Embryo donation: outcome and attitudes among embryo donors and recipients

The outcome of an embryo donation programme was evaluated and attitudes among donors and recipients studied by means of a questionnaire survey. A total of 27 couples went through 54 treatment cycles with frozen-thawed embryos donated by other infertile couples. The indications for treatment were premature or incipient ovarian failure in combination with severe male factor infertility. The mean age of the recipient women was 36 years, and that of the recipient men was 35 years. The mean duration of infertility was 8 years (range 2-19 years). Forty-six couples donated 209 excess frozen embryos to the programme. The clinical pregnancy rate in the recipients was 27.8% (15/54) per embryo transfer. An average of 1.9 embryos were transferred on each occasion. The response rate to the questionnaire was high (80-91%). Significantly more recipients (69%) than donors (47%) considered that the child should be informed about the manner of conception (P < 0.05). Some 29% of recipients and 42% of donors thought that the child should receive identifying information concerning the donor couple. The interest of the offspring, not only as regards knowing his/her genetic origin but also knowing full-blood genetic siblings, should be kept in mind in embryo donation programmes.     

Embryo donation: attitudes toward donation procedures and factors predicting willingness to donate

BACKGROUND: The aim of the study was to assess infertile couples' attitudes toward the procedures of embryo donation (ED) and to identify factors predicting interest in donation. METHODS: Fifty-one couples who had received IVF treatment and had subsequently had embryos cryopreserved for >3 years were located and sent written information about the procedures for ED and possible implications of donation. A total of 49 couples agreed to participate in the study with 36 women and 31 men subsequently returning questionnaires describing their reasons for not claiming unused embryos and attitudes towards ED. RESULTS: Patients were supportive of donor screening procedures, but less comfortable sharing non-identifying information. Comfort levels declined as information became increasingly personal. Support for unconditional (i.e. the donation of embryos without conditions attached) and conditional (i.e. where couples could limit the donation of their embryos to persons/couples according to their preferences) models of donation was highly polarized and a substantial minority expressed strong opposition to each model. Willingness to donate was associated with greater comfort about disclosing personal information, a desire to know the outcome of donation and willingness to have future contact with a child, but not with current family size. CONCLUSIONS: Comfort in sharing information with a recipient couple is more important than acceptance of screening procedures, or attainment of family size goals in predicting willingness to donate embryos. Offering the option of conditional donation could increase the acceptability of ED for some patients.     

Patients' attitudes towards donation of surplus cryopreserved embryos for treatment or research

BACKGROUND: The aim of the study was 2-fold: first, to investigate couples' reasons for not using cryopreserved embryos within the maximum storage period; second, to study their attitudes towards potential embryo donation for specific purposes. METHODS: A questionnaire was sent to 284 IVF/ICSI couples who experienced destruction of their cryopreserved embryos (n=1180) because the cryopreservation period exceeded the Danish legislative limit of 24 months. RESULTS: Seventy-four per cent of the couples responded. The main reasons for not utilizing surplus embryos was 'successful delivery' (85%), 'consider family completed' (61%) and 'too short legislative limit for cryopreservation' (59%). Sixty per cent of the couples agreed to the concept of donation of cryopreserved embryos for infertility research, 57% responded affirmatively to donation for stem cell research and 49% for stem cell treatment, but only 29% agreed to the concept of donation to infertile couples. Multiple logistic regression analysis showed that delivery of a child after IVF treatment (OR 3.8, 95% CI 1.4-10.2) and female age <35 years (OR 2.2, 95% CI 1.3-6.0) were predictive of agreement to the idea of donation for stem cell research and stem cell treatment respectively; however, male age, duration of infertility, mode of conception (IVF or ICSI) and having IVF children were not significant predictors. The following predictive variables were entered into the analysis: female and male age, duration of infertility, IVF versus ICSI, donor semen and +/- IVF children. CONCLUSIONS: This study shows that 23% of all couples having cryopreserved embryos do not utilize them for further treatment within the legislative storage period of 2 years. A major reason is successful delivery. More than half of these patients agreed to the concept of donation of surplus outdated embryos for research, whereas less than one-third agreed to donation to other infertile couples. Based on these figures, an alternative utilization of surplus embryos for stem cell research would require a 100-fold larger pool of available embryos to provide a realistic basis for this purpose.     

Follow-up study of Finnish volunteer oocyte donors concerning their attitudes to oocyte donation

A questionnaire was sent to the first 30 Finnish volunteer oocytedonors at 12–18 months after donation to determine theirexperiences concerning treatment and attitudes to donation.All donations were carried out anonymously and without payment.The donors were recruited by advertising in newspapers. Mostdonors were very satisfied with the experience. The side-effectsof the treatment had been slight and tolerable. In all, 85%of the respondents reported no gynaecological problems afterwards.The problems reported by the other 15% were minor and unrelatedto the donation. A total of 67% of the respondents would haveliked to have known if pregnancy had been achieved in the recipient,and 89% reported that they had thought about the possibilityof a child from their donation. Some 42% of the respondentspreferred to receive no information concerning either the childor the recipient couple. Of the respondents, 59% thought theoffspring should be told about its origin and 33% thought thechild should be given identifying information about the donor.About half of the others would agree to the release of non-identifyinginformation. In all, 96% of the respondents reported that theirown feelings were sufficiently taken into consideration duringthe treatment and 78% would donate again. No-one regretted theirdonation.     

Embryo donation families: mothers' decisions regarding disclosure of donor conception

BACKGROUND: Previous data suggest that parents who adopt a child tend to support full disclosure while donor conception families prefer to keep the method of conception relatively private. It is not known whether parents in embryo donation families will tend towards the adoption model, therefore, we studied families with a child conceived using donated embryos. METHODS: A total of 21 embryo donation families with a child aged 2-5 years were recruited through UK fertility clinics. Mothers were administered a standardized semi-structured interview, obtaining data on the extent of their disclosure to children and other family members and their reasons for this decision. RESULTS: At the time of interview, 9% of mothers had told their child how they had conceived; 24% of mothers reported that they were planning to tell the child in future; 43% had decided that they would never tell the child, and the remaining 24% were undecided. However, nearly three-quarter of mothers (72%) had disclosed to other family members. Maternal grandparents were more likely to have been told than paternal grandparents (P < 0.025). Reasons cited for non-disclosure to the child included the desire to protect the child, the belief that disclosure is unnecessary, and the concern that family relationships would be damaged. Reasons in favour of disclosure included the desire to avoid accidental disclosure and the belief that the child has the right to know. CONCLUSIONS: Embryo donation mothers were similar to parents of donor insemination and oocyte donation children in their attitudes towards disclosure of donor conception.     

Ethics and Society: Current attitudes towards egg donation among men and women

Recent widespread concern has led to legislation in the UK preventingthe use of fetal ovarian tissue for the treatment of infertilewomen. This questionnaire-based study aimed to assess the attitudesof both fertile and infertile men and women as well as egg donorsand recipients towards the use of donated eggs for treatment,diagnosis and research. Fertile individuals were significantlyless aware of egg donation but the majority in both the fertileand the infertile groups approved the use of eggs for research(89 and 95% of women and 88 and 92% of men respectively) andtreatment (similar percentages). However, fetal sources of oocyteswere acceptable to only 15% of women in the fertile, 21% inthe infertile, 35% in the recipient and 19% in the donor groups.Cadaveric sources of oocytes were slightly more acceptable (28%fertile, 28% infertile, 50% recipient and 42% donors). Boththese sources of oocytes were slightly more acceptable to men.Education had little influence on attitudes, although men andwomen of tertiary education level said they would be less likelyto have gamete donation themselves. Thus there would appearto be widespread approval for the use of donor eggs in researchand treatment but not if the source of eggs is fetal or cadaveric.     

Oocyte donation for stem cell research

The future success of stem cell research by means of somatic cell nuclear transfer (SCNT) depends on a sufficient supply of human oocytes. However, oocyte donation presents certain risks for the donor, and concerns for women's welfare are rightly vocalized. At the same time, these risks are comparable with the risks faced by other healthy research subjects. Thus, research donation can withstand ethical scrutiny if it fulfils the same conditions as other research involving healthy human subjects. Specifically, this means that the benefits of the research project need to outweigh the harms, that risks must be minimized, that informed consent has to be guaranteed by averting undue inducement and the recruitment of vulnerable women and that donors can and should be reimbursed for their research participation.     

Parents' knowledge about the donors and their attitudes toward disclosure in oocyte donation

BACKGROUND: Oocyte donation is a popular treatment option among women with ovarian dysfunction. Little is known about the amount of information recipients have about their donors and if the amount of information the couple has relates to their plans to disclose. The purpose of this study was to assess the amount of information recipients had about their donors and their disclosure plans. METHODS: Sixty-two sets of oocyte donation parents from five programmes completed a self-report questionnaire. RESULTS: Ninety percent of both men and women knew their donor's age, ethnicity, hair colour, eye colour, height, weight, education and medical history. Significantly more women than men told others about using a donor to conceive, but two-thirds of women and men would not tell others if they had to do it over again. Fifty-nine percent of women and 52% of men planned to or had told their child; 34% of women and 41% of men do not plan to tell. The amount of information known about the donor was related to plans to tell the child for men only. CONCLUSION: Approximately half of couples plan to tell their child of their oocyte donor origin and a majority have told others but many regret having done so. Knowledge about the donor is related to disclosure for men only.     

Intrafamilial sperm donation: ethical questions and concerns

Sperm donation seems to be the only solution in cases of negative results with testicular sperm extraction (TESE). However, it implies a genetic dissociation between husband and offspring that results in psychological stress, as well as ethical and existential dilemmas for the couple. Facing these dilemmas, some couples prefer father-to-son donation as an alternative solution. However, father-to-son sperm donation involves many potential medical, ethical and emotional risks. A broad discussion within the scientific community on these issues should contribute towards a better approach of these cases.     

A comparison of the attitudes of volunteer donors and infertile patient donors on an ovum donation programme

The attitudes of anonymous volunteer donors (n = 20) and infertile patients who were undergoing treatment in an IVF programme and who donated oocytes (n = 15) towards the donation, the recipient, the potential children conceived, the recording of information and their experience of the procedures were sought by posted questionnaires. All donations were made for altruistic reasons and no payments other than expenses were made. Both groups agree that donors should not be paid and they both deny any connection with the child resulting from their donation. The majority in both groups also did not object if their eggs were donated to unmarried single women and they did not wish to meet with the recipient. The majority of both groups would however agree to donate to known recipients. Over 80% had told others of their donation and a similar number in the volunteer group held no objection to the recipients knowing their name whilst only 40% held the same view in the patient donor group (17/20 versus 6/15 P less than 0.02). The feelings of the groups was also different in relation to their desire to know if a child was born from their eggs. Eighty five per cent in the volunteer group (17/20) would like to know the outcome and only 40% (6/15) of the patient donor would want to know the outcome, P less than 0.02. Although greater than 50% in both groups experienced side effects, 60% of volunteers and 90% of patient donors expressed a willingness to donate eggs again.(ABSTRACT TRUNCATED AT 250 WORDS)     

How to facilitate decisions about surplus embryos: patients' views

BACKGROUND: In Victoria, Australia, legislation governing fertility treatment provides that surplus human embryos must not be stored for longer than 5 years. Couples must then choose one of three options: discard, donate to research or donate to another infertile couple. Previous research suggests that many people find these decisions difficult and emotionally distressing. This study aims to elucidate the nature of these difficulties and to identify ways in which the decision-making process could be facilitated. METHODS: This project used a combination of qualitative research methods. In total, 42 people agreed to participate in either a structured interview or a group discussion. All participants had completed IVF treatment and had surplus embryos in storage. The aim of the interviews was to discuss participants' decision making regarding their surplus embryos. Data were thematically analysed. RESULTS: Most participants described the decision-making process as difficult and emotional. Findings indicate that participants could be assisted by more information about each of their current options, and opportunities to talk to others in similar situations. Many responded positively to the idea of having more options, including choice about which research projects to donate to (directed research), and about the recipients of their donated embryos (directed donation). CONCLUSIONS: This study suggests that there are practical ways to assist people in making decisions about their surplus embryos, which could be easily implemented. In addition, the study demonstrated interest in the possibility of directed donation to other couples.     

Comparative assessment of pre- and post-donation attitudes towards potential oocyte and embryo disposition and management among ovum donors in an oocyte donation programme

BACKGROUND: In anonymous oocyte donation programmes, the disposition of retrieved oocytes and subsequent embryo management are at the discretion of the IVF programme and the oocyte recipients, as donors waive all rights following their donation. Nonetheless, donors are routinely made aware of ways in which oocytes and resulting embryos may be used and elect to proceed with the process even in the presence of reservations to some clinical scenarios before their donation. The aim of our study was to examine oocyte donors' attitudes to oocyte and embryo disposition and management and how initial reservations change over the course of the donation process. METHODS: Oocyte donors in a university-based IVF programme were asked about their willingness to donate in relation to various clinical scenarios during the initial screening interview and at the post-donation exit interview. Results were tabulated as 'yes' or 'no'. RESULTS: At the pre-donation interview, 72% of donor candidates expressed reservations to one or more clinical scenarios. More reservations were expressed at the post-donation interview compared with the pre-donation interview. The greatest reservations were donating to recipients >50 years of age (P < 0.05). Despite this, 97% of donors were willing to donate again. CONCLUSION: Oocyte donors' attitudes towards various clinical scenarios changed following their donation, reflecting overall greater reservations following the donation process. Although speculative, donors may be more willing to assert their opinions or donor attitudes become more restrictive.     

Whole body donation for medical science: a population-based study

Although cadaveric whole-body donation for the purposes of medical science is extremely important for medical education, the number of persons who choose to donate remains low. We assessed persons' willingness to consider whole body donation in a standardized telephone survey of Maryland households, identified using random digit dialing. In multivariable analyses, we assessed the independent relation of sociodemographics and attitudinal factors to willingness to consider donation, and we determined the amount of variation in willingness to consider donation among the study population that could be explained by these factors. Of 385 participants (84% of randomized homes), 49% reported they would consider whole body donation. In bivariate analysis, younger age, African-American race/ethnicity, less education and income, greater number of dependents, marital status, and attitudes about religion/spirituality, trust in hospitals, and income, gender, and racial/ethnic discrimination in hospitals were statistically significantly associated with 40-70% less odds of willingness to consider donation. After adjustment, persons of African-American race/ethnicity, less education, and those agreeing with the statements, "Rich patients receive better care at hospitals than poor patients," and "White patients receive better care at hospitals than other racial or ethnic groups," had 40-60% less odds of willingness to consider donation when compared to their counterparts. Respondents' race/ethnicity and education contributed most to willingness to consider donation. We conclude that demographic and attitudinal factors are strongly related to willingness to consider whole body donation. Efforts to enhance donation should seek to identify ways in which potential barriers to donation can be addressed by health professionals.     

Ethics and Society: A survey of parental attitudes toward oocyte donation

A questionnaire was sent to couples who had successfully completedoocyte donation cycles to survey their experiences and makesuggestions to others considering this option. A majority ofcouples were successful in their first cycle, despite advancedmaternal age or length of time attempting conception. A preferencefor non-anonymous arrangements was highlighted, despite theunknown long-term impact, and the importance of finding supportwas stressed. Respondents indicated no confusion about theirrole as parents of children conceived through oocyte donation.     

Ethics and society: A survey of semen donation: phase II -- the view of the donors

This report presents the findings of phase II of the surveyof semen donation commissioned by the Human Fertilization andEmbryology Authority (HFEA), the purpose of which was to obtaininformation about the motivations and attitudes of semen donorsin comparison with a matched group of non-donors. A total of14 centres licensed by the HFEA to conduct donor inseminationparticipated in the investigation. At each centre, all men whoattended for their first or second appointment between 1st November1993 and 31st January 1994 were asked to complete a questionnaireabout the factors which prompted them to attend the centre andabout their knowledge of, and attitudes towards, semen donation.In spite of the recommendation by the HFEA that attempts shouldbe made to recruit as semen donors older men in stable relationshipswho already have children of their own and who wish to donatefor altruistic reasons, it remains the case that the large majorityof men in the UK who donate semen are young single studentswho are largely motivated by payment. Views on oocyte donationof women who had never donated oocytes were also obtained, andcompared with views on semen donation of a matched group ofmen who had never donated semen.     

Attitudes towards gamete donation among Swedish gynaecologists and obstetricians

BACKGROUND: Assisted reproductive technology (ART) legislation in Swedenhas undergone a gradual transformation from being fairly restrictivewhen first introduced to becoming more permissive in recentyears. Regarding gamete donation, Sweden became the first countryto pass legislation about disclosure by establishing a child’sright to find out the identity of the gamete donor once thechild has reached maturity. Our aim was to investigate attitudestowards gamete donation among Swedish gynaecologists and obstetricians. METHODS: A questionnaire was mailed to all gynaecologists and obstetricianslisted from a commercial register of all working in Sweden.Among 1230 eligible gynaecologists/obstetricians, 854 (69%)answered the questionnaire. RESULTS: In general, the majority of Swedish gynaecologists/obstetricianshad positive attitudes towards gamete donation. Although a majorityadvocated openness regarding informing the child that he orshe was conceived by making use of gamete donation, 40% opposedallowing the child to receive any information about the donorwhen the child has reached maturity. Even though Swedish legislationhas allowed sperm donation to lesbian couples since July 2005,one-third of the gynaecologists/obstetricians opposed donationto lesbians. CONCLUSIONS: The results indicate that the gynaecologists’/obstetricians’negative attitudes towards disclosure may influence patients’ability to discuss their thoughts and feelings about donation.This may also have a negative impact on donor recruitment aswell as on the extent of methods made accessible within ART.     

Ooplasmic donation in humans: the potential for epigenic modifications

Ooplasm donation, wherein ooplasm is transferred from a donor oocyte to a recipient oocyte in an effort to increase embryo viability, has been applied in the human, with resulting pregnancies and births. Neither the safety nor efficacy of this method has been adequately investigated. Mitochondrial heteroplasmy in the blood of children conceived using ooplasm donation has recently been described. A follow-up study of children born following the use of this technique primarily focused on the presence of mitochondria from the donor oocyte highlighting possible problems due to mitochondrial heteroplasmy. Other effects related to epigenetic events may also arise, but have not been addressed. Studies using inbred mouse strains reveal that genetically diverse ooplasms can impose diverse epigenetic modifications on parental genomes. Incompatibilities produced by combining maternal genome and ooplasm from different genotypes leads to defects in gene expression and development. Such defects can be heritable and observed in the next generation. Given the potential for epigenetic modifications to arise following ooplasm donation, the safety and efficacy of this method need to be evaluated in a suitable animal model.     

Counselling couples and donors for oocyte donation: the decision to use either known or anonymous oocytes

In order to avoid a long waiting period, the Centre for Reproductive Medicine of the Free University of Brussels suggests that couples in need of donor oocytes search for a donor among family and friends. Recipient couples can choose between two types of donation: known donation, i.e. treatment with the oocytes of the donor recruited by the couple, or anonymous donation, i.e. an exchange of the donor recruited by the couple with a donor recruited by another couple in order to ensure anonymity between donor and recipients. In total, 144 couples were counselled by a psychologist in the decision-making process with regard to the kind of donation to be used. Some 68.8% of the recipient couples preferred known donation. This choice was mainly motivated by reasons related to fears associated with anonymity, such as fear of the unknown origin of genetic material and the trust that couples had in 'their' donor. Almost one-third of the couples opted to use anonymous oocytes. The desire to establish explicit boundaries between the two families involved was the major motivation for this choice. Approximately 44% of the couples were willing to tell the child about the oocyte donation.     

Anonymous oocyte donation: a psychological study of recipients, donors and children.

The psychological features of anonymous, personalized oocyte donation are examined. The specific psychological profiles of recipients and donors are described, as well as the psychological experience of patients undergoing fertilization attempts. Preliminary data from an ongoing 3-year longitudinal study of children born by these medically assisted procreation techniques are reported.     

ESHRE Task Force on Ethics and Law 12: oocyte donation for non-reproductive purposes

The present paper focuses on oocyte donation for non-reproductive purposes, i.e. research and future therapy. The general principles of research ethics apply to these interventions. The proportionality principle demands that any possible harms to the oocyte donors should be proportionate to the possible benefits for society. The non-maleficence principle states that every reasonable effort should be made to minimize risks for donors. The position is adopted that, mutatis mutandis, women who donate oocytes for research should be treated similarly to research participants in clinical trials. This implies, among other things, that oocyte donors for research should receive reimbursement for all costs of the procedure and should get compensation for the time lost and inconvenience suffered during the treatment. In order to avoid malpractice and exploitation of poor women, a number of measures are proposed such as a ban on the import of oocytes.