Donation program

I) Ovum donors
II) Sperm donors
III) Which woman needs donated ovum?






I) Ovum Donation

Donors
We launched our ovum donation program in 1995 as a respond to the already existing demand.

Who needs donated ovum in order to become pregnant?
The candidates for receiving donated ova are those women who would like to become pregnant, but for some reason are not able to produce their own ova (absence of ovary, premature ovarian malfunctioning, ovariectomy, chemotherapy, climax) or they are of bad quality (failure of IVF) or there is a risk of transmitting some genetical disease.

Who could be a possible ovum donor?    
According to the Act of Assisted Reproduction, the ovum donor is between 18 and 35 years old, fully capable of working, is in good physical health, his ascendants do not suffer from hereditary chromosomal aberration, genetic or metabolic disease, and have not yet reproduced 6 or more descendants through assisted or non-assisted reproduction.

How are the donors selected?
All future donors have to undergo a medical examination that covers the recognition of the medical history of their ascendants and a physical check-up that, in all cases as a minimum, includes the examinations mandatory by law, such as: blood-type, Rh factor, VDRL or a similar test to detect syphilis, screening for hepatitis, HIV test, clinical examination for detecting the infective clinical phases of toxoplasmosis, rubeola, herpes virus and cytomegalovirus, and also clinical examination for detecting of Neisseria gonorrhoeae and Chlamydia trachomatis..

Is the ovum donation absolutely anonym?
The donation is always anonym, in which way the recipient woman is not in the position of approving or selecting her donor. The selection of the donor falls within the competence of the medical team that carries out the treatment, which guarantees that the donor will possess the maximum similarity in phenotype and immunology, and the highest possibility of compatibility with the recipient woman and her family circle. Only two possible circumstances exist when the identity of donors are revealed, provided that such an exposure is indispensable and restricted (without making public the identity of course):

1. Extraordinary circumstances in which the life of the child is in danger.
   
2. When it’s in accordance with the decrees of criminal law.

In these cases the exposure of the identity never implies the legal determination of affiliation. In regard of obtaining general information about the donors, which never includes the identity, the law establishes the right of the born child as well as that of his legal representatives and that of the recipient women of the donated gamete.

Does the donor receive any financial compensation?
The ovum donation is a voluntary and altruistic act. However the actual law of assisted reproduction allows a financial compensation, the amount of which is not supposed to be financially incentive, for the physical inconveniences and to cover the travel expenses arising from the donation (Act 14/2006).

What happens in the phase of donating ova?
Once admitted to the centre, the donor has to undergo a hormonal treatment which stimulates the ovary in order to obtain the production of multiple follicle that facilitates the collection of a considerable number of ovum. This stimulation is controlled by ultrasonography and intervallic hormone tests (approximately 4 or 5 occasions). The donor receives the daily medication in the centre that is applied under her skin by herself with the support of the infirmary personnel. When the follicle reaches the desired number and size, the ova are extracted from the donor’s ovaries by paracentesis of the follicle via the vagina. This surgical intervention is controlled by ultrasonography and it is performed under anaesthesia (deep sedation). Three hours after the intervention the donor can leave the centre, but she has to spend this day in relative rest.


What kind of inconveniences can be expected by the donor?
Always and when no complications occurred, the inconveniences caused by the hormonal treatment and the posterior paracentesis with ultrasonography, would be inflation and premenstrual symptoms.

What happens to the donated ova?
After the ova have been selected and classified, those that have been found in a state of optimal maturity are put together with the previously prepared spermatozoa of the spouse of the recipient woman. After a period of 48 – 72 hours and a process of culturing and selecting, the two embryos that achieved the most optimal development are transferred to the uterus of the recipient woman, while the rest, in case there are more of them in acceptable condition, are frosted for their later use. 12 days after the implantation of the embryos, it can be diagnosed by an analysis whether the recipient woman has conceived not.

Can the treatment generate complications or secondary effects?
Generally the process is well tolerated and only in exceptional cases involves hazard to the health. The most frequently occurred known side effect is the syndrome of ovarian hyperstimulation, which is an exaggerated reaction to the ovulation-stimulating treatment. Other risks could be the type of anaesthetic, perforation, infection or haemorrhage. At our clinic all the donors are subjected to an exhaustive examination and until now we haven’t experienced any serious complication.

How dangerous are the medicines used during the assisted reproduction treatments?
Many studies had been carried out focusing on the supervision of the effects of hormonal medicines used for stimulating the ovulation, and it’s proved that with the exception of the adverse effects of the ovarian hyperstimulation or the multiple gestation, do not exist other risks for those women who undergo this treatment, moreover it has no relation with breast and ovary cancer.

Is it possible to exhaust the resources of ova? Can one experience difficulties in becoming pregnant after being an ovum donor?
Donating ova does not mean exhausting the resources of ovaries. A healthy woman, even before she was born, possesses approximately 400.000 future ova in her ovaries in an immature state. During the whole length of the fertile period of her life, without hormonal treatments, only one single ovum of all the developed follicle reaches the state of maturity during a mensual cycle, thence has the possibility of being fecundated. When a cycle is stimulated by hormones, not only the ovum, but also the follicle reaches the state of maturity, instead of decaying what it would do in a natural process. Therefore by stimulating a cycle, the number of ova that remains in the ovaries does not decrease, and the future fertility is not influenced by these treatments.

What should those women who would like to donate their ova do?
Make contact with our Unit via telephone (952 122565, 952 604040, 952 210317) or via e-mail: ure@centrogutenberg.com for more information or to ask for an appointment to have an informative consultation with one of our geneticist, without any commitment. In this first consultation we explain the treatment in full details and if after one week of consideration the candidate is still interested in donating her ovum, we schedule the next consultations. During these meetings we do all the necessary examinations, analyses and studies in order to determine if the candidate can be accepted as a donor or not.

ask for appointment

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II) Sperm donor

What requirements does someone have to meet in order to become a sperm donor?
The sperm donor has to be between 18 and 30 years old, fully capable of working, is in good physical health, his ascendants do not suffer from hereditary chromosomal aberration, genetic or metabolic disease, and have not yet reproduced 6 or more descendants through assisted or non-assisted reproduction, and has the optimal quality of semen that endures the process of freezing and defrosting.

How the sperm donors are selected? What kind of examinations does a future donor have to pass for being selected?
All future donors have to undergo a medical examination that covers the recognition of the medical history of their ascendants and a physical check-up that, in all cases as a minimum, includes the examinations mandatory by law, such as: semen analysis, blood-type, Rh factor, VDRL or a similar test to detect syphilis, serology of hepatitis B and C, HIV type 1 and 2, karyotypo and foetal haemoglobin (Hb F) to detect thalassemia or mediterranean anaemia, y clinical examination for detecting Chlamydia trachomatis in the urine.

Several of these tests have to be repeated if the intervals between the sperm donations are short.

How the samples of semen are obtained and in what frequency?
After an appointment has been previously arranged with our staff and all the conditions are fulfilled, the sample will be obtained in our institution by masturbation, complying with the given recommendations of asepticism.

How to contact us in order to became a sperm donor?
Make contact with our Unit,
via telephone: 952 122 565, 952 604 040, 952 210 317
via e-mail: ure@centrogutenberg.com  
or by filling out our application form 


Legal aspects to take into consideration in regard of the sperm donation
The Act 14/2006 of the Assisted Reproduction Treatments, defines the gamete and embryo donation (the intention of which is authorised by the same act), as a gratis contract, which is formal and confidential between the donor and the centre; which has to be concluded in writing, and states that the donor has to be previously informed about the objectives and consequences of the proceeding.

It also applies the R.D. 412/1.996, establishing the obligatory etiquette for the donors and recipients related to the reproduction treatments.

a) The anonymity and confidentiality of the donation. Exceptions.
The donation is always anonym, in which way the recipient woman is not in the position of approving or selecting her donor. The selection of the donor falls within the competence of the medical team that carries out the treatment, which guarantees that the donor will possess the maximum similarity in phenotype and immunology, and the highest possibility of compatibility with the recipient woman and her family circle.

Only two possible circumstances exist when the identity of donors can be revealed, provided that such an exposure is indispensable and restricted (without making the identity public): 1) Extraordinary circumstances in which the life of the child is in danger. 2) When it’s in accordance with the decrees of criminal law. In these cases the exposure of the identity never implies the legal determination of affiliation.

In regard of obtaining general information about the donors, which never includes the identity, the law establishes the right of the born child as well as that of his legal representatives and that of the recipient women of the donated gamete.

The data identifying the donors are kept in strict privacy in the data bank of the centre and, in accordance with the law (Act 14/2006), as soon as it is set up, also in the “National Registry of Donors of Gametes and Preembryos with the aim of human reproduction”.



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Most frequent questions asked by the patients (recipients):

Is it possible to choose the sperm donor?
Complying with the law, the selection of the donor falls within the competence of the medical team that carries out the treatment, which guarantees that the donor will possess the maximum similarity in phenotype and immunology, and the highest possibility of compatibility with the recipient woman and her family circle. Thus ensured that the most adequate donor among the disposable ones is chosen from the sperm bank.

Is it possible to make a reservation for a certain donor, so that he could be involved in the second pregnancy of a patient as well?
Yes, it is possible to make a reservation for the sample of semen of a certain donor, provided that it’s made by a recipient woman who once had already conceived pregnancy and had a new-born child in consequence of using the sample of semen coming from this donor, about which request the medical team has to be informed. The only exceptions when it’s not possible, is when there are no available frozen samples of the donor anymore, or when the donor has been eliminated from the sperm bank.

When the recipient woman is a carrier of a hereditary disease that can be transferred to the descendants, it is possible to perform some special genetical tests on the donors, in order to ensure that they are not carriers of the same disease.

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III) Which woman needs donated ova?

Women with lack of ovarian function

1. Women with primary ovarian disorder:Generally those women are concerned who are affected by dygenesis gonadal through an alteration of chromosomes already numerous and structural (Turner’s syndrome, etc.).
   Women with Syndrome of resistant ovary..
2. Women with premature ovarian malfunctioning (under 40 years old), are women with high level of gonadotropin (FSH and LH). The causes of this ovarian disorder are generally hereditary factors, autoimmune disorders, enzyme alterations, infectious factors, environmental,... etc.
3. Patients subjected to treatments of chemotherapy.
4. Women with ovariectomy through surgical intervention
5. Women in the climacteric phase of their life who, for certain reasons, still desire to be a mother.
   
   

1. Women with genetic anomalies that contra-indicate the use of their own ova in order to avoid any problem with the descendants.
   
2. Women with repetitive failure of IVF that could be caused by weak respond, poor quality of ovum, failure of fecundation during IVF cycles or absence of gestation after 3-4 attempts (unsuccessful implantation).
   
3. Women with unidentified ovarian failure or weak respond. Those women who perform weak respond to the ovarian stimulation in the IVF cycle.
4. Women advanced in years (>40 years), as in case of this type of patients the possibility of a pregnancy with their own ova is very low, furthermore there is a high risk of transmitting chromosomal alterations to the descendants, such as the Down’s Syndrome.
5. Women who repeatedly suffered abortions, which can indicate the presence of a genetic factor.

Phases of receiving Donated Ova:

1. Freezing of the semen obtained from the spouse of de recipient woman.
2. Waiting list and selection of the suitable donor for each recipient woman.
3. Supplemental hormonal treatment for the preparation of the recipient woman.
4. Extraction of ova from the donor, informing the recipient woman, changing the treatment of the recipient woman and inseminating the ova with her spouse’s semen (fresh or previously frozen sample) or in case it’s necessary, with donated semen.
5. Transfer of embryos. (number of embryos to transfer, quality of embryos, freezing of embryos, possibility of no transfer).
6. Pregnancy Test.

Risks

The principal risks of this therapeutical procedure are:
— Multiple pregnancy (two or more foetus), which is a complication that is considered to be a physical risk for the mother and the foetus.  
— Ectopic pregnancy, meaning that the pregnancy is being developed outside of the uterus. It occurs 2-4% more often, than in the event of spontaneous pregnancies.

Other risks that could occur in extreme cases:
— Genital infection.
— Haemorrhages.

Specific risks concerning women advanced in years:
— In these cases there is a higher risk of complications during pregnancy (gestosis, premature birth and CIR).

Psychological risks:
Sometimes there are complaints about significant psychological discomforts, like:
— Symptoms of anxiety and depression could be experienced by both the man and woman, and in some cases sexual and/or emotional difficulties could emerge in the relationship of the couple.
— High level of anxiety during the waiting periods between the applications of the treatments and the conformation or not of the conception, and also caused by the repetitive failure of the treatment.

Freezing the semen.
If it is possible and especially if it is required by the embryologist, the couple is asked to provide a sample of fresh semen to the laboratory on the same day, at a set time. To be prepared for unforeseen circumstances, the couples, who enter the ovum donation program at REU, will need a frozen sample of semen as well, so that it could be defrosted if needed on the day of the donation, to perform the ICSI.

Waiting list for receiving ova.
We launched our ovum donation program in 1995 as a respond to the already existing demand, and soon found that the demand for this treatment increases at an astonishing rate. As there are more women who needs ovum, than those that are willing to donate them, at present the demand exceeds the offer. In addition, there are a lot of women who would like to donate their ova, but for different reasons their application is disapproved by the medical team. Therefore the waiting list is relatively long, approximately 3-6 months.
The waiting list is administered with the recommendations of the medical team,and the order of entry is always guaranteed by a code assigned to each patient.

Selection of the donor
The selection of the donor falls within the competence of the medical team that carries out the treatment, which guarantees that the donor will possess the maximum similarity in phenotype and immunology, and the highest possibility of compatibility with the recipient woman and her family circle.

Hormonal Treatment.
In general, the IVF procedure with donated ova is realized after having prepared the uterus of the recipient woman through a supplementary hormonal treatment. To follow up the progress of this treatment, ultrasonography and hormone tests are carried out.

FIV-ICSI.
The “in Vitro” Fertilization (IVF) consists of the fecundation of the feminine gametes outside of the woman’s body. The process of FIV-ICSI is performed in the laboratory on the same day when the donation took place, inseminating the donated ova by the semen of the spouse of the recipient woman (except when the recipient woman does not have spouse, in which case a sample of semen from the Donor Bank is used).

The ova can be inseminated through conventional in vitro fertilization or by sperm microinjection. In the conventional in vitro fertilization (IVF), the spermatozoa and the ova are put together and stay in incubation for a few hours. In the method of sperm microinjection (ICSI), a previously selected and immobilized spermatozoon is placed into the cytoplasm of the mature ovum (M II)

The rate of fecundation can fluctuate according to the cases, but on the average it is 65-70%.

Transfer of embryos.
After the fecundation took place, it’s decided through observing the first embryonary divisions that, depending on the case, in which number and state (cellule/zygote) the embryos should be implanted into the woman’s uterus.

It’s recommended to transfer two embryos, although the maximum number is three (Act 14/2006). Approximately in 7% of the cases the transfer of embryos cannot be accomplished due to failure of fecundation, or not being able to obtain embryos apt for transfer, or desquamation of the endometrum of the recipient woman.

General legal aspects.
The regulatory legal frame of the OVUM DONATION is provided by the Act of Assisted Reproduction Treatments (14/2006.), completed by the Royal Decrees 412/1996 and 1301/2006. Some aspects of these directives that arise from the interest of the OVUM DONATION users are the followings:

The gamete donation is always an anonym and altruistic act, in which way the recipient woman is not in the position of approving or selecting her donor, while it’s also ensured that the donor does not receive payment for the donation.

The recipients of the donated gametes, as well as the children who are born due to the application of this treatment, have the right to obtain general information about the donor, which information cannot include his identity. However in extraordinary circumstances in which the life of the child is in danger, or when it’s in accordance with the decrees of criminal law, the identity of the donor can be revealed.

The donors should be between 18 and 35 years old, fully capable of working and in good physical health. Do not suffer from genetic, hereditary diseases or infections that can be transmitted to the descendants.

Also, the centre has to take measures to exclude those persons from the donation program as donors who have already generated 6 or more descendants through assisted or non-assisted reproduction.

The donor cannot claim the affiliation of the child born from his gametes, neither the recipient can refuse to provide such data when her non-biological mother status is argued.        

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