When all fertility treatments seem to have been exhausted, the chance of having children is in vitro with an anonymous donors egg. However, the issue of adopting oocytes raises many questions and doubts. Is that right? We will talk to Dariusz Mercik, MD, gynecologist, infertility specialist at Gyncentrum Infertility Clinic.
When all fertility treatments seem to have been exhausted, the chance of having children is in vitro with an anonymous donor’s egg. However, the issue of adopting oocytes raises many questions and doubts. Is that right?
We will talk to Dariusz Mercik, MD, gynecologist, infertility specialist at Gyncentrum Infertility Clinic about the adoption of oocytes and in vitro with the donor’s cell.
1. Doctor, you have been helping infertile couples to fulfill their child’s dreams for many years. Sometimes a little help for the nature is enough for patients to enjoy the birth of a new life after a few months. However, it is quite often the case that many years of treatment and traditional in vitro treatment do not bring the expected results. Then the only way a woman can give birth is by adopting an egg. Please tell me what is the adoption of an egg and how is it different from traditional in vitro?
Adoption of oocytes is a procedure in which the patient receives another woman’s oocytes. In the process of adopting oocytes, we obtain oocytes from a donor and fertilize them in laboratory conditions (in vitro) with the semen of the recipient partner (or donor semen). The resulting embryo, after prior preparation of the endometrium, is transferred to the recipient’s uterus. In Gyncentrum we have just introduced the only program in Poland with a 4-embryo guarantee.
What is the difference between procedures? In traditional in vitro the patient is hormonally stimulated to cause multiple ovulation. Obtained oocytes are collected, fertilized with partner / donor sperm. The resulting embryos are transferred to the uterine cavity. In the in vitro case with a donor cell, the recipient is not subjected to ovulation stimulation, ovarian puncture is not performed, and no egg cells are collected. In both procedures, the recipient is prepared in the same way for the transfer and the embryo is transferred to the uterus.
2. What are the indications for in vitro with a donor egg?
Indication for in vitro with donor’s egg cells is the patient’s inability to obtain oocytes. Most often these are women with very low ovarian reserve and patients whose ovarian function has expired as a result of premature menopause. Another indication is the condition after surgery of ovaries removal and other surgeries of reproductive organs after chemotherapy. All situations in which we are unable to obtain fertilized eggs can be a premise for in vitro fertilization with an egg.
If the patient’s AMH is very low, but the Couple still wants to try to get pregnant with their own eggs, we attempt to stimulate the patient. Normal FSH and estradiol values on day 2 and 3 of the cycle, with low AMH, give you the chance to get eggs. If oocytes cannot be collected in a few cycles, I suggest Patients to consider adopting oocytes. In patients in premature menopause whose AMH is undetectable (practically 0), we do not start stimulating our own eggs.
Patients are aware that this is a cell of a foreign person. Therefore, the use of donor’s eggs is always the last resort. I suggest such a solution only if I am absolutely convinced that all other options for infertility treatment have been exhausted and the only chance for pregnancy may be in vitro with the donor’s cell.
3. What is the reaction of patients when they hear from you that the only chance for them to become parents is in vitro with the donor’s cell?
Most of my patients are aware of the treatment options offered by modern medicine. They are also aware of the moment when traditional in vitro will not solve their problem and knowing that it is possible to use the donor’s egg, they ask if it is possible in their case. As I said, I suggest this solution when I am convinced that there are no other options for infertility treatment in a given couple. I then consider using another woman’s eggs for the procedure. This is an open proposition. I realize that this is not an easy decision. So I don’t expect them to take it right away. If the patients agree and there are no medical contraindications, then we begin the procedure of adopting the egg.
4. In vitro with fresh eggs or in vitro with frozen eggs – what’s the difference?
We have an ideal situation when the donor and recipient are at the same time prepared in parallel for the procedure. The donor is hormonally stimulated to induce multiple ovulation and the recipient prepares the uterus endometrium. On the day of the puncture of the donor’s ovaries, the recipient’s partner gives semen to which the fertilized eggs are fertilized. On the same day, the recipient begins to take progesterone to transfer fresh embryos after 3-5 days. However, it is quite difficult to synchronize. Therefore, other variants of the procedure are also used in which oocytes obtained from the donor or embryos created from them are vitrified. In the first case, after donor’s stimulation, ovarian puncture takes place and the oocytes obtained are frozen. In the next cycle, the recipient prepares the endometrium.
When it reaches the right thickness, the oocytes are thawed and fertilized with the partner / donor sperm. Embryos are transferred within 3-5 days. In the second case, during ovarian puncture, the recipient’s partner gives sperm to fertilize the eggs. The resulting embryos are frozen. In the next cycle, the recipient prepares the endometrium. When it reaches the appropriate thickness, the embryo is thawed and transferred to the patient’s uterus. In the era of modern methods of freezing – vitrification, the effectiveness of these procedures is comparable.
5. How is the recipient prepared for the in vitro procedure? What are the challenges for the doctor and patients?
The biggest challenge is to prepare the endometrium and the entire female body so that the embryo has the right conditions for implantation and development. Preparation for the procedure therefore requires tests to check the patient’s overall health. They are made, among others tests for thyroid hormone balance, vitamin D3 levels and many other tests based on the patient’s health. In the cycle in which the transfer is performed, the patient also takes estrogens to get the right endometrium after 10-14 days. Then, progesterone substitution is activated to recreate the cycle of the woman’s preparation for embryo implantation. Normal menstrual patients can be prepared on natural cycles without drugs that promote endometrial growth, using only progesterone substitution.
6. How does the in vitro with egg donation looks like in women, who cannot have children because of underwent cancer disease?
Patients who have lost fertility as a result of disease and cancer therapy can use a donor cell and undergo in vitro fertilization. Of course, if embryo transfer is possible and there are no medical contraindications for the patient to become pregnant. Women who are affected by this problem are usually very well versed in the subject and want to take advantage of this opportunity. In these cases, we usually don’t try other treatments. If a woman has high FSH, low estradiol and very low AMH, and she is aware that the adoption of eggs is the only way for her to have a child, we immediately proceed to the oocyte adoption procedure.
7. Can every woman undergo in vitro donor egg donation? What are the contraindications?
The contraindications for the in vitro procedure with the donor cell are the same as for traditional in vitro. These include cases in which we are unable to carry out the embryo transfer, i.e. uterine defects preventing the embryo from entering and the proper development of pregnancy, as well as serious diseases that are contraindications to pregnancy itself.
8. What does the selection of an egg donor look like? Can a couple who decide to adopt an egg cell decide to choose the cell of a specific donor, e.g. a friend?
The doctor, when choosing the donor, takes into account the similarity of phenotypic and morphological features. Polish law guarantees the full anonymity of both the recipient and donor of oocytes. The legislator has foreseen only anonymous donation and reproduction of reproductive cells. Donation with indication and intra-family donation is also not allowed. Therefore, patients cannot identify a particular woman as a donor.
9. What criteria must a donor candidate meet? What does the preparation and stimulation of an egg donor look like?
A candidate for a donor must meet certain criteria and undergo a multi-stage qualification procedure in our clinic. Ladies who want to join the oocyte donation program must be at least 20 and no more than 32 years old, be in good health and have no addictions. The candidate must also perform a number of genetic and viral tests (HIV, hepatitis B and C, syphilis, HTLV). Only positive verification, no genetic load and negative results of viral tests qualify her for the program. The donor is then subjected to hormonal stimulation to induce multiple ovulation. Stimulation involves taking hormonal drugs in the form of injections. After about 10 days, ovarian puncture is performed, followed by the collection of eggs.
10. Over the years, have you noticed any change in the approach of Polish patients to in vitro and the adoption of eggs? Do foreign patients show less concern about it?
I have to admit that I have noticed a big change in the Poles’ approach to this type of procedure in recent years. Patients currently have unlimited access to information. They are more aware and more willing to use the opportunities offered by medicine. Patients who come to me usually know what procedures are performed and what they consist of. They also know the opinions of others on the subject. I usually meet my patients at the very beginning of their journey, i.e. at the stage of infertility diagnosis. Then we go through the next stages of treatment until we reach the moment when we have to decide what to do next. Often, the only chance for a child is the adoption of eggs. There are fears and doubts that are most justified.
For most couples, however, they are not an obstacle to continuing treatment and deciding to adopt a donor’s cell. Another group of patients are people from abroad who are treated in the Gyncentrum clinic. These patients are usually at a different stage and already have a history of infertility treatment, including unsuccessful in vitro trials. When they come to our clinic, they are usually 99% decided to adopt eggs and hence their fears are not as big.
Throughout my professional career I don’t remember a single couple who would undergo in vitro with a donor’s cell, get pregnant in this way and come back unsatisfied with me. Patients, like couples who manage to conceive a child naturally, feel 100% parents and have no doubt about it. Parenting gives them a lot of joy. Because of the way they travelled, they enjoy it even more. Often, after a successful procedure, they visit our clinic to show off their comfort and share their happiness. They are also happy to send pictures of toddlers who are developing properly, to everyone’s joy. It’s uplifting! Not only for the entire Gyncentrum team, but also for couples who are undergoing treatment and waiting for the desired child.
