Donation & Surrogacy
Donation & surrogacy at a glance
- Donation is when a third party provides eggs, sperm or embryos to individuals or couples to use in trying to conceive a pregnancy.
- Surrogacy is an arrangement in which a third-party woman carries a pregnancy on behalf of an individual or couple using an embryo created via in vitro fertilization (IVF) by the couple.
- Counseling is beneficial for all parties involved in donation and surrogacy, to address the complex legal, emotional and medical issues that can arise.
What is donation?
In fertility treatment, individuals or couples who are unable to conceive using their own sperm or eggs may use third-party reproduction to achieve pregnancy. The term third-party reproduction includes the use of donor eggs, sperm or embryos. Another aspect of third-party reproduction is surrogacy, which is explained below.
If problems with a woman’s eggs make it impossible for her to become pregnant, donor eggs can be used in IVF treatment to achieve pregnancy. Women with genetic conditions that do not want to pass on to their children may also use donor eggs.
Some patients use egg donors they know, such as family members or close friends. Others work with egg donation agencies to find donors, many of whom prefer to remain anonymous. Although women who use egg donation will not be genetically related to their child(ren), they will be able to experience pregnancy and childbirth.
Becoming an egg donor
Healthy, non-smoking women in their peak reproductive years are eligible to donate their eggs for use by infertile individuals and couples. The age range for donors may vary in different states, but is typically between 21 and 34 years old.
To become an egg donor, a woman must pass extensive screening tests for genetic, psychological or medical conditions. If she is approved, the egg donor will begin ovarian stimulation using hormonal medication, and undergo the egg retrieval process. The donor eggs will be fertilized in a laboratory by the male partner’s (or donor’s) sperm, and the embryo(s) that result will be transferred to the recipient’s uterus.
Donor egg recipients
To use donor eggs, the woman who intends to carry the pregnancy (donor egg recipient) must use hormonal medications to prepare the lining of her uterus (endometrium) so that it is synchronized with that of the egg donor.
Within three to five days of fertilization through IVF, one or more embryos are transferred to the recipient’s uterus. The patient will continue to take hormonal medications throughout the first trimester of pregnancy.
Use of donor sperm
Donor sperm is used by patients who do not have a male partner, or by couples whose male partner has very low sperm count, blocked sperm ducts or problems with sperm production.
Sperm donors are thoroughly screened by sperm banks communicable diseases. In addition, their sperm is quarantined for six months, until sexually transmitted disease testing is complete.
According to the American Society for Reproductive Medicine (ASRM), sperm donation has been used for more than 100 years. The use of donor sperm among couples with male factor infertility has decreased in recent years due to the effectiveness of intracytoplasmic sperm injection (ICSI), which injects one sperm directly into an egg, increasing the chance of fertilization and successful pregnancy.
Embryo donation and adoption
When patients have IVF treatment, there may be more fertilized eggs (embryos) created than the individual or couple will use. Some may choose to donate their embryos to other patients experiencing infertility, rather than storing, discarding or donating their extra embryos to scientific research. Embryo donors may be known to the adoptive parent(s) or anonymous.
Patients may consider embryo adoption if they are carriers of genetic disorders they do not wish to pass on, or are unable to conceive using their own sperm and/or eggs. While they would not be genetically related to their child(ren), embryo adoption makes it possible for the intended parents to be involved in their child’s growth and development from the earliest stages.
What is surrogacy?
In fertility treatment, surrogacy is an option for individuals or couples who are unable to carry a pregnancy. A surrogate is a woman who carries and delivers a baby on behalf of its intended parents.
In gestational surrogacy, the gestational carrier agrees to have the intended parents’ embryo(s) transferred into her uterus, and will carry and deliver their child. In this arrangement, the gestational carrier is not genetically related to the resulting child(ren). the intended parent(s) and the surrogate should seek counseling from a mental health professional who is familiar with the complex psychological and emotional issues related to the surrogacy arrangement.
Who should consider donation or surrogacy?
- Men or women who are known carriers of genetic conditions they do not want to pass on to their child(ren)
- Women who were born without ovaries, have premature ovarian failure or who have reached menopause
- Women with medical problems in their uterus, who were born without a uterus, who have had hysterectomies, or who currently have medical conditions that make pregnancy impossible or very risky
- Men with azoospermia or very low sperm count, blocked sperm ducts or sperm quality problems
- Men or women who have been treated for cancer or other serious diseases using radiation or chemotherapy that has damaged their fertility
- Women or couples who have experienced several unsuccessful cycles of IVF due to poor egg or embryo quality
What are the risks of donation and surrogacy?
The risks involved in egg and embryo donation are comparable to those involved in traditional IVF. Sperm donation presents minimal health risks to the recipient, since the sperm donor is thoroughly screened and the sperm is quarantined prior to donation to ensure that it is disease free.
Donation and surrogacy can be emotionally or psychologically challenging for patients and their families. Counseling by professionals who are experienced in providing support to fertility patients can be very beneficial.
Partnering with a surrogate or gestational carrier involves some legal risks related to the complex contracts used to define the relationships and outcomes. Prospective parents should seek advice from lawyers who are experienced in the field of third-party reproduction.