Exclusive donor, guaranteed eggs or embryo guarantee – what’s most beneficial for a patient?
The steadily growing interest in egg donation lead clinics to introducing new programs and services. Among the many new innovations in egg donation are exclusive donor, guaranteed eggs and embryo guarantee programs. All of them are aimed at different types of patients – what, then, is the best option for you? We invited three experts to explain the differences between these three options.
Our experts are:
- Dr. Raul Olivares, Barcelona IVF, Spain
- Dr. Uljana Dorofeyeva, Intersono, Ukraine
- Dr. Maria Arque, Fertty International,
Answer from Dr. Olivares
In our egg donation program, we have 2 different types. We have exclusive egg donation and we have this shared egg donation. In both cases, we are talking about dedicated donors, so the shared donation does not mean we have a patient who is going to share eggs with some recipient. So, we are talking about a fully dedicated egg donor. The main differences are in the exclusive egg donation, the patient gets all the eggs, and we get from that egg donor with a minimum 8 guaranteed mature eggs. And in the shared donation, it’s key that what we do is distribute the same number of eggs amongst different couples, guaranteeing a minimum of 4 mature eggs for each couple. Also, in exclusive egg donation we are going to guarantee a minimum of 2 embryos on the day of the embryo transfer, and in the shared donor we are going to guarantee the fresh transfer. In terms of results, well, the results are slightly better in the exclusive egg donation, and it makes sense because the number of eggs that we have at the beginning is much higher. That means the more eggs we have, the higher the chances we can later get a good embryo to be transferred. So, it’s just a matter of numbers. In general, we accept that in an exclusive egg donation in which there are no other issues, there’s really no male factor, the pregnancy rate of the first embryo transfer is going to be roughly 60% while in the shared donor scheme, the first transfer is going to offer 50%, so there is a 10%.
On top of that, there is another, let’s say long term difference because in 95% of the exclusive egg donations, we are going to freeze embryos. That means that the patients might have more attempts without having to go through the same process, going through the full egg donation again, and also even thinking in a more, long term. The fact that you can have frozen embryos means that in the future you want a sibling for your baby, it’s also going to be possible, you get that sibling, that biological sibling, because the embryos are going to be created with the same eggs, and with the same sperm. If you go for a shared donor scheme, it may happen that you have a good egg transfer, but if you want to come back 2 years later, and to seek for a sibling, that the donor isn’t going to be available because she is pregnant, or she doesn’t want to donate again.
In general, we accept that the exclusive egg donation offers higher, fresh pregnancy rates. It also offers the possibility of freezing embryos which means not having more attempts and not having to start from the beginning, and the possibility of getting a sibling in the future, a biological sibling. Of course, the shared donor has also advantages. It’s cheaper because we also offer the shared costs of the treatment amongst different couples. And it’s also a good option for those patients who are basically seeking for one baby, let’s say, because they already have their own offspring from previous relationships, or because they are just too old, and the woman is 48, 49, and they just want to have one baby. In these cases, it’s a really good treatment that offers a balanced pregnancy rate for the costs of the treatment. I would say in absolute terms it would be better to have the exclusive egg donation, but the shared donor scheme can also have good targets and couples who are going to get that as the first option.
Answer from Dr. Dorofeyeva
We need to understand that the donor material—the donor oocytes—is a very important source and a factor in successful treatment. Of course, in order to guarantee a successful pregnancy and a live birth for the patient, we need to be sure that the quality of the material that we use during the egg donation cycle is the best that it can possibly be. So, in our clinic, we do provide all the options. We can offer an exclusive donor for the patient, meaning that all the retrieved oocytes will be fertilised by the patients’ sperm and all the blastocysts will be used for the cycles for the patient. We can also provide cycles with a certain number of oocytes or embryos guaranteed and even if we talk about 2 other options, we do guarantee both: a certain number of oocytes and blastocysts transfer for the patient.
The difference between exclusive donor and the certain number of eggs or embryos is that in cases when we perform ICSI for all the oocytes that we retrieve from an exclusive donor, the number of blastocysts that we receive is very often much higher than we really need for successful treatment. The number of surplus embryos received in those cycles is very high. We made a statistical analysis for our previous fresh cycles performed with exclusive donations at our clinics and over 1 year we had more than 500 surplus embryos which were not going to be used by the patients, so our recommendation now is that in order to have successful treatment using donor eggs you need to consult with the doctor concerning the number of oocytes the doctor suggests in your case so that you may achieve a successful pregnancy.
When there is no issue with the sperm, we will definitely receive a good number of blastocysts from the treatment cycle and we will not have so many additional embryos which are not going to be used. Since this clinic provides high-quality services, the total number of embryos needed to be used in a cycle is not huge. At our clinic, the success rate is 87% or more after 3 blastocyst transfers in egg donation treatment. Both options are available and it’s very hard to decide which one is better for each individual case. Recommendations need to be made on a case by case basis in consultation with the doctor in order to achieve the best success.
Answer from Dr. Arque
We have to remember and to keep in mind that the most important objective, whenever we’re doing fertility treatment, is to have a healthy baby born at home. So, whenever we’re thinking about the guarantees we can give when we are doing a cycle with an egg donor, the most important thing or the most reliable thing is to have the guarantee of embryos rather than to have the exclusivity of the donor or the number of eggs. Why? Because even though, usually what happens is that the better number of eggs will have the better outcome because we know that if we have more eggs, we will have a better likelihood of having blastocysts for transfer that might not be exactly that way in all the cases. Now, there might be labs that might require 12 eggs that might end up having one blastocyst, there might be other labs that might use very high-quality standards and with less number of eggs might end up having the same results. So, to have the best guarantees of achieving a pregnancy, with treatment, with a guarantee of having a blastocyst, would be for me the best guarantee that a fertility clinic can give you about the results of the cycle.