Answer from: Nurit Winkler
One question comes up, when I choose an egg donor and everything goes well, can something go wrong? There is always the question of can something go wrong? This is always one of the questions when someone does fertility treatment and the answer is yes, unfortunately things don’t always go the way that we want and sometimes an egg donor’s treatment gets canceled. The most common reason, I would say, for a cancellation would be, if the donor is not responding to the medication as expected and I know for myself, I do not want to go through an egg retrieval process unless I have the confidence that we will get a lot of eggs.
Part of it is also to do with financial things as from the moment the egg donor goes through the process of egg retrieval, the couple or the person, have to commit financially to the agency, to the egg donor and it is a huge expense where nothing is given back. If the egg donor has not performed well, then the cycle is not an ideal cycle and we don’t have a lot of eggs, so it is better to cancel earlier. Yes it is disappointing but at least financially you don’t have this big expense, plus we are not going through this without having enough embryo’s. So I would say, one reason is that if the donor does not respond well, sometimes the donor may come up with things that we did not know before. Now there is Covid, or infectious diseases that we are unaware of, very rarely the egg donor will change their mind. That is extremely rare. Things may happen we we do the screening or before we start the cycle and so on, I think the key to canceling an egg donor is to do it early enough, before there is the financial burden on the family, because at that point it is very disappointing but financially we are safe as opposed to doing it after. Financially, people pay everything and then we don’t have a lot of embryo’s and this whole process becomes very stressful.
Answer from: Daniel Alexander, MUDr
Yes. Unfortunately, in any fertility treatment, an IVF cycle can be cancelled. And even if you as a recipient are prepared for your IVF donation cycle, there can be a cancellation due to reasons on your side – the recipient’s side. For example, if your lining is not growing at all, or if you are using the medication in a wrong way, or if you cannot travel due to the current pandemic situation, and of course due to reasons on our side or basically because of the donor – if she is not reacting to the stimulation (which is rare) or if her eggs are not mature. We always have replacements and we always stimulate more donors than recipients but of course, there might be a situation where the donor is not responding and is not stimulating and there might be rarely a situation that your egg donation cycle has to be cancelled.
Answer from: Laura García de Miguel, MD
Unfortunately, the answer is yes. The main problem we can have in an IVF program with donor eggs is the endometrium preparation. So, in general, we want to be sure before starting that you don’t have any problems with endometrium preparation, but anyway, if your endometrium does not arrive at a good morphology or a minimum of 7.5 mm, we will cancel the embryo transfer because we want to be sure to give you the highest chance of success.
The second situation we can have is that the donor is not responding correctly to the medication, or there is some problem with the egg retrieval. If this happens, we will cancel the treatment for you, but at Clinica Tambre, we have blastocyst guarantees, which means that we will cancel the transfer, but we will do another treatment for you at no extra cost.
Answer from: Luboš Vlček, MD
The organization of the whole process of egg donation is a delicate process. We try to do it as easily as possible for the patients. We have a big team cooperating during the treatment with the donor and the recipient. The majority of the donor programs in our clinic are with fresh eggs, which means there must be a precise synchronization of the cycles of the donor and the recipient. This gives the advantage of better outcomes of the treatment, but there could be some points when something could go wrong. Some unexpected situations could occur during this process, for example, there could be some unexpected bleeding during the synchronization. For this, we use the birth control pill, which is the method best tolerated and accepted by the patients and by the donors as well. The period could be delayed, or there could be some intermenstrual bleeding, which makes the synchronization worse, and could, for example, delay the time for the transfer of the embryo.
The next thing could be that the donor could produce less than the expected amount of eggs, and of course, in our treatment policy, we respect the rights of the donor, and the first point for us is the safety of all sides, so the donor could decide to finish the treatment and not to go through the process of the egg collection. This happens very rarely, but we must inform the patients in advance about that.
However, whatever happens, the clinic’s staff is trained to deal with those unusual situations, and our egg bank always has a reserve of frozen eggs. Before we use frozen eggs, we always discuss this with the patients, and this is a special situation. As I said before, we try to use mostly fresh eggs for fertilization. After all, this brings the best outcome of the therapy. The frozen donor eggs are used in situations, for example, when the patient has already bought their flight tickets, and they are ready for the treatment in a specific time frame, and they cannot change the time of their stay here in the Czech Republic.
The next thing could be that during the process, some patients do not react to the medication, for example, their endometrium thickness is not thick enough for the embryo transfer. This should be at least six or seven millimetres because then we have the best outcome. This adverse event could lead to the change of the type of the medication during the preparation, and if the patient doesn’t react to it, we try to make a probe cycle, which can show us how the patient may react to this medication next time.
The next thing could be that the man is not able to produce the sperm for the fertilization, which can happen sometimes. It is very stressful for the man to come here and have to give sperm. This can, of course, be discussed in advance with the patients to ask if they are ready for this slightly stressful process of providing the sperm, but most of the problems have nothing to do with this. Another thing that has happened before with some patients is that because they send the results of the scan of the uterine cavity, we monitor if there are no polyps.
Sometimes, there are visible polyps in the cavity, and if it is bigger than five millimetres, we are not insured to transfer the embryos into the cavity as this does not bring good outcomes for the treatment. In those situations, it is better to advise the patients to cancel the treatment, remove the polyp, and transfer the embryos in the next cycle after the freezing and thawing process.
Answer from: Jennifer Rayward, MD
Since egg donation depends on biology, we cannot 100% guarantee that the treatment will take its course as planned. The reasons why treatment may be cancelled could be because of the donor, the recipient, or because of a failure in embryo development. If the donor does not produce enough eggs to move forward with the treatment, we look for a new donor and sometimes can even follow almost the same timeline as planned.
Sometimes the recipient does not respond well to the medication, and the endometrium is not thick enough to transfer. As in the case of abnormal bleeding, we cannot do the transfer according to the planned schedule. The eggs or the embryos will be frozen, depending on when we realize we cannot go forward with the transfer, and then we will prepare the endometrium in a later cycle.
Is it possible for my egg donation program to be cancelled?
Not everyone likes being surprised, even less so in medicine. Many patients express worries about unexpected circumstances interrupting or even completely stopping their treatment. These worries are especially prevalent among those undergoing donor egg IVF cycles. The majority of egg donation recipients have previously undergone unsuccessful own egg treatments. The stress caused by those experiences combined with the additional costs of egg donation can be overwhelming. The fear and uncertainty can be defeated by understanding the circumstances that could lead to an egg donation treatment being cancelled.