Egg donation (recipient)

Who may benefit from treatment using donated eggs?

A couple may need to consider treatment using donated eggs because of the following reasons:

• Absence of functional ovarian tissues (caused by congenital absence, e.g. Turner’s syndrome, premature ovarian failure, previous surgical removal, or premature menopause secondary to chemotherapy or radiotherapy)
• Transmissible disease inherited through the woman
• Repeated poor response to IVF treatment, indicating reduced ovarian reserve
• Unexplained poor quality of own eggs
• Some types of medical treatment, such as radiotherapy and chemotherapy for cancer, can destroy the natural store of eggs

Anonymity of Egg Donors

Egg donors give details of their characteristics (hair, skin and eye colour; blood group, etc) which is provided to the recipient couple. Any further voluntary information the donor wishes to provide (e.g. occupation, hobbies, religion, hand-drawn profile) may also be given to the recipient couple.  Since April 2005, all new donors are required to provide the previously mentioned information, plus their names, addresses at the time of birth and at the time of the donation. They will also be required to keep the HFEA (Human fertilisation and Embryology Authority) updated as to changes of address. Their names and addresses will not be available for the recipient couple, but will be held on record by the HFEA and may be released to any child born as a result of their donation if they request it when they reach the age of 18.  This does not entitle the child to have any legal claim on the donor’s estate, nor does it allow the donor to have any legal, material or emotional claim on the couple or the child.

Other Legal Issues

Certain information relating to treatment using donor gametes (eggs and sperm) is required by law (The Human Fertilisation and Embryology Act 1990 and 2008) to be filed and kept with the Licensing Authority (the Human Fertilisation and Embryology Authority, HFEA):

• The names and dates of birth of patients being treated
• The name and date of birth of any offspring
• The name, date of birth, characteristics and an optional pen picture of the donor

The stated aims of the legislation are:

• Protection of the rights of the child
• Identification of any genetic defects
• To minimise the risk of intermarriage between people who are related

Egg donors (and indeed any gametes donor) are allowed by law to request and be provided with information about children born as a result of their donations, including number of children, their gender and year of birth.

Similarly, people seeking treatment with eggs donated by an anonymous donor are allowed to be given non-identifying information about donor, including:

• Physical description (height, weight, and eye, hair and skin colours)
• Year and country of birth
• Ethnic group
• Whether the donor had genetic children when they registered
• other details the donor may have chosen to supply (e.g. occupation, religion and interests)
• Details of screening tests
• Reason for donating
• A goodwill message, and
• A description of themselves as a person (e.g. pen portrait)

Children born following egg donation treatment are allowed access of the above non-identifying information of the donor from the age of 16. They also have the right to access the following information:

• Anonymous information of any donor conceived genetic siblings from the age of 16
• Identifying information about the donor (where applicable) from the age of 18, including full name, date of birth and last known postal address
• Identifying information about donor-conceived genetic siblings, with mutual consents, from the age of 18
• Information about the possibility of being related to the person they intend to marry or enter into a civil partnership with, at any age, and
• Information about the possibility of being related to the person they intend to enter into an intimate physical relationship with, from the age of 16

Talking to your child about their origins

If your child is conceived using egg from an anonymous donor, telling them about their origins can be a sensitive topic to discuss. However, if done honestly and if discussed at the right time, the issue need not be a difficult one to broach.

Evidence from the experience of adoption, as well as studies of donor-conceived people, suggest that it is best for donor-conceived people to be told about their origins in childhood. Finding out suddenly, later in life, may be emotionally damaging to donor-conceived people and their family. This, coupled with the donor-conceived people’s legal right to find out about their genetic origins, means that it is advisable for parents to be open with their children from an early age.

Family secrets can undermine trust and lead to conflict and stress. They can also suggest to donor-conceived children that their parents are ashamed of how they were conceived. If parents are open about how the child was conceived, there is no reason they should feel any different to any other child. If donation has been part of the family story for as long as the child can remember, their genetic origins need not be an issue. Some donor-conceived children are likely to want to know more about their donor, while others will not be particularly interested.

It is therefore recommended that parents should let their children know about their origins at an early age. The “Donor Conception Network” has produced a series of booklets called “Telling & Talking”, which prepare and support parents of donor-conceived people to tell their children about their origins.

What does it involve for the recipient couple?

The potential recipient couple are required to attend for consultation with a consultant and a counsellor. For a couple who are bringing their known donor, the donor and her partner are also required to attend the consultation, initially separately from the recipient couple, and then together. The donor couple are also required to undergo independent counselling, which enable them to explore their own feelings of the donation process and to fully appreciate the treatment process and the implications of egg donation.

At the initial consultation, medical and family histories of the recipient couple are taken. A clinical examination and a pelvic ultrasound assessment of the woman are carried out. The male partner is asked to produce a semen sample for analysis. The clinical details of the donation programme are fully discussed during the consultation.

The physical characteristics of the recipient couple are recorded on a “Characteristics Matching Form”. Arrangements are made to ascertain the woman’s rubella (German measles) immunity status and cytomegalovirus (CMV) status, and the blood and rhesus groups of both partners. These can be carried out at the Fertility Centre or via the couple’s general practitioner(s). All couples in the egg donation programme are required to have HIV, hepatitis B & C screening.

About the Donor

Regardless of whether the egg donor is known or anonymous, there are strict criteria they must fulfil:

• Between the ages of 18 and 35
• Body mass index (BMI) of 30 or less
• Absence of personal or family history of genetic disorder or heritable condition (donors who are adopted, thus without full family history, are usually excluded)
• Preferably has had at least one normal pregnancy or has completed her family
• Consent to blood samples being taken for various screening tests

All donors have to undergo health screening, which includes obtaining a personal and family medical history. All reasonable steps are taken to prevent passing-on of serious genetic disorders. In most situations, this is served by taking a thorough family history. In this respect, blood tests are also carried out for chromosome patterns, and for carrier status for cystic fibrosis.

All donors also have blood tests to check for infections such as hepatitis B and C, and another for HIV, the virus that can lead to acquired immune deficiency syndrome (AIDS). The blood and rhesus group, and cytomegalovirus status of the donor are also checked, mainly for matching purposes.

Many couples ask if there is any chance of suffering from any other sexually transmitted infection following donor egg treatment. Although no guarantee can be given, the chance of this happening is very small. Similarly, despite all reasonable efforts made to exclude the possibility of heritable conditions, egg donation treatment does not protect the baby from having some form of congenital defects. The risk of this developing is no greater than if donated eggs were not used. It should also be borne in mind that every pregnancy carries some risks, regardless of whether donor egg is used or not.

All egg donors are informed of the possibility that, if a child is born disabled as a result of a donor’s failure to disclose defects, about which she knew or ought to have known, she may be liable to damages in the court of law.

Although ideally the general characteristics (skin, eye and hair colour, build, height, CMV status, and blood group) of the donor should match those of the recipient woman, the matching is seldom perfect due to the rarity of donors.

The number of families that can be helped by each donor is restricted by law to no more than 10. Once this number is reached, the donor is no longer allowed to donate her eggs. This is largely to reduce the likelihood of marriage between two people conceived from eggs of the same donor.

There are no payments for egg donors.  They are, however, reimbursed for reasonable expenses and material costs (e.g. loss of earnings) up to a maximum of £750.00 over the whole course of donation.

Egg donors retain the right to withdraw consent to the use of the eggs or resultant embryos, or alter the terms at any time up to the point of transfer of the embryos (created using their eggs) into the recipient’s uterus (womb), although in practice this is highly unlikely.

What does the treatment involve?

For the donor

Once the screening process is complete, the timing of the treatment is entirely at the discretion of the donor. Even if the treatment has started, the donor has the right to suspend the process at any time until the procedure of embryo transfer. In practice, this is very unusual, and recipient couple are given ample of time to prepare for the treatment.

In order to be able to donate eggs, the donor undergoes a treatment cycle of In Vitro Fertilisation (IVF); full details of which are available in our IVF Information Leaflet. IVF treatment essentially entails a series of different daily injections for the donor, in order to stimulate the production of eggs within the ovaries. When the eggs are mature, the donor undergoes the procedure of ‘egg collection’, which is a minor operation involving aspiration of eggs from the ovaries via a sharp needle inserted into the ovaries through the vagina. On average, 8 to 10 eggs are collected during each procedure, but the number of eggs varies hugely, and is dependent on the response of the donor’s ovaries. Donated eggs are then subjected to an insemination process in the laboratory, using the recipient husband’s/partner’s sperm.

Once the egg collection procedure is completed, this spells the end of the treatment for the donor. A review consultation is arranged for the donor a few weeks after the procedure.

For the recipient couple

The treatment for the recipient couple depends on whether they would use the fertilised eggs (embryos) fresh (i.e. within a few days that they are produced) or if they prefer to freeze (cryopreserve) all the embryos for used at a later date. Most couple prefer to plan for a ‘fresh’ cycle of treatment, whereby any embryos created in the treatment cycle are available for fresh transfer and freezing. The main advantage of this approach is that the success rate associated with fresh embryos is significantly higher than that with frozen embryos. The main disadvantage is that the embryos have not been quarantined to exclude a very small possibility of transmitting HIV infection.

Occasionally, all the embryos have to be frozen because it has not proved possible to synchronise the cycle of the donor with the recipient, or alternatively to prepare the recipient to receive the eggs. Some couples prefer to have any resulting embryos frozen for a short period of time, so that their treatment can be planned for a more convenient time.

For treatment involving an anonymous donor, every step will be taken to maintain anonymity of the donor.

Treatment using fresh embryos

In order for the recipient woman to be able to have a fresh embryo transfer, it is important to synchronise the recipient menstrual cycle with that of the donor’s IVF stimulation cycle. This is achieved by temporarily “switching off” the recipient’s ovaries using medication. After this generally speaking the process detailed below is followed:

• On the morning of the donor’s egg collection procedure, the recipient male partner produces a semen sample, so that it can be processed and prepared for insemination of the donor’s eggs. If it is anticipated that there may be difficulty for the man to produce the semen sample on the day (be it non-availability or failure to produce due to stress), it is perhaps advisable to freeze a few samples of semen before the start of the treatment, and use them as backup samples. It should be understood that frozen-then-thawed semen is not of as high quality as fresh samples.
• The donor’s eggs are subjected to the insemination process in the laboratory. In the situation where the recipient male partner produces poor quality semen “intracytoplasmic sperm injection, ICSI” is employed to enable efficient fertilisation of the eggs.
• Fertilisation of the donor’s eggs is usually confirmed the day after the egg collection and insemination. The recipient couple will be informed of the number of fertilised eggs, if any, and will be given the timing of the fresh embryo transfer, which can be 3 to 5 days after the donor’s egg collection.
• The embryo transfer procedure is usually a painless procedure and uses a fine tube which is passed into the womb via the vagina. It normally takes a few minutes to complete the procedure. The woman is usually asked to rest for 15 – 30 minutes after the procedure.
• A pregnancy test is usually performed two weeks later.
• In the event of a positive pregnancy test an ultrasound scan is offered to confirm the status of the pregnancy 4 weeks after the pregnancy test.
• If the pregnancy test is negative, all medication is stopped; following which a menstrual period will ensue. A review appointment a few weeks later will be offered.

Treatment using frozen embryos

There is no requirement of synchronisation between the egg donor and the recipient woman, in this situation.

The donor will undergo a standard IVF treatment cycle. The only requirement from the recipient is for the male partner to produce a semen sample on the day of the donor’s egg collection procedure. All fertilised eggs will then be cryopreserved and kept in storage in the laboratory.

If a couple elect to cryopreserve all the embryos, it is advisable to keep them in storage for no less than 6 months. This is the quarantine period; at the end of which the donor will be tested again for her HIV status, thus ensuring negligible risk of transmitting HIV infection.

When the time comes when the couple decide to have the “frozen-thawed embryo transfer” (or FET) treatment, the medication schedule is implemented.

There are a few essential points that must be appreciated regarding frozen embryos:

• Not all embryos survive the freezing and thawing process. The average survival rate is 65 - 70%.
• The initial storage period is up to 10 years, but this can be extended to a maximum total of 55 years although strict criteria of embryo storage have to be adhered to.
• Stored embryos are considered joint property of the woman and her male partner. If one party withdraws his/her consent for the use of the embryos, the embryos have to be thawed and allowed to perish. There is, however, a “cooling off” period of 12 months before the embryos are disposed of, allowing some time for the partners to reconcile the difference.
• The donor also has the right to withdraw consent to the use of the embryos up to the point of transfer into the recipient woman’s uterus.
• There is a charge for the cryopreservation and storage of embryos.
• Couples who have embryos in storage must keep regular contact with the centre informing us of any change of addresses or other circumstances (e.g. marital separation).

Preparation before treatment for the recipient couple

It is important to look after yourself (both woman and man) before and during treatment. Smoking has a negative effect on fertility, general health and the health of the baby. Similarly, excessive alcohol drinking is detrimental to fertility and pregnancy. These should therefore be best avoided. It is also advised that all women undergoing fertility treatment should take folic acid supplements before and during early part of pregnancy. This minimises the risk of having a baby with spina bifida (spinal defect).

Counselling

Before committing to an egg donation programme, all couples are required to receive counselling, which is provided free of charge. Counselling provides an opportunity to discuss with an impartial person any concerns you may have about your treatment. It is part of your initial consultation and decision-making process. Further counselling is available to you at any stage of your treatment.

The HFEA Code of Practice sets out the types of counselling that should be available through all licensed clinics. This includes:

• Implication counselling: to enable the people concerned to understand the implication of the proposed course of action for themselves, their family and any children born as a result. This may be particularly relevant for people considering treatment with donated sperm. This may also include genetic counselling.
• Support counselling: to give emotional support at times of particular stress, e.g. when there is a failure to achieve pregnancy.
• Therapeutic counselling: aims to help people to cope with the consequence of infertility and treatment and resolve the problems these may cause. It includes helping people to adjust their expectations and to come to terms with their situation.

Apart from counselling offered by the clinic, it may also be helpful for you to contact one of the national support groups who may be able to put you in touch with others who have had egg donation treatment.

Risks associated with this treatment

Multiple pregnancy

As the number of embryos put back into the womb often exceeds one, multiple pregnancy is not uncommon, occurring approximately in 25% - 30% of all pregnancies (majority of which are twins). It is important to realise that complications of pregnancy, e.g. miscarriage, bleeding problems, high blood pressure, cerebral palsy in the children and premature delivery are higher the more babies a woman is carrying.

According to the current legislation (HFE Act 1990 & 2008), any couple undergoing oocyte donation treatment can have no more than 2 embryos transferred into the womb. However, it is strongly advisable (and indeed one of the regulations of the Human Fertilisation & Embryology Authority) that no more than one embryo is used at any one transfer. This regulation reduces the chance of multiple pregnancy occurring.

Risk of infections

As previously mentioned, all donors are screened carefully for common and serious infections. It is however impossible to exclude all forms of infection which may be transmitted via the embryos. The chance of this happening is very small.

Pregnancies following Egg Donation 

If you become pregnant it is important to keep the fertility unit fully informed - it is a legal requirement. It is necessary to keep a check on the effectiveness of each donor, and to ensure that the legal limit on the number of children from each donor has not been exceeded.

Once you have conceived through egg donation treatment, your pregnancy should follow a normal course. Having egg donation treatment will not affect your chance of having a normal pregnancy, a normal delivery, and a normal baby. However every pregnancy carries some risks, including congenital abnormality of the baby, bleeding and blood pressure problems in the mother. It is generally recommended that the pregnancy should be monitored more closely.

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