The Oocyte Donation Programme at IVI began in January 1991, and it is specially designed for women who have infertility problems as a result of early menopause or surgery, having had their ovaries removed due to diseases such as cancer or other benign conditions such as cysts or endometriosis. It is also available to women who risk passing genetic diseases on to their offspring, and to older couples who have had the misfortune to lose a child and who prefer to think that it is not too late to become parents again.
In addition, as women move into their forties, oocyte donation is the assisted reproduction technique which is the most successful. There are many women who, by waiting for the most suitable moment to have children, take the road to motherhood at an age when their own eggs have become too old, and have lost the capacity for implantation and development required to achieve pregnancy. This is also the time when the risk of chromosomal anomalies becomes higher.
In all of these situations, receiving donated oocytes is the only way in which women can become mothers. This is made possible thanks to women who take part in rigorous oocyte donation programmes in order to help other women who feel the same way they do, and who wish above all else to have a child.
The pregnancy rate with embryo transfer is 55%. The accumulated pregnancy rate when patients undergo 4 cycles rises to 95%. The miscarriage rate is 13% and the ectopic pregnancy rate is 1.28%.
The percentage of multiple pregnancies which is inherent to
assisted reproduction techniques is also reflected in oocyte donation; in this respect, our record of births resulting from oocyte donation shows that 64.70% of births have been a single live new born, and 33.58% have been twins. When the babies are born, patients must inform us of the date of birth, how it happened, the weights of the new-born babies, etc., so that we can record the birth appropriately in the register of children born as a result of assisted reproduction.
Oocyte donors must fulfil the following requirements:
- Age: 18 to 35
- Not have a family history of genetically transmitted diseases
- Have a normal genetic record
- Test negative for the following sexually transmitted diseases:
- AIDS
- Hepatitis B and C
- Clinical test for herpes
- Syphilis
- Have a normal reproductive system
- Be physically and mentally healthy
- Have a previous history of fertility and/or an adequate response to ovarian stimulation treatment.
According to the law on
Assisted Reproduction Techniques, any donation of gametes or embryos must be anonymous and voluntary, on account of which IVI is not permitted to reveal the identity of either donors or recipients. As a result, the only information which can be given to the recipient concerning the donor is important information for monitoring the pregnancy correctly: the age and blood group of the donor.
The donation of oocytes is an altruistic act, as with all other donations of human organs and fluids, and as such it cannot be for financial gain. IVI does not pay its oocyte donors. However, as the donor must undergo ovulation stimulation treatment and the subsequent harvesting of oocytes under general anaesthetic (sedation) she is entitled to financial compensation for any travel required and for the treatment which she must undergo.
Due to the great variety of nationalities of the patients who come to IVI, donors of different ethnic backgrounds and races may participate in the programme, to allow oocyte donation to be as suitable as possible for each particular case.
Donating oocytes does not reduce the donor’s chances of becoming pregnant
Donating oocytes does not mean that you will use up the reserve of eggs in your ovaries. If a woman is born with 2 million ova, as an approximate average, and will only ovulate between 400 and 500 times during her reproductive life at a rate of one egg per month, what will happen to the rest?
In order to produce one egg naturally and spontaneously every month or menstrual cycle, nature requires hundreds to be selected, which will gradually be narrowed down to just a few, until only one of these, the best one, makes it to the final phase of ovulation, while the rest of those which began to grow in that cycle are lost. The eggs which did not continue developing are removed from the body, because the body cannot recycle them and use them again.
From birth, eggs are continually being lost at a speed which is determined by genetics. Even when taking a contraceptive or medication which inhibits ovulation, during pregnancy, before puberty... the number of ova that we can use for ourselves is diminishing all the time.
By giving oocyte donors hormones like those which control the natural menstrual cycle, we can stimulate the production of ova which in a cycle without medication would begin to grow and develop, but which would be lost if they had not been stimulated. Their growth is monitored by vaginal ultrasound, just as we would do when monitoring a natural cycle, in order to see when ovulation is going to take place; except that on this occasion, a greater quantity of eggs will reach the ovulation stage.
The hormone treatment for oocyte donation does not involve a significant risk to the donor if it is done in a specialised centre such as IVI, thanks to our many years of experience in ovulation stimulation and the stringent controls that we carry out, as well as the personalised nature of treatment based on the donor’s characteristics.
A full study of the donor’s reproductive system
Women between the ages of 18 and 35 can be egg donors. To be accepted into the oocyte donation programme they must undergo a study of their reproductive system, every detail of which will be checked. This will give us valuable information about the fertility of donors and their state of health, as well as specialised advice on their potential to become mothers, which is much better than any woman would get if she wished to become pregnant be her own means.
A vaginal ultrasound allows us to understand the woman’s anatomy, discovering, for example, the causes of irregular cycles, and ruling out the presence of cysts, myomas, polyps and other irregularities of the reproductive organs. She will be given a very thorough gynaecological check, and a chromosomal study – a karyotype showing the information contained in the chromosomes – will be carried out to rule out the possibility of any future defects in her own babies or in babies born to recipients of her oocytes (for example Down’s syndrome, resulting from a loss of genetic material, the duplication of genetic information or a missing piece of a chromosome.) The quality of the ova, their maturity and their potential for fertilisation will be studied. It will be confirmed that she is free from any transmissible diseases such as Human immunodeficiency virus (HIV), hepatitis, syphilis, cytomegalovirus, genital herpes, rubella or toxoplasmosis, and her blood group and Rh factor will also be checked.
Donation is an outpatient treatment
Once the donor study has been done, oocyte donation consists of the controlled stimulation of the woman’s ovulation following a hormone treatment administered by injection over about three weeks, during which period the development of the ova is monitored very thoroughly by ultrasound and analysis, and which culminates in the extraction of these ova. In some cases, if we observe either excessive development which entails a risk of hyperstimulation, or the opposite case scenario of low production, the treatment will be cancelled before the donation stage. Depending on what we learned during the previous stimulation, this will not prevent a new cycle from being started in order for a donation of oocytes to be achieved.
If development is normal we will go ahead with extracting the ova, which is carried out as an outpatient procedure lasting between 15 and 20 minutes. This is done by vaginal ultrasound and a very precise puncture-aspiration system, which is pinpointed on the contents of the ovarian follicles, or the cavities containing the ova, meaning that no visible scar will be left. To avoid any pain involved in puncturing the vagina, this is done under sedation. After one hour, the woman can go home and carry on with her normal life. In the case of there being any discomfort, this is no worse than you might experience with a normal period, although it depends on the sensitivity of the individual.
In all cases, IVI takes care of the medical and medication costs arising from the treatment, as well as the costs associated with any complementary examinations carried out on donors.
The donation of oocytes is an altruistic, anonymous and voluntary process, as with other biological donations such as donations of blood, bone marrow and other organs. The law prohibits any buying or selling of eggs as well as any financial remuneration for donation, as the main purpose of this act is to help other women voluntarily. The law also prevents IVI from revealing the identity of the donor to the recipient and vice versa.
Spanish legislation
The donation of oocytes or ova is an assisted reproduction technique in which the female gamete is provided by a woman other than the one who receives either this or the resulting embryo. The recipient will carry the pregnancy to term and deliver the foetus. The donation of female gametes was authorised by Spanish legislation in 1988, (Law 35/1988, of 22 November). According to this law, maternity will be granted to the woman who gives birth to the foetus.
The law makes provision for financial compensation for any inconvenience caused to the donor: injections, periodic medical consultations, occasional analyses or travel to IVI.
Apart from voluntary anonymous donation, it is also possible for sterile couples to give up their surplus eggs if they have an excessive response to their own treatments, as this would give rise to too large a number of embryos. In such cases the sterile woman must meet certain very specific conditions in terms of her age, not having an ovarian-related cause for her sterility, etc., and she must also fulfil the same serological, karyotypic and other requirements as donors. As a result, donations of this kind to other couples are much more limited.