Egg donation is a complex process – not only from the medical point of view but also from the patient’s mental perspective. Getting ready for it requires completing thorough clinical and psychological evaluations as well as learning various responsibilities – both on the part of donor and recipient. In this webinar, dr. Jon Aizpurua (Founder & CEO IVF Spain) not only explains egg donation process in detail but also addresses the most common concerns and doubts related to it.
Defining the time when one should go for egg donation is really difficult. Generally, most patients who face such a challenge, have already had a story of the standard IVF treatment. Dr. Jon Aizpurua admits that egg donation is surely the most efficient and the easiest way to achieve a pregnancy and the most successful treatment in ART (assisted reproductive technologies). However, fighting for patient’s own eggs and gametes should be the doctors’ initial approach – in any case. Going for donor eggs is, on the other hand, a pragmatic solution.
Dr. Aizpurua says that choosing egg donation is sometimes the only possible road to parenthood, taking into account all unsuccessful attempts with own eggs. As he stresses it out, we are all somehow the victims of delaying motherhood and not being educated in the right way about methods of preserving one’s fertility (like e.g. egg freezing). That’s the reason why a lot of patients are confronted with the necessity of considering egg donation at some point in their treatment.
In order to help fertility patients come to terms with the decision of egg donation, dr. Aizpurua collected the most common questions related to the subject. By answering them, he wants to provide support and assistance to all those who find themselves on this surely most demanding stage of the fertility journey.
According to dr. Jon Aizpurua, this question stresses the cumulative frustration on the part of a patient. However, he says that it is not the frequency of IVF cycles that is decisive here – but it’s their quality. That should be the basis for exploring the reasons for the failure. So it’s not only about ‘how often’ – it is also about ‘when’, ‘ where’, ’with what technology’ and ‘what the results show’. The precise diagnosis of failure is crucial here – one should ask if it was related to bad eggs’ quality, high aneuploidy risk, woman’s advanced age or metabolic disorders (e.g. polycystic ovaries). Because of all the latter, it is not possible to give one and the same answer to everybody. It is not possible to define the number of suggested IVF attempts precisely. This number should be estimated for every patient individually.
According to dr. Aizpurua, the decision about egg donation always depends on various factors. Apart from everything that was mentioned before, there are also additional ones, such as emotional distress, economic factor or the timing of one’s desired parenthood. In the end, it is very difficult to give a general answer that would suit everyone. That’s why it is a conscious decision that patients have to take themselves – doctors can only provide them with information, evidence and advice about possible options.
Unfortunately, there are no real parameters to find out if eggs have good or bad quality. There are just some indicators and prognostic factors, such as appearance and blood supply to the ovaries, the volume of ovaries, antral follicle count (AFC), the stimulation capability of follicles and anti-Müllerian hormone (AMH). However, all this data is quite difficult to know in advance – most of the investigation on the egg can be done once it is retrieved. That’s why there is no advanced way of predicting how the egg will behave. The only way to classify eggs as the bad quality ones is when they fail during fertilisation or produce embryos of bad quality. Dr. Aizpurua admits that, in the end, it is a very useful way – it is about the functionality of the eggs. The only fact about eggs that we can take for sure is the link and dependency between woman’s age and eggs’ chromosomal imbalance. Aneuploidy and the age of eggs is something that can be defined in advance. Dr. Aizpurua mentions statistics which show that in the case of a 35-year old woman, more than 50% of eggs after stimulation would have some genetic disorder (this number rises in 40-year old women – then its even up to 60-70%). When it comes to the molecular capacity of eggs, it can be checked during the embryo development using Time-Lapse technology. It gives a reliable picture if the mitochondrial supply of the egg is correct. Together with genetic competence, the metabolic competence of the embryo can give us enough information if the egg was good quality or not. That’s why at IVF Spain some mathematical algorithms were created on the basis of those two, in order to predict how an embryo (coming from a particular egg) will behave in terms of implantation.
And although implantation does not refer only to the embryo and there are other factors to be considered (e.g. endometrium, immunology, receptivity of the uterus, blood supply), about 70%-80% of its success (or failure) is because of chromosomal instability of the embryo. Only when all of these factors are taken into account, doctors receive the information about the quality of the eggs that helps a lot in giving further recommendation on when to change the treatment strategy. Dr. Aizpurua says that the doctors’ aim is to make a patient aware of how much time and resources each of the paths to pregnancy (IVF or egg donation) will take. Only in such a way they can compare their efficiency, cost and time and make a conscious decision.
In this case, dr. Aizpurua leaves no doubts – the best way would be to turn back time. Unfortunately, it’s not possible. Of course, there are some new methods, such as regenerative medicine that aims at reprogramming tissues to let them behave younger. However, although these methods look promising, they are still under clinical trials. Apart from that, there are recommendations of a healthy lifestyle and supplement intake. But having said all that, dr. Aizpurua admits that improving eggs’ quality is congenital: if there is a hormonal disruption in the maturation of the eggs, this is usually inborn. And doctors cannot turn the way nature works. They can help patients keep in the best possible shape – but that’s all they can do. In the case of eggs’ quality, everything is restricted by one’s own congenital conditions. And although doctors can turn the eggs to their best possible stage (thanks to e.g. rejuvenation therapy), in the end they cannot change that much. According to dr. Jon Aizpurua, eggs’ quality is only one of the constant parameters in the bigger equation.
Egg donation is surely the best option in case of a serious surgery (such as e.g. ovaries removal) or congenital genetic disorder with both ovaries. Dr. Aizpurua mentions also chromosomic disorder, like translocation, resulting in very poor-prognosis embryos. These are the primary indications for egg donation – and the real reason why egg donation appeared in the late 80s of the twentieth century. In the meantime, fertility experts have learned that there are other indications for that kind of treatment as well. Nowadays egg donation is recommended in cases of recurrent abortions or implantation failures, too. It is also chosen for pragmatic reasons, such as safety or efficiency of treatments.
According to dr. Jon Aizpurua, mental preparation is the first step towards egg donation. Most patients at some point face the dilemma: whether to continue with own eggs or go for egg donation. What would happen if they admitted the so-called ‘third party’ into their family? This process entails psychological, philosophical and ethical dilemmas and consists of a few stages, including rejection, accommodation and assumption. The final stage, after a successful pregnancy and child-delivery, is simply happiness. Original fears and doubts disappear once the patient has a child in her arms. The treatment itself, on the other hand, starts with the consultation with a doctor. After considering all the options and possibilities, the second stage begins. This is the preparation of the endometrium with endometrial receptivity test (ER Map), immunological tests or HLA-profiles of the couple to make genetic matching with the donor. Once all of this is done (together with sperm analysis) and the donor is found, the patient is prepared for the embryo transfer. Patients generally have to come to the clinic once or two times – firstly, for the consultation and secondly – for the final transfer.- Questions and Answers
I think you’ve already given us the answer. If you have energy for one more round with own eggs, then I’d do a lot of things in another way beforehand. These miscarriages are not normal – there has to be a very deep analysis of your immunology as their possible cause. For sure, the genetic part of the sperm also has to be studied in advance before making another round. So if you’re ready for only one shot more with own eggs, then it is important to take extreme care of genetics and immunology before. If you mean one shot more at all, then please go immediately for egg donation. After all this story of unsuccessful trials and at the age of 40, it is possible that also under the best conditions and using the best technology, you don’t get a stable pregnancy with high percentage of success. Knowing all we know, I assume in the best case you could achieve about 60% of the success rate. And this still means 40% of non-success. In case of egg donation, you will have 3 transfers and the expectation of take-home baby rate higher than 90%.
Q10 is a co-enzyme and it has less impact on egg quality than the endocrine hormonal way with DHEA and growth hormone. But it improves some of the metabolic processes of the cells that surround the egg and provide it with growth and maturation signals. So I have nothing against that – just remember it is less effective than hormones.