IVF with a donor eggs. Interview with PhD D. Mercik

When it seems that all methods of infertility treatment have failed, the last chance for having a baby is in vitro with the donor eggs of the anonymous donor. However, the issue of adopting oocytes raises a lot of questions and doubts. Rightly?

In vitro with a donor eggs

When it seems that all methods of infertility treatment have failed, the last chance for having a baby is in vitro with the donor eggs of the anonymous donor. However, the issue of adopting oocytes raises a lot of questions and doubts. Rightly?

We talk about the adoption of oocytes and in vitro fertilization with the donor eggs with PhD Dariusz Mercik, a gynecologist and specialist in infertility treatment at the Gyncentrum Infertility Clinic.

Doctor, for many years you have helped infertile couples to successfully get pregnant. Sometimes it is enough to help nature, so that after a few months Patients can enjoy the birth of a new life. However, it happens quite often that long-term treatment and even IVF procedure do not bring the expected results. In some cases the only way for a woman to give birth to a child is to adopt an egg. Please tell me what is the adoption of an egg and how does it differ from traditional in vitro?

Adoption of oocytes is a procedure in which the patient (female) takes the oocytes of another woman. In the process of adoption of oocytes, we obtain oocytes from the donor and fertilize them in laboratory conditions (in vitro) with the semen of the recipient partner (or the donor's sperm). The formed embryo, after preparation of the endometrium, is transferred to the uterine womb of the recipient.

What is the difference between procedures? In a conventional in vitro, the patient is stimulated to induce multiple ovulation in her. Obtained oocytes are collected, fertilized with the sperm of the partner / donor. The resulting embryos are transferred to the uterine cavity. In the case of an IVF with donor cell, the recipient is not subjected to ovarian stimulation, ovarian puncture is not performed and the oocytes are not taken from it. In both procedures, preparation of the recipient for transfer and transfer of the embryo to the uterine cavity is the same.

What are the indications for in vitro with donor's eggs?

The indication for IVF with donor's egg is the inability to obtain oocytes in the patient. Most often these are women with very low ovarian reserve, patients who have lost function of their ovaries due to premature ovarian insufficiency, also after radiation of the pelvis and as result of chemotherapy severe side effects causing damage to the reproductive organs. In women with removed ovaries IVF with donor’s eggs is a chance to become pregnant. All situations in which we are unable to obtain oocytes capable of fertilization can be an indication to start an in vitro procedure with donor’s eggs.

If Patient’s AMH is very low, but the couple still wants to try to get pregnant with their own eggs, we try to stimulate the patient. Valid values of FSH and estradiol on the 2nd and 3rd day of the cycle, with low AMH, give a chance to obtain oocytes. If, during several cycles, oocytes cannot be obtained, I suggest Patients to consider adopting oocytes. In patients with premature menopause, in woman with almost undetectable AMH (practically 0), we do not start ovarian stimulation.
The use of donor eggs is always a last choice. I suggest this solution only if I am absolutely convinced that all other infertility treatment options have been exhausted and that the only chance for pregnancy for this pair is IVF with the donor eggs.

What is the reaction of patients when they hear from the Doctor that the only chance for them to become parents is egg donation?

Most of my patients are aware of the treatments offered by a modern medicine. They are also aware when a conventional IVF  does not solve their infertility problem and are conscious of the possibilities of using donor oocytes. As I said, I propose this solution when I am convinced that there are no other options for treating infertility. Then I am suggesting the possibility of using other woman's eggs. I realize that it is not an easy decision. I do not expect from patients to decide right away. If there is an agreement and no medical contraindications, then we start the eggs adoption procedure.

In vitro with a fresh  or frozen donor eggs - what is the difference?

The ideal situation is when the donor and recipient are simultaneously prepared for the procedure at the same time. The donor is hormonally stimulated to induce multiple ovulation and the recipient’ s endometrium is being prepared simultaneously. On the day of the ovarian puncture, the donor's partner donates the semen that is used to fertilize the collected donor’s eggs. On the same day, the Patient start taking the progesterone to prepare for transfer of fresh embryos after 3-5 days. However, this is quite difficult in synchronization. Therefore, other variant of the procedure is when the oocytes or embryos obtained from the donor are vitrified (frozen very fast). In the first case, after stimulation of the donor, ovarian puncture takes place and the oocytes are then frozen. In the next cycle an endometrium  of the Patient (recipient) is prepared. When it reaches the appropriate thickness, the oocytes are thawed and fertilized with the sperm of the partner/donor. Embryos are transferred within 3-5 days. In the second case, during ovarian puncture, the oocytes are fertilized by Patient’s partner semen. The embryos are frozen then. In the next cycle the Patient’s endometrium is prepared. When it reaches the appropriate thickness, the embryo is defrosted and transferred to the uterine cavity of the patient. In the era of modern methods of freezing - vitrification, the effectiveness of these procedures is comparable.

How the Patient is being 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 whole woman's body so that the embryo has appropriate conditions for implantation and further development. Preparation for the procedure therefore requires examinations to diagnose the health of the patient. Among the tests which are performed are thyroid hormone balance, vitamin D3 level and many other tests checking the patient's health condition. In the cycle in which the transfer is performed, the patient also takes estrogens, so that after 10-14 days the correct thickness and structure of endometrium can be obtained. Then, progesterone substitution is introduced to support the embryo’s implantation. Patients with regular menstrual cycles can be prepared on natural cycles without drugs stimulating the growth of the endometrium, suplementing only the progesterone.