In this webinar, Dr Zineb Meski, a Specialist in Assisted Reproduction at IVF-Spain Madrid has been discussing some alternative family options for women like the ROPA method for lesbian couples as well as options for single women.
Since 1988, the IVF legislation changed a lot in Spain, nowadays, there are more treatment options for heterosexual, and homosexual couples as well as single women, especially since 2006, the law for same-sex female couples have been approved, it’s called ROPA, which stands for ‘reception of oocytes from the partner’.
Female couples need to be married or be in a domestic partnership. There are some steps of the procedure that need to take place. First is the synchronizing of both female cycles, a woman who is going to provide eggs is stimulated, and at the same time, the other woman is going to be prepared for the embryo transfer. There will be a donor and a recipient. Usually, the younger woman or the woman with a better ovarian reserve will provide eggs, and once the egg retrieval is done, the eggs are going to be fertilized by ICSI with a sperm donor. The embryos will develop in an incubator to the blastocyst stage (a day 5 or a day 6 embryo), and then the embryo is going to be transferred into the recipient’s uterus. Therefore, both cycles have to be synchronized to do a fresh embryo transfer, so when the egg retrieval is done, the recipient’s endometrium has to be ready for the embryo transfer.
There is also an option for delayed of a frozen embryo, where the stimulation is performed in the same way, but the embryo will be frozen and can be transferred at a later time, this is a more flexible method. It’s done on some special occasions, for example, when Preimplantation genetic testing needs to be performed because the results are available after 2 weeks or when the recipient cannot do the embryo transfer because her endometrium is not prepared for the embryo transfer.
Other treatment options
Other treatment options include IVF with sperm donation, IVF with pre-implantation genetic testing (PGT-A)and sperm donor or embryo banking with sperm donation for women with low ovarian reserve.
IVF with PGT-A means that instead of transferring the embryos at a blastocyst stage, they are going to be analysed to see if there is any genetic abnormality in the embryos before they are transferred. In such case, a fresh embryo transfer is not possible because when the embryos are biopsied, some cells are taken out, therefore, a blastocyst stage is necessary as more cells are needed. The results are available after 2 weeks, that’s why all embryos need to be frozen then, and once the results are known, the embryo transfer can be performed. In this case, the cycles of both female partners don’t need to be synchronized
Another option is embryo banking with sperm donation, that’s for women with a low ovarian reserve, it aims to accumulate embryos. Sometimes when a woman has a low ovarian reserve, the stimulation has to be repeated, and that way it’s possible to accumulate more eggs, and in turn, there is a higher chance of having more embryos. Only around 50% of all the embryos are going to make it to the blastocyst stage. Therefore, embryo banking starts with the stimulation, fertilizing the eggs, and when the embryos are created, they are frozen, and another cycle is done to get more embryos, 2 or 3 stimulation cycles may be needed to get a good amount of embryos.
Why is the accumulation of embryos needed? It’s because if there are more embryos available, this allows the patients to have an option for more attempts if it is needed. It will also permit to do PGT-A testing and increase the chances of a successful transfer and a healthy baby.
The sperm donor is a crucial part of ROPA treatment, the sperm donation is strictly anonymous, the patient cannot choose the donor, the medical team will choose the donor for you according to your physical characteristics, your blood type, and there are also some preferences that you can tell the doctor like the colour of the eyes, the skin if you want, that you wish for the sperm donor to be more like the egg donor or the recipient since the recipient is not going to give her eggs. You can select the sperm bank that the clinics cooperate with, but you cannot choose a donor, you won’t have any information about the donor.
Treatment step by step
During the first visit to the clinic, you’ll learn all about the process, and personalized treatment plan, then once the treatment is confirmed and you are ready, you will get the prescriptions for the medication. You will also receive a schedule so you can plan your ultrasound scans, and all your blood tests and then send it back. Once you start the treatment, the team at the clinic will tell you if any further analyses have to be done, like an endometrium biopsy or a Carrier screening, genetic test to see if you are carrying any genetic disease or any mutation, and it’s also done to the sperm donor. Some diseases are always checked in the sperm donor, but there are millions of genetic diseases, and it’s impossible to check them all, therefore, the most common ones are going to be checked, like cystic fibrosis, fragile X syndrome, etc.
There’s also a possibility to do a genetic matching. It means that you will need to do a Carrier screening genetic test, the sperm donor will also go through this test, and then with all this information, the medical team will do the matching to see if you do not carry the same diseases.