Egg donation and Genea
There are many reasons why some women may only be able to have children using eggs donated by another woman. The decision to use donor eggs or to become a donor is a complex one, with lifelong implications. At Genea we acknowledge and respect that all participants presenting for this treatment have their own unique circumstances and needs.
Genea believes it is important for both psychological and medical reasons that a child know his or her genetic origins.
Ethical guidelines require that we do not use donors who do not consent to the release of identifying information to the donor conceived person. Legislation requires that donor information is placed on a donor register. It is necessary that recipients of donor eggs be prepared to share the donor information with their child.
Who can be helped with egg donation?
Women who need donated eggs to have a child either do not produce eggs of their own, or their eggs no longer appear capable of producing a healthy pregnancy.
Reasons that a woman might need eggs from a donor include:
- her own eggs are failing to fertilise or create embryos that are able to sustain an ongoing pregnancy
- ovarian failure due to chemotherapy treatment for cancer
- premature ovarian failure or menopause.
Egg donation is also one option for women who have a high chance of passing on a serious genetic condition to their children.
"Parents conceived using ART procedures are entitled to know their genetic parents. Clinics must not use donated eggs or sperm in reproductive procedures unless the donor has consented to the release of identifying information about themselves to the persons conceived using their eggs or sperm."
Ethical guidelines on the use of assisted reproductive technology in clinical practice or research NHMRC Sep 2004.
Who can donate eggs?
At Genea we recommend that donors ideally be women who are under 35 years of age and have already completed their families. This is so that in the rare event of a complication occurring it does not jeopardise the donor’s own chances of having a family; and secondly, to ensure that her desire to become a mother has already been met.
Genea requires that recipients find and are happy with their own egg donor. We do not act as an agency for donor eggs.
Your Genea specialist will try to ensure the donor is healthy and does not appear to have an increased risk of passing on a serious medical condition, but normally it is not possible to be certain of this.
You will need to be aware that there are certain circumstances where Genea will not provide treatment. These are:
- using anonymously donated eggs
- daughter to mother donation
In every other situation, it is up to the treating doctor to determine, in consultation with you, if the donor participants are suitable for your treatment. Genea counsellors and nurses are not gatekeepers to treatment, but at times they may raise concerns or special considerations with the donor, the recipients and the treating doctor*.
Egg donation is an extremely generous act from one person (the donor) to another (the recipient). In Australia, egg donors are not paid. They voluntarily give their own eggs for the wellbeing and happiness of another person.
* Genea accredited doctors are independent of Genea and each other. If you would like a second opinion about your treatment, you should feel free to consult another Genea accredited doctor.
How are eggs donated?
In order to donate eggs, the donor must go through most of the components of an IVF cycle. The eggs that are collected will be fertilised with the recipient's partner's sperm to create embryos.
The Reproductive Technology Accreditation Committee (RTAC) of The Fertility Society of Australia guidelines recommend that embryos created through egg donation be quarantined for a 4-month period.
The donor is tested for infectious diseases before the cycle and then again at the end of the 4 months. Tests include HIV, hepatitis B, hepatitis C, cytomegalovirus and human lymphotropic virus (a rare cause of cancer of the lymph nodes).
Although quarantining embryos is not mandatory, we recommend it for medical reasons. We understand, however, that some patients are willing to accept the risk of infection and will waive the quarantine in order to proceed with an immediate "fresh" transfer. Such a waiver needs to be given in writing.
In vitro fertilisation (IVF)
Depending on the woman’s age, anywhere between 1 and 30 follicies, known as "recruits", will begin to develop in each menstrual cycle. Whatever her age though, only one of these developing follicies will dominate and ovulate at the level of FSH (follicle stimulating hormone) that a woman produces naturally.
With IVF, the goal is to keep the level of FSH constant, and thus to encourage more of the recruits to grow and to develop mature eggs, which are collected surgically under vaginal ultrasound guidance. The eggs are then fertlilised in the laboratory, cultured for several days, and then one, or rarely two embryos are transferred back into the recipient's uterus. If there are additional embryos, they may be frozen and stored for later use.
An IVF cycle typically takes up to 3 weeks from the time of the first injections to egg collection. Although generally very safe, as with all medical procedures IVF has risks of which you need to be aware. Your Genea doctor will review IVF treatment with you and be able to address any questions or concerns you might have.
It’s important to us that you are completely comfortable with your treatment and that you decide to go ahead with it only on a fully informed basis. If you have questions or concerns, please raise them with your doctor or your nurse before you sign your consent forms.
To find out more about the IVF process, read our section on IVF.
Once the eggs have been fertilised and embryos have resulted, they may be frozen and quarantined, or transferred immediately if you have waived the quarantine period. To prepare the lining of her uterus for fresh embryo transfer, the recipient’s cycle will be synchronised with that of the donor for step 6 through the use of estrogen and progesterone.
The National Health and Medical Research Council (NHMRC) guidelines stipulate that: "In using gamete donations, clinicians must carefully consider the physical, psychological and social wellbeing of the person to be born, and the participants, and are enforced by the Reproductive Technologies Accreditation Commitee (RTAC) of the Fertility Society of Australia."
Counselling before treatment using donated gametes is required at all IVF clinics in Australia, as outlined by RTAC.
Counselling helps all parties involved in the process to understand the implications of the proposed treatment and how it will affect the donor, the recipients, her partner, their families, and any children born as a result of the treatment. Educational and psychological counselling specifically covers the feelings of the non-genetic parent and the donor, and the perceptions of the needs of the offspring throughout childhood and adolescence.
Whilst counselling follows a standard format, it will be focused and adapted according to individual situations and needs.
In general the following is discussed:
- family background and significant history
- current relationships and future relationships between donor and recipient
- existing children
- issues in donation for donor, donor’s partner, recipients, offspring and other children, and extended family
- medical and psychological history, previous counselling
- consideration of some “what if” scenarios (such as relationship break ups)
- legal considerations
- managing the treatment process
- attitudes around disclosure to offspring and others.
Supportive counselling services are available to all participants before, during and after treatment.
IVF using donated gametes requires a number of appointments with different people in a complex process. The following flowchart sets out the steps in that process.
Flow chart from initial consultation to IVF treatment
- Donors and recipients require their own referrals to a Genea doctor.
- Your doctor will determine what tests and screenings need to be done in order to determine the suitability of this treatment. In some cases it will be necessary to get those results before proceeding to counselling. In other cases, the doctor may advise you to begin the counselling process.
- Your Genea doctor will refer you to a Genea counsellor.
- The counsellors prefer participants to contact them directly to arrange appointments. Typically there are five appointments altogether, in the following order: recipient; donor; recipient; donor; joint session of all participants. The recipient will be asked to pay the counselling fee for the set of sessions, before the first session. This fee is non-claimable from Medicare or health refunds.
- After the last session, the counsellor will submit a brief report to your treating doctor and a copy of this will be retained for Genea’s medical records. If the counsellor has any significant concerns or issues that need addressing she will raise these matters with the participants and the treating doctor.
- Nurse interviews for all parties usually take place after the completion of the counselling; however they can take place sooner, if required. Depending on your doctor, the nurse interviews may occur before or after a clinical decision to treat has been made by the doctor.
- The completion of counselling does not guarantee that treatment will occur. It is your doctor’s decision whether or not to treat in any specific situation.
The proposed treatment must fall within Genea’s policies. Recipients and donors can also withdraw at any time. Genea will not allow treatment to begin until all requirements have been met.