The process of recruiting an egg donor Linda Henderson Sister Regional Fertility Centre 3 rd October 2015

Understanding the Egg Donation Process Who needs Egg Donation The Recipient’s Perspective The Donor’s Perspective The Clinic’s Perspective The Child’s Perspective

Who Needs Egg Donation? Ovarian failure, a condition in which menopause has started much earlier than usual, typically this affects 1-2% of woman under 40 Diminished ovarian reserve, meaning that the eggs that you have are of low quality; this can often be caused by age, because fertility drops off steeply after the age of 40 A Risk off passing on genetic disorders to their children Ovaries damaged by chemotherapy or radiotherapy Woman born without functioning ovaries (e.g Turners Syndrome) A previous history of failure with IVF, especially when your doctor thinks that the quality of your eggs may be the problem Ovaries resistant to stimulation by the pituitary hormones

Backdrop to donation Approximately 1400 women every year in the UK are treated with donated eggs It is estimated that thousands of British women choose to go abroad for this treatment.

Recipient Perspective

Many couples are struggling to conceive, starting a family can be a very emotional journey to take. It is a very big jump to go from understanding that you need fertility treatment, to being prepared to use donor gametes.

Recipient Perspective “ I can’t believe I’m considering this option.” Fears, concerns, doubts are normal when using a third party to conceive Non traditional form of family building No one expects to give over control of their reproduction to strangers It may take some time to get comfortable with the idea of using another person’s eggs

Recipient Perspective “ Who are the donors?” year old women Can be known or unknown Family complete No genetic risk factors General health is good BMI below 30 Non smokers Motivated by altruism

Recipient Perspective “ How will I find a Donor?” Almost all fertility clinics run an egg donation programme which allows altruistic women to donate their eggs HFEA also now allows a payment of £750 to Egg Donors to help cover any expenses incurred There is however an acute shortage of egg donors Many people are taking a proactive approach to finding an egg donor

Recipient Perspective “How will I find a Donor?” Advertising

Recipient Perspective “ How will I find a Donor?” Known Donation National Gamete & Donation Trust (NGDT) Help from the unit Unit’s website

Recipient Perspective “ Once I've found a Donor...” Potential Donor Contacts the Licensed Clinic Donor Information Pack is posted to the Potential Donor A Welfare of the child form is given to be completed and stamped by the GP and sent back to the unit If the Donor then wishes to Proceed, she contacts the Unit and an appointment is made with the Ovum Donor Coordinator At this appointment a full discussion takes place and a medical questionnaire is completed, an AMH is taken along with Screening, covering infectious diseases, genetics, rubella, and CMV status Help from the unit Trust website 1

Recipient Perspective “ Once I've found a Donor...” Counselling is mandatory for all potential Donors and their partners and a referral to counselling services will be made at the first appointment When all test are back and counselling has been completed the next appointment will be a medical consultation where the treatment is discussed in detail including possible complications. Consent forms are signed for treatment 2

Recipient Perspective “Once I've found a Donor...” The recipient and her partner will have already been screened at the outset. When all information is in order the donor and recipients will each meet again with the Ovum Donor Coordinator to commence treatment. 3 Donor -Synchronize cycle with Recipient -Ovarian Stimulation -Egg Retrieval Recipient -Synchronize cycle with Donor -Preparation of the Uterus -Fertilization -Embryo Transfer

Donor Perspective

Donors Perspective Altruistic egg donation can offer a chance to create a child. It is perhaps the greatest act of kindness to donate ones own eggs in the hope of helping another.

At present donors are within their rights to say to whom their eggs can be donated.

Donors Perspective Considered as a patient HFEA and National Institute for Health and Care Excellence(NICE) guidelines are followed Receive counselling Educated about the process -Pre donation testing – -IVF process - Medications – -Complications – -Time commitment

Donor Perspective Post Donation Information on the cycle outcome (usually not informed of the outcome unless they ask) Potential contact with the recipient or the child born as the result of their donation in the future To be counselled about advances in genetics that may impact on donors Advised that laws and circumstances may change

The HFEA- The Law and Donation PRE 1991 – No central treatment outcome register of donor information (The UK Donor Conceived Register runs a DNA- based matching contact register) Post HFEA keep a register (secure) Parents In 2004 parents were granted discretionary access rights  Non identifying information about their donor  Number, sex and year of birth of any donor-conceived siblings  If their donor has removed anonymity Donors  Number, sex and year of birth of any children conceived from their donation  August donors were anonymous  2005, donors had to be identifiable to any children conceived from their donation and at the age of 18 the young adult can request this information

Clinic Perspective Clinicians have an obligation to all the parties involved Safety and well-being of the donor Protecting the health of recipients Ethically obligated to screen donors for infectious diseases and genetic risk factors Protecting the health of the unborn child

The Childs Perspective

Rights of Child

Disclosing the use of donor eggs Avoid secrets that can strain the family relationships Avoid inadvertent disclosure that can be far more damaging than planned disclosure – Especially true in light of advances in genetic testing Laws have been enacted to facilitate access to information about the donor

Rights of Offspring: Disclosure Issue Proponents of disclosure believe: Everyone has the right to know how they were conceived It a violation of the child’s autonomy if the information is withheld This knowledge enhances the child’s understanding of their identity

Arguments for Nondisclosure Protect the child from social & psychological turmoil Protect the child from disapproving family members Protect the non- genetic parent from rejection by the child

Summary It is increasingly hard to recruit a donor There are multiple parties involved in egg donation Clinicians are facilitators and educators The interests of the child must always be paramount If you are considering going abroad please do your research and seek guidance from a fertility specialist

Thank you