For some people pregnancy occurs on its own. Others need medical assistance. For still others, the only possibility to become pregnant is by using donor eggs (oocyte donorship) or the use of donor sperm. Sergei Vladimirovich Lebedev, president of the "SweetChild" Group of Companies talks about how and where to find them.
What are some of the problems that women, who need donor eggs, can run into?
Above all, psychological ones. The conclusion about the necessity to use donor oocytes is usually unexpected for the woman and her family. Quite often this is a rather serious psychological problem, therefore time is needed to evaluate and accept the situation. A woman makes the decision herself –whether or not she's looking for an oocyte donor or abandoning the idea of conceiving via this method. Some decide that an egg donor is acceptable, others walk away from the in vitro fertilization field. Families, of course, make this difficult choice on their own, but people often accept oocyte donorship as yet another version of assisted reproductive technologies.
Because the baby will still be your own, related to you?
A mother who gave birth to a child with the help of donor eggs, is not genetically related to him or her. However, according to research data, the majority of women view the babies as their own. There is no rejection, aversion to the "foreign body". Moreover, with IVF procedure with an egg donor, a woman undergoes all the necessary procedures, pregnancy, delivery like any other mother, which allows her to "forget" about a third-party participation.
Is it easy to find a donor?
In addition to being a rather psychologically uncomfortable procedure, the process of using IVF with donor material can sometimes be plagued with technical difficulties. A search for donors, or women, whose eggs the patients are prepared to use for artificial insemination, is, perhaps, one of the major issues. At the present time, there are several sources of donor oocytes. Each of them has its advantages and disadvantages.
Tell us about them?
The first possibility is frozen oocytes.
Several IVF clinics in Russia are very successful in conducting oocyte cryopreservation, and those oocytes can later be used to conduct IVF procedures. The main advantage of this method is affordability. Eggs are sold by piece, depending on the need, and they are fairly inexpensive. The other advantage is reliability. You can be certain that a donor underwent complete examination prior to giving the biomaterial and another control examination – six months later, following the so-called quarantine. There are no doubts that a donor is physically healthy.
The first disadvantage is the absence of guarantees for thawing the prepaid material. Oocyte freezing technology is fairly new and, unfortunately, has not been sufficiently time-tested. Although it must be said that even with cryopreservation of sperm or embryos nobody can guarantee that the material will thaw properly.
The other disadvantage is possible extra expenses. For example, there is a woman, who is undergoing preparations for oocyte transfer at an X clinic. Two eggs were brought in for her from a Y clinic. Both gametes, unfortunately, may not thaw "properly", and that means that the costs for transfer preparations will be irrecoverable. And the final disadvantage is this: you need to understand that IVF clinics began setting up an oocyte donor bank fairly recently, which means they will likely be unable to provide you with a large selection.
Can unfrozen oocytes be used?
Of course. The use of native oocytes is more widespread in all IVF clinics in Russia. For that purpose, a certain woman is employed, who enters an ART programme as an egg donor and who "transfers" her gametes to recipients under certain conditions. The technological process (algorithm) of conducting an IVF procedure with donor participation has been described so many times that it is clearly unnecessary to repeat it within the framework of these recommendations.
Where can one find this donor woman?
The following options are possible:
- When a woman makes a decision to look for an egg donor, the donor she comes to is often a close relative – a sister, or sometimes even a mother. This is the simplest solution to this issue. There are problems with this method as well, but it is unquestionably the most affordable of all possible methods. If the recipients do not have an altruistic oocyte donor, a stranger comes to their aid. In accordance with the current Order of the Ministry of Health, an egg donor, who is not closely related to the recipient, must be anonymous. In practice this means that a patient will receive detailed description of the donor: phenotype, height, weight, nationality, eye and hair color, skull shape, blood type, Rh factor, number of live births, education, health status... The full extent of examinations that an oocyte donor must undergo is stipulated in the Order of the Ministry of Health No. 67 dated 02/23/2003.
Is it possible to be certain that a donor is perfectly healthy?
Here are the requirements, as well as the full extent of examinations of an anonymous egg donor, stipulated by the aforementioned Order:
- age between 20 and 35;
- existence of a healthy child of their own;
- absence of pronounced phenotypic manifestations;
- good physical health.
Extent of examinations:
- blood grouping and Rh typing;
- examination by a physician, report on health status and absence of any contraindications for surgical interventions (valid for 1 year);
- examination and report by a psychiatrist (given once);
- medical genetic examination - clinical genealogical examination, karyotyping, etc., as indicated;
- gynecological examination (prior to every attempt to induce superovulation);
- urinalysis (prior to every attempt to induce superovulation);
- ECG (valid for 1 year);
- fluorography (valid for 1 year);
- complete blood count, blood chemistry test, as well as coagulability test prior to every attempt to induce superovulation;
- blood test for syphilis, HIV, hepatitis B and C (valid for 3 months),
- urethral and cervical smears for flora and determination of the degree of vaginal cleanliness (prior to every attempt to induce superovulation);
- examination for infections: gonorrhea, chlamydia, genital herpes, ureaplasmosis, mycoplasmosis, cytomegalovirus (valid for 6 months);
- cytological screening of cervical smears.
The most common question asked by patients, who require IVF procedure with egg donorship is about the donor woman's genetic and mental health. As you can see above, these examinations are conducted based on indications. There is a huge number of human genetic diseases, for which reason it is, unfortunately, impossible to rule out the manifestation of some of those diseases in using an egg donor.
Is it possible to somehow protect yourself from genetic abnormalities?
To a large extent, the current criteria for selecting egg donors ensures this protection. Age limit established for donors is taken into account, as well as the existence of the donor's own healthy child. In addition, careful attention must be paid to examinations conducted during the course of pregnancy: it is essential to undergo screening during weeks 9-11 and 16-18. This method is not one hundred percent accurate, but it is fairly informative. And should any doubts arise, invasive diagnostics should be conducted. In some cases I would even recommend conducting a PGD procedure (preimplantation genetic diagnosis).
Some people search for donors on the internet. What are your thoughts on that?
I believe that internet as a communications tool should be regarded with a certain element of skepticism in principle. As far as searching for a gamete donor... I believe that it is, first of all, not very legal and correct (I think that anonymity is an important legal and psychological aspect for egg donors), and second of all, it is not very effective: you can run into some not very scrupulous people. There are, of course, certain resources that are geared toward that type of search, for instance the www.surmama.com website, and I know of cases where families have successfully found an egg donor through this method, which is wonderful.
I want to say right away that if you decided to use this method, you need to describe clearly and distinctly whom you wish to find. Appearance, evidently, is an important component of the search, but you should not forget that you need to undergo an IVF procedure, and that means that a donor you find will have to be in proper health and have ovarian follicular reserve. Moreover, keep in mind that if you find a donor that resembles you like a twin, it, unfortunately, does not guarantee that a baby will look like you. A baby might come out resembling the donor's great-grandfather, rather than the donor herself. Another drawback of an internet search is that you will have to bear all expenses related to donor examination yourself, and perhaps more than once (i.e., you might have to examine several women prior to starting an IVF procedure). So, in the end, this method might turn out to be not as money-saving as it seemed.
Which type of donor search is the best from the cost standpoint?
I suppose, that would be obtaining oocytes in a clinic, where an in vitro fertilization procedure will be conducted. Relative cost-efficiency of this method is due to the fact that egg donor search is not a business in itself for those clinics, the cost of an IVF procedure is more important. You can be certain that a doctor has information not only about the oocyte donor's health but also about her effectiveness (clinics generally work with "long-established" people).
Several points can be counted among the drawbacks of searching "through an IVF clinic":
1. a rather scanty description of the donor.
2. also the fact that one donor generally gives eggs to several recipients at once, and the total quantity of the material is divided, which decreases the chances of successful conception.
3. donor selection is very narrow in most clinics, and recipients sometimes end up waiting for several months.
4. generally, due to sharing of the total quantity of donor oocytes between recipients, a family does not have any cryopreserved embryos left for a second attempt or, for instance, for the use of these embryos a few years later for the birth of one more baby.
So what to do if patients want to have their "personal" egg donor?
Some IVF clinics will probably provide you with this opportunity. But I believe that it is better to turn to a specialized company or agency. For instance, our company«МАРТ». This method is the most comfortable for a patient. All donors that we work with are not only examined for their physical health but also have a "psychological portrait" put together by a specialist. Patients are offered photos of the egg donor and her children, without the names and personal data, of course. On average, our oocyte donors "sacrifice" 12-15 eggs per centesis. That is enough to not only conduct an in vitro fertilization procedure a second time, if the first attempt was unsuccessful, but also to create cryo-supply for the future. Many couples come to us several years later to undergo the artificial insemination procedure one more time and give their baby a blood brother or sister from the same "tried-and-true" donor.
Working with donors is the "MART" company's core business. That is why our selection criteria are very strict: we eliminate about half the candidates for various reasons. Moreover, our company always has a very large selection of egg donors and we have no waitlist. As far as the price goes, it is clearly comparable to all the previous options, and if you take into account the final cost of one egg, then searching for donors with the help of specialized firms ends up being the most advantageous. A client receives a good quantity of embryos for a reasonable price and the possibility of using them in the future. Whatever option you choose, it will be the right one for you. I wish all of you luck and many-many children. And we will try to help you in that endeavor.