By fertility experts from Spain.
Watch the webinar recording from webinar “IVF with donor eggs – is it for me? Indications & good practices” presented by GYNEM, a fertility clinic from Prague, in the Czech Republic.
IVF with donated oocytes (eggs) is a widely accepted and practiced treatment for female related infertility and is associated with higher rates of pregnancy success. Deciding to use donor eggs to conceive can be a hugely overwhelming and confusing decision; how do patients know whether it is the right option, and at what point should donor egg IVF be suggested, by clinics, as the way for patients to create a much longed-for family?
In this webinar, Dr Maria Khutorskaya, an IVF Specialist from GYNEM Fertility Clinic in Prague, Czech Republic, looks at various case studies and discusses when the use of donated oocytes might be considered as a treatment for female infertility.
There are five main indicator groups for women considering egg donation IVF; low ovarian reserve; female factor genetic disorders; congenital absence of ovaries; women who have entered an early menopause and those who have tragically suffered from repeated IVF failure.
When understanding low ovarian reserve, it is key to note that this refers to both the number and calibre of a woman’s remaining follicles and oocytes. For women, over 40, egg quality and quantity do decrease. However, despite being the most common denominator of a diminished ovarian reserve, age is not the only concern. External factors also play a role in influencing the condition of a woman’s eggs. These include genetics, environmental factors and medical history, such as endometriosis, autoimmune disorders and idiopathic premature ovarian failure, often caused by treatments for cancer. Genetic disorders are also known to affect a woman’s chances of conceiving when using her own eggs. Many women are unaware of any genetic anomalies until they struggle to conceive.
Dr Khutorskaya advises that the most difficult situation for couples arises when both partners are healthy, follicles can be stimulated and eggs are collected, yet IVF constantly fails, either through lack of fertilisation or implantation. Medical teams are able to retrieve eggs from women who have a diminished reserve, but simply collecting an egg does not mean it will fertilise; the quality of the oocyte/s is key to a positive treatment outcome.
For women undergoing IVF, initially using their own eggs, it may be impossible to tell if there are any issues until embryologists have been able to investigate the harvested eggs.
The main indicator of IVF success is embryo quality. However, even with a healthy, euploid (chromosomally normal) embryo, a pregnancy is not guaranteed, as additional concerns can affect the outcome. These include endometrial receptivity, immunological and overall health, as well as any anatomical anomalies such as post-infectious tubal damage. GYNEM fertility clinic has therefore established a set of diagnostic parameters, in order to fully assess and investigate whether the use of an egg donor should be considered. The parameters tested for and used are; patient age, AMH (Anti Mullerian Hormone) and FSH (Follicle Stimulating Hormone) levels and/or antral follicle count (measuring of ovarian reserve). If a woman’s test results show two or more of these issues, then the clinic would advise the use of IVF with donated eggs.
Data from the GYNEM clinic suggests that the use of an egg donor does appear to reverse the effects of age-related infertility, meaning that even if a woman has a low ovarian reserve, she still has the capacity to carry a child, to term, when oocytes from a younger, or healthier donor are used.
Dr Khutorskaya shares real-life case studies, of patients treated at the clinic, to demonstrate when donated eggs have been used, to successful outcomes.
The first case study shows a 42-year-old mother of one, naturally conceived, child with a regular menstrual cycle and no relevant medical history as to why IVF was needed to conceive a second child. Her husband was 45 years old, at the time of treatment, with no fertility issues. The couple underwent two cycles of IVF, using the female’s own eggs, but unfortunately no oocytes fertilised during their first treatment. The second cycle resulted in one eight-cell (cleaver stage) embryo being transferred. The embryo did not implant. Secondary infertility, due to maternal age, was diagnosed and egg donation was recommended. On their first cycle, with donated oocytes, pregnancy was confirmed and resulted in a live birth.
Another case study details the fertility journey of a 35-year-old primary infertility couple. The female was diagnosed with premature ovarian failure and underwent multiple cycles of own egg IVF. However, even after varying protocols were tried, the couple experienced repeated failure to conceive. It was agreed that an egg donor would be used, resulting in a live birth, plus five frozen embryos, should the couple want a larger family in the future.
Dr Khutorskaya stresses again that the quality of the egg, sperm and embryo is imperative, when it comes to a positive outcome from IVF, but advises that all patients and their cases are individual.
The decision to use an egg donor is incredibly personal and is not always an easy choice to make. Clinics should be supportive in helping couples choose whether this is the right route for them, understanding that no two clients are the same and each situation is unique.
FSH is a follicle-stimulating hormone, a gonadotropin that secrets in pituitary gland of every woman. This hormone helps follicles grow. In the reproductive age in all women it is below 10. When FSH starts to grow, it can be a sign of some problems with ovarian reserve or ovarian function decrease. It’s one of the diagnostic parameters.
Both of them. From the reproductive history, you get the information if the donor has had a child or children, about personal gynaecological history, about the regularity of menstrual cycles as well as the hormonal level, ultrasound check-ups.
Unfortunately, in the Czech Republic is not allowed. There is an agreement that has to be signed by both partners. Also, I can see Rosa has asked me if FSH can change by the day of the test. Yes, sure. The test must be done on day 2 or 3 of the cycle, at the beginning of the cycle.
It’s one of the indications as we already discussed. If you don’t have periods, it’s even better: you don’t need to synchronize your cycle with the donor cycle. We will just choose the best timing for you, when you plan to come, then we start to prepare you, and at the same time – the donor.
As I mentioned before, after the age of 40 the chance to get pregnant with own eggs is really low, a maximum 10%. After 42 it really decreases drastically, about 2%. In your case, I would suggest you don’t waste your time and proceed with donor eggs.
It’s a good question. There are no advantages. It doesn’t influence the success rate. But many patients choose the same blood group and rhesus factor because in case your child needs you as a blood donor, and you want to keep it anonymous, this is the main reason to choose a donor with the same blood group, but again it’s not necessary. If you don’t mind, we can select a donor with a different blood group as well.
I have showed this before. You can check the algorithm. In some case, of course, you should directly proceed with the egg donation program. But, in some cases, for example, if you’re 40, the AMH level is normal for your age, of course we know the good range is 1-7 but after 40 we can’t expect AMH more than 1-1.5. So that’s why in your case you can try IVF with own eggs a few times. But you have to understand that the success rate is not so high. Try, of course, but if using different methods of IVF with your eggs doesn’t result in pregnancy, you should consider egg donation program.
It’s a good question. As I mentioned before, immunological factor is a very controversial issue, however, we usually give to all recipients a small dosage of prednisolone to decrease the immunological response. Considering the high success rate, I wouldn’t take it as an issue.
I think it’s the same when you have your own egg. An embryo from your own egg or from a donor egg is the same. As you can understand an embryo is half yours and half of your partner. The implantation failure doesn´t happen. Nature is clever and takes care of this matter.
Yes, of course, we can use donor eggs, but we have to understand that, as I mentioned before, the good embryo quality comes from the good egg and good sperm quality. But we have many possibilities to select good sperm, mature sperm (PICSI, INCI, MACS). In case it fails, we can try PGS screening. If you don’t have good embryo quality, then you can think about a sperm donor.
First of all, you should contact our coordinator. Then, we’ll organize a Skype consultation with a doctor. We’ll discuss everything, your doubts, your previous treatments and then we’ll plan if you come directly for IVF or donor program.
As for the time, it depends. For egg program, if you travel together with your partner, it’s about a week. If you have no time, then your partner can come anytime to our clinic to leave the sperm sample. And then you’ll come just for a few days for embryo transfer.
In our clinic we only work with fresh eggs. We have great experience with fresh eggs programs, so that’s why we decided to continue with such programs.
As I answered the previous question, we work only with fresh eggs.
I think it is a question for an andrologist. It depends on the reason why sperm has bad quality. Maybe there is an idiopathic reason or because of some previous treatments or hormonal reasons. Based on that, the andrologist plans the treatment. But as I said it depends on the reasons.
I’m not sure if it’s really a good idea. Theoretically, of course, it’s possible. It’s better to understand what we’re going to transfer. So in case you use donor eggs, usually we do not proceed with PGS screening, but in case of your own eggs and when the age is over 40, then we have to understand what we will transfer. Also to prevent miscarriage or other complications. That’s why I would recommend transferring an embryo from your own eggs. And then, in case it doesn’t work, in the next cycle, we can transfer embryo from donor egg and see if you have more chances.
An additional explanation to question 11: What are the advantages/disadvantages of frozen egg vs. fresh egg transfer from donors?
As I mentioned before, at our clinic we work with fresh eggs only. That’s why based on my experience, for women to whom we provide the egg freezing services (i.e. single women, women before chemotherapy or ovarectomy), I always recommend, in case they have a partner, to freeze their embryos and not just eggs. We have more experience in that and it works better. So that’s why in our clinic we don’t work with frozen eggs.
Yes, I think we already had that question. Of course, it’s possible. It doesn’t influence the IVF success rate. But with the Rh factor, I would suggest using donor eggs with Rh+. It’s not because of the IVF success rate. It’s for your pregnancy because we can have a pathological situation with the Rhesus conflict – that’s why it is better to use the same Rh factor, but it’s not so important with blood group.
Of course, both FSH and AMH can change, but the change won’t be huge. Of course, we have to test on day 2 or 3 of your cycle. For example, in one month you may have FSH 12, in the next month 14, and then next month 10 or 11. It’s always the same range. The same with AMH: if you have 0.3 nanograms or 0.5 – it’s not so huge change. It shows the actual situation, but as I mentioned in the presentation, the combination of diagnostic parameters is important, not just single FSH or AMH result. We have to consider all parameters: FSH, AMH, antral follicle count and age.
Now it’s very difficult to answer. Why you have this situation. I need to know your hormonal level and I need to see your ultrasound results. Then only we can discuss the possibilities. Unfortunately, this is not enough information.
As I mentioned before, we can’t consider just FSH. It’s important to see the combination of various parameters. 9.9 and 11 – it still ok, maybe it shows a sign of poor ovarian function, but to answer this question we also need to consider AMH level and antral follicle count.
In case when we have normal sperm range, the quality of sperm doesn’t decrease with time. Sometimes our patients, if they have no time to stay one week in the Czech Republic, the partner can come for one day and leave the sperm sample. We will freeze it and then we proceed with the fresh donor cycle.
FSH 67 is really high. Such result is common for women who starting their menopause. I also don’t know the cause why it happened. Maybe it is some genetic predisposition or maybe some congenital problem. In your situation where FSH is really high and you don’t have period, it recommended to proceed with donor eggs.
It’s also difficult because FSH is really high and AMH is really low, but you are young. It’s also important that you have regular periods. If you’re ovulating, then maybe in your case we can try natural cycle or maybe soft stimulation but FSH is really high here. We can try maybe not IVF yet, but natural cycle. Then, in case it doesn’t work, we have to proceed with a donor program.
I think I already answered that. Based on our experience it is better to use fresh eggs and it doesn’t matter if you have fresh or frozen sperm sample. Just in the case when the sperm range is not good, then it is better to proceed with fresh sperm material.
We can proceed with embryo freezing and prepare your endometrium for the next cycle. You will get a hormonal replacement therapy plan, where on day no. 10 of HRT we do endometrium ultrasound control (check-up). According to this data we can change the medication and prepare you better for the transfer. But if the case is that your endometrium is not ready for some reason, we can freeze all the embryos and do the transfer later.
It all depends on the individual patient. But before trying with the donor egg program, you can try some hormonal treatment just to understand if your endometrium is reacting to the treatment. This is important. If it is reacting and you have endometrium of at least 7mm, then we can plan the transfer. However, if it does not happen and your uterus will not answer, then we have to consider other treatment possibilities, such as the surrogacy program.
You had just 3 follicles and how many mature eggs did you get? This is important information. How these eggs were fertilised and if you had embryo transfer or not. It’s important information. But even if we don’t have results, your age is still OK, you are 36. Maybe I would try soft stimulation protocol. In your case, different protocols may work, sometimes long protocol. But I would try IVF with own eggs one more time.
So it’s a philosophical question. From my experience, we’ve had couples who came back to our clinic for a second child. They had their first using donor eggs. I think when you are pregnant and you have all pregnancy symptoms, you hear your child’s heartbeat, then you give birth and breastfeed the baby…all those things don’t let you feel that the baby is not yours. Of course, it’s very personal feeling, but from my experience, I never heard anything like that.
As I mentioned in the egg donor program the age is not so important. We have the same results for women aged 40 and 47. The implantation rate and the success of IVF depend mostly on the embryo quality. So that’s why when we use donor eggs and if your husband has good quality sperm we can expect a good quality embryo and a good implantation rate.
I’m not sure. We might have some Chinese donors. I will check this information with our coordinators. Unfortunately, we currently don’t have African and Indian origin donors.
I think donor eggs might be a solution.
Yes, why not? With donor egg program your previous ovarian answer during IVF with own eggs is no longer important. We use donor eggs, that’s why you have good chances.
Usually, we have patients who travel directly after the transfer. They sometimes go back home on the same day, because we have a lot of patients from Germany or, for example, from the Czech Republic. You can also travel the day after. It doesn’t really influence the results.
No, because donors are anonymous and if we show you a picture is not anonymous anymore. That’s why we will provide you with as much information as possible about the donor’s hobbies, education, job, hair/eye colour, height, but not a photo.
Our egg donors are young, between 18 and 32 years old in our clinic. They are healthy of course, with no diseases in personal or family history, they are all tested for STD, they are gynecologically monitored, genetically tested. If you mean selecting donors for the recipient, then, first of all, the recipient needs to fill in a form asking for their phenotype characteristics. According to this information we select a donor and match her to your profile. Then we contact this donor and plane the timing of the treatment.
Gender selection in the Czech Republic is prohibited. We can do single embryo transfer or we can transfer two embryos.
We have a good donor database, so you contact our coordinator and then you have a consultation with a doctor and if everything is OK, then the coordinator sends you 2 or 3 donor descriptions (A, B or C). You will have to choose one of them. Then we contact the donor and you will inform us what date you prefer when you plan to travel. So it’s one month maybe from the first contact with our clinic.
We guarantee six mature eggs.
Your donor is just for you (exclusive donor), so it means all eggs that we will have from this donor are yours. If we have 10, 12, 15, all are yours. But the minimum that we guarantee is 6 mature eggs. How many times can an egg donor donate? In the Czech Republic 5, maximum 6 times, but in our clinic 5 times.
There is no waiting time, except if you have special requests. We have a wide donor database, that’s why it’s really fast from the first contact with the coordinator, appointment or Skype consultation and then donor selection – it can take about a week.
To select a donor is enough 1 or max. 2 weeks, but to start the treatment and synchronize donor with a recipient might take min. 1 month.
Of course. It’s according to your wishes. We can provide you with this information. Yes, we can do it.
All embryos are yours, so according to the program we will keep them for a year and then every year you can decide what you want to do. If you want us to keep them in our clinic until you decide to have another child, you can come back for frozen embryo transfer. If you don’t need it anymore, you need to inform us.