Donation (Egg, Sperm & Embryo)
These pages provide information relating to Egg, Sperm and Embryo donations. It is expected to supplement but not replace further opportunities for you to discuss the implications and any other specific questions that you may have with a counsellor, nurse or a doctor.
You should not feel under pressure when making up your mind and we hope that this information may help you to decide if donating eggs or accepting donated eggs is right for you.
What is the risk of a Congenital abnormality?
The risk of a congenital abnormality after treatment using donor sperm is believed to be the same as for natural conception in a normal couple that is approximately 1 - 2%. GP's and those responsible for the obstetric care routinely advise the recipient couples about prenatal diagnostic tests as appropriate.
Regulation of egg, sperm & embryo donation
We recommend reading the leaflet What you need to know about donating sperm, eggs or embryos" produced by the Human Fertilisation and Embryology Authority, the official government body regulating and licensing IVF units in this country.
Identifying information regarding the Donors
A recent change in the law has established that the child has a right to know his/her genetic origin. Children born following treatment taking place after 1st April 2005, have the right to know their origins at the age of 18 years or at 16 years, if contemplating marriage.
- People who donated before 1st April 2005 on an anonymous basis, and whose donations have either been used in treatment or remain in storage, may choose to become identifiable.
- Donors registering after 1st April 2005 have to provide identifying information which the HFEA may release, on request, to people aged 18 years or more and who have been conceived with gamete or embryo donation.
- Donations made before April 2005 can only be accepted if the donor has waived their right of anonymity.
- An exception to above is where donation was made before 1st April 2005 on an anonymous basis and samples are stored for a sibling pregnancy. In this case sperm, eggs or embryos may still be used up to the maximum legally permitted storage period.
Identifying information about donors is held on the HFEA Register and may be given to any child born from a donation once they are 18 years old (if the donor is registered as identifiable). All donors have to waive their right of anonymity since the Only HFEA s empowered to release identifying information about the donors to the child.
A donor-conceived person aged 16 and over, is entitled to apply to the HFEA and access non-identifying information that the HFEA hold about the donor. At the age of 16 years, persons conceived with donated gametes or embryos can submit a joint application to establish whether they are genetically related to their partner before entering an intimate physical relationship.
From the 1st October 2009 the HFEA permits centres to release non-identifying information to recipient couples about their donors. This includes information about the screening tests performed before donation and their results as well as personal non-identifying information such as hobbies, likes/dislikes/ professional qualifications and a personal message written by the donor.
We encourage couples to tell the child/children if donated gametes have been used. This should be done at an appropriate time in their lives. Information, support and implications counselling is available within the clinic to help guide you through this process. External support is also available- see useful addresses.
All couples and donors are advised to explore the implications of these regulations. Counselling services are available to all donors and recipient couples to assist in the process of consideration. When in doubt, please seek independent legal advice.
The donor has the right to change her mind up to the point the embryos have been placed in the recipient. Embryos created using donated eggs can only be stored for a patient with the consent of the donor. On the other hand, the donor has no rights once embryos have been transferred to the recipient.
The donor may ask the centre, at any time, how many children have been born as a result of their donation, their sex and year of their birth.
Limitation to the number of pregnancies with each donor
Legally in the UK, eggs or sperm from any one donor can be used to produce a maximum of TEN children or TEN families. In reality, this possibility is extremely unlikely for egg donors. However, donors may set a lower limit should they wish to do so.
Implication counselling is required for both donors and recipients.
In addition to this:
Free counselling service with a trained counsellor is routinely available to all upon request. It is carried out by HFEA licensed counsellor/s, either on or away from the unit in the Department of Clinical Psychology which you may find less stressful. Appointments can be made directly by yourselves or via the Centre. If you require an interpreter, you are advised to give sufficient notice for an independent interpreter to be arranged.
The counselling is entirely confidential and private between you and the counsellor and will not be judgmental or prejudicial. The counsellor is also HFEA licensed and has a statutory duty to give essential information that may affect the Welfare of future or existing children to the team. This is exceptional.
The effect of embryo donation on the donors and any existing children is carefully discussed with donors. If the children of the donors are of an appropriate age they are also asked to discuss the matter with their children.
Screening of Donors
Donors, by law, have to be at least 18 years of age and the woman must not exceed 35 years in age, and the man cannot be more than 40 years of age. They have to be of normal intelligence, in good health and with no past or family history of severe physical, mental or genetic disease. All donors are required to submit details about their personal, medical and family history.
Please be advised that it is possible that a donor-conceived person if disabled as a result of an inherited disorder may be able to sue the donor for damages if he/she can prove that the donor knowingly did not disclose the inheritable disorder or reasonably ought to have known about the disorder.
All donors are carefully screened according to current guidelines and best practice.
Which screening tests are performed?
All prospective embryo donors (both female and male) have an analysis performed of their chromosomes.
In addition, we routinely test for cystic fibrosis. The screening will be performed for only the 12 commonest gene mutations in the Caucasian and Northern European populations. These mutations account for 85% of all varieties known to medicine to date. Exclusion of these mutations reduces the risk of being a carrier for cystic fibrosis to about 1% for these populations. In other population's e.g. Asians, the incidence of cystic fibrosis is much lower than that among Caucasians. Whilst all 12 mutations known to be common in the Caucasian and Northern European populations are excluded, the risk of being a carrier among the Asian donors cannot be accurately determined.
In addition, wherever appropriate additional screening tests may be applied. For example:
- East European, South Asian and Middle Eastern donors are screened for Thalassaemia.
- Donors with African descent are screened for Sickle cell disease.
- Jewish donors are screened for Tay Sach’s disease.
It is very important for the recipient couples to understand that not all known gene mutations are or can be possibly screened for and even after screening of some, there may be others for the same disease that are either uncommon or are not yet known. Hence the likelihood of developing these illnesses can be minimised with this screening but cannot be completely eliminated.
Screening for infections
- All embryo donors are screened for HIV, hepatitis B and C.
- Syphilis: All embryo donors are screened for syphilis
- Cytomegalovirus (CMV): This virus commonly infects people and in normal circumstances gives a minor flu like illness. However it can become activated in pregnancy and can harm the baby. It is a very common infection in the normal population and many of us are exposed to it during our lifetime. We screen all donors and use CMV negative donors only for CMV negative recipients. On the other hand, CMV positive recipients can have gametes from both negative and positive donors.
How are the Donors matched to the Recipients?
Physical characteristics such as height, weight, body build, hair colour, complexion, eye colour, race and blood group etc are recorded. We try to provide an acceptable match. There are fewer donors and detailed matching for physical characteristics can prove difficult. Matching for ethnic origin and rhesus blood group is always performed. Exceptions are always discussed with the recipient couple in advance.
The first pregnancy following the use of donated sperm was reported in 1884 but it was not until 1983 that the first pregnancy following the use of a donated egg was reported. Sperm can easily be collected and frozen (cryo-preserved) for storage. Eggs, in contrast, are difficult to collect and, at present, cannot easily be frozen for storage and future use.
With the advent of the technique of IVF, however, it is now possible for a woman to donate eggs (the egg donor) to another woman (the egg recipient). Only clinics that have been inspected and are licensed by the Human Fertilisation and Embryology Authority (HFEA) can set up an egg donation programme. Such a programme has existed in Leeds since in 1993.
Why do some infertile couples need egg donation?
Some couples can only achieve pregnancy by using eggs donated by another (fertile) woman.
They can be divided in 2 categories:
Women whose ovaries cannot produce eggs at all, or produce poor quality eggs
- For a variety of reasons some women's ovaries are not able to produce eggs. The most common causes are:
- Women born without ovaries or with under-developed ovaries (eg Turner's syndrome).
- Women whose ovaries stopped working prematurely. Most women go through the menopause in their mid to late 40's or early 50's. After the menopause a woman is no longer capable of conceiving because her ovaries stop producing eggs and sex hormones. However, to some women these changes can occur much earlier, even in their teens or twenties before they would even have contemplated to try to get pregnant. This is known as premature ovarian failure or premature menopause.
- Women who have become sterile after surgery, radiotherapy or chemotherapy.
- Women undergoing infertility treatment but whose ovaries do not respond to traditional fertility drugs (such as Clomiphene tablets or FSH injections).
- Women undergoing infertility treatment but whose ovaries consistently produce poor quality eggs when stimulated (particularly more common in the older age group).
For these women, egg donation is their only realistic chance of achieving a pregnancy.
Women who are suffering from, or are carriers of certain genetic diseases
Some women may be carriers of diseases such as Duchenne muscular dystrophy or haemophilia. These diseases can be passed on to their offspring. Rather than risk giving birth to a child who might suffer greatly and die at an early age, they may choose to avoid the possibility of having an affected child by using donor eggs from another woman who is not a carrier.
Who donates eggs?
Donors undergo the procedure voluntarily and for altruistic reasons. The HFEA provides guidance on financial reimbursements to the donor, which covers expenses for travel and loss of earnings (SEED REVIEW: details can be accessed from the ACU staff and the HFEA website).
Our donors are recruited from several sources
Anonymous volunteer donors:
Women who are in a stable relationship, have already had children, preferably have completed their own family, and feel that they want to help infertile couples. Such women have come forward on their own initiative and have only altruistic motives. No financial incentives are involved.
Close relative of the patient:
- Some patients for ethnic, cultural or religious reasons and others as a personal preference choose to have a 'known donor' such as a sister or close friend of the female partner. Donation between known donors and recipients is acceptable after careful implication counselling. We adhere and remain within the law and its provisions at all times.
- Nationally there is a shortage of anonymous donors and some donors as well as recipients prefer anonymous donation because it makes the likelihood of emotional conflict in the family or between friends less likely. We can match another donor recruited by a different couple for your friend /relative whilst you donate anonymously to a different recipient. In this way treatment can be expedited for both your relative/friend and for others.
Some programmes have an egg-sharing scheme where screened and counselled infertility couples donate some of their eggs in return for subsidised treatment for themselves. We have not initiated this scheme because we have been concerned with the effect that loss of permanent anonymity between donors and children might have in time on the children, donor and recipient couples. However, such a scheme is operational in several other centres with HFEA's permission.
Information for Recipients
What to do if you are interested in receiving donated eggs?
Only clinics that have been inspected and are licensed by the Human Fertilisation and Embryology Authority (HFEA) can set up an egg donation programme.
You may have recruited a donor to assist with your treatment via the newspaper or television, or via a friend or relative who is willing to undergo IVF treatment in order to donate eggs.
Once a donor has been recruited to assist you directly or indirectly by donating anonymously with in the programme, the first step is to go and see your GP and ask him to refer you to our centre or if you are already a patient contact our egg donation nurse co-ordinator.
You and your donor will be sent an appointment to be seen in The Leeds Centre for Reproductive Medicine (LCRM) itself and will be seen by a doctor within the team. It is preferable to come together as a couple with your partner and also the donor if known to you. The doctor will discuss your motivation, the social, medical and legal aspects of egg donation; explain the techniques involved and the potential side-effects and risks. A full medical and family history will be taken from you unless you are already known to us.
For donors it is of particular importance to mention any inherited diseases in your family. It may be necessary to obtain further details from other clinics or your GP. You will be given some further literature to read at home and some time for reflection.
If you would wish to seek information about your child’s donor or genetically related donor-conceived siblings you may find counselling, or similar support services, on the implications of receiving such information beneficial and highly advisable.
Information for Donors
What to do if you are interested in becoming an egg donor?
You may have heard about becoming an egg donor via the newspaper or television, or via a friend or relative who is undergoing IVF or needs donated eggs. The first step is to go and see your GP and ask him to refer you to a unit with an egg donation programme. Only clinics that have been inspected and are licensed by the Human Fertilisation and Embryology Authority (HFEA) can set up an egg donation programme.
You will be sent an appointment to be seen in The Leeds Centre for Reproductive Medicine (LCRM) itself and will be seen by a doctor within the team. You can also make such an appointment yourself by telephoning the LCRM directly on the direct line in front of this booklet between 8am and 5.30pm.
It is preferable to come together as a couple with your partner. You will see one of the doctors in the centre. The doctor will discuss your motivation, the social, medical and legal aspects of egg donation; explain the techniques involved and the potential side-effects and risks. A full medical and family history will be taken from you.
It is of particular importance to mention any inherited diseases in your family.
It may be necessary to obtain further details from other clinics or your GP. You will be given some further literature to read at home and some time for reflection.
Freezing of Embryos
Decisions regarding freezing, storing and discarding embryos formed with donated eggs must comply with written consents of both the donor and recipient. This includes how long embryos can be stored and whether or not they can be used after the death or mental incapacitation of the donor or recipient.
It is possible for either donor or recipient to withdraw consent to storage, in which case the embryos have to be allowed to perish.
We usually advise embryo freezing only if there are at least three suitable embryos. The embryos can be kept frozen for 5 years (up to a maximum of 10 years in certain circumstances) from the date of freezing.
Recipients may wish to have embryos frozen for 6 month quarantine period (as in the case of sperm donors) to ensure that the risk of transmission of infections is minimised. However there is a loos of viability in some of the embryos when they undergo the freezing and thawing process and pregnancy rate may be lowered by 5-10% per cycle on an average. There is also delay in your ability to receive the embryos for transfer and pregnancy which you must consider.
The donor’s eggs could be used to create embryos with donated sperm that are then donated to a recipient couple who has been specifically and suitably matched to both donors. Such an option is only possible if both an egg donor and donated sperm are available as per the legal requirements. Occasionally other couples donate their spare embryos to other recipients who need both the sperm and the egg. The donating couple are screened as per legal requirements for any donor and as descried above.
Research is carefully regulated and centres have to obtain specific research licences for the projects that they conduct or take part in. From time to time we are involved in research projects and we will provide relevant information to you if appropriate.
A Typical Cycle
This section has been written in the expected order of various steps in treatment. You may find helpful to refer to this section regularly during treatment.
a. First clinic appointment.
A full discussion of the relevant personal and family history takes place in The Centre. We aim to minimise your visits and do not repeat investigations unless deemed essential for the conduct of your treatment.
b. Screening tests.
These tests are arranged as explained above.
c. New Patient's Seminar.
We very strongly recommend that you attend this open seminar by the team. Dates are available on request from the unit.
d. Implication counselling.
You will be advised to see the counsellor so that implication of what you r donation to you , your spouse and your family can be discussed fully and all legal issues can be discussed.
e. Follow up clinic visit.
You will attend the clinic for discussion of screening tests and you have this opportunity to clarify any outstanding issues that have arisen in your mind with respect to your treatment. At this visit, you will receive a prescription and also be advised to see the Egg Donation Nurse co-ordinator on your way out so that you can be given a start date for your treatment.
f. Consultation with the Nurse Specialist.
Both Partners must attend this appointment (see details) because you both will be required to sign consents, receive instruction for self administration of injections and a cycle plan.
g. Suppression of your natural hormones.
Your treatment needs to be co-ordinated with that of the donor if you are to receive ‘fresh embryos’. Hence for women with regular periods, we prefer to inactivate your menstrual cycle first. We do this by starting drugs on the 1st or the 21st day of the menstrual cycle using a nasal spray, a daily injection or a single depot preparation. This is maintained until you are ready to receive oestrogen tablets and can last for 3 to 7 weeks. In women without a menstrual cycle as in case of women with premature menopause, we simply stop the HRT tablets allow you to have a period and then do not start the next packet until we are able to start your oestrogen tablets in co-ordination with the donor’s cycle. A baseline scan is performed, usually prior to starting this phase, unless you have had another recent scan within the preceding 3 months.
h. Endometrial Stimulation.
In order to develop your lining of the womb we start you on the oestrogen tablets at the correct time and in co-ordination with the donor’s cycle unless the embryos have been created and frozen already. This treatment can lasts for approximately 9-14 days and until the donor is ready to receive her HCG injection to begin the final phase of egg maturation. Then you also start the progesterone in the form of pessaries or injections. These medoications continue until the pregnancy test and can take further 20 days.
i. HCG injection.
This injection prepares the eggs for ovulation and is given late in the night (usually between 10 p.m. and 2.00 a.m.) to the donor.
k. Egg Collection. The eggs are collected approximately 35 to 37 hours after the hCG injection.
j. Insemination or ICSI.
Male partner of the recipient gives a sperm sample (unless a frozen sample is already available) for preparation and insemination of the eggs by the direct method or by the ICSI procedure.
k. Checking Fertilisation.
The recipient will receive a telephone call with necessary information on this day.
l. Embryo Transfer and Hormonal Support.
The embryos are replaced in the womb of the recipient.
m. Luteal phase medication.
This is provided to all recipients until the pregnancy test as described above. Once pregnant theses medications are continued until we know that the placental function is fully established which is usually at 9-10 weeks gestation. After this we can gradually withdraw all hormonal support and allow the pregnancy to progress naturally.
n. Follow-up consultation.
This is arranged after the cycle has been completed and if you have not conceived.
p. Pregnancy scans.
These are preformed for successful couples at 7 weeks and at 10-12 weeks gestation.
If you would wish to seek information about your child’s donor or genetically related donor-conceived siblings you may find counselling, or similar support services, on the implications of receiving such information beneficial and highly advisable.
Risks in an egg donation cycle
There are no treatments that are completely free of risk. In an Egg donation cycle there are the following risks
The risk of miscarriage after a positive pregnancy test alone is approximately 10-20%. This is no different to that after a normal conception. Once the pregnancy sac has been seen and the fetal heart action identified then the risk of miscarriage is substantially less. The risk of a congenital or genetic abnormality in babies born after IVF has not been higher than that in spontaneously conceived pregnancies. Your personal risk is more likely to relate to your age, your family history and whether or not you have a multiple pregnancy.
Risk of an ectopic pregnancy
The embryos are not ready to implant at the time of their replacement. At that time they are in a very small volume of fluid which we expect to spread like a thin film on the surface of the lining of your womb. The embryo may sit in a fold of the lining of the uterus until it reaches the stage of implantation. The risk of embryo floating away in the direction of the fallopian tube exists in all patients. In normal circumstances we expect that the fine hair in the tube that beat in the direction of the womb will prevent such a migration. However in some cases this may not happen and the embryo enters the tube. Unable to return to implant in the uterus and especially in women with damaged tubes, it may attach itself to the tube and thus a tubal pregnancy occurs. If left undiagnosed, the tube may rupture and internal bleeding may take place. We endeavour to make an early diagnosis by performing an ultrasound scan at 7 weeks of pregnancy (3 weeks after your pregnancy test).
- It is therefore important to attend for the pregnancy test even if you have bled and for the scan after a positive test. If a pregnancy sac is not seen on scan, a blood test is taken to measure the pregnancy hormone (hCG) level in your blood. You may be asked to attend for more tests after a few days interval. If this level is rising or static then we may perform a laparoscopy.
- If you are unlucky and have a tubal pregnancy then you will require the removal of the tube. We may also counsel you regarding the future of your remaining tube in case it is already known to be irreparably damaged or is found to be such at surgery. We advise you to consider removal of both tubes in those circumstances in order to avoid a recurrence of this complication in future. This is an important decision as it is sterilising and no steps are taken with out your written consent and complete agreement.
- For the operation you will be admitted to St James's to prevent an untoward occurrence whilst travelling. The risk of an ectopic pregnancy is approximately 3-4%.
- Occasionally you can have a combined intrauterine and an ectopic pregnancy (heterotopic pregnancy). These are more difficult to diagnose. If present then often but not always, the tubal pregnancy can be removed with out harming the uterine pregnancy.
- We perform a risk assessment for this complication too in our pre-assessments. If you are already known to have damaged tubes you may choose to have removal of the tubes (salpingectomy operation) performed before the treatment cycle in order to minimise the risk of this complication. This is a sterilising procedure and future pregnancies will only be possible after IVF. Therefore you have to be completely at terms with your infertility if you undertake this procedure. It is performed in most cases laparoscopically (key hole method) and you do not need prolonged recovery or delay to treatment afterwards.
Risk of equipment failure
The trust maintains service contracts for all equipment that is regularly serviced. There are also many standard operating procedures in the laboratory that help us have an early warning for problems. Despite all our efforts and very uncommonly equipment failure may sometimes lead to loss of eggs or embryos. This is a 'Category A' incident that will be immediately notified to HFEA, the trust and you. There would usually be a thorough investigation and steps taken to prevent a recurrence of similar problems. The HFEA also operates an Alert system which we use to learn from incidents elsewhere.
- Although some have raised alarm over the risk of ovarian cancer with the use of hormones, these preparations have been used in treatment since early 1960's without any notified cases that can be directly liked to the use of these hormones. The available evidence suggests that there is no increase in your risk over and above that exists naturally. Infertility per se, delay in first pregnancy, and failure to breast feed, family history, obesity and smoking are known risk factors for the cancer of the ovary and the breast.
- There have been no cases of complications with protein impurities in the urinary preparations. Theoretically some have worried those external proteins when injected could transfer viruses or prions that could lead to an illness like CJD at a later date.
This section is there for your information and to reassure you that as far as we know none of the publicised risks have been scientifically confirmed.
Risks of ICSI
ICSI was pioneered by a group in Brussels in 1992 and hence since rapidly become accepted in IVF centres around the world. The oldest child is therefore very young still and as it is significant invasion into natural processes where a natural fertilisation and pregnancy would not have occurred, its long term risks are not known.
ICSI is an invasive technique and may also use sperm that would not otherwise be able to fertilise an egg. For these reasons, concerns about the potential risks to children born as a result of ICSI have been raised, and several follow-up studies have been published. ICSI is still a relatively new technique, and all children conceived using ICSI are still very young. Consequently, these follow-up studies involve relatively small numbers of children and do not include effects that may be seen in older children or in the next generation.
The HFEA considers follow-up studies to be extremely important and would encourage patients to talk to their treatment centre about participation in such studies. Clearly, more studies are needed, but the use of ICSI has been potentially linked with certain genetic and developmental defects as explained below:
These risks are only to the offspring and primarily relate to the recipient and the male partner’s cause of Subfertility. It is therefore appropriate that you consider it an experimental procedure. Hence this section is not described here in detail. However further information can be provided to those who are interested.
Common causes of failure
These are as follows:
- Failure to recruit optimum number of follicles with or without poor hormone levels.
- Premature release of the eggs (very uncommon).
- Unexpected illness.
- Failure to Fertilise: This may be due to defective sperm, low number of sperm, functional abnormalities of the sperm, unknown technical failure and infection in the seminal sample (uncommon).
- Failure of Cleavage: Occasionally fertilised eggs fail to divide and continue their development. Not all fertilised eggs will cleave to form embryos.
Although these are common causes of failure, sometimes failure also occurs even when everything has apparently gone well. Sometimes we may not have an explanation for why a pregnancy fails to occur. Mostly in these cases the embryos have failed to maintain their growth and development because of indigenous, not necessarily repetitive genetic abnormalities. We know that the risk of genetic abnormalities in naturally formed embryos and In normal couples is nearly 50%. Embryos created in IVF cycles have the same incidence overall but this risk exponentially increases with age and is substantially increased in women at or above the age of 40 years.
Most genetically abnormal embryos fail to implant, maintain growth to become pregnancies or may miscarry after a positive test. In this situation usually the prognosis for future attempts is good and we will discuss any specific predisposing factors that you may have. We may consider the removal of hydrosalpinges (swollen tubes), endometrial polyps or fibroids (if present) in some cases before repeating the treatment cycle.
Who donates embryos?
Couples with frozen embryos are offered the chance to donate their spare embryos to other couples if they have completed their family or concluded their treatment. All donating couples do so voluntarily and for altruistic reasons. The HFEA provides guidance on financial reimbursements to the donor, which covers expenses for travel and loss of earnings (SEED REVIEW: details can be accessed from the Centre staff and the HFEA website). No financial incentives are involved.
Why do some infertile couples need embryo donation?
Some couples can only achieve pregnancy by using embryos donated by another couple.
- Both the woman and the man have undergone infertility treatment but have failed due to the profound effects of age (for example women >43 years in age) on the developmental competence of their eggs or sperm. This is by far the largest group of patients who could receive donated embryos.
- Woman or the man has become sterile after surgery, radiotherapy or chemotherapy when the spouse may have other reasons for failing to produce eggs or sperm.
- Some couples may be carriers of genetic diseases that can be passed on to their offspring. Mostly only egg or sperm donation will be required in this group but very occasionally embryo donation would be appropriate, for example when the male partner is the acrrier and the female partner is above the age of 43 years.
For these couples, embryo donation may be their only realistic chance of having a child.
Treatment for same sex couples and single women is considered on an individual basis after careful consideration of the Welfare of the Future Child/Children.
Who needs Sperm Donation?
Broadly the recipients are female partners of men suffering from
- azoospermia (absence of sperm)
- sub-fertility due to genetic causes
- Couple’s suffering from dominant hereditary diseases
- Same-sex couples and single women