Oocyte donation in Argentina

Dr. Gabriel Fiszbajn is an Associate Director and Chief of the Department of Reproductive Medicine of CEGyR, Centro de Estudios en Ginecología y Reproducción (Center of Studies on Gynecology and Reproduction).

The first fecundation with an in vitro fertilization technique in Argentina was performed in this center in 1985. The development of the ICSI (injection of one spermatozoon into an oocyte) procedure in this country in 1994 was again pioneered by CEGyR.

The Oocyte Donation Program run by CEGyR is the most important one of its kind in Argentina and South America. A total of 220 procedures were performed in 2005 and 248 in 2006, with a pregnancy rate of 45% and 47.5% respectively.

This large number of cases and the excellent pregnancy rate is due to the fact that this program has been developed in recent years in accordance with the ASRM (American Society for Reproductive Medicine) standards for the study and selection of donors, as well as for the preparation of recipients and for the coordination of this treatment.

The remarkable sucess achieved by this program has called the attention of both professionals and patients from Argentina and other countries, and this has positioned CEGyR as an assistance, advice and treatment center for patients from Argentina, Chile, Uruguay, Paraguay, Bolivia, Peru, Ecuador, Venezuela, Colombia, Brazil, as well as from Mexico, US, Spain, Italy, France, Germany, England and other European countries.

Nowadays, 60% of the patients undergoing Oocyte Donation treatments with Dr. Gabriel Fiszbajn are from Argentine interior provinces or from other countries, and this has resulted in the doctor’s regular contact on the Internet with doctors and patients with the aim of streamlining and optimizing times and thus limiting visits to Buenos Aires to the minimum necessary.

Indications for Oocyte Donation:

Menopause
Precocious menopause or premature ovarian failure
gonadal dysgenesis
Perimenopause
Poor oocyte quality
Poor embryo quality ascribable to oocytes
Repeated abortions probably caused by poor oocyte quality
Genetic disorders of female transmission


The ovary has the capacity of producing oocytes, which are the female gametes forming the embryo when joining the spermatozoa. Ovaries produce oocytes during women’s reproductive life, that is, from the moment they begin to menstruate to the moment menstruation disappears at 45 or 50 years (menopause). Sometimes, a woman may no longer ovulate because she ceased to menstruate before the age of 40 (precocious menopause or premature ovarian failure). In both cases she might want to have biological children and this would not be possible. There are also other possibilities, for instance, when a woman does ovulate but her oocytes are of a poor quality, incapable of forming an embryo and thus of achieving pregnancy. This condition is detected only in assisted reproduction procedures (such as an IVF or an ICSI), when oocytes are retrieved and the specialist can observe them and their behavior. Anyway, it is a known fact that after 42 or 43, the scanty remaining oocytes are generally of a poor quality, which makes it extremely difficult to achieve pregnancy. In this case and the previous ones a couple may turn to oocyte donation.

Technique:

Unlike spermatozoa, freezing oocytes is extremely difficult and is still considered experimental. This is why there are no oocyte banks yet (though there are many efforts and advances going on in this area). The oocytes that are donated in Argentina come from voluntary women. Voluntaries’ ovaries are stimulated with hormones so that they may produce a significant quantity of oocytes.

These oocytes will be used by the recipient couple (that is, the couple in which the woman produces inadequate oocytes or no oocytes at all), and injected (via ICSI, injection of one spermatozoa into an oocyte) with her partner's sperm. This is how the embryos to be transferred to the recipient woman will be formed. This treatment requires an important coordination effort to retrieve oocytes (from the donor) and to transfer embryos (to the recipient) within the same cycle. We use 4-8 high quality oocytes for each recipient and the regular procedure is the transfer of 2 high quality embryos, with high implantation potential.

This calls for very accurate coordination between donor and recipient. In CEGyR, this procedure is performed on an anonymous basis, which means that the recipient ignores the donor's identity and the donor ignores the recipient's identity.

Donors:

Each recipient is assigned a minimum of 4 high quality oocytes. In this program, the oocytes are shared among recipients according to the number of high quality oocytes available. There is also the possibility of selecting a minimum of 8 high quality oocytes, which allows to select the embryos to be transferred from a wider range and also provides the chance to cryopreserve embryos.

Recipients

Women who are to use donated oocytes are known as recipients.

They receive all the information and required forms by e-mail. They are informed about the program guidelines and have to sign the corresponding consent agreement forms.

Then they are required to go through specific tests: clinical, gynecological, infectious disease, endocrinological tests, etc.

* Depending on medical opinion.

Additional tests for patients over 40:

The recipient is also required to hand in an updated photograph of herself and her partner (if she has one) which will be used for the process of compatibilization with the donor.

If possible, she will also be required to undergo a psychological evaluation.
Once the donor has been selected and her ovaries are being stimulated, the recipient’s endometrium has to be prepared.

By the time the follicle retrieval is performed on the donor, the recipient should be in Buenos Aires so that when her partner's sperm is injected into the oocytes, embryos can be transferred in 48-72 hours.

Compatibilization:

CEGyR performs a process of responsible compatibilization between donor and recipient, respecting demands based on physical characteristics of both parties.

Pregnancy rate:

Pregnancy rate with this procedure is 45-50% per attempt. This is the highest pregnancy rate of all reproduction treatments, because it combines oocytes from a young woman and an endometrium perfectly prepared to receive embryos. As each attempt has a similar success rate, if the procedure is repeated, the long-term and medium-term chances are really high.On the other hand, chances of multiple pregnancy are 20%, which is acceptable for any reproduction center in the world. This percentage corresponds to twin pregnancies, never triplet or quadruplet pregnancies, for only two embryos are transferred.

Treatment Arrangements:

Arrangements for this treatment are simpler than it might seem, for the contact is established immediately and straightforwardly by e-mail. Once the woman or couple has decided to undergo this treatment, the first step is to go through the required tests taking into account the validity period. Tests are sent by e-mail, together with an updated photograph which will help the process of compatibilization and the consent agreement forms (authorizations signed by patients which are essential for the treatment to be performed and should be sent after the first contact). Based on the photograph and the elements which may arise from the dialogue between patients and doctor, the donor is selected and the preparation of both women begins. The preparation of the recipient is very simple and is developed through an ongoing communication.

Preparation of the Recipient:

If the recipient menstruates either regularly or irregularly she should be administered a long-acting Gn-RH agonist (gonadotropin- releasing horone agonist) intramuscularly on the 21st day of the cycle previous to the procedure with the aim of causing ovarian supression. Once the menstruation after the injection occurs, ovarian supression is confirmed by means of a transvaginal ultrasound and a serum estradiol measurement and the recipient starts orally taking 4 mg a day of 17 beta estradiol. If the recipient no longer menstruates there is no need to use the long-acting Gn-RH agonist and the treatment begins directly with 17 beta estradiol. After taking this medication for 10 days, a transvaginal ultrasound is performed. Probably the endometrium is ready by then and the embryo transfer can be carried out. The woman can remain with her endometrium "prepared" for 45-60 days without modifying her pregnancy chances. After the endometrium is prepared and ready, we should arrange the date for the recipient to arrive in Buenos Aires for the embryo transfer. In fact, the scheduling of the date of arrival in Buenos Aires is usually made many days in advance, because many patients have their last checkups in Buenos Aires. They often arrange tours to different tourist destinations in Argentina during waiting periods.

Endometrial Preparation Diagram:

Endometrial preparation of amenorrhea patients

Endometrial preparation of menstruating patients

For further information:

If you are interested in further information about the program and treatment costs, please contact Dr. Gabriel Fiszbajn either by e-mail ( fiszbajn@cegyr.com ) or through Online Queries.

For further information, please see Dr. Fiszbajn’s website at www.fiszbajn.com or CEGyR website at www.cegyr.com 
 

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