In-vitro fertilisation with donor eggs and sperm from your partner is an assisted reproduction treatment performed in a laboratory that involves fertilising eggs from an anonymous donor with your partner’s sperm.
Who is it recommended for?
• Women with premature ovarian failure
• Woman with hereditary diseases that may be transmitted to offspring and that are unable to be detected by pre-implantation genetic diagnosis techniques.
• Woman who have experienced repeated In-Vitro Fertilisation failure with their own eggs.
• Women with severe endometriosis.
• Women over the age of 43; pregnancy rates drop significantly after this age.
• Women with recurrent pregnancy loss.
• Women with any disease that makes ovarian stimulation inadvisable.
1. Selecting a Donor
All of the donors at our clinic are, as required by the Spanish Law on Assisted Reproduction, between 18 and 35 years old and have undergone comprehensive testing to verify that they are in optimal health conditions. Aside from the serology tests, they undergo additional tests that include: a genetic analysis with karyotyping, tests for cystic fibrosis, beta thalassemia, Fragile X, and a psychological evaluation. Moreover, with prior informed consent, we keep a DNA sample from the donors in case it is needed for future use.
2. Donor Treatment
Donors receive treatment with gonadotropins for follicle recruitment on day 3 of their cycle, and when their ovulation is triggered an appointment is scheduled for 36 hours later to perform the follicular puncture and retrieve the oocytes. Cycle length may vary even in different cycles of the same donor. This is why it’s impossible to know exactly when the puncture will take place until it has been scheduled and why the recipient cannot be notified any earlier (48 hours before the puncture).
3. Recipient Preparation
Before staring treatment:
The recipient must undergo a series of tests to verify that she is in good health. These include serologic tests to check for sexually transmitted diseases (HIV, Hepatitis, Syphilis).
Women over the age of 45 must also undergo a series of test to ensure that she can become pregnant without any risks for her or the future child.
It’s recommended that the couple receiving the oocytes undergoes a joint psychological evaluation since this procedure is associated with higher levels of stress. A psychologist will see all patients wishing to do so free of charge.
Generally speaking, the medical treatment for the recipient involves preparing her endometrium (the layer of cells that lines the uterus) to later receive the embryos. This treatment will vary depending on whether the patient menstruates or not. If the first case is true, GnRH agonists are used so that there are no “interferences” with other hormones (which is named pituitary suppression) and afterwards controlled doses of oestrogen and progesterone are used to prepare the endometrium. If there is no menstruation, the treatment is performed using only oestrogen and progesterone.
If the patient does not live in Madrid, or even if she is from another country, the treatment may be administered by her doctor in her place of residence and she may contact Clínica Tambre for necessary check-ups by telephone or email.
To determine if the endometrium is prepared, several ultrasound scans are performed to measure its thickness and, in specific cases, a blood test will be taken to determine oestradiol levels. Once the patient is considered “prepared,” the only thing left to do is wait for the donor to undergo follicular puncture. The wait time ranges from one to four weeks depending on the availability of a suitable donor.
The endometrium can be prepared in about 6 days, but a two-week minimum is recommended. Oestrogen replacement therapy can used for up to 2 months without any adverse effects so the patient can synchronise with the donor.
4. Donor-recipient Synchronisation
The donor and the recipient’s cycles must be synchronised to ensure that the embryos are transferred to a receptive endometrial cavity. Oral contraceptives can be used by donors, recipients, or both to make synchronisation easier. When the donor’s follicular puncture is scheduled the recipient is called and given advance notice. On the day of the follicular puncture the recipient is called again to confirm the number of mature oocytes she will be assigned and to inform her that she may begin progesterone treatment.
As we mentioned before, since we cannot know the exact date of the puncture, we recommend that the male comes in beforehand to leave his sperm sample for cryopreservation. That way we are able to avoid any possible logistical issues on that specific day. Using a frozen sperm sample that is thawed on the donation day yields the same results as if it were collected that same day.
The recipient is assigned a donor based on the recipient’s traits: first of all, according to blood type and Rh group, aiming for compatibility between both. Secondly, the aim is to ensure that there are no differences in race or hair, skin, and eye colour.
However, the Spanish Law on Assisted Reproduction prohibits assigning donors “à la carte” or based on the patient’s choice.
5. Follicular Puncture and Assigning Oocytes
On the same day that the oocytes are retrieved from the donor they are also fertilised with your partner’s sperm. An intracytoplasmic sperm injection (ICSI) is always performed beforehand to determine the quality of the oocytes.
The average number of oocytes assigned to a recipient ranges from 6 to 15, depending on the donor’s ovarian response. The recipient must inform us beforehand if she does not wish to freeze any embryos; if that is the case, then we won’t need to use a high number of oocytes in that cycle.
Before being considered “prepared” it is very important that the recipient has read and signed the consent form that explains all of the steps of the procedure.
6. Embryo Transfer
The day after the donor’s puncture, the recipient will be contacted by phone to inform her of the number of fertilised oocytes and the scheduled date for the embryo transfer.
The embryo transfer is a simple and painless procedure that is performed with the help of an abdominal ultrasound scan. The process involves placing embryos in the uterine cavity using a thin cannula. A hormone treatment is also prescribed to create favourable conditions for embryo implantation.
It is important to drink several glasses of water beforehand so that your bladder is full, this makes it easier to see on the ultrasound exactly where the embryos are being placed. After the transfer, the patient will spend approximately half an hour resting in the room before she is discharged. Therefore, we recommend that the patient brings a nightdress or a dressing gown to be more comfortable during the wait.
The embryo transfer can be done 2 days after the puncture (48 hours after), 3 days after (72 hours), or 5 days after if a long-term culture and blastocyst transfer are being performed. The transfer day will depend on the patient’s individual circumstances and her cycle.
The Spanish Law on Assisted Reproduction allows a maximum of 3 embryos to be transferred. To avoid a multiple pregnancy, at Clínica Tambre we usually transfer a maximum of two embryos and, in many cases, we recommend transferring only one.
Finally, if there are viable embryos left over from an In-Vitro Fertilisation cycle these will be preserved by freezing or vitrification.
7. Pregnancy Test (beta hCG)
The pregnancy test will be performed 16 days after the follicular puncture. The test is used to determine the level of beta hCG hormone in the blood (which is why the days prior to the test are sometimes referred to as the “beta-wait”). This allows us to quantify this level and thereby know more precisely how the gestation is progressing.