What’s better – using frozen donor eggs or fresh donor eggs? Is there any difference in success rates? Is there a difference in the protocol? Is quality of frozen oocytes lower than quality of fresh eggs? Are there any indications for frozen embryo transfer? These are the questions that many fertiliy patients ask before their IVF treatment. Would you like to know the answers?
Watch the video recording of the webinar by EggDonationFriends and fertility experts from Assisting Nature and find out the answers to the above questions from the experts in the fertility field:
- MD, Vagelis Papanikolaou – Assisting Nature Co-founder,
- MD, Robert Najdecki, – Co-founder, Scientific Director,
- Evi Tymotheou – Senior Clinical Embryologist, Lab Director,
The world of assisted conception is ever developing and, at times, can leave patients feeling overwhelmed and confused as to what is the best route for them to proceed along. Advances in medical and scientific technology have, greatly, changed the way couples conceive, and new processes of freezing oocytes (eggs) and embryos have forged the pathway for a new generation of IVF.
In this webinar Dr Papanikolaou MD PhD, and his Assisting Nature, co-founder, Dr Robert Najdecki MD PhD, discuss the use of IVF with fresh and frozen donor oocytes (eggs). Their Lab Director, Dr Eva Timotheou MSC, explains the practices behind vitrification (freezing) and looks at whether the use of frozen eggs and embryos can lead to a successful pregnancy. Assisting Nature is a clinic and college of reproduction based in Greece.
When entering the world of assisted conception, many options are presented, especially when looking at oocytes. There’s the question of donor gamete use and whether, for varying reasons, frozen eggs might be more beneficial. How, then, can patients understand what the differences are and whether fresh or frozen might offer the best outcome for their situation?
As with all fertility treatments, it’s hugely important to remember that not all cases are the same, and therefore each protocol and procedure will differ, for everyone. Medical experts now have the capacity to freeze eggs and sperm and embryos, which inevitably leads to many different combinations, per cycle, whether or not a donor is used.
Every situation is unique and so is every oocyte. Not all fresh and / or frozen eggs will become fertilised, and the route from oocyte to blastocyst (five-day old embryo), to pregnancy and live birth, is not always easy or, indeed, guaranteed.
Dr Papanikolaou explains how historically, a fresh synchronised cycle was the most common; fresh embryos would be transferred after using fresh eggs and fresh sperm. However, with fresh cycles, factors such as uterine cysts or bleeding could have a negative impact on implantation. He advises that the ability to better freeze gametes offers a more personal approach to assisted conception, individually designed protocols can be developed for each person, allowing medical care of any conditions, which might arise during an IVF cycle, whilst also creating flexibility, which can be especially useful if treatment is being sourced abroad.
In the past, freezing did take place, but Dr Timotheou describes how the slow procedure previously used had a low survival rate, leading to a poorer quality of thawed eggs and embryos, which, she explains, was due, in part, to the formation of ice on the embryos and / or oocytes. Ice crystals can be razor sharp and easily cause damage to the cells, also, as water in the cells turns into ice, it expands, meaning the risk of a rupture is increased. In order to successfully cryopreserve (freeze) an oocyte or embryo, biological matter is, in simple terms, cooled to an extreme temperature, so how then, is it possible to achieve that, without the formation of ice?
Dr Timotheou explains that the development of new vitrification processes has, enormously, enhanced previous freezing methods and higher survival rates have been noted. Vitrification is described as the transformation of a substance into a glasslike component, meaning the eggs, embryos, and surrounding solution, are directly solidified to a vitreous (glasslike) state. In order to achieve vitrification, and ensure ice crystals do not form, cryoprotectants are used; in basic terms, these are substances used to protect biological tissue from ice formation damage caused by freezing. The job of the cryoprotectant is to draw the water out of the permeable cells, and then replace the water, thus enabling protection from ice damage. The reverse then happens during the thawing process; cryoprotectants are replaced by water.
Vitrification has led to a revolution in oocyte, and embryo, cryopreservation and at Assisting Nature clinic and college of reproduction, an increase in survival rates of frozen oocytes and blastocysts has been found.
From their recorded data, out of 580 cycles, between 2013-2016, there was a 91% survival rate, of frozen to thawed eggs, from donor vitrified oocytes. This then led to a 79% fertilisation rate, for their clients, with a 41% rate of ongoing pregnancy. Dr Najdecki advises, that there is now no better or worse program; frozen may be preferred for some, fresh may work for others, it’s all about finding the right solution for you.
From this webinar, it definitely seems as though the technology now used, in order to “freeze” both eggs and embryos has vastly improved, allowing much more flexibility, and health awareness, when creating a family using IVF.
Whilst this has opened many doors, in the world of fertility treatments, it does also make it confusing, which is why the co-founders at Assisting Nature are keen to stress that clinics should not treat all cases in the same way. Every situation is unique and individual protocols need to be created, in order to generate the best possible outcome, of a pregnancy and live birth, for every patient under their care.
Frozen oocytes vs fresh eggs for IVF – Q&A
Is it necessary to match the phenotype of the donor with egg donor recipient in Greece?
Yes, in Greece it is required by law to match the blood type and Rhesus, but what we’re trying to do is to match also the appearance: the hair & eye colour, height and weight.
The phenotype matching is not obligatory, but it is a corporate index of the procedure: the better the matching, the more satisfied you will feel with the result afterwards. Once everybody tells you that your child looks like you, it gives you more satisfaction to the couple.
Is there any interest to study the best optimal embryo implantation window via the so called ERA test in case of IVF donation?
This is a very interesting question researched by IVI genomics in Spain. But actually, if you do proper monitoring of the acceptor then it is extremely rare that there is a lack of implantation window, as the test implies. So what happens many times, some acceptors have developing follicles that do ovulate and the treating physician, because they’re not one of our team, misses this ovulation. This is the main reason for not appropriate implantation window and for pregnancy outcome of the acceptor. So it is really very rare that we ask for an ERA test in patients with many blood tests and failures after donor oocytes and until now we have not identified anyone that had positive ERA test meaning that the implantation window was not synchronized.
As far as I understand oocytes have to be thawed before fertilization. So how many oocytes survive thawing?
We have 96% survival rate.
Is it the same survival rate for using donor embryos? I would need a double donor. Is the success rate good? I am 43. I already have a daughter from my own eggs and donor sperm.
The embryo success rate is even higher than of donor oocytes. It’s about 98%. This is the survival rate of embryos. (repeated answer) The double donor success rate is even higher than the vitrified oocytes because they are embryos already and the survival rate is about 98%.
What is the cost of treatment at Assisting Nature in Greece?
The cost of oocyte donation is usually EUR 5,000 but we have a special offer for EggDonationFriends that is EUR 4,500 with up to 6 mature oocytes guaranteed. This is the number of oocytes guaranteed. If the patient asks for a bigger number of oocytes, we have another program for more than EUR 7,000 where we can guarantee 12 mature oocytes. As we have shown you, what really matters is the number of oocytes given. Some IVF centres squeeze down the cost by dividing the oocytes between more than two recipients. But this has a negative effect on the pregnancy outcome. We never share the donor between more than two recipients. Most of our patients have more than six oocytes, because we do not violate the stimulation of the donor to produce more than 15 eggs. As we stated in the beginning, the donor’s health is more important for us. So trying to keep moderate stimulation of the donor, most of them produce from 12 to 15 eggs. But if the patient is about 45 years old, doesn’t have much time left or has had multiple implantation failures, then we advise here to get the full package where you get more than 12 oocytes. The cost is of course higher, it’s more than EUR 7,000, but as you saw the delivery rate can be, in cumulative way of speaking, more than 70%.
Is there anything I should be afraid of as far as frozen donor eggs are concerned? Fresh food is always better than frozen. Sorry for that kind of comparison.
That’s a nice topic that you touched upon. Until now we lack really good studies on the health of the offspring after fresh and frozen oocytes treatment. However, there are many records from China and Australia showing that with vitrified blastocysts and vitrified eggs there is no difference in the rate of congenital abnormalities in offspring. However, many studies have been performed with only a questionnaire sent out to the families. You understand that a family living in a very poor village in China having a child with autism, may never reply back, so there is a bias to under-report these problems. From our onsite records, we have not found any difference in the concentration of the congenital abnormalities up to now. But once we have much more studies to elucidate this question, then all of use might feel more secure.
Do you guarantee embryo/blastocyst quantity?
We cannot guarantee the blastocyst quantity but what we can guarantee is the number of oocytes. It is because the number of blastocysts depends also on the sperm quality of your husband or your partner. But, in general, with oocyte donation we have 50% blastulation rate on the number of fertilized eggs. So if we get 10 eggs, and you get 8 of them fertilized, so normally you’re going to have 4 blastocysts at the end of the procedure 50% of the fertilized eggs.
What if I use a donor sperm as well as donor eggs? Would you guarantee the blastocyst quantity then?
Definitely with donor sperm the blastulation rate would be much better. If someone gets 6 oocytes, then we can guarantee more or less 2 blastocysts. If you get more than 10 oocytes, then we can in quotes guarantee 4 blastocysts. But everything in quotes.
Is the age of the recipient important?
Studies are showing that indeed the age of the recipient plays a role, as well as the age of the father. The biological father can also play a negative role. If we try to give it in terms, if you’re between 40-45, your success is approximately 50%, and in cumulative way as we showed you 70% if you have extra frozen embryos for second attempt. But if you are around 48-50, although initial pregnancy success rates are really high (50%), however, the miscarriage rate is increased. So in the end we end up with relatively lower delivery rate about 40-45%.
What is the maximum sperm recipient and donor egg recipient age in Greece?
The law allows egg donation for recipients up to the age of 50.
Is it good idea to do chromosome/embryo testing like PGS for embryos from donor eggs?
That’s our specialty. We are in favour of PGS testing, but not to egg recipients, unless they have two failed attempts at other centres. Then we have to determine if it is the embryo or the uterus that does not allow implantation. Since in oocyte donation, the chance of having a good euploid embryo is very high and the cost is about EUR 2,000 for embryos to be tested, we do not advise PGS for oocyte donation program unless the patient has had multiple failures. In such a case then we have to find out if the reason lies in the embryo itself or the endometrium. Our own experience is that even with thin endometrium, we can have, for example, twin pregnancy in a patient 4.9 mm of endometrium. It may take a little bit more trials but in the end we can succeed. Nature created the uterus in such a way that it can overcome all the difficulties. It is the oocyte that really matters and very rarely endometrium.
Is it 40-45% success rate for each transfer?
If you have, for example, 4 blastocysts, you have 45% with first embryo transfer, and then you have 25% with surplus embryos. It means that, in a cumulative way, you end up with 70% delivery rate. But we mean oocytes from a specific donor.
If I decided to come from the UK, are you able to arrange flights, accommodation, etc.?
Answer: Yes, of course. We cooperate with tourist company called “First Class Greece”. You can check it on our website. They arrange flights, accommodation, absolutely everything.
What about donors? Is there any waiting list? Have you got a database of donors who are “ready to go” and database of frozen oocytes?
Yes, of course. Our waiting list is very short. We can provide a new donor in two months’ time. We also have a cryobank with a large number of frozen oocytes. This means we have “ready to go” eggs and a list of donors whom it is possible to match within a period of two months.
We have many patients from abroad and their main concern is whether the Greek female phenotype can match the phenotype of European women. Many European patients think that Greek women are of the Mediterranean type like Italian women from Naples or Spanish women from Seville, Spain. Actually, if you come and visit Greece, you’ll find that more than 30% of the population is blonde, more than 17% of the population has blue eyes, especially in northern Greece, because of mixing with many European nations. Actually, this makes an excellent combination of genes, a mixture of Mediterranean, Central European and even Eastern European genotypes and phenotypes. So you shouldn’t have any concerns about the Greek phenotype.
Do you get many patients from the UK?
We have many patients from many countries, from Belgium, Denmark, France, many from Italy. UK patients started to visit us last year. We haven’t done any publications in the UK media so far. We have been establishing our reputation slowly but steadily. We are definitely interested in the UK market but we want to do it step by step.
How many egg donation cycles do you perform each year?
We are running approximately 1,000 cycles per year. Almost half of them are IVF with egg donation. We don’t have patients only from abroad. Many Greek women get married after 35 so we can say that even 50% of female population is of higher reproductive age and need oocyte donation in the end. 50% of our cycles are performed with egg donation.
Dear attendees, thank you for all your questions!
If you are just embarking on your IVF journey or planning pregnancy with frozen donor eggs, it is understandable that you want to know as much as possible about your future treatment, especially if you’re planning to use frozen oocytes. Using frozen donor eggs is a well-known alternative to fresh oocytes. That is why EggDonationFriends teamed up with Assisting Nature, IVF clinic from Greece, to provide you with a FREE webinar on in vitro with donor eggs and, specifically fresh and frozen oocytes. This topic was chosen as one of the most popular on fertility forums and our correspondence with patients.
EggDonationFriends constantly receive a lot of questions from infertile couples and fertility patients around the world. Many of the questions refer to the issue of frozen eggs vs fresh eggs for IVF. The other most often asked questions include:
- What is a fresh IVF cycle?
- How are the eggs vitrified (frozen)?
- How are they devitrified (thawed)?
- Are frozen oocytes worse than fresh eggs?
- What is the difference for the patient?
- Do frozen oocytes work?
- What IVF protocol should I choose?
- What are the egg freezing success rates in the clinics?
Many patients have also very personal questions about the course of their treatment, choices they should make, etc. As you can see from the above video and Q&A, most of the questions were answered by the fertility doctors from Assisting Nature, Greece. If you have a question that has not been answered here or you have a question related to your treatment, please contact the clinic through Assisting Nature clinic profile.
Using fresh eggs vs frozen eggs IVF
Fertility patients also ask what kinds of eggs are offered by various IVF clinics. They also want to know the details of in vitro with donor eggs that are frozen, the process of transfer with frozen donor eggs and the results of getting pregnant with frozen donor eggs, etc. The webinar presentation also touched on those subjects. You have also learned the difference between fresh and frozen oocytes, which ones are better in what circumstances and what you should know before you start in vitro with donor eggs.
Assisting Nature Greece
The Greek clinic offers a variety of reproductive health services and procedures including IVF for single women or same sex partners, embryo donation or surrogacy. The clinic accepts male patients without the age limit and female patients up t0 50 years old. What is important for patients, Assisting Nature Greece offer egg donation fresh cycle where all donor oocytes are guarenteed.
The webinar by EggDonationFriends and Assisting Nature could be watched live from the comfort of your home. You can now view it here on our website (the video above) and also on EggDonationFriends YouTube channel. Stay tuned for more news from EggDonationFriends on our Facebook and Instagram and watch all our webinars.
About an author:
Robert Najdecki MD, PhD is a Reproductive Gynaecology Specialist. His experience in diagnosis and treatment of fertility disorders, such as endoscopic surgery is long and extensive and includes more than 6000 stimulated cycles. Assisting Nature IVF clinic provides international couples who are struggling to conceive with the most advanced donor eggs programs in Greece.