Monday, September 27, 2010

Infertility and Recipients of Embryo Donation

Last week my blog concerned embryo donation. This blog will focus on the recipients of embryo donation. With the large number of cryopreserved (frozen) embryos available in the U.S., only a small percentage are designated for donation to other individuals and couples. Who might be the recipients of these embryos? Why might this option be more appealing than egg (oocyte) donation or adoption? What psychological issues will recipients face as they pursue parenthood via embryo donation?

Among those individuals who consider becoming recipients are infertile couples whose treatment has been unsuccessful, single and lesbian women, individuals who have experienced repeated pregnancy losses (based on other than uterine implantation factors), and individuals with transmissable genetic diseases, absent or nonfunctional testes or absence of or nonfunctonal ovaries (with a functional uterus). However, the choice to be a recipient may not be available to these populations in all countries, so in this blog I will focus on options in the U.S., where practices can vary by agency/clinic.

So why might an individual or a couple decide to become a recipient of embryo donation, where the embryo is placed in the uterus of the woman recipient, with the hope that it will implant and develop into a healthy fetus? Many recipients pursue embryo donation because it is a less expensive family building option than egg donation or traditional adoption. Also, the process of obtaining donated embryos may take less time than adoption. Some couples are drawn to this option because of their wish to experience pregnancy, delivery and nursing of an infant. Others value that it offers greater control over prenatal care and nutrition than would be likely with adoption. Still others anticipate that future pregnancies using the same embryo donors would allow their children to be genetically related to one another, even as they do not share the genes of their gestational mother and her partner.

So what are the words of caution for individuals considering this alternative form of family building? In one's eagerness to locate a donor, some potential recipients may decide to travel to other countries to receive treatment that would be much less available or more expensive in the U.S. Known as reproductive tourism, this practice shortcuts the education and counseling provided in U.S. agencies/clinics, may not be performed under ideal medical conditions and, in some cases, is both financially and emotionally exploitive to the non-domestic embryo donors.

However, assuming that you remain in the U.S. working with an agency/ clinic whose staff are skilled in supporting both donors and recipients, you and your partner may need to travel for treatment and counseling, will need to have a home study performed in advance of receiving the embryo, and are likely to be expected to explore issues with a mental health professional in several areas: how have infertility and infertility treatment affected you? what are your concerns/fears/fantasies about building your family through embryo donation? what coping strategies do you envision using as you proceed with this option? how will you contend with the knowledge that any offspring born via embryo donation will probably have genetic siblings who are being raised by the genetic parents? will you disclose to any offspring about their embryo donation origin? how "open" or "closed" do you want your relationship with the donor couple to be? (Clinics make every effort to match donors and recipients with the same preferences) and how have you and your partner come to terms with giving birth to a baby not genetically related to either of you?

The World Health Organization recommends that counseling should be made available to all individuals and couples undergoing embryo donation. In the U.S. this is typically provided through embryo donation agencies. In the U.S., RESOLVE, the national infertility organization, has published extensive materials related to embryo donation (see Among other issues, these resources will inform you about a number of financial expectations, which can include the cost of fees for medical examination, blood testing and professional fees that must be assumed for both the donating and recipient couples, psychological counseling before and after the transfer process, shipping of embryos, reimbursement to donors for storage expenses, the agency fee for its work in facilitating the donation, medical and genetic screening, and the home study.

So do you think of yourself as a potential recipient of donated embryos? With this as a relatively new parenting option, there exists some beginning research, an increasing number of agencies serving both donors and recipients, and excellent publications through RESOLVE for U.S. residents who would like to become more fully informed. If you are intrigued by this option for building your family, I hope my blog has pointed you in several directions to explore further!

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