Egg donor information

Introduction

For many couples, egg donation offers the only realistic opportunity to have children. Unfortunately egg donors are hard to come by and the demand far exceeds the supply. Many national newspapers and magazines carry emotional advertisements from couples that are desperate to find an egg donor, inviting the potential donor to contact a particular Assisted Conception Unit on their behalf. Centres are always very grateful to receive enquiries from women who are interested in becoming egg donors.

Why are egg donors required?

Sometimes a woman is unable to produce eggs for her own use because:

her ovaries have failed to develop normally and do not contain eggs;
her ovaries have been removed by surgery;
she has had radiotherapy or chemotherapy for cancer;
she has had an unexpected premature menopause ("change of life");
her ovaries fail to produce any eggs of the required quality when stimulated to do so (this may be particularly true for the older woman in her forties).

Sometimes a couple will deliberately decide not to use the woman’s own eggs because:

she may be the carrier of a serious life threatening genetic disease (e.g. haemophilia, Huntington’s chorea or Duchenne’s muscular dystrophy) and not wish to take the considerable risk of passing the condition on to her own children via her eggs.

Who can be an egg donor?

An egg donor must be over the age of 18 and younger than 36. Very occasionally exceptions may arise when an older donor may be acceptable.

Ideally the potential donor should have already proved her own fertility and have completed her family but this is not an essential requirement.

A donor is required to be fit and healthy and must not have any serious medical disability. Her family must be free from any known inherited genetic disorder. Donors should not be significantly overweight and ideally should be non-smokers.

Who should not become an egg donor?

It is essential that a donor knows about her past family history in order to be able to state with certainty that there is no known inherited disorder in the family. As a result, centres cannot accept women who have been adopted as they will not have any knowledge of their family history.

Very occasionally potential donors may unknowingly carry the AIDS (HIV) virus in their bodies. This is of course screened for, but women in high risk groups should not donate eggs. These include:

intravenous drug users;
women who have visited areas where considerable numbers of AIDS cases have been reported and have had unprotected sex with people living there (men or women);
a woman whose partner has haemophilia and may have received infected Factor VIII before it was made safe by heat treatment.

What happens first if I want to become an egg donor?

All potential donors are interviewed either by one of the centre's consultants or perhaps by an Infertility Nurse Specialist. A detailed medical and family history is taken. With your consent a letter will be written to your GP asking if there is anything in your own or your family medical history that would make it inadvisable for you to become a donor. An appointment is arranged for you to see an experienced counsellor who will discuss your views about the implications of egg donation as well as the legal and ethical aspects of donation. The counsellor will aassess both your emotional and psychological suitability to become an egg donor.
At a second consultation the necessary screening tests are arranged.

What are the screening tests?

There are three major groups of blood tests that are carried out. These will be explained to you in some detail.

The first group of tests is a hormone profile performed during the first few days of the menstrual cycle. This is to make sure that there is no hormone imbalance that may make it difficult to obtain eggs. Centres tend to carry out the hormone test first rather than perform all the tests together and subsequently find out that you cannot become an egg donor due to a hormone imbalance.

The second group of tests is to ensure that there are no infections that could be passed on to the recipient of donated eggs. These tests include hepatitis B and C, HIV antibody (AIDS), syphilis, gonorrhoea, chlamydia and cytomegalovirus. HIV counselling before testing is available.

The third group of tests is for blood grouping, full blood count, chromosome make-up (karyotype) and cystic fibrosis screening.

Will I have any expenses to pay?

No. All medical expenses are paid for completely by the centre. Your travelling expenses (public transport or private car) will be reimbursed. It is very important that you are not out of pocket. As an anonymous donor, you should keep a record (receipts) of all of your expenses such as petrol or transport costs to get to the centre. Even in the event of you needing to be admitted as in the case of ovarian hyperstimulation syndrome, centres can only reimburse expenses or loss of earnings for up to a maximum of £55.19 per day and a total of no more than £250 per course or cycle of treatment.

Will I be told who has been given my eggs?

No. Except for the situation where a sister donates eggs for a sister, or a friend donates for a friend, your donation of eggs will be anonymous. You will be told how many eggs were obtained and how many people received your eggs. If you wish, you will be told if a live birth results from your egg donation (see below).

What will the recipient of my eggs be told about me?

Only non-identifying information can be given. Physical characteristics such as height, hair colour and eye colour as well as your blood group are given so as to try and obtain as close a match as possible or one that is acceptable to the recipient.

As the law stands, apart from the centre, only the Human Fertilisation & Embryology Authority (HFEA) will know your identity. By law your name and details and the name and details of the recipient of your eggs must be registered with the HFEA. When you complete the registration form you will also be invited to write some non-identifying information about yourself and a "goodwill message" such as your interests, the type of person you are, your general outlook on life, why you made the donation of your eggs etc. This information can be revealed to the recipient.

It is already established in law that the HFEA will be able to give non-identifying information to a future enquirer whose conception resulted from egg donation. From the age of 16 such an enquirer can be told whether or not he or she is closely related to someone they are intending to marry. At the present time, from the age of 18 an enquirer can be told whether or not he or she is the result of IVF, egg, sperm or embryo donation, but not who the donor was.

All identifying information held by the HFEA is confidential. Indeed, unauthorised disclosure of your name is a criminal offence.

At the present time, it is not possible for the recipient of your eggs to obtain identifying information about you. However, following public consultation, both the HFEA and the government obtained a change in the regulations of the HFE Act (1990). Since 2005, all new egg donors are only accepted as donors if they agree that identifying information about themselves will be provided upon request to donor-conceived people after they have reached the age of 18 years. So if you were the donor, you would be notified that an enquiry had been received from a person who was conceived following your egg donation. You would then be advised to seek appropriate counselling. It is therefore important that the HFEA are kept informed regarding any change of address. Otherwise your last known address or address at registration as a donor will be provided to the enquirer.

The only other way in which your identity could be disclosed would be in a court of law. In the most unlikely event of you not informing the centre of an inherited disease in your family that you either knew about or reasonably should have known about, a child affected by that genetic disorder could then sue you for damages.

Do I have any responsibility towards a child that results from my egg donation?

No. You will not be the legal parent of any child that results from your donated eggs. You will have given up all rights and responsibilities and will have no legal claim upon such a child.

What does the actual process of egg donation involve?

This is the same as for IVF (see IVF information).

Once all the preliminary tests have been performed there may then be a lull while the recipients' tests etc are sorted out. You will then have a planning session with an experienced member of the centre’s staff who will discuss every aspect of your egg donation cycle and the "timetable" of the procedure.

Is egg donation risky?

Your safety is of paramount importance to the Centre. There is no question of any significant risk being taken in order to obtain eggs.

The drugs involved in your treatment produce little in the way of side-effects. Hot flushes while using the "down regulation" treatment may occur. As the eggs grow, the ovaries increase in size and may cause you to feel bloated across the lower abdomen.

Sometimes a treatment cycle is abandoned. If the response of the ovaries is inadequate there is little point in proceeding further. Conversely, if the response has been very excessive there is a significant risk of your developing a potentially serious complication called ovarian hyperstimulation syndrome (OHSS). Severe OHSS occurs in less than 1% of all IVF procedures. Rather than get into this position the treatment cycle will be cancelled (see Ovarian Hyperstimulation Syndrome information).

Very rarely pelvic infection can follow egg retrieval. Every precaution is taken to prevent this, as the egg retrieval is carried out as a sterile procedure and under antibiotic cover. There is a very small risk of puncturing bowel or a blood vessel with the needle used for the egg retrieval. Applying pressure to the vaginal puncture site can stop bleeding.

All this sounds rather scary, but it must be stressed that serious complications are rare indeed. It can now be understood why Centres prefer that egg donors have at least already had children or that their families are complete.

You will have direct access to the team at your Centre at all times should you have any concerns whatsoever during or after your egg donation.

What about intercourse and contraception during the treatment cycle?

The last thing you will want is to get pregnant yourself during the egg donation cycle! A pregnancy is possible once the treatment cycle commences. If you have been taking the pill it is best that you stop this form of contraception about three months before the planned time of egg stimulation. An Intra-Uterine Contraceptive Device (IUCD) need not be removed. You must not use any form of hormonal contraception during the treatment cycle. Condoms are preferable. From Day 1 of the FSH injections it is advisable that you abstain from intercourse until the next period begins.

How much time will I need to take off work?

The initial interview and the counselling appointment is carried out at a time that is suitable to you. More than one appointment with one of the centre’s consultants is usually necessary.

The ultrasound scans and hormone blood tests that are required during the treatment cycle can also be arranged at a time that is convenient for you. However you may find that the hormone blood tests need to be carried out during the morning so that the results are available before the end of the day.

It is advisable to be off work on the day of egg retrieval and for the next two days.

What happens if I change my mind?

Before you even begin the treatment cycle, you will have been very fully informed on all aspects of your planned egg donation. You will have signed a consent form before treatment begins.

You can change your mind at any time before egg retrieval without the threat of any financial penalty or fear of recrimination.

You will be told how the embryos resulting from your egg donation are either transferred as fresh embryos or stored by freezing (cryopreservation) for the recipients future use.

At any time you may vary your consent or even withdraw consent altogether about the use of stored embryos that have been produced from your donated eggs. This cannot of course apply to an embryo that has already been transferred to a recipient.

Egg donors are remarkable people. Donors go through a complex treatment process and then their gift of eggs is anonymous. As a donor you will help a couple fulfil a dream that may otherwise have been unattainable to them. That’s an amazing thing to be able to do! To the couple you will rank with the angels.

March 2009