A woman who provides a number of eggs (ova, oocytes) for another person or another couple who desire to have a child, is called an egg donor.

Egg donation uses the process of in vitro fertilisation. This means that the eggs are fertilised in the laboratory. Once the eggs have been obtained the role of the egg donor is completed.

• The female recipient may not have any ovaries or may have ovaries that are damaged perhaps through cancer.
• She may have experienced a premature menopause
• She is producing eggs which are of insufficient quality to become pregnant¹.
• She faces the risk of passing on an inherited disorder to her child.

It is also important to note that egg donation can also be used to obtain eggs for research purposes. Human eggs that are donated to research can be used in the creation of embryos from which stem cells can be derived.

In the UK, the Human Fertilisation and Embryology Authority (HFEA) has issued a licence to the Newcastle NHS Fertility Centre at Life to permit the practice².

Sperm donation is the name given to the process by which a man gives, or in the vast majority of cases, sells his semen to be used specifically to produce a baby. Sperm is normally donated at a sperm bank.

• The recipient’s partner may be infertile or may well carry a genetic disease.
•  The recipient’s partner is fertile but produces low amounts of sperm or sperm of poor quality.
• The recipient’s partner has previously undergone a vasectomy.
• In the case of a single woman, she may want to have a child but doesn’t want a male partner.
• Sperm donation allows a lesbian couple to have a baby.

Natural procreation depends on four parental contributions, namely the father’s sperm, the mother’s egg, fallopian tubes which connect the mother’s ovaries to her womb and where the fusion of egg and sperm take place, and the womb in which the embryo develops³. Whilst this may be an oversimplification of the process, it nevertheless identifies the four main parental contributions. Should any of these four be defective in any way, it causes fertility problems. For example infertility results if the fallopian tubes are blocked.

The sperm and egg may be fused outside the mother’s body as opposed to inside it, using in vitro fertilisation (IVF). IVF was first successfully performed in Britain in 1978. Louise Brown was the first child born using the IVF technique developed by Patrick Steptoe and Robert Edwards⁴. Since then IVF treatment has been used in a variety of contexts alongside other assisted reproductive technologies (ART).

There are a number of assisted reproductive technologies (ART):

IVF involves the use of medication to hyperstimulate the women’s ovaries to produce multiple eggs. These eggs are then extracted from the ovaries using a laparascope and mixed with sperm in a dish in the laboratory. The resulting embryos are then allowed to develop for several days in the laboratory and a small number of the embryos are subsequently implanted back into the women’s uterus.

Gamete Intrafallopian Transfer (GIFT) involves ovarian hyperstimulation to obtain multiple eggs as with IVF.  However the eggs are then mixed with sperm and immediately placed into the women’s fallopian tubes using a laparoscope. The goal of this procedure is to enable fertilisation to occur within the fallopian tubes rather than in a dish in the laboratory⁵.

Zygote Intrafallopian Transfer (ZIFT) is rather like IVF with fertilisation of the woman’s eggs taking place in the laboratory. However, unlike IVF the fertilised eggs (zygotes) are injected into the woman’s fallopian tubes using a laparoscope⁶.

Egg donation practices vary with individual cases.  Some women find bring their own designated donor while others rely on the services of anonymous donors.  It is important to recognise that egg donation carries significant health risks to the donor mainly because of the risk of a serious adverse reaction to the medication used to induce ovarian hyperstimulation. There are a number of methods used for fertilisation, including IVF, intracytoplasmic sperm injection (ICSI) or GIFT. The female recipient will then carry and deliver the pregnancy and keep the baby.

The first pregnancy which resulted from egg donation was in 1984⁷.

Sperm donation, involves the use of licensed donation clinics.  Sperm donors are screened to meet certain requirements including age and medical history. The sperm is donated at a clinic by way of masturbation. It is then screened, washed and prepared.  The sperm may then be used to inseminate a recipient woman using intrauterine insemination (IUI), or it is used to create an embryo using IVF, ICSI or other assisted reproductive treatments.

Women may decide to become egg donors for a number of reasons. Many respond to an altruistic concern for infertile couples particularly when this involves a relative or a close friend.  Some assisted reproduction clinics will provide in vitro fertilisation for infertile couples at reduced cost in return for donation of eggs for use by other recipients.  In the UK financial compensation for egg donors is restricted by the HFEA.  However in USA and other countries it is not uncommon for women to provide eggs for significant financial compensation.

Most sperm donors are between the ages of 18-25 years and financial compensation seems to be the major motivation for donation.

Historically sperm donation was practiced under conditions of strict anonymity although physical details such as height, weight, hair colour and education were sometimes passed onto the recipient.  More recently systems have been devised in some countries whereby children conceived by donor sperm may be able to obtain information about their biological father once they have reached adulthood.

Until 2002 donor anonymity still existed in the UK. However, following the case of Rose v The Secretary of Health and the HFEA, the European Human Rights Act was employed to challenge the practice of donor anonymity. This prompted the Department of Health to undertake a review of donor insemination.  In 2004 the decision was taken that only sperm and egg donors who were willing to be identified at a later stage should be used, with effect from April 2005⁸.

Since this move, there have been reports in the media of a significant decrease in donor numbers⁹. The Government has responded by pledging further finance to help improve donor recruitment levels.  Some argue for the rights of those who are infertile who undergo immense pain and distress at not being able to conceive.  The loss of donor anonymity is apparently reducing the numbers of donors and therefore having an adverse effect on infertile couples.  However, others argue in favour of the rights of the child to be able to know their true genetic identity.  Although official policy is that children should be informed by their parents that they were conceived by donor sperm, in practice many children are never told about their biological origins.  There are many stories of individuals who have experienced major psychological distress at discovering this information later in life.  Some have likening it to a trap door opening up beneath them¹⁰.

ART provides couples who are unable to have children naturally, with a series of alternative options. However, as with many emerging biotechnologies, there are a number of ethical and social concerns.

Risks of Egg Donation

Whilst comprehensive and detailed research has not been carried out into the long-term impact of egg donation on donors, certain risks have been acknowledged.

• Bleeding and trauma from the laparoscopic procedure used to obtain eggs.
• Ovarian hyperstimulation syndrome (OHSS)
• Unintended pregnancy
• Liver failure (rare)

There is particular concern over OHSS, which arises from the use of medication to stimulate the ovaries.  Whilst most cases are mild, some very severe cases have occurred.  OHSS can lead to weight gain, edema, abdominal distention, pain, breathing difficulties, circulatory collapse and even death.  The recognition of the real risks of egg donation has alarmed many people and brought about the convergence of groups of both pro-life and pro-choice feminists.  They have voiced common concern at the way in which the health and welfare of women does not seem to be central to the planning of any biotechnological research that seeks to use the female body or tissues¹¹.

Recipients

There is a small risk that the recipient may contract an infection from donor gametes.  Whilst every effort is made to reduce the risk by screening donors for a range of infections, such testing cannot provide complete protection and recent HIV infection for instance may not be detected.  There are risks of undetected genetic conditions in the donor or inaccuracies in the recording and screening of the donors medical and genetic history.   All ART techniques may lead to multiple pregnancies which involve significantly increased health risks both to the mother and to the children

The joy of being a mother

Some argue that a key advantage of egg donation is that it allows older women to become pregnant.  An extreme example is 66 year old, Adriana Iliescu who is currently the oldest women to give birth in such a way.  Others argue that there are adverse consequences for the children of older women conceived by egg donation.  For example, the mother may die or become too frail to care for the child necessitating others to take on the maternal role.

Gamete market

In some countries there are signs of the development of a market for sources of egg and sperm¹². It is not that difficult to envisage the burgeoning of such a market as ART develops and becomes more sophisticated.  There are concerns that in many countries the use of ART is not regulated in a democratically accountable way¹³.

Commodification

ART gives greater power to potential parents to control the biological characteristics of their children.  Whilst some regard this development as desirable, other argue that this implies the increasing commodification of children.  It is possible that the traditional model of child bearing is shifting perspective to one of consumerism and the acquisition of a desired product¹⁴.

One man: many children

Efforts have been made to try and limit the number of offspring which are created from the sperm of one donor.  However, donors have opportunity to donate at several different sperm banks and via the Internet. The DonarSiblingRegistry.com website received a posting from one man who claimed to have fathered 650 children via sperm donation.

The creation of large numbers of children from single donors raises major concerns.  Firstly there is the real possibility that individuals who are unknowingly genetically related may meet and have children, a situation described as unrecognised consanguinity.  As a result there is a risk of major recessive genetic disorders in subsequent offspring.

Other concerns have been raised about lack of regulation of sperm donation procedures especially in the USA and unrecognised genetic predispositions in donors including autism and behavioural disorders.  To date little detailed research into the long-term medical and psychological outcome of children created through gamete donation has not been carried out.