IVF Treatment in some form is needed for all kinds of fertility treatment, whether it is a donation cycle or own egg cycle.

Motherhood comes through love, not DNA.

Summary of the Procedure

For the kind called donation cycles, hormone treatment stimulates the egg donors during the preparation for an egg collection. First our expert team collects the eggs from a donor, and the eggs are injected with sperm from the couple. The fertilised embryos are then transferred to the recipient after she has been prepared in synchronisation with the donor. This method of IVF has been used widely for nearly 30 years.

History of Egg Donation

Dr. Jon Buste carried out the first Egg donation transfer in America during the 80’s.  This cycle resulted in a pregnancy and a live birth on the 3rd February 1984 in California.

Egg donation was a new way for women who had no eggs or poor quality eggs, which disabled them to get pregnant via IVF treatment. It is widely used in many European countries and few Muslim countries such as Iran, Lebanon and Egypt.

It is forbidden in some European countries. However the laws in Greece, England, Spain and Belgium allow it. North and South America, Africa, Australia and in many Asian countries also accept this method. In Northern Cyprus Egg donation is allowed in certain circumstances and forbidden in specific cases due to the Turkish law.

How do we carry out Egg Donation Treatment?

Deciding about the donor

There are two choices when a recipient is looking to choose an Egg Donor.

1. Anonymous: It is the situation when the couples(recipients) do not know and trace the donor and they do get limited information during the treatment process, i.e. Blood group, hair and eye colour, height, skin tone, country born etc..

2. Non-Anonymous: It is the situation when the couples know the donor and even the born child has a right to contact her in the future.

Procedure Outline

The egg donation procedure is when the donor goes through the stimulation process to increase the possibilities of the number of eggs produced. In turn we make the female recipient start on separate medication not to stimulate her eggs but to prepare her body for transfer and possible pregnancy. When women undergo Egg donation. the main focus for development is the thickening of the endometrium lining in synchronisation with the donor while she undergoes egg stimulation. It is the same preparation method that we use for women undergoing a frozen embryo cycle. The statistics at our clinic have showed that there is no difference in the percentage of women falling pregnant via a fresh or frozen donation cycle.

Fresh donation cycle

When there is a a fresh donation cycle, we collect the sperm from the recipient’s partner on the same day of the donor’s egg collection and conduct Microinjection (ICSI) procedure with which we inject the sperms that we collected into the healthy egg. The gamete (egg and sperm) fertilise. Once fertilisation takes place, the embryo develops for either 3 or 5 days before the transfer to the recipient. We also freeze embryo sometimes at these stages too. After the transfer, at least two weeks later on, our patients run the pregnancy blood test.

Who is eligible for Egg Donation ?

Egg Donation is the most effective treatment for women who are of an age where they are unable to produce eggs or have poor egg quality.

The following are the situations that we assess before commencing treatment for the women;

• who have a womb but have entered menopause early and are unable to produce eggs are candidates for Egg donation;
• with hereditary disorders e.g. Turners Syndrome, where a female can suffer from Premature Ovarian Failure;
• who have undergone chemotherapy or radiotherapy for treatment of cancer;
• whose ovaries are poorly stimulated or cannot be stimulated once hormone treatment has begun;
  

  “You can prevent inheriting diseases to your child.”

• with Hemophilia, Duchenne’s muscular dystrophy, Huntington’s chorea, in which the transporter gene maybe passed to the child from the mother also prefer Egg donation to prevent the risk of having children with inherited diseases;
• who have continuous unsuccessful IVF cycles;
• who are advanced aged with poor egg reserve or no eggs to conceive; Please check our blog about Menopause in women
• who have genetically inherited diseases passed by the mother;

Necessary Preparation and Procedure Outline for Donors

When choosing the donors among the applications, we consider a number of elements, such as;

• Psychological assessments in which Preliminary tests assess the mental wellbeing of the donor candidate
• General information,
• depression and anxiety tests
• detailed medical analyses
• depressive personality disorder. Psychosis and neurotic individuals are disqualified.

Serological Evaluation; Infectious diseases (HBsAg, HCV, HIV, syphilis, chlamydia, CMV) and thalassemia test which is legally mandatory as well as Cystic Fibrosis.

“All mentioned tests are completed in a trusted laboratory that has all the necessary ISO certificates and all is accompanied with valid ID control.”

We have the donor candidate through a Gynaecological Review in which they assess her Egg reserve and antral follicle counts to see if she is suitable to become a donor.

Definitely, without exceptions, we make them have blood tests such as LH, FSH, and AMH, which shows whether the candidate is fertile. Trans-vaginal scans are carried out to determine whether the donor candidate is suitable for the stimulation process.

Hematologic Tests; Due to risk of bleeding during the egg collection, we identify the adequacy of the person’s blood cells and clotting potential .

“This procedure is also same for men who will have a surgical intervention for sperm collection.”

Genetic tests; If the recipient`s partner is a genetic carrier of a specific gene that can affect any off springs health, we also screen the donor for this also to reduce the risk of a child being born with the same gene. The routine tests on donors for Chromosome Analysis are for Thalassemia and Cystic fibrosis. As a clinic, we can complete screening up to 1800 genetic disorder tests  or can negotiate with centres abroad in order to fulfil this request. There are still many new techniques that scientists go on creating to thoroughly screen and test genetic disorders. However, the results are not 100% and we recommend all our patients that they should keep screening during any pregnancy.

A donor receives a certificate once the conclusion of all the additional tests come out. This certificate includes all the physical and medical details along with their psychological profile.

Choosing the donors

We offer the couples who intend to have Egg donation treatment a choice of the most suitable donors who not only matches their blood group but also their characteristics. Once the couple makes the selection, we inform the donor to begin preparation. The egg stimulation begins on the 2nd or 3rd day of menstruation. Once the eggs are mature enough the, we administer HCG or GnRh analogue injection.It enables us have around 35 – 36 hours to collect the eggs under general anaesthesia.

“Eggs collection is over; now it is time to transfer.”

Once we collect the eggs, our staff in the laboratory prepare them for ICSI and they are left to fertilise and develop. The embryos that have developed are prepared then for transfer.

The donors and the recipient do not have interaction in any circumstances. Our team keeps all personal information private and confidential. Misusage or mishandling the information cannot be a matter of discussion.

Information and Guidance for Donors of Egg Donation Treatment

We provide the information to the donors about the certain points and they are free to accept or withdraw. The donors firstly sign a consent form at the beginning of the procedure, so that they provide a consent to begin treatment and that any child born with via donated eggs is not legally hers and that the woman receiving the eggs is the legal guardian. Families can get information about the donor except for her name and any other information that can reveal the identity of the donor.

Confidentiality of the information

The information for both parties is confidential and kept between doctor and patient. The only way this may be exposed is if the information is required in legal circumstances. The donor has the right to cancel treatment at any time from the date egg development starts to the point of egg collection. Sometimes things might not go according to plan and the donor has to pull out of her commitment to the cycle. Treatment may need cancellation. If there is a reserve donor then treatment is completed with her.

We explain the complications associated with treatment in details during and after the procedure. We also provide them in a written form that the donor signs a consent form that they are aware of these. First, we get sure that all information is provided. Then with the donors full awareness and consent, we proceed with stimulation.

Procedure Outline of Egg Donation for Egg Donor Recipients

It is a must that we also prepare the receiving families properly. We inform them about the stages of the procedure thoroughly. Below, you can find the necessary information about the procedure. For the mother-to-be, procedure begins with her having an ultrasound. It is very important that the man definitely has a sperm analysis. Afterwards, the couple had blood tests to rule out contagious illnesses such as Hbs AG, HIV AND HACV. We file the results for them. The key to success comes from the proper examination of the couple. The list of necessary steps are below according to importance;

1. HSG (Hysterosalpingogram – medicated screening of the uterus)

The medicated screening of the uterus is the most important as well as the easiest method to analyse the state of the fallopian tubes. We conduct this by inserting fluid containing radiopaque being via the entrance of the uterine cavity through to the fallopian tubes. It allows the x-ray to see where the liquid has travelled. It also enables us to see the growths like myoma and polyps more clearly. We can also see Hydrosalpinxs where tubes are swollen due to liquid retention. These conditions can fail the pregnancy and can also cause an ectopic pregnancy. Hydrosalpinx are treatable by tying the fallopian tubes or by surgically removing them. In the case of existence of Polyps and myomas, we need to remove them surgically before commencing treatment.

IMPORTANT NOTE – usually when patients hear that they need surgery for Hydrosalpinx (swelling in the tubes) panic is a natural reaction. The fallopian tubes are not only useless; at the same time they obstruct pregnancy from occurring and removing them is necessary.

2. Endometrium (the lining of the womb) – easily observable with USI (ultrasound contrast imaging)

This is the easiest and most effective way to examine the tissue that lines the inside of the uterus. This layer is called the endometrium. We measure the thickness of the endometrium. Finding problems with this lining and treating them are very important for patients undergoing IVF treatment. Careful examination can increase the patient’s chance of pregnancy.

“The endometrium is sensitive to woman`s Oestrogen hormone.”

The hormone estradiol is around the tissues that surround the egg during development. The progesterone hormone is also around the same place. Towards the end of a period, the amount of this hormone decreases. Due to this withdrawal, bleeding may occur. When women become pregnant, this hormone will continue to increase in the blood. The endometrium will not shed. Throughout the pregnancy, the placenta will be keeping this hormone and a withdrawal bleeding will not occur.

For an endometrium to accept an embryo and for pregnancy to occur, it needs to produce enough estradiol for 10 days. Only afterwards the progesterone hormone can work best.

The important paints for the preparation of the endometrium are;

           In order pregnancy to take place;

1. We should make the endometrium take estradiol hormone for at least 10 days. The receptors found in the endometrium should be saturated. Due to this, the endometrium should thicken by about 8mm-14mm. Studies carried out in the recent years have shown that at least 7mm and above are suitable.
2. Estradiol needs to be present in the blood for about 24 days so that a withdrawal bleeding does not occur. There is no pre-agreed period about the duration of estradiol after embryo transfer.
3. About 5 days after transfer, the placenta starts to secrete estradiol and progesterone.
4. The patients take supplements externally of Estradiol and progesterone for egg donation, embryo donation and frozen embryo transfer cycles.
   

   “It is hard to conduct the procedure when the patient is following their natural hormone cycle.”

5. The levels of progesterone and the following of natural cycles are very important. If there is the situation of exposion of progesterone to endometrium for more than 7 days, the patient’s failing pregnancy is unlikely. The limit of saturation of progesterone is 1.85. For the preparation of the  patient’s endometrium, she should use 10 days of estradiol. After that, by checking the development of embryos, we decide for how long more we should supply progesterone. This may go up to 17 days.

PROBLEMS WITH THE ENDOMETRIUM

Factors that cause damage to the endometrium

Theoretically, Tuberculosis and Pre-cancerous pathologies (where tissues are different before the diagnosis of cancer ) are problems that help doctors to confirm diagnosis. When the endometrium sheds every month, it rarely catches microbial infections. Tuberculosis is the only microbial illness that causes damage to the endometrium. This illness can occur when droplet which comes through the airway and then it sticks to the endometrium. I, myself, have seen this once in my professional life and the patient got pregnant and gave birth.

“One of the largest hospitals had actually told this patient of mine in Ankara that she would never become pregnant.”

Patients that attend our clinic, have in one way or another damage to their endometrium. We see this in about 18% of patients but I feel that this rate is not as high as in other clinics because we see this as a challenge. This is because when people come to us, they are in a critical state.

If we were to put the importance in order then, reasons of the damage are;

1. Hysteroscopy is the most common surgery that can cause endometrium damage. It has become very common procedure and sometimes some doctors perform it unnecessarily. They do not do it for for diagnosis but perform and treat like a routine check-up. They accept this procedure easy and harmless. However, although performing is easy, it is time consuming and it may damage to the surrounding tissue.Again, without causing any damage, we cut out and burn the septum inside the uterus. We use the same procedure for heart shaped uteruses. Also after we find out polyps and myomas via ultrasound and HSG.
   

   “Taking out large myoma in one operation may cause endometrium damage. The endometrium, afterwards, do not thicken as the same way anymore.”

2. Myoma operations come back to us as a second reason
3. Women who have undergone abortions are not at risk of damage to the endometrium as long as she had the procedure carried out properly. It is not an advantage to have an abortion with the vacuum method.
4. There might be damages inside of the uterus due to frequent injections to the uterus, frequent IVF treatments and usage of the coil.
5. Polyps should be removed if they are under 0.5mm
6. Myomas which grow towards the gap of the womb can be a reason why a pregnancy may not continue. Myomas which are on the wall of the womb or grow towards the empty part of the belly do not harm a fetus as long as they are not too big in size. There is no agreed number on the limit of size.
   

   “In my personal experience, it is best to proceed with treatment and see. 15cm is the largest myoma I have seen.”

   I have witnessed many times women with large myomas have given birth with no problems.

7. Hyperplasia and pre-cancerous conditions. In these situations, patients need to get the treatment for cancer or illness.
8. Chronic endometriosis that goes away with thickenings reasons. It is still difficult to explain the those reasons.

•  Endometrium cancer
• Uterine tuberculosis

The patients who go through the treatment of breast cancer use drugs like tamoxifene and femara. Moreover, those drugs may also help thickening of the endometrium. There is no need to panic as they are harmless.

ANALYSING AND RECOGNISING ENDOMETRIUM DAMAGE

The best method to observe the endometrium is by vaginal ultrasound. It is also medically known as transvaginal USI.

The endometrium sheds and thins when the menstruation periods starts. On the first 6-7 days of this period, it is thin and then later, the endometrium thickens with the increase of the estradiol hormone that the body produces when the egg cells begin development or we can also increase it with the aid of medication. When the egg reaches 20 mm or when the women uses the medication for 10 days, the thickness of the endometrium should ideally be a minimum of 8mm. For women in their menopause may need a longer medication process (about 20 days). If the endometrium does not reach 8mm despite the correct usage of the medication and the occurrence of ovulation, it shows that there is a problem with the endometrium lining. We also examine the shape and layer of the endometrium in order to make sure that there are no abmormalities.

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