Information about Egg donation www.ginefiv.co.uk Tel. (UK): +44(0)203 129 34 19 Tel. (Spain): +34 91 788 80 70
Index This brochure contains the following information: Index About Ginefiv...3 Our Egg Donation Program...4 Your first visit to Ginefiv...5 The Egg Donation procedure...6 A. Before beginning...6 B. Ovarian stimulation of the egg donor...7 C. Fertilization and embryo culture...7 Your second visit to Ginefiv: the embryo transfer...10 Why choosing Ginefiv?...11 2
About Ginefiv Ginefiv, with over 25 years of experience, is a point of reference both at a national and European level in the field of assisted reproduction, both for couples wishing to have a child and for professionals that entrust patients to our care once a fertility problem is detected. Ginefiv is made up by a team of over 80 professionals specialising in different fields and led by Dr. Bajo Arenas, which makes us be one of the biggest and most complete clinics in Spain and offer the best assisted reproduction treatment for each fertility problem, with a global and integrated perspective. Having a clinic of these characteristics and a culture of innovation supported by our Foundation allow us not only to be at the forefront of assisted reproduction but also to make progress. Ever since our beginning we have been pioneers in the application of new techniques both in Madrid and in Spain. In 1988 our work led to the birth of the first baby resulting from the use of a frozen embryo in Madrid, to the birth of the first baby conceived through an Intracytoplasmic Sperm Injection in 1996 and, more recently, to the birth of the first baby conceived through IMSI in 2007. Thanks to this, at Ginefiv we are able to offer our patients the latest advances in assisted reproduction. Our assisted reproduction team treats the larger number of cases in the Community of Madrid and combines a 25 year experience with its daily practice, using the latest medical technology and advances in assisted reproduction. This allows us to offer our patients the maximum guarantees of success in each fertility treatment we perform. Moreover, since we are aware of the importance of having and proving we offer the best quality conditions, Ginefiv has been one of the first clinics in Spain in meeting the requirements specificied by ISO and SEP (Excellence in Private Health). 3
Egg Donation Program A general approach Our Egg Donation Program at Ginefiv, which began in 1991, is one of the pioneering programs in Spain and is aimed especially at couples whose sterility problems can be resolved by substituting their female gametes with those of a young, healthy and fertile donor, and at couples who risk passing a genetic disorder on to their children. The Egg Donation Program at Ginefiv is a simple scheme since our patients only have to attend our clinic twice: the first time for a medical consultation with our medical team and the second time for the embryo transfer. This technique is unquestionably the most effective available, resulting in a rate of pregnancy following embryo transfer of 57% and a cumulative rate of pregnancy rising to 94% when patients undergo 4 cycles of treatment. It is the technique which more and more couples are turning to in order to make their dream of having a child come true. What is the essential difference in our donation-program compared to other clinics? We guarantee your embryo transfer. Donors are not shared. IMSI is performed at no extra cost for all patients. Thanks to the high number of egg donors at Ginefiv, our clinic is able to easily find an egg donor with physical features compatible with the recipients. We offer the latest assisted reproduction technology: Embryoscope, Macs and PICSI, among other techniques, are available at Ginefiv and can be applied in order to have the highest chances of success. Our results. Finally, although this is the simplest and most effective assisted reproduction technique for the patients who choose it, at the same time it is the technique which requires the greatest level of coordination and synchronization among the team involved in the assisted reproduction, and in this respect the experience of our team at Ginefiv makes all the difference. 4
Your first visit to Ginefiv Preparing the procedure Your first visit to Ginefiv will only last three hours, so it does not require an overnight stay in Madrid, allowing you to fly back to your country on the same day. During your first visit to our clinic, a gynaecologist will perform a gynaecological examination and will discuss your medical case with you and your partner, and at the same time will explain in detail all the particulars of the treatment. Finally, if everything is correct, they will carry out a mock transfer test which will enable us to select the cannula for transferring embryos which is most suitable for you. Finally, your partner will visit our Andrology Laboratory to provide a semen sample. This sample will be analysed (using a test to determine sperm survival) and frozen for subsequent use. For this, and to ensure that the semen sample is of the best possible quality, we will require you to abstain from sexual activity for 3 or 4 days, but any longer than this is not advisable. Is it possible to have the first appointment via videoconference? Yes, it is possible to have the first appointment via videoconference and to come to Spain only once (for the embryo transfer). However, we generally recommend all patients to come to our clinic, if possible, before starting the treatment so that our medical team can meet them and perform a mock transfer test. Moreover, if you are using your partner s sperm for the treatment, we will be able to perform all necessary sperm tests and we will freeze a semen sample. This is very important since if the sperm has not been previously frozen, your next visit to Madrid will last 5 or 6 days, while having a frozen sample would allow you to stay in Madrid only 24-48 hours. 5
The Egg Donation procedure What happens while you are back home During the donation process it will not be necessary for you to come to the clinic. Our team will be in contact with you on a regular basis to keep you informed of progress and to inform you of the necessary guidelines to follow. You can also get in touch with us at any time through our international department if you have any doubts or questions. A. Before beginning Based on the data obtained during your first visit, our team will select the donor who is most compatible with you both in phenotypical and medical terms. Once this selection has been made, our international department will inform you by telephone and we will begin the process of synchronizing her menstrual cycle with yours. During this time you will be kept in a state of endometrial and ovarian repose by the administration of anovulatory drugs or a single dose of GnRh-analogs (unless you have already reached menopause, in which case this would not be necessary). This synchronization period may last for several weeks. During this waiting period, our Patient Care Service will keep you informed about anything you need to know about, and you can also get in touch with them about any doubts or questions you might have. What should you know about our donors? The donation of eggs is totally legal in Spain. Spanish legislation dictates that the donation of eggs must be: Anonymous: At Ginefiv it is not allowed under any circumstance to reveal the identity of the donor to the recipient and vice versa. Voluntary: The donation of eggs is a generous act of solidarity and must not be for financial gain. All of our donors at Ginefiv are subject to strict medical controls through interviews and medical tests which ensure the fertility and physical health of the donor and that neither they nor their relatives carry any hereditary diseases. Thanks to our large number of egg donors, Ginefiv has an excellent capacity for finding donors who have phenotypical similarities with the recipient. The waiting periods for receiving eggs are approximately of 3 to 4 weeks, although this period depends on the phenotypical complexity of the recipient. 6
The Egg Donation procedure What happens while you are back home B. Ovarian stimulation of the donor Once your menstrual cycle has been synchronized with that of the donor we can begin the process of ovarian stimulation in the donor, which is similar to the process for patients undergoing in vitro fertilization treatment. The objective is to induce multiple ovulation through the administration of hormones to the donor similar to those which regulate the menstrual cycle. Once ovarian stimulation is complete the eggs are collected from the donor through a minor outpatient procedure called follicular puncture. During this period we will be preparing your endometrium for the embryo transfer, and to achieve this you will be given a small dose of oestrogen (oral or transdermal). This step is essential to the success of the technique, as the endometrium must have the optimal level of receptivity for implantation. C. Fertilization and embryo culture After the egg retrieval the laboratory phase will begin, during which our biologists will select the best spermatozoids and will fertilize the eggs obtained from the donor with them. It is important to mention that in our clinic donors are not shared, which means that you will receive all eggs obtained from the donor. Our embryologists will use the Intracytoplasmic Sperm Injection (ICSI) technique for the fertilization of the eggs. It involves injecting inside the egg a single spermatozoid previously selected from the sperm sample. 7
The Egg Donation procedure What happens while you are back home How are spermatozoids selected? Our biologists use 3 techniques to select the best spermatozoids: IMSI: It involves examining carefully the spermatozoids by using a microscope five times more powerful than normal ones. This technique enables us to choose the best quality sperm by magnifying 6000 times more than the conventional ICSI method. At Ginefiv, this technique is performed systematically for all egg donation treatments. MACS: This technique enables the immunomagnetic separation of healthy spermatozoa apt for the fertilization from apoptotic spermatozoa which have less possibilities of survival. PICSI : This sperm selection technique is based on nuclear maturity. Once the spermatozoa acquire the maturity of its nucleus, a molecule appears on its cell membrane. This technique involves recognising those sperms which have that molecule on their membrane. From this moment on, the embryos are kept in a culture medium which is adequate for their development and they are periodically checked to verify their evolution and cell division. To do this, our biologists can choose among traditional IVF incubators which keep the embryos in optimal conditions or special incubators called EmbryoScope. What is the Embryoscope? The Embryoscope is a new IVF incubator with a built-in camera for automated time-lapse imaging that allows us to monitor all fertilized embryos from conception until the time of transfer without taking them out of the incubator. What advantages does it offer? The EmbryoScope slightly improves embryo culture conditions regarding traditional methods, therefore increasing the chances of achieving the pregnancy. Thanks to its time-lapse imaging system this new technology offers excellent information about each embryo without having to take them out to the incubator to see and/or manipulate them. Thanks to EmbryoScope a much more stable incubation is achieved without producing temperature and humidity changes, which allows us to obtain better quality embryos. 8
Moreover, the EmbryoScope optimises embryo selection since, as it offers much more information about the embryo, it allows to detect morphological abnormalities that otherwise would have gone unnoticed. The embryos that present specific cell division timing and correct morphological changes have been proved to have between 10% and 15% more chances of implantation. 9
Second visit to Ginefiv The embryo transfer Once the eggs have been obtained through follicular puncture we will fertilise them with your partner s sperm. Our team will get in contact with you to inform you of the result of the process (number and quality of embryos obtained) and to tell you the day on which the transfer of the embryos is scheduled to be carried out (normally the transfer takes place between 48 and 72 hours after the ovarian puncture of the donor, even if it can take place later if the embryos are cultured to blastocyst stage). Our team will also give you instructions which you need to follow until then, which will mainly involve complementing the treatment followed up to that point with a simple progesterone treatment. Embryo transfer is a totally painless process which will require you to stay in the clinic for approximately 45 minutes, after which you can go home. 10
Why choosing Ginefiv? 1. Our wide experience: Experience is the mother of knowledge and at Ginefiv, with 25 years of experience and having treated a large number of patients, our wide experience is hard to beat. That is why Ginefiv is a point of reference both at a national and European level in the field of assisted reproduction, both for couples wishing to have a child and for professionals that entrust patients to our care once a fertility problem is detected. 2. Our personalised diagnosis: Our team of over 80 professionals specialised in different fields of assisted reproduction will study your case and will provide you with different point of views depending on their field of speciality. This will allow you to have a complete medical diagnosis and you will know which treatment is the most adequate for you. 3. Our team of professionals: Having recruited the best professionals and being as innovative as we are has allowed us to have one of the best trained teams of professionals in Spain and Europe. All members of our team have a wide experience in the field of assisted reproduction and are continuously carrying out research and training activities to be up to date with latest technology. This allows us to stay at the forefront of assisted reproduction as well as to make progresses. 4. Our prestigious medical director at an international level: Our medical director, Professor Bajo Arenas, is one of the most prestigious gynaecologists at an international level. He is currently professor at the Universidad Autónoma (Madrid), as well as President of the Spanish Gynaecology and Obstetrics Society, President of the Federation of Spanish Scientific-Medical Associations (FACME), and Honorary Fellow ad-eundem of the Royal College of Obstetricians and Gynaecologist (UK). 5. Our technical resources: Our commitment with our patients makes us invest time and resources in order to stay at the forefront of reproductive medicine. This allows us to offer our patients all diagnostic tests or treatments they may need. For that purpose, our facilities are equipped with the latest medical technology. 6. Our permanent support: Being one of the biggest clinics in Spain and having a team of over 80 professionals allow us to be available 7 days a week and 365 days a year, as well as to offer long opening times to attend our patients. The reproductive system knows no bank holidays or weekends. At Ginefiv we are available any time you need us. 11
Why choosing Ginefiv? 7. Our personal care: We are conscious that apart from treating fertility problems we are, most importantly, treating people. That is why our Patient Support Team offers a personal and constant care and is available to answer any question you may have during your treatment. Apart from this, we also offer a Psychological Support Service if needed. Our aim is to be with you any time you may need it. 8. Our guarantee of quality: Our clinic has been one of the first ones in meeting the requirements specified by ISO 9001 and SEP (Excellence in Private Health) for all medical and biological assisted reproduction procedures. Exhaustive internal and external audits are conducted every year at Ginefiv in order to guarantee the quality services that we offer. Additionally, our clinic has a UNE 71502:2004 security certification that guarantees our correct management regarding personal information, which is quite relevant when treating patients with fertility problems. 9. Our quality/price ratio: At Ginefiv we have always offered our patients the best quality fertility treatments at competitive rates, always using the most state-of-the-art techniques. We have always strived to have agreements and preferential rates with most Spanish medical insurances. 10. Our results: Having - Over 25 years of experience in the field of reproductive medicine; - The best trained professionals; - A prestigious medical director at the international level; - Access to the state-of-the-art techniques; - A unique and personal care; - And a guarantee of quality;... Allow us to offer our patients the best possible results and to treat thousands of couples that choose our clinic every year 12