What is Donor Conception?
Families come in all shapes and size, and are formed in many miraculous ways.
Donor conception, in some circumstances, is the right and sometimes the only way for many women and couples to create a family.
Donor conception is the use of sperm, egg and sometimes both that have been donated to a woman or a couple so that they can use them to conceive and have a baby.
How common is donor conception?
Donor conception is common at present, and is becoming more and more common with evolving social freedoms and pressures.
Women whose own eggs are no longer of viable quality to conceive, but who are otherwise healthy, can use donated eggs to have a family. A woman’s egg quality declines progressively and rapidly from the age of 35 years, and around 50% of women over 40 require egg donation to have a baby through IVF.
Despite the fact that this is a common issue, perceived social stigma unfortunately persists, and donor egg conception is still rarely openly discussed.
Gay male couples can become biological parents using an egg donor and with the assistance of gestational surrogacy. Lesbian couples and single women can also use donor sperm to start a family.
Heterosexual couples where there is a severe and untreatable male cause for infertility can use donated sperm to successfully conceive.
Occasionally there may be medical incompatibility concerns (e.g. immune or genetic disease related issues), that may lead a couple to choose to use a sperm or egg donor.
Some women who have gone through an early menopause may be able to conceive and carry a baby with the help of a donated egg.
How can I/we find a donor?
A known donor might be a friend or a family member (depending on your circumstances). A known donor may offer help spontaneously or this may be negotiated after you approach them about the possibility.
Known donors still need to understand and comply with Australian legislation around donor conception. A donor is not the same thing as a co-parent and where using a known donor is on the cards, it is important that from the outset the relationship and expectations are mutually very clear.
For this reason and also for reasons of safety and practicality, many women and couples conceiving with the help of a known donor still employ the professional services of a fertility specialist and an affiliated IVF clinic donor program.
Planning your treatment through Women’s Health Melbourne means your donor will receive professional counselling and formalised screening for infectious diseases like HIV and some common genetic diseases that can be carried silently like cystic fibrosis.
Sperm is frozen and a cooling down period of three months is instituted to ensure the important decision to be your donor sits well with all parties. This coincides with the period of time where a new infection of a blood borne virus like hepatitis or HIV will be detectable. Donors have a further blood test after frozen sperm has been “quarantined” for three months. This helps to ensure that you are protected from sexually transmitted infection (STI) transmission risks as much as is possible.
Some known donor arrangements can proceed without medical or professional counselling help. In such instances, a woman can “self-inseminate” freshly ejaculated semen using a syringe during her fertile window. However, as each month the chance of natural pregnancy is no better than 20-25%, this method can take time (up to 12 months trying). This requires a lot of effort and co-ordination for all parties and exposes the woman to a higher degree of STI risk. Not accessing professional counselling and advice can also create risk where parenting intentions and donor status is not clear legally, which can impact child custodial interpretations if relationships change into the future.
Evidence shows that Women’s Health Melbourne’s approach, in collaboration with the long established Melbourne IVF donor program, is a low stress pathway that minimises the risk of downstream problems for everyone.
IVF Clinic Donors (donor programs)
IVF clinics create a bank of anonymous sperm and egg donors that can be accessed by people who do not have a preferred known donor. Eggs are harder to access than sperm in Australia through this channel and there are several reasons why this is the case.
For example, a single ejaculate contains millions of sperm, whereas an egg donor can make only 10-15 eggs in a treatment cycle, many of which do not ultimately result in a baby.
Sperm donation is (procedurally speaking) fairly painless for a donor with minimal physical preparation required. Egg donation is complex, requiring medical preparation and a comparatively invasive egg collection procedure – much like what a woman experiences when undergoing IVF treatment.
Women’s Health Melbourne, through Melbourne IVF, can access Victoria’s largest pool of private sperm and egg donors for our patients to choose from.
While clinic-recruited donors are initially anonymous, when your child is 18, the identity of their donor can be released to them if they are interested to know.
There are also ways where donor linking can be accessed earlier if this is important to recipient parents and if the donor also agrees.
Unknown donors through advertising
You can advertise for an egg or sperm donor. In the state of Victoria, the law requires that your ad is approved before it is published. To apply for approval of your draft advertisement, contact the Victorian Minister for Health:
Minister of Health
Department of Human Services
GPO Box 4057
Melbourne Victoria 3001
Unknown donors through internet forums
Some people connect with an Australian egg donor through online forums. Online, it is important to take measures to protect your privacy and consider potential risks. Examples of egg donation forums include:
Sperm donor forums also exist. Women and couples should be cautioned against proceeding with an anonymous sperm donor arrangement online, as they offer no protection against STI and other physical, emotional and legal risks.
Are egg and sperm donors compensated financially?
In Australia, commercial egg donation is illegal. This means that human eggs and sperm cannot be owned, bought or sold.
The law allows a recipient of donor egg or sperm to compensate their donor for reasonable expenses incurred because of their donation (e.g. medical expenses, travel and parking). Sperm donors are generally paid around AUD $250 per donation.
Egg donors are paid more due to the increased medical cost and physical burden of treatment involved in donating eggs.
In countries like Australia where egg and sperm donation is altruistic (whereby donors’ motivation is purely to help the recipient), there is a low risk of donor exploitation compared to countries where donors are motivated by financial gain. However, it also leads to Australia having fewer people interested in egg and sperm donation compared with other countries like the USA where commercial egg and sperm donation is practiced.
Who donates sperm and eggs to IVF clinic programs?
It was decided in the 1980s that anonymous sperm donation should no longer continue in Victoria. The decision was made because donor conceived people felt harmed by the fact that they were deprived of the chance to ever find out identifying information about their donor.
However, one strength of the anonymous sperm donation system was that at the time it was practiced, there was no shortage of willing sperm donors.
Men who donate sperm to IVF clinics are now counselled that one day, their adult donor offspring will be able to make contact and this has made many men think twice about becoming a sperm donor.
IVF clinics now undertake active strategies to recruit sperm donors. This includes advertising strategies and also importation of donor sperm from overseas clinics.
Clinic-recruited egg and sperm donors in Victoria are allowed to produce up to 10 families (including their own family if applicable). This is to reduce the social risks of creating too limited a gene-pool among donor program offspring.
What motivates men and women to donate sperm and eggs?
In Australia, as financial gain for egg and sperm donation is not significant, donors are motivated by altruism, the desire to help another person or couple.
Another motivation for some men is a desire to be biological fathers, when they may be unlikely to form a parenting relationship.
Women sometimes become egg donors having had their own experience with IVF (personally or through shared experiences of a family member or close friend) or have undertaken elective egg freezing (and have decided against using resultant frozen eggs themselves). Their motivation is to help other women who are not able to produce their own viable eggs.
What kind of identifying information about donors is recorded on the Victorian Donor Register?
Fertility clinics in Australia collect the following information about sperm and egg donors:
- Name (current and any previous), date of birth, recent address. Clinics also inform donors that they should update their contact details if these change over time
- Personal and family medical history, including any relevant genetic test results. Clinics ask donors to alert them to new information regarding any serious health problems that they may develop that could be genetic/affect their offspring
- Physical characteristics, such as height, skin, eye and hair colour
In Victoria, information collected by fertility clinics is lodged in a central register, managed by VARTA
Who goes on the birth certificate when using an egg or sperm donor?
When a woman conceives through assisted reproductive treatment via a fertility clinic like Women’s Health Melbourne, the donor is not named on the birth certificate. If the recipient is single, she alone will be named on the birth certificate.
If the recipient has a partner (gay, straight, male or female), as long as they are either married or in a de-facto relationship at the time of conception, the partner is also considered a parent and named on the birth certificate.
The woman who gives birth to a child born as a result of fertility treatment is the “mother” of that child. If the mother’s partner is male he is termed “father” and if the mother’s partner is female she is termed the “legal parent”.
In other words, same sex couples and opposite sex couples are treated identically.
There is a notation on the birth certificate indicating that further information regarding the conception may be available (referring to details about the fact that a donor was involved).
How long can donor eggs and sperm be frozen for? How long are they kept in the freezer?
From a biological perspective, once frozen, sperm and eggs can be kept pretty much indefinitely. There are legal restrictions which limit the time they are kept for in practice. In Victoria, after 10 years in the freezer, special permission must be sought to continue to keep sperm and eggs frozen.
The time that eggs and sperm remain frozen for before use does not influence their survival rate (as long as the conditions they are under remain constant). What can influence success rates from frozen eggs in particular is that older freeze methods used more than five years ago are not as fail-safe as modern methods. A lesser proportion of slow frozen eggs result in a live birth compared to eggs frozen using vitrification techniques.
In the case of sperm freezing, newer methods are also more successful. Due to the fact that millions of sperm are usually frozen in a single sample, even with older methods, enough sperm for use in IVF survive the warming process in most circumstances.
What barriers can lesbian couples face when starting a family?
Female same-sex couples have both disadvantages and advantages when starting a family. Advantages can include both partners having their own eggs and the potential to carry a baby. This leads to a set of questions to negotiate like who will get pregnant (or in many cases who will get pregnant first), who will provide the egg (often but not necessarily the partner who will carry the pregnancy) and who will be the sperm donor (either known or clinic recruited). For some couples, these decisions are natural and obvious and for others they are less straightforward.
Decisions of who will carry first and whose eggs to use can be emotional. Medical factors to consider are partner’s ages, ovarian reserve (estimate of ovarian egg number) and physical barriers to pregnancy, for example severe endometriosis or uterine fibroids. Other factors include feelings about the importance of having a direct genetic link to your child and about the importance of experiencing pregnancy and birth. IVF where one partner provides the egg and the other partner carries the pregnancy is known as “reciprocal IVF”, or “egg sharing”.
Finding a suitable known donor can be challenging. An absolute necessity is to have clear and compatible expectations about parenthood.
A known donor may desire more or less involvement than the lesbian parents feel comfortable with. A man willing to donate may have a partner who is not comfortable with the idea. Men may feel uncertain about the long-term responsibilities attached to giving sperm.
Professional counselling provided by an experienced ANZICA (Australian and New Zealand Infertility Counsellors Association) counsellor is provided to all couples and donors treated at Women’s Health Melbourne through Melbourne IVF. This process is incredibly beneficial to all parties, ensuring that a couple and their donor have clear expectations of parenthood and are on the same page. It is the job of our experienced counsellors to bring up and pose the difficult questions that you may not have thought of yet, so that predictable issues can be canvassed right from the start.
Many lesbian couples may prefer the independence of using a clinic-recruited sperm donor, which provides safety and convenience, without the need to negotiate co-parenting scenarios. Disadvantages in this situation include the lack of contact with their child’s donor during their childhood.
What are the fertility treatment options for gay men to start a family?
When a heterosexual couple decide to start a family, unless they suffer from infertility, the decision is theirs alone and does not require a lot of further discussion. Lesbian couples need to involve a third party to start a family, their sperm donor. When gay male couples and single gay men wish to start a family, they face further major challenges.
Firstly, gay men face the obvious major barrier that biologically, they will need to obtain the help of a gestational surrogate (a third person, whose involvement in the process of pregnancy and birth will be prolonged and intense) and they will also need to obtain an egg donor (a fourth person, as your egg donor should not be your gestational surrogate).
In Australia, surrogacy cannot be commissioned but must be altruistic. This means that a gay couple cannot financially compensate a gestational surrogate for carrying their baby. The reasons behind this are to protect vulnerable women from financially motivated exploitation, with arguments that commercial surrogacy represents commodification of the female body and that separation from the baby after birth can cause considerable psychological harm to the surrogate.
A result of this situation however, is that Australian gay men’s pathways to creating families are relatively limited compared to countries where commercial surrogacy is legal such as in the USA.
It has therefore become popular for Australian gay men to form families through surrogacy programs overseas.
Many Australian gay men have donated sperm both to IVF clinic donor programs and for lesbian and single heterosexual friends. Some men negotiate “donor dad” or co-parenting relationships with their biological children conceived in this way.
How can parents obtain information about overseas sperm and egg donors?
Australian IVF clinic donor programs that import donor sperm and eggs have to comply with NHMRC (National Health and Medical Research Council) guidelines, which support all donor conceived adults being able to know identifying information about their donor. Therefore, clinics record identifying information about overseas donors and in Victoria. This information is also held at a central donor register at VARTA.
If Australians travel overseas to have IVF donor treatment in a country where anonymous sperm and egg donation is legal, there can be no possible way of finding out the donor’s identity in the future.
How are donor eggs and sperm transported long distance/overseas?
Frozen eggs and sperm are kept in liquid nitrogen at a stable temperature of minus 196 degrees Celsius. Transportation needs to be facilitated professionally and safely in a dry shipper container, which is designed to maintain stable conditions and protect against liquid nitrogen leakage.
Occasionally, this process can fail and eggs and sperm can be damaged or lost but usually the process is safe.
Does using donor eggs from a younger woman increase my chances of having a baby?
Many women use donor eggs to have a baby, but the most common circumstance for needing an egg donor is when women over 40 years have not been able to conceive using their own eggs because of poor egg quality and low ovarian reserve. Using a donor egg from a younger woman significantly increases the chance of successfully having a baby. Similarly, some women who have proactively frozen a good number of their own younger eggs can use these to have a baby, like being their own ‘younger egg donor’.
Using donor eggs doesn’t get around all possible pregnancy complications. Women who use donated eggs to have a baby over 40 (at what doctors define as advanced maternal age) are at higher risk of some pregnancy complications such as gestational hypertension (high blood pressure), pre-eclampsia, gestational diabetes and are more likely to need to have a caesarean birth.
Why is ICSI (Intracytoplasmic Sperm Injection) used in IVF with donor sperm?
ICSI is a technique where a single sperm is used to fertilise each egg and is commonly used in scenarios where sperm quality is compromised or if a man has a very low sperm count (male infertility). Sometimes, men with even a zero sperm count in their ejaculate can become fathers using ICSI, where doctors retrieve sperm surgically, directly from the testes.
ICSI is technically complex and costs more than a standard IVF treatment, where approximately 200,000 motile sperm are prepared and placed next to each egg.
Natural fertilisation does not occur in a one sperm to one egg ratio. Many thousands of sperm work together, even in the IVF lab to first prime and penetrate the outer layers of the egg so that after a critical sequence of chemical events, one leading sperm achieves fertilisation.
The main reason ICSI is used in donor sperm conception is to conserve supplies of donated sperm, so that a donor does not have to be recalled to donate over and over again. This way, a limited amount of donor sperm can be used in more patient treatments.
ICSI is also required to inseminate frozen-thawed eggs. This is because in egg freezing by vitrification, the outer layer of the egg called the cumulus layer is stripped before freezing. This layer is important in the process of standard IVF fertilisation. When ICSI is used to fertilise eggs that have been previously frozen, optimal fertilisation rates are achieved. Using ICSI, a scientist can ensure that abnormal fertilisation is prevented (for example making sure only one sperm enters each egg).
What is donor linking?
Donor linking is communication between people connected by treatment involving donor conception (e.g. parents, donor conceived people and donors). Contact can be in person or may refer to the exchange of information though a third party such as the staff of the Victorian donor register.
Disclosure of information may be limited (e.g. the sharing of medical information) or a resulting friendship may form where communication is more significant.
In Victoria, the first step towards donor linking is to contact VARTA and to make an application to the donor conception register.
What are some issues for non-biological parents considering donor conception?
When seeking to conceive using a donor egg, sperm or embryo, it is important you feel very confident that you are able to love your child regardless of whether you share genes with them.
This issue is important to think about, discuss and process.
A common concern for parents who do not share genes with their baby is whether or not they will bond with their baby and love them. Non-biological parents may also worry about defining their role with their child and in the family.
Most parents who conceive using donor sperm and egg say that their experience as a parent and the love they feel towards their child is not dependent on sharing common DNA.
If you are considering donor conception but are stressed by these issues, here is a list of options to assist your decision making:
- Write down a list of the issues that do not sit well with you. Break it down in detail.
- Share your list with your partner and close support network
- Seek the advice from of an experienced ANZICA counsellor
- Research the experience of other people in a similar situation
- Speak to other parents of donor conceived children or join a support group
How does Victorian state legislation impact egg and sperm donation?
In Victoria, sperm and egg donors can assist in the creation of up to 10 families (including their own).
All births that involve IVF clinic donor programs are reported to the Victorian donor register at VARTA.
The birth mother and her partner (if she has one) are identified on a donor-conceived child’s birth certificate as the parents. A donor is not a legal parent and has no legal rights or obligations to children born as a result of their donation.
All donor conceived adults (over 18 years) have the right to apply to receive identifying information about their donor.
All donations must be altruistic, and cannot be financially compensated beyond what is considered reimbursement for “reasonable expenses”.
What should I look for in an egg donor?
Age is an important factor to consider when finding an egg donor. Younger women are naturally more fertile, however very young women who have not yet considered having their own family may not psychologically be the best candidates to be an egg donor. The ideal age for an egg donor is between 25-36 years.
Older women may still be able to be your donor but the chance of success is less. It is preferable that your donor has already had a child of her own and has ideally completed her family. Women who are already mothers have proven fertility, and can also more fully understand the consequences of donating.
Ideally an egg donor should be physically healthy and mentally strong.
The motivation of your donor should be altruistic, with the desire to help you.
If choosing a known egg donor, choose someone you like and get along with as they will be genetically linked to your child and may have future contact.
Your donor should appreciate clear boundaries and respect that only you and your partner will be the legal parents of your child. Negotiate mutually acceptable terms from the outset. If this is difficult, it may be better to reconsider your choice of donor.
To learn more about donor conception, and to find out if it’s right for you, contact Women’s Health Melbourne today. Dr Raelia Lew and her team are passionate about empowering couples and individuals to make the best choices, while delivering the best possible outcomes.