A woman who has had children and who has perhaps experienced the distress of childlessness in her family or friends sees an article in a paper or donate eggs either to her a program on television and contacts either a clinic or through a support group or agency (not permitted in the UK). Her offer is altruistic, anonymous to the generous and, of course, can be absolutely anonymous. Donors and recipients can be friends or relatives.
Donors should be under 36 and will usually have had at least one child. Donors and recipients are counselled to ensure that they understand all the implications and issues. The UK HFE Act (1990) states that the woman who gives birth to child is the mother and her husband/partner is the father. Under that Act the child has the right to certain non identifying information about the donor but (for anonymous donors) do not have the right to information leading to the identity of the donor - if the UK parliament does change the regulations they cannot apply retrospectively.
Recipients will need to think about whether they wish to tell the child' about their origins - only they can make that decision. The donor is stimulated with drugs and hormones so that she will produce several eggs - the average might be 8-1 0 (see Figure 1). Careful monitoring (over several days), by blood tests and ultrasound scans, determines the precise time for egg collection. Care is taken to minimize any risks (Over stimulation, infection, hemorrhage) and the donor is usually fit to return home on the same day as egg collection.
Egg recovery is usually by Trans-vaginal ultrasound directed methods either under a light general anaesthetic or under sedation. If the donor has also asked for sterilization this can be done at the same time during laparoscopic egg recovery under a general anaesthetic.
Treatment with donor eggs can be very successful: it is comparatively simple to stimulate a recipient to accept an embryo even though she is no longer producing eggs of her own. Age seems no difficulty although most clinics would not want to go much beyond nature's normal limits for conception. Some clinics insist on screening the donor again after six months. The procedure of testing, freezing embryos and then retesting the donor for HIV antibodies six months later does provide assurance that the donor was free from HIV infection when the eggs were taken. The disadvantage of frozen embryos for subsequent donation is that the success rate can be less than with fresh embryos. The Code of Practice of the Hunan Fertilisation & Embryology Authority (UK) does however allow for fresh eggs to be transferred to the recipient after a single HIV test. Paragraph 4 of Annex B states: "At the beginning of the treatment and collection cycle of a women whose eggs are to be taken for the treatment of others, her blood should be for the presence of HIV antibodies... The eggs should only be used if the HIV antibody test is negative. The small risk of HIV infection should be explained to the recipients of donor eggs. Recipients must consent to the transfer of fresh donated eggs.
Donors are always carefully selected. They volunteer to donate eggs because they want to help couples who are suffering from infertility, knowing that each month many of their eggs are wasted. There is some hesitation in many peoples minds to the payment of donors. They should have had at least one healthy child, be of average intelligence, healthy, and with no history of severe physical, mental, or genetic illness, and they should be below 36 years old to reduce the incidence of genetic abnormalities. They perhaps should not be considered if they themselves suffered from infertility - some people have suggested that patients undergoing IVF could (for a reduced charge treatment cycle) donate a proportion of eggs retrieved. All donors should be required to undergo a medical examination and details of their medical history are carefully taken. Questions need to be asked about their families (going back several generations where possible). Is there any history of severe medical or mental illness in the family? Has any member of the family died young? Is there any history of hereditary disease? Is there any reason which they know of which would preclude them from being a donor? Are they happy about the possibility of there being a child somewhere who is genetically half theirs. They must be comfortable with what they are proposing to do, and in donating their eggs they renounce all rights to them. Donors should be tested to ensure that they are free from AIDS and Hepatitis - this should be mandatory.
The eggs will be fertilised with sperm of the recipient woman's husband; the resulting embryos can be stored by freezing but can only be transferred to the recipient woman's uterus if a second HIV test on the donor (repeated after six months) is also negative. Many clinics send blood for genetic screening to ensure that the donor does not suffer from or carry genetic abnormalities which the donors are unaware of. These precautions mean that the eggs should be of very high quality, and the success rate should he higher than in IVF with a woman's own eggs.
Many clinics achieve a success rate of above 40% with eggs donated from younger women. Although a woman may not be producing good eggs herself it is comparatively simple to stimulate her to accept embryos which have resulted from donated eggs - theoretically this can be done up to almost any age but most clinics restrict treatment to women up to the age of about 45 or perhaps 50. It is often very difficult to draw precise boundaries particularly as clinicians will want to do their best for their patients. The risks of an abnormal child being born should therefore be less than in the general population. After all we don't ask each other these questions when we decide to try and have a baby. If patients are still worried tests during pregnancy can reveal many major abnormalities. Clinicians would advise about these tests, their risks, and knowing the medical history.
There will inevitably be a waiting list for anonymously donated eggs, because the availability of eggs from anonymous donors is still not very great - new initiatives to make the public aware of the needs may eventually shorten the waiting time which can be as long as two years or more. Many of the women who initially volunteer to donate eggs drop out when they know what is involved. Some people feel that its is asking too much to expect a woman to donate eggs without any reward or payment - in the UK payment or inducement is contrary to law. This has prompted clinics to suggest 'egg sharing' where patients undergoing IVF are offered reduce fee treatments if they can donate some of their eggs to other people if they produce more than a certain number (e.g. 10). Approached with care and proper counselling this may be one solution to the shortage of eggs - see also section 'Care in Egg Donation@ below.
Some clinics may agree to consider egg donation from a sister or friend and this can significantly reduce the waiting time. This will require very special counselling to ensure that all parties are fully aware of the implications, and the very real strains that this form of egg donation can place upon personal relationships. An independent counsellor will need to be satisfied that all the issues and implications have been carefully explored.
Patients will be asked for details of your characteristics - this will include such details as height, weight/build, hair colour, complexion, colour of eyes, blood groups, and race (i.e. colour). Other characteristics can be taken into account if they feel they are important for example religion, particular facial characteristics (nose shape etc). Many ethnic groups may want to take religion, caste, etc into considerations and clinics will do their very best to take these wishes into account and keep you informed - it may however take some time to achieve a perfect match.
Sperm can be stored by freezing but eggs cannot yet be adequately frozen with any great success - when that becomes more effective many options will become easier to consider. Matching characteristics from husband and wife are usually taken and there is no reason why a child born as a result of donated eggs should look out of character with the couple. The experience is very good and many couples say that friends and relatives remark that the child looks like its mother: this may say more about why we recognize likenesses in children who often copy our facial mannerisms (the way we smile, use our facial muscles, laugh, frown, cough etc.). Adopted children often seem to "grow' like their adopted parents and yet there is no genetic reason why they should.
Clinics offering treatment with donor gametes from anonymous donors (sperm or eggs) observe very strict rules of confidentiality and they cannot communicate details of your treatment to unlicensed persons without your consent you have control over who knows that information. There is no reason why the GP or referring doctor need know if patients wish to keep it secret unless they wish to tell them, although it might be simpler to adopt an open policy - the decision must be the patients.
At the moment we can say with confidence that, in the UK the identity of donors would not be disclosed to anyone, including the child and you would not be able to learn their identity nor they know anything about you. However we have to qualify that statement because the Human Fertilisation and Embryology Act passed by Parliament (1990) established an statutory authority (the Human Fertilisation and Embryology Authority) which regulates certain forms of infertility treatment including the use of donor sperm or eggs:- Section 29 of the UK HFE Act (1990)requires the Authority to keep information about donors and persons to whom treatment services are provided, and regulates circumstances under which information may be disclosed. A person aged 18 or over may on application be given certain information to be specified in regulations by the Authority. Certain information may also be provided to a person under the age of 18 who proposes to marry. Data of this kind held by the Authority is exempt from the subject access provisions of the Data Protection Act 1984. This means that only the child shall have access to the information except under clause 31 where there may be reasons for the registrars general to need the information - say to prevent brother marrying sister.
The UK Government originally indicated that it was not their intention that the information referred to in clause 29 would include information leading to the identity of the donor. Furthermore the term "specified by regulations" means that regulations can be changed without a further Bill being placed before Parliament and a future government could change that what is enacted in this Act by affirmative assent of both houses. It could not be made retrospective unless a new Bill was presented. There are new suggestions that the UK government may change regulations so that a child at reaching 18 will have aright in the future to trace the donor - that has yet to be decided. Some countries already have that provision (e.g. Sweden) The Legal Situation vary from country to country Under the 1990 Act in the UK the mother is defined as the woman who carries or gives birth to a child and her husband/partner is the father. Most people would consider that to be the right definition. Registration is therefore straightforward and no mention is made of donor assisted treatments. This applies whether or not the child is genetically hers but does not affect the position where a child is adopted.
A new website, (http://www.ronsangels.com), recently opened and claimed
to be auctioning off the eggs of models and actresses at prices up to $150,000.
The ASRM Board of Directors, Ethics Committee finds the 'Ron's Angels' website,
www.ronsangels.com, both offensive and unethical. Infertility is a serious
disease affecting 6.1 million American women and their partners. In 1996 alone,
more than 3,768 cycles of assisted reproductive technology (ART) were attempted
with donor eggs resulting in 1,849 babies, 8% of total 1996 ART cycles. Donor
egg programs exist to help this nation's infertile couples have the children
they very much want to have - even if it means using another woman's eggs to do
so.
The ASRM Ethics Committee states that reasonable compensation is
justified for the time and trouble of both sperm and egg donors. Compensation
should not vary based on attributes that a child may have. The 'Ron's Angel's'
website is essentially a donor egg 'auction' to sell human eggs to the highest
bidder in the hopes of providing potential parents with more attractive - and
therefore desirable - children. We believe that the 'Ron's Angels' website
violates the ethical principles outlined by the Committee, promotes unrealistic
expectations to potential parents, commercializes what is otherwise a voluntary
donation process, offers undue enticement to potential donors, and has great
potential to exploit highly vulnerable people.
We have already considered the question of anonymity under the 1990 Act which might have a direct influence on whether or not you would want to tell a child that he or she was conceived as a result of donor eggs. As the law stands, at the moment, unless the parent reveal this to their child there is no reason for him or her ever to know that he or she was conceived as a result of the generosity of a donor. Some people would argue that we all need to know our genetic backgrounds, that it is a part of our heritage. They would draw a parallel with adoption where the child has the right at eighteen to know and trace its genetic parents. They would go on to argue that parents must tell their children the facts about their conception. Others would say that it must be left up to the individual couples, and that it is not similar to adoption where there may be all sorts of unhappy, tragic, even violent reasons why a child was placed for adoption. A couple who have made a positive decision to have a child as a result of the generosity of a donor are doing so with each others support and through an act of love. They move forward in a positive way using the gift which made it possible to have their own child. Many successful recipients say that the generosity of a woman who donated eggs to them literally changed their lives.
A child would be very hurt to discover the facts by accident. So much will depend on how many other members of the family know the facts - the more who know, the more difficult it will be to hold that secret. In adoption 'parents' have no choice as the child has the right to know the facts and, if they wish, to trace the birth mother. In donor assisted treatments, in many countries, the child does not have the right to the identity of the donor and this might influence your decision whether to be open or not. Parents will need to think very carefully about your attitudes because what is said cannot be unsaid. The truth, however only has to be told once. How to Tell and When to Tell? Nobody can tell parents exactly how and when they might tell a child about his or her conception. But if they do decide to tell the child they might find it easier to do so in stages starting with a simple explanation which emphasized that they wanted the child so much, that they needed some help from the doctors, going on later on to provide more details - children in any case don't want all the details at once and you would not want to talk about sperm and eggs until the child is old enough to understand the basic facts of conception.
A happy story at an early stage is more likely to be accepted by the child as neither so special that they brag about it or so horrendous that they are ashamed about it. What you would want to emphasize is that you needed this help because you wanted him or her so much. Parents might want to seek the help of counsellors or other couples who have experienced the same questions. Some children's books are listed in the site under 'Books' and are available from the IFC Resource Centre. Information to given to Patients.
Code of practice Para 4.4 (from the UK Licensing Authority) is a useful set of guidelines-
Information should be given to people seeking treatment on the following points:
a. the limitations and possible outcomes of the treatment proposed, and variations of effectiveness over time:
b. the possible side effects and risks of treatment to the woman and any resulting child, including (where relevant) the risks associated with multiple pregnancy;
c. the possible disruption of the patient's domestic life which treatment will cause, and the length of time he or she will have to wait for treatment;
d. the techniques involved, including (where relevant) the possible deterioration of gametes or embryos associated with storage, and the possible pain and discomfort;
e. any other infertility treatments which are available, including those for which a license is not necessary;
f. that counselling is available.
g. the cost to the patient of the treatment proposed and of any alternative treatments;
h. the importance of telling the clinic about any resulting pregnancy;
i. who will be the child's parent or parents under the Act. Patients who are nationals or residents of other countries, or who have been treated with gametes obtained from a foreign donor should understand that the law in other countries may be different from that of the United Kingdom.
j. The child's right to seek information about his or her origins on reaching 18 or on contemplating earlier marriage;
k. the information which clinics must collect and register with the Authority and the extent to which that information may be disclosed to people born as a result of donation;
l. A child's potential need to know about his or her origins;
m. the clinic's statutory duty to take account of the welfare of any resulting or affected child; and
n. (where relevant) the advantages and disadvantages of continued treatment after a certain number of attempts d