Donor Sperm, Eggs, and Embryos
IVF may be performed with a couple’s own eggs and sperm or with donor eggs, sperm, or both. A couple may choose to use a donor if there is a problem with their own sperm or eggs, or if they have a genetic disease that could be passed on to a child. Donors may be known or anonymous. In most cases, donor sperm is obtained from a sperm bank. Both sperm and egg donors undergo extensive medical and genetic screening, as well as testing for infectious diseases. Sexually transmitted disease screening and testing for both sperm and egg donation are highly regulated by the US Food and Drug Adminstration (FDA).
Donor sperm is frozen and quarantined for six months, the donor is re-tested for infectious diseases including the human immunodeficiency virus (HIV), and sperm are only released for use if all tests are negative. Donor sperm may be used for insemination or in an ART cycle. Unlike intrauterine insemination (IUI) cycles, the use of frozen sperm in IVF cycles does not lower the chance of pregnancy.
Donor eggs are an option for women with a uterus who are unlikely or unable to conceive with their own eggs. Egg donors undergo much the same medical and genetic screening as sperm donors. Until recently, it has not been possible to freeze and quarantine eggs like sperm. Recent advances in oocyte freezing, though, have made this a possibility, and there are a few companies and clinics that are using such an approach. The egg donor may be chosen by the infertile couple or the ART program. Egg donors assume more risk and inconvenience than sperm donors. In the United States, egg donors selected by ART programs generally receive monetary compensation for their participation. Egg donation is more complex than sperm donation and is done as part of an IVF procedure. The egg donor must undergo ovarian stimulation and egg retrieval. During this time, the recipient (the woman who will receive the eggs after they are fertilized) receives hormonal medications to prepare her uterus for implantation. After the retrieval, the donor’s eggs are fertilized by sperm from the recipient’s partner and transferred to the recipient’s uterus. The recipient will not be genetically related to the child, but she is a biologic parent in the sense that she will carry the pregnancy and give birth. Egg donation is expensive because donor selection, screening, and treatment add additional costs to the IVF procedure. However, the relatively high live birth rate for egg donation, over 50% nationally, provides many couples with their best chance for success. Overall, donor eggs are used in nearly 10% of all ART cycles in the United States.
In some cases, when both the man and woman are infertile, both donor sperm and eggs have been used. Donor embryos may also be used in these cases. Some IVF programs allow couples to donate their unused frozen embryos to other infertile couples. Appropriate screening of the individuals whose genetic embryos are used should adhere to federal and state guidelines. The use of donor sperm, eggs, or embryos is a complicated issue that has lifelong implications. Talking with a trained counselor who understands donor issues can be very helpful in the decision-making process. Many programs have a mental health professional on staff or the physician may recommend one. If a couple knows the donor, their physician may suggest that both the couple and the donor speak with a counselor and an attorney. Some states require and most IVF centers recommend an attorney to file paperwork for the couple with the court when donor gametes or embryos are used.
A pregnancy may be carried by the egg donor (traditional surrogate) or by another woman who has no genetic relationship to the baby (gestational carrier). If the embryo is to be carried by a surrogate, pregnancy may be achieved through insemination alone or through ART. The surrogate will be biologically related to the child. If the embryo is to be carried by a gestational carrier, the eggs are removed from the infertile woman, fertilized with her partner’s sperm, and transferred into the gestational carrier’s uterus. The gestational carrier will not be genetically related to the child. All parties benefit from psychological and legal counseling before pursuing surrogacy or a gestational carrier.