Reprofit International

Information for oocyte recipient

1. For whom is a treatment with donor oocytes intended
2. Advantages of a donor oocyte treatment
3. Recipient’s necessary testing prior to the beginning of the treatment
4. Our results
5. Treatment Guarantee
6. Risks associated with donor oocyte treatment
7. Selection of the right donor
8. How is a recipient’s mock cycle carried out?
9. Treatment protocols
10. How many and how are oocytes retrieved?
11. How are oocytes fertilized?
12. When is embryo transfer carried out?
13. What medications to take and what to do after an embryo transfer?
14. What to do when my pregnancy test is positive?
15. What to do when my pregnancy test is negative?
16. I tested positive but I started spotting

1. For whom is a treatment with donor oocytes intended
For couples where the woman doesn’t produce own oocytes.
Most frequently they are women whose ovaries were not properly developed or both of their ovaries were surgically removed. Also women with premature ovarian failure need donor oocytes.

For couples where the woman doesn’t produce quality oocytes.
Women, that have repeatedly undergone IVF treatments and quality oocytes couldn’t be produced or quality embryos couldn’t be developed. Also women of an advanced maternal age can produce oocytes of a lower quality that are not capable of fertilization or created embryos are unable to attach in the uterus.
For couples where the woman is a carrier of a hereditary disease. Genetic testing of these women showed chromosomal changes that can be transferred onto the future offspring.

Age limit for patients (recipients of donor eggs) is 49.

 2. Advantages of a donor oocyte treatment
Treatment success rate reaches 55-60% for a single treatment cycle and exceeds success rates of IVF treatment methods where patient’s own oocytes are used.
The reason being is the use of quality oocytes from young women – donors.
Oocyte donation offers, in comparison with adoption, the possibility to effect the nourishment and happiness of the baby by the mother before the birth; besides the obvious father’s genetic contribution (50%). Also the pregnancy experience from the very beginning, birth and immediate possibility to breastfeed is a definite benefit for the baby, mother and the whole family.

3. Recipient’s necessary testing prior to the beginning of the treatment
General information for the recipient
• For women over the age of 45 we require internal exam, ECG, blood pressure and blood sugars testing and we recommend mammography exam and a recommendation from an OB/GYN that pregnancy is possible

Ultrasound exam
• Women with a regular menstrual cycle, we ask for results of an ultrasound exam carried out on the 13th or 14th day of their cycle (1st cycle day = 1st day of a menstrual bleed). Important is the thickness of the uterine lining (endometrium)
• Women who have irregular cycle or no longer have a cycle have to have an ultrasound exam carried out after 14 days of using estrogen supplements.

Partner or husband
• Sperm analysis

Both partners
• Blood test results of HIV, Hepatits B &C, Syphilis (results must not be more than 1 year old)

4. Our results

Results in 2009

Results in 2010

Results in 2011

 5. Treatment Guarantee
During the donor’s preparations and stimulation followed by the egg retrieval, failure can occur (no eggs are retrieved), causing cancellation of the entire treatment; we would like you to get familiar with the guarantees that Reprofit International offers before you even start your treatment.

1. If the failure is caused by the donor (she doesn’t administer her medication, gets ill, terminates the stimulation), you will be immediately offered a back up donor, if at all possible, that meets your requirements and treatment will continue without interruptions.
2. If back up donor is not available, your doctor will immediately offer you the earliest possible treatment date.
3. If donor’s eggs don’t fertilize by the ICSI method (and sperm is of good quality), your next treatment will be offered to you free of charge.
4. If fertilization doesn’t occur because of poor sperm quality, next treatment will not be offered or performed free of charge.
5. We guarantee at least 2 quality embryos on the 3rd day of cultivation ready for transfer.
6. If only one quality embryo is available, you will receive a 33% discount.
7. If no quality embryos are available (and sperm is of good quality), you will not be charged and your will be offered the earliest possible treatment date.
8. The cost of your medication, used for your uterus lining preparation, will not be reimbursed to you, should the treatment not result in embryo transfer.

6. Risks associated with donor oocyte treatment
Just like with natural pregnancies or pregnancies after an IVF treatment, about 12-15% of the pregnancies end up with miscarriage. IVF treatment with donor oocytes is no exception.
About 20-30% of pregnancies are multiple pregnancies, depending on the number of embryos transferred.

7. Selection of the right donor
In the Czech Republic, oocyte donation is anonymous, voluntary and gratuitous. Our donors are young women up to the age of 34, meeting very strict criteria for oocyte donors selection (Guidelines for oocyte donation of The American Society of Reproductive Medicine, published in Fertility and Sterility, Vol. 77, No. 6, Suppl. 5, June 2002)
All donors undergo gynecology, endocrinology and genetic testing and they are repeatedly tested for the presence of sexually transmitted diseases (HIV, Hepatitis, Syphilis and Chlamydia, CMV).
When matching donors to recipients, we consider the donor’s blood type matching the recipient’s (or her partner’s), height, weight, hair/eye color and education. Clearly, we cannot guarantee an exact match, but our team is doing their best to provide you with the closest match possible.

8. How is a recipient’s mock cycle carried out?
Woman, who has decided to undergo an infertility treatment using donor oocytes, needs to have her uterine lining checked during a mock cycle to make sure it gets thick enough to accept and accommodate the transferred embryo(s).
You will be prescribed synthetic estrogen in the form of tablets, injections or patches (Estrofem, Estraderm, Agofollin) that you will take in an increasing dosage for 14 days. Subsequently, an ultrasound will be carried out, measuring the thickness of your uterine lining; possibly your estrogen dosage will be adjusted. This mock cycle will take you about 14 days to 3 weeks, when successful, treatment cycle can be scheduled immediately.

9. Treatment protocols
• Women with a regular menstrual cycle
Before treatment cycle begins, injection of a depot GnRH analog is administered (Diphereline, Decapeptyl, Zoladex). The goal is to neutralize the patient’s own hormonal background that could negatively effect the treatment. The injection is affective for about 3 weeks and then estrogen regimen (just like during the mock cycle) is commenced. 14 days later, ultrasound checking for the thickness of the uterine lining is carried out and when findings are positive, patient is scheduled for her embryo transfer. When maintaining her estrogens, the lining will remain prepared this way for up to 8 weeks.

While recipient is preparing her lining, donor’s synchronization and stimulation is started. After the donor’s egg mature, they are retrieved and consequently fertilized by the sperm of the recipient’s partner (fresh or frozen sperm can be used). On the day of donor’s oocyte retrieval, the recipient starts using her pregnancy hormones – gestagens (Utrogestan, Crinone), they will prepare her uterine lining for the embryos.

Following oocytes’ retrieval and fertilization, recipient is informed about the number and quality of her embryos over the phone.  After 3-5 days of embryo cultivation, embryo transfer of one or two embryos into the recipient’s uterus (future mother) is carried out. Surplus quality embryos can be cryopreserved. Recipient continues taking her estrogens and gestagens after her embryo transfer and 14 days later takes a home pregnancy test (urine test)

• Women with a non-existing menstrual cycle
After menstruation is induced, Estrogen treatment is started right away.

10. How many and how are oocytes retrieved?
Oocytes are surgically retrieved directly from donor’s ovaries. Donors need to be hormonally stimulated prior to this procedure. It is impossible to guess the number of retrieved oocytes in advance as it always depends on the donor’s reaction to the prescribed hormonal stimulation. Not all oocytes are mature and can be used for fertilization. Usually, we are able to retrieve 5-8 mature eggs from each donor. All mature donor oocytes are then fertilized by the recipient’s partner’s sperm. It cannot be 100% guaranteed that all of them will fertilize and develop into healthy embryos.

11. How are oocytes fertilized?
 Immediately following the oocyte retrieval, all mature oocytes are fertilized by the recipient’s partner’s sperm via intracytoplasmic sperm injection into the oocyte (ICSI). Frozen or fresh sperm can be used for fertilization. Fresh sperm is obtained on the day of oocyte retrieval. Donor sperm can be used as well.

12. When is embryo transfer carried out?
 Embryo transfer can be carried out after 2-5 days of cultivation. Timing of embryo transfer is determined by one of our specialists after consulting the treated couple.
After the fertilization, the treated couple is informed about the quality and number of their embryos over the phone and embryo transfer is scheduled. Embryo transfer is carried out in our small operating room and partner can be present.
Most frequently, we transfer 1-3 embryos.  After the embryo transfer, patient is informed about: continuing her medications, when to schedule her pregnancy test and the possibility of freezing her surplus quality embryos.

13. What medications to take and what to do after an embryo transfer?
 You will remain lying in our small operating room for about 15-20 minutes immediately following your embryo transfer. Afterwards, you can go back home or to your hotel room. We recommend no exercise and no strain for at least 2-3 days. We prefer a state of a mental rest to a strict bed rest and therefore, a cup of coffee or a glass of wine can only help things.
Your doctor will prescribe you estrogens (Estrofem, Estrimax, Divina) and progesterone (Utrogestan, Crinone, Agolutin) that you will use daily without any change until your pregnancy test. It is also recommended to take folic acid supplements. Prednisone, Anopyrin or an injection of a low molecular weight heparin are prescribed individually.

14. What to do when my pregnancy test is positive?
 You can finally relax after a long wait. You will keep taking your medications without change and inform us about your positive test over the phone or via email. Make an ultrasound appointment either with us at Reprofit or with your OB/GYN. It is important to maintain your medications, discontinuing them may result in spotting, bleeding and consecutive miscarriage. If you were not certain about your positive home pregnancy test, make an appointment for an hCG blood test. Louis Vuitton outlet

15. What to do when my pregnancy test is negative?
 If you home pregnancy test (urine test) was negative, it is not a good sign but it is not all lost yet. It is necessary to get your blood tested for the levels of hCG – pregnancy hormone. Results of this test are conclusive. You can schedule your appointment either with us at Reprofit or with your OB/GYN. Please inform us about your results over the phone or via email.

16. I tested positive but I started spotting
 In 20-25% of cases, spotting occurs shortly after the embryo has implanted. If this spotting is not accompanied by pain or cramps, it doesn’t have to mean anything but certainly makes you worried if everything is OK. The only thing you can do in this situation is to increase your dosage of estrogens to 2mg four times daily and your Utrogestan to 200mg four times daily. Please inform us of this situation and your specialist will explain and recommend the best approach for you.

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