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In-vitro fertilization with donor eggs

There are a number of circumstances where the best alternative for a woman or couple to be able to have a baby is performing Invitro Fertilization with eggs coming from a young and healthy woman (the donor).

The current legal framework in this country establishes that egg donation is an act of solidarity, anonymous, altruistic and voluntary where a young lady, the donor, donates eggs to a recipient woman or couple to give them the opportunity to have their own child and enjoy maternity.

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Indications

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Ovarian failure: Whether due to a primary ovarian failure (absence of menstruation during puberty) or premature ovarian failure, also called early menopause (early loss of ovarian function, before 40 years of age).

Limited ovarian reserve: Relatively young women with apparently normal ovarian function, able to produce eggs but of poor quality. This loss in egg quality is associated with low ovarian reserve and chronological age (that is, a physiological reduction in ovarian reserve is expected to happen as from 38-40 years of age).

Age: Egg donation is the assisted reproduction technique with more probabilities of success in women over 40 years of age. This is of utmost importance as from 42 years of age because the egg quality and the implantation potential of the embryos produced by these eggs and their genetic load are closely related to female age.

Hereditary female diseases undetected by Preimplantation Genetic Diagnosis that can be transmitted to the offspring.

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  • IVF repeated failure with own eggs.
  • Severe endometriosis.
  • Repeated abortions.

Current legislation on gamet donation (eggs and sperm)

Female gamet (oocytes) and male gamet (sperm) donation was authorized by Spanish legislation in 1988 Law 35/1988, November 22. Later, Real Decret 412/1996 and Law 14/2006, May 26 have further regulated this procedure both from the medical as from the ethical and legal point of view.

The aforementioned laws establish that the donation of gamets and preembryos for the purposes authorized by law is a non-frofit, formal, anonymous and confidential contract between the donor and the authorized center. The law also establishes that donation shall be non-profit making and non comercial and specifies the tests and health controls to be carried out on donors and recipients to guarantee their good health. Of course, the law specifies that for all legal purposes, the egg recipient shall be the legal mother of the offspring born in case of pregnancy.

Steps:

Donor selection (tests and assignation)

Donor selection is a very serious and perfectly regulated procedure. The law states that female donors should be over 18 years of age, in good physical and psichological health and in full capacity to act.

After receiving detailed and complete information about the procedure, the donors follow a strict and rigorous testing protocol to guarantee, according to the scientific knowledge and the techniques existent at the time of implementation, that they do not suffer psychological, genetic or infectious diseases transmissible to the offspring.

  • Therefore, the candidate undergoes a thorough medical examination that includes:
  • Age: Between 18 and 35 years
  • Physical characteristics: Race, height and weight (BMI), eye colour, hair colour and texture, skin colour
  • Blood group and Rh factor
  • Genetic study with normal karyotype, negative result for Cystic Fibrosis and X-Fragile syndrome
  • Personal and family background free from genetic and infectious diseases transmissible to the offspring
  • General examination to assess physical and mental health
  • A normal reproductive system (physical exam, ultrasound scans and vaginal cultures)
  • Full blood test: Negative results for HIV, Hepatitis B, Hepatitis C and Syphilis, cell count, clotting and biochemical values.
  • Antecedents of fertility and/or optimal response to ovarian stimulation treatment

Finally, if all requirements are met, altruistically and free from any kind of pressure, donation is formalized via a written consent that strictly guarantees the anonymity and confidentiality of the information.

Assignation of a donor to "her better half" (the recipient woman or couple) is based on meeting the highest phenotypical (race, skin type, eye colour, hair colour and texture) and immunological (blood groups and Rh factor) similarity between them, as well as assessing the fertile pontential of the donor with her reproductive history.

Donor-recipient synchronization

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Cycle using fresh eggs

Once a donor is assigned to a recipient, their menstrual cycles are synchronized so that both are aligned. This can be achieved by using contraceptive pills or hormonal treatment to substitute the normal menstrual cycle.

In this case, the whole process including ovarian stimulation and egg retrieval , will be carried out on the donor as is regularly done.

The preparation undergone by the recipient is very simple, but it is vital to develop a highly receptive endometrium for the embryos. It entails the exogenous administration of hormones (estrogens and progesterone) through transdermal route (patches) and/or oral route so that the endometrium, or internal mucosa of the uterus -the bed where the embryos will implant- presents enhanced receptivity on transfer. During the preparation treatment, an ultrasound scan is performed to measure thickness and pattern of the endometrial lining and a blood test is taken to adjust the dose of medication used in each individual case.

Cycle with frozen eggs (eggs from the Egg Bank at Embriogyn)

Since 2010, Embriogyn has its own Egg Bank. Thanks to this bank, the cycles of In-vitro Fertilization with donor eggs can also be carried out with vitrified eggs. In this case, the assignation of eggs to the recipient woman is also based on phenotypical and immunologic similarity and can be made at any time with no specific synchronization needed. That is to say, frequently with a simple hormonal treatment or even with the natural cycle of the recipient, the eggs are defrozen when the endometrium is ready to perform the Invitro Fertilization process.

The technical procedure in the In Vitro Fertilization Lab with donor eggs is identical to this treatment with the patient’s own eggs.

Normally, in cycles of In Vitro Fertilization (IVF) with donor eggs a maximum of 1 or 2 good quality embryos is advised for transfer because the embryos proceed from a young donor and therefore, carry a very high probability of achieving pregnancy.

Likewise, in cases where there are surplus viable embryos not transferred, these are to be frozen for their subsequent use in case of absence of pregnancy or when there is a desire to enlarge the family later on in life.