By fertility experts from Spain.
Deciding whether to use a non-anonymous gamete donor (who agrees to disclose personal information) or completely anonymous donor has always been a hot topic. And no wonder – the choice you make will have an impact not only on you but also on your future child and the donor.
In this webinar, Mireia Poveda Garcia, MSc, Embryologist & Director of the Laboratory at UR Vistahermosa, Alicante (Spain), is discussing anonymous vs. non-anonymous egg donation treatment, including the main differences and most important aspects.
One of the most crucial questions each patient going for egg/sperm donation has to ask herself is: what would you like the selection process to be? And the answer depends mainly on the law of each country (and some of them allow only for non-anonymous egg donation). Nowadays, more and more patients, who are not accepting the limitations set by their closest environment, visit fertility centres abroad in order to fulfil their dream of becoming parents. Mireia Poveda Garcia stresses the importance of a well thought out choice in this matter – one has to realise its potential impact (on our life, the life of our child, the donor’s and her own kids’ life, etc.) and always consider all possible options very carefully.
Egg donation is allowed in a number of countries around the world – with the U.S. as the leader in terms of egg donation treatments performed annually. Spain holds the second place in the share of total egg donation transfers worldwide. Both of these countries can also boast the highest number of experienced fertility clinics performing this procedure. According to the European Society of Human Reproduction and Embryology (ESHRE), most European countries allow egg donation (except Germany, Switzerland and Norway). Spain, the Czech Republic, Russia and the UK represent 80% of all egg donation procedures performed in Europe.
Whenever you decide on egg donation treatment, you have to realise the fundamental premise in all donor conception regulations. Mireia Poveda Garcia reminds us that the recipients will be the child’s parents from the beginning, the donor cannot claim any family rights (but has parental responsibility) and the couple receiving the donation become the legal parents of the child, according to the general rules governing legal parentage. With the exception of special cases, claiming or challenging the legal parentage of the child born as a result of egg donation is forbidden.
According to Mireia Poveda Garcia, learning all the legal aspects of gamete donation treatment is just the initial step. There are many factors to evaluate when choosing a specific egg/sperm donation treatment plan, such as rates of pregnancy, donor qualification tests, similar phenotype features and – last but not least – open or anonymous donation. In order to help patients make well-informed choices, it is very important to provide them with a flexible dual-track system that includes psychosocial support and education.
There are clearly many important differences between non-anonymous and anonymous donor treatments. That’s why it is essential for intended parents to receive comprehensive consulting in the matter in order to understand the proposed treatment options and the advantages and disadvantages associated with them.
In case of non-anonymous egg/sperm donation, Mireia Poveda Garcia differentiates three types of donors: known donor, open donor and semi-open donor. The first type refers to an acquaintance, a friend or a relative – someone who knows and understands the recipient very well. Apart from that, there are non-anonymous donors that can be found on online platforms or fertility clinics. There two kinds of such donors: open donor ( when more identifying details are shared and meetings with recipients take place) and semi-open donor (when personal information is exchanged with the recipient but communication usually fails to occur directly).
When it comes to anonymous egg/sperm donation, there is no way for the intended parents or the donor-conceived child to contact the donor (and vice versa). Her/his identity and personal details will never be disclosed. In most European countries (such as Spain, Greece, Croatia, the Czech Republic and Ukraine), potential egg and sperm donors remain completely anonymous. The donor selection is made by the medical team and tools for that process are based manly on facial similarity. A good example of the latter is Fenomatch – the first biometric facial recognition programme that allows doctors to select the donor that looks more like the patient. Mireia Poveda Garcia says that the assisted reproduction law in Spain establishes the criteria for the doctors to follow when selecting the gamete for donation. The same law also states the impossibility of the couple to choose the physical characteristics or the sex of the child. However, embryologists nowadays are able to classify and select eggs or sperm according to the phenotype similarities (such as height or eye/hair/skin colour) and immunological factors between the donor and the recipients.
Mireia Poveda Garcia admits that when trying to determine whether one system is better than the other, the conflict is bound to arise. The decision about the type of donor is very complex. When evaluating donor anonymity, several factors have to be taken into account – first of all, these are genetic, psychological and ethical aspects.
In case of genetic aspects, there is one most common argument against maintaining the donor anonymity – if the child’s health is at stake. It refers to genetically inherited diseases. However, advances in decoding the human genome has made comprehensive genetic testing for heritable diseases more accessible. Today donors are screened more than before – and for that reason, the claim that removal of donor anonymity addresses the child’s health is simply a weak argument. Another genetic aspect is epigenetics. It includes inheritable changes in gene expression that don’t involve changes in DNA sequence – meaning changes in phenotype but not genotype. Epigenetic markers can be affected by prenatal and early postnatal environmental factors, such as health or lifestyle. So we can say that there is some genetic implication of the recipient woman in the future child – and it’s one of the reasons given in the countries that maintained the donor anonymity.
Egg donation is always related with many psychological and ethical aspects. Mireia Poveda Garcia reminds us that all parties involved into donation process must be taken into account: potential parents, donor and donor conceived children. Parents have the right to privacy and confidentiality of their decisions that they take according to their values and beliefs. Studies on egg donation show that a vast majority of couples who choose a known or identifiable donor do not accept to share parenting with the donor and they prefer that the donor has a limited relationship with their child. According to Baetens et al. (2000) report on 144 couples, 69% of recipients prefer open donation. However, approximately one third of recipients couples preferred an anonymous donor because their motivation was supported by the wish to feel secure being parents and to avoid intrusions into family relationship.
The biggest problem with non-anonymous donation is that it could negatively affect the number of gamete donors. It is believed that the removal of anonymity will simply decline the donor pool. However, Mireia Poveda Garcia admits that these beliefs may be too far-fetched. The reality proves that when donor-child encounter is attempted, many simply reject a personal encounter and encourage contact by email.
Probably the most controversial issue regarding gamete donation is whether or not donor-conceived children should always know their origins. Some authors indicate that donor-conceived children may be curious about their physical characteristics, family skills or medical background of their gamete donors. Donor identity disclosure is said to have the emotional benefit for the child and is a central argument in protecting the children’s rights. There have been attempts to assess the psychological effect of such knowledge on donor-conceived children but unfortunately, they did not lead to any satisfying conclusions. The reason is that the vast majority of donor-conceived adults may not even know that they have been donor-conceived.
Mireia Poveda Garcia has no doubts that building a family through the process of egg or sperm donation is a complex and emotional process. There are no absolute wrong or right answers. The decision-making process should always include considering what kind of donor relationship you and your potential donor-conceived children will have. It is surely a subject to discuss thoughtfully and carefully with a therapist – and the final decision should always be based on all the information available.
When there is anything out of the normal process and condition, our suggestion would be changing a donor. It does not make any sense to change a diet or go on a birth control pill – the best thing is to look for another donor and continue the process with a different person. The fact that the donor ‘worked’ with someone else does not mean that she will work with you. A donor always has to be 100% fine.
It is true that in uterine ambience we can have epigenetic changes. So as you say, it can happen. In Spain, as you know, surrogacy is forbidden so it means we’re not very experienced in this area. So you should ask this question to the clinic that can answer it properly, e.g. a clinic in the US or Ukraine – these are the countries that usually deal with surrogacy.
If there isn’t any pathology that could cause any contraindications during a pregnancy, then it should be preferable to transfer 1 or 2 blastocysts.
In case of Spain, we have the Spanish Fertility Society (SEF) where you can find all the information. I think that most countries will have that kind of website. If not, then in Europe you can visit the ESHRE website (www.eshre.eu). You’ll find there the reproductive health legislation of most European countries. However, if you cannot find it, you can send us an email and we will send you the link.
When it comes to egg donation, we have very high success rates. So most of the patients should get pregnant in the first cycle. If not, maybe they will need a second cycle. Two cycles should be enough to have a baby. Most of the times, we have also remaining embryos which are frozen. So you have a fresh cycle and the remaining frozen blastocysts that can be used for a sibling (in case you are pregnant in the first cycle) or for the next transfer in case the first cycle hasn’t worked.
Yes, the age affects success rates. However, when it comes to a recipient, using donor eggs minimises the importance of the age so it should not matter so much. When it comes to a donor: the younger the donor, the better. Success rates we have. According to the Spanish law, donors should be under 35 years old – otherwise, babies could posses some abnormalities. In our clinic, we request the donors to be under 30 and normally, most of them are in their early 20s.
Normally, it takes about one month and a half because we need to synchronise both the donor and the recipient. That’s why it takes a little bit longer – but it shouldn’t be longer than that.
No, we meant the period from the moment we found the donor and we had the screening of the donor. The 6-week time we mentioned is the time from the first stage of the synchronisation to the embryo transfer. You need to add 3 more weeks for finding the right donor and getting all the genetics and blood results.
There is a continuous debate on this issue. There are much more people against changing the law than for doing it. The main difference between Spain and Portugal is that the law in Portugal was really very restrictive when it to comes the patient and the donor. There, even in case of any future health problems of the baby, you could never contact the donor. Here in Spain, you have some ways of contacting the donor – with keeping the anonymity of course. So the law they have there is a little bit different from what we have here. We don’t think it will change immediately. It’s been repeated many times that even if the law changes here in a few years, it won’t be retrospective. So patients can have peace of mind when it comes to this issue.
In both cases, success rates are getting more and more similar. It is because vitrification techniques are improving daily. However, we prefer fresh cycles because they are having slightly better results than frozen egg cycles. It is true that for clinics it is easier to go with frozen eggs than to synchronise donors with recipients. Probably in the future, the success rates of both types of cycles will be exactly the same – but at the moment, fresh cycles still have slightly better results than frozen donor eggs cycles.
Not necessarily. Big clinics will probably have more donors, but they will also have more patients. There might be small clinics that have very good donors and they do the screenings very well. The same with big clinics: there are big clinics that have a lot of donors who are screened very well but there are also the big ones that don’t have well-screened donors. So it depends on the clinic itself – and not on its size.
We have been doing egg donation for decades. However, there are still no studies showing the psychological impact of egg donation on people. We also have to take into consideration the fact that most of the today’s grown-up children conceived via egg or sperm donation still don’t know about it. It is so because most of the patients – at least the patients that we have – normally don’t tell their children about where they come from. So we don’t have any such information now – maybe we will have it in some years but not yet.