Deciding whether to use a non-anonymous gamete donor (who agrees to disclose personal information) or a 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 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 becomes the legal parents of the child, according to the general rules governing legal parentage. Except in 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 on the matter in order to understand the proposed treatment options and the advantages and disadvantages associated with them.
In the 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 are 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 mainly on facial similarity. A good example of the latter is Fenomatch – the first biometric facial recognition programme that allows doctors to select a donor that looks more like the patient. Mireia Poveda Garcia says that the assisted reproduction law in Spain establishes the criteria for 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, 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, these are genetic, psychological and ethical aspects.
In the 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 have made comprehensive genetic testing for heritable diseases more accessible. Today, donors are screened more than before – and for that reason, the claim that the 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 for 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 to many psychological and ethical aspects. Mireia Poveda Garcia reminds us that all parties involved in the donation process must be taken into account: potential parents, donors and donor-conceived children. Parents have the right to privacy and confidentiality in the 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 recipient couples preferred an anonymous donor because their motivation was supported by the wish to feel secure being parents and to avoid intrusions into the family relationships.
The biggest problem with the non-anonymous donations is that they 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 the 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 donor-conceived children should always know their origins. Some authors indicate that donor-conceived children may be curious about the 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.