The CEFER Reproduction Institute: The solution to human infertility

The CEFER Reproduction Institute is a private, interdisciplinary medicalcenter devoted to studying and treating reproduction and sexuality problems. The Institute was set up in 1977, when it established the first human SemenBank in Spain. Since 1982, the Institute has been a pioneering center in theuse of in vitro fertilization techniques.

In 1999, the CEFER Institute published the first paper in the world on a simple method for retrieving sperm from paraplegic men who do not ejaculate.

The director of the CEFER Reproduction Institute is Dr. Simón Marina, who has been working in the field of male reproduction since 1970. He was the  founder and president of the Spanish Andrology Association and was a member of the Executive Committee of the International Society of Andrology.

The importance of the relationship with patients
Infertility has a significant human side. Our aim is to develop a friendly relationship with patients and provide couples with all the information they need to be able to make informed decisions. Couples should feel comfortable with the medical staff that treats them so the nature of their infertility problem can be ascertained as fully as possible and the best way to help them can be found.

The multidisciplinary study of infertility
A number of medical specialists in different fields but with a mutual aim are involved in the diagnosis and treatment of infertility. It is very important for the people in these disciplines to work closely together when making an evaluation and providing treatment for a couple's infertility problems. The team at the CEFER Reproduction Institute consists of 25 specialists, including andrologists, gynecologists, biologists, urologists, sexologists and auxiliary staff who take care to balance the human and scientific sides of each of their functions as effectively as possible. This organizational structure allows the Institute to satisfy all patients' diagnostic and therapeutic requirements under one roof.

EGG DONATION

The Foundation for Egg Donation was set up in Barcelona in 1993 as an ethical, operative and effective answer to the fertility problems faced by many women who want to be mothers. The Foundation complies with all the regulations established in Spanish Law 35/88.

The Foundation for Egg Donation was the first foundation of its type in Spain and is the only one that has been created on the world-wide level.

The aim of the non-profit Foundation for Egg Donation is to help infertile couples have children by providing the infertile woman with eggs from an anonymous donor.

· How is the procedure organized?

An initial examination of the woman who will receive the eggs can be carried out at the center that recommended egg donation, as can eventual monitoring of the pregnancy. The endometrium, or mucous membrane lining of the uterus, can also be prepared for the transfer of embryos at the woman's own gynecologist. We will then provide an initial, informative consultation for patients. If the couple lives outside the province of Barcelona, a semen sample can be brought to the Foundation for freezing on the day of the consultation. Once we have a frozen semen sample, only the woman has to come to Barcelona for the embryo transfer.

· How long does it take to find a donor?

It usually takes from two to three months to find a donor. It may, however, take longer if the waiting period coincides with university vacations.

· How are donors selected?

Egg donors are selected from among adult university students. The donor must fully understand the donation process and have enough free time to devote to the process. The selection process includes checking the potential donor’s medical history and performing a gynecological examination, a blood test and ultrasound scans. A bacteriologic study of the vagina and cervix is done and the donor's blood is tested for HIV, syphilis, hepatitis B and C, thalassemia and hemophilia. A karyotype analysis is also performed. If the results are normal, the donor is accepted. Currently, around 40% of applicants are approved as donors. Women interested in donating eggs are told the results of their gynecological tests and those who are not accepted are told why. All donors are assured that their eggs will only be used to help other women overcome their fertility problems. Donation is anonymous and neither the donor nor the woman receiving the eggs are informed of the other's identity. Donation is voluntary and free and the donor's consent must be given in writing. However, donors may be compensated for the costs they incur (such as traveling expenses, time spent making the donation, etc.). The donor has no rights or obligations with regard to the pregnancy of the woman or any children born as a result of the donation. Donating eggs is legal in Spain when performed at an authorized medical center and if it complies with the applicable legal requirements.

· How are eggs donated?

Once accepted, the donor begins hormone treatment (involving daily injections) that is controlled by a gynecologist. The treatment is designed to stimulate the maturing of eggs in the ovaries. Treatment begins at the onset of the ovulatory cycle, that is, on the first day of menstruation, and is monitored through the use of ultrasound scans and blood tests so the gynecologist can confirm that the ovaries are responding well to the treatment. Once this has been confirmed, the date for retrieving the eggs is set. The extraction of the eggs involves puncturing the follicles that have grown in the ovaries. This is a straightforward process that does not involve stitches or checking into the hospital. It takes about 30 minutes and is performed with a mild anesthetic or under sedation.

· What happens to the eggs?

On the day the eggs are extracted, the semen sample from the male partner of the woman who will receive the eggs is retrieved and the sperm is added to the eggs. If the semen has been previously frozen, there is no need for the man to provide the sample on the same day. Sixteen to 20 hours after the sperm has been added to the eggs, the result is checked under a microscope to see whether fertilization has occurred. The gynecologist will have meanwhile prepared the recipient’s uterus (endometrium) by means of the appropriate treatment to facilitate implantation of the developing embryo in the uterine wall. The embryos are then transferred in the woman's uterus or, if the uterus is not ready, frozen for later use. Donated eggs are used exclusively to help infertile couples have children.

GIVING EGGS IS GIVING LIFE

The Foundation for Egg Donation is the first and only foundation whose main aim is to provide women with the eggs they need to have children.

For this reason, information about the Foundation for Egg Donation must be made available to the young and healthy women who may be donors. Women who are interested in donating their eggs are informed of all the requirements they must meet, including how the egg-donation process is carried out, the possible risks involved and the positive aspects involved in donating eggs. They are also informed of the legal aspects relating to egg donation. The Foundation also works towards increasing social awareness of the fact that egg donation is sometimes the only solution available to women who want to be mothers.

What are eggs?

An egg is a female germinal cell that contains 23 chromosomes and which, when fertilized by sperm (that contains another 23 chromosomes) forms an embryo. The human embryo develops for nine months before being born as a child. When a girl reaches puberty, she has some 400,000 eggs in her ovaries. Around 400 of these eggs are likely to mature during the course of her reproductive life. When a woman donates eggs, six to twelve eggs are extracted from her ovaries. Figure 1 shows a mature human egg seen under a microscope with a magnification of 400.

Who can donate eggs?

Any healthy woman aged 18 to 35 can donate eggs as long as she meets the following requirements:
- she cannot be a virgin, as vaginal ultrasound scans will be performed.
- she cannot be adopted, as she must be able to provide information aboutthe health of her biological parents.
- she should live in or near Barcelona, as donating eggs requires repeatedtrips to the CEFER Reproduction Institute.

Donor selection

Donors must agree to undergo medical and gynecological examinations, ultrasound scans and blood tests.

The donation procedure

Risks involved

The risks involved to the donor are minimal and generally acceptable. They may include the following:

- Ovarian hyperstimulation. These risks can be minimized by performing ultrasound scans, hormone treatment and analyzing the ovarian response. Hyperstimulation usually occurs when a woman becomes pregnant and, as the donor is not going to receive the embryos, it is unlikely for her to be affected by hyperstimulation.

- Reduced fertility. The number of eggs extracted during a donation procedure is minimal (6 to 12) compared to the number still left in the ovaries.

- Use of anesthesia. This is controlled by a qualified anesthetist. Sedation lasts around 20 to 30 minutes and there is no need to intubate (i.e., insert tubes in the trachea to allow the patient to breathe).

Is donating eggs painful?
It is not painful and discomfort is minimal. The hormone injections are subcutaneous and very fine needles are used. The ovarian follicle puncture is performed under anesthesia.

Positive aspects
Donating eggs can be a very positive experience because:
- it is a generous gesture to help a woman you don't know become a mother.
- it involves a medical examination, which is always useful for the donor.

Financial compensation
The Foundation for Egg Donation gives every woman who donates eggs 150,000 pesetas to cover the costs involved in trips to the center and the time spent making the donation.

What is the legal position regarding egg donation?
Donating eggs is legal in Spain if the donor is between 18 and 35 and gives her informed written consent. Donors should understand that donation is anonymous and they will have no rights or obligations with regard to any children that are born from the donation of their eggs.