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Embryo transfer, implantation window, and fresh donor egg cycle – is it complicated to synchronize the cycles?

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4 fertility expert(s) answered this question

Answer from: Nurit Winkler

Gynaecologist, Co-Onwer and Co-Founder at Los Angeles Reproductive Center
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Another important question is, we go through the IVF process, we find an excellent egg donor who goes through the screening, we take all the eggs out, fertilise them, grow embryo’s and then what? Every clinic is a little different and I think that probably, the US might be a little bit different from Europe or other countries, not good or bad but just a different style. In the US today, the embryo transfers are done with something called frozen embryo transfer’s meaning we do not do fresh cycles, as was done in the past. In the old days you would find an egg donor, then prepare the mother for implantation and then once the eggs were out, you would transfer them back fresh. We do not do it today for one of the main reasons that we test embryo’s. Most clinic’s in the US test the embryo’s as we know that an egg donor can have 40 or 50 percent of the embryo’s being abnormal so we recommend testing them to make sure we have a good success rate. To test the embryos we cryo freezing them.
The second reason is that the technology for freezing nowadays has changed so much. Around 15 years ago we were afraid of freezing embryos because the success rate was not as good. The thawing was not good and we compromised the embryo’s. Nowadays I would say that in our clinic as well as 98 percent of others, the cycle is done with frozen embryos, with the success rate being 70 to 80 percent. Technology has changed a lot and we are no longer worried about changing embryo’s.
I know this is not the topic but sometimes it is very counterintuitive if you think about something as delicate as embryo’s, are you sure there won’t be any damage and it doesn’t affect genetics and so on. We have done so many studies on this topic over the years, although counter intuitive embryo’s do very very well frozen. I would say in regular IVF cycles, not egg donation, there is even an argument that frozen embryo transfer is better because you put embryo’s back when the uterus is not stimulated with so many hormones, so there are a lot of other benefits for frozen embryo transfer. So we recommend not synchronizing the cycle, finding an egg donor, fertilize the eggs, check the embryo’s freeze them and at the end of this process we know for each embryo, the gender, of course if the couple or the single do not wish to know the gender we won’t tell them. We know if the embryo is normal or abnormal genetically, chromosome wise. We also know something called grading of the embryo’s, how strong the embryo is in order to implant. So we end this cycle by having those embryo’s that we have so much knowledge about and that guarantees a much higher success rate compared to when we used to transfer embryo’s without knowing.
I compare my practice 10 years ago when we didn’t test embryo’s where I would say the success rate would be about 50 percent and now we are up to 70/80 because we have so much information on the embryo’s. Not to mention that nowadays, embryo’s are kept for the future so let’s say someone has one child and they want another one, they know ahead of time, how many usable embryo’s they really have. Technology nowadays for testing embryo’s is really advanced so now we do not just get normal or abnormal, we get much more information where they tell us about something called mosaic embryo’s meaning embryo’s that have some normal cells and some abnormal cells. So the technology is very advanced and I am a big believer in it and that’s why most of our cycle is a frozen cycle.

Answer from: Maria Arquè, MD, PhD

Gynaecologist, Reproductive Specialist
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In order to synchronize the cycles for an egg donor and recipient, they usually have to take the oral contraceptive pill for a few weeks, because that way, we can get them both to have their period at the same time. Once they both stop the pill, they are going to have their period between two and four days after, and what is going to happen next is that the egg donor will begin the egg stimulation treatment to make the eggs grow and the recipient will undergo endometrial preparation. Around ten to twelve days after, the egg donor is going to be ready for the egg collection and the endometrium of the woman who is going to receive the eggs is going to be ready as well.

What is going to happen then is, on the day of the egg collection, the eggs are going to be fertilized with the sperm and the woman who is going to receive the embryos is going to start progesterone treatment as well, and five days later, she will undergo the embryo transfer. Obviously, it is a little more difficult to synchronize the cycles when we are using fresh eggs, but it is possible, and we need to take into consideration that there is a very small risk of cancellation because of unexpected events during the cycle, such as the donor not responding to the cycle as we were expecting, or the endometrium not responding as we were expecting, and we have rescheduled.

Answer from: Esther Marbán, MD

Gynaecologist, Fertility Specialist
Clinica Tambre
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We do it daily. We try to synchronize patients and donors day by day, so we can do it in different ways. One of them is by using the contraceptive pill. The patient and the donor can take it and then stop taking it at the same moment, and their periods will start more or less on the same day, and they will go through the cycles in parallel.

Apart from that, we can also use an injection called Decapeptyl, which the patient is going to use in a certain moment of their cycle – when they start endometrium preparation, the endometrium is going to wait until the donor starts the cycle, and we have the eggs. We can use both of these methods, so they can be synchronized as we need.

Answer from: Juan Carlos Castillo, MD, PhD

Gynaecologist, Fertility Specialist
Instituto Bernabeu
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Well, let me tell you that all oocyte donation cycles are a well-established approach in assisted reproductive techniques. Oocyte donation cycles give us the unique opportunity to treat patients with or without ovarian function. In patients without ovarian function—this means having a premature ovarian failure or even menopause—previous artificial endometrium preparation is mandatory before proceeding to oocyte donation. Endometrium preparation involves the sequential use of two hormones: estrogen and progesterone.

The role of using estrogen is to promote the thickness of the endometrium, and this hormone can be provided via several routes. It can be administered orally, transdermally, or vaginally. After the endometrium has been primed with estrogen, a second hormone must be added—progesterone—which can also be administered in several ways. For example, we have the vaginal route, which is the most frequent method, especially here in Europe. It can also be given orally, subcutaneously, or via an inter-muscular route of administration.

In patients with active ovarian function, the best approach is to, first, induce a blockage of the ovarian function by using mediation called a gonadotropin-releasing hormone agonist to render the patients functionally agenda—this means inducing a transient period of pharmacological menopause. The goal of doing this is to circumvent the cycle of synchrony between the donor and recipient. Afterwards, we may continue with the endometrium preparation in the same way as with a patient without ovarian function

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Fresh embryo transfer – how complicated is it to synchronize the cycles of the donor and recipient?

Oocyte donation, embryo transfer, implantation window, and the synchronization – it’s a lot and yet not everything crucial for the successful result of IVF treatment.
Regardless of whether you’re at the beginning of the IVF process or after a few attempts, you want to know how it all works, especially since it is a highly complicated matter. It’s a well-established approach in assisted reproductive techniques for doctors. For you, it’s a lot of uncertainty. That’s why our experts explain each step along the way.

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