Portugal is not the first destination that comes to IVF patients’ mind when they are looking for treatment options abroad. And it is worth to take a closer look at what this beautiful country has to offer in terms of assisted reproduction techniques – especially if you are interested in non-anonymous donations. In this webinar, dr Vladimiro Silva, Embryologist, CEO, Founder & IVF Lab Director at Ferticentro (Coimbra, Portugal) is answering the most common questions about legal framework and availability of non-anonymous egg, sperm and embryo donation in Portugal.
Portugal can surely boast one of the most progressive and patient-friendly IVF legislations in Europe today. According to dr. Vladimiro Silva, it became even more exceptional on April 24, 2018 when the paradigm of egg/sperm donation treatment was unexpectedly changed. While deciding on a surrogacy legislation issue, the Portuguese Constitutional Court “accidentally” banned donor anonymity (which it ruled in favour of only 9 years earlier). And as it was the highest court in the country, there was no appeal possible. As a result, all IVF clinics in Portugal simply lost of all their donors overnight. Anonymous donors were no longer authorised so a lot of egg/sperm donation treatments were put on hold very abruptly. Since no one saw it coming, the challenge was enormous – and it required a quick reaction.
Non-anonymous egg donors – the new reality
Dr Vladimiro Silva says that in the first two weeks after the change in IVF legislation, his team called more than 600 people, asking them whether they accept to donate their cells on non-anonymity conditions. As it was a difficult shift also from a psychological point of view, it required a lot of counselling and thorough explanation of the new reality to donors. Surprisingly, 97% of the clinic’s registered egg donors and 70% of their registered sperm donors accepted to be non-anonymous. However, examples from other countries with the non-anonymity legislation showed that the overall number of donors could drop very significantly. That’s why a lot of campaigns were launched immediately, including official public hospitals campaigns, campaigns from private IVF centres as well as the ones from the Portuguese Society for Reproductive Medicine and patients associations. And the effects were more than impressive. Donations peaked and Portuguese clinics ended up having more donors than ever before. According to dr. Silva, it was totally counter-intuitive – and even paradoxical. Currently, there’s no shortage of games in private IVF centres in Portugal. And his clinic, Ferticentro, even established the first private egg and sperm bank in the county.
IVF legislation in Portugal – How it works
Dr Silva admits that initially, he was against the new IVF legislation as he was afraid that the clinics would lose all their donors. However, when he saw it in practice and started talking to patients who were undergoing the process, he changed his mind. In his opinion, the current legislation is much more ethical and much more respectful of human rights.
Nowadays, the Portuguese IVF legislation is one of the most progressive and patient-friendly in Europe. Children born from donations have the right of access to the identity of their donors at the age of 18. The access to donor’s ID is granted and guaranteed by the Portuguese state and the information about donors is kept for 75 years. The latter is especially important as it means that an 18-year old child does not have to decide to learn about their donor if they are not ready yet. The decision can be done later and the information will still be available.
Donation – per egg donor is limited
Dr Silva also stresses that the number of donations per donor is limited: egg donors can donate 4 times per lifetime and sperm donors can donate to up to eight families. The process is controlled and transparent – everything is registered in the database of the national ART authority. Besides, the process of donor compensation in Portugal is fixed by law: it is 878€ for egg donors and 44€ per sperm collection (the same for all public and private centres).
The importance of knowing one’s origins
In Dr Silva’s opinion, the process of non-anonymous donation – apart from being ethical and transparent – is also in compliance with human rights standards. It is indisputable that getting to know one’s origin is something that everybody wants – and can’t help learning. And nowadays it is more than easy due to the availability of innovative technology and genetic testing. There are a lot of online databases where you can send your DNA swab from and get information on your genetic profile. There are also associations that help you find your genetic relatives. For example, a French association PMAnonyme has already revealed 37 sperm donors and found 186 siblings. So the truth is that there’s not such thing as an anonymous donor anymore. Dr Silva thinks it’s pointless to continue with donor anonymity as databases of genetic information are growing bigger every day. It is not even needed for the donor to register himself or herself in these databases – a couple of their cousins could be enough for them to be found. Besides, there are still other ways of finding the truth, such as mitochondrial DNA studies or even DNA detective services.
From such perspective, keeping donor anonymity is highly risky. Dr Vladimiro Silva says that with anonymous donation, we lose control over the process of finding donors which means that a donor may be suddenly contacted by his genetic kids when he or she least expects it. On the other hand, the number of donations is not controlled in any way what may result in one person originating hundreds of kids in many different countries.
A human rights perspective
Taking into account all that was said before, we also have to remember that knowing where you come from is simply a question of human rights. Dr Silva says that this fact has already been recognised by the European Parliament. It issued the declaration saying that international and European human rights law has moved towards recognition of the right to know one’s origins. The Committee on Social Affairs, Health and Sustainable Development believes that anonymity should be waived for all future gamete donations – however, the anonymity of gamete donors should not be lifted retrospectively.
According to Dr Silva, getting to know the identity of the donor is something that we cannot help now, and certainly not in the future. So we can either do it in a controlled way (by introducing non-anonymous donation) or in an uncontrolled way (by keeping donor anonymity). The latter may lead to the situation when donors – who don’t want to be found – are discovered in one of the many possible ways currently available. Children born from donations, on the other hand, may experience a lot of disappointment when they realise the donor they searched for does not want – or simply cannot be – contacted.
Dr Vladimiro Silva says the Portuguese legislation is the best solution to all the problems he mentioned in his presentation. Firstly, it assures that no donors are surprised by unexpected genetical offspring knocking at their door. Secondly, every family controls how and when the information on donor conception is disclosed – so it cannot happen by accident. Thirdly, because of the transparency of the legislation (including transparency in donor compensation and number of donations), donating one’s gametes is perceived as a generous act to be proud of and Portuguese clinics have no problems with the availability of donors. It translates into the lack of waiting lists and affordable treatments.