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Embryo Donation: Myth and Facts

The following questions were originally part of an online survey offered online to RESOLVE constituents in February 2008. Approximately 500 people responded which represents approximately .5 % of those who were eligible to take the survey.

The questions below are those to which a large number of respondents answered incorrectly in our survey, indicating that there is confusion about these questions. The goal of this online tool is to provide additional information about embryo donation as a family building option.

This publication was supported with funding from the U.S. Department of Health and Human Services by grants EAAPA071007-01-00 and EAAPA071007-02-00. Its contents are solely the responsibility of RESOLVE and do not necessarily represent the official views of the Department of Health and Human Services.

Please answer true or false to the following questions:

1. The Recipient’s costs for using donated embryos are the same as costs for undergoing one IVF treatment cycle.

True or False

2. Embryo donors receive compensation similar to compensation that egg donors receive.

True or False

3. Donors, but not recipients of donated embryos must undergo medical screening and testing prior to embryo donation.

True or False

4. The procedure to implant donated embryos is similar to the in vitro fertilization procedure.

True or False

5. Live birth rates per frozen embryo transfer are approximately 50%.

True or False

6. A child created from a donated frozen embryo has no genetic connection to the woman who carries/gives birth to the child.

True or False

7. It is recommended that both recipients and donors of donated embryos must meet with a mental health professional to discuss using/donating embryos.

True or False

8. Opinions vary about whether to disclose to a child his/origins.

True or False

9. Embryo donation is a private arrangement, and is not subject to laws and regulations.

True or False

10. The embryo donation is always anonymous, meaning the donors and recipients never meet each other.

True or False

11. A minimum three-month waiting period is recommended between the time a couple signs the consent form to donate and the actual donation.

True or False

12. All IVF clinics can help any donors and recipients with an embryo donation arrangement.

True or False

Answers

Click here to go to Question 1.

1. The answer is false.

Costs for embryo donation may range from $2,500-$4,000. The American Society of Reproductive Medicine (ASRM) lists the average price of an in vitro fertilization (IVF) cycle in the U.S. to be $12,400. (ASRM does not qualify if this includes medications.)
Donors are not paid for the embryo donation, but are reimbursed by the recipient for specific expenses related to the donation. These expenses may include testing and screening (e.g. obligatory blood tests) as well as expenses incurred transferring the embryos to your clinic and costs for thawing the embryo.

The overall costs for an entire cycle including screening may range from $2,500 to $4,000, which may not include psychological counseling or legal fees. Even if there are no embryos to transfer due to failure of the thaw procedure, you still must pay all expenses.

Click here to go to Question 2.

2. The answer is false.

Donors are not paid for the embryo donation, but are reimbursed by the recipient for specific expenses related to the donation. These expenses may include testing and screening (e.g. obligatory blood tests) as well as expenses incurred transferring the embryos to your clinic and costs for thawing the embryo.

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

Click here to go to Question 3.

3. The answer is false.

Both donors and recipients must undergo medical screening and testing.

As a potential recipient, there are several steps you must be willing to take. You should be prepared to undergo standard prenatal medical screening and testing for infectious diseases. Recipients should provide complete medical and obstetrical history.

Uterine evaluation for female recipients includes:

Sonohysterogram, hysterosalpingogram, or hysteroscopy

Laboratory Screening includes:

STI screening: Hepatitis B surface antigen, hepatitis C antibody, syphilis, gonorrhea, Chlamydia, cytomegalovirus (CMV)
Risk factors for transmissible spongiform encephalopathy (TSE) such as Creutzfeldt-Jakob disease
Blood Type and Rh factor
Prenatal testing

General Medical considerations for recipients include:

Health status
Age
History of the IVF cycle from which the embryos originated
Future concerns

Guidelines for medical evaluation of donors, published by the American Society of Reproductive medicine include collection of historical data; laboratory evaluation, screening for heritable diseases.

Collection of Historical Data:

Complete medical history
Complete genetic history
Laboratory Evaluation:

Sexually transmitted infection (STI) screening STI screening includes:

Hepatitis B surface antigen, hepatitis C antibody, syphilis, gonorrhea, Chlamydia, cytomegalovirus (CMV)
Risk factors for transmissible spongiform encephalopathy (TSE) such as Creutzfeldt-Jakob disease
Blood type and Rh facto

Screening for Heritable Diseases Specific to Ethnic Background:

Caucasians: cystic fibrosis
African Americans, people of Mediterranean descent: sickle cell disease and thalassemia
Asians: alpha thalassemia
Ashkenazi Jews: Tay-Sachs, cystic fibrosis, Canavan disease, Niemann-Pick, Gaucher, Familial Dysautonomia, Bloom Syndrome, Fanconi anemia, Mucolipidosis IV

Click here to go to Question 4.

4. The answer is true.

Most clinics transfer frozen embryos during an artificial cycle (a cycle in which you receive hormones to prepare the endometrium for the embryos). You may be given oral contraceptives to suppress your menstrual cycle. Once suppressed, you will be given estrogen in increasing doses for 14 days. On or about day 15 the estrogen dose will be decreased, and progesterone introduced.

Embryo transfer is usually performed on day 17 or 19 of the cycle. During the transfer, a small catheter is passed through the vagina and cervix into the uterus, where the embryos are deposited. The number of embryos transferred is based on the age of the woman who created them, the embryo quality and cell stage. If the embryos were created using donor eggs, then the age of the egg donor is important. In general, if the donor is young, fewer embryos will be transferred.

Because more than one embryo is usually transferred, you should discuss the risk of a multiple pregnancy and how that might affect your health and the health of the babies.

There are very few, if any, complications related to the embryo transfer process, and the risk of infection is very small. If you do not get pregnant, the medications will be stopped, and you will have a bleed similar to a menstrual period.

If you do get pregnant, you will continue progesterone for several more weeks. Risks of pregnancy complication are no greater to you than other woman your age who conceived naturally. Freezing and thawing embryos has no known negative impact on the health of the newborn baby and does not appear to affect the growth or health of children during infancy and early childhood.

Click here to go to Question 5.

5. The answer is false.

Success rates vary considerably. Current estimates indicate live birth rate per frozen embryo transfer is 27.7%.
(2006 SART Clinic summary Report)

The following factors may impact success rates:

Many embryos, although appearing structurally normal, do not have good reproductive potential
The best quality embryos are used for fresh transfer, while lesser quality embryos may be cryopreserved
Not all embryos are viable after freezing and thawing
Implantation problems may reduce the chance that viable embryos will result in pregnancy
Some embryos will be damaged when they are thawed and some will not divide. Other factors can impact the pregnancy rate as well.

Ask your clinic or practice:

How old was the female donor when she created the embryos? (The quality of the embryos is impacted by the age of the woman at the time she created the embryos; embryos created by a younger woman have a higher chance of pregnancy.)
What was the quality of the embryos when they were frozen?
How long have the embryos been frozen? Because freezing and thawing protocols have improved over time, the success rates for embryos frozen in the last ten years may be higher than those frozen more than ten years ago.
What was the IVF clinic’s live birth rate per embryo transfer at the time the embryos were frozen?

Click here to go to Question 6.

6. The answer is true.

The recipient will have no genetic connection to the child unless the embryo donor has a genetic connection to the woman who carries/gives birth to the child.

Click here to go to Question 7.

7. While this requirement varies from clinic to clinic, professionals agree that meeting with a mental health professional is beneficial for both donors and recipients.

Click here to go to Question 8.

8. The answer is true.

Proponents of openness believe that knowing your genetic origins contributes to a person’s sense of identity. They also think withholding this information might compromise the quality of medical care the child receives. Because the child is not genetically related to you, he or she will have a different medical history, a different DNA and possibly a different blood type. As a result, the chances that the child will eventually learn of their non-genetic relationship to you are great. Some consider it unfair to keep this information from children, as they may assume they are vulnerable to their parents’ health problems.

Many mental health professionals feel that disclosure is important in maintaining an open, honest and trusting family relationship. Evidence suggests that accidental or delayed disclosure can cause children to feel shocked, confused, betrayed, and impairs their sense of trust.

Some people believe that their right to privacy is more important than the child’s right to know. They argue that important medical information can be put into the child’s medical history without revealing the donation.

They also feel disclosing a child’s origins leaves him or her open to social stigma and judgmental or prejudiced attitudes. In addition, some feel that a child’s need for information or contact with the donor may not be able to be satisfied, resulting in anger or disappointment for the child.

Click here to go to Question 9.

9. The answer is false.

All parties should seek separate, independent legal representation to write an agreement addressing the issues surrounding the embryo donation, such as the donor couples relinquishment of rights, the parties’ responsibilities and obligations towards one another and the child, issues involving future contact, and terms of reimbursement. Prevailing state laws as well as the specific needs and circumstances of each party should dictate the precise terms of contractual provisions. The donor and recipient agreements should contain the same information. To date, eight states (DE, ND, OK, TX, UT, VA, WA, WY) have laws governing embryo donation, six of which use identical language: “A donor is not a parent of a child conceived by means of assisted reproduction.”
(“Assisted reproduction” includes eggs & embryos.)

Click here to go to Question 10.

10. The answer is false.

There are two types of embryo donation to another couple:

Anonymous donation - the donor and recipient are not identified to each other
Known donation the donor and recipient are identified to each other; you may or may not have known one another prior to the donation

Anonymous donation
Many IVF clinics only offer anonymous embryo donation to their patients. The donor couples IVF clinic takes responsibility for the matching process and bases it on their first-hand knowledge of you and the donor couple. They try to match the physical characteristics of both couples as closely as possible, according to height, weight, eye and hair color and ethnicity.

There is usually limited information shared regarding the occupation, level of education and personality type of either couple. The clinic or practice will try to make sure the recipient and donor do not live geographically close to each other. In most programs, the donations of embryos are to one couple only and are not divided.

Known donation
In a known donation, the donor couple takes an active role in selecting the recipient, often working with an embryo matching service or agency. The donor couple may want information about the recipient, the date the embryo is transferred, whether a pregnancy resulted, and possibly periodic updates about the child. There may be face-to-face meetings or pictures exchanged. Some donors may want to open their nuclear family to include the recipient family.

Click here to go to Question 11.

11. The answer is true.

It is recommended that the embryo donors wait a minimum of three months between the time they sign the consent form to donate and the actual donation.

Click here to go to Question 12.

12. The answer is false.

Some, but not all clinics offer embryo donation. If you are interested in donating your embryos or using donated embryos, ask your clinic if they offer this service.

Click here to go back to the survey questions.