Embryo Adoption: What Stays Behind This Growing Trend?

When the IVF cycle is started, one of its aims is to generate more than two good–quality embryos in the lab so that the best ones with good morphology and high implantation potency can be selected and transferred. Whilst the legislation on assisted reproduction in many countries permits the transfer of 3 embryos per cycle, new sophisticated algorithms, techniques, and technologies make it possible to choose the most intelligent embryo with the highest implantation potential for an “elective single embryo transfer” (eSET), maximizing the chance of success and minimizing the chances of multiple pregnancy. This is why there are usually ‘excess’ embryos with a good morphology at the end of a cycle. What happens to them? The available options include the following:

• Vitrifying and storing them for future use in a new cycle or the current one if it results in embryo implantation failure or miscarriage;
• Donating them to another person or couple; 
• Donating them to research; 
• Disposing of them.

Most couples select vitrification of the remaining embryos for future cryotransfer cycles or/and donation of some embryos to other singles and couples wishing to adopt them. Some couples who earlier thought about discarding the remaining embryos rethink and decide to give their embryos the chance of being a new addition to someone’s family.

Embryo Donation, also called “embryo adoption,” is a simple, sophisticated, low–cost alternative to the standard IVF cycle with excellent results in which an embryo is adopted and transferred to the future mother’s uterus.

Embryo adoption advantages

Embryo donation has many advantages that make it unlike any cycle — no waiting lists; shorter timeline; elimination of controlled ovarian stimulation, trigger shot, egg retrieval, and fertilization; less medication and needles; adoption of the Blastocyst (a Day 5 or Day 6 embryo with higher potency to implant); and lower costs. It doesn’t involve Egg and Sperm Donor IVF cycle to create the embryos; thus, it is less expensive compared to the cycle with Duo Donation (egg and sperm donation) and other assisted reproduction options.

When to opt for embryo donation? 

Many singles and couples adopt an embryo because they want a less expensive, less invasive, and less medicated cycle. The others opt for embryo donation because it is just impossible to retrieve healthy and viable eggs or sperm; no oocytes left in their ovarian reserve, or they are diagnosed with genetic causes of spermatogenic failure. Having a high risk of passing on a genetic or chromosomal abnormality/disease may be the other reason for choosing the donor embryo. Fertilization failures, recurrent implantation failures (RIF), or recurrent pregnancy loss (RPL) can also make singles and couples think about adopting a healthy embryo instead of having one more heartbreaking experience. Singles and couples who have mosaic embryos may consider donated Euploid Blastocyst as an option to expand their family too. Whatever your reason is — adopting a healthy embryo can make your family complete while eliminating many steps and risks.

Embryo adoption cases:

• In cases when less complex, less invasive, less medicated, and less expensive treatment is desired. 
• In cases when parents want to bypass sperm or egg donor IVF.
• In cases of poor response to ovarian stimulation, having a low ovarian reserve, or having no oocytes left.
• In cases of poor quality of the oocytes, premature ovarian failure (POF), or early menopause. 
• In cases of recurrent implantation failures (RIF), recurrent pregnancy loss (RPL), and when other treatments have failed.
• In cases of a high risk of passing on a genetic/chromosomal abnormality/disease.

The benefits of embryo donation

Both parties — the couple who donates their embryo to a person/couple who is unable to conceive and the person or couple who adopts the donated embryo benefit from the process. The couple who makes the donation — gives their embryo a chance to be born, and have a loving parent(s), instead of thawing and disposing of them. And the couple who adopts — receives the most desirable gift ever. Together with receiving the Miracle, the person/couple gets three extra benefits only this cycle has.

No waiting lists & noninvasive treatment protocol

First of all, there is no waiting list for starting a cycle. The embryos are cryopreserved and ready to be adopted. The cycle involves fertility assessment and endometrial preparation. As soon as the maternal endometrium is prepared for implantation, the embryo is thawed and transferred, all on the same day. The fertility specialists always try to match embryos that are most compatible with the blood type, Rhesus (Rh) Factor, and physical characteristics.

Although there is no needle–free endometrial preparation (per–cycle tests and monitoring sessions involve blood work), expect fewer needles than in any other cycle. Unlike standard IVF, where you have to administrate medication, experience one or two egg retrievals depending on stimulation protocol, have one or two Trigger Shots to complete the oocyte maturation, wait for positive news after fertilization, counting down hours until hearing that you have at least one healthy embryo for transfer, — embryo adoption works in a following way: in most cases, the embryos waiting for adoption have been screened for genetic and infectious diseases before freezing, reached the Blastocyst stage (Day 5 or Day 6), are powerful enough to survive thawing and ready for transfer.

High success rates

Introduction of vitrification technique, run on specific protocols designed for delaying transfers and/or preserving embryos for future frozen embryo transfers (FET), increased percentage of embryo survival rates up to 100%, and pregnancy & gestation rates when a single blastocyst is transferred (SBT) up to 60%. 

Shorter timeline 

As embryo adoption doesn’t require compatible egg donor selection, using the donor’s sperm, starting controlled ovarian stimulation, doing an oocyte retrieval, selecting the mature oocytes, and fertilizing them with sperm, — the work performed by the IVF lab is limited to thawing, Time–lapse imaging of thawed embryos, culturing for 2–4 hours before transfer (short culture) or thawing in the day before embryo transfer and culturing for 20–22 hours before embryo transfer (long culture), evaluating the blastocyst quality at the time of transfer, and transfer of the healthy embryo, — the cost for the single mom or couple, is also much lower than any basic IVF program.

Is it safe to use a donated embryo? 

Before any treatment cycle, the couples undergo comprehensive screening. And when this couple donates their embryo after IVF treatment, it can be safely adopted as most of the tests have been done. The only screening that might be left is preimplantation genetic testing, as some couples complete their cycles, eliminating PGT. But it is possible to do it after the embryo is thawed.

When the embryos come from egg and sperm donation, before gamete donation takes place, the donors are screened for many conditions, including screening for infectious diseases and genetic testing that allows detecting and avoiding transmission of over 3000 genetic disorders. And because the clinics are required to follow regulations for screening and testing, the risks of infectious diseases or transmissible genetic disorders are minimal.

Standardly, before gamete donation, egg and sperm donors undergo multistage screening that includes the following: 

• A personal interview with a fertility specialist, including disclosure of medical history and filling out a comprehensive questionnaire about health history, fertility history, diseases, family history of mental health and neurological disorders, endocrine disorders, blood disorders, oncology, and many other conditions and diseases). 
• Carry out a psychological assessment.
• Undergo karyotyping, cystic fibrosis testing, thalassemia screening, fragile X, muscular spinal atrophy, a Genetic Compatibility Test (GCT) to identify mutations in the genes that cause recessive and X–linked disorders, and non-syndromic hearing loss (GJB2) screening. 
• Sexually transmitted diseases (STDs) and serology.
• Screening for genetic and infectious diseases.

And only after inclusive screening and testing the egg or sperm donor can donate the gametes.

Embryo adoption step-by-step

Adopting an embryo is having a multistep but shorter treatment protocol. The adoption cycle consists of seven steps: first appointment, fertility assessment, preparation of the endometrium for embryo transfer, endometrial receptivity test, embryo thawing, and transfer. In addition, some cycles may include mock embryo transfer or preimplantation genetic testing. The other cycles may involve up to 48 hours of embryo development in the lab after devitrification.

Step 1: First appointment

Each case is unique; therefore, each treatment is tailored to resolve the issue in the best possible way. The first session with a fertility specialist routinely includes a medical history review, conversing on options, basic fertility tests, booking the time for follow–up fertility tests, and discussing the desired characteristics of the embryo that would be adopted (genetic makeup, physical characteristics). Sometimes, it is even possible to view the images of the embryo that will be adopted (if they were taken during cultivation). 

Step 2: Pre–cycle fertility assessment & follow–up session

Before starting any treatment cycle, the first step is undergoing an infertility workup. This screening consists of a series of tests that have to be completed before the cycle, enabling the fertility consultant to adapt the endometrial preparation to the specific case. 

Step 3: Preparing the endometrium for embryo transfer

Successful implantation requires synchrony between a healthy embryo and a receptive endometrium. It takes up to 30 days to prepare the endometrium for embryo transfer. This step consists of taking Estrogen orally or using transdermal estrogen patches or capsules and attending appointments to monitor the endometrium response to medication.

Step 4: Endometrial receptivity test 

The endometrial receptivity test may be scheduled to identify the ideal moment for performing an embryo transfer. It shows if maternal endometrium is receptive enough to accept an embryo. A small sample of the endometrial lining is taken to determine a unique personalized embryo transfer timing and synchronize the embryo transfer timeline with the implantation window.

Step 5: Embryo thawing

The thawing technique depends on the freezing protocol that had been used. Until now, the IVF labs have performed two cryopreservation techniques: slow freezing and vitrification. Cryopreservation using slow–the freezing technique takes up to 2 hours and involves two–staged cooling. In the first stage, the embryologists place embryos in a Slow Cooling Device, and the embryos are cooled there very slowly — at a decrease of 3º–2º Celsius per minute until the cooling temperature reaches the final temperature — 196º Celsius (or about –321º Fahrenheit). Slow freezing may involve the formation of ice crystals in the embryos as low concentrations of cryoprotectants are used, and the temperature is gradually decreased. That is why, during thawing, the physiological temperature (37º Celsius) is gradually and slowly reached once again, and this is followed by the replacement of the cryoprotectants with water.

In contrast, vitrification is an ultra–rapid freezing technique that cools embryos so quickly to –196º Celsius that they become like glass or vitrified, avoiding the formation of the ice crystals in the embryos by increasing the concentration of cryoprotectants and blazing–fast cooling speed. Whilst the slow–freezing technique takes hours, vitrification is completed in minutes. Therefore, a quick heating process takes place during devitrification (from –196ºC to 37ºC), followed by the replacement of cryoprotectants with water, which is vital.

For cases when Day 3 embryo is vitrified, but it is suggested to transfer a Blastocyst (Day 5 embryo), the IVF lab work also includes devitrification and 2–day monitoring of the embryos left to continue developing before transfer. In other cases, when Day 3 embryo is vitrified, and the person or couple wishes to have a Day 3 embryo transfer, thawing takes place the same day as the transfer procedure. The same thing is for vitrified Blastocyst — it is thawed the same day before embryo transfer.

Step 6: Embryo transfer

Embryo transfer is a painless ultrasound–guided procedure that consists of placing the embryo (Elective Single Embryo Transfer (eSET) or Double Embryo Transfer) in the mother’s uterus. It lasts between 15 and 30 minutes, and fertility specialists suggest taking rest for 30 minutes after transfer. 

The embryo will implant within hours after hatching out (hatching involves embryo stretching and rupturing the zona pellucida). The Blastocyst moves deeper into the uterine lining, and if this contact between embryo and endometrium is successful, the gestation begins.

Step 7: Pregnancy test & ultrasound scan

A blood pregnancy test (Beta hCG test) is done two weeks after embryo transfer to lower the risk of getting a false positive or false negative result. The test checks the levels of the pregnancy hormone (beta–hCG) in the blood. A positive beta–human chorionic gonadotropin (hCG) level usually means that you are pregnant. This hormone is produced by the embryo and passed to the mother via the placenta. This is the first sign of embryo implantation. After the positive pregnancy test (two weeks later, between the sixth and seventh week of pregnancy), an ultrasound scan will be performed to see clearly if the pregnancy is progressing or not.

Cost of embryo donation: frozen vs. fresh

The cost of embryo donation varies across countries but generally ranges from $1,600 to $10,000 for frozen embryo adoption and from $10,000 to $20,000 for adopting a fresh embryo created through Double Donation (egg and sperm donation) cycle. This cost may or may not cover the cost of the medication needed for cycle preparation. Cycles with elective single embryo transfer are less expensive compared to double embryo transfer. But if adopting two embryos in one cycle, it is possible to save up to 40% on medication, thawing, and transfer as instead of two endometrial preparation cycles, there will be one.

In cases that involve the shipment of the embryo, the cost is higher as it also covers CryoShipper (the delivery container designed for the safe transportation of biological samples at cryogenic temperatures (–150ºC or colder) and delivery expenses. What’s more, fertility clinics may charge registration, shipping, storage, and other fees. Although health insurance may cover the cost of IUI or IVF treatment, it’s best to consult with your insurance company to determine what is covered. In the case of embryo donation, the insurance might cover less than desired (some tests or medication, consultations, and monitoring sessions).

Wrapping Things Up

Creating little miracles can be easier than you may imagine. Even if it is impossible to use your oocytes and there is no partner on the show, or it is impossible to retrieve your partner’s sperm, and your ovaries don’t produce and release eggs, there is still a chance to have a baby paying less. Embryo adoption is a sophisticated option of having a baby using the embryos donated by the other couple or embryos created with DuoDonation (egg and sperm donation). Unlike conventional IVF cycles, embryo donation has a shorter timeline, less invasive procedures, and is less expensive. Run on specific protocols, embryo adoption resolves many cases, including the complex ones: single women desiring to have a baby but having no oocytes left in their ovarian reserve, couples with severe male and female infertility factors, singles having a limited budget for treatment, and many other cases. Singles and couples wishing to eliminate egg and sperm donation may also try embryo donation. And those who would like their embryo to have specific characteristics may choose an Egg and Sperm donor instead of adopting a frozen embryo. But whatever option you choose, you will gift to that frozen or fresh “waiting to be adopted” Miracle the Life.