Donation programmes

Sperm donation in the so-called male-factor infertility has been in practice for more than a century. Egg and embryo donations became possible only with the revolutionary breakthrough in the development of assisted reproductive technologies at the end of the XX century. Today various combinations of donation programmes allow anyone who has an intention to become a parent to fulfill their dream. Our clinic treats infertility through third parties, that is the so-called third party reproduction, and disposes its own sperm and oocyte donors database.

Legal issues

Many European countries either directly or partially ban the use of donor oocytes, which considerably lowers chances of successful treatment outcomes in certain cases. Most European donation programmes are carried out in Spain where it does not go against the law.

Russia is one the countries where the law protects the right of any woman to become a mother through donation programmes despite her civil status, having or not a partner. Article 35 of the legal grounds of healthcare of the Russian Federation stipulates that ‘any major woman of fertile age is entitled to the right to have an artificial insemination and have an embryo implanted. Artificial insemination and embryo implantation programmes are carried out in specialized medical institutions who have obtained the state license allowing them to do medical practice. All programmes can be implemented with the woman’s written official consent only. All information concerning artificial insemination and embryo implantation constitutes a medical secret’.

Therefore, the patient’s civil status when implementing ART programmes in Russia is not important, as any single woman can start a programme and determine her child’s father later, as it is provisioned by the Family Code of the Russian Federation. The only limiting factor here is the applicant’s age, she is to be major, i.e. older than 18, and be of fertile age. Under the age of fertility the law means the age in which one is physically capable of bearing and delivering a child. However, today great achievements in ART make this factor conventional in Russia. Medicine has seen cases when women of a rather advanced age became mothers. Contrary to Russia, there are a number of countries where the law sets a maximal age of a woman willing to become a parent.

In Russia citizens of other countries enjoy the same rights as the Russians do.

Gamete donors give their gametes (sperm or oocytes) to other patients for them to treat infertility and thus do not have any parental rights to the future children. To implement a donation programme, written formal consent of all the parties involved is a necessary prerequisite. The doctors will also need the donor’s consent to carry out hormonal stimulation and ovary puncture. Donation can be anonymous, in which the future parents are given only brief anthropometric and phenotypic description of a donor from the clinic’s database or individual, in which parents take their own donor to the clinic.

Oocyte donors can be:

non-anonymous female relatives or female acquaintances of the woman undergoing the treatment;
anonymous.

Oocyte donation can be performed after getting from a donor a written informed consent for superovulation induction and ovarian puncture.

Requirements for oocyte donors:

aged from 20 to 35 years;
must have a healthy child of her own;
must have no pronounced phenotypic manifestations;
somatic health.

IVF with donated oocytes is indicated in the following cases:

absence of oocytes, caused by natural menopause, premature ovarian failure syndrome, specific states of health typical for post-ovarian ectomy period, post-radiotherapy period or post-chemotherapy period, as well as abnormal development (gonad dysgenesis, Shereshevsky-Turner syndrome, etc.);
oocytal functional inferiority in female patients suffering gender-specific hereditary diseases (hemophilia, Duchesne myodystrophy, Х-linked ichthyosis, Charcot-Marie-Trusseau peroneal myotrophy, etc.);
repeated IVF attempts with no success, when the ovaries were insufficiently responsive to inducement of superovulation, and when embryos obtained were, more than once, of poor quality, so that no pregnancy could be achieved after their transfer.

Medical examinations required for oocyte donors

blood type and Rh factor identification;
examination by general practitioner and report on the state of health and absence of any contraindications to operative invasion (valid for 1 year);
examination by and report from psychiatrist (one time);
genetic examination/test (clinical-genealogical examination/test, karyotype analisis, etc.) as per indications;
gynecological examination (before each superovulation inducement attempt);
general urine analysis (before each superovulation inducement attempt);
cardiogram (results are valid for 1 year);
fluorogram (valid for 1 year);
clinical and biochemical blood sample tests and blood sample testing for coagulation time before each superovulation inducement attempt;
blood sample tests for syphilis, HIV, Hepatitis B and Hepatitis C (results are valid for 3 months);
testing of samples taken from urethra and cervical channel for microflora and testing of actual vaginal cleanness (before each superovulation inducement attempt);
tests for the following infections: gonorrhea, chlamydiosis, genital herpes, ureaplasmosis, mycoplasmosis, cytomegaly (validity period: 6 months);
cytological tests of smears taken from the uterine cervix.

Screenings:

For the woman:

Compulsory:

general and special gynecological examination;
ultrasound examination of small pelvis;
blood type and Rh identification;
clinical blood sample testing, including coagulation time (results are valid for 1 month);
blood sample testing for syphilis, HIV, Hepatitis B and Hepatitis C (results are valid for 3 months);
testing of samples taken from urethra and cervical channel for microflora and testing of actual vaginal cleanness;
general practitioner’s report on the actual state of health and chances for child bearing.

Per indications:

Examination of uterus and uterine tubes (hysterosalpingography or hysterosalpingoscopy and laparoscopy);
endometrial biopsy;
bacteriological testing of samples taken from urethra and cervical channel;
cytological testing of samples taken by way of uterine cervix smears;
blood sample testing for FSG, LG, Е2, Prl, T, cortisol, P, Т3, Т4, NNG and STG;
examination for antispermal and antiphospholipid antibodies;
examination for infections (chlamydiosis, uro- and mycoplasmosis, herpes simplex, cytomegaly, toxoplasmosis, rubella);
per-indication reports from other specialists.

For the man:

Compulsory:

blood sample testing for syphilis, HIV, Hepatitis B and Hepatitis C (results are valid for 3 months);
spermogramme.

Per indications:

blood type and Rh identification;
andrologist’s consultation;
examination for infections (chlamydiosis, uro- and mycoplasmosis, herpes simplex, cytomegaly).

Oocyte donation programme stages:

Oocyte donor selection;
Synchronization of the patient’s and the egg donor’s cycles;
Donor’s hormonal simulation;
Monitoring of follicle genesis and endometrial development;
Ovarian puncture;
Sperm collection;
Fertilization of the donor’s oocytes and cultivation in vitro of the embryos;
Transfer of the embryos into the surrogate mother’s uterus;
maintaining of the lutein phase within the stimulated menstrual cycle;
diagnostics of early-stage pregnancy;
pregnancy surveillance.

Selection of oocyte donor

The clinic can offer you a rich database of egg donors who have already been carefully screened in accordance with the provisions of Order 67 of the Ministry of Healthcare of the Russian Federation. There is no waiting list, we can start implementing your programme immediately.

Sometimes, patients prefer hiring their own relatives or friends as egg donors.

Synchronization of the patient’s and the egg donor’s cycles

The cycles are synchronized in order to carry out the first embryo transfer attempt in the fresh-stage, i.e. the embryos are not cryoconserved before transferring. A fresh transfer considerably raises the chances of achieving a pregnancy at the first attempt. Sometimes it is recommended to implement with a dubbing surrogate mother, when the cycles of the patient, donor and the surrogate mother are simultaneously synchronized. This programmes is technically more complicated, yet, it raises the chances of successful treatment.

Superovulation induction

To increase chances of successful fertilization hormonal medication stimulating the follicle genesis is prescribed to patients. Thus, the patient’s ovaries produce more than one oocyte.

To induce superovulation only drugs that are registered in the Russian Federation can be used. Selection of specific stimulation patterns and medication, as well as adjustment of dosage and introduction of modifications into the induced superovulation protocol are performed on an individual basis.

As a rule, the stimulation starts on the 2nd or 3rd day of the cycle and lasts for 10-12 days. The following drug groups can be used here: selective modulators of estrogen receptors (SMER); gonadotropines (human menopausal gonadotropine – hMG; follicle stimulating hormone – FSH; recombinant FSH – rFSH; recombinant luteinizing hormone – rLH; chorionic gonadotropine – CG); agonists of gonadotropine releasing hormone (a-GnRH); antagonists of gonadotropine releasing hormone (ant-GnRH).

Monitoring of follicle genesis and endometrial development

During the stimulation regular ultrasound and hormonal monitoring is carried out. Ultrasound monitoring allows to estimate the ovarian response to the stimulation, determine the number of follicles, their rate of growth, modify the stimulation pattern if needed and choose the best moment to induce CG – medication that finalizes the stage of follicle growth.

Ultrasound monitoring is the principal method to carry out dynamic control over the development of follicles and endometrium during superovulation induction. Ultrasound monitoring makes it possible to precise the number of follicles available and their average diameter (as per sum total of two measurements made) and to measure the endometrial thickness.

Hormonal monitoring implies dynamic identification of estradiol (Е2) and progesterone (Prg) concentrations in blood and, therefore, is a supplement to ultrasound examination results to estimate the maturity of the follicles.

Criteria of the completion of superovulation induction and prescription of CG

The induction of superovulation is completed at the moment when the leading follicles become more than 17 mm in diameter and the endometrial thickness exceeds 8 mm. Some other indicators to complete the induction depend on how active steroid genesis (Е2 concentrations in blood plasma) is.

To finalize the process of oocyte maturing, CG is induced (recommended dosage: 5,000 – 10,000 IU at a time, intramuscularly).

Follicle puncture and oocytes retrieval

Puncture of ovarian follicles and aspiration of oocytes are carried out 32-40 hours after CG’s induction. It can be done on-site, in a minor-operation room, usually through transvaginal access under ultrasound control, with special needles designed for puncture purposes. In case transvaginal puncture is not possible (ovaries are located atypically, etc.), oocytes can be retrieved through laparoscopy.

The puncture does not take more than 15-20 minutes and is not dangerous for the donor. After the operation the woman stays in a special post-care unit for 1,5-2 hours under surveillance of the medical staff. After that she can be released home.

Sperm collection and registration for IVF

Specially prepared husband’s or donor’s sperm is used in IVF. Sexual abstinence of 3-5 days is recommended for the man before sperm collection. The sperm is collected through masturbation. Sterile container intended for collection of the ejaculate should be marked appropriately. Sperm collecting is to be performed in an appropriate room with a separate entrance, appropriate interior design and lavatory with a washbasin. The sperm may be frozen for a later use.

Oocyte insemination and in vitro embryo cultivation

Follicular liquid obtained after the follicle puncture is placed into a Petri dish. The material is examined by a stereomicroscope. At this stage qualitative estimate of the retrieved oocytes is carried out. Then they are transferred into a cultivation environment. The dish is placed into an incubator imitating the uterine flora and environment.

Both fresh and cryconserved spermatozoa should be washed of any seminal plasma before use. Fraction of morphologically normal and top-mobile spermatozoa should be separated from all other spermatozoa. Today 2 principal methods for sperm processing are used: flotation centrifugation and density centrifugation.

If the spermogramme results are not sufficiently good, ICSI (intracytoplasmic sperm injection) is then recommended which ensures conception even if there are few viable spermatozoa.

Presence of fertilized oocytes is usually estimated 12-18 hours later, when male and female pronuclei become clearly visible. Zygotes are put into a fresh cultural medium, where initial embryo development takes place. Embryos are cultivated in a special incubator during 2-5 days.

Embryo transfer into the uterine cavity

Embryos can be transferred into the uterine cavity at various stages, starting from the zygote stage and up to the blastocyte stage, which is usually formed in humans 5-6 days after fertilization.

It is recommended to transfer not more than 3 embryos into the uterine cavity. However, it is possible to transfer a greater number of embryos, if expected implantation probability is low. Embryos are transferred with special catheters that are induced into the uterine cavity through the cervical channel.

In case of the cervical channel permeability impairment which cannot be treated, embryo transfer can be performed through the uterine wall (transmyometrally). Mandrin-containing needle can be put into the uterine cavity transvaginally, transabdomenally or transurethrally.

To increase the chances of implantation the so-called assisted hatching can be used. In this procedure the outer layer of the embryo is hatched out in order to help it implant into the uterus.

Maintaining of lutein phase within the stimulated menstrual cycle

Lutein phase within the stimulated menstrual cycle is usually maintained by progesterone or its analogues.

In case there is no risk of ovarian hyperstimulation syndrome (OHS), maintaining of the lutein phase can include inducement of CG-based drugs, normally prescribed on the embryo transfer date, and, afterwards, each 2-4 days (on the individual basis).

Diagnostic of early-stage pregnancy

Pregnancy diagnostic methods involving identification of beta-CG content in blood or in urine are performed 12-14 days after the embryo transfer date. The first ultrasound screening can be carried out 21 days after the embryo transfer date.
Pregnancy surveillance

Pregnancy surveillance after IVF is special. Our clinic specializes in maintaining such pregnancies at all stages. You can order pregnancy surveillance by trimesters or for the whole period at our clinic.

Sperm donation

Donated sperm can be used in IVF and artificial insemination. Our clinic also uses sperm collected at other medical institutions that dispose their own sperm banks.

Cryoconserved/thawed sperm samples can only be approved for a programme after repeated HIV, Syphilis and Hepatitis blood tests have proved negative. The use of cryoconserved/thawed sperm allows to exclude the possibility of transmitting of various infectious diseases (HIV, Syphilis, Hepatitis etc.) and avoid meetings between the donor and the recipient.

Sperm donors can be:

non-anonymous relatives or friends of the husband’s of the wife’s;
anonymous donors from the clinic sperm bank.

Requirements for sperm donors:

age from 20 to 40 years;
absence of any deviations in normal organometric and phenotype.

Requirements applicable to donated sperm:

the volume of ejaculated matter should be more than 1 ml;
spermatozoa concentration should be more than 80 million per 1 ml of the ejaculated matter;
share of progressively mobile forms (А+В): more than 60%;
share of morphologically normal forms: more than 60%;
cryotolerance.

Examinations and tests for sperm donors:

blood type and Rh factor identification;
examination by and appropriate report from general practitioner (1 time a year);
examination by and appropriate report from urologist (1 time a year);
examination by and appropriate report from psychiatrist (one time);
genetic examination/test (clinical-genealogical examination/test, karyo type identification, etc.) as per indications;
blood sample tests for syphilis, HIV, Hepatitis B and Hepatitis C (results are valid for 3 months);
tests for the following infections: gonorrhea, chlamydiosis, genital herpes, ureaplasmosis, mycoplasmosis, cytomegaly (validity period: 6 months).

Indications for usage of donated sperm

for men:
- male infertility;
- ejaculatory-sexual disorders;
- unfavourable medical-genetic prognosis.
for women:
- absence of a sexual partner.
Female-factor contraindications for carrying out artificial insemination
- somatic and neurological diseases that might impede pregnancy;
- uterine pathologies in which it is impossible to carry a pregnancy;
- ovarian cancer;
- malign formations of any nature;
- acute inflammatory diseases of any nature.

Screening for women in IVF or artificial insemination with donated sperm

Compulsory:

general and special gynecological examination;
ultrasound examination of small pelvis;
blood type and Rh identification;
clinical blood sample testing, including coagulation time (results are valid for 1 month);
blood sample testing for syphilis, HIV, Hepatitis B and Hepatitis C (results are valid for 3 months);
testing of samples taken from urethra and cervical channel for microflora and testing of actual vaginal cleanness;
general practitioner’s report on the actual state of health and chances for child bearing.

Per indications:

Examination of uterus and uterine tubes (hysterosalpingography or hysterosalpingoscopy and laparoscopy);
endometrial biopsy;
bacteriological testing of samples taken from urethra and cervical channel;
cytological testing of samples taken by way of uterine cervix smears;
blood sample testing for FSG, LG, Е2, Prl, T, cortisol, P, Т3, Т4, NNG and STG;
examination for antispermal and antiphospholipid antibodies;
examination for infections (chlamydiosis, uro- and mycoplasmosis, herpes simplex, cytomegaly, toxoplasmosis, rubella);
per-indication reports from other specialists.

Embryo donation

IVF patients who have their own cryoconserved embryos left after the birth of their child might wish to become embryo donors. Thus, these embryos can be donated to an infertile couple and to an unmarried woman upon their mutual consent.

However, the most common and reasonable solution is when embryos are conceived through fertilization of donated eggs with donated sperm.

Patients should be aware of the fact that IVF programmes in which remaining cryoconserved embryos are used have a lower success rate than when newly conceived embryos are used. The patients are given the donors’ phenotypic data which allows them to choose the most suitable candidate. The criteria of embryo donors selection is the same as in selecting a gamete donor.

A couple willing to donate their embryos should undergo a careful medical examination necessary for any gamete donor.

IVF involving use of donated embryos is indicated in the following cases:

absence of oocytes;
unfavorable medico-genetic prognosis;
poor quality embryos were obtained more than once, and their transfer produced no pregnancy;
it is not possible to obtain or use the husband’s sperm in combination with the above mentioned factors (or any other factors).

Contraindications for IVF with donated embryos are the following:

somatic and mental diseases contraindicative to child bearing and child birth;
innate uterine malformations or acquired uterine deformities precluding any embryo implantation or child bearing;
ovarian tumors;
benign uterine tumors requiring operative treatment;
acute inflammatory diseases, wherever located;
malignant neophytes, wherever located, including those in anamnesis.

Screening for the patient:

For the woman:

Compulsory:

general and special gynecological examination;
ultrasound examination of small pelvis;
blood type and Rh identification;
clinical blood sample testing, including coagulation time (results are valid for 1 month);
blood sample testing for syphilis, HIV, Hepatitis B and Hepatitis C (results are valid for 3 months);
testing of samples taken from urethra and cervical channel for microflora and testing of actual vaginal cleanness;
general practitioner’s report on the actual state of health and chances for child bearing.

Per indications:

Examination of uterus and uterine tubes (hysterosalpingography or hysterosalpingoscopy and laparoscopy);
endometrial biopsy;
bacteriological testing of samples taken from urethra and cervical channel;
cytological testing of samples taken by way of uterine cervix smears;
blood sample testing for FSG, LG, Е2, Prl, T, cortisol, P, Т3, Т4, NNG and STG;
examination for antispermal and antiphospholipid antibodies;
examination for infections (chlamydiosis, uro- and mycoplasmosis, herpes simplex, cytomegaly, toxoplasmosis, rubella);
per-indication reports from other specialists.

Cryopreservation

Cryopreservation of sperm and oocytes

Cryopreservation of sperm and oocytes is permitted only upon getting appropriate written application- informed consent from the patients.

Selection of the best possible method for sperm and oocyte freezing and thawing depends on chosen cryoprotectors and equipment available. Such selection is to be performed by each laboratory at its own sole discretion.

If sperm cryopreservation is performed for the first time, it is required to make a control-test sperm freezing/thawing. The patient/donor should be informed about the results of the control test.

Cryopreservation of embryos

Such cryopreservation is to be made by way of appropriately programmed freezer or vitrification. Specific cryopreservation program to be used in each case depends on embryo development stage and cryoprotector type.

Frozen embryos are to be stored at plastic straw pieces appropriately marked and put into liquid nitrogen.

Cryopreservation of biological material obtained from the testicle or its epididymis

The biomaterial should be frozen provided that it contains spermatozoa for further use in IVF-ICSI program. The freezing is performed in a way similar to that for the sperm cryopreservation.

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