Donation and preservation of fertility

Egg donation

Egg donation is a technique that allows a woman to carry a child with the eggs of another. Egg donation has been legislated since 1988 and it is always a voluntary, altruistic and anonymous act.

Any woman between the ages of 18 and 35, who has no known diseases or a history of inherited diseases, can be an egg donor. To do this, you must first undergo tests to ensure its suitability. A physical examination consisting of a gynecological examination with cytology1 and ultrasound is performed. A blood test is then requested that includes a general analysis in addition to a hormonal study, karyotype2, a study of cystic fibrosis and fragile X syndrome, tests of infectious diseases that include HIV, hepatitis B and C, syphilis, and the blood group with the Rh. The candidate is also subjected to a psychological test. The patient is then informed of the risks of the treatment and an informed consent is requested. If everything is correct, the necessary medication is administered for the treatment.

The egg donor will be medicated with injectable drugs to induce ovulation just like in a conventional IVF process. Analytical and ultrasound controls will be carried out to be able to specify the ideal moment for the retrieval of the eggs and rule out possible complications such as ovarian hyperstimulation syndrome or poor response to treatment. Egg retrieval is performed by follicular puncture, consisting of a simple surgical procedure, lasting about 10-15 minutes, performed in the operating room under sedation. The ovules are obtained by ultrasound-guided transvaginal puncture, under ultrasound control the vaginal cul-de-sac are punctured and each follicle is aspirated with a fine needle. The fluid obtained and containing the oocytes is transported to the laboratory in sterile tubes. That same day the patient is discharged and can continue her normal life.

The medical team will select the donor with physical characteristics as similar as possible to the recipient in terms of hair color, eyes, features, height and weight, as well as blood group and Rh.

Egg donation is indicated in cases where a woman of childbearing age is not capable of producing her own eggs or where these eggs have some problem to carry out a normal pregnancy. Among the women who receive eggs are those who do not have ovaries (due to surgical removal) or they are not functioning (due to early menopause or due to medical treatments that may have damaged them, such as chemotherapy). Women who produce eggs but who may be carriers of genetic diseases or who have failed to fertilize in previous IVF cycles are also candidates to be recipients of eggs.

The first step for recipient couples is a visit with a specialist who will explain all aspects of the donation. A gynecological examination with cytology should be carried out if there is no recent one and the woman should be asked for an analysis, which includes a general examination with determination of the blood group, serologies for the detection of possible infectious diseases such as rubella, toxoplasma, chickenpox, hepatitis B and C and HIV. The couple will be asked for a seminogram to be able to carry out a study of the sperm, a blood test very similar to that of the recipient woman that includes a karyotype2 along with the detection of possible genetic diseases.

The recipient woman must undergo treatment so that the womb is in optimal conditions to receive the embryo. For this, hormonal treatment is administered in patches or in tablets at low doses and therefore very well tolerated. Women who have preserved ovarian functionality should first undergo a treatment that inhibits their functionality in order to better control the steps of hormonal treatment. They should do a check-up approximately 14 days after starting the drugs.

Synchronous donation is one in which the recipient's cycle is synchronized with that of the donor. The same day that the ovules are obtained by follicular puncture, the semen sample must be delivered to proceed with the fertilization of the ovules in the laboratory. Subsequently, the couple is informed of the embryos obtained, the transfer is scheduled and the possibility of cryopreservation of the remaining embryos is evaluated if necessary.

Asynchronous donation is one in which it is not possible to transfer the embryos in the same cycle in which they obtain, so they are frozen to be transferred later.

Fertility preservation

Current cancer treatments achieve more than 70% survival in cancer patients, but one of the most frequent side effects is post-treatment infertility, in both men and women. That is why fertility preservation programs have emerged.

In men, semen cryopreservation can be performed, which will be the chosen technique whenever possible. It should be done before starting cancer treatment and with a previous study of the quality of the semen. The alternative would be the cryopreservation of testicular tissue, which is performed by biopsy of a small piece of testicular tissue.

In women, egg cryopreservation can be performed, a treatment that requires ovulation induction with obtaining the eggs by follicular puncture under sedation. These eggs can be vitrified and kept until the decision of a gestation. In patients in whom ovulation induction is not possible due to contraindication to treatment or in girls who have not reached puberty, fragments of ovarian tissue obtained by laparoscopic surgery can be preserved.

Another more controversial indication of fertility preservation are women who decide to postpone the age of childbearing to a time when it is more difficult to obtain good quality eggs, that is, those over 38 years of age.