Sperm donors may be known or anonymous. If the donor is someone the woman or couple knows, the sperm are collected and washed preceding the normal IVF process. In most cases, donor sperm is from an anonymous donor provided by a sperm bank. Donors are young, healthy men with healthy lifestyles and family medical histories who undergo extensive medical and genetic screening, as well as testing for infectious diseases. The sperm are frozen and quarantined for six months, and then the donor is re-tested for infectious diseases including the AIDS virus. The sperm are only released for use if all tests are negative. If the female partner is fertile, insemination is the preferred treatment. Insemination can be highly successful, especially if accompanied with drug stimulation, but IVF can also be used with donor sperm for a highly effective treatment.
If a couple is using donor eggs, the infertile woman uses a fertile woman’s donated eggs to undergo assisted reproduction like IVF. The male partner’s sperm are used to fertilize the donor eggs, and the resulting embryos are transferred to the recipient’s uterus.
Infertility treatment is made more difficult with age, and many women are unable to conceive using their own eggs. As women enter their late 30s and early 40s, they experience a significant decline in the function of their ovaries, generally causing a sharp decrease in egg numbers and quality and an increased miscarriage rate. Other women may have a genetic disease that would be passed on to the embryo if her own eggs were used.
Using donated eggs offers a dramatically improved outlook and an excellent chance for a woman to become a biological mother of a healthy child. The egg donor may be chosen by the infertile couple or the reproductive clinic. In the United States, egg donors generally receive monetary compensation for their participation.
While highly successful as an option for family building, using donor eggs requires more careful consideration and preparation. 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 hormone 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 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 (approximately 50 percent nationally) provides many couples with their best chance for success. Donor eggs are successfully used in approximately 10 percent of all assisted reproductive technology cycles.
In some cases both the man and woman are infertile, so both donor sperm and eggs or donated embryos may be used. Some IVF programs allow couples to donate their unused frozen embryos to other infertile couples. Appropriate screening of the individuals donating their unused embryos 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 and is highly recommended. A counselor can help in considering the use of donor sperm and eggs or embryos. Life issues, such as telling the child about his origins someday and many other uncertainties can be addressed. 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 legal paperwork for the couple when donor eggs or embryos are used.
Women having uterine problems that cannot be corrected or women who have undergone a hysterectomy, but whose ovaries are functioning normally, may opt to have their embryos carried by a woman with a normal uterus. Women with other medical problems that may make pregnancy dangerous may also choose to have another person carry a child to term for them.
There are two types of surrogates: a traditional surrogate carries a pregnancy using her own eggs. A gestational carrier carries a pregnancy that does not use her eggs, but that is created by the couple’s eggs and sperm, and the resulting embryo is transferred to the carrier’s uterus. If the embryo is to be carried by a surrogate, pregnancy may be achieved through insemination alone or through IVF or other assisted reproductive means. The surrogate will be biologically related to the child. However, this is becoming more uncommon with current technology. 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.