Embryo donation is a new path to parenthood that allows the opportunity for a couple that has struggled with infertility to experience the wonders of pregnancy and the joy of giving birth.
Embryo donation is when another couple’s embryo is implanted in your womb during IVF. This is an option if you and your partner need both egg and sperm donation, or if you’re a single woman who cannot use your own eggs.
When couples undergo in-vitro fertilization (IVF) to conceive a child, often they have embryos (egg and sperm joined together) that are not used. These remaining embryos often are cryopreserved, or frozen, and put into storage for later use. Once an embryo has been cryopreserved, decisions must be made on their behalf. The embryos could be used in a future family building cycle by the family; thawed and discarded; submitted to science for research purposes; or donated to another couple that is struggling with infertility.
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In other words, in the current practice of in vitro fertilization (IVF), some patients may create more embryos (fertilized eggs) than they need. The extra embryos may be cryopreserved (frozen) so that they can be transferred later. However, sometimes these embryos may not be used. These patients have the option to have their embryos discarded, donated to research or donated to another woman to achieve pregnancy.
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Egg donation is when eggs from another woman are fertilised with your partner’s sperm in a laboratory. The resulting embryos are then transferred to your womb (uterus).
The use of donated embryos may be considered by women with untreatable infertility that involves both partners, untreatable infertility in a single woman, recurrent pregnancy loss thought to be related to the embryo, and genetic disorders affecting one or both partners.
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There are certain criteria we apply before we will consider a woman for treatment with donor eggs. These apply to those receiving eggs from an anonymous donor recruited by the clinic:
. Women's age less than 48 years when placed on waiting list or less than 50 at the time of treatment.
. Have no medical contraindications to having a pregnancy
. Have a uterus capable of carrying a pregnancy
. Have undergone appropriate counselling and screening tests
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Your doctor may recommend egg donation if:
. If you have no ovaries, produce low-quality eggs, or no eggs at all. This may be due to premature menopause, an inherited condition such as Turner syndrome, surgery to remove your ovaries, or treatment for cancer using chemotherapy or radiotherapy.
. If you and your partner have been unsuccessful with other treatments, such as IVF.
. If you’re at risk of passing on an inherited disorder or chromosomal abnormality.
Your doctor may recommend embryo donation if:
. You and your partner are unlikely to conceive using your own eggs and/or sperm for fertility treatment.
. You or your partner is at risk of passing on a genetic disorder to a child.
. You’re single and have gone through the menopause.
How does egg and embryo donation work?
The process starts with finding a donor. This is usually carried out by your fertility clinic.
Egg donations can be from egg donors or egg sharers:
. Egg donors are women who are not receiving fertility treatment themselves, but who choose to donate their eggs to help other women, or a particular woman they know.
. Egg sharers are women undergoing fertility treatment, who donate some of their eggs as part of their IVF cycle.
Embryos are usually donated by couples or women who have successfully had their baby or babies from IVF and who want to help other parents-to-be.
Most clinics in Iran have waiting lists because there are more people wanting the treatment than there are donors. It may be worth contacting several clinics to find out what their waiting times are.
It’s recommended that egg donors are under 36 years of age, because fertility treatment is more successful with younger eggs. But there can be exceptions to this, such as when a woman is donating eggs to friends or family.
All egg donors are screened for infectious diseases such as HIV, hepatitis B, hepatitis C, and some genetic conditions such as cystic fibrosis, before their eggs are used.
Where possible, egg donors may be matched as closely as possible with the recipient couple for characteristics such as hair colour, eye colour, occupation, and even interests.
No information that could identify an egg donor is allowed to be given to a child until he or she is 18. However, if a child born as a result of donation is in a sexual relationship when he is 16, he can find out about the donor.
In cases of both egg and embryo donation, the woman giving birth to the child is the legal mother. Your partner will be the other legal parent if you’re married or in a civil partnership. If not, you’ll need to sign legal parenthood consent forms before the treatment takes place.
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IVF sometimes produces extra embryos that may be used if your first treatment cycle fails, or if you want to have more children in the future. These embryos are usually kept in storage for up to 10 years. Sometimes couples decide that they don’t want to attempt to have more children, and agree to donate the embryos to another couple.
If you’re the recipient, your doctor will transfer one or two of these embryos into your womb through your cervix with a thin catheter (tube). This happens between two days and six days after fertilisation.
If two embryos are transferred, there is a risk of having a multiple pregnancy. Your doctor will counsel you on the number of embryos you should transfer, balancing the chances of success against the risk of multiple pregnancy.
If all goes well, at least one of the embryos will stick to your uterine wall and continue to grow. You can take a pregnancy test in about two weeks. If you do become pregnant through donation, you’ll have careful monitoring.
This process needs to be coordinated so that you and the egg donor have synchronised fertility cycles. You will both be given hormones to make sure this happens. So at around the time that your womb lining is able to support an embryo, your donor needs to be ovulating.
Your egg donor will also be given fertility drugs to help her to develop several mature eggs for fertilisation. When the eggs are ready, a doctor will remove them using a fine, hollow needle.
On the same day as the eggs are collected from your donor, your partner needs to provide a semen sample. The eggs will then be mixed with his sperm in a laboratory if you’re having standard IVF. Or if you’re having ICSI, one sperm is injected into each egg. Two days later, any fertilised eggs become a ball of cells called an embryo.
The embryo is then transferred into your womb through your cervix with a thin catheter (tube). This happens between two days and six days after fertilisation. As donors are usually under 36 years of age, it’s recommended that only one embryo is transferred in order to avoid a multiple pregnancy.
In some cases, the fertilised donor eggs and the resulting embryos are frozen to allow for embryo transfer to take place on another day. This means your menstrual cycle doesn't need to be synchronised with the donor. This may make your treatment cycle less stressful.
Improvements in freezing technology means it’s also possible for donor eggs to be frozen until selected for treatment. The thawed eggs are then fertilised with the sperm and the resulting embryos are transferred to your womb. This approach doesn’t require synchronisation with your menstrual cycle either.
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The waiting lists for treatment using donated eggs varies, but can be long. You can find a clinic that offers treatment using donated eggs and embryos on the internet.
If you want to shorten the wait, you could consider advertising for a donor or talking to a friend or relative who is willing to help. Many clinics offer egg-sharing, in which another woman who is already having treatment donates eggs for you to use. Once treatment begins, one cycle of IVF takes between four weeks and six weeks to complete.
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If you’re unable to produce healthy eggs, using donated eggs gives you the chance to conceive. Success rates for donor egg and embryo IVF can be higher than with regular IVF because donor eggs are almost always from young women.
. The shortage of donors can make it a lengthy process.
. Egg donation can be more stressful than regular IVF, because of uncertainty over whether the donor will produce enough eggs.
. You and your partner will need to talk through the difficult issues raised by donation. In the case of egg donation, you won’t be the genetic parent of your child. With embryo donation, it’s possible that neither of you will be genetically related to the child. So it may take time for you both to come to terms with that.
. You and your partner will also need to consider how you will tell your child about her genetic origins. Experts say that talking about it openly and honestly during childhood is usually the best course.
. Once you've conceived by donation, you may be more likely to develop high blood pressure conditions, such as pre-eclampsia. Experts believe this is because your immune system is reacting to the implanted embryo, which is genetically foreign to your body. It’s important to go to all your antenatal appointments, as your midwife will check for high blood pressure as part of your routine care.
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Donating your eggs is generally very safe; most women won’t experience any health problems beyond the discomfort of having the treatment itself.
The only potential risk to be aware of is having a reaction to your fertility drugs. Normally if this happens the effects are mild and include hot flushes, feeling irritable or down, headaches and restlessness.
In some very rare cases women develop ovarian hyperstimulation syndrome (OHSS). OHSS is a very serious and potentially fatal reaction to fertility drugs, which happens about a week after your eggs have been collected.
Symptoms include a swollen stomach and stomach pains and, in extreme cases, nausea, vomiting, breathlessness, fainting, a swollen stomach and reduced urine.
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Several factors may affect a woman's ability to donate eggs.
These factors increase the likelihood of a successful pregnancy and reduce the risk of congenital anomalies.
Generally, donors are between 21 and 35 years of age. Women in this age group tend to respond better to fertility drugs and often have a higher quality and quantity of eggs.
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The embryo adoption process may vary slightly depending on the agency embryo donors and adoptive parents choose to work with. In general, all embryo adoptions will include the following steps:
. Embryo Donation
The embryo adoption process begins when a couple chooses to donate viable, healthy embryos to another couple or individual who is struggling to grow their family on their own. Embryo donors are parents who have completed their families through in vitro fertilization (IVF) and have unused, frozen embryos left over. These embryos may be kept frozen in storage, discarded, donated for scientific research or donated to another person or couple who is interested in embryo adoption. Those who choose embryo donation are then matched with adopting parents through a fertility clinic or embryo adoption agency, or the donors may pursue an independent adoption with already-identified parents they’d like to donate to directly. Embryo donors also have the option of making their donation anonymously, meaning they are generally not involved in choosing the adoptive family they are matched with and do not meet or exchange identifying information with the adoptive family.
. Agency Selection
Adopting parents will apply to work with the embryo adoption agency. These agencies facilitate the embryo adoption, coordinating legal, medical, matching and counseling services and mediating contact for the donating and adopting families. The agency a family chooses to work with can impact the embryo adoption process, costs, eligibility requirements, available services and more. It is important for adoptive families to do careful research and select the embryo adoption agency that will best meet their needs.
When they are ready to begin the adoption process, prospective parents will be asked to provide information about themselves and the types of donated families they are interested in. Donors will similarly provide information about themselves, including their medical history, and the types of adopting families they desire for their embryos. Age, race, income, religion, existing children and desire for future contact are some of the factors parents might consider when selecting the types of families they’d like to be matched with. Families who match each other’s criteria will then receive profiles from matching donor/adopting families that they can choose from. If the families select each other and both agree to the match, they will move forward with the process together.
. Legal Contracts
The adoptive and donating parents will then complete legal contracts to transfer custody of the embryos. The donating parents will relinquish all rights to the embryos prior to the embryo transfer, and the contracts will give adoptive parents complete control over the pregnancy and parental rights when the child is born.
. Embryo Transfer
Once contracts are signed, the medical procedures may begin. The adoptive mother will likely receive fertility treatments to prepare her for the frozen embryo transfer (FET), which is a procedure very similar to IVF.
After the embryos are transferred, a pregnancy will hopefully be confirmed, and the adoptive mother will begin receiving prenatal care as she would for any other pregnancy. The entire embryo adoption process typically takes at least a year to complete. The exact length of time will vary based on many factors, including the adoption agency the family chooses to work with, the requirements they specified for the donor parents, the quality of embryos they require, and more.
Families interested in embryo adoption should contact different embryo adoption agencies and fertility clinic to learn more about estimated wait times for their specific circumstances. Just as in infant adoption, embryo adoption does not end with the placement or birth of the baby. Adoption is a lifelong process that presents unique benefits and challenges for adopted children and their parents long after their family is formed.
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Some women find they need several days of rest to recover from the transvaginal ovarian aspiration. Others return to normal activities the next day.
Some programs provide aftercare to donors, but others do not. As the egg donation process can have a psychological impact, some women may find it useful to work with a counselor or psychotherapist after the procedure.
Choosing embryo donation can also be cost-effective. According to a national infertility association, the average cost of embryo donation ranges from $2,500 to $4,000. IVF is an expensive fertility procedure in general. The price of a cycle of IVF depends on many factors, including the fee of the specialist and clinic, medications needed, and the number of embryos you want to get implanted.
Costs also vary depending on the pre-implantation diagnosis (PGD), and post-op care services. Additionally, some couples need egg donation, which increases the overall cost of treatment.
That said, the cost of an IVF procedure in Iran is much more affordable than many other countries. This is because fertility specialists and clinics in Iran charge much more reasonable fees compared with those in other countries though the cost of medications is not much different.
Typically, the cost of a cycle of IVF in Iran ranges from $3,000 to $5,000, inclusive of medications and all other related costs. This is while a cycle of IVF in the US, for example, would cost around $15,000, which does not include medications. This decent price of IVF in Iran has encouraged many couples who were looking for IVF abroad to travel to Iran to undergo the treatment
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Egg donors are women, usually between the ages of 21 and 34, who are willing to provide their eggs to a recipient. They may be anonymous (unknown) or known to the intended parents. Anonymous donors are recruited through egg donation programs or agencies and are not known to the recipient. However, some couples find donors through advertisements. Recipients should be cautious about recruiting donors without the use of an intermediary to screen the donors and should strongly consider seeking legal counsel. Known (also called directed) donors are generally a close friend or relative of the recipient Embryo donation may be handled via an agency or your fertility clinic. The donor is tested for infections such as HIV, Hepatitis B and C, gonorrhea, chlamydia and syphilis. All donors should be tested to be sure that they are not carriers of the cystic fibrosis gene. Other genetic testing should be performed based on the donor’s history and ethnic background. Some programs perform chromosome analysis and test for Fragile X syndrome; however, this testing is not required. Psychometric testing is often done as part of the mental health screening.
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