Egg donation. Anonymous egg donation
The most reliable assisted reproduction technique involves eggs (oocytes) from an anonymous donor which, following fertilisation, are transferred to the recipient in order to obtain a pregnancy
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What is egg donation?
Egg donation is currently one of the most effective assisted reproduction treatments available because it means that women who are unable to have children using their own ova can experience pregnancy. In vitro fertilisation treatment (IVF) is performed using the anonymous donor’s ovum which is fertilised using the partner’s semen. The embryos that are generated are transferred to the recipient.
Starting a treatment that uses donated egg cells is a very important decision that must be made with all the necessary information. For this reason, the doctor in charge of your case will provide you with detailed information about possible alternatives and the most relevant aspects of the treatment.
It is crucial that you are provided with detailed information about those aspects having to do with the donor, both as regards legislation and the selection procedures that are required to accept candidates as donors. Fortunately, legislation in Spain is clear, and it offers a legal security framework that allows treatments to be carried out in a simple way.
You will also receive information on the procedures followed to select the best donor for you based on your physical and clinical traits.
On this visit, and once you have agreed to take the treatment and selected a time frame to complete it, you will receive information on the necessary steps to get started. The arrangements to receive the embryos are much simpler than the ones for in vitro fertilization (IVF): they do not include daily injections and the number of visits for ultrasound control is limited. You could receive an approximate start date for the treatment at this moment.
At the end of your appointment with the gynecologist you should meet with your Comprehensive Care Provider to complete all the medical and legal requirements (i.e. to sign consents) and receive prescriptions for the necessary drugs as well as accurate and detailed instructions to use them.
Designing the treatment and synchronizing
At the moment when you are informed about the treatment that uses donated egg cells and you make the decision to start it there begins a process where all the different departments in Instituto Bernabeu are coordinated to offer you the greatest chances for success and the best personal care.
Preparing the endometrial cavity to receive the embryo
The endometrium is the “layer” in the uterus where the embryo becomes attached and is subsequently implanted so that pregnancy can happen.
This “layer” should be prepared and synchronized with the embryo. For this reason, drugs need to be administered to send the right signs to the uterus so that its “receptivity” is optimal.
Fortunately, preparation is extremely simple: injections, tests and frequent appointments are not necessary at this stage. In most cases only one injection is needed for the whole treatment and one or two ultrasounds are normally enough to confirm that preparation is going well.
The drugs needed for the treatment are administered orally or transcutaneously (i.e. patches) and have a high tolerance level, as the hormone levels that are sought are very similar to those in women during their natural cycle.
After egg cells have been retrieved from the donor, administration of progesterone begins, normally performed vaginally (eggs). The beginning of the administration of progesterone is extremely important, since it is when the sign for the endometrium to be receptive at the moment of transference is “sent”. In other words, it is what creates the correct synchronization between the embryo and the uterus.
You will receive accurate and detailed written instructions about each and every step for preparation. Even so, the whole of our team is at your disposal, so please do not hesitate to let us know if you have any questions or concerns.
Selecting the most appropriate egg donor
Aware of the great responsibility that the trust placed on our team entails, we begin a thorough selection of egg donors to guarantee the highest quality and the best results to our patients. Having successfully passed a thorough analysis
(e.g. a psychological evaluation and medical, gynecological and genetic tests) and tested negative for the main illnesses that could be transmitted, the candidate is accepted as an egg donor.
No additional cost is a genetic carrier test (GCT) of the 600 most common genetic diseases with the greatest involvement for health, offering the additional possibility of comparing it with the father to avoid transmission to future offspring.
Previously, the recipient couple has informed us about their blood type and their main physical characteristics (weight, height, skin colour, eyes, hair, and so on) and provided a photograph to facilitate the search for physical likeness. The law in Spain stipulates that under no circumstances will the identity of the parents or the donor be disclosed. Yet, the results of the medical and gynecological tests and the donor’s age may be disclosed in case they are needed in the future. In addition, the donor’s genetic matter (DNA) is stored for a period of 20 years in case it becomes necessary to carry out an advanced comparative genetic study of the future newborn.
Stimulating the donor’s ovaries
Stimulation of the donor’s ovaries begins at the same time as the therapy to develop the recipient mother’s endometrium. Stimulation is key to future success. It is important to produce the highest possible amount of oocytes, but it is even more important to ensure their quality.
For this reason, we follow their development closely by means of ultrasound scans that allow us to determine the most optimal dose to enhance their quality without compromising the donor’s quality of life during stimulation –just like we do with all of our patients
Simultaneously, the male provides a sperm sample. The sample is capacitated in the laboratory to increase its power to fertilize.
In Vitro Fertilization
Fertilization is initiated in the Human Embryology Laboratory by joining an oocyte with the male’s sperm, either through the usual IVF procedure (more natural) or the ICSI procedure, whereby a single suitable sperm is injected into the oocyte through a thin needle. This procedure facilitates fertilization in cases of male pathology.
The result of fertilization (day 1 of the embryos’ life) can be seen within approximately 18 hours. At this point the amount of naturally fertilized oocytes, which is the same as the number of embryos, can be determined.
Starting to take progesterone
Just like it happens in a woman’s natural cycle, progesterone must be included in the recipient mother’s medication at the time of fertilization. This drug is extremely important, as the fetus will need it during the first months of pregnancy, until s/he produces enough placenta.
Culturing the embryos
After fertilization, embryos start to develop in incubators in a culturing environment that provides them with everything they need in order to grow. They are watched daily, and both embryo cleavage (the number of cells) and important data about their morphology are recorded. The quality of each embryo is determined both by division and morphology.
Embryo quality is determined by a combination of cleavage and morphology. It should be kept in mind that not all oocytes will fertilise and that not all of them will generate embryos with the same characteristics. Every embryo faces a different fate. Some have good quality, others become blocked and others make it to the end despite their bad quality. From the way they evolve we propose either short cultures (2-3 days) or long cultures (4-5 days: blastocyst). 75% of our egg donation cycles reach the blastocyst stage.
Transferring the embryos
Embryo transfer is normally scheduled between two and five days after fertilization (i.e. at the peak of the treatment). The goal is to move the embryo from the laboratory to its final destination for development: the future mother’s uterus. It is carried out with the help of an abdominal ultrasound in order to find the perfect spot for implantation.
A thin catheter is introduced through the neck of the uterus, and a drop taken from the culturing environment where the embryo is floating is poured into the uterus. Sedation is not necessary, it is not painful and, as a matter of fact, it is very similar to a regular gynecological checkup. The procedure is performed at a temperature of 36ºC in a dimly lit, sterilized room located next to the laboratory to make it as unintrusive as possible.
Testing for positive pregnancy
A pregnancy test is scheduled 13 to 14 days after starting to take progesterone to confirm pregnancy or not: it is determined by the blood levels of a hormone named beta-hCG. This hormone produces the embryo and is transferred to the mother through placenta. It is the first sign of the embryo and can be measured as proof of development.
In case of failed pregnancy, every member of the human team that participated begins to examine the whole treatment so as to evaluate the causes. Afterwards, a meeting with the couple is arranged to provide a medical report.
When pregnancy is confirmed and after 15 days, an ultrasound scan is performed to make sure that pregnancy is proceeding normally. To perform it earlier might create confusion and uncertainty, as the results are not conclusive in most cases.
What happens if transfer does not take place?
On 3% of egg donation treatments there is no transfer. At Instituto Bernabeu, should this be the case and the male factor is not altered (5 million count and 30% mobility), we offer a new treatment at no cost as a proof of commitment to you.
- It's the reproductive medicine technique which gives the best results.
- It does not involve ovarian hormonal stimulation or daily injections to the receptor
- It does not require anaesthesia or sedation
- It yields the lowest rates of miscarriage caused by chromosomal abnormalities related to age
- Undergoing egg donation in Instituto Bernabeu also comes with the assurance of flawless management at each stage of treatment.
Why opt for anonymous egg donation?
Often and for different reasons (e.g. age, hereditary diseases, past surgical operations, and so forth), ovaries lose their ability to produce healthy egg cells. Egg cells are vital for conception. This makes anonymous egg donation necessary, as part of In Vitro Fertilisation treatments.
Instituto Bernabeu is a leading egg donation centre in Europe counting with one of the first programmes in Spain. Because of our experience of more than 20 years, the large number of egg cell donations in our repository and the social and cultural status of our donors, we can guarantee that:
- No waiting times.
- We will conduct rigorous medical and genetic screenings of donor candidates.
- We will select the most compatible donor from a medical perspective.
- We assign an exclusive donor for each receptor, which results in a better quality of egg cells and a higher number for donation. We guarantee an average donation of 11 egg cells and a minimum amount of 8 high quality eggs donated.
- We will perform a thorough selection of physical characteristics that are similar to the receptor’s.
Duration of egg donation treatment
Egg donation treatment takes between a month and a half and two months. In the first appointment, the course of treatment is designed and synchronised with the donor. The donor is selected taking into account optimum patient compatibility. Ovarian stimulation in the donor is synchronised with endometrial preparation in the mother and, once the eggs have been retrieved, in vitro fertilisation (IVF) is performed. Following transfer, around 10 days go by before a pregnancy test can be done and, 5 days after a positive result, the first ultrasound scan can be performed.
|ACCUMULATIVE POSITIVE PREGNANCY RATE OVER 3 CYCLES||96%|
|POSITIVE PREGNANCY RATE (INCLUDING FROZEN EMBRYO TRANSFERS)||83,5%*|
(We synchronise fresh donation, unless the recipient patient wishes otherwise)
CYCLES OF EGG DONATION WITH EMBRYO FREEZING (an average of 2.3 blastocysts per cycle)
|TRANSFERS ON DAY 5-6 (BLASTOCYST)||99,5%|
|EMBRYOS REACHING BLASTOCYST STAGE (including male factor)||75%|
|EGGS DONATED||We guarantee a minimum of 8 and an average per cycle of 11 (2017)|
|ALL OUR EGG DONORS ARE THOROUGHLY SCREENED||Maximum rigor:|
|ANALYSIS OF 600 AUTOSOMAL RECESSIVE DISORDERS (GCT: GENETICAL ANALYSIS IN DISORDER CARRIERS)||
Given to all our egg donorsat no cost to the patient. This allows us to identify the presenceof up to 555 genetic mutations that cause more than 600 diseases. Read more
*Optional: Possibility of contrasting theCGT with the future father.
|STATE-OF-THE-ART TECHNOLOGY ASSOCIATED WITH THE TREATMENT AT NO COST (IF MEDICALLYADVISED)||
|VIABLE PREGNANCY 100% GUARANTEED||Optional (subject to medical criteria). Read more|
* Transfer of 1 fresh cycle plus 1 frozen cycle with no PGS/PGT-A/CCS and elective vitrification.
At Instituto Bernabeu, we perform rigorous and comprehensive screenings of donor candidates, including psychological, clinical and genetic evaluations, in order to maximize the suitability and safety of the procedure:
- A psychological evaluation performed by a clinical psychologist. This evaluation includes a personal interview and completing our Psychological Evaluation Questionnaire (EMAE) to evaluate the candidate’s personality.
- An evaluation of the candidate’s personal and family history performed by a gynecologist specialized in fertility, and a physical and gynecological examination that shows the candidate’s good state of health and excludes the possibility of a gynecologic pathology.
- Chromosomal and genetic studies to rule out the possible presence of hereditary diseases: Karyotype (including chromosomal polymorphisms associated with an increased risk of miscarriage), screening for Fragile X Syndrome, Thalassemia, Spinal Muscular Atrophy (SMA) and the study of 552 genes linked to over 600 autosomal recessive diseases (CGT: The most comprehensive genetic compatibility test). The future father can take the CGT in parallel to contrast the results with the egg donor in order to avoid transmitting diseases to offspring. In addition, the DNA extracted for genetic testing is stored in a biobank for future testing.
- General laboratory tests: blood type and Rh factor, syphilis serology, hepatitis B and C serology, HIV serology, and coagulation tests.
Tests for Cytomegalovirus (CMV).
Donor DNA Repository
Thanks to the donor DNA cryobank driven forward by Instituto Bernabeu since its pioneering launch in 2010, patients who need to make use of donated gametes for their fertility treatment can, at any time, make a request for a genetics study with a view to preventing and adequately treating possible diseases which might affect their children in the future (further to egg donor consent). No extra costs.
Epigenetics and egg donation
Epigenetics is a science based on studying how certain environmental factors and as well as lifestyle habits such as eating, smoking, drinking and exercising in the mother can have an impact on the expressions in certain genes. Evidently, the mother’s habits cannot have an impact on the embryo's genetics but they do influence epigenetic markers. As such, the mother carrying the child also has an impact on the future child’s development and shapes certain genetic expressions. She is not merely a receptacle.
Legal aspects of egg donation
It is worth pointing out the main aspects of Law 14/2006 on assisted reproduction techniques with regards to egg donation. They are explained below:
- Egg donation must be altruist and unpaid because one of the fundamental principles of Spanish healthcare legislation is that the human body and its cells cannot be commercialised.
- It is also a free and formal contract between the donor and the clinic that has the authorisation to perform the technique. As such, donor selection is the responsibility of the medical team at the clinic.
- The essential characteristic is anonymous donation and a personal data and donor identity confidentiality guarantee, both on behalf of the gamete bank and on behalf of the reproduction clinic.
- Only in exceptional circumstances when the life or health of the child is in danger can donor identity be revealed and only when revealing that information is absolutely essential.