Oocyte Recipients

Groups of women who are possible candidates as recipients for the oocyte donation programme:

• Those lacking spontaneous menstruation, due to the menopause, premature ovarian failure, or removal of both ovaries or after chemo- or radiotherapy.
• Women who, despite normal menstruation, cannot use their own oocytes, either because of their poor quality or because of hereditary transmittable diseases.

Nowadays, many social factors have led to menopausal women wishing to be pregnant: their increased life expectancy, their integration in the work place (something that has delayed the age of marriage and the timing of first pregnancy), as well as a greater number of couples starting off in their forties. Women over 40 with a normal ovarian cycle often prefer this technique rather than using their own oocytes, as they have very little chance of pregnancy, while the miscarriage rate and the risk of Down's Syndrome and other genetic abnormalities in the pregnancy are significantly increased because of their advanced egg age.

• Women with recurrent in vitro fertilization failure.
• Low (poor) responders: those who do not respond well or at all to ovarian stimulation.
• Recurrent failure of the eggs to fertilize with ICSI.
• Recurrent failure of the embryos to implant.
• Poor egg quality.
• Repeated miscarriages due to poor oocyte quality
• Ovaries inaccessible for obtaining oocytes safely: the ‘frozen’ pelvis with multiple adhesions after surgery or severe infections.

Couples who wish to undergo this treatment must provide:

Treatment of the Recipient

The preparation of the endometrium - or uterine lining – of the recipient is vitally important for the technique to be successful. To achieve this, the administration of hormones is necessary; these simulate the effects of the ovarian hormones on the endometrial lining.

In patients with intact ovarian function, GnRh (a hormone stimulating the gonadotrophins) analogues are used, to prevent the recipient’s own hormones from interfering with the transfer cycle. With the subsequent menstruation, the patient will have a vaginal ultrasound scan to check ovarian response and will begin hormone treatment (substitute hormone therapy).

Patients without ovarian function will begin hormone treatment immediately after receiving medication to medically induce menstruation.

Hormone treatment consists of increasing doses of oral estradiol valerate with different guidelines for administration depending on the individual patient. The start and duration of the hormone treatment to the time of the donation depends on whether the cycle is nonsynchronous or synchronous with the donor. Non synchronous cycles are when a donor is available but the recipient is not ready. The eggs are retrieved from the donor and fertilized with the recipient’s partner’s sperm. The resulting embryos are frozen and then replaced into the recipient at a later stage.

All patients will have a vaginal ultrasound scan to measure the thickness and pattern of the endometrial line. Depending on the result, individual estradiol dose may be adjusted. Treatment can be maintained for up to 90 days, as long as there is no vaginal bleeding. If this does occur, the recipient must inform VITALAB for further medical instructions.

In both synchronous and non-synchronous cycles, the recipient will be notified 36-48 hours beforehand. It may be necessary for a semen sample to be cryopreserved (frozen) previously at VITALAB so that the oocytes can be fertilized as soon as they have been collected. On the day after the donation, 800 mg of vaginal progesterone will be added to the hormone treatment. This will be continued until the 9th week of pregnancy.