Egg or sperm donation

Couples who are planning a family want a child using their own eggs and sperm. Sometimes, however, couples with infertility have to compromise, realising that otherwise they may not be able to fulfil their desire for a family. When couples need to consider using either eggs or sperm from someone else, it can cause an even greater sense of loss and feelings of inadequacy or failure.
If a man is donating sperm, the procedure is called donor insemination, or DI. If a woman is donating eggs, the procedure is called egg or oocyte donation. These are not treatments in the true sense of the word, but rather a means of bypassing a severe fertility problem. 

WHAT ARE THE IMPLICATIONS OF TREATMENT?

For the donors

Egg or sperm donors have to go through rigorous medical screening, a detailed review of their family history, and physical and psycho­logical testing to ensure their suitability. Both egg and sperm donation are undertaken anony­mously, although, occasionally, a female friend or relative may act as an egg donor for an infertile couple. For both egg and sperm donors, screening is recommended for a number of diseases (for example, cystic fibrosis).
After April 2005, as a result of new legislation, children who are born as a result of donation of sperm or eggs (or even embryos) will be able to discover the identity of their donor when they reach the age of 18. However, the first 18 year olds to do this will not be able to do it until 2023.
For men who are potential sperm donors, semen and blood specimens are collected and examined for the presence of several infectious diseases, including HIV and hepatitis B and C.

Once the suitability of the donor has been decided, the collection and storage of sperm may proceed. Semen samples are produced by masturbation and then freeze– stored in a liquid nitrogen ‘sperm bank’. As there can be a three-month interval between acquiring an infection with HIV and the development of antibodies (which can be detected by a blood test), testing at the time of donation is not an absolute guarantee of a donor being HIV negative. For this reason, a donor is re-tested for HIV after six months, and his semen can be used for treatment only after this second HIV test is negative. The freeze–stored sperm from each individual donor can be used to father no more than ten live births. The donor’s physical characteristics and blood group are matched with those of the man in the couple who are being treated.
For women who are potential egg donors, similar blood tests are undertaken, particularly to exclude HIV. Once the donor is considered suitable, the preparation for egg donation can proceed. For the donor, this involves taking the usual drugs required before IVF and an egg collection operation. These procedures do have small risks, and most fertility centres are reluctant to take on women whose own families are not complete. Egg donors must also be under 35 years of age, as eggs from older women carry an increased risk of abnormal chromosomal division leading to Down’s syndrome. After her eggs have been collected, the donor’s involvement is over and she does not require any additional drugs.

Eggs from a donor are used fresh because, unlike sperm, they do not survive freeze–storage very well. However, after they have been fertilised (usually with sperm from the husband of the recipient couple), they can be frozen and stored more successfully, to allow the necessary quarantine period for the egg donor to have repeat HIV testing. In practice, most clinics will transfer fresh embryos to the recipient woman’s uterus, as these generally have a better chance of implanting than frozen embryos. The recipient woman then has to accept that this may involve a very small chance of her acquiring HIV infection. To date, there is no record of this happening in such a way.

Egg sharing

This is a modification of egg donation, where the donor is the female partner of a couple who are having IVF treatment themselves. In exchange for donating some of the eggs collected from the woman, the couple receive subsidised IVF treatment themselves. The subsidy for this treatment is paid by the recipient couple. Unlike standard egg donation, the egg-share donor is not going through the risks of hormone stimulation and egg collection without any benefit to herself. The egg-share donor is getting the benefit of IVF treatment that she and her partner might not otherwise be able to afford. For the recipient couple, they are getting donated eggs that might not otherwise be available. As the supply of standard egg donors falls far short of the demand for donated eggs, egg sharing offers a way of meeting this higher demand.
Egg-share donors have to undergo all the same preliminary tests as standard egg donors. With the removal of anonymity for egg donors from April 2005, there is speculation that the number of women who are prepared to act as standard egg donors will fall. This is likely to mean that egg-share donors will become an increasingly important source of donated eggs. Egg sharing is available only through a relatively small number of clinics at the present time. Details of these centres can be obtained from the Human Fertilisation and Embry­ology Authority (HFEA).

For the infertile couple

For DI treatment, a sample of sperm is inseminated (introduced) at midcycle into the woman’s cervical mucus or her uterine cavity. The timing of the procedure is obviously important and may be based on dates if her cycles are regular, or on urine hormone tests to predict ovulation if not. If donated eggs are used, the lining of the woman’s uterus is prepared artificially using oestrogen and progesterone, for the transfer of embryos.

After the transfer, the drugs need to be maintained well into the pregnancy, until the placenta can function on its own (because in most cases, the primary reason for egg donation is ovarian failure, and in these women there is no ovarian production of hormones to support the early weeks of pregnancy).
With sperm donation, the likelihood of success varies from clinic to clinic and, within individual clinics, with time. With frozen sperm, the success rate is around seven to ten per cent per cycle of intracervical insemination treatment. In general, most clinics will suggest up to six cycles of treatment before further investigations of infertility, or other treatment options, are considered. Egg donation relies on the application of IVF techniques. In general, the supply of egg donors is not sufficient to meet the needs of the number of potential recipients. The chance of pregnancy is about 20 to 25 per cent per cycle.
The issues for any couple who wish to undergo donor treatment are complex. The use of an egg or sperm from someone else will mean the child is not genetically their own, and this can be distressing. As well as a full consultation with their specialist, couples who are considering egg or sperm donation are offered independent counselling which is also a legal requirement. If a couple feel that sperm or egg donation is too intrusive, they may consider other treatment options, such as adoption, and should be given adequate support. The issues of whom to tell and what to tell others are important, but there are no hard and fast rules. Long-term research has found that a relaxed and open approach is probably best – you may consider telling some of the following: your parents, other family members, close friends and your GP.
With regard to the legal situation, any child born within a marriage is considered a child of the marriage and the male partner is the legal father. In unmarried couples, the same is true if the male partner gives written agreement to the treatment. As this is a difficult issue, some clinics prefer to treat only married couples.

For any child born as a result of treatment

Children born as a result of DI or egg donation are accorded the full rights of any child of the family in law – including inheritance. The only exclusion to this is the inheritance of hereditary titles. For all children, their natural inquisitiveness will lead to questions:
• Who am I?

• Where did I come from?

A gradual and sensitive approach in answering these questions is necessary, particularly if they are the result of using donor eggs or sperm. You wouldn’t tell a child about the rigours of labour and childbirth when they first ask these questions. Similarly, the amount of information regarding their genetic origins should fit the ability of the child’s understanding. Questions shouldn’t be avoided – but answers needn’t be completely explicit.
Most researchers in the area would, however, suggest the child should be told – emphasising initially the specialness of the way in which they were conceived, how much their parents wanted them and what they were prepared to do to have them. How much is disclosed depends on individuals. In later life, the child may wish to know more about the donor. The HFEA maintain a confidential register of all egg and sperm donors and their offspring. Very occasionally, two people may wish to marry who are both the result of gamete donation – they can find out through the HFEA whether they share the same genetic mother or father, although not the identity of the individual.

Gamete donation and anonymity

In this country, until recently, the majority of egg or sperm donation was anonymous. The recipient did not know whom the donor was. There was no provision for information about donors being made available to children born after treatment with donated sperm or eggs. This has now all changed and, as stated earlier, Parliament has introduced new legislation. As from April 2005, children who are the result of egg, sperm or embryo donation can find out identifying information about their donor(s) provided that they have been told that they are the result of such a donation. Donation before that date remains anonymous, and only non-identifying information can be passed to the child at the age of 18. The website of the HFEA gives more details.