Kiev, Majorova Str. 7А, section 7, Mon-Fri from 9:00 to 18:00 | Sat-Sun - operational and labaratory

Main Activities OOCYTE DONATION

OOCYTE DONATION

Oocyte donation has brought new hope and changed a dreams to many couples who otherwise would remain childless but had some not be solved problem get oocyte/s for fertilization during IVF treatment or have not good quality oocytes including genetic problems. Currently situation is changed from 1983 when Trounson and colleagues from Australia first reported on oocyte donation with success outcome.

INDICATIONS FOR OOCYTE DONATION

From beginning the most oocyte donation programs was carried out for women with premature ovarian failure. However, the high pregnancy rate achieved with oocyte donation led to its more widespread.
Today egg donation use in other groups of patients, primarily in older patients and those with genetic diseases.
Free encyclopedia Wikipedia show us practically unlimited age for getting pregnancy after egg donation. It is absolutely clear that oocyte donation is the most successful technique for achieving pregnancies in perimenopausal women. But acceptance of oocyte donation over the age of 45 – 50 years is becoming controversial.
We have not tenets about age limitation for egg donation in Ukraine but we need understanding the reasonable age in all cases.

Specking shortly about indications for egg donation we could speak about two groups of indications:
First one
Premature ovarian failure and Resistant ovary syndrome.. Almost 50% of oocyte recipients suffer from premature ovarian failure due to different reasons and the most of them younger of 40 years. It is estimated that at least 1–3% of women experience premature menopause due to premature ovarian failure. This condition can present in 10–20% of women as primary amenorrhea and in up to 18% as secondary one. The diagnosis of ovarian failure is based on the finding of raised follicle stimulating hormone (FSH) levels over the realistic level and decreasing anti mullerian hormone level bellow the reasonable level. Actually premature (preterm) ovarian failure could be resulted after suffering of such conditions like autoimmune disorders, hypothyroidism, diabetes and other less commonly associated conditions such as autoimmune thyroiditis and inflammatory bowel, autoimmune polyglandular syndrome, fragile-X syndrome or its family risk that could be checked in 13% with premature ovarian failure; and of couse rare inherited syndromes such as blepherophimosis and ptosis or Perrault's syndrome (deafness and short stature); a history of Addison's disease and others.
Resistant ovary syndrome is the type or early phase of premature ovarian failure. This syndrome has been reasoned that a lack of sensitivity of the gonadotropin receptors, or a defect in the adenylate cyclase pathway, and is characterized by amenorrhea, normal secondary sexual characteristics and raised levels of FSH and lutenizing hormone (LH).
Genetically transmissible diseases and syndroms. Couples with risk of genetically transmissible diseases having children with fatal or severely disabling diseases may request oocyte donation. Even if prenatal diagnosis is available for a most number of these conditions, for some couples termination of pregnancy is unacceptable. Recent advances in preimplantation genetic diagnosis (PGD) have enabled couples to undergo IVF and transfer of normal embryos selected by embryo biopsy but the high cost and complexity of the procedure puts it beyond the means of many. X-linked diseases which includes hemophilia A and B, and some varieties of primary musclewasting diseases such as Becker's muscular dystrophy (X-linked recessive) and Duchenne's muscular dystrophy (X-linked recessive), should be offered genetic counseling. Galactosemia is transferase deficiency is usually fatal by 4 weeks of life and strictly needs lactose-free diet. Patients with galactosemia could have mild learning difficulties and could suffering of infertility. Thus patients with galactosemia seeking fertility treatment may opt for donated oocytes to avoid transmission galactosemia to the offspring. Turner's syndrome is characterized by an XO chromosome pattern or mosaics (XO/XX) and the rest have deletions, rings or isochromosomes. Patients typically present with short stature, cubitus valgus, low intelligence quotient (IQ) and amenorrhea due to streak gonads. Congenital cardiac defects in the form of coarctation of the aorta, bicuspid aortic valve, ventricular septal defect and aortic root abnormalities are common. A small proportion of patients, particularly the mosaics and the variants, can be fertile, but premature ovarian failure is more common in this group.

Oocyte donation may be an option for all such patients.
Second group of indications for egg donation is including repeated IVF failures such as: repeated poor response to superovulation gonadotropin stimulation; repeated failure of oocyte recovery; repeated failure of fertilization due to poor oocyte quality; repeated poor-quality embryos; repeated implantation failure of apparently normal embryos.

SOURCE OF OOCYTE DONORS

There are anonymous donors program, are practiced in Ukraine where a donor donates her oocytes to a suitably matched recipient anonymously.
Ukrainian practice are paid egg donors program. Usually payment for
donors include in the price and paid donors receive monetary benefits by donating their oocytes at once after ovum retrieval.

RECRUITMENT AND SCREENING OF DONORS AND RECIPIENTS

Recruitment and screening of oocyte donors include all needed test according to order of Ministry of Health of Ukraine.
Women recruited to treatment as oocyte donors are generally young, with regular cycles and without gynecological/general problems. Donors should be younger then 36 years of age. They have to have live healthy baby or babies that prove their fertility and improve pregnancy success rates in recipients to born live healthy baby.
Body mass index (BMI) should be < 26 kg/m2 .
Ovarian reserve testing using sing of antral follicle account and early follicular phase (day 2 or 3) FSH, LH estradiol and AMH levels is carried out.
Full medical and family history is taken according to questionnaire and recruitment rules.
Comprehensive general-physical, gynecological and genetic examination is done. And of course full blood count; blood group and rhesus status; tests for cystic fibrosis carrier status; infection screen: 
(a) Hepatitis B, hepatitis C, human immuno- deficiency virus (HIV)-I and –II; 
(b) Venereal Disease Research Laboratory/ Treponema pallidum hemagglutination assay (VDRL/ TPHA) for syphilis; 
(c) Cytomegalovirus (CMV) antibody, immunoglobulins IgG and IgM; cytogenetic analysis for karyotype;

Screening tests for oocyte recipients is conduct according to order of Ministry of Health of Ukraine

MATCHING PHYSICAL CHARACTERISTICS OF DONORS AND RECIPIENTS

The physical data compatible with the oocyte donor's phenotype are utilized in recruiting recipients.
Blood group, rhesus status and viral status are matched as closely as possible.
Other physical characteristics of the donor, such as: skin color, eye color, height and weight are matched as closely as possible to the characteristics of the recipient couple.
One of the an important aspect of matching is ethnicity and religious faiths.
We try to provide recipients with as close a match as possible and to comply with their specific requests.

PROTOCOLS FOR TREATMENT

Oocyte donors
The standard ovarian follicular stimulation protocol involves pituitary desensitization with a gonadotropin releasing hormone (GnRH) analog from the midluteal phase (days 16 - 25) in women with 28-day cycles and usually ovarian stimulation with human menopausal gonadotropin (hMG).
Usually the dose of gonadotropin depend on the patient's age and ovarian reserve assessments. Long-acting GnRH analogs give the same results as those administered daily form.
The main goal to match of donors and recipients protocol are to accurately plane visit of recipients clothe to day of hCG administration when the leading follicle is between 16 and 18 mm in diameter. Stimulation usually takes about 11–12 days.
LH surge is achieved with an injection of human chorionic gonadotropin (hCG) 10000. Oocyte retrieval is timed 32–36 hours after hCG administration under general anesthesia and under ultrasound guidance transvaginal needle aspiration with appropriate syringes. The oocytes are then fertilized with recipient's partner's sperm.

EMBRYO TRANSFER IN OOCYTE RECIPIENTS

Our practice is not differentiate recipients for ovarian function (acyclic or cyclic women). Its gives us the guarantee of good flexible schedule of treatment and in the most cases we use GnRH analog to get down regulation that gives us maximum of synchronization. But in some case when we sure that women have not ovarian activity we conduct hormone replacement therapy (HRT) protocols.
Thus women without active ovaries are started on HRT a few months prior to their planned treatment. Then we carefully assess of the endometrium to rule out patholo- gies such as endometrial polyps, inadequate endometrial thickness or hyperplastic endometrium.
The treatment is then synchronized with the donor's cycle.
Women with regular menstrual cycles vigorously undergo down- regulatin with a GnRH analog, and receive estradiol valerate (pills) or estradiol hemihydrate (transdermal form) in incremental doses to achieve endometrial growth.
Progesterone is added on the day after hCG administration for donors or at the donor's oocyte retrieval day.
Synchronization of donor and recipient cycles can be achieved in various ways but checking strong evidence of the temporal window of maximal endometrial receptivity.
Cryopreservation of the embryos and replacement at a later date may be need in some cases with problem of dys-synchrony of endometrium and embryos.

RESULTS OF TREATMENT WITH DONATED OOCYTES

In our practice the cumulative pregnancy rate after three cycles is about 90%. In addition, the overall the cumulative delivery rate was more then 80%.
This is shows that neither the recipient's age nor the diagnosis plays a substantial role in the success of oocyte donation.
There are no reports of increased fetal abnormalities following oocyte donations

SOME OTHER ISSUES OF EGG DONATION

Legal status of oocyte donation is clear in most countries.
In moral issues the vulnerability of oocyte recipients are still are problematic. Thus gentle but professional implications counseling is mandatory. The recipient couple should be sure that they would become the legal and genuine parents.
In ethical view some couples, donated oocytes are unacceptable due to their religious beliefs.

Thus oocyte donation remains one of the ways of bringing the joy of parenthood to many couples who has all indications for this type of infertility treatment.
And we have possibility to help you in this issues.


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Kiev, Majorova Str. 7А, section 7 Mon-Fri from 9:00 to 18:00

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