Oocyte Donation in Artificial reproductive technology: Emphasis On The Nigerian Situation - Dr Abayomi Ajayi www.abayomiajayi.com.ng

1. OOCYTE DONATION IN
ART:
EMPHASIS ON THE
NIGERIAN SITUATION.
DR ABAYOMI AJAYI
NORDICA FERTILITY
CENTRE, LAGOS.

2. DISCLOSURES
None

3. SYNOPSIS
Introduction
Definitions
The process
Indications
Types
Risks
Sourcing for donors
Issues with oocyte donation
Recommendations
Conclusion

4. INTRODUCTION
The burden of infertility particular in Africa is worrisome with a reported
prevalence of up to 30% (2017)
Many factors have been incriminated
Sometimes this is due to egg factor

5. INTRODUCTION
One option in cases where the
woman’s egg is deemed the
problem is the use of donor eggs
With relatively good success rates up
to 50%
Affords women who otherwise
would not be able to conceive due
to egg factor to do so

6. INTRODUCTION
The first child born from egg
donation was reported in Australia in
1983
CDC in the USA reports 47,000
donor oocyte births
Oocyte and embryo donation
account for up to 18% of all IVF
births in the USA

7. INTRODUCTION

8. INTRODUCTION
Adriana Iliescu oldest mother in
2004 at 66 years (surpassed in Dec
2006 by María del Carmen
Bousada de Lara she was 66 years
and 358 days and world’s oldest
verified mother)
Died of cancer in 2009 when her
twin boys were 2 and half years old
Setting up a debate on limits of age
for assisted conception using donor
oocyte

9. DEFINITIONS
OOCYTE DONOR
 A woman who undergoes COH and
donates her oocytes for another to use for
the purpose of assisted conception via IVF
RECIPIENT
 A woman who receives the eggs from the
donor and uses it to achieve conception via
IVF.

10. THE PROCESS

11. INDICATIONS
Advanced female age
 Late presentation is relatively
common in Nigeria (mean age
37yrs)
 Own eggs cannot generate
viable pregnancy
Premature Ovarian Failure
Born without/abnormal ovaries
 Turner’s syndrome
 Gonadal dysgenesis
Ovaries damaged/removed due
to disease or surgery
Trying to avoid passing genetic
disorders
Repeated IVF failures with own
eggs,
Medical conditions and their
treatment eg Cancer radiotherapy
and chemotherapy
Gay couple /Single male** (legal
and ethical issues)
 Not allowed in Nigeria

12. TYPES
Anonymous/Unknown
 Mostly preferred in Nigeria
Non-anonymous/Known donor
 Less utilized in Nigeria
Semi-Anonymous
Donor photographs, profile and some other details provided to recipients
Cross donation (France)
Egg sharing/Shared oocyte program

13. TYPES: MOTIVATION
Altruism (30% US Survey of 80 donors)
Financial (20%)
Both (40%)
45% were students at the time of first donation
In Nigeria it appears to be mainly financially driven
Countries introduced compensation caps eg EU not more
than $1500, US $5000 must be justified, $10000 not
appropriate.
Countries with no compensation have a dearth of oocyte
donors and oocyte donation may be much more
expensive eg US up to $26,000 excluding donor
medications

14. TYPES: LEGALITY
Legality varies from country to country
 Totally illegal: Italy, Germany, Austria
 Legal only if anonymous and gratuitous: France
 Non anonymous and gratuitous: Canada
 Anonymous but with compensation for inconvenience and expenses: Spain, Czech republic,
South Africa, Greece, Nigeria?*)
 Non anonymous may be compensated : UK

15. TYPES: LEGALITY
Consent forms must be signed
Legal document to renounce rights and responsibilities on donors part

16. RISKS
Low risks generally as in IVF
 OHSS
Varies from clinic to clinic 6.6-8.4%
Highly preventable by using GnRH agonist trigger with similar oocyte maturity and fertilization rates with HCG
trigger
Poorly recognized and poor knowledge of management by medical practitioners in Nigeria
Non disclosure of donation by donors to managing doctors
 Bleeding at egg retrieval
 Liver failure rarely
 Death 1 in 10,000 (Netherlands study), rarely reported

17. RISKS
 Long term effects not well studied
 Cancer risks no evidence
 Psychological effects 1 in 5 (positive or negative)
 ASRM limit of 6 cycles
 In Nigeria it is common for donors to move from clinic to clinic without disclosing this information
 Repeated oocyte donations does not accelerate ovarian aging, no decrease in AMH in such women

18. RISKS-RECIPIENT
HIV
 Recent infection in previously screened negative donor
 Screen again few days to OPU/ET or not later than 30 days before
Psychological factors
Multiple births
 Transfer 1 or 2 embryos only (ASRM)
Slightly increased risk of PIH

19. RISKS: FETUS
Increased risk of placental pathology due to decreased maternal immune
tolerance

20. RISKS: FETUS
Risk of Aneuploidy
 We analysed 97 blastocysts from donor oocytes(PGS using NGS)
 The average age (years)of the oocyte donors was 27.33 ± 2.67
 4 (4.1%) – No amplification
 93 were diagnosed
 Overall 71 (76.34%) were Euploid
 Overall 22 (23.66%) were chromosomally abnormal
 Euploid rate per donor cycle was 72.63 ± 13.08
 Aneuploidy rate per donor cycle was 30.50 ± 16.21

21. RISKS: CHILD
Telling the child
 Advised by pschyologists
 Improves relationship (open and honest)
with the child long term
 Avoid the child knowing from 3rd party of
law suit
 Parents who say no: to protect the child,
avoid social stigma

22. DONOR REGISTRY
For donor conceived people, sperm donors, egg donors to establish contact
To find genetic siblings

23. SOURCING DONORS
Donor agencies
 Not very common in Nigeria yet
 In places where they are readily available
they market the donors
 Leading factors attracting recipients to
donors include
 Proven pregnancy from previous oocyte donations
 Attractive donor (pictures put on website)
 Healthy, good family history
 Overweight donors not usually accepted for fear of
poor response
 Smart, well educated (CGPA and IQ may be
displayed)
 Hobbies, likes and dislikes too.

24. SOURCING DONORS: SCREENING
Age less than 35 years preferably less than 30 years
History/family history of genetic illnesses
Infections disease screening
 HIV, Hepatitis
Blood group, Rhesus factor, Genotype
Ovarian reserve testing
Physical and pelvic examination and scan
Psychological screening
 Not commonly done in Nigeria
Carrier Genetic Testing can help avoid recessive genetic disease in offsprings
 We found the gene for Cockayne syndrome in one of the donors screened

25. ISSUES: DONORS
 Multiple donations for pecuniary reasons impacting on response/safe number of total
donations/consanguinity
 However some have used this to complete studies, start a business etc
 Non disclosure of such donations and any prior untoward incidents
 Non compliance with the treatment plan/medications affecting outcome (some clinics house
them and inject them)
 Poor response: some clinics do not compensate fully if less than a certain number of eggs
are retrieved

26. ISSUES: RECIPIENT
 Inheritable diseases fears (CGT screened donors
 Desire to have genes transferred (3 parent baby/cytoplasm transfer?)
 Spousal acceptance
 Potential marital disharmony when the child is born (not your child/eggs), hating the child
 Delay in taking a decision/accepting donor oocytes
 Counseling is important
 Social stigma
 They want to meet the donor physically or see pictures. Not yet popular in Nigeria.

27. ISSUES/REQUESTS: RECIPIENT
 Do not let partner know that donor oocytes are to be used
 Mixing of own and donor eggs
 Not disclosing that conception was by donor eggs but by a miracle or use of folic acid only
(even in 60 year olds), so not helping others take that decision
 Age limit for recipients??

28. ISSUES: MEDICAL PRACTITIONERS
Exploitation of donors
 Multiple donations not minding risks
 Poor compensation
 Sharing of oocytes
Poor OHSS prevention and poor knowledge of its management
 Donors may not specify what they did (donation) to help dianosis and management

29. ISSUES: MEDIA
 Poor understanding of the process
 Misleading the public
 ‘Egg selling industry’…Newspaper article

30. ISSUES: SOCIETY AND RELIGION
 Poor understanding
 Some religions do not accept this
 Stigmatization of couples who conceived
with donor oocytes

31. RECOMMENDATIONS GOING
FORWARD
Egg banking, ready eggs 24/7 Success rates equally good
Donor profile display/accessible to recipients and their partners?? Are we ready for
this in Nigeria
Public enlightenment on oocyte donation to reduce/eliminate misunderstanding
Proper prevention and management of OHSS by educating donors and medical
practitioners
Genetic Screening of donors (CGT)
Ethical regulation/legal framework to prevent abuse
Donor workshops to educate donors on dos and don’ts for their safety as well as
their rights.

32. CONCLUSION
Oocyte donation is an important and beneficial aspect of assisted
reproduction.
However a proper legal framework as well as ethical guidelines for the
program is very necessary.
Enlightenment of donors, recipients, medical practitioners and the general
public about this process is important to improve its acceptance and success.

33. THANK YOU FOR LISTENING