Should patient always travel for IVF treatment? Options of biological materials transportation.

Uliana Dorofeyeva, MD
Director of International Cooperations at IVMED, Medical Director at OVOGENE Egg Donor Bank, IVMED

Category:
IVF Abroad

Biological material transportation
From this video you will find out:
  • Reasons to transport oocytes / sperm / embryos
  • How to prepare for shipment of gametes
  • International regulations for the transportation of cryopreserved materials
  • Transportation practices – transport of cryopreserved gametes vs. travelling patients
  • Methods of biological materials cryoshipping
  • Oocyte vitrification – storage – handling – transportation – warming – effect on survival and outcomes

Gametes transportation options during and IVF treatment

Dr Uliana Dorofeyeva, Medical Director at Intersono IVF Clinic is talking about options of biological materials transportation during an IVF treatment.

Gametes transportation options during and IVF treatment - Questions and Answers

I have embryos already frozen in Spain. I am 48 nearly 49, so time is an issue I live in the UK. We have been told, we need to do new serology tests as ours are now out of date, but my husband cannot travel. What are the limitations to transport the embryos to the UK? (regards anonymous donor). What is the risk of damage to the embryo during the transfer? Is there any UK-based clinic that can do that transfer? The embryos are at IVFBarcelona but now with the two-week quarantine both ways, it would be impossible. We used Spain due to cost in the UK. We have to pay for another year of storage in Spain in October.

This is one of the stories we are facing these days, and this is a complicated story because definitely, this is one of those patients who were almost ready for the transfer having the embryos somewhere in the location far away from them. They were just stopped, for an indefinite period, and now we need to think about what can be done in order to proceed with this wanted pregnancy. Definitely, I would say that the priority is to use those embryos and not to create new ones. What I know regarding the UK, because we also have our partner clinics there, 20 out of 60 something clinics have received their licenses to restart the IVF. Regarding the license, to receive the materials, I don’t know really yet, we need to talk to our courier department, and I think they will be happy to help. As to the possibility to move the materials from Spain to the UK, it is possible right now. It would be road transportation, it will take some time, and we would prefer to fly it, but this would be impossible. For example, next week our couriers are going to Sweden. It’s not very close to us, and this is a complicated trip, but this will be done because this needs to be done. What are the limitations to transfer the embryos to the UK? Because the HFEA is the regulatory body, their clinics need to receive all the documents regarding the lease but also the confirmation from the clinic. You need to contact the clinic in the UK first, and they will be able to provide all the instructions. Unfortunately, I cannot tell you all the details regarding the UK. I can tell you everything about Ukraine, but it’s definitely possible to get into communication with the clinics, and I’m sure that they will be happy to answer. Regarding the age, I know that different countries have different age limits if I’m not mistaken for the UK it’s 50years old. In Ukraine, there is no age limit, but in our clinic, we have an ethical committee, and we regulated the highest age for the embryo transfer to 54years old. This is the highest possible by the regulated authorities in different locations in the world, but some clinics in Ukraine can even offer transfer for patients over 54. You can also contact us by email and then our staff will be able to tell you more about it.

The UK does not allow anonymous donors. Can an embryo be sent here anyway?

That’s true, I didn’t stop on this issue in my previous answer. All donations should be known, non-anonymous or identifiable for the UK. In this case, probably the patient needs to consider another country where an anonymous donation can be performed. Or maybe Spain is going to reopen. We do not have really close contact with Spanish clinics, but we can get this information. You should check if the Spanish clinic can do the transfer. Probably this could be also an option. A comment has just been added that the UK clinics cannot accept embryos created with donor eggs from Spain. That’s why probably the UK would not be the option for this patient.

My husband and I have three frozen sperm samples but only the most recent one in the USA in 2018 had the infectious disease test. Our problem is the sample we want to use, which is the best quality out of all other samples was Slow Frozen Assisted in 2007 in Australia. The donor did not have any infectious disease test within two or three months as I think Ukraine requires, I was going to be the recipient of the embryos and told it was not the protocol that the clinic follows. As I’ve had multiple miscarriages. I am now being advised to use a surrogate, which we will do. So the closest infectious tests were done six or seven months beforehand, which proves heor I had not had an infectious disease. We can provide all blood tests since then and even before then. We don’t want a fresh sample as my partner is older now, and the possible risk of children being born with autism or dwarfism is higher. Can you accept this frozen semen? Can you do an infectious disease test on frozen sperm to prove it is clear of any disease?

Firstly, I should say that if surrogacy is the option here and this is the last chance we value those patients who have, and they try to use their last chances. We are ready to cooperate with those patients and do our best in order to ensure a successful outcome. I would recommend bringing all three samples into the facility. I definitely need to explain what can be done regarding infectious disease tests. According to the new legislation which is enforced right now, all infectious diseases should be checked within three months before the patient creates the biological materials or before we receive it. However, if the materials were frozen in 2007, the legislation also was different for us, and it was six months before creating the material. Also, there is a possibility to redo the testing for the patients even right now by getting the blood samples. The testing can not be done from sperm, but we can do the blood test, and by analyzing the specific factors, the immunoglobulins, etc., we could get the proof. Having the results of testing done six months prior to freezing 2007, we can prove the patient never had a disease like HIV or hepatitis B&C. Under these conditions, we will be able to receive those materials and consider them as non-infected materials.

The three samples are in different countries will prove very costly to transport all of them. We’ve already done 10 IVFs so it would be more costly.

Unfortunately, sometimes it happens. What is the quality of this sperm sample which is the most recently frozen, because in this story this is the sample which is the easiest to be used and to be shipped. Maybe here we need to see the sperm count and the sperm quality results. Because if we are talking about ICSI, which is the regular method we are doing fertilization right now, it is very important. We also have some advanced techniques for sperm selection. Maybe this sperm sample is not too bad for this.

We have all reports, and the best quality is 2007 .Dr Don Evenson who invented the DNA fragmentation said we should only use this one.

I cannot comment as I don’t know all the information in this case. Probably you can trust the recommendations of the doctor, but it’s sometimes good to get a second opinion and just to see the results of the sperm samples. Maybe this is the fact, and then we would need to work on the specific sample stored in 2007, and then we would need to do the retesting, and check the conditions of the patients, and the tests which were done six months prior to the freezing in 2007. I guess it’s best if you could just get in touch with us. I will be happy to receive your email. In order to suggest something best, we need to know the whole story, and then we would think about what to do.

Do you have an age limit for intended parents at your clinic? We will use a donor. Do you have a Guarantee Live Birth package for surrogacy?

Independently of the method of the IVF, the maximum age by the ethical committee decision is 54. Sometimes we can consider accepting patients in very rare cases up to 56, but only after the medical Concilium decision is made. I don’t know what your age is, so I cannot comment here. We do have the guarantee of a live birth package for surrogacy.

Can the embryos be shipped as known or anonymous donor material? Some countries will only accept known embryos, like Australia, and in Cyprus, only the unknown or anonymous embryos are accepted. 

Unfortunately, some countries have very strict rules, even if the egg donation is allowed, but it is a specific egg donation. For example, in the UK, it’s only identifiable, non-anonymous while many countries are still providing an only anonymous donation. Unfortunately, if this is an anonymous donation, this material cannot be shipped to the countries which are using identifiable donations. The clinic would not receive those materials.

Do you have a partner clinic in Canada, and do you know if Canada accepts anonymous donor egg created embryos?

We have several partners clinics in Canada, and they have changed their law in reproduction, and it also concerns the egg donation. Now, all the donors should be checked according to the FDA requirements or they are very similar to the FDA and the donors are identifiable there. Ukrainian clinics can accept both anonymous and non-anonymous donation. I thought you were wondering about sending your material somewhere to the countries which require identifiable donation. But in Ukraine both are possible, and we can work with both kinds of materials, either identifiable or anonymous.

I have one high-quality embryo in the Czech Republic, and the doctor stated that it would thaw and still be very good. Do you still expect this to be the case if it was transferred from there to your clinic?

Taking into account that our survival rate has been between 93 to 96 for several years for vitrification, it should be the same. We need to know what is the method of vitrification of your blastocyst and if this is a blastocyst or day two or day three embryo. For the blastocyst, the survival rate is really good. What I have commented during my presentation, the survival rate depends on the quality of the biological materials before freezing. This also can influence the survival rate results, meaning if this was not a strong embryo at the time of the vitrification, the probability of this embryo to survive would be lower. We would like to get the information regarding the embryo cultivation report and check the quality of the embryo. If this was the day five blastocyst AA rated it should survive and if it was stored in great condition and we will take responsibility for the transportation, and this would be transported with all the rules being followed this would survive like 95% to 100%.

I had one C graded embryo, but the doctor did not allow me to freeze it or strongly suggested that I did not. 

Actually, also in our practice and in our clinic we are not freezing BC or CC graded embryos and this is just because the probability of those embryos to survive warming is very low. We are not transferring them because the probability of implantation is very low. I would rather agree with those suggestions from your doctor.

In Germany, the law does not allow women to donate their eggs. One of your slides has shown that you ship biological material to Germany. Do you ship only the sperm or also eggs?

In Germany, egg donation is not allowed, and if Germany was on that slide probably, we ship embryos either to or from Germany. If we send something to Germany, these are usually the embryos of the patient’s created using own eggs, not the donor eggs.

Can an embryo you create be shipped to Australia?

This is probably a case when we would need to create embryos from fresh material then vitrify them and then to ship them to Australia. We can do it, but as you have seen probably on the map Australia is the only country where we are not shipping yet. We are negotiating with some clinics there, but this is not happening yet. We would need to discuss with everything with the clinic, like the method of vitrification, the procedures we would follow. We have to share the SOPs, the protocols, standard procedures, in order for them to be sure that they are receiving good quality biological materials, and then you will be happy to go there and receive the treatment.

We have four embryos in Spain. If we would like to transport them to your clinic, what do we need to do? What is the transport procedure? Who arranges transport and how much does it cost? Is your clinic open for patients travelling from Poland? Finally, what tests would we need to repeat before the treatment? 

If we are talking about frozen embryos in Spain, we will be happy to transport them to our clinic. In order to do this, you need to contact our courier department, click the contacts where on the slide. I know that we are planning the shipment from Spain sometime in the first week of June, so if you are fast, probably we will be able to also add your materials into that transportation which is going to happen. In order to plan this, you just need to send your request to our courier department, and they will send you the detailed instructions what is needed, like the documents, the forms filled, the communication with the clinic. They will also do the part of this communication and all the arrangements that need to be done on the way with the customs and things like that.

They will also provide you with information about the cost. I cannot say this right now, because the conditions are a little bit changed. If I am not mistaken the transportation cost within Europe was about 1400or 1500 Euro. Our clinic is open for patients travelling from Poland. We are working already, and we are back to the regular conditions of our work. International patients are not coming to Ukraine yet, but those whose surrogates deliver the babies we contacted the respective consulates, and it helped them come into Ukraine. They all came, and they are all staying with their babies. If there is a real need, we can also support you. We can provide the documents explaining that there is a need to get here to Ukraine for the treatment. This can be done, and if we are talking about the conditions, if you are not in the quarantine, this is absolutely easy, and patients are happy to come to us as we are very close to Poland. It’s about 65 kilometres from the border to Lviv. Regarding the tests, you would need to repeat before the treatment we have a list of those. It is not really long, but these are all tests that are needed according to the Ukrainian legislation. Our coordinators will send you that list. We would like to see all the previous examinations and the results, and sometimes we are recommending something more, like the immunogram, thyroid tests, maybe some genetic tests if there were multiple miscarriages or multiple negative outcomes in the previous cycles. A doctor from our clinic and the coordinator will work on this together with you.

Is it true that Spanish clinics cannot send embryos to non-EU clinics? So they cannot ship to Ukraine?

Actually, European clinics can work with the non-EU clinics under the conditions of the contract of the cooperation conditions if the clinic in the non-EU country has received the authorization for this. For many of the clinics and for many of the countries, after having the negotiations and providing the quality documentation and showing the controls, and answering the questionnaires, and receiving their representatives in our clinic, we got the permission for working with those clinics and the countries. Also for some countries whose representatives did not visit us and we didn’t get direct permission, we have our partner clinics in the EU. The materials could be brought to either Poland or to Slovakia and then from those clinics under the contracts we can do the parcel transportation. We are also communicating this to our patients of course.

Can our frozen embryos from egg donation be used for surrogacy? What are the requirements to be accepted as intended parents?

The embryos created either from own oocytes or from the donor material can be used for surrogacy. The requirements are in relation to the genetic connection. One of the patients should be a genetic father or mother of the baby, meaning that in the case of egg donation, the sperm of the husband should be used to create those embryos. Then that embryo will be allowed to be transferred. Another very important condition is that there should be a medical indication for surrogacy in order for us to be able to perform the treatment. The medical indications are the absence of the uterus, theRockatansky syndrome or the status after Hysterectomy, the big myomas which are deforming the uterus cavity so carrying the pregnancy is not possible, or somatic diseases supported with a doctor recommendation stating that this patient cannot carry the pregnancy or multiple negative outcomes of the IVF treatments before. These are the medical conditions. And also an important condition is that couples should be married. We cannot accept couples who are living in together but are not officially married for surrogacy. We should have a marriage certificate.

Our frozen embryos are from donor eggs and their sperm. The courier company asked us if we are if our embryos are replaceable. We were told they can only transport not replaceable biological material (embryos). Could you explain what it means?

Some countries are not allowed to ship the biological material for surrogacy, and this is the specific regulation of the countries. I think that replaceable here means that they were asking if you are going to transfer those embryos to yourself. Because surrogacy is not legal in Spain, they can not recommend it, and they cannot support this treatment in any way, so that’s why probably they were asking that question. You probably need to confirm this and clarify this question with our courier department. I would like you to send this by email and we will be happy to check, and our specialist will be able to answer you.

What questions do I need to ask my clinic in the Czech Republic so that you have the needed information with regards to my single donor egg embryo? You stated that it would be best for the media material used for the embryo to be compatible with what you use? What about assisted hatching? I believe that my embryo already had assisted hatching (at least the first one that resulted in a successful pregnancy which was done in the Czech Republic but your package price includes assisted hatching.

Regarding the questions which you specifically need to ask your clinic in the Czech Republic all those questions are in the transfer form act. This is a specific form, as soon as you receive this you will see and understand what the information is for. This information is mostly for the embryologist on what is the day of the vitrification of the embryos, what was the quality of the embryos before they were vitrified, which media and carriers are used. This is the most important information. In addition to the analysis and the contact person in the clinic because some paperwork needs to be done by the couriers in order to move the materials. Regarding the assisted hatching, in our clinic we are believers, and we did our analysis, and we have done the work for many years, and we compared the results of the cryo-embryo transfers with the use of the assisted hatching and its result. And the results of the implantation and clinical pregnancy rate for the embryos for whom we performed the assisted hatching were higher. That’s why we decided already in 2018to use the assisted hatching for all vitrified warmed embryos. I am not sure that the assisted hatching for your embryos was already done, because usually that procedure is done after thawing and directly before the embryo transfer. Maybe it was done for the embryo which was already transferred, so then this is a good practice. Usually, the implantation is better after we have performed the rupture of the so the embryo has more potential and it’s easy for the blastocyst to get out and to be implanted faster.

We were also told that the embryos should be thawed with the same procedure and media. Will you be able to use the same media in your clinic?

Yes, we have access to all the suppliers. We have our regular practice for all the patients or local patients. We are using one media which has shown the best results for our conditions in the lab. We trust the supplier, and we have are gular supply. We can get any kind of media which we are using for some partner clinics. These were their requirements, so we have three or four different media regularly in the clinic. Even if we don’t have some and we receive materials vitrified in the specific media, we can get this media, and we warm it according to the recommended protocol.

When shipping our embryos from egg donation, is the destination clinic informed that the embryo is from a donor egg?

Yes, you write this information in the transcript of course.

What current rules might prohibit the transport of a fresh and recently frozen sperm sample on a commercial flight from the USA to the Czech Republic or Ukraine? Do airlines prohibit the carry-on of this material?

This can be specific for some air companies or aircraft companies, but most of them are following the rules of the IADA and the regulations, and there is nothing that can stop this if the conditions are met. We have the contact clinic and the person in the US and the Czech Republic or Ukraine, and we did all the paperwork, we arranged the time of the visit of the courier, the container that the courier will bring. There are no issues why this should not be alright.

Should we be concerned regarding various raids on some clinics in Ukraine? There is a lot of negative publicity regarding surrogacy e.g. at Mini IVF and the Biotexcom babies being looked after at a hotel in Kyiv. What is your opinion that there might be a chance that surrogacy will be banned in the near future? I worry that we will go ahead and then we won’t be able to get the baby.

This is really very unfortunate situation for all of us here in Ukraine. It is due to the fact that there is legislation but there is no proper control on how the legislation is followed by some of the clinics. There is no general registry, and there is no official body gathering any general statistics. Unfortunately, there are some clinics that are doing the IVF more in a commercial way, than in a legal way and helping patients. For us, it’s also unbelievable to hear all this from the media. But also, the media and the way they are presenting this situation is scandalous. I would comment only about the hotel and Kyiv and those babies being there. If the clinic is busy with the surrogacy and within two months there are more than 50babies delivered, they take the responsibility and take care of those babies whose parents were not able to come to Ukraine. For me, it’s an understandable situation why they were not able to come. Since we are not providing so many surrogacy cases, the number of babies born in our clinic is much lower than these numbers in Kyiv. After our lawyers contacted the consulate and got the permission for patients to come, all of them found that the way to fly over to Ukraine. Some of them flew to Belarus and crossed the border by car, some of them flew or came by car, some of them took even the chartered flights and came to Ukraine after getting the permission for landing in Lviv. There are many options for doing this, and I think the most important thing is the desire to follow your needs. I don’t know how the legislation will go forward in Ukraine. Personally, I do not believe that surrogacy will be banned in the near future, but I think that we need some changes in the law. I would like the changes to happen in the way of controlling this and making sure that everybody works according to the legislation.

Do you have permission to work with the clinics in Spain generally or only with some clinics? If our clinic is in Spain, can we be sure that you can cooperate and we will be allowed to ship our embryos to your clinic?

You need to contact us directly, and we will explain the situation regarding Spain with some clinics. I would answer your question, but also there is an algorithm saying how we need to act in order to get the materials into Ukraine. We are not doing anything that we call illegal we just need to understand the rules and the conditions of all sides, and we work in accordance with those.

My partner has just finished a sperm improving protocol, and I wanted to go abroad to freeze samples for fertilization, and I would come later for the IVF. With the quarantine in the UK, my partner’s unable to travel. Would it be fine for my partner to go to a clinic in the UK to freeze the sperm and then send it abroad during this time? 

This will be possible, but you need to confirm this with the clinic in the UK, but I don’t see any issues why this couldn’t be done right now.

Is it now safe to transport by land on such long distances Spain – Ukrainian is over 3,000 km, and for land transport, it was recommended for distances less than 1500 km before the pandemic.

We need to be ready for different conditions. As I said, we would prefer flying. Why land transport was recommended between 1000 and 1500 was because this is something that can be done even if two people are driving the car, they can change. Within two-three days they will get to the destination. The transportation arrangements also include the payment for the hotel accommodation for the courier. You need to pay daily money for them, so it’s much more cost-effective to fly. It is also better for the material if they are faster at the destination. In these conditions right there is no other possibility, so the only possibility is to go by road. And as to keeping the embryos safe, definitely, there are no risks because I also mentioned in the presentation, the containers we use are big even if you are taking one sample or two samples. We decided on this because they are keeping the temperature stable for two weeks and if they are going somewhere in Europe, like Sweden or Spain, they will be back faster than two weeks. We are on the safe side being able to control the temperature and being sure that we have enough liquid nitrogen inside. There is a possibility to stop somewhere on the way and to bring more liquid nitrogen into the containers, so it’s absolutely safe. It’s a bit more complicated for the people doing this, and there is a higher cost here, but we need to be prepared for the conditions around, and we would like to do our best to help the patients even under these unexpected conditions.

Are the borders open for patients coming by car to Ukraine?

After getting the special confirmation from the authorities. If there is really a need, we would be happy to support you. We will send a request, as we did this for the surrogacy cases, and we never got denied. In this situation, right now the conditions of the quarantine are not really so strict that as they were a month ago. I believe this could happen, but also the borders are probably going to be open after either June 1st or June 15. This is how the government mentioned, so I think we are talking about the nearest future.

Is only the temperature important or also the movements of the container, like shaking?

If there is just shaking or some small movements, there is no problem. It is a big container which has two walls. Between the walls, we have the vapours of the liquid nitrogen if this is on-road transportation. In the cane of the door, there could be liquid nitrogen fraction, and there is a small tiny straw located in the cane, and it’s locked with the specific material, so it’s very safely located inside. If the container is moving like this even a little bit, there is not a risk for the materials themselves, because the conditions anyhow inside are absolutely stable. The temperature is the most important. There are two couriers usually so when one is driving the other one is checking the condition of the container, how it is standing, whether everything is fine. It’s absolutely safe. You should not be worried about this.

Can you recommend a courier company that is transporting embryos from Spain to Ukraine?

We are using our own courier department, and we have had those people with us already for more than six years. These are really professional people who know what is most important. All the needs of the Ukrainian side. In some countries in Europe and the USA, there is a possibility to transport materials as cargo shipments, which is not possible for Ukraine, because the transported materials are stopped at the customs and all of them are x-rayed. The customs do not check if there is a label ‘ do not x-ray’ or ‘fragile’. This is a specificity of the country, which we must deal with. Please contact our courier department, and they will be happy to help you.

Authors
Uliana Dorofeyeva, MD

Uliana Dorofeyeva, MD

Dr Uliana Dorofeyeva is a Director of International Cooperation at IVMED, Ukraine, and a Medical Director at OVOGENE Egg Donor Bank. She is a multi-talented, engaging and results-oriented fertility specialist with significant experience in ART. She is trained in all aspects of andrology and reproductive endocrinology with exceptional knowledge in the areas of laboratory quality control, vitrification of oocytes, cryopreservation of gametes, embryos and unique ovarian tissue, micromanipulation of gametes including Intracytoplasmic Sperm Injection and Assisted Hatching. Worth mentioning that Dr Uliana is a member of ASRM and ESHRE (American and European Society of Reproductive Medicine).
Event Moderator
Caroline Kulczycka

Caroline Kulczycka

Caroline Kulczycka is an International Patient Coordinator who has been supporting IVF patients for over 2 years. Always eager to help and provide comprehensive information based on her thorough knowledge and experience whether you are just starting or are in the middle of your IVF journey. She’s a customer care specialist with +10 years of experience, worked also in the tourism industry, and dealt with international customers on a daily basis, including working abroad. When she’s not taking care of her customers and patients, you’ll find her traveling, biking, learning new things, or spending time outdoors.

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