When IVF does not lead to pregnancy, many patients begin asking difficult questions. Is the problem related to egg quality? Is ovarian reserve too low? Have all options with their own eggs truly been explored? And at what point should egg donation be considered?
In this presentation hosted by Carly Garrett, Reflexologist and Fertility Coach, Dr Natalia Szlarb, a fertility specialist in reproductive medicine based in Alicante, Spain, discussed poor ovarian response, low ovarian reserve, embryo quality, genetic testing, and the role of egg donation when IVF treatment is not working.
Dr Szlarb explained that egg donation should not be seen as a quick or automatic decision. Instead, it should come after a careful medical assessment of a patient’s age, ovarian reserve, previous IVF results, and the realistic chance of achieving pregnancy with her own eggs.
As Dr Szlarb said, For me, it’s very important to diagnose it well and show you the solution for the problem that we have.
Dr Szlarb opened the presentation by explaining that the topic was poor ovarian response to IVF treatment and what can be done about it.
Poor ovarian response refers to a situation where the ovaries produce fewer eggs than expected during IVF stimulation. This can be emotionally challenging for patients, especially if they have already gone through several IVF cycles and still do not have a pregnancy.
According to Dr Szlarb, one of the key questions is how long patients should continue trying with their own eggs before understanding that they are poor responders and may need to consider another option.
She framed the question clearly: how can a patient be certain that all options with her own eggs have been explored before moving forward with egg donation?
When patients come for infertility treatment, Dr Szlarb explained that doctors first need to assess the chance of pregnancy using the patient’s own eggs.
This assessment can often begin even from a distance, for example during an online consultation. Dr Szlarb said that three main factors are needed:
Age is one of the most important factors in IVF because it affects the genetic quality of eggs and embryos.
Dr Szlarb explained that younger patients with low ovarian reserve may still produce a meaningful proportion of healthy embryos. However, in patients of advanced maternal age, the number of genetically healthy embryos is much lower.
This means that two patients with similar AMH levels may have very different chances depending on their age.
AMH, or anti-Müllerian hormone, is used to estimate ovarian reserve.
Dr Szlarb described AMH as a factor that tells doctors how many eggs a patient may generate. She emphasised that AMH is “just a number” that gives information about egg quantity, not the full picture of egg quality.
She explained the following AMH ranges:
According to Dr Szlarb, if AMH is above 2 ng/ml, a patient may have a good ovarian reserve and may generate at least 15 eggs in a mild cycle. If AMH is between 1 and 2 ng/ml, ovarian reserve is diminished. If AMH is below 1 ng/ml, the situation becomes more concerning.
The third factor is an ultrasound assessment of the antral follicle count.
Antral follicle count helps doctors understand how many follicles are visible in the ovaries and how the ovaries may respond to stimulation.
Together, age, AMH, and antral follicle count allow the doctor to estimate whether treatment with the patient’s own eggs is still realistic or whether egg donation should be discussed.
Dr Szlarb gave two examples from her consultations.
One patient was 29 years old, had previously had an ovary removed, and had an AMH of 0.3. Another patient was 42 years old and had an AMH of 0.2.
At first glance, both patients had very low AMH levels. However, Dr Szlarb explained that their situations were not the same.
In a 29-year-old patient, an AMH of 0.3 may mean that only 5 or 6 eggs are generated. However, because the patient is young, there is still a higher chance that some of those eggs or embryos may be healthy.
Dr Szlarb explained that when a patient is under 35, around 60% of the eggs and embryos generated may be healthy. Therefore, a young patient with low AMH may still produce one or two healthy embryos.
In contrast, a 42-year-old patient with a similarly low AMH may also generate 5 or 6 eggs, but only a much smaller proportion may be healthy.
Dr Szlarb said that in this age group, perhaps only 10% of embryos may be healthy. This may mean “either one or none.”
This distinction is central to the decision-making process. Low ovarian reserve in a younger patient may sometimes be overcome with persistence, embryo banking, and genetic testing. In an older patient, the same low ovarian reserve may make pregnancy with her own eggs much less likely.
For younger patients with low ovarian reserve, Dr Szlarb explained that one possible strategy is embryo banking.
Embryo banking means performing more than one IVF cycle in order to collect and create more embryos over time. This may give the patient a better chance of finding genetically healthy embryos.
Dr Szlarb explained that in a younger patient, even if fewer eggs are collected, the genetic quality may still be good enough to continue trying.
She said that with younger patients, low ovarian reserve can sometimes be overcome “through hard work, through embryo banking.”
For example, if a young patient creates embryos across two or three cycles, genetic testing may help identify healthy embryos for transfer.
However, Dr Szlarb explained that this approach is not something that can be repeated in the same way for patients over 42. At that age, generating enough day-five embryos may be very difficult, and the chance of finding a healthy embryo is much lower.
Dr Szlarb described egg donation as a solution for patients who have low ovarian reserve and generate few eggs.
However, she also made clear that the decision should be stepwise.
The first step, where appropriate, is usually to allow the patient to try a cycle with her own eggs and apply genetic testing to the embryos to identify healthy ones.
The first step is always allowing them a cycle with their own eggs and applying genetic testing of her embryos to find the healthy ones, she explained.
This may be recommended even in younger patients because embryo selection can shorten the time to pregnancy.
Egg donation may become the treatment of choice for patients who have already had several IVF cycles in their home countries without success. When such patients come to Spain, Dr Szlarb explained that embryo selection through PGT-A may be used. If it becomes clear that treatment with the patient’s own eggs is not progressing successfully, egg donation may be recommended.
According to Dr Szlarb, one group of patients who may be candidates for egg donation are those under 40 who have few eggs or who, after genetic testing, cannot generate healthy embryos from their own eggs.
Another group includes patients who are over 42 or 43. In these cases, Dr Szlarb said that it is almost impossible to find genetically normal embryos in many patients, and egg donation may be recommended from the beginning.
However, she also recognised that this can be emotionally difficult.
She explained that some patients are not ready to accept egg donation immediately. They may still hope that, despite advanced maternal age, they will find healthy embryos with their own eggs.
In these cases, Dr Szlarb said she sometimes prefers patients to go through one cycle with PGT-A so that they can understand what is happening genetically.
She explained that if a patient sees that everything from her own genetics is abnormal, she may then be more prepared to move to egg donation.
Age was one of the central themes of Dr Szlarb’s presentation.
She explained that when patients are over 43, less than 10% of eggs and embryos may be good. This is why patients in this age group may be candidates for egg donation.
Dr Szlarb made it clear that this understanding comes from clinical experience and statistics. However, she also acknowledged that patients may need time to process it.
The decision to move to egg donation is not only medical. It is also emotional.
Patients may need to feel that they have done everything possible with their own eggs before they can accept donor eggs as the next step.
Dr Szlarb also discussed premature ovarian failure as another reason why egg donation may be needed.
She described seeing a patient who was 20 years old and came for a second opinion with symptoms such as hot flashes. Further testing confirmed that her AMH was extremely low.
Dr Szlarb explained that in such cases, AMH alone is not enough. A complete hormonal evaluation is needed, including:
She explained the logic of reproductive medicine in this context. If there are no eggs in the ovaries, the ovaries do not produce estrogen and female hormones in the expected way. The brain receives this information, and the pituitary gland produces a high dose of FSH, or follicle-stimulating hormone.
When FSH is very high, for example, more than 40 or 60, this can be a sign of premature ovarian failure.
Dr Szlarb explained that premature ovarian failure can happen in patients in their twenties or thirties. It may run in families, or it may occur after infections. She gave the example of a patient who developed ovarian failure after an acute hepatitis B infection with high fever.
Patients with premature ovarian failure may be candidates for egg donation.
Another indication Dr Szlarb discussed was endometriosis.
She explained that endometriosis is a disease in which endometrial tissue can move outside the uterus, including through the fallopian tubes into the abdomen and ovaries.
When endometriosis affects the ovaries, it may damage ovarian tissue and reduce the number of eggs.
Quite often, patients with endometriosis need egg donation, Dr Szlarb said.
This means egg donation is not only connected with age. It may also be considered when ovarian function has been affected by medical conditions.
A key message from the presentation was that egg donation is not only for patients of advanced maternal age.
Dr Szlarb explained that egg donation can also be needed by younger patients, including those in their twenties, if they have premature ovarian failure or other conditions affecting ovarian reserve.
She said there are several indications for egg donation, and advanced maternal age is only one of them.
So there are few indications for egg donation. It’s not only advanced maternal age, she explained.
Dr Szlarb then discussed embryo development and why day-five embryos are important.
She described her training in Germany and explained that, because of legislation, reproductive medicine there was more limited compared with Spain. In Germany, embryos were transferred on day three of development.
On day three, embryos have only around eight to ten cells. Dr Szlarb compared them to grapes.
She explained that if one cell is removed from an eight-cell embryo, a significant part of the embryo is affected.
In Spain, embryos can be developed to day five, the blastocyst stage. At this stage, an embryo has around 200 cells.
This matters because only the strongest embryos can develop from day three to day five. Dr Szlarb described this as a form of natural selection.
So you can imagine if somebody does a jump from eight cells on day three to 200 cells on day five, only the strongest embryos can do it, she explained.
Dr Szlarb explained that, in Spain, embryos can be tested genetically at day 5.
At the blastocyst stage, two or three cells can be taken from the embryo. The embryo is then frozen, and the cells are sent for genetic testing.
This allows doctors to know which embryos are healthy and which are not.
Dr Szlarb referred to data from a Spanish laboratory involving 60,000 genetically tested blastocysts. She explained that, in younger patients around 35 or 36, 50% to 60% of embryos may be healthy. At ages 37 to 40, this may fall to 20% to 30%.
She explained that this kind of embryo selection can lead to higher pregnancy rates because only embryos that are both strong and genetically healthy are transferred.
Dr Szlarb explained that embryo appearance alone does not always show whether an embryo is genetically healthy.
A patient in her forties may have embryos that look good, but only a smaller proportion may be chromosomally normal.
She gave an example of a patient in her forties with good-looking embryos. Even if three embryos appear good in quality, only one may be healthy.
So out of these 3 good-looking guys, only 1 is healthy, she said.
This is why PGT-A can be important, especially for patients of advanced maternal age or patients with repeated IVF failure.
Based on Dr Szlarb’s explanation, patients may need to start thinking about egg donation when the chance of generating healthy embryos with their own eggs becomes very low.
She explained that egg quality drops dramatically with age.
At ages 26 to 30, she said, 60% to 80% of eggs and embryos may be healthy. At ages 34 to 36, she described the situation as still quite good, with around 50% to 60% healthy. At age 40, patients need to be very fortunate to generate healthy embryos. Between 42 and 48, she said, this is the point where patients should slowly begin thinking about egg donation.
Dr Szlarb then explained how egg donation works legally in Spain.
She said that in the 1980s, the Spanish government allowed anonymous egg and sperm donation.
This means that the donor remains anonymous. When the patient is pregnant, the clinic can tell her only the donor’s age and blood type. Nothing else can be disclosed.
Dr Szlarb explained that, under Spanish law, the clinic must help create a child who reflects the combination of the recipient and her partner.
She simplified this by saying, I have to find you a twin sister.
This means the clinic looks for a donor who resembles the recipient physically. The donor should have similar features, such as:
Dr Szlarb explained that the aim is for the child to appear consistent with the family’s physical characteristics.
Dr Szlarb said that in Alicante, the clinic has more than 1,000 donors available in its database.
She explained that donors are divided into five phenotype groups:
Donors with blue eyes.
Donors with green eyes.
Donors with brown eyes.
Donors from Asia.
Donors from Africa.
The donor must be young. Dr Szlarb explained that, in reproductive medicine, young means under 33 years old.
The donor must also be healthy.
According to Dr Szlarb, donors are screened for infectious diseases, genetic diseases, and mental health.
She explained that Spain’s approach to donor screening developed over time. When egg donation was first allowed, genetic carrier panels were not obligatory. Later, after children were born with genetic issues and legal cases were brought, legislation changed.
Today, Spanish legislation obliges clinics to test donors for recessive diseases.
Dr Szlarb explained that donors are tested for the most common recessive diseases. In more complex cases, where the male partner is known to carry a rare disease, the donor may need extended genetic panel testing.
The clinic then performs a genetic match, comparing the donor’s results with the patient’s or partner’s results to see whether they share any recessive mutations.
If both carry the same recessive mutation, the chance that the child could be born with that condition may be around 25%.
For this reason, donor matching is not only about appearance. It is also about safety and genetic compatibility.
Dr Szlarb also explained that donors undergo psychological evaluation.
A psychologist sends a special questionnaire to all potential donors to evaluate their psychological state. Donors with schizophrenia, depression, personality issues, or drug-related issues cannot be accepted.
The donors also have a face-to-face meeting with the psychologist.
Dr Szlarb described this as step one in the donor selection process.
The second step in donor selection involves information from the patient.
Patients receive documents where they describe themselves, including:
The clinic also asks what is important to the patient in a donor.
Some patients may want the donor to be educated or to be a student. Others may say that it is important that the donor is sporty or does not take drugs.
Dr Szlarb explained that patients can share whatever they feel is important to them.
Patients are also asked to send photographs showing how they look now and how they looked in their twenties.
The clinic uses an AI tool to compare the patient’s face with donor profiles. The tool analyses features such as face shape, eyes, nose, and mouth. It compares the patient with donors who have the same eye colour and blood type.
After this, the team holds a medical meeting. Dr Szlarb explained that this usually includes her, the lab director, the patient’s assistant, and sometimes another colleague.
Together, they decide who they believe will be the best donor for the patient.
Dr Szlarb acknowledged that international patients often worry about travel.
Patients ask how many times they need to come to Spain and how long they need to stay.
She explained that if a patient wants to come for a first appointment in person, she may be able to fly in and out in one day. However, the initial consultation does not always need to be in person.
Dr Szlarb said that one positive outcome of the COVID period was that online consultations became normal. Many patients now begin with an online consultation because they live busy lives and may be located in another country.
In many cases, the main treatment visit requires approximately one week in Spain.
Dr Szlarb described the process as follows.
The first consultation can often take place online. During this consultation, the clinic explains how the donor will be selected and begins planning the treatment.
The clinic also establishes the week when the patient needs to be in Spain. This is adjusted to the patient’s availability, vacation time, or free time.
The patient’s body needs to be prepared for embryo transfer. Dr Szlarb explained that the clinic wants the uterine lining to be between 8 and 12 millimetres.
The clinic performs egg retrieval using fresh eggs from the donor.
The donor eggs are fertilised with the partner’s fresh sperm or donor sperm.
The embryos are cultured to day five, the blastocyst stage.
Dr Szlarb explained that this is why the patient needs to stay in Spain for at least five days. In practice, she said, it is usually from Monday to Monday.
The clinic transfers one or two embryos, depending on the case.
The remaining embryos are frozen for the patient.
Dr Szlarb explained that, for many patients, the best approach is to stay in Spain for one week.
Everything else can happen online.
She described the main reason for travelling as the period covering egg retrieval, fertilisation, embryo development, and embryo transfer.
Dr Szlarb said that, in the majority of cases, the clinic recommends extended culture to day five of embryo development.
When sperm quality is good, she said the clinic may guarantee, depending on the patient’s needs, two, three, or four blastocysts.
One embryo is transferred, and the remaining embryos are frozen.
Dr Szlarb discussed pregnancy rates after egg donation treatment at her clinic.
She said that after one transfer with a good-quality blastocyst from egg donation, the clinic has more than a 70% pregnancy rate.
After two transfers, she said the rate is more than 80%.
After three transfers, she said the rate is 93%.
She explained that, in practical terms, the clinic aims to have three embryos in order to reach more than a 90% possibility of pregnancy.
She also said that these results are age-independent because the eggs come from a young donor.
Dr Szlarb stated that patients can be treated in Spain until the age of 52.
After embryo transfer, Dr Szlarb said patients are advised to perform a pregnancy test in their home country 10 days after the transfer.
The clinic follows patients until 12 weeks of pregnancy.
Patients also need a doctor in their home country, such as a gynaecologist or obstetrician, who can see them once a month.
Dr Szlarb said the clinic can continue to consult on results if needed until the end of pregnancy.
Dr Szlarb returned to the topic of anonymity and explained that egg donation in Spain is anonymous.
The clinic can tell the patient only the donor’s age and blood type once the patient is pregnant.
She acknowledged that some patients may have difficulty with this aspect of treatment.
For this reason, Dr Szlarb said the clinic teaches patients how to explain to their child that they were conceived through donation.
The clinic psychologist explains the stages of personal growth and psychological development, and what should be communicated to the child at each stage.
Dr Szlarb said the clinic recommends telling the child as soon as possible in an age-appropriate way.
She suggested reading fairy tales to small children and bringing them to Spain for a summer holiday. Families can show children the clinic team, embryologists, and assistants, and take pictures so the child understands the story of how they were conceived.
Dr Szlarb explained that children can be proud that their parents took this step.
Dr Szlarb explained that the recipient is the child’s legal mother.
The donor will never receive information about the recipient, and the recipient will never receive identifying information about the donor beyond age and blood type.
The donor has no parental rights.
Dr Szlarb said egg donation is available for patients with recurrent implantation failure, single women, and lesbian couples.
She explained that sometimes lesbian couples are both in advanced maternal age and no longer have eggs, so egg donation may be needed.
Dr Szlarb described egg donation as a final and unique step for many couples and patients.
She said it can offer more than 90% success rates after multiple transfers and that the results are age-independent.
She also described egg donation in Spain as well-regulated, safe, ethical, and well-established.
According to Dr Szlarb, egg donation was introduced in Spain in the early 1980s, and the regulation was later changed and developed, including the introduction of genetic testing.
Dr Szlarb addressed one of the most emotional questions patients may have: will the baby be my child?
She answered by describing the experience of carrying a pregnancy after egg donation.
She explained that as the pregnancy develops, patients see the gestational sac, then the heartbeat, then the baby growing during scans. They continue to be followed by medical professionals, and they experience the pregnancy in their own bodies.
When you see it, so small and already has a character, this is the moment where you start loving this baby, Dr Szlarb said.
She described how, later in pregnancy, patients see the baby’s anatomy, follow its growth, think about delivery, and go through birth, whether vaginal delivery or caesarean section.
She emphasised that no one can take away the experience of carrying, delivering, and raising the child.
You’re gonna be a mom. Trust me, she said.
For Dr Szlarb, motherhood develops through pregnancy, birth, and the daily reality of caring for the child.
Dr Szlarb also discussed why a second opinion can be important.
She explained that Europe has different fertility laws in different countries. Because of this, reproductive medicine in one country may not offer the same options as reproductive medicine in Spain.
Sometimes, patients speak with doctors in their home country who may not have access to the same tools or experience with certain treatments.
Dr Szlarb explained that a consultation with a reproductive medicine specialist in Spain may be very different because Spanish clinics may have more options available in specific cases, especially around embryo development, genetic testing, and egg donation.
She said that patients do not necessarily need to come in person for a second opinion. It can be done online.
Knowledge is the power, she said. The more you will know what can we offer for you, the best decisions you’re gonna take.
Dr Szlarb described her own method as a strategy-based approach.
She said that when she sees a patient for the first time, she looks at the patient’s age, AMH, and antral follicle count. Based on these factors, she can estimate what may be possible with the patient’s own eggs and what may be possible with donor eggs.
However, she emphasised that this decision should not be taken quickly.
It’s not a decision that we’re gonna take quickly, she said.
For a second opinion, the patient needs to send a medical history form. Dr Szlarb explained that she asks about previous IVF cycles, whether embryos reached day five, whether fertilisation occurred, which protocols were used, and which hormones were used.
This helps the doctor decide whether changing medication or protocol may still help, or whether egg donation is the more realistic next step.
Dr Szlarb’s presentation made clear that egg donation is not automatically the next step for every patient whose IVF has failed.
Instead, the decision depends on a careful review of:
For younger patients with low ovarian reserve, embryo banking and genetic testing may still offer a path using their own eggs.
For patients over 42 or 43, or patients with repeated failed cycles, no genetically healthy embryos, premature ovarian failure, or significant ovarian damage from conditions such as endometriosis, egg donation may become the recommended option.
When IVF is not working, the question of egg donation can feel overwhelming. Dr Natalia Szlarb’s presentation showed that this decision should be based on diagnosis, evidence, and a clear treatment strategy.
Egg donation may be the next step when the chances with a patient’s own eggs have become very low, but it should be discussed carefully and personally. Patients need to understand why IVF has not worked, whether there are still options with their own eggs, and what egg donation would involve medically, legally, emotionally, and practically.
As Dr Szlarb explained, the aim is to give patients an honest opinion and help them make the best decision for their situation.
The donor choosing process has been covered. If a patient wants to work with us, we explain how the donor is selected, how the treatment is prepared, and what documents are needed.
If everything is clear and all documents are signed, the patient usually comes to Spain for one week. During that week, we prepare the body for embryo transfer, aiming for a lining between 8 and 12 millimetres. We perform egg retrieval from the donor, fertilise the eggs with the partner’s fresh sperm or donor sperm, wait for the embryos to develop to day five, and then transfer one or two embryos. The remaining embryos are frozen.
Do not discriminate against yourself because of your age. I have children through egg donation in my own family. My cousin from Germany had many IVF cycles in Germany — eight IVF cycles — and then she came to me for egg donation. At that time, she was with a partner, and she had twins.
Having twins is hard work. One cries, the other one sleeps. After spending a weekend with the twins, my daughter said, “Mama, let’s go back home because I’m tired.” She was 10 years old.
Later, my cousin stayed alone, but she was not really alone. She had the whole family supporting her. She is also a medical professional. She went back to work, but she could not work full-time, so she worked part-time. She had a nanny and support from her mother. When she comes here with the children in the summer, she has my daughter and me enjoying the children with her.
The children are 10 years old now. Every summer, I dedicate at least two weeks of my vacation to spend with them because it is amazing to see what has become of embryos that we could not even see with the naked eye. I saw them on ultrasound, and now they are children going to school and becoming completely independent.
What is also amazing is that her egg donor is Spanish, and the children are growing up in Germany, in German culture. They speak fluent German to us. They know Spanish and nothing else.
So do not discriminate against yourself because of your age, your family situation, your background, or your economic independence. Your support system will allow you to raise a child through egg donation.
I do not recommend twins. Twins are hard work. The whole family becomes involved, and nannies may be needed. It can be a lot of fun, but it is hard work.
With one child and with support such as a nanny, you should be good. I have transferred embryos here until the age of 52, so you are not the oldest one.
Allow yourself to have a consultation with us, and we will explain how we can prepare the treatment. If you work and you are independent, you can be a great mother. It is one more job in your life.
With your own eggs, it is a very difficult question. It is a tough one.
There are hormonal results that are cycle-dependent and cycle-independent. Your AMH is definitely not on your side for IVF treatment.
To understand completely where you are, if you still have cycles and menstruation, on day three of the cycle, you should measure FSH, LH, estrogen, and progesterone.
You can have a consultation with us, and we can write the test sheet for you so you can give it to your doctor in your home country. Then, on day three of each cycle, you should especially measure FSH. We do something called cycle monitoring.
If you have many eggs in the ovaries, there is a signal to the brain, and the pituitary gland produces low levels of FSH. If there are no eggs, the pituitary gland responds by producing high FSH. It can be more than 40 or more than 60.
If you do cycle monitoring and measure FSH on day 3 of the cycle over 2 or 3 menstrual cycles, and you see that your FSH is more than 20, you need egg donation.
Sometimes it takes time to understand this. If you have very high FSH, no matter what dose of medication I give, your ovaries will not respond. We would waste time and money because medication costs money.
If you start a cycle with this FSH, and on day five you have a scan in your country showing zero eggs, I will cancel the cycle, and you will not fly.
We have to establish the inclusion criteria for an IVF cycle very well before we start. There is something in your body that we cannot overcome. If your FSH is more than 20, you need egg donation. Then allow yourself a second opinion consultation with me, and I will do my best.
I do not like the name or nickname “geriatric mom.”
I recently had a patient with her own eggs who was 38 years old. She said, “Natalia, put me 2 embryos because I am going to be a geriatric mom. If I have children, I need 2 children, and they have to support each other.”
We treat patients until the age of 52, but you are not geriatric.
Yes. The fertility blood tests should be checked on day three of the cycle. We need to see what FSH is showing and go from there.
It depends on what you need.
My obligation as a doctor, through evidence-based medicine, is to tell you whether we can make your dream come true with your own eggs or not.
It is learning by doing, step by step. The more we work, the more I know about you, and the better decisions we can make.
The decision is not easy because we are not born with the idea that we will have a child through donation.
If you have no embryos, no eggs, no fertilisation, or after PGT-A, there are zero genetically normal embryos, this is the moment when we have to sit down. You will cry, I will be serious, and we will discuss different solutions for you.
From the very beginning. From 3 or 4 years old.
We use Professor Erikson’s theory of psychological development. There are eight stages of psychological development. From zero to 10 years old, children develop their primary support group: mother and father. From these people, they should learn the truth.
This is the moment when you take a fairy tale. There are many good books written by women who have gone through donation and have published books about it. They are not medical books full of numbers without pictures. These books about how to explain egg donation to a child are beautiful and colourful.
We had a patient from Germany who published this kind of book. In the book, I saw a picture of Playa San Juan beach. She wanted to explain to her son that she found him on Playa San Juan, and that this is where the child is from.
This information then grows with the child. It is very wise to fly to Alicante and show the child the clinic. You can say, “These are the people who supported me and made it happen with me.”
At first, the child may take pictures, run around, and not understand very much at five or six years old. They just want to play. But then you go back home, open the book again, show the picture and say, “Remember, this is where you are from.” Every two or three years, you can fly in and see us, and you will see your children understanding more about where they are from.
You should be proud that you did this kind of treatment. You did something that natural biology could only dream about, but you made it. You are a hero to the child.
Yes, it can be.
We are born with a certain number of antral follicles. The higher the number of antral follicles, the higher the number of potential eggs, and the higher the AMH.
I recently had a patient with polycystic ovary syndrome. She had 24 antral follicles in one ovary and 20 in the other. Her AMH was 15, which in UK units is about double, around 30. In the cycle, we had 35 eggs, 8 embryos, and 8 blastocysts. It was an amazing cycle.
With age, the number of follicles naturally drops, and AMH goes down.
For patients in perimenopause, they usually have fewer than 6 antral follicles in each ovary and AMH under 1. This is the moment when catching ovulation can be challenging.
We would love to help, but we need to know what kind of treatment it is for.
We cannot generate embryos for surrogacy in Spain because we cannot generate embryos for something that is not allowed in Spain.
If we move embryos from Spain to the US, we need permission from a bioethical committee. These committees are usually not quick. Sometimes it takes up to two years for approval, and quite often the answer is no.
It is a complicated situation. If the eggs are from an egg donor, the donor on the day of egg retrieval has to meet all FDA criteria to be on the donor list in the United States.
I worked in the United States, in Detroit, Michigan, and I know that the donor list and the requirements to be put on the donor list in the US are much more extensive than the Spanish ones.
Theoretically, if all these obstacles are overcome, it is possible. Practically, I do not recommend it.
What we can do, and what we do quite often, is that patients pay for their treatment. Then we write a letter explaining what has been done.
If you have good insurance, you need to check what percentage of the treatment may be covered by your insurance.
We have done this a couple of times.
Phenotype is the way you look.
We have many Latin American donors. They have beautiful olive skin. For Indian patients, they are matched by phenotype, including the same colour of face, eyes, nose, mouth, eye colour, and skin colour.
Then you need to ask yourself psychologically whether you are comfortable, as an Indian person, with a Latin American donor.
I can say that we have performed quite a few cycles like this, and our Indian patients were very happy and very pleased with the results.
Yes. It is very important to understand that reproductive medicine is teamwork.
We need a psychologist because it can happen that the first transfer works, the patient is pregnant, and she forgets us. But it can also take a couple of transfers. It is very difficult for patients to experience this emotional roller coaster and these ups and downs because there is a lot of hope before each transfer.
If the result is negative, patients need somebody to support them. We have a psychologist who takes care of this.
You also need psychological support in order to explain to your child that the child was conceived through donation. This includes books, Professor Erikson’s theory, and established psychological guidance on where the child is from and how to communicate it.
This is the job that needs to be done by psychologists.
It is a good-sized database. We try to make the donor matching process as quick as possible.
We have a database, and the patient signs the documents, consents, phenotype questionnaires, and sends pictures. The pre-match can usually be done in two weeks.
Usually, one week is for consultation and the medication plan, and then we establish the time frame when the patient is available. Then, for one week, the patient needs to be here for egg retrieval, transfer, and the related steps.
When you send us all the documents, it is quite quick to find the donor. But then we have to prepare you. You cannot arrive and say, “Do the transfer.” We have to do a test cycle.
Most egg donation cycles are substitute cycles. When you have your period, you take oral estrogens. We need to rehearse your uterus. On day 10 of this substitute cycle, we scan you to see how thick the lining is.
You are scanned in your country, and I need the result. I need to see whether six milligrams of Progenova generates an endometrial lining between 8 and 12 millimetres. If this is the case, I know that this dose of hormones is well adjusted to your body.
So I need one month for a rehearsal cycle and one month for a transfer cycle.
In the transfer cycle, you have your period together with the donor. You bleed in the UK, and your donor bleeds here in Spain. You take oral estrogens again with the adjusted dose, and your donor, in parallel, takes injections to let her eggs grow for you.
Then we double-check you again and make sure the lining is good. After that, we have a one-week time frame when your body is perfectly prepared, and your lining is good. You fly in for egg retrieval, fertilisation with partner sperm, embryos grow to day five, and then we transfer one embryo back to you and freeze the rest.
From the day I see you, including the test cycle and transfer cycle, it is at least 8 weeks.
Economically, doctors do not talk about money.
If you really want to find out and work with us, allow yourself the first consultation. There are some days when I have many consultations because we do them for free. For a second opinion, we do not charge.
Then we talk about the best solution for you. We send you the medication plan proposal, prescriptions, and prices. This is something our patient assistants do every day.
Please allow yourself a second opinion consultation, and we will be very happy to help you.
No. The embryos that we transfer genetically have to be from the same parents.
What we can do is perform an IVF cycle with your own eggs. If we see that it is not working, if the eggs are not growing or the eggs do not fertilise, we can switch.
In the same cycle where I would have cancelled you, you may have generated a good lining because your natural estrogens are rising, but your eggs are not there, are not mature, or something else happens that means we cannot use them.
On the day of egg retrieval, when we see that this is the case, we ask whether you would be happy to switch directly from your own eggs to egg donation. Most patients say yes.
In some cases, if we are fortunate and have a donor who is being stimulated at that time and has some eggs available, we can even do it in the first cycle. But most switch cycles are done with frozen eggs.
Instead of continuing with your own eggs, we fertilise donor eggs, wait for the embryos to develop to day 5, and then transfer 1 embryo, or 2 embryos, from egg donation back to you.
Transferring 2 genetically different embryos in Spain is not allowed.
My reproductive medicine training was in Detroit, so the American BMI is very different from the European one.
I am not going to discriminate against you because of your BMI. I will work with you. I will give you a chance to generate eggs and embryos.
If it does not work, we will talk about how you can lower your BMI.
I myself had to take chemotherapy and prednisone for five years. I had iatrogenic Cushing’s disease. Through good diet, exercise, and now modern injections, people can move from 80 kilos to 60 kilos in six months.
Everything in this life is doable. Allow yourself to have a consultation with us, and we will do our best to help you.
No. Egg donation in Spain has to be completely anonymous.
In the US, I worked with anonymous and non-anonymous donors. The majority of American patients choose anonymous egg donation. They say it is a very tough decision and a very expensive project, and they do not want an issue where somebody at the age of 18 knocks on the door to meet the child, or the child looks for the donor.
The more anonymous, the better.
Feel free to contact us to discuss it.
