Is it possible that my IVF program with donor eggs will be cancelled?
Not everyone likes being surprised; even less so in medicine. Many patients express worries about unexpected circumstances interrupting or even completely stopping their treatment. These worries are especially prevalent among those undergoing donor egg IVF cycles. The majority of egg donation recipients have previously underwent unsuccessful own egg treatments; the stress caused by those experiences, combined with the additional costs of egg donation can be overwhelming. This fear and uncertainty, however, can be defeated by understanding the circumstances that could lead to an egg donation treatment being cancelled.
We asked three European IVF experts to explain what can cause the cancellation or suspension of an IVF treatment. Find their what they say on the topic in 3on1 #IVFANSWERS below.
Our experts are:
- Dr Jennifer Rayward, ProcreaTec, Spain
- Dr. Laura García de Miguel, Clinica Tambre, Spain
- Dr. Luboš Vlček, GYNEM Fertility Clinic Praque, Czech Republic
Answer from Dr Rayward
Since egg donation depends on biology, we cannot 100% guarantee that the treatment will take its course as planned. The reasons why a treatment may be cancelled could be because of the donor, because of the recipient or because of a failure in embryo development. If the donor does not produce enough eggs to move forward with the treatment, we look for a new donor, and sometimes can even follow almost the same
timeline as planned. Sometimes the recipient does not respond well to the medication, and the endometrium is not thick enough to transfer. In this case, as in the case of abnormal bleeding, we cannot transfer according to the planned schedule. The eggs or the embryos will be frozen, depending on when we realise we cannot go forward with the transfer, and then we will prepare the endometrium in a later cycle.
Answer from Dr. de Miguel
Unfortunately, the answer is yes. The main problem we can have in an IVF programme with donor eggs is the endometrium preparation. So, in general, we want to be sure before starting that you don’t have any problems with endometrium preparation, but anyway, if your endometrium does not arrive at a good morphology or at a minimum of 7.5mm, we will cancel the embryo transfer because we want to be sure to give you the highest chance of success. The second situation we can have is that the donor is not responding correctly to the medication or there is some problem with the egg retrieval. So, if this happens, we will cancel the treatment for you, but at Clinica Tambre, we have blastocyst guarantees, which means that we will cancel the transfer, but we will do another treatment for you with no extra cost.
Answer from Dr. Vlček
The organisation of the whole process of the egg donation is a delicate process. We try for it to be as easy as possible for the patients, with a big team cooperating during the treatment for the donor and for the recipient. Because the majority of the donor programmes in our clinic are fresh eggs, it means there must be a precise synchronisation of the cycles of the donor and the recipient. This gives the advantage of better outcomes of the treatment, but there could be some points when something could go wrong. There are some unexpected situations which could occur during this process, for example there could be some unexpected bleeding during the synchronisation, because for this we use the birth control pill, which is the method best tolerated and accepted by the patients and by the donors as well. The period could be delayed or there could be some intermenstrual bleeding, which makes the synchronisation worse, and could for example delay the time for the transfer of the embryo. The next thing could be that the donor could produce less than the expected amount of eggs, and of course in our treatment policy we respect the rights of the donor, and the first point for us is the safety of all sides, so the donor could decide to finish the treatment and not to go through the process of the egg collection. This happens very rarely, but we must inform the patients in advance that this could happen.
However, whatever happens, the staff at the clinic are trained to deal with those unusual situations, and our egg bank always has a reserve of frozen eggs. But before we use frozen eggs, we always discuss this with the patients and this is a special situation because as I said before, we try to use mostly fresh eggs for the fertilisation because this brings the best outcome of the therapy. The frozen donor eggs are used in situations for example when the patient has already bought their flight tickets and they are ready for the treatment in a specific time frame, and they cannot change the time of their stay here in the Czech Republic. So, the next thing could be that during the process, some of the patients do not react to the medication, like for example their endometrium thickness is not thick enough for the embryo transfer—this should be at least six or seven millimetres because then we have the best outcome. This adverse event could lead to the change of the type of the medication during the preparation, and if the patient doesn’t react to it, we try to make a probe cycle, which can show us how the patient may react to this medication next time.
The next thing could be that the man is not able to produce the sperm for the fertilisation, which can happen sometimes, as it is very stressful for the man to come here and have to give sperm. This can of course be discussed in advance with the patients, to ask if they are ready for this slightly stressful process of providing the sperm, but most of the problems have nothing to do with this. Another thing that has happened before with some patients is that because they send the results of the scan of the uterine cavity, we monitor if there are no polyps. Sometimes, there are visible polyps in the cavity, and if it is bigger than five millimetres, we are not insured to transfer the embryos into the cavity, as this does not bring good outcomes for the treatment. In those situations, it is better to advise the patients to cancel the treatment, remove the polyp, and transfer the embryos in the next cycle after the freezing and thawing process.