​August 2016

I write this blog for two reasons: First to better deal with the topic myself. Second, for other women interested in the process of vitrification, egg freezing or egg banking. This blog is meant to provide a picture of the issues involved and help women considering it to get a better picture. 

What are my reasons

I decided to try egg banking (my preferred term) to increase the probability of me being able to fall pregnant in my late 30ies/ early 40ies. 

Background

When I first considered the procedure, I was 30 years old. One of my best friends, let's call her Mathilda was the one who pushed me further about the topic. She suggested that she thought it was more goal orientated to do egg banking than later having to pray to a holy person to hope for better fertility and pregnancy. We should do it together. 

At that point in June 2013, I had just started working for an American law firm in London, working in average 70 hours a week. I was putting the topic off. The topic of fertility is for 30+ not a comfortable one, it confronts us with getting older.

When I then in autumn of 2014 saw my friend again, we had made little progress. She was just about to finish her doctoral thesis, when we considered to write to the different clinics. I was depressed about my slave job, which I quit shortly after. After quitting I had different issues to worry about, so our egg banking project had to be put off. Privately, a pregnancy was also not on the table. So it took until 2015 when Mathilda again brought up the topic. She surprised me with an email in March 2016, in which she had put together several centres that appeared to offer the procedure. I then completed the table. Moreover, my gynecologist in Berlin had provided me with other centres in Berlin that might offer the procedure. 

So, when we finally worked on realising our plans, it was May 2016 and I was nearly 33 years old. Mathilda did not want to disclose her name to the clinics, so I sent all inquiry emails from an anonymous hush account. Most of the institutes we considered were in Spain, Germany, Denmark and Czech Republic. All institutes answered our questioned within a few days. Some asked us to do a telephone consultation. More often than not, the institutes patiently answered our questions in email form. 

Our selection criteria

The following were our questions/ selection criteria:

• How long can you legally store the vitrified ova?

• Up to which age can the vitrified ova be implanted?

• Is it possible to also buy sperms, if needed?

• Is IVF possible for unmarried women?

• What are the costs of the procedure inclusive of storage costs for the vitrified ova?

• What are the costs for the medication needed?

• How long does the clinic wait until implanting? Can embryos be checked for genetic defects before implanting? Can embryos be vitrified?

• What is the reputation of the clinic. What do other women say about it?

Denmark and Czech Republic

Although Denmark has some of the biggest sperm banks in Europe and offers extensive pre diagnostics, vitrified ova can only be stored for 5 years. The same rule also applies for Czech Republic. Although it was of course possible to get the vitrified ova transported elsewhere after 5 years to find a different home, there was no point to accept that as a starting position. 

Germany

At the time, Mathilda was not in a relationship. It was therefore important for us to be able to also buy sperm cells, if she wasn't successful in finding a suitable partner.  In Germany, though it is possible to buy sperm, some legal interpretations meant that there may be a need to find a man to accept legal paternity for the child. Even if I later planned to do an IVF in Germany, it was then still possible to transport the ova to Germany for this purpose. The advantage of Germany would however have been that the ova can be kept for an unspecified period. This is however also possible in Spain.  

Spain

Spain has a very attractive legal framework for fertility treatments including egg banking. It is possible for a woman to buy sperm, even if unmarried or gay. No man has to officially recognise the paternity.  Spain has one of the biggest sperm banks in Europe. The disadvantage is that it is the clinic that decides on the sperm donor. The implanting of the ova after IVF is, depending on the clinic, possible until 48 or 51. Extensive genetic testing of the fertilized ova is possible and the embryo can be assessed for vitality and genetic defects for longer than is possible in the other reviewed states. Spain is a world leader in fertility treatments. I also note here too that egg donations are legal in Spain, as opposed to Germany or Switzerland for example. The clinics are open on Saturdays and for the punctuation (egg retrieval) also on Sunday. 

Change in Law

Of course, it is possible if not likely that the laws in Europe develop within the coming years and that the hostile framworks in some states will be changed. However, given that we had to make the decision now, we chose the country with the best legal framework. 

Our decision

We decided to go with the IVI (El Instituto Valenciano de Infertilidad), that is associated with the university of Valencia. IVI has in Spain and Italy several centres. The clinic answered our email within 24 hours. The International Department is reachable well, even at the weekends. The clinic has done the procedure more than 500 times; it is one of the leading centres in Europe. It has its own sperm bank and offers genetic testing in-house. The clinics in Madrid, Valencia, Barcelona und Alicante have English and German speaking doctors. There are other institutes in Spain that are cheaper. We however thought it would be more important to do the procedure with a well experienced clinic.

Costs

If I had done all mandatory tests and procedures at the IVI and the medication bought at one of the recommended pharmacies in Spain, the total costs in August 2016 would have been ca. EUR 4400. 

• First consultation

The first consultation cost EUR 145.

• Blood tests

In addition, there are costs for blood tests. Tests which should be brought to the first appointment are as follows:

Not older than 12 months:

1. HIV

2. HBV (HBs Ag et HBcAb)

3. HCV

4. Syphilis (RPR/ TPHA/ VDRL/ Lues) (not generally mandatory, depending on age)

Not older than 6 months:

1. coagulation test

2. ​Complete hemogram

3. Biochemistry 

Not older than 12 months:

1. Rubella-AK (HAH)

2. Blood type

3. Toxoplasmosis (not generally mandatory, depending on age)

If the patient cannot do the tests prior to the first consultation, IVI can also do them. In June 2016 the test costs were as follows: 

• The costs of the procedure

The vitrification cost EUR 2630. The price is inclusive of (i) unlimited hormone blood tests during the treatment, (ii) unlimited ultrasound scans during stimulation, (iii) the punctuation, (iv) the vitrification of the ova, (v) the storage for 5 years following the procedure (thereafter it is subject to a fee).

• Medication cost

In addition to the above costs, the medication needs to be bought. The costs for that vary depending on the protocol used, as well as the pharmacy. They vary heavily within the EU.

For me they used an antagonist protocol with the following medication bought in the pharmacy recommended by the IVI in Madrid (we did not shop around):

After the procedure, which I describe in a separate post, I had 2 Bemfola and two Menopur-flasks as well as Orgalutran syringe and 3 Decapetyl left over. For Menopur I had to buy the syringes separately, which cost me an additional EUR 20 in Germany. I note here that I experimented with the syringes a little before being able to use them properly, so the costs would have been a bit lower had I been more cost conscious. 

​​Why egg banking?

What are the costs?