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Understanding Embryo Donation
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| "Reach high, for stars lie hidden in your soul. Dream deep, for every dream precedes the goal." |
-Pamela Vaull Starr |
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| Embryo Donation |
Trying to learn about Embryo Donation? Find some of the most Frequently Asked Questions here.
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FAQ
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What is Embryo Donation? How does it differ from Embryo Adoption?
Embryo Donation and Embryo Adoption are similar concepts, and
sometimes the terms are used interchangeably. Both refer to the
giving and receiving of fertilized eggs (embryos) that are created during an In Vitro Fertilization (IVF) cycle.
During the process of IVF more embryos may be created than will be
used. Once the individuals involved have determined that they
will not use the additional embryos themselves, they are faced with the
challenge of what to do with them. Their options, depending on their
state of residence and the policies of the clinic used, are to:
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Continue to maintain them in storage indefinitely |
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Thaw and don’t use (or transfer in a way that is unlikely or impossible to result in pregnancy) |
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Donate them to scientific research |
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Donate them to someone else who wants to conceive (embryo donation) |
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Embryo donation
can provide the opportunity to assist others who want to conceive by
donating available embryos and giving someone else the chance to start
or add to their own family.
Frequently, organizations using the term ”embryo adoption” treat the
donation as a traditional adoption, and may require home studies,
lengthy application processes, and costly up-front fees. From a
legal perspective, the terminology “adoption” implies that a child has
already been born and is being placed into a family. In the case of
embryo donation, the child will be born into the family, with the
recipient couple being named on the birth certificate as parents. Like
the donation of sperm or unfertilized eggs, embryo donation is a way of
helping someone else conceive. In most states, embryo donation is
legally handled as a transfer of private property, and medically
handled as a donation of cells or tissue. A recent poll conducted by
Harris Interactive indicates that, “respondents overwhelming think the
term ‘embryo donation,’ as opposed to ‘embryo adoption,’ best describes
this process.” (Embryo Donation Research: Select Findings, August 21,
2003)
Miracles Waiting, Inc. feels that embryo donation more accurately
describes the process of giving and receiving embryos, and chooses to
use this terminology.
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What is a Known Embryo Donation?
A known embryo donation (also sometimes called a “directed donation”)
is one in which the donation is made to someone specific, who knows and
is known by the donors. The parties involved have exchanged their full
names and other information about themselves, and have reached a mutual
agreement regarding the donation of embryos that both couples are
comfortable with. It’s up to the donors and recipients to determine the
level of contact (both current and future), as well as the type and
degree of pertinent information they want to share with each other.
Miracles Waiting, Inc. is in no way a mediator or moderator between
donors and recipients, but rather allows these parties the opportunity
to settle details between and among themselves.
The advantage of a known donation is that the donors and recipients are
in communication with each other, have information about each other,
and in most cases, can be available for future information should the
need arise (i.e. medical needs.) A known donation gives both
parties some control over the selection process.
In some cases, donors want only to select the recipients of their
donation, and desire no further contact once they have completed the
donation. In other cases, ongoing contact is maintained. Such
arrangements allow flexibility for future contact among any biological
siblings, and the chance for children to get answers to any
genealogical questions, should their parents choose to tell them about
how they were conceived.
There are also some situations in which embryos can only be donated to
a known recipient. One such situation is when embryos created after May
25, 2005 have been indelibly labeled with the name of the patient
undergoing IVF. It is important to check with your clinic regarding
their labeling protocols, as many clinics currently use patient names
in order to reduce the risk of a mix-up. By law, such embryos cannot be
donated through anonymous programs, because their labeling violates the
confidentiality of the donors. However, they can still be donated
to a recipient who is known to and by the donors. Another such
situation is when communicable disease testing or relevant risk factor
screening determines that a donor does not meet the FDA-mandated donor eligibility requirements
for an anonymous donation. In such cases, a directed donation can still
be made with the informed consent of the recipients, after notification
of the donor’s status and their attendant risks.
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What is an Anonymous Embryo Donation?
An
anonymous embryo donation occurs when donors and recipients do not know
eachother's identities. With an anonymous donation, no contact can
be made between donor and recipient, either now or in the future.
Anonymous donation most often takes place through an IVF clinic, but
may also take place through an agency. Most clinics that have an embryo
donation program provide very limited information to recipients about
the donors. Donors are rarely involved in the process of selecting
recipients, but sometimes are permitted to set stipulations for
eligibility to receive their donation. Some egg donation and surrogate
agencies handle embryo donation as well, and can facilitate the
exchange of information between parties without revealing their
identity.
Many people who have chosen to donate their embryos anonymously do not
feel the need to be involved in the process of selecting recipients. It
is enough for them to know that they are donating to someone who is
facing challenges similar to those they have been through in their
quest to have a child.
Donors and recipients who want the flexibility of being able to contact
each other in the future through a third party can make such
arrangements by corresponding through email on a first name basis and
involving an attorney as a liaison. If occasion for contact arises in
the future, information can be exchanged through the attorney. This is
still considered an anonymous donation, as the identities of the
parties are not known to one another at the time the donation is made.
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How do donors and recipients find each other?
Before Miracles Waiting, Inc. was formed, donors and recipients had to
rely on donation through their IVF clinic or an agency, or find a match
themselves by searching the Internet or through word of mouth. Now,
with the Miracles Waiting, Inc. website, you can place your ad in the
donor or recipient listings, then search through the listings. When you
locate someone that you think might be a fit, you simply e-mail them
and wait for their response. Once contact has been made, the donors and
recipients together will determine if a match has been made. Miracles
Waiting, Inc. is not responsible for matching donors and recipients;
rather we provide a repository of profiles, creating a mechanism for
contact between donors and recipients.
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What is involved in the known embryo donation process? What happens once a match is made?
A number of important elements need to be considered early on in the
known embryo donation process if the recipient does not plan to travel
to the donors’ clinic for the transfer. The recipients must do some
homework on their end to determine:
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if their clinic will accept embryos from another clinic for transfer |
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whether their clinic will perform a frozen embryo transfer (FET) using embryos from a known donor |
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what testing or screening procedures will be required of themselves and the donors |
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any other criteria to accept the embryos and perform the transfer |
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what paperwork is required by the receiving clinic, and the timeframe required to process paperwork |
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Ideally, the recipients will have researched these questions and feel
confident that their clinic is willing to work with known donor embryos
prior to reaching an agreement with a donor couple.
Once an agreement has been reached between the donors and recipients,
it will need to be formalized in a legal contract. These contracts can
be as simple or as complicated as you see fit. The main criteria are
that they meet the requirements of the donors, recipients, sending and
receiving clinics and any applicable state or federal laws. Click here
for more information on embryo donation agreements. Click here for examples of contracts others have used.
Important Note: Laws vary so it is important for a lawyer,
knowledgeable in donor law, to review the contract to make sure that it
is legal and binding. If the embryos will be transferred across state
or country lines, the attorney should have knowledge of the laws in
both localities.
Once the contract has been agreed upon, it is executed. A common way to
handle this when the parties live in distant locations is for the
donors to sign and notarize two original copies and mail them to the
recipients, who countersign and notarize both originals. One original
is then returned to the donors. Typically, the sending and receiving
clinics will each require a copy of the fully executed contract, but
most clinics will accept photocopies of the original document.
The donors will instruct their clinic to ship the embryos to the
recipients’ clinic. The recipients can proceed with the embryo transfer
procedure once the shipment has been completed. The American Society
for Reproductive Medicine recommends that you wait at least three
months between signing the consent form to donate and the actual
donation, and some clinics may require such a waiting period.
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How is shipping handled?
In order to minimize the possibility of risk to the embryos during
transport, some recipients choose to travel to the clinic where the
embryos are stored and have the transfer performed there. Recipients
who plan to do this will need to contact the donors’ clinic to find out
what will be required of them in order to become patients and have the
frozen embryo transfer performed there.
In other cases, this may not be practical. Where permissible by law,
embryos can be shipped to a clinic in the recipient’s area for
transfer. The clinic shipping the embryos will require a signed release
from the donors. The paperwork required varies, depending on the
clinic’s policies and state law. Donors will need to check with
their clinic to determine exactly what is required in order to release
and ship the embryos and what carrier(s) the clinic uses.
Frozen embryos are typically stored in glass ampoules or plastic
straws, with 1 – 6 embryos in each (depending on how many are likely to
be transferred together at a later time, and/or clinic
protocols). If the embryos are being shipped to the recipient’s
clinic, they will typically be shipped via overnight air courier. They
are shipped temperature controlled to ensure that the frozen embryos
remain safe and frozen throughout their journey. Shipping the embryos
via a reputable overnight shipping company is not a serious concern.
Shipping charges will typically run in the $200 - $500 range per
shipment. If a number of straws are being shipped, concerns over
shipping can be minimized by separating the straws into two shipments
on two separate days.
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What is involved in the Frozen Embryo Transfer process?
The Frozen Embryo Transfer (FET) process using donor embryos is the
same as the FET process using your own embryos. This is referred to as
Donor Frozen Embryo Transfer (DFET). The procedure can be performed
during a medicated or unmedicated
cycle. Some clinics prefer to do a mock cycle first to ensure that you
will respond appropriately to any medications used, and that they can
insert the catheter through the cervix without incident. A mock cycle
is a chance to see how your body responds; no embryos are used during
the simulated transfer. Once the cycle is underway, and the lining of
the uterus is at an acceptable level, the embryos will be thawed and
transferred. A beta test will be done 10 – 14 days after the transfer.
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What type of testing, screening and other criteria is generally required for donors and recipients?
Before donated cryopreserved embryos created after May 25, 2005 can be
transferred to the recipient, federal law now requires that, if
possible, an eligibility determination be made regarding the providers
of the egg and sperm used to make the embryos. If the embryos have not
been frozen (as occasionally occurs when patients undergoing IVF donate
remaining embryos to another couple during their fresh cycle, rather
than cryopreserving them), a donor eligibility determination is
mandatory. [Human Cells, Tissues,
and Cellular and Tissue-Based Products (HCT/Ps); Donor Screening and
Testing, and Related Labeling; Interim Final Rule]. The donor
eligibility determination process focuses on screening and testing for
“relevant communicable disease agents and diseases” (i.e., those which
can be transmitted through use of a particular type of HCT/P).
Tests currently required for both male and female embryo donors are
HIV-1, HIV-2, hepatitis B, hepatitis C, Treponema pallidum (the agent
for syphilis), Chlamydia trachomatis and Neisseria gonorrhea. Female
donors whose eggs were removed by non-vaginal laproscopy (rather than
transvaginally) are exempt from the last two requirements. The
screening process involves a review of medical history and test
results, a physical examination, and a patient interview in which an
evaluation of risk factors (including high-risk social behaviors) is
made. In addition, donors are also screened for risk or evidence of
human transmissible spongiform encephalopathy (e.g., Creutzfeldt-Jakob
Disease). The list of diseases and agents that must be screened or
tested for is subject to expansion in the future.
Egg and sperm donors donating after May 25, 2005 must also undergo a
donor eligibility determination, which automatically applies to any
embryos created. (If remaining embryos are later donated, no additional
testing would be required of the egg or sperm donor, although the
original donor eligibility requirements for sperm donors are more
extensive than for egg and embryo donors). If frozen donor sperm
collected prior to May 25, 2005 was used to create embryos after May
25, 2005, there is no requirement for a donor eligibility determination
to be performed on the sperm donor. The majority of sperm banks have
been testing and screening donors for most relevant communicable
diseases for many years.
A potential donor is deemed ineligible to donate if either the testing
or screening indicates the presence of a communicable disease or risk
factor. In a known donation, it is possible for recipients to
receive embryos from donors who have completed the testing and
screening process and been deemed ineligible to donate. In such cases,
the recipients should be prepared to sign a legal waiver acknowledging
informed consent, and accepting all responsibility. Check with your
clinic for details as to any exceptions they will allow. Similarly, if
a donor eligibility determination cannot be made (for example, if a
donors refuses to be tested or is dead), both known and anonymous
donations can still proceed with the informed consent of the recipients
after they have been informed that an eligibility determination
regarding the donors was not made.
Federal law does not require that any attempt be made to conduct a
donor eligibility determination on donors of embryos created prior to
May 25, 2005. However, clinics may have uniform policies for all
embryo donors, so potential donors should be prepared to undergo the
related testing and screening. Donor screening for heritable diseases
may also be required.
The requirements for recipients vary from clinic to clinic. Testing for
sexually communicable diseases is common practice, along with a medical
records review. Recipient women generally undergo an assessment of any
potential obstacles to achieving a pregnancy via frozen embryo
transfer. This most often involves hormone testing and imaging
techniques to evaluate the uterus (such as a hysterinsalpingogram or
hysteroscopy). Some clinics utilize Doppler ultrasound to measure blood
flow to the womb. A pap smear may also be required. Requirements for
any given patient will depend on what tests have already been
performed, when they were performed, and the doctor and clinic used. A
mammogram may be required of women over the age of 40 (or those over 35
who have not had a previous pregnancy). Women over the age of 45 may
also have to undergo additional tests to evaluate them for any special
health risks associated with pregnancy and childbirth. These may
include a treadmill stress test, diabetes screening, blood chemistry
workup and platelet count, thyroid testing, and/or chest x-rays.
Depending on the history and risk factors associated with a particular
patient, additional blood tests or an endometrial biopsy may also be
performed.
Many clinics require that donors and/or recipients meet with a
psychologist who specializes in infertility and donor issues to ensure
that they are fully informed and in agreement. The psychologist’s role
is not necessarily to evaluate donors and recipients, per se, but more
to help them explore the issues and their thoughts and feelings
regarding the donation of embryos or the use of donor embryos. Some
clinics do not require counseling, but do require that both partners be
present for a consultation, or require some other evidence that they
are both fully informed and in agreement (such as a signed document of
informed consent from the spouse of the recipient female).
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Are donors paid for the embryos?
The law regarding direct compensation for embryos has not yet been
defined in all states; it is illegal in some locations, and
specifically allowed by the law in others. However, it is possible that
payment for embryo donation could be construed as constituting undue
influence or coercion or may be interpreted as a violation of other
state laws. The practice guidelines of the American Society for
Reproductive Medicine (ASRM) and the ethics guidelines of the American
Medical Association (AMA) clearly recommend against the sale of
embryos. Donors and recipients would be well advised to seek legal
guidance from an attorney specializing in third party assisted
reproduction regarding the applicable laws in the states where both
parties reside.
Donation is, by definition, an altruistic act. Donors should not expect
payment for any portion of the personal medical expenses incurred
during their own fertility treatment that resulted in the creation of
the embryos, but recipients routinely assume responsibility for
any additional costs related to the donation itself. Recipients
normally reimburse donors for legal fees, embryo shipping, any current
embryo storage fees, the costs of any medical or psychological
screening or retesting of the donors in conjunction with the donation,
and any other expenses involved in the transaction. The recipients
should incur responsibility for the related fees even if there are no
embryos to transfer after the thaw.
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What are the costs associated with embryo donation for the recipients?
As with most medical procedures, costs will vary depending on the
individual patient, clinic used, and insurance coverage (if any). Some
sample costs are given below, just for informational purposes:
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Retesting of donors for infectious diseases
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$100 - $500 |
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Infectious disease screening of recipient |
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$100 - $500 |
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Legal contract |
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$0 - $1,500
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Shipping of embryos |
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$200 - $500 |
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Prescription drugs |
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$500 - $2,500 |
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Blood work and ultrasounds |
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$500 - $2,000 |
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Frozen Embryo Transfer
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$900 - $4,000+
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What medications are generally used by the recipient during a frozen embryo transfer?
The medications used will based on clinic protocols, and may be
adjusted for an individual patient based on her body’s response to
certain drugs and the outcome of prior cycles. Some clinics will
perform a non-medicated cycle for patients who produce an adequate
uterine lining without assistance, but medicated cycles are more
common. In a non-medicated cycle, the embryos will be transferred to
your uterus at the time during your normal cycle that conception and
implantation would naturally occur. Many clinics perform medicated
cycles to allow for more precise timing and control of the process.
Consult with your clinic to determine which method they recommend, what
drug protocol they use in the case of a medicated cycle, as well as any
risks and side effects of medications prescribed. A typical medicated
cycle may include the following medications:
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Antibiotics – used to fight off infection, generally taken around the time of transfer. |
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Oral
Contraceptives (birth control pills) – prevents ovulation, helps
regulate the timing of the cycle, and helps to prevent cysts which may
delay a cycle. |
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Prenatal Vitamins & calcium supplement – ensures adequate intake of folic acid and other vitamins. |
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Lupron
(or other pituitary suppressor)- suppresses ovulation that could
interfere with a frozen embryo transfer. Administered via injection. |
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Baby Aspirin – helps increase blood flow to the endometrial lining. |
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Estrogen Supplementation – develops the lining of the uterus. Administered via pill, patch, suppository or injection. |
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Progesterone
– supports the lining of the uterus and prepares it for implantation.
Critical to the ongoing viability of a pregnancy conceived via FET.
Administered via injection or suppository. |
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What are my chances of success using donor frozen embryos?
A number of factors determine the success rates of frozen embryo
transfers. These include the quality of the embryos that are
frozen, the stage of the embryos when they were frozen, and how well
the embryos survive the thawing process.
Depending on the stage the embryos were in when they were frozen (at
fertilization, day 3 or day 5), between 50-80% of the frozen embryos
typically survive the thawing process and continue dividing. You should
understand that there is a possibility that no embryos will survive.
The overall chance of pregnancy with a FET is 20% - 25% per transfer.
While this number may seem low, it still offers great hope for the
thousands of infertile couples who may benefit from receiving donated
embryos.
There is an increased risk of multiple births when multiple embryos are
transferred to the uterus. You should discuss this risk and any
concerns with your doctor prior to transferring embryos.
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Are there any special risks to pregnancy resulting from embryo donation?
A pregnancy resulting from embryo donation has the same risks, to the
baby and the recipient, as any other pregnancy with the additional
consideration of the age and medical conditions of the donors. It is
extremely important to be open with your obstetrician regarding details
of your pregnancy as this information may affect the specific care
received.
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How do I get started?
We recommend that you learn as much as possible about embryo donation
through our website. If you have not yet discussed this option with
your clinic, contact them to discuss their embryo donation program and
fee structure. You can also search our website for clinics in your state that offer embryo donation services.You may also want to discuss these options with a trained psychologist or counselor
who specializes in fertility (specifically donor issues) and who also
specializes in dealing with loss and grief. You may also want to join a support group
to talk to people who are experiencing similar issues. For information
on organizations and professionals who can provide emotional and mental
health support, or for tips on coping, visit our Find Support Page.
Once you have made the decision to donate embryos, or if you would like
to become a recipient, you can visit our registration page to become a member.
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This
page was written by the Miracles Waiting, Inc. Team based on the
personal experiences of individuals, and information gathered regarding
the process of embryo donation in the United States. Nothing contained
herein should be construed as constituting medical or legal advice.
Miracles Waiting, Inc. does not guarantee that all of the information
provided herein is accurate or up-to-date. Furthermore, procedures and
practices can vary greatly from clinic to clinic and state to state.
For this reason, we suggest that you verify all of the information
provided with your physician, attorney, or other applicable
professional.
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Nearly 400,000 embryos are stored in the United States,
88.2% are targeted for patient use, and
2.8% are available for research.
FERTILITY AND STERILITY
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