IVF DOUBLE GAMETE DONATION
Double gamete donation is the most successful type of reproductive medicine technique available. It entails transferring developed embryos that have been generated by fertilising donated ova and donor semen
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What is in vitro fertilisation with double donation?
The procedure entails performing IVF treatment using gametes obtained through an oocyte donor sperm donor. The donated oocyte and sperm are used to generate an embryo that is implanted in the recipient patient during blastocyst stage. Law requires that the identity of both the donors and the recipients be absolutely confidential.
Double donation is the assisted reproduction technique that gives the best results. The reasons for this include exhaustive donor selection processes performed by Instituto Bernabeu during which we rule out the transmission of over 600 genetic disorders. Donors also undergo a psychological, general health and reproduction (fertility and genetics) assessment. In addition to the fact that donors are young, this significantly reduces the risk of pregnancy loss, malformations and genetic abnormalities.
Double donation at Instituto Bernabeu
Instituto Bernabeu has been a leading entity in gamete donation since 1992 and this is mainly as a result of the following commitments:
All the ova generated by the donor are used in the course of treatment. We ensure a minimum of 8 mature oocytes and an average of 10. Therefore, it is common to achieve several embryos.
All double donation transfers are performed during blastocyst stage. The chances of implanting during this phase of embryo development are higher than when transfer is performed earlier on. Should we be unsuccessful, we commit to giving patients an additional course of treatment at no additional cost.
In-house storage bank
We have our own donor programme. Our semen bank has been running since 1985 and it was one of the first semen banks in Europe. This means we are able to control traceability at all times and ensure rigorous donation processes as well as increased agility because there are no waiting lists.
Similarities in phenotype
We take donors’ physical features very much into account with the aim of ensuring that they are as similar as possible to the recipient mother’s features. The main features taken into account are face shape, skin tone, hair colour and type, eye colour, height, weight, blood group, Rh and so on.
Rigorous selection from a medical, psychological and genetic perspective
In addition to compliance with the provisions of Spanish laws on assisted reproduction treatment involving donors, Instituto Bernabeu applies the strictest of controls in order to be able to give our patients the assurance that, before being accepted onto our donor programme, donors have passed the strictest of medical, genetic, psychological and socio-cultural controls.
The average age of our oocyte donors is 24 and they are never older than 33. Semen donors are never over 35 years of age.
- Medical check-up and analysis of the donor’s medical background and the medical background of his/her family members.
- Gynaecological analysis
- Psychological analysis
- Genetic Analysis
Only 22% of potential egg donors and only 9% of sperm donor candidates pass these strict tests. Some of the main reasons for exclusion include sperm quality (mobility, motility and sperm count).*
(*) statistics based on the first term of 2019 and 510 female candidates and 500 male candidates.
Genetic Compatibility Test (GCT) performed on both donors
We look after the health of the future baby, which is why we carry out the most complete recessive disease test (more than 600 or 2,500 hereditary diseases, depending on the modality) at no added cost, to each of the donors( also known as carrier genetic test (CGT)®, Carriermap®, CarrierDNAinsight® o Recombine®.
Gamete donor DNA storage
We store donor DNA for 20 years so that it can be used in any necessary additional future genetics analyses further to receipt of donor consent.
Transparency in results
The results of our courses of treatment are audited by two external companies - Applus and Instituto Fidelitas - and the results are reported each year to the Spanish Fertility Society (Spanish acronym SEF).
Duration of double donation treatment
Gamete double donation treatment takes between approximately 6 and 8 weeks to complete. This is the time that we need to select the most appropriate donors and prepare the ovarian stimulation cycle. Following oocyte retrieval, we perform in vitro fertilisation using the donor sperm. When the embryos reach blastocyst stage, they are transferred to the recipient patient and unused embryos are frozen by means of vitrification. We need to wait between 8 and 10 days before performing a pregnancy test.
Epigenetics and gamete donation
Epigenetics is a science that studies how certain environmental factors and the mother’s lifestyle (for example, nutrition, smoking, drinking and exercise) can affect the expressions in certain genes. The gestating mother also has an impact on the future child’s development and can influence certain genetic expressions.
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
From the moment when patients are advised to undergo double donation and accept this treatment option, a process that entails coordination between all the departments at IB is initiated. The aim is to give patients the very best chances of success based on the foundations of excellent 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.
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
We are aware of the huge responsibility that our team undertakes in these cases and we begin by completing strict selection of appropriate sperm and egg donors in order to guarantee quality and the very best possible results for our patients.
After passing strict psychological, gynaecological and genetic tests with a negative result for the main hereditary diseases, candidates are accepted as egg donors. In addition to the genetic and medical tests, sperm donors must also pass the strict Instituto Bernabeu sperm count, sperm mobility, sperm motility and sperm freezing tests. These include, for example, a minimum of 80 million in the sperm count (the World Health Organization indicates that 15 million is a normal result).
Donors take a genetic carrier test (GCT) for the 600 most common genetic disorders and the ones that have the greatest impact on a person’s health.
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.
We simultaneously proceed to defrost the donor sperm. The sample is capacitated in the laboratory in order to optimise its ability to fertilise.
In Vitro Fertilization
Fertilisation is carried out in the human embryology laboratory by uniting the egg and the sperm using the ICSI technique. It entails selecting a spermatozoon and placing it directly inside the oocyte.
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
Fertilisation is followed by development in a culture medium that provides everything that is needed for growth. The embryos are assessed during development.
Growth is periodically assessed because not all human embryos reach blastocyst stage.
It is important to keep in mind that not all of them will fertilise and become viable embryos. There will be good and poor quality embryos and others that will simply block.
In our donation cycles, 75% of embryos reach blastocyst stage and 100% of transfers are performed on day 5 or 6.
Transferring the embryos
Once the blastocyst stage has been reached, embryo transfer takes place. It is an essential stage during treatment. It entails placing the embryo in the mother's uterus.
The procedure is performed using an abdominal ultrasound scan. The culture medium containing the embryo is positioned inside the uterus. It is a quick and painless procedure.
Embryos that have not been transferred and wish to be preserved, after vitrification, proceed to storage. After identification, they are deposited in an exclusive location in the cryogenic tanks of our laboratories. For complete security, this location is not shared with other samples, nor with other patients, to protect them from potential cross-infection or inaccuracies.
It is common for several embryos to reach the blastocyst stage following dual donation treatment. Therefore, the embryos that are not initially transferred are frozen by means of vitrification
Testing for positive pregnancy
13/14 days after the progesterone medication began, a blood sample is taken from the patient in order to determine if she is pregnant or not. It consists of detecting beta-hCG levels in blood since this hormone is produced by the embryo and passed on to the mother. It is the first measurable sign sent by the embryo.
If the patient is not pregnant, the medical team involved in the course of treatment assesses the causes and decides what steps need to be taken. The patient is given an appointment in order to be able to tell her about the team’s evaluation of the situation.
If the result of the pregnancy test is positive, the patient has an ultrasound scan around two weeks later. Performing this scan any earlier would lead to confusion and doubts since the results are generally not conclusive at this stage.
THERE WILL ALWAYS BE EMBRYO TRANSFER. When patients undergo double donation, Instituto Bernabeu guarantees transfer during blastocyst stage.
IVF double gamete donation treatment success rates
|ACCUMULATIVE POSITIVE PREGNANCY RATE OVER 3 CYCLES||96%|
|POSITIVE PREGNANCY RATE (INCLUDING TRANSFER OF FROZEN EMBRYOS)||93%*|
|FRESH EMBRYO DONATION||
(We synchronise procedures to ensure fresh egg donation, except when the contrary is expressly requested by the recipient)
|CYCLES OF EGG DONATION WITH EMBRYO FREEZING (an average of 2.3 blastocysts per cycle)||96% AND AN AVERAGE OF 2.6 BLASTOCYSTS|
|TRANSFERS ON DAY 5 TO 6 (BLASTOCYST)||100%|
|EMBRYOS THAT REACH THE BLASTOCYST STAGE||75%|
|DONATED EGGS||We guarantee a minimum of 8 and an average of 10 per cycle|
|COMPREHENSIVE SCREENING OF ALL OUR DONORS||
|ANALYSIS OF 600 AUTOSOMAL RECESSIVE DISORDERS PEFORMED ON DONORS (GCT: GENETICAL ANALYSIS IN DISORDER CARRIERS)||For all our donors. At no cost to the patient. It enables us to identify up to 555 genetic abnormalities that give rise to over 600 diseases. Further information|
* Optional: Option of contrasting the genetic compatibility test with the future father.
|TREATMENT USING AVANT-GARD TECHNOLOGY FREE OF CHARGE (IF MEDICALLY ADVISED)||
|100% VIABLE PREGNANCY GUARANTEE||Optional (subject to medical criteria) Additional information|