The egg recipient’s treatment

Egg recipients (women who need donor eggs to get pregnant) may or may not still have a menstrual cycle. Whether or not you do, whether you are 25 or 49, you have the same high chance of having a baby through egg donation.

If you have a regular cycle, you will usually be asked to take birth control pills (combined oral contraceptive tablets) for a certain number of days and then stop. This should result in a ‘withdrawal bleed’ or period.

If you are in the menopause, you will need to take one or more cycles of hormone replacement therapy (HRT), which contains natural oestrogens and progesterone. The aim of this therapy is to make your uterus work regularly again: to build your endometrium up and to thin it down. Sometimes more than one such “training cycle” is required to ensure that your uterine lining grows well in response to the medication. You will also need to do several ultrasounds to see how you respond to the drugs. I will write all this into your individual Treatment Plan very precisely, so that you know your steps for every single day.

If you still have your own menstrual cycle, you will also have one injection of Gonadotropin-releasing hormone agonist (GnRH). This is a so-called ”down-regulation” drug to prevent your own egg follicles from growing in your Embryo Transfer cycle, thereby ensuring optimal synchronisation with your donor. We use medicines like Decapeptyl, Procren or Zoladex, or analogues (gonadotropin- releasing hormone agonists (GRH-Agonists)).

After your withdrawal bleeding starts, you will have an ultrasound examination in your local clinic to check that the lining of your uterus is thin and that there are no cysts before starting the actual treatment cycle. If the result of the ultrasound examination is normal, you start taking oestrogen tablets, patches and/or cream to build up your womb lining in the best way. We use the following brand names: Progynova, Estrofem, Estradot, Evorel, Vielle, Divigel and others. After one week, you have an ultrasound examination again to see if you are responding well to the medication. If your response is not sufficient, we elevate your medication dosages. We aim to provide you with the maximum chance of pregnancy, so we want to ensure your uterus is in the best possible state to receive the embryo. Five days before the exact date for Embryo Transfer, you start taking progesterone in addition to oestrogen. This is normally in the form of vaginal progesterone pessaries or cream (Utrogestan or Crinone)

The male partner

The fresh donor eggs should be fertilised or frozen within 4 hours of the Egg Collection, otherwise they become too old and incapable of further development. The donor’s eggs may be fertilised either by fresh or defrosted sperm on the day of Egg Collection.

If your partner has already provided sperm of sufficiently good quality on the day of the Initial Consultation, this can be frozen and then defrosted to fertilise the donor’s eggs on the day of Egg Collection. In this case, you will need to arrive 2 days before the planned Embryo Transfer date and will only need to spend 5 days in St. Petersburg. It is good if your partner accompanies you on your Embryo Transfer visit, but you may also choose to come alone.

In certain cases I do recommend using fresh sperm. In some patients, the sperm quality is not good enough for successful freezing and defrosting. In others, the sperm quality is very good and may be used for the simple IVF procedure (without ICSI). However, once even good-quality sperm has been frozen and thawed, it is usually necessary to carry out IVF with the additional procedure of ICSI.

In simple IVF, the sperm and the eggs are placed together in a nutritious liquid culture where the sperm cells fertilise the eggs on their own, by their own efforts. For IVF to work well, the sperm cells should be in sufficient number and most of the sperm cells must be motile (able to move well). In ICSI, each egg is injected with a single live sperm chosen by an embryologist. The ICSI method aims to ensure that the majority of eggs are not wasted due to sperm being too slow or available in insufficient quantity. ICSI is therefore performed if the risk of fertilisation failure is significant.

I believe that in cases when your fresh sperm is good enough for normal IVF, it is a pity to freeze it to do ICSI afterwards. IVF is a more natural procedure due to the fact that it allows sperm selection to be carried out by nature. It is also less invasive and several per cent more effective than ICSI. But of course every case is individual and the treatment logistics depends on medical but also social and organizational issues.

If using fresh sperm, we advise the male partner not to ejaculate (during sexual intercourse or through masturbation) for 2-5 days before the date of Egg Collection. On that day, he produces a sperm sample to fertilise the eggs produced by the egg donor. This can either be done at a private room in our clinic or in your own hotel room. If you collect sperm at the hotel, we need to receive the pot containing the sperm within an hour after the sperm collection takes place, and the sperm needs to be kept at body temperature during that time (for example, in an inner pocket of your jacket).

Fertilisation and Embryo Transfer

After they are fertilised with the sperm and start to divide into more and more cells, the eggs are called embryos. They are grown in our laboratory, usually for five days. During this time, they continue to divide and develop. At five days old, embryos are known as blastocysts. By this stage, our expert embryologists can determine which are the most promising embryos to provide the best chance of pregnancy.

We transfer one or two of the best embryos into the womb of the egg recipient. We decide the number of the embryos for transfer (one or two) together with in advance and finalise your decision together before your Embryo Transfer. We take in consideration your wishes, quality of the embryos, condition of your uterus and your previous medical history. If there is a superior quality embryo available, your endometrium is good and this is your first egg donation attempt, you have a 50% chance to get pregnant after the transfer of only one embryo. Single elective embryo transfer is the safest procedure due to the low risk of it resulting in a twin pregnancy.

Either one or two of the best embryos are transferred through the cervical canal into the egg recipient’s uterus using a thin, soft plastic catheter. This procedure is usually quick and painless. I recommend freezing any good-quality embryos remaining, which can be used either for a second attempt or for your second child.

We do not replace more than two embryos in any cycle in order to minimise the risk of a multiple pregnancy. The chance of a pregnancy is very high with egg donation, and a multiple pregnancy carries more risks both to the mother and the unborn children. The rest of the embryos can be frozen if they are of sufficient quality. They now belong to you and can be used for second or third attempt, or for another child whenever you decide to use them.

Treatment after the Embryo Transfer

After the Embryo Transfer, you continue taking oestrogens and progesterone medication for two weeks and then take a pregnancy rnd_test. This can be a blood rnd_test or a urine rnd_test, but the blood rnd_test is more precise. If the rnd_test is positive, you should have a scan to confirm the pregnancy around two weeks later. If a ‘foetal pole’ is seen on the scan (this looks like a grain of rice within the foetal sac), this provides clinical confirmation of your pregnancy. Both medications should be continued until the 12th week of pregnancy, and then you continue taking only the progesterone until you are 20 weeks pregnant. The calculation of your gestational weeks starts from the day of the Embryo transfer minus 19 days. This is due to the  general agreement amongst healthcare professionals to calculate gestational weeks from the first day of the last menstruation.

If your pregnancy rnd_test is negative, it is sadly very unlikely that you are pregnant. Some patients of course prefer to continue their medication and take another rnd_test a few days later. If you have another negative result, the hormone medication can be discontinued.

Please inform us of your pregnancy rnd_test result as soon as you are able to. If you are pregnant, I would like to be kept informed of your progress. And if this time things have not worked out as you would have hoped, I will do my best to offer you help and advice you need.

Over the last few years, we have managed to maintain above 60% clinical pregnancy rate and a 49% live birth rate in my patients, calculated per transfer of 2 fresh embryos on day 5 (5 days after Egg Collection). 87.5% of our patients achieve a live birth within 3 donor stimulations.