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Fertility 360

Donor Management: How Do We Find Your Perfect Match?

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Find Perfect Egg Donor

As we await the news on IVF Spain’s second couple we asked their team to tell us how they find the perfect egg donors.

Women’s role change and their personal and professional development are important achievements in our current society, but it is common that they lead to a delay in motherhood and all the disadvantages it entails. The prevalence of infertility due to late motherhood is gradually increasing and the need to resort to egg donation treatments is becoming ever more commonplace.

Thanks to events like the Fertility Show, in which we participate every year, we have had the chance to meet many couples interested in egg donation as the solution to their fertility issues.

Egg donation is the most requested treatment by international patients in Spain, and especially in our clinic. In IVF Spain we consider the patient the centre of our work and motivation, so we strive every day to offer a useful, evidence-based and high-quality information to them.

We believe that any person or couple that decides to undergo a fertility treatment must have access to clear and accurate information that helps them choose according to their own needs. Therefore, we have decided to dedicate this article to explaining one of the most relevant and doubt-generating aspects of egg donation: the donor selection.
Due to numerous causes (a woman’s age, early menopause, genetic disease, ovarian resection, cancer treatment), the ovaries can lose their ability to produce good quality eggs or any eggs at all. In these cases, egg donation can help achieve pregnancy successfully and safely.

In fact, this treatment consists of a perfected in vitro treatment with the additional difference of using eggs from a donor; the sperm sample can be that of the male partner’s or also a donor’s. Among the treatment’s resulting embryos, and by means of advanced embryo selection techniques, the best embryo will be chosen to be transferred to the patient’s womb. If it implants successfully, a normal pregnancy will follow.

The main appeal of Spain as a destination for a fertility treatment is that it is a global leader in medicine in general, and in assisted reproduction in particular.
Another reason for foreign couples to show interest in Spain is that the donor system here, and our awareness-raising campaigns for the recruitment of donors means very short or no waiting lists, as opposed to the long waiting lists in other countries, especially in the UK.

Another key aspect of egg donation in Spain is that it is totally anonymous. In Spain the patient is not allowed to know the name of the donor, or see her picture and choose according to it, or have access to any information that would make it possible to identify her. The anonymity protection system is made so that the donor is not traceable by anyone except for the donor selection team. Still, the donor’s medical history will always remain in possession of the fertility clinic in question for the biological child to be able to access it in case of ever needing medical attention.

Since the responsibility of choosing the donor lies in the fertility clinics, the Spanish law strongly regulates the donor selection to guarantee the maximum possible phenotypical similarity between the donor and the patients and, of course, excellent health standards.

In IVF Spain we have an excellent egg donation program that relies on a pool of over 500 donors, in which all phenotypes are represented (Caucasian, Nordic, Mediterranean, West Asian, East Asian, etc).

This way we make sure that the donor and the patient share the maximum similarity in their physical traits during the donor selection process.

To be considered as a potential egg donor in Spain women must be within a range of 18-35 years of age. In IVF Spain we accept donors of 18 to 30 years of age.

In accordance with the Spanish law, we perform numerous medical tests to the aspiring donors, the results of which must be excellent in order to accept them as donors. IVF Spain takes the medical study one step further including a psychological evaluation and a genetic study.

The genetic study consists of an in-depth study of the patient’s medical history to evaluate the risk of suffering and/or transmitting hereditary diseases, a chromosome analysis to detect any possible alterations (which would be transmitted to the embryos), and a carrier map able to detect more than 300 monogenic diseases.

In our clinic the donor selection process for a concrete couple starts with a form that the patients complete, which consists of two parts.

On the first part, both patients fill out a questionnaire about the most important aspects of their own physical appearance. On the second part they give a priority number to each trait of a list of 5, which represent important aspects that the donor could share with the patients, including the blood group. For some couples, coinciding blood groups are not important because they plan to tell their future child that he or she was conceived through an egg donation treatment. For other couples the said coincidence is crucial, since they prefer not to share any information about the treatment with the child and maybe even with their families.

The form also has a section for the patients to add any possible personal preferences about the donor. Also, we request the patients to provide us a representative picture of them in which they like themselves and they are reflecting a personal trait that they like about themselves.

We take these pictures into account when choosing the final donor.

As mentioned, the law states that the chosen donor must be as physically similar to the patients as possible. Apart from that, IVF Spain guarantees a match for at least 3 of the 5 traits of the form’s list, although normally a complete match of the 5 traits plus the extras is achieved, thanks to the size and diversity of our donor pool.

IVF Spain works with a custom-made highly-specialised donor selection software that, after we introduce the patients’ data, generates a list of compatible donors in descending order of similarity. The human donor selection team then chooses the best donor among the list’s top 3, considering more subtle characteristics.

The selection is also done according to the donors’ biological availability, that is to say that each donor is ‘rested’ over a number of cycles. This means the collection of high quality and perfectly matured eggs is guaranteed, and we can avoid “overstimulation”, or an excessive pre-stimulation that would lead to the collection of a higher number of lower quality eggs.

In our clinic we advocate for “fresh” fertilisations and embryo transfers, since experimental data have shown a 10% decrease in the pregnancy rate when performing fertilisations with previously cryopreserved eggs or sperm, in comparison with using fresh samples. So, once the donor has been chosen and her availability has been confirmed, the donor’s ovarian stimulation and the patient’s endometrial preparation are synchronised.

This way, patients come to our clinic in Spain twice: the first time for a few hours for the consultation, physical exploration, performing of tests and design of the treatment strategy; and the second time, for around 10 days for the donor’s egg collection and immediate fertilisation with the male patient’s fresh sperm sample, in order to transfer a fresh embryo in blastocyst stage (around 5 days later) to the female patient’s womb.

The donors’ stimulations are performed in the same way and with the same medication as those of our own patients undergoing IVF with their own eggs. They are planned and cared for down to detail, personalised according to each donor’s hormonal response, and conducted so that the eggs’ maturation in each case is optimal.

All the treatment’s steps are taken optimally in accordance with the scientific community’s most advanced and recent knowledge. Thanks to this our success rates are well above the European average and among the highest in the world.

In IVF Spain we are aware of the strong emotional stress caused by going through a fertility treatment that may end up failing. For this reason, in our clinic we develop strategies for each concrete case, offering an individualised attention and personalising each step of the treatment in order to offer the maximum success chance in each cycle.

For more information click here to visit the IVF Spain website.

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Fertility 360

Study Points To Fertility As A Leading Economic Indicator

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Study Points To Fertility As A Leading Economic Indicator

Many research studies have shown that when the economy does well, people have more babies, and when the economy does poorly, they give birth less.

New research from the University of Notre Dame, however, discovers something unique — people appear to stop conceiving babies several months before recessions begin.

The study, “Is Fertility a Leading Economic Indicator?” was published Feb. 26 in the National Bureau of Economic Research’s working paper series. It is coauthored by Notre Dame economics professors Kasey Buckles and Daniel Hungerman, and Steven Lugauer from the University of Kentucky.

The team compared conceptions to other well-known economic indicators — such as consumer confidence and durables purchases — over the past 30 years and found that conceptions fall at the same time or even before other indicators whenever a recession is about to start.

“We show that for the last three recessions, conceptions predicted the downturn just as well as traditional economic indicators did,” Buckles says.

The team examined data on more than 100 million births spanning decades in the United States. Unlike most studies that use data aggregated up to the year level, the NBER paper focuses on the timing of births within the year using monthly or quarterly data, which allowed the researchers to study changes occurring months before a recession — changes that papers using annual data would miss.

“Once you examine monthly or quarterly data, the pattern becomes obvious,” Hungerman says. “We show the existence and magnitude of this pattern before the Great Recession, and it’s striking since that recession was famously hard to predict. None of the experts saw it coming, and in its first few months, many business leaders were convinced the economy was doing OK — even as the number of conceptions plummeted and had been falling for a while.

“While the cyclicality of fertility has been studied before, the possibility that conceptions change months before recessions begin has not been shown before,” he says. “In fact, some well-known studies have even declared that the pattern we find shouldn’t exist.”

“One way to think about this,” Buckles says, “is that the decision to have a child often reflects one’s level of optimism about the future.”

The study also shows conceptions are slow to rebound when recessions end. The Great Recession famously had a “jobless recovery.” This study finds it also had a “babyless recovery.”

The paper is available online at http://www.nber.org/papers/w24355.


Also published on Medium.

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Fertility 360

Rainbow Babies: Tips To Move Through The Joys, Fears And Tears Of Pregnancy After Loss

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Rainbow Babies

Congratulations! You’re pregnant! Everyone around you is excited except, perhaps, for you. Last time this happened and/or the time before that and/or the time before that, the pregnancy didn’t continue. You may have had a miscarriage, a stillbirth or a neonatal loss. You may have felt isolation, grief, anger.

In fact, you may have thought this pregnancy would resolve these feelings when, in fact, you’ve been noticing lately that they’re all still lurking in the background. To make matters worse, you may now be feeling petrified you’ll lose this baby too. Worry, fear and uncertainty are very commonly felt by pregnant people who’ve experienced a loss.

Here are some suggestions to help you move through the challenges and enjoy pregnancy again.

1) It was not your fault
Whatever happened last time, it was not your fault. Not all pregnancies are perfect. Not all births end up in live babies. You did your best. Shitty things happen. It was not your fault.

2) Choose the right health care provider
It’s normal to be emotionally vulnerable. It’s normal to feel anxiety. It’s normal to want a million extra appointments but then simultaneously feel like that high after your fourth ultrasound was too short-lived. It’s also normal to be happy.

Research suggests that pregnant people following a loss do better with care providers that respect their unique experiences. Most often, this can be found in a care provider that provides strong continuity. For some this is someone they’ve worked with in a previous pregnancy. Others prefer to start afresh. Good, consistent professional support that honours your individual experiences is not only important for your personal wellbeing but it also improves pregnancy outcomes.

3) Ask for what you need
After a loss, many people find the need for more personalised care to support them through their pregnancy and birth. If you think you need a more frequent schedule of visits for your own wellbeing, ask. If you want to know how to get reassurance in the middle of the night, ask. If you need them to start the appointment with a fetal heart rate check, ask. If you want an additional ultrasound for reassurance, ask. Take an active role in planning your pregnancy and birth. If you’re not finding your care providers responsive, ask to change to someone else. Research suggests that feeling a sense of control in your journey can help you enjoy your pregnancy again.

4) Build your community
After experiencing loss, it’s not uncommon to delay emotional involvement in a subsequent pregnancy and that’s okay. This is your pregnancy and your baby. You get to decide when you announce your pregnancy to the world. You get to decide how you feel about your baby. However, sometimes this valuable protective mechanism also deprives us of seeking necessary support. Many woman do not get adequate emotional and psychological support to deal with their feelings.

While you may be turning to your partner, he or she may also be processing the pregnancy differently, particularly at triggering times, for they are on their own journey of isolation, grief, anger. Bring those into your community who will be there for you when things are tough. Ask your care provider to connect you with someone who’s experienced loss. Consider seeing if there are any support groups in your area for folks who’ve had similar experiences to your own. Research suggests group support helps diminish feelings of isolation and allows for stronger relationships between partners moving forward.

5) Prepare for your rainbow baby
The vast majority of people who’ve experienced losses do go on to have healthy babies. We call them rainbow babies. For, they are the beautiful babies we welcome into the world after the storm that is loss. Just think: you’re pregnant with your rainbow baby! Find ways for you and your support people to celebrate milestones, even when you’re feeling fears to the contrary. Find ways to do the things that normalise, even if a bit of adaptation is necessary.

If you think you’d feel isolated attending a regular childbirth education class, sign up for a private one instead. Read positive books about pregnancy, childbirth and parenting. Do the silly things you always imagined you’d do. Be determined to maintain hope: your rainbow baby is on the horizon!

If you want to find more support you can contact Rishma via her website www.rishmawalji.com

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Fertility 360

If You Wish To Get Pregnant Do Not Waste Time. Put Yourself In The Very Best Hands

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If You Wish To Get Pregnant Do Not Waste Time. Put Yourself In The Very Best Hands

Time-wasting is not an option when racing against the clock. When the aim of that race is to get pregnant, missed opportunities can never be recuperated. If a woman is of a certain age and not getting pregnant, there is only one sensible piece of advice: put yourself in the very best hands and do not leave what quality reproductive medicine can do for you to chance.

“The greater our ability to resolve issues, the more complicated the issues in the patients we treat become,” admits Instituto Bernabeu, a leading clinic for patients who, according to the statistics, have previously been unsuccessful an average of 2.5 times in courses of treatment performed by other clinics. These couples turn to Instituto Bernabeu looking for efficiency, effectiveness and quality. The clinic is convinced that personalisation and a comprehensive analysis of the patient are essential. Experience is also key. Each situation is studied in detail and the specialist then transmits the patient’s characteristics and needs to the medical committee and the case is studied and assessed. Gynaecologists, biologists, embryologists, geneticists, andrologists and pharmacists all play a role. This multi-disciplinary team helps the patient by pooling all its knowledge and using ground-breaking technology in order to achieve the desired pregnancy.

Understanding human reproduction requires sub-specialisation in each phase of the process so that personalised responses can be provided. Treatment cannot be generalised. Over a decade ago, Instituto Bernabeu was a pioneer in setting up different healthcare and research departments and these departments are continually updated and enriched with each new development. The clinic’s Implantation Failure and Recurrent Pregnancy Loss, Poor Ovarian Reserve units, the unit that deals with immunology issues and the specialists in the impact of genetics in gametes and embryos are clear examples of this. Each unit is managed by experts in the field. Each couple is a world in itself and needs cannot be met using standard courses of treatment.

In a society where globalisation is a trend, health issues must be given the importance they deserve. Medicine must search for solutions suited to each patient. Personalisation is key and, with this in mind, Instituto Bernabeu invests heavily in on-going training for its entire team; leading technology; and a specific infrastructure that, furthermore, adheres to strict quality standards and performs external audits in order to verify the efficiency of each phase of the process.

Healthcare goes hand in hand with constant research. “Each couple teaches us something new. Each course of treatment opens up a door to understanding human reproduction. The challenge we face is amazing because we have to design the specific solution that each patient needs,” explains Dr Rafael Bernabeu. In 2017 alone, Instituto Bernabeu delivered over 25 scientific research projects that were accepted for presentations at leading international human reproduction congresses. They were all borne of the search for an answer.

Personalisation and use of the very latest developments can turn into the difference between getting pregnant or performing unsuccessful treatment.

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