What is gamete donation?
By Francesca Steyn RGN, Head of Nursing at the Centre for Reproductive and Genetic Health (CRGH)
Many individuals may require the assistance of a gamete (sex cells) donor in order to create their family. This can be for a number of reasons and factors including:
Azoospermia (when semen contains no sperm)
Same sex female couples who may require a sperm donor
Same sex male couples who may require the use of an egg donor and surrogate
There are many factors as to why individuals decide to embark on treatment with donor gametes and those reasons will be explained. The donation process will also be highlighted. In the UK, gamete donors can create up to 10 families by donation. This is recorded and the information is currently held with the HFEA (Human Fertilisation and Embryology Authority).
In this piece, we will focus on egg donation, sperm donation, embryo donation and recipients. We will mainly focus on gamete donation within the UK through an HFEA licensed fertility centre. However, some individuals and couples do travel overseas for treatment with donor gametes and this may be for a number of reasons including donor anonymity laws and donor availability.
When one woman donates her egg to another either in a known or unknown treatment cycle in order to achieve a family. The donor will undergo a cycle of ovarian stimulation in order to stimulate and mature the follicles (fluid filled sacs that contain female eggs).
In the UK, the HFEA regulate gamete donation and provide criteria for fertility clinics to follow:
Egg donors should be under the age of 35
Fit and healthy
Should not be carriers of any genetic or hereditary conditions
Egg donors will undergo screening for blood borne viruses, such as HIV and Hepatitis B and C, they will also be screened for blood karyotype and Cystic Fibrosis amongst other tests. An egg donor will also undergo ovarian reserve testing and this is usually in the form of an ultrasound scan to measure the Antral Follicle Count, ovaries and uterus, and then some hormonal blood tests which are usually AMH (Anti Mullerian Hormone) and/or FSH, LH (Follicle Stimulating Hormone and Luteinising Hormone) and E2 (Oestradiol). Egg donors are also required to attend implications counselling and their emotional wellbeing should be considered, a full history of their physical and psychological health will be taken including that of their immediate family.
Once the donor has been assessed and meets the criteria for donation, she will begin the donation process. Some clinics have an egg bank on site and they are able to stimulate egg donors, perform an egg collection to obtain the eggs and then cryopreserve the eggs and store them in the egg bank for future use. This allows egg recipients to choose the characteristics that they are looking for from the eggs already stored.
The eggs will then be thawed and fertilised by either IVF (In Vitro Fertilisation) or ICSI (Intra Cytoplasmic Injection) with either donor or partner sperm at the time of treatment to create embryos to be transferred.
Other options are to synchronise the egg recipient with the egg donor so that at the time of the donor’s egg collection, the eggs can be fertilised with donor sperm or partner sperm to create embryos. Those embryos are then transferred into the uterus of the recipient known as a fresh embryo transfer.
It is good practice to recommend ESET (Elective Single Embryo Transfer) for good quality embryos to minimise the risk of multiple births and the complications that can arise surrounding multiple pregnancy and birth. Any good quality surplus embryos can be cryopreserved for future use.
Egg sharing is a type of egg donation treatment that is offered at some clinics. This is a process where a female (who needs IVF herself) will donate 50% of her eggs to an anonymous recipient and fertilise the rest of the eggs for her own treatment with either partner sperm or donor sperm. Many individuals may opt for egg sharing as it significantly reduces the cost of their own treatment and they are able to help another woman/family.
This is also a popular treatment type for same sex female couples as they can both be physically involved in the treatment and pregnancy process. The above process works the same way, but one female will donate her eggs to her partner (and in some cases an anonymous recipient) this is often called shared motherhood.
When a man chooses to donate his sperm to a donor sperm bank, or to a female embarking on treatment in a known sperm donation or co-parenting arrangement. The man providing his sperm will complete a number of tests and investigations (as the egg donors outlined above) and they will provide sperm samples that meet the WHO (World Health Organisation) criteria for semen analysis parameters. The semen sample will be prepped in a laboratory and cryopreserved for future use by a recipient in a treatment cycle such as IUI (Intra Uterine Insemination) or IVF.
Some people choose to import donor sperm from overseas as they are able to obtain further information about the donor, which we are unable to provide in the UK for example photos of the donors. If someone decides to import donor sperm from overseas, they must be made aware that they should choose a donor who has consented to export to the UK and most importantly, that they have consented to comply with HFEA regulations regarding family limits. We also need to ensure that the donor conceived person can have access to identifying information about the donor when they reach 18 years of age, which is an HFEA regulation.
As sperm donation is not as invasive as an egg donation cycle, sperm donors will be encouraged to bank enough samples (ensuring that the abstinence period to allow sperm cells to reproduce is followed) during a specific time period to ensure that a good amount of sperm is available for a recipient’s treatment cycle. The same rules apply for sperm donors as they do for egg donors with regards to the 10-family limit. Sperm donation is offered in most UK fertility clinics both within the NHS and private sector.
More and more people are now deciding to donate any excess embryos they may have cryopreserved in the laboratory from previous treatment cycles if they have completed their families. This gives recipients the choice of choosing a donor embryo for their treatment if they require both egg and sperm (double) donation. In this case, both the male and female that have provided their gametes will need to be screened as donors as outlined by the HFEA. This is often done retrospectively as the embryos are donated after their creation. Embryo donors may also not fit into the usual criteria of being under 35 (egg donors) or under the age of 41 (sperm donors), but clinics will take into consideration any medical history of the donors that may have an impact on the outcome of the donation or any child born as result of the donation.
Clinics may also only accept good quality embryos to be donated to ensure the best possible outcome for the recipient’s treatment.
As a recipient of donor sperm, eggs or embryos, the first step in the process would be to see a fertility specialist at a fertility clinic to discuss your options, the treatment type and drug regime if applicable, and the timelines for your treatment. It is also best practice to attend an implications counselling session with a fertility counsellor through your clinic to ensure that you have all of the information required in order to make an informed decision about your treatment. Most clinics will be able to provide you the details of a counsellor they work closely with.
Your treatment will be individualised and planned for you, taking into account your medical history. Treatment as a recipient of donor eggs, sperm or embryos can take place by means if IUI (Intra Uterine Insemination), IVF (In Vitro Fertilisation) and by means of an FET (Frozen Embryo Transfer) cycle.
Individuals that undergo treatment with donor gametes or embryos will become the legal parents of the child when they are born and the donor themselves will not have any parental rights or parental responsibilities unless they are donating as part of a co-parenting arrangement.
The HFEA have provided legal parenthood consent forms for unmarried couples using donor sperm or embryos in their treatment to confirm legal parenthood status and for the parents to be named on the birth certificate. Legal advice can always be sought if any queries arise prior to treatment. More information regarding legal parenthood can be found on the HFEA website.
For more information about the use of donor gametes, please see:
FOR FURTHER INFORMATION, CONTACT:
Francesca Steyn RGN
Francesca Steyn is the Head of Nursing at the CRGH (Centre for Reproductive and Genetic Health) based in London and has a specialist interest in gamete donation and surrogacy.
She is a steering committee member on the Royal College of Nursing (RCN), Fertility Nursing Forum and is also an active member of the Senior Infertility Nurses Group (SING).
Francesca has co-authored national guidance and publications on surrogacy, fertility education and fertility preservation and has presented both nationally and internationally on fertility nursing care and best practice.