Using donors for assisted fertility treatment
Sometimes there are situations where donor sperm, eggs or embryo are a logical consideration when looking at Fertility Treatment, including:
- a man has no sperm
- a woman has been through menopause
- pregnancy has not occurred despite repeated IVF treatments and the fertility potential of the man’s sperm or the woman’s eggs is questioned
- single women or women in same sex relationships.
Donor treatment and surrogacy (described below) come with important social and ethical responsibilities, and all are highly regulated in New Zealand to look after the interests of the children, the donors and surrogates as well as the couple or single woman who want a family. Some types of donor treatment are ‘established procedures’ under the Human Assisted Reproductive Technology (HART) Act 2004 which means they are available ‘off the shelf’. A few require case-by-case application to the national Ethics Committee of Assisted Reproductive Technology (ECART). ECART applications are always needed for surrogacy, embryo donation, and sperm or egg donation between family members who are not brothers, sisters or cousins. An example would be a mother donating eggs to her daughter.
For sperm and eggs donated after August 2005, donors must be identifiable. Under the HART Act the clinics notify the Department of Births, Deaths and Marriages whenever a child is born using donor sperm, donor eggs, or donor embryos donated after August 2005, or when a child is born after surrogacy. Births, Deaths and Marriages hold basic identifying information about the donor that can be accessed anytime after birth by the parents or by the child when he or she reaches adulthood. The clinics offer the same service, with the addition of counselling to help prepare people for exchanging information.
Donor sperm is used where a man has no viable sperm and by single women or same sex couples, who often try self-insemination at home, turning to a clinic if this does not work. Donors may be recruited by fertility clinics or personally by the recipient. The process of sperm donation involves the following stages:
- The donors are screened for their family medical history and for diseases than can be transmitted through semen.
- Sperm is frozen and typically banked over several months for its future use.
- Three to six months later the screening tests are repeated, and the frozen sperm can be made available for use.
- Counselling is essential for both the recipient and donor, and covers the implications of being a donor or having children conceived in this way.
How donor sperm is used depends on the quality and quantity of the banked sperm, the age of the woman, and the presence of any other fertility factors. The simplest approach is IUI without ovarian stimulation, with insemination timed by blood tests. Adding mild ovarian stimulation increases the chance of pregnancy especially in older women. If sperm quality is lower, or the amount of sperm available is limited, or IUI has not worked, then the donor sperm can be used with IVF or even ICSI.
For younger women, the chance of pregnancy from simple IUI with donor sperm is about 20% per month, similar to that of fertile couples.
Donor eggs are used for two broad scenarios, lack of eggs or poor quality eggs.
Lack of eggs can be caused by early menopause or no response to ovarian stimulation for previous IVF treatment which has therefore been unsuccessful. Many women who do not respond to IVF drugs will be peri-menopausal and enter the menopause within the next five years or so.
Poor quality eggs may be the problem either because of a woman’s age or because she has not become pregnant after several IVF cycles and this can reduce the chance of success of conventional IVF.
The process of egg donation involves the following stages:
- The donor undergoes the steps of IVF stimulation up to and including egg collection.
- The eggs are then donated to the recipient couple and fertilised with the recipient partner’s sperm.
- The recipient woman also receives hormonal drugs to synchronise her ’cycle’ so that her uterus is at the right stage to receive the transferred embryo.
- Again counselling is essential, as the donor also has to be prepared for the medical risks of IVF.
In New Zealand about half of all donor egg cycles involve a close friend or family member as the egg donor. Pregnancy rates are similar to that of conventional IVF, but depend on the donor’s age rather than the age of the recipient.
Couples who have completed their family but still have frozen embryos remaining have the option of donating those embryos to another couple or woman. This treatment is technically simple; the recipient woman’s menstrual cycle is monitored with daily blood tests and an embryo is thawed and transferred at the right time. Complexity arises because the recipient’s child, if there is a pregnancy, will be a full sibling of the donors’ children. ECART requires separate and joint counselling for those involved, and a police check of the recipients as in adoption.