with success. Therefore, it’s not something for the patient to worry about.
How would I get tested in the UK for the endometrium lining?
It’s necessary to perform an ultrasonography scan. It is also possible that when it’s the beginning of your cycle and you send us the ultrasonography scan via email.
Is the success rate the pregnancy rate or live births?
The success rate is the rate of pregnancy not live births because live births depend on many different factors that were mentioned in our presentation.
In fresh eggs programmes with stimulation, will the eggs be shared, or will they all go to one patient? I mean oocytes from one stimulation cycle.
The oocytes can go to one patient but it costs more. This depends on the number of oocytes, but, generally, oocytes are shared.
Do you have any clinics that you are connected to in the UK?
No, we don’t have any but we’ve got a lot of patients from Great Britain.
Do you have a guarantee programme?
Yes, we guarantee these four embryos, and there are also other possibilities, but all the details can be sent by e-mail because it depends on what you would like to be guaranteed.
Is your success rate for the cumulative cycles or for single cycles?
This is for a single cycle.
You have said that there is no BMI limit? Are there any additional tests to be done? My BMI is 35.
We do not perform any additional tests here in Poland. We ask you about your general health condition, and if there any other diseases or chronic diseases. All the consultations should be done in your own country, and then if there is an additional problem, you’re asked to show us this kind of consultation, because we want to know that the pregnancy won’t be dangerous for you.
In your opinion, if somebody gets pregnant after a frozen cycle at age 44, what are the things they should be extra-careful about? Should they be more careful than somebody who gets pregnant naturally at the same age?
Generally, there’s no difference between a woman that is pregnant with frozen eggs compared with one who fell pregnant naturally, so there are no extra things that the patient should be careful about.
Do you have many patients over 50? If so, are they all successful?
Achieving a live birth, no. We do not have many patients over 50. Most of our patients are over 40 years old, and the success rate depends on other things, not only on the oocytes because the oocytes originate from young women.
How do you decide which patients get which eggs? Is it possible that one patient gets the less good eggs?
No, because nobody will get worse eggs, because this is guaranteed in our package. All eggs are good quality. What we guarantee are the embryos, two or four good quality embryos. The matching is a very important part of our work, and matching between the donor and the patient is done by a coordinator.
What is the average age of the patient for egg donation?
As I mentioned before, the donors are about 25 years old, and the average age of our patients is about 40.
How many oocytes do you give to the patient in order to achieve the four guaranteed quality blastocyst on day 5?
We do not give patients oocytes to guarantee good quality. We guarantee four embryos, and this does not depend on the number of oocytes. If it’s necessary, we perform more oocyte fertilization just to have these four good quality embryos.
What information do we get from the donors? Can we get their childhood photos?
No, it is impossible, because the donation is anonymous.
Is there strictly no type matching in Poland? If I would like my donor to be much smaller than me, would that be possible?
Yes, and in some way, it is possible, of course.
Is it risky to get pregnant for a healthy woman at the age of 39?
Generally, it is said that pregnancy after the age of 35 becomes a little bit riskier, but a healthy woman, even in their forties or later become pregnant, and if they are healthy and this happens, there are no complications during pregnancy or labour.
So you perform another stimulation with the same donor in case we do not achieve all four blastocysts with the first stimulation programme?
Yes. If we guarantee four embryos, the patient must be given four embryos, and it’s on our side how we do it.
From the same donor?
That would be the same donor.
How does the paperwork look, and what kind of documents would I have to sign to proceed? Would it be possible to sign them without a personal visit to the clinic?
We can send you all the documents that are necessary for us. However, you will have to come to us for the first visit on your own, so that we can also sign all those documents.
I wonder if it’s possible to send the frozen partner sperm? In that case, he wouldn’t have to come to the clinic.
Well, it would be better if he came here just one time and then we will perform semen analysis and freeze the sperm, and then later we’ll use this frozen semen in our procedures. We know that sometimes it doesn’t work very well. After transportation, there might be some problems, and we do not take responsibility for the quality of this kind of sperm, so it’s advisable to come to us.
If the pregnancy rate is 60% and you guarantee four blastocysts, then it is most likely that a patient gets pregnant with one egg donation, since the patient gets four transfers and four times 60%? Do I understand this correctly?
Of course, in one egg donation, the success rate is 60%. However, as we know our patients are very different, and we are talking about donation programmes in older patients, we must be aware that sometimes one transfer is not enough for the patient. Sometimes, it is, but if we take the population of older women, it will a little bit decreased.
Do you do double donation?
No, we don’t perform double donation.
How strict is the matching process?
I don’t know what you mean by “how strict” because we’ve got our own procedures. Patients fill in a special questionnaire where they tell us about the phenotype. We also look at the phenotype. We perform tests, blood tests and so on, and the same things concern our donors. We do this to engineer the best similarity between our patients and our donors.
Do you have embryo adoption treatment?
If you want to adopt an embryo, it is also possible.
Do you perform embryo transfers with frozen embryos from abroad? Is it allowed and do you organize the embryo transport?
Well, it is possible, but it is similar as with frozen semen, in that we don’t want to take responsibility for the quality of the embryos transported. We had cases of embryos that arrived to us that were not of good quality, and therefore the success rate was not as high as we would like, so we want to perform the procedures ourselves.
What are the most important features to be matched with the donor, such as the blood group and phenotype features?
These include blood type, phenotype features, height, weight, colour of eyes and hair and so on.
You said that double donation egg and sperm donations are not allowed but that embryo adoption is allowed?
Yes. So it is possible that we’ve got the donation of eggs and sperm from the anonymous donor and the embryo adoption is allowed.
What is the success rate of embryo adoption? I have heard it is cheaper treatment?
These are also embryos of very good quality, so the success rate is over 50%. Whether it’s cheaper depends on what you would like to achieve. If it’s not possible to have your own gametes, for example, sperm, when your own eggs are of very low quality, then you can use donor’s eggs and your partner’s sperm, or you can have an adoption with donor’s eggs and the sperm of the donor, so this will be a little bit more expensive.
Do you recommend intralipid infusions?
In some cases, we do recommend this to patients after consultation, if it is recommended by doctors of another speciality.
I meant embryo adoption, the embryo from couples that achieve pregnancy and donate their embryos to others.
Yes, it happens, and we’ve got these kinds of embryos from couples that have already achieved their own pregnancy and donated embryos.
Do you have additional procedures if the male factor is involved? I mean procedures techniques in an IVF lab.
Yes, we do perform additional diagnostic tests and almost all procedures are ICSI procedures, dedicated to male factor.
Is the egg donation totally anonymous in Poland? I have heard it was not.
Yes, it is anonymous. You will have no information about your donor.
For a woman at the age of 39 and two failed IVFs with their own eggs and an AMH of 8.9 and AFC of 12, do you recommend egg donation or IVF with her own eggs?
Of course, it depends on the AMH results. Here it is 8.9 is, because it might be in nanogrammes. If it’s nanogrammes, and the antral follicle count is 12, even at the age of 39, I would recommend IVF with her own eggs.