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When should I think about IVF with donor eggs? Indications.

When and why to consider Donor Egg IVF?

Do you consider IVF to have a baby? Do you wonder what are the indications for IVF with donor eggs? And is this treatment for you?
You will know all about it from experts answering these questions in 3on1 #IVFANSWERS:

• Dr Stavros Natsis – Obstetrician/ Gynaecologist, Fertility Expert – Gennima IVF
• Dr Robert Gizler – Medical Director at InviMed
• Dr Harry Karpouzis – Scientific Director and Founder of IVF Pelargos Fertility Group

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Dr Stavros Natsis, GENNIMA IVF, Greece

Answer from Dr Natsis, Fertility Expert

IVF is generally a difficult procedure for every couple, especially if you go ahead with egg donation. This is probably one of the most difficult decisions that somebody has to take through their lifetime.
Generally, we would consider egg donation in couples that had a lot of IVF attempts that unfortunately weren’t successful. It’s a very thin line for some couples to decide whether they should try again with their own eggs or go ahead with egg donation.
Generally, egg donation is a very good choice for young women who are already in menopause.
They usually suffer from premature ovarian failure, the reason for which we still do not know. It is also a choice for women who had their ovaries surgically removed, because of various reasons, such as severe endometriosis or ovarian torsion. It is also for women who had malignant tumours that unfortunately can happen at a young age as well. Similarly, it refers to women who had some form of chemotherapy that impairs the ovarian function a lot. They could also consider going for egg donation, especially if they are already in menopause.
When it comes to women who are above 40 years old, it is a difficult decision. A lot of them have ovaries that are working really well. However, the statistics have shown that women above 42, even if they are menstruating every month and have regular cycles, have relatively low chances of the success with IVF. These women have a really difficult time deciding which road to go ahead.
We can only recommend to consider egg donation for women who had 2 or more unsuccessful IVF attempts. Egg donation has proven to have high success rates – in most of the labs it’s above 80%.
It’s a very cost-effective way. It also results in healthy children with very low chances of chromosomal abnormalities. Egg donation is like travelling back in time and being 22 years old again and getting pregnant. Chromosomal abnormalities rates are based on the donor’s age and not on the recipient’s age.
For couples who had 2 or more unsuccessful IVF attempts, it is a very difficult decision. There are couples who have very poor quality embryos and for them the choice to go for egg donation is easier. However, there are also couples at the age of 42 or 43 who have good quality embryos. But if you take into account the statistics and costs, in the end the decision to go for egg donation is made. We covered this topic extensively in the webinar a couple of months ago. Maybe you could watch that presentation again as that would give you a lot of answers.
I know that the decision about egg donation is very hard for many women. But they should bear in mind that thanks to it, their babies are going to be healthy in the end. Also, there is something that we call ‘epigenetics’. Women who receive the baby contribute a lot to their health and also the way their baby will look like. Definitely they should remember that they will play a crucial role in their babies’ development.

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Dr Robert Gizler, InviMed, Poland

Answer from Dr Gizler - Medical Director

Egg donation is a process during which a healthy young woman donates her oocytes – that is eggs obtained in the process of hormonal stimulation – to another woman who does not have her own oocytes or can get pregnant using her own ones. When should we consider using donor oocytes? A definite indication is the lack of normal eggs in the recipient’s ovaries. The number of oocytes in each woman’s ovary is ultimately determined in puberty, and forms the so-called ovarian reserve – a pool of cells from which, during each menstrual cycle, several hundred are used for the ovulation process. Afterwards, no new oocytes appear in the ovaries. So with age, the ovarian reserve is depleting, leading to a physiological period of menopause at around the age of 50. At the same time, the quality of egg cells also decreases, which means the woman’s overall fertility does exactly the same. Thus, after the age of 40 it represents only about 15% of the initial maximum capacity as in the age of 22. Therefore, the first indication will be the woman’s age. Generally, turning 45 means the chances of getting a healthy baby from the woman’s own cells in the IVF procedure fall below 10%. We then propose using oocyte bank.
Sometimes the lower supply of eggs in the ovaries is caused by a previous surgery on the adnexa, for example due to endometriosis treatment, or is idiopathic as the result of a primary poorly developed ovarian reserve. Such condition is called premature ovarian failure or premature ovarian insufficiency. A similar process can take place if the eggs are damaged as a result of oncological treatment (chemo- or radiotherapy). If normal oocytes cannot be obtained as a result of various stimulation methods, we suggest the patient to use donor cells.
Sometimes, despite normal ovarian reserve, good partner’s semen parameters and good quantitative stimulation effects, we don't get either good quality embryos or any sign of pregnancy in several subsequent IVF cycles. In such a situation, using egg cells from the bank should always be considered.
In some cases, carrying specific genetic defects may also make pregnancy from one’s own cells impossible. Some genetic disorders (e.g. Turner syndrome) lead to a complete lack of eggs. After genetic counselling, the donor eggs will be the only solution to the problem of infertility.

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Dr Harry Karpouzis, IVF Pelargos Fertility Group, Greece

Answer from Dr Karpouzis - Scientific Director

The main indication of egg donation is premature ovarian failure. When we have premature ovarian failure, by definition it means that we do not have any eggs to retrieve. The only way to go around in this case is to use donor eggs. Premature ovarian failure can happen by itself and there is an increased risk percentage in women who have a family history of it. It can be associated with immunological diseases, detected or even undetected. Finally, it is very common after chemotherapy and radiotherapy in women that have suffered from cancer before. All these are indications for egg donation.
Another indication is women’s older age. In my personal belief, if a woman is older than 44, egg donation should be a recommended treatment as we know very well that the quality of eggs depends only on the age (and not on hormones, AMH, etc. ). When a woman is more than 44 years old, the chances of success with IVF with own eggs are much lower than the chances of egg donation.
Another indication is for women who have Turner syndrome. For women like these, the chances of success with own eggs are very poor. It has also been found that there is an increased risk of miscarriages and chromosomal abnormalities to the offspring, like e.g. trisomy 21. Such women would definitely benefit from egg donation.
Finally, a genetic disease like autosomal recessive genes is also an indication for egg donation. Of course, nowadays PGD or PGT-A can be a solution. However, PGT-A, when done in women who have combined factors, like monogenetic conditions and increased age, does not have the best chances of success. On occasions like these, egg donation will give the solution.

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