IVF Treatment with Sperm Donation

IVF treatment with sperm donation is very similar to regular IVF treatment. The only difference from a standard IVF treatment is that the female patient’s eggs are fertilised with a sperm sample chosen by our patients and not with the partner’s sperm. Although still not accepted by some communities, sperm donation-based IVF treatment is applied by professional centres to patients who require this treatment. In our centre, we frequently host patients receiving donation treatment because we work with complete confidentiality and patient records are not shared with any third person except the patient and, if possible, their spouse. As in all of our treatments, our primary goal in the treatment of IVF with sperm donation is to make our family smile and gift our family with a baby.

Sperm donation therapy is only applied to patients who are really in need. The situations in which sperm donation is a necessity are summarised below:

• If the male patient is unable to provide sperm that has fertilisation capacity
• If the male patient has a disease that will be genetically transmitted to his children
• If the male patient has a severe disease like HIV or HCV which he can transfer to his partner and children
• If there is reproductive failure of the male patient’s sperm in previous treatments
• There is no male partner

Essential details such as the treatment schedule, the process, and the medications used are determined before starting treatment. Since the clinical information of each patient will be different from that of the other, the stages of sperm donation treatment vary among patients. The aim is to prepare the treatment that will bring the highest success for each patient. Therefore, the examinations required before treatment are the primary investigations of infertility research. Knowing some issues before treatment allows us to take precautions in preventable situations; success is hidden in these small details. Below, you can find the stages of IVF treatment with sperm donation in detail.

Egg maturation period: The leading indicator determining the period in which the couple will start treatment is the female patient’s menstrual cycle. Long or short-protocol treatment can be applied to our patients. While the short protocol begins with the patient’s treatment, the extended protocol starts on the 21st day of the previous menstruation. In both treatment groups, with the start of her menstruation, the patient begins to use the stimulating needles in the specified dose, and the egg development is followed by an ultrasound at predetermined intervals. Some of the needles the patients use are applied under the skin, and patients can easily apply them themselves. Preferred regions are generally the belly region and the arm. Some needles are made from the hip, and health personnel should apply these needles. In addition to the egg-enhancing and developmental control needles used in therapy, vitamin support, hormone supplementation, antibiotics, blood thinners, and immunosuppressive drugs can be added to the treatment in the form of pill, needle, vaginal gel or suppository. Again, because not all medicines are helpful for all patients, only using medically necessary drugs increases success. One of the most critical factors determining the success rate of sperm donation is the development of good numbers and quality of eggs.

While egg development is monitored by ultrasound, the necessary dose adjustments or drug additions/removals should be adjusted according to need. Our doctor reviews the results and makes the necessary arrangements, even if you have these examinations done in your local area. In the ultrasound, the growth of the cystic follicles in which the eggs are followed, while the endometrium, i.e. the uterine wall, is monitored. Since the baby will adhere to this area after embryo transfer, feeding appropriately and maturing is vital.

After the egg development treatment, the day and hour of the trigger injection are determined following the maturation of the eggs. This needle, which is an HCG-like drug, makes the eggs available to be collected. It is essential to apply the needle at the right time, as collecting eggs 34-36 hours after the needle is made will be necessary. While the eggs collected too early are immature, collecting them too late is no longer possible as they are entirely cracked. Since we are in direct contact with our patients, all the details are explained to them, and all the needed information will be shared.

Collection of eggs: Egg collection is performed under sedoanalgesia (a mild type of anaesthesia). In this way, even though the patient has not taken a deep anaesthetic, she is asleep and does not feel pain. Egg collection time is 10-20 minutes on average and depends on the number of eggs, the location and condition of the ovaries, and the expertise of the infertility doctor. While the patient is under anaesthesia, the genital area is cleaned with a sterile liquid. Using a sterile special egg collection needle, all mature follicles in which eggs are found are taken by ultrasound. Eggs are given to the embryology laboratory without any waiting. After the egg collection, our doctor evaluates the ease of passing the cervix through a special catheter. According to the stenosis of the passage, a decision is made about which catheter to use for embryo transfer, and plans are made to prepare for the transfer day.

Eggs fertilisation procedure: After the eggs are collected, they are rested for a while, and the unnecessary tissues around them are cleaned. This allows the observation of whether they are fertilisable and prepares them for fertilisation. The eggs are divided into four classes. The eggs called M2 are eggs which are ready to fertilise, and these eggs are the most important. The eggs, called M1, have yet to acquire the ability to fertilise. As these eggs can grow to the M2 level, they can wait for a certain period, and those that grow to the M2 level are added to those separated for fertility. Eggs called GV (short for germinal vesicles) are not suitable for fertilisation, and immature eggs; these eggs cannot be used. Eggs called anomalies or postmatures are not normal, too old, and, therefore, unhealthy.

While preparing the eggs, on the one hand, the sperm sample pre-selected by our patients is removed from the tank and prepared for processing. Prepared eggs are fertilised by the ICSI process, which means that the best sperm is chosen in terms of movement and structure through the sperm sample and injected into the egg with a particular system so that there is one sperm per egg. In the ICSI process, sperm does not use any energy to enter the egg and fertilisation success is very high since the best sperm will be used. ICSI procedure is routinely applied in our hospital for IVF treatments and sperm donation.

Embryo development follow-up (embryo culture): After fertilisation, embryos are monitored by daily control and scored according to the speed of development by a particular system. On the first day of control, a 2 PN embryo image shows that fertilisation has occurred correctly. 3 PN and 1 PN show that fertilisation is unhealthy, while some embryos do not develop. Unfertilised eggs are often unhealthy. Fertilisation success depends on egg quality and laboratory conditions. Since the sperm are certified and have passed many tests, sperm quality is first-class and is unlikely to impair fertilisation. The embryologist feeding the embryos under special conditions and liquids regularly checks the environment and makes the necessary adjustments. They share the developments daily with both patients and our doctors. In this period, while the embryos are followed, hormone medicines that mature the inner wall of the uterus are given to our female patient.

Embryo transfer: Transfer is performed after the embryos become suitable for transfer. The embryo transfer is a painless process if there is no problem with the cervix or the shape of the uterus. As this process is a very emotional moment for our female patients, in terms of motivation, we do not prefer to put our patients under anaesthesia at this stage.

Our infertility doctor passes the embryo or embryos placed in a special catheter into the most suitable place in the uterus under ultrasound guidance. Embryos can be transferred on the first and sixth days of embryo development, but the third or fifth-day transfers are the most common practice. Although the embryos on the fifth day have a slightly higher pregnancy rate than the third-day embryos, the embryos are less likely to survive as days pass in the outside environment, and some embryos are lost when healthy. For this reason, the primary marker in determining the day of transfer is the status of the embryos, and the patient, the doctor and the embryologist make the decision.

The number of embryos that will be transferred during embryo transfer is another decision that needs to be taken. Medically, it is appropriate to administer 1 to 3 embryo transfer to the patients. In some countries, transfers are limited to 1 or 2. According to the laws in Cyprus, this limit is determined as 3 for appropriate patients. The number of embryos transferred to patients depends on the rate and number of embryos, the clinical status of the female patient, the condition of the uterus and the patient’s opinion. While multiple embryo transfers increase the chances of pregnancy, the risk of multiple pregnancies (especially twin pregnancies) also increases, so at every stage, during this stage all variables should be evaluated at this stage.

On the day of embryo transfer, all extra success-enhancing measures applied to our regular IVF treatment are also used on embryos of patients who have received sperm donation. The embryos to be transferred are rested in the embryo glue fluid named embryo glue. Immediately before the transfer, a unique beam-assisted hatching process will be performed on all appropriate embryos without additional charge. In this process, the edge of the membrane in which the embryo is located is thinned, and after the transfer, the chance to hold the inner wall of the uterus is increased.

If our patients have additional embryos in good condition, these can be stored under their names after discussing with them. If a pregnancy is achieved, the transfer of these additional embryos allows the second child to be the biological sibling of the first child without having to deal with the treatment and development of eggs. If a pregnancy cannot be achieved, the stored embryos can be used for a second trial, which can be done much more conveniently.

IVF treatment with sperm donation is completed at the same time as standard IVF treatment, and it takes between 17-21 days or 24-28 days, according to the treatment schedule used. A large part of this period is when only medications are used and ultrasounds are performed, and our patients who do not live in Cyprus can spend this period easily in their own country. Our doctor determines the days of the ultrasound and manages the treatment by evaluating all ultrasound results. After the eggs mature, our patients come to Cyprus, and all procedures, including egg collection, are done by our doctor in our centre in Cyprus. This enables the time that patients need to stay in Cyprus to be between 7 and 9 days, depending on the day of embryo transfer. Although the male patient’s sperm sample will not be used, the presence of the male partner, if there is one, increases the motivation of the female patient, reduces the stress and increases the success of the pregnancy. In addition, spousal approval is also legally necessary for legal partners. For this reason, we recommend that male partners are present with our female patients.

According to the laws in Cyprus, individual sperm donation is not taken in our centre; only imported certified sperm is used. This ensures complete safety for patients. There is a wide range of sperm banks in several countries around the world, but not all have the same security level. The leading indicators that should be considered regarding security are that the bank provides complete information security, the sperm samples come to our centre with the liquid nitrogen tank in complete safety, and all written data is kept for at least 50 years. For sperm donations, we work with Cryos, the largest sperm bank in Denmark.

After a detailed general screening, donors accepted to the centre are genetically evaluated, infection and blood group scans are performed, and all common genetic diseases in our region are screened. After a detailed psychological test is taken from the donor and his family is analysed, the sperm sample is taken, saved and frozen under a particular coding system. After 6 months, the donor is called again, and the infection analyses are repeated. If the repetition of the results is again negative, the first sample can be used. Therefore, the certification of a sperm sample requires both considerable labour and detailed work.

All general features of the registered donor are recorded in the centre. Under the relevant law in Cyprus, information and pictures that may reveal the donor’s identity cannot be shared. However, all anonymous donor information can be shared with our patients. These features include height, weight, hair colour, eye colour, skin colour and tone, educational status, occupation, age, blood group, race and country of the donor.

The sperm donor receives no information about the family receiving the donation. As our law requires, the donor has no right to learn any information about the family.

Since sperm donation requires a donation, it is a very sensitive process. The sperm selection process is, therefore, a condition that must be handled with care. During the selection process of sperm in our centre, our patients are directly in contact with the prevailing embryologist, and they can make their choices among the available options. Since there are many sperm samples for each feature, we select the most appropriate sample for our couple by comparing the donors’ details.

All the data that the embryologist can share with the donor is anonymous. Physical characteristics, educational status and occupation, blood group, age and racial characteristics of the donor can be easily shared. The donor’s picture or identification information cannot be shared following the laws of Cyprus. The donor does not have the right to know any characteristics of the patient. In this way, the donor, the family and the child are protected.

Since the female patient’s eggs are used in the IVF treatment with sperm donation, the baby resembles the mother. Since the donor sperm is also used, and the sperm transfers DNA, the baby can also take the donor’s physical characteristics. Therefore, in the selection of sperm samples that have physical characteristics consistent with the male patient, the baby will genetically carry the donor’s genetics but will be similar to the father’s physical characteristics.

As with all IVF treatments, some measures in the treatment of IVF treatment with sperm donation increase the chances of pregnancy of patients. For this reason, we continue to support our patients during and after the treatment process.

The main factors affecting success are the quality and number of female embryos, the status of the female patient’s uterus, the stress factor in the couple, the correct use of medication, and the technical success of the doctor and the laboratory. Patients should remain calm after embryo transfer, as this is a factor that increases the success rate of pregnancy.

On the day of embryo transfer, it is recommended to pass the day calmly after 1-2 hours of rest, as it is known that lying down in the following days and spending time counting days reduces the chance of success by increasing stress levels in the patient. Therefore, we recommend that our patients be as active as pregnant women in the following days.

As with all other IVF treatments, we do not recommend the use of teas that are capable of contracting the uterus, such as clary sage tea and green tea. Additionally, since caffeine is also shown to be associated with miscarriages, we do not recommend coffee and cola consumption. Finally, avoiding food that causes gas and swelling of the abdomen will increase our patients’ comfort.

The B-Hcg test done in the blood 12 days after transfer determines whether there is a pregnancy or not. Before the recommended day, the test may show positive results, but the patient’s trigger injection will cause the test to be a false positive at an early stage, so doing the test early may cause false results. The patient should take the test on the recommended day and share the result with the consultant and the doctor. Our doctor will assess the outcome level according to the day and give information about the presence and status of pregnancy. If the test result of our patient is positive, pregnancy is determined, and it is recommended that the test be repeated two days later. After two days, the rate of the increase compared to the first test is evaluated, information about the course of pregnancy is obtained, and the day of ultrasound is determined. The patient whose test result is positive should continue on the same medication as recommended and should not stop any medication unannounced. Our doctor will advise about the regulation of medicines in due time.

As with all IVF treatments, the result of this test can also be negative. Repeating the test may sometimes be necessary in the case of a negative result. It is recommended for patients with definite negative results to discontinue their medication. Detailed investigation of the files of the patients who could not achieve pregnancy, the research on the current situation, and the preventative measures to be taken can increase the chance of pregnancy in a subsequent trial.

In Cyprus, IVF treatment with sperm donation is a legal process and is protected by law. If there is a male partner, registration is done in the file of our patients without seeking the condition of marriage and treatment with sperm donation is performed. In the absence of a male partner, the file is filled with only the information of the female patient, and the treatment can take place entirely as a legal process. In sperm donation, donated sperm must be certified as imported from abroad and must have been identified for genetic, infection, blood type and psychological screening. All the samples that we import to our centre enter the country and are used only after the control and written approval of the Ministry of Health.

IVF treatment with sperm donation is performed with complete patient confidentiality, and no identity information and treatment details of the patients are shared with third parties. This subject is treated with high sensitivity because there is the probability that the majority of our patients will not tell their families and perhaps their children in the future about the details of their treatment.

By law, we cannot share information on the price of sperm donations to IVF on our website. You can contact us for detailed information.