Science and medicine have helped overcome some of the biggest fertility challenges through the use of donor eggs or sperm, donor embryos and surrogacy. Third party reproduction is a widely available technology that enables infertile couples, single women and same sex couples to build their family. It is called ‘third-party reproduction’ because the reproductive process is made possible by a donation from a third person, the donation of eggs, sperm, embryos or a womb (in cases of surrogacy). Women and couples are able to conceive even in cases of irreversible ovarian failure, lack of sperm, anatomic anomalies, genetic disorders and same-sex marriages. While adoption is certainly an option for any person, some patients would like to experience pregnancy, breast feeding and/or the early newborn bonding process that may not be available in all cases of adoption. In this article, we will discuss the process for the use of donor eggs, donor sperm, embryo adoption and/or surrogacy to create a pregnancy.
Women may not be able to conceive with their own eggs for a variety of reasons. Some women may experience pre-mature ovarian failure or age-related ovarian failure which can cause a women‘s eggs to be unsuitable for pregnancy. Medical therapies like chemotherapy or surgery for certain pelvic disorders can leave a woman with limited or no ovarian function. These are just a few of the reasons why a woman may consider conception with donor egg. A boardcertified reproductive endocrinologist, like the physicians at Fertility Solutions, can discuss and initiate treatment options for conception using an egg donor. Donor eggs can be obtained via an anonymous donor, an egg bank, or, less commonly, a known donor (like a sister or a friend).
Eggs from a bank are ready for use immediately, whereas a fresh cycle with an anonymous or known donor requires a longer period of time to identify a suitable donor and then synchronize the donor and recipient cycles. There are pros and cons to bank vs. fresh donation: eggs that have been frozen may slightly lower success rates, however, there are also risks associated with a fresh donation-such as the donor not responding to medications as expected and not producing the eggs needed or a donor that decides to drop-out mid-cycle.
When considering donor egg as an option for conception, patients are able to see an in-depth profile for each donor, and can narrow their search for “the right egg” by choosing preferred ethnicity and physical characteristics. Donor profiles can include baby pictures of the egg donor, along with additional information like special talents, hobbies and education level. Most women prefer to choose donors who share similar ethnic backgrounds and physical attributes, increasing the likelihood that the child will resemble the recipient mother.
In a fresh anonymous donor egg cycle the egg donor and recipient undergo a process of cycle synchronization by administering hormones to both parties. This is to ensure the development of multiple eggs in the donor’s ovaries and to ensure the recipient’s uterus is in the correct receptive phase once the embryos are ready for transfer. The donor eggs are harvested from a pre-screened egg donor via IVF, where a physician extracts the eggs directly from the ovary. Once the eggs are retrieved, the donor’s job is complete. The donor eggs are placed in a small dish where they can be fertilized with sperm from the recipient couple. Within 3-5 days, if healthy embryos develop, 1-2 can be transferred into the recipient’s uterus. A pregnancy test 10 days post transfer will reveal if the procedure worked. Fresh donor egg cycles can have a pregnancy rate as high as 70% (depending on the age of the egg donor)! Babies born from donor egg will share the genetic makeup (DNA) from the egg donor and father. Though there is no genetic link to the recipient who bears and births the child, the child is biological to the recipient mother, and the law recognizes this: the donor has no rights beyond what was discussed contractually prior to conception. While the donated egg provided the DNA needed to create the child, the recipient also plays a critical role by nourishing, bearing and using almost every part of her body to grow this child in her womb for nine months.
Women may choose to use donor sperm if their male partner is infertile or carries a genetic disease that they do not want to pass on to their child. Donor sperm can also be used if a woman lacks a male partner, and for same-sex couples who wish to conceive. Like egg donors, sperm donors are screened for communicable and genetic diseases. Profiles containing in-depth information about the donors (including physical characteristics and ethnicity) are available so that couples can choose a donor that either resembles the male partner or has ethnic or physical characteristics that closely resemble theirs. Unlike egg donation, donor sperm is almost always obtained from a sperm bank.
Frozen donor sperm can be thawed and used for intra-uterine insemination (IUI), a simple procedure performed by an experienced nurse or physician. The IUI procedure maximizes the chance for conception for several reasons. Ovulation stimulation medication may be prescribed for several days prior to the procedure to maximize ovarian response and uterine receptivity. The procedure itself bypasses the vagina and cervix, depositing the sperm directly in the uterus, where it can easily reach the egg ready for fertilization. Because insemination success depends on many different factors, like age of the female, sperm quality and overall health, it is difficult to determine overall success rates for donor insemination procedures. In general, the monthly chance of pregnancy ranges from 8- 15%, these percentages may have a slight boost since the female is typically treated with hormones prior to insemination. If insemination treatments are not successful, donor sperm can also be used with IVF.
Donor Embryos/Embryo Adoption
Couples who have had to undergo IVF treatment to overcome infertility sometimes end up with surplus embryos frozen in storage. If they have completed building their family, they may choose to donate their remaining embryos to a woman/couple in need rather than discarding the embryos or donating them to science. Because the donated embryos have no genetic link to the recipient couple, it is much like adopting a child- but still having the opportunity to experience pregnancy and childbirth. The risk however, is that the procedure may not work, whereas in a typical adoption, a child is guaranteed.
Embryo adoption is a great option for couples who are interested in domestic adoption, that suffer with dual infertility, or women having difficulty conceiving due to an egg quality issue in addition to the absence of sperm. Fertility centers and embryo adoption agencies can match women/couples with an embryo based on ethnicity and other preferred characteristics. As with donor sperm or egg, embryo donors are screened for communicable diseases and some genetic diseases prior to donating, thus decreasing the risk of disease in the recipient and offspring. Due to the limited number of embryo donations nationwide, there are no national statistics for pregnancy rates following this procedure. Success depends upon the embryo quality, age of the donor and the number of embryos transferred.
Gestational surrogacy refers to the utilization of a third party to carry a pregnancy for a couple. The gestational surrogate has no genetic connection to the child she bears-the embryo is created and provided by the intended parents. Couples may need a gestational surrogate to carry their child for them if there are anatomical abnormalities that prevent the intended mother from carrying her own child. Uterine anomalies or the absence of the uterus, as well as other non-fertility related disorders (such as autoimmune disease, chronic pain, cancer or cardiac issues) are just a few reasons why a woman or couple may need to pursue gestational surrogacy. Donor egg can be used to create the embryos needed in gestational surrogacy if needed. Gay male couples may choose to use donor egg and gestational surrogacy to build their biological family. A fertility center familiar with the surrogacy process can refer couples to the proper agency that can match a couple with a surrogate that has been pre-screened. Legal contracts are drawn up prior to pregnancy to outline the relationship the couple will have with the surrogate during the potential pregnancy-such as prenatal care and the intended parents desire to attend prenatal care visits and the child birth. Typically, the relationship with the surrogate ends completely following childbirth.
Using Third-Party Reproduction: Other Considerations
Couples are encouraged (and sometimes required) to attend counseling sessions that will help them explore the many emotions associated with third party reproduction. The purpose for this is to discuss social and ethical issues associated with the procedure. Approaches for disclosure to the child and family can be explored and discussed. It is recommended, but not required, that parents inform children born through donation of their medical history.
All options for pregnancy using third parties whether donor egg, sperm, embryo or surrogacy, need legal contracts put in place (prior to pregnancy) that protect donors, recipients and their offspring. These legal documents ensure that donors are not responsible, financially or otherwise, for the children created from their donation, and recipients are recognized as legal parents of their offspring. Unless a specific contract or open donation is agreed upon prior to pregnancy, most third-party reproduction donations are anonymous and the relationship limited to the donation process (or in cases of surrogacy, limited to the pregnancy only). Fertility centers and donation agencies are familiar with the needed legal counsel when patients are undergoing third party reproduction, and can assist patients in navigating the complex but rewarding process.