How to choose a clinic?

Fertility Seminars

Egg donation can cost anything from a few thousand euros to tens of thousands for each attempt. The success rates and options at different clinics and in different clinics can vary widely. The databank of donors whose eggs can be used may be limited, or there may be many to choose from. You may be offered an individually matched or chosen personal egg donor or just a few donor eggs available at a certain period of time. Do ensure that you know exactly what your options are, and what bills you will be presented with.

Things to consider:

If you are thinking of going abroad to have egg donation treatment, it is very important that you know exactly what procedures your chosen clinic offers and what you are paying for. Below are some of the main considerations:

— Are you eligible for treatment?

In some countries, women in their early or late forties are excluded from egg donation treatment. In other countries (such as Norway, Germany or Italy), egg donation is forbidden by law.  In others, such as Sweden or UK, egg donation is allowed, but there is a huge shortage of donors. Fortunately, in Russia, the law is more flexible and at the AVA-Peter Clinic we may treat egg recipients aged up to fifty one. You may be married, in a relationship or single.

— Are you medically suitable?

After being told that they have no chance of having a child via IVF or other standard treatments, many of our patients have felt very discouraged. However, egg donation is a very successful alternative to standard IVF. My deep belief resulting from years of successful work is that there are almost no “bad egg donation recipients”. Only if there are serious general health problems that make pregnancy inadvisable, or (very rarely) severe, untreatable conditions within the uterus or if there is no uterus at all, do we have to accept that egg donation would not help. In all other cases, we have proven methods to enable us to prepare any egg donation recipient properly.

— Are you “sharing” the donor’s eggs with other patients or getting some “spare eggs” from an IVF patient?

If so, you should not be paying the same price as if you were able to use all of the eggs from one professional donor’s stimulation yourself. Egg sharing can bring down the cost of treatment, but it also reduces the number of embryos available for each recipient. If you are not sharing the eggs, then all the eggs that are received after one stimulation of a donor are your property and can be used only for you. This means that the embryologist can choose the best fresh ones to implant, and that you may also have a store of good embryos to freeze and use on another occasion (for a second/third try or even your second/third baby!).

— How are the donors screened?

The best egg donors are young (preferably in their twenties), have proven fertility (i.e. at least one child) and have been medically and psychologically tested to ensure they are suitable. You should ask which tests they have undergone to check how rigorous the clinic’s screening process is. The egg donors whom we recommend to our patients are under 30, with an average age of just 26. They have at least one child of their own, healthy, attractive, well educated. They undergo detailed laboratory screening including HIV, Hepatitis B and C tests every 3 months as well as a complete medical evaluation by a general doctor, gynaecologist and psychiatrist.

— Is there a waiting list?

Check how long you will have to wait, not just for the initial appointment but to find a suitable egg donor. In Russia, we are allowed to offer donors adequate financial compensation for their efforts, and this has helped us to build up AVA-Peter Egg Donor Bank and detailed Egg Donor Database from IDEAS. These egg donors all have proven fertility as they have at least one child of their own, and have a good ovarian reserve — i.e. their tests have revealed that they have a good chance of producing a good number of eggs. They have already undergone a large number of laboratory tests and have seen at least 3 specialists, and are therefore available to donate if they are matched or chosen.

You should therefore aim for a clinic with a large amount of donors to choose from for you not to have to waste precious months hoping that the clinic will be able to recruit the right person. Ideally, you should be confident that the clinic will have already screened enough suitable candidates for you to make a good choice.

— Can you ask a clinic perform an accurate egg donor matching to you?

If you would like to distance yourself from the process of the donor selection a clinic should be able match the donor to you. For our Matched Donor Programme we will use AVA-Peter’s Egg Donor Bank, which contains detailed optical, medical, social and psychological information about our egg donors, available only to the clinic. During the matching process  we will use all this available information and our personal impression about each egg donor whom we have an opportunity to meet personally during our daily work: interviews, consultations, medical tests. To the future recipient these egg donors, who have agreed to disclose only a limited amount of information:  age, blood group, colours, height and weight, family situation, children, education, occupation, interests, character traits.

— Can you choose your donor yourself from a large detailed data base?

Choosing egg donor from a detailed large data base was available until 2013 only in the US.

Since 2013 together with International Donor Egg Agency (IDEAS) AVA-Peter can offer you an opportunity to choose your egg donor yourself from the detailed data base of IDEAS  which contains more than 120 details about each egg donor including 2-3 photos in her age under 10. IDEAS invites to participation in the Data base only those egg donors who have already donated before with a good amount and quality of eggs and whose donation has resulted in live birth or an on-going pregnancy.

To enter the Data base from IDEAS the egg donors disclose their photos in the age under 10 and 120 more details about themselves to a potential recipient. They undergo a detailed 2 hour interview with the professional moderator from IDEAS to introduce themselves. Such a detailed donor profile still leaves the identity of the donor anonymous but presents a very clear picture about each egg donor as a person. Here you can see an example of how such a profile looks.

— Are you guaranteed a certain amount of donor eggs available for you?

It is important to ensure that a good amount of donor eggs is available for fertilization for each egg recipient. A good amount of eggs is the first successful step to the good amount of embryos on day 5 when an embryologist is going to choose one or two best embryos to transfer in the uterus. A good balance between the number and quality of eggs  is also very important.

Even we use very low dosages of hormones for our donors, we collect usually more than 10 eggs form each donor due to critical and thorough screening of potential donors.

Because we use all the collected eggs from one donor only for one recipient, it is usually not less than 10 eggs available for fertilization.

AVA-Peter Clinic provides you with guarantee of 10 eggs.

— Does a clinic have a large bank of frozen donor eggs?

Nowadays egg freezing (vitrification) and storage became possible. This is a wonderful opportunity for creation of donor egg banks. AVA-Peter set up its Cryobank of Donor Eggs in 2009. The first children conceived from vitrified donor eggs were born in 2010. In 2012 AVA-Peter has achieved clinical pregnancy rate of 63% per Embryo transfer.

Now AVA-Peter Clinic has the largest Cryobank of Donor Eggs in Europe. More than 1500 donor eggs from more than 100 egg donors are available to our clients’ choice or matching.

Advantages of using frozen donor eggs are the same success rates as in fresh ED cycle, no need for synchronization with a donor, one day visit for each partner. To disadvantages of using frozen-thawed donor eggs belongs wastage of 20-25% donor eggs during freezing-thawing procedure and hence a lower amount of eggs and embryo available for each recipient.

As a clinician I recommend fresh egg donation in the first line. It is more time consuming, but provides recipients with maximal cumulative chances within one IVF or ICSI, because more eggs and embryos available. But availability of the Bank of frozen donor eggs from my point of view provides a perfect back-up for the fresh egg donation programme. In those rare cases when an egg donor has failed to produce a good amount of a good quality eggs within a fresh egg donation procedure, a large variety of frozen eggs can be offered to a patient to her choice with no need to cancel or postpone the treatment.

— What is the clinic’s success rate?

This is a crucial question, so do make sure you understand exactly what the clinic’s success rate refers to. It may refer to the percentage of positive urine tests, clinical pregnancy rates or live birth rates. There will always be more positive urine tests than positive clinical pregnancy tests, and sadly some of these pregnancies will miscarry, so the live birth rates will be lower than with both of these tests. Once you know what the success rates refer to, check whether these relate to just one embryo transfer procedure, to a whole average egg donation cycle (which includes all the embryo transfers, fresh and frozen, within one egg donor stimulation process), or even to an average of two or three cycles! Also, you need to know how many embryos were replaced, whether these were fresh or frozen, and whether the partner’s sperm was used or whether the sperm was contributed by a sperm donor. Success rates with a sperm donor may be higher than when using a partner’s sperm. 

At AVA-Peter Clinic we calculate clinical pregnancy rates and life birth rates per one fresh embryo transfer, which were respectively 60% and 49 % during the recent 4 years in our international donor egg recipients, who have received 2 fresh embryos.

— How many embryos will be transferred into the uterus?

It is inadvisable to replace more than two embryos at any time in order to avoid the risk of creating a triplet or quadruplet pregnancy. This is particularly true in egg donation, where the chances of success are much higher than in normal IVF due to the young age, fertility and good health of the donors. We always discuss with our patients individually whether to have one or two fresh embryos replaced. We discuss the state of the endometrium and the patient’s previous history in advance. On the day of the embryo transfer we analyse the number and quality of the embryos. Discussing these aspects with the patient in advance helps us to give the patient proper information and recommendation and helps the patient to make the right decision without stress. When using previously frozen embryos, we normally replace two rather than one, as there is less chance of success than when using fresh embryos.

— Does a clinic use vitrification freezing method for your surplus blastocysts?

Vitrification now is considered the most effective method of blastocyst cryopreservation and performed mostly in all IVF clinics all other the world.

If during your egg donation procedure with fresh or frozen donor eggs more embryos were obtained than are going to be transferred into the uterus, these embryos, if of good quality, can be frozen. These frozen embryos are property of the couple or a single woman and can be used for the next attempt or a next pregnancy.

The benefit of cryopreservation is that a woman has an additional chance to conceive without new stimulation procedure and follicular puncture in the donor. Also new sperm collection is not required. Hence the transfer of frozen embryos is much less time consuming and very cost effective. It requires only one day visit for a woman and does not require a visit of a man. Preparation of uterus to the embryo transfer does not differ much from the preparation to the fresh embryo transfer.

Within a period since 2009 — 2012 more than 8 740 embryos were frozen in AVA-Peter clinic, around 1 800 have already been thawed. We have achieved 43% clinical pregnancy rates with vitrified blastocysts in 2012.

— Is the pricing clear?

Some clinics don’t like advertising their prices on their websites, and others don’t make it clear precisely what is and isn’t included in the price of an egg donation cycle. The more specific the clinic is, the more confident you can be that you will not be presented with a large bill for unexpected costs. Do ensure you know in advance exactly what you will definitely have to pay for, and which extra costs may be incurred (such as for drugs, extra blood tests, etc.). In my view, it is very important for a clinic to offer a course of egg donation treatment with a clear explanation about its prices in advance. This is the way that the AVA-Peter clinic acts and you can find very clear information about prices on the clinic’s website page.

— Does the clinic have a quality certification?

Fertility clinics are not always regulated, depending on which country they are in. It is also unlikely that you will be able to check the regulatory status with the issuing body if you do not speak the local language and do not know the regulatory framework. It is therefore a good idea to check whether the clinic you are thinking of visiting has an international quality certification, such as ISO9001. For example, the AVA-Peter is the first Russian IVF clinic which has developed and introduced quality management system (QMS) for IVF scopes in accordance with DIN EN ISO 9001:2008. Currently AVA-Peter has a QMS certificate valid until 2014. You should also check whether the medical and clinical staff are members of an international fertility body such as ESHRE (the European Society of Human Reproduction & Embryology). This will enable you to know the standards to which they operate.

— Can you communicate well with the clinic?

If you don’t speak the language of the country where your chosen clinic is located, it is crucial that the staff  at the clinic should be able to communicate with you properly. Sometimes this may be through a third language, such as English. Do ensure that the staff’s language skills are good enough for you to feel confident in discussing medical and other matters. Ideally you should be able to contact the clinic via e-mail as well as by phone, so that you can get good written answers to any questions. I am fortunate to head AVA-Peter’s International Department, which is a very dedicated and professional English/German speaking team (2 consultants, 2 nurses, 4 patient and donor coordinators). We know that every small question may have very great importance for our clients and are used to precise and prompt communication.

Also, there should be an emergency contact number if you need one. All our patients have our direct e-mail address which they use for medical communication and my mobile number, which they use in case of medical emergency. I find that this direct style of communication quickly eliminates any misunderstandings and worries. I am thankful to my patients for never misusing my number.

— Are you happy with the way the clinic treats you?

Infertility is a miserable condition that many patients have been struggling with for years before deciding to embark on egg donation. Your chosen clinic should be sympathetic to your situation, and sufficiently experienced and professional to advise you properly. Being in close contact by e-mail and phone with our foreign patients before and after their visit to St. Petersburg, we always aim to ensure that the whole process surrounding egg donation is dealt with in an optimal manner so that it is a positive emotional experience as well as a successful procedure.