Embryo Donation

Thanks to modern procedures like IVF and IUI, infertility is nowadays no hindrance to couples that desire a child. Even couples that are dealing with both female infertility and male fertility issues can now successfully get pregnant and carry a child to term. How? Through embryo donation.

What is Embryo Donation?

When a couple undergoes IVF treatment, a number of eggs are artificially fertilised. Since as many as 20 eggs may be collected from a woman, multiple embryos are likely to develop, yet only a few will be transferred back to a woman for implantation. The remaining embryos are usually frozen for later use.

However, not all couples go on to use their embryos for another pregnancy. As a result, couples may decided whether they would like to have their embryos destroyed, as they can only be frozen for so long; if they would like to donate the embryos to research; or to donate the embryos to another couple who cannot conceive on their own.

Alternatively, embryo donation may occur through embryo creation. This is when an infertile couple uses donor eggs and donor sperm to create an embryo. As with a donated embryo, this embryo will not be biologically related to you or your partner.

Recipients for Embryo Donation

If you and your partner both have some problems that are not allowing you to conceive naturally, or if you have undergone several IVF cycles without success, opting for embryo donation may be beneficial. It is also recommended for those couples who might transmit some genetic disease to the new born.

Embryo donation can be considered when,

• The woman is suffering from premature ovarian failure or is menopausal
• The woman has ovarian defects due to chemotherapy or radiation therapy
• The woman is suffering from resistant ovarian syndrome in which her ovaries do not respond to hormones
• The ovaries have been totally removed as a treatment for other diseases, like cancer
• The man can not ejaculate or has a very low sperm count
• The male partner had his testicles removed as a measure to treat other diseases
• There is a danger of passing genetically transmitted disease, such as haemophilia, to the child
• Chromosomal abnormalities prevent a child from being born
• The female partner does not respond to fertility drugs and is therefore unable to conceive even with IVF treatment
• There is a poor ovarian reserve in the female partner, likely due to maternal age

The Donors

Under most circumstances, embryo donors are those couples who have undergone IVF cycles and have decided not to use their remaining frozen embryos. Some fertility centres also provide embryos that have been fertilised in lab conditions from a donor egg and a donor sperm, though this is not a usual practice.

In the latter case, strict guidelines given by the Human Fertilisation and Embryology Authority (HFEA) are adhered to, regarding the age and health conditions of the donors. The egg donor is usually between 18 and 35 years of age, physically fit and with no known hereditary diseases. Eggs from older woman generally tend to be of poorer quality and are therefore not preferred as donors. Likewise, sperm donors too are screened for any health problems that might be transmitted to the child.

To prevent the transmission of any infection to the recipient mother or the offspring, as well as to safeguard the child from any hereditary or genetic diseases, the HFEA also recommend a strict screening of the donors who give their frozen embryos. These tests may include:

• HIV
• Syphilis test
• Blood test to determine blood group and blood count
• Testing for Hepatitis B/C
• Cystic Fibrosis

Counselling for Donors and Recipients

Before saying yes to egg donation, the donor as well as the receiver need to be aware of many facts and legalities concerning the process. While donors have every right to know the complete procedure of how their embryo will be donated; choose who will receive their embryo; and opt to remain anonymous or be known to recipients, donors do not have any legal rights to any children born once the embryos have been donated.

A recent amendment to the HFEA guidelines has also given a child born after March 2005 the right to know the identity of his genetic parents if he so wishes.

As a recipient, you should fully understand the facts like the choice of donors, whether they have been properly screened, the chances of pregnancy, and the cost you have to bear. Also, some clinics might only accept recipients who are married or in a stable relationship. Once the child is born, you are the legal parent and thus fully responsible for the child’s well being. You should also be well prepared to deal with the outcome of the treatment.

Counselling can help resolve most of the queries of the donors and the recipients and can also help in coping with the legal, physical, psychological or ethical issues related to the donation.

Preparation

Once you have decided to opt for egg donation, your doctor needs to conduct a few tests to find out your blood group and blood sugar level. An ultrasound may be carried out to scan the uterus and check the reproductive organs to make sure they are healthy and able to take on a pregnancy. The hormone levels in your body may also be tested so that when it is time to implant the embryo, you and your fertility specialist can be sure that the correct environment for growth is present. In older women (those over the age of 40), the chances of complications increase so the prior tests become all the more important.

Donors and recipients are matched based on their similar physical attributes and, if possible, ethical backgrounds. More importantly, it is necessary to match the blood groups to avoid future complications with the child. After these initial steps the actual procedure of embryo transfer starts.

The Procedure

The transfer may take place during your natural menstrual cycle or through a hormone replacement cycle where you will be given fertility drugs to increase the level of hormones (i.e. estrogen and progesterone) in your body. Again, for women over 40, it is always better to have hormone supplements to prepare the inner lining of the womb for implantation.

Initially you may be given natural estradiol pills or patches and later progestrone in the form of gel, injection or vaginal tablets. The amount of these hormones differs for from woman to woman, according to her physical characteristics, age and body requirements. Additionally, an ultrasound will be carried out to check the response of the organs to the hormones and observe the development of the endometrium, the inner lining of the uterus.

Once you are ready for the transfer, your doctor will transfer the embryo with the help of a catheter that is placed in your vagina and lead up into your uterus. This is a relatively painless process and does not take much time.

About two weeks after the transfer, a pregnancy test will be administered. You may need to continue taking hormones after the transfer for up to the first two months of pregnancy. If the transfer was successful and you are pregnant, an ultrasound check-up will be done after 5 weeks to see the development of the foetus, its position and also to check if there are multiple pregnancies.

Success of an Embryo Donation

Studies on embryo transfer carried out around the world show that for a single cycle, there is about a 20% to 25 % chance of pregnancy. Generally, two to three embryos are transferred per IVF cycle and doctors usually suggest a couple try three to four embryo transfers. If you still have not had success after this time, it is likely best to consider other fertility options.

Two important factors that may affect your success rate:

• Since the embryos are frozen, they may be less viable than fresh embryos
• The couple providing the embryo may themselves be dealing with fertility issues or be of advanced age, thus the number of good embryos present might be less

Risks Involved

As the donors are screened for any infections or birth defects they may pass on to the child or mother, risks are minimised to a large extent. The use of frozen embryos and transferring fewer embryos can reduce the danger of multiple pregnancies. However, this risk cannot be completely eliminated.

Other risks, like a negative response to fertility medications or the chances of an embryo not implanting, are present as with any other fertility treatment.

Cost

According to HFEA, as embryo donation is considered a humane gesture, donors are not charged a fee or given any compensation for their embryo, although they may be paid for their time and travel. If the embryo is that of a donor egg and a donor sperm, then costs to the recipient might be more.

The costs mainly include the screening of the donor, evaluation cycle and the embryo transfer. On average, using a donor embryo is less than half of the cost of IVF. However, you will still need to pay for IVF, any tests or medications associated with the treatment and appointments with your fertility specialist.