Embryo Donation

Embryo Donation - A Family Building Option
An Online Guide for Potential Embryo Donors

A Publication of RESOLVE: The National Infertility Association
Edited by Diane Clapp, BSN, RN and Jennifer A. Redmond

Introduction

During your in vitro fertilization (IVF) treatment cycles, you may have created extra embryos that were cryopreserved (frozen) for use in future cycles. This may have resulted in surplus embryos that you, like many couples, will never use for your own reproductive purposes - because you completed your family, or decided not to proceed further with treatment.

As of 2003, approximately 400,000 of these microscopic embryos are cryopreserved in the United States (Fertility & Sterility, May 2003, Vol. 79, No. 5). Thousands of embryos are potentially available for embryo donation to other infertile patients.

If you have extra embryos you do not need for you own reproductive purposes, and are unsure what to do with them, this online guide can help you make the decision that is right for you.

Please note: RESOLVE recognizes that an embryo donor and an embryo recipient may be a single individual or a couple. Here, the terms donor couple and recipient couple represent both.

What can we do with our extra embryos?

Your beliefs will influence your decision about your excess embryos. There are four options for you to consider:

  1. Continue to store your embryos and pay fees
  2. Donate your embryos to research
  3. Thaw and not use your embryos
  4. Donate your embryos to another couple

This online guide will focus on the option of donating your embryos to another couple.

Donate to another couple

If you choose to donate your embryos to another couple (the recipient couple) you are potentially helping them build their own families.

Couples consider using donated embryos for various reasons. They may wish to experience pregnancy, but:

  • Have had multiple pregnancy losses unrelated to implantation or uterine issues
  • Have had repeated IVF failures
  • Risk transmitting genetic problems to their offspring

Some believe there an imbalance is introduced when using donor sperm or donor egg, as only one member of the couple is genetically related to the child. And others feel uncomfortable with adoption.

There are two types of embryo donation to another couple:

  • Anonymous donation your identifying information is not given to the recipient couples
  • Known donation you are identified to the recipient couple as the donor

Anonymous donation

Many IVF clinics only offer anonymous embryo donation. The IVF clinic takes responsibility for the matching process, and you may have no say, or limited say, in the selection of the recipient. The clinic makes the match based on their first-hand knowledge of both couples. They try to match your physical characteristics to the recipient couple, including height, weight, eye and hair color and ethnicity.

When considering anonymous donation, ask yourself these questions:

  • Do you believe embryo donation is like other tissue donations?
  • Do you feel you cant have psychological closure as long as the embryos remain frozen, and that anonymous donation may give you that closure?
  • Would it make you feel good to potentially help another couple build their family, even if you do it anonymously?
  • Would you prefer the boundary you would get from an anonymous, rather than known, donation?

Known Donation

When considering known donation, ask yourself these questions:

  • Would selecting a recipient couple help you regain feelings of control that were lost during the infertility treatment process?
  • Is it important for you to take part in the selection of the recipient couple? (e.g., they are selected according to race, religion, ethnicity, income, education, appearance, etc.)

A known donation may be best for you if you are comfortable with the recipient couple having some of your identifying information, and if you want information about the recipient couple and the embryo donation which may include:

  • The date of transfer
  • Whether a pregnancy resulted
  • Updates about the child

Your IVF clinic can suggest an embryo-matching agency that will coordinate this type of embryo donation. Before selecting an agency, make sure you discuss their fees and protocols.

During the matching process, profiles from donors and recipients may be exchanged, containing information about education, race, religion and possibly income. In some cases, you may see photos and videos of one another, or exchange information through phone calls. Some couples exchange information directly and meet face-to-face.

Who should NOT consider donating embryos?

Embryo donation may not be right for you if you or your family has a history of heritable psychological or medical conditions, history of recent substance abuse or a history of sexual or physical abuse without professional treatment. If you have an unstable marriage, impaired cognitive function or mental incompetence, excessive stress, or engage in any high-risk behavior you should not consider embryo donation.

Other factors that would prevent you from donating your embryos include: you and your partner are not in agreement about donating your embryos or you are an employee of the IVF clinic where your embryos are stored.

If we decide to donate our embryos, what do we have to do?

Whether the donation is known or anonymous, most programs require you be at least 21 years of age and undergo a series of blood tests. The doctor will ask for your complete medical and genetic history.

It is recommended you and your partner be tested for blood type and Rh factor, infectious diseases and certain genetic diseases. It is also recommended that you be re-tested for human immunodeficiency virus (HIV-1) after the embryos have been stored for 6 months and evaluated for risk factors for transmissible spongiform encephalopathy (TSE) such as Creutzfeldt-Jakob disease, hepatitis B surface antigen, hepatitis C antibody, and syphilis.

Who should we talk to about making this decision?

It is strongly recommended that couples who wish to donate their excess frozen embryos to another couple meet with a mental health professional. Psychological counseling is often offered at the clinic or program during the decision-making process. Since both male and female partners are considered potential embryo donors, you should both talk to a mental health professional.

During the appointments, you may be asked about your family medical and reproductive history and your psychiatric history. The mental health professional may want to know about your educational background, your current stresses and coping skills, and if you have any substance abuse or abuse/neglect issues. You may also be asked about your motivation to donate and any emotional attachment you may have to the embryos.

The purpose of these meetings is to make sure that all parties are fully informed and in agreement before proceeding with the embryo donation, and to explore thoughts, feelings and fantasies regarding this unique family-building option.

If you are considering embryo donation, answer the following questions:

  • Have you evaluated all options for your surplus embryos?
  • Are you clear about the psychological and ethical issues inherent in donating embryos?

There are many things to consider. For example, some couples feelings change about embryo donation after they have children through IVF. They say they can no longer donate a potential child once they equate it to the one they are now parenting. On the other hand, some couples who have gone through IVF and completed their families feel that their donating their unused embryos would be a wonderful gift to give a couple struggling with infertility.

You also need to consider if you would feel comfortable donating to more than one couple. Although this type of donation is rare, you need to think about the implications of full genetic siblings being raised in several households.

Some individuals and couples who are comfortable donating gametes (sperm and egg) feel very differently about donating embryos. Many gamete donors say that they have no emotional ties to their eggs or sperm but perceive embryos as potential children.

There are unique considerations if you used donated gametes to create the embryos you are thinking about donating. This situation may trigger a variety of different feelings. There may be differences in desire to donate embryos based on which partners gametes were used to create the embryos. Conflict may arise if the partner using his/her gametes feels more entitled to make the decision to donate or not.

Will we be paid for donating our embryos?

You will not be paid for the donation itself. Once a match has been made, the recipient couple will reimburse you for fees associated with the embryo donation, which may include specific screening expenses (e.g. obligatory blood tests), as well as expenses incurred in storing or transferring the embryos to the recipient couples clinic.

The recipient couple pays for their screening tests, counseling, and costs to thaw and transfer the embryos. The recipient couples costs for an entire cycle including screening may range from $2,500 to $4,000, and might not include psychological counseling or legal fees. Even if there are no embryos to transfer after the thaw procedure, the recipient will incur all expenses.

Prior to the donation, all details regarding donor reimbursement should be agreed upon in writing and should be detailed in any contractual agreement entered into between the parties.

What legal and ethical factors should we consider?

There are several legal and ethical factors to consider. The embryos could be damaged during the thaw process, or not survive. Donation requires that you give up all rights and responsibilities to any donated embryos or any child born of such arrangement (including custody, visitation, and inheritance) even if you are unsuccessful with your own future infertility treatments. You should be aware that any child born through embryo donation would be your genetic offspring and a full sibling to any of your biological children. The future psychological implications, both positive and negative, need to be carefully considered by both families.

There is little legal precedent regarding embryo donation. All parties should seek separate, independent legal representation to write an agreement addressing the donors relinquishment of rights, all parties responsibilities and obligations towards one another and the child, specifics involving future contact, and terms of reimbursement. The donor and recipient agreements should contain the same information.

Prevailing state law as well as the specific needs and circumstances of each party should dictate the precise terms of contractual provisions. To date, only California, Florida, Louisiana, North Dakota, Oklahoma and Texas have enacted legislation particular to embryo donation.

What is informed consent?

Informed consent is a process of communication between a patient and physician culminating in or manifested by a contract. It should be a clear expression of the intent of all parties involved and should define the nature of the relationship created. It should also acknowledge that the law regarding embryo donation is unsettled, unless you or the other couple are residents of one of the few states with embryo donation laws.

You should have your own lawyer, ideally one who specializes in reproductive technology law, help draw up an agreement according to the laws in your own state. It is recommended that you wait a minimum of three months between the time you sign the consent form to donate and the actual donation.

Think about your own specific needs and circumstances and include those in the consent contract. For example:

  • Whether the donation is known or anonymous
  • Expenses for which the donor will be reimbursed. Expenses paid for by the recipient
  • Provisions in the case of death or divorce of the donor or recipient couple
  • Circumstances (like a life-threatening emergency) under which future contact is permissible
  • Disclosure to the recipient couples child or children
  • Disclosure to your child or children
  • Release of your medical information if the child needs it
  • The recipient couples rights and responsibilities for the donated embryos and any child resulting from the embryo donation

Legal considerations regarding the role of the clinic or practice include:

The participating clinic or practice may have the right to refuse to donate embryos on the basis of medical or mental health factors related to the donating couple.

The participating clinic or practice may have the right to refuse frozen embryo transfer to a recipient whom they feel is an inappropriate candidate.

Summary: Is embryo donation the right choice for us?

If you are considering embryo donation, answer the following questions:

  • In general, how open or closed are you about your personal history?
  • Did you tell others about your IVF?
  • Did you tell others that you have cryopreserved embryos?
  • Have you told, or do you plan to tell your child that he/she was conceived through IVF?
  • Are there any health concerns with your existing child?
  • What ethical, moral or religious concerns do you have about embryo donation?
  • Do you want to have any role in the selection of the recipient?
  • If so, what characteristics are important to you in selecting a recipient couple?
  • Do you want to know when the match and the donation have taken place?
  • Are you interested in knowing if a pregnancy resulted?
  • Are you interested in knowing the recipient couple?
  • Do you want yearly, semi-annual, or quarterly updates on any child or children that result from your donation?
  • Would you tell your existing children that they may have a genetic sibling, and if so, at what age?
  • How do you think your children will be impacted by the knowledge that they have full genetic siblings being raised by another family? Will the children have contact with one another?
  • How would you and your partner feel if one of your children died, and you knew a child resulting from your embryo donation resided with another family?
  • How would grandparents and other extended family respond if told about the decision to donate embryos?

Perhaps the major underlying issue is how much control you do or do not have over the outcomes related to your embryos. If the answer to any of these questions raises difficulty, you should seek counseling before you make a decision to donate your embryos.

What resources are available to us?

RESOLVE: The National Infertility Association

Email: info@resolve.org
Website: www.resolve.org

2001 Assisted Reproductive Technology Success Rates Report
CDC Website: www.cdc.gov/reproductivehealth/art.htm

American Society for Reproductive Medicine (ASRM)
Website: http://www.asrm.org/

Society for Assisted Reproductive Technology (SART)
Website: http://www.sart.org/

Centers for Disease Control and Prevention (CDC)
Website: http://www.cdc.gov/

Food and Drug Administration (FDA)
Website: http://www.fda.gov/

American Association of Tissue Banks (AATB)
Website: http://www.aatb.org/

Glossary

anonymous donation Type of donation in which identifying information about the donor is not disclosed or available.
ART Assisted reproductive technologies.
Creutzfeldt-Jakob disease Fatal degenerative disease affecting the brain.
cryobank Place where frozen sperm, eggs or embryos are stored.
cryopreservation Freezing of embryos or sperm in liquid nitrogen.
donor couple Couple who is releasing their embryos to either research or another couple.
embryo Group of dividing cells 14 days following fertilization of an egg by a sperm. Prior to 14 days the dividing cells are considered pre-embryonic.
embryo donation Process in which a couple donated their frozen embryos to another couple.
gamete Reproductive cell, either sperm or egg.
hepatitis Condition or disease of the liver, may be chronic or acute.
HIV Human immune virus.
in vitro fertilization (IVF) - Form of assisted reproduction in which an egg and sperm are combined in a laboratory dish and the resulting embryo is subsequently transferred into a womans uterus.
known donation Type of donation in which information about the donor is disclosed and the donor may have input into the selection of the recipient.
miscarriage - Spontaneous loss of a pregnancy.
Rh factor Blood group, which when positive is Rh+, and when not present is Rh-.

RESOLVE wishes to thank the Embryo Donation Advisory Board:
David Adamson, M.D.
Linda Applegarth, Ed.D
Aytan Bellin, J.D.
Lee Rubin Collins, J.D.
Nidhi Desai, J.D
Nanette Elster, J.D., M.P.H.
Nancy Harrington, R.N.
David Hoffman, M.D.
Sheryl Kingsberg, Ph.D.
Susan Klock, Ph.D.
Jacob Mayer, Ph.D.
Gail Norbryhn, W.H.C.N.P.
Gretchen Sewall R.N., L.C.S.W.
Jan Elman Stout, Psy.D.
Sean Tipton
Paul Wolpe, Ph.D.
Joyce Zeitz
Katherine Zimmerman

Additional thanks to:
Maria Bustillo, M.D.
Lucinda Veeck, M.L.T., D.Sc.

Supported with funding from the U.S. Department of Health and Human Services under grant EAAOP002099.

The information contained in this fact sheet is offered as part of RESOLVEs educational efforts and is in no way intended to substitute for individual medical advice. Discuss your medical situation with a qualified medical professional.

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