By Marna Gatlin and Sue Taylor

PVED encourages and supports intended parents who wish to build their families through embryo donation, or families who have completed their family building and wish to “pay it forward” by donating their embryos to another family.

What Is Embryo Donation?

Making the decision regarding what to do with any remaining frozen (cryopreserved) embryos after you have completed your family building can be very difficult and emotionally charged. After all, creating these embryos may have occurred after many years of struggle and treatments that hopefully resulted in one or more successful pregnancies and births.

There may be several disposition options available to families who have stored embryos and are done with their own family building.

These include:

The donation option can be a very compassionate and a fulfilling decision for those who want to “pay it forward” and give the ultimate gift of potential life to others who have been traveling the same painful infertility journey the donors once experienced.

Embryo donors represent a wide cross-section of former infertility patients, including those of different religions, races, ethnicities, economic backgrounds, sexual orientation and marital status. What all embryo donors do seem to have in common is a desire to ‘give back’ or ‘pay it forward’ to other individuals struggling with infertility. Often patients who received donated eggs find embryo donation to be the most satisfying disposition option for their remaining cryopreserved embryos. Some embryo donors may also have strong religious or spiritual beliefs while others simply want to contribute their embryos to helping another family come into existence all the while giving the cryopreserved embryos a chance at potential life.

Compensation

It is neither legally or ethically acceptable for embryo donors to be compensated for donating their embryos. Some embryo donation programs may offer to reimburse for past storage costs, usually passing these costs onto the embryo recipients. If there are current storage fees, these fees may be negotiated and paid to the storage facility by the embryo donation facility or the embryo recipients.

Embryo donors are not responsible for any fees assocated with the embryo donation process including transportation of the cryopreserved embryos, medical evaluations, laboratory testing, mental health evaluations and/or legal fees. The embryo recipients pay all of these fees.

Acceptance Criteria

The decision criteria for private transfers is as varied as the donating and receiving individuals themselves. However, in a clinic or agency based program, there may be specific objective criteria used to determine if cryopreserved embryos will be accepted into a program for donation. The decision to accept donated embryos is based on a bit of science and a bit of ART. Please remember that the embryo donation facility and the embryo recipients want to succeed – but the acceptance criteria varies widely by program. Below are a number of variables that may be considered in making this decision.

The following questions are often asked when making the decision to accept donated embryos:

1. What was the age of the woman at the time the embryos were created? (i.e., embryos created through egg donation typically have higher success rates)
2. Did a pregnancy occur in the “batch” of embryos during a fresh or frozen transfer? Singleton, twins or more?
3. How many cryopreserved embryos are available for donation? (i.e., single cryopreserved embryos are infrequently accepted while sets of three or more are highly desired)
4. What is the quality and grade of the embryos according to the IVF facility that created them?
5. If the embryos were created with donor eggs and/or donor sperm, were there any limitations stated by the donors with respect to future embryo donation?
6. Are there any genetic diseases that may be transmitted from the donors to the embryo donor-conceived offspring?
7. At what stage were the embryos cryopreserved? (i.e., Day 5 cryopreserved embryos may be preferred over Day 3)
8. How were the embryos cryopreserved?
9. Does the IVF facility that created the embryos have a good track record with their own frozen embryo transfers?
10. Was any genetic testing performed on the embryos themselves?
What probably doesn’t matter as much is the length of time the embryos have been cryopreserved. At least one child has been delivered from embryos frozen for almost twenty years!

(Dowling-Lacey D, et al. Live birth from a frozen-thawed pronuclear stage embryo almost 20 years after its cryopreservation. Fertil Steril. 2011 Mar 1;95(3):1120.e1-3.) In an article published a year earlier, the length of storage did not affect embryo survival rates or delivery rates of frozen/thawed embryos. (Riggs R, et al. Does storage time influence postthaw survival and pregnancy outcome? An analysis of 11,768 cryopreserved human embryos. Fertil Steril. 2010 Jan;93(1):109-15.)

The reality is that no one really knows how long frozen embryos will last. It is quite possible that frozen embryos will last for decades and perhaps even centuries. At this point, there are no expiration dates.

Where to Donate

If a donor is doing a private match, they can set any criteria they wish for the recipient. These matches can happen through online services such as Miracles Waiting, through a PVED Private Match, or any other private connection.

If a donor prefers not to find and screen potential recipients, they may elect to use a clinic or agency. In that case, donors should thoroughly research their choice and make sure they are comfortable with any restrictions imposed by programs based on sexual orientation, marital status or religion. Donors should also be aware of any open ID or donor-recipient contact options that may be facilitated by the clinic if they wish to have any contact with the recipient prior to or after the donation. Some programs will only allow anonymous donations, while others are more willing to facilitate communications if both parties are in agreement.

Potential embryo donors may start by asking your IVF clinic if they have an in-house embryo donation program. Some potential donors prefer to donate their embryos to a clinic or facility located at a distance from where they live so that potential children resulting from the donation are not living in the same region as the children they are raising. Some programs are willing to allow those donating to set geographic area requirements for the recipients; and for clinics that serve a national population, it might not be so difficult to find a recipient outside of the local area.

Legal Requirements

Legal requirements will vary depending on the state in which the embryo transfer is performed. PVED always recommends that both the donor and recipient be represented by a qualified attorney who has expertise in third party reproduction. The nuances of embryo donation legal documents are best handled by experts rather than a general lawyer, because they have the expertise to make sure that all legal aspects are covered – including many issues that might not be obvious to someone outside of the industry (e.g. what happens to remaining embryos when the recipient is done with their family building). The legal process is to ensure compliance with any legal requirements and to provide clinic required legal clearance letters, make recommendations about court orders to terminate or declare parental rights, as well as to create the donation contract between the donor and recipient that spells out the wishes and responsibilities of both parties. Typically all legal costs of both parties are covered by the recipients. PVED is happy to offer a referral to attorneys who specialize in this type of law.

Anonymous or Open Donation

One of the first decisions most potential embryo donors must make is whether they want any contact with the recipients either before the donation, or after a child is born. This decision is one that may influence the options of where you can donate. Some programs or agencies will only facilitate anonymous donations, while others are willing to facilitate more open communication.

PVED recommends that whatever program you should choose to select with regards to embryo donation that both parties participate (generally separately) in an educational session with a licensed Mental Health Professional before embarking upon embryo donation. This is so that both parties understands what it means to be a donor of embryos and a recipient of embryos. It often helps to talk through the choices about what it means to be anonymous or open, and can help recipients learn about the terminology of embryo donation, the language, the definitions and most importantly how to talk to children conceived through embryo donation.

Anonymous Donation

In this form of embryo donation, the donors and recipients never meet. It is perfect for the embryo donors who want to provide a wonderful gift while desiring closure and privacy in donating their embryos. It is also ideal for the embryo recipient who wants the least expensive option in obtaining donated embryos. Depending on the agreement between donors and recipients, even with anonymous donation, however, the parties might agree for the embryo donor-conceived offspring to have access to his or her medical records without learning the identity of the donors.

Open, Known or Directed Donation

Open embryo donation contains some of the steps commonly reserved for adoption of a live child. Embryo donors select the recipients. Potential embryo recipients also have to be willing to undergo this more involved and (and sometimes more expensive) process. Other terms used to describe this are Known Donation or Directed Donation.

It requires a greater level of participation for both donors and recipients. The donors and recipients will clearly know each other. It is up to the participants themselves as to the relationship they will have after the embryos are transferred. This process often takes longer and is more expensive – particularly if additional testing, home studies, or other requirements are desired by either party. This option is ideal for the embryo donor who wants to be more involved in choosing the recipients while also desiring a potential relationship with the recipient family.

Semi-Open or Open ID

Semi Open embryo donation maintains anonymity while providing the donor with a increased level of screening of the recipients. The donors can specify the criteria for the recipient, but a third party actually may make the match for them and they stay anonymous to each other. The donors and recipients still never meet, although in some cases, the donors may agree to have their identity released to offspring when the child reaches at a certain age such as 16 or 18 (sometimes this is called Open ID donation).

This option is well suited for the embryo donors who want additional information about the potential recipients or want to set more detailed or specific criteria for their selection without necessarily having an ongoing relationship.

Disclosure

Recipients often ask how if, when and how they should discuss embryo donation with their donor conceived children. The answer to this complicated question will differ among embryo donation recipients and will be based on their personal beliefs, as well as their religious or cultural backgrounds. It also differs among infertility mental health professionals, though there definitely is a trend towards advocating for disclosure even without having any identifying knowledge of the embryo donors. This deeply personal decision must be based on what you feel is right for you and your family. The decision process probably will be similar to what egg donation recipients experience. However, once you tell one person, please assume that everyone will know, including your child. Still, you will be this child’s parents, capable of making thousands of other decisions regarding their welfare and have the ultimate say in the knowledge you want to share with him or her. The PVED article Building Your Family Through Embryo Donation is an excellent resource when exploring these options.

Embryo Adoption and Embryo Creation

You may have seen or heard the terms “embryo adoption” and “embryo creation” used in the context of embryo donation. However, these three terms are not interchangeable and each one has a distinct meaning with its own set of ethical and legal implications.

Embryo donation is the donation of excess frozen embryos from fertility treatment; embryo adoption also involves the donation of embryos but transforms the medical procedure into a legal one involving home studies and other legal requirements normally reserved during an adoption of a live child; embryo creation is the deliberate creation of embryos from donated eggs and donated sperm wherein the resulting frozen embryos are designated to various intended parents selected by the fertility clinic.

From a professional perspective, the American Society for Reproductive Medicine (ASRM), the leading body for reproductive medicine practitioners, does not consider that the use of the term “embryo adoption” to be ethically appropriate and issued this report several years ago:

“Requiring infertile patients who need donor gametes or patients who need donor embryos to suffer the imposition of unnecessary administrative and legal trappings of adoption and the costs that accompany them is not ethically justifiable. The donation of embryos for reproductive purposes is fundamentally a medical procedure intended to result in pregnancy and should be treated as such.”

The full ASRM report can be found below:

http://www.asrm.org/uploadedFiles/ASRM_Content/News_and_Publications/Ethics_Committee_Reports_and_Statements/DefiningEmbryoDonation.pdf

Success Rates

Frozen embryo transfer success rates will differ from clinic to clinic. Success rates for embryos created through egg donation yield better results because of the higher quality eggs from the young donor. Specific success rates for donated embryos are not currently collected and reported to the public; however, a clinic’s frozen embryo transfer success rates can be used as a proxy for the type of results one might expect.

For example, for 2012, the Society for Assisted Reproductive Technology (SART) reported national live birth rates per transfer from frozen embryo transfers:

• Embryos created from egg donors: 37.2%
• Women less than 35 years old: 42.4%
• 35-37 years old: 39.8%
• 38-40 years old: 33.9%
• 41-42 years old: 26.4%
• Greater than 42 years old: 17.8%

Please recall that donated embryos are provided from patients in the same categories listed above. Because the donated embryos are often screened before acceptance (i.e., not all will be accepted), they estimate delivery rates to range between 35-45% with a 20-25% twin rate, remembering that triplets and more are hardly ever seen. Please ask your clinic or program for their specific success rates.

Of course, it is also very important that the embryo recipients be healthy before receiving donated embryos. Diligent embryo donation facilities will carefully look for medical and uterine problems that could reduce the overall success requiring that these be fully addressed before transfer.

Choosing Donated Embryos

Potential embryo donation recipients may choose this path to creating their family because of a variety of medical and/or social reasons, including:

Many potential embryo recipients have considered egg donation, but find it cost-prohibitive. Because of a strong desire to experience pregnancy, embryo donation offers an option not possible with traditional adoption. Lastly, using donated embryos can eliminate any “genetic imbalance” when one member of a couple is excluded from procreation.

Costs

Typically the donating family does not incur any costs with embryo donation. All fees are paid by the embryo recipient. The fees incurred by the embryo recipient will vary from clinic to clinic and also with respect to the type of donation. For example, anonymous embryo donation is typically less expensive than an open donation. Fees quoted by clinics may not include such costs as travel to the embryo donation facility, time away from work, food or lodging. They also may or may not include legal fees, psycho-educational sessions, costs to ship embryos (if necessary), and recipient testing or medications.

The range of total costs to a recipient for a single donated embryo transfer can vary from as low as $2000 - $3000 dollars for some private matches or clinic programs to nearly $15,000 - $20,000 in programs that are facilitating open donations that may require home studies, have additional agency fees, or higher legal and mental health professional fees. Given the altruistic reasons that many families donate their embryos, the costs to the recipients do often factor into the donor’s decision making about where to make their donation.

Donor and Recipient Screening

All embryo donors underwent intensive screening processes including history and physical exams, detailed genetic histories and extensive laboratory testing for communicable diseases while undergoing their initial IVF treatment. Unless the embryos were created from donor eggs and donor sperm, nearly all embryo donors will have some reproductive and/or medical issues that resulted in their infertility.

Essentially all embryo donors will have undergone screening for Sexually Transmitted Infections (STI's) including hepatitis, syphilis and HIV. In some cases, the embryo donors may be requested to re-screened for STI's before the donated embryos are thawed and transferred. Embryo donors often want closure and are unwilling to repeat this evaluation, so this post-retrieval screening is not always feasible.

Depending on the clinic or program, the embryo donors may or may not be required to have additional screening tests - while the FDA does not require it, the ASRM strongly encourages it.

All embryo recipients undergo the routine testing of any IVF patient, including a history/physical, pelvic ultrasound, a uterine cavity evaluation and laboratory testing. Additional testing is often requested if embryo recipients are older than 45, including a heart evaluation and consultation with high-risk obstetrics. Basically, we are simply trying to make sure the embryo recipient is healthy, that she will have a safe pregnancy and that the embryos will be placed into a stable uterine environment optimized for success. Please contact your embryo donation program for additional details.

In Summary

Embryo donation is a wonderful alternative for the embryo donor who wants to “pay it forward,” giving an amazing gift to patients in need. Likewise, receiving donated embryos is an excellent way to still experience pregnancy for those that will be unable to conceive otherwise.

Embryo donation builds families that would otherwise not exist.

** Marna Gatlin, Founder and CEO, Parents via Egg Donation
After many years of struggling with infertility Marna Gatlin herself become a mother via egg donation. Feeling passionate about infertility with a focus on third party reproduction Marna set out to give back, educate, and support women through their own journey with infertility. Marna decided to create an organization that would embrace every parent who had chosen egg donation to grow their family. She wanted to welcome traditional parents, single mothers and fathers, and gay and lesbian couples into a warm community of intended parents. Many of these individuals didn’t feel they had the means to receive support, get educated, become empowered, or have a voice. Often they felt isolated.

Marna’s vision was to create a global resource for unbiased, timely, and accurate information about egg donation, eliminating the need to search far and wide for answers. Today, PVED is home to thousands of members who share emotional support, as well as clinic, donor agency, medication, mental health, and other information about egg donation on a daily basis.

Their mission is simple: We educate, support, and empower families and individuals at any stage of the process who choose to use egg donation to build a family.

To date Marna has aided thousands of women all over the globe in becoming mothers via egg donation.

**Sue Taylor is an experienced IVF consultant with a passion for helping others on their journey to parenthood. A member of the PVED advisory board since 2011, Sue has over 27 years’ experience in the healthcare industry and now assists patients with selecting a clinic, or even assisting with all aspects of going abroad for more affordable IVF and donor egg IVF and embryo donation treatments. She has assisted hundreds of donor IVF patients seeking treatment abroad. Her blog, www.ivftraveler.com/blog, offers practical details for patients traveling for IVF services or an IVF vacation. Sue Taylor can be reached at sue@ivftraveler.com.