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Embryo Recipient: Questions and Answers
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Adoption is an excellent
option for many couples. For some, however, embryo donation may be a preferred alternative:
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Embryo donation is quicker with
delivery often within one year of the first visit.
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Embryo donation is often much
less expensive than adoption.
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Embryo donation is usually less
complicated and less expensive than many alternative
ART procedures.
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Unlike adoption, one has a tremendous
amount of medical information regarding the mother
and the true father of the donated embryos. At
times in conventional adoption, the genetic father
of the gestation is incorrectly identified leading
to uncertainty and future custody/legal issues.
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Unlike adoption, the embryo
recipient can choose the genetic traits they value
by looking for donated embryos from specific genetic,
social and religious backgrounds.
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Unlike adoption, the embryo
recipient can protect and nurture the pregnancy
minimizing the prenatal exposure to drugs, poor
nutrition and Sexually Transmitted Infections
(STI's).
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Unlike adoption, the embryo recipient may go to the Obstetrician of her own
choice. In conventional adoption, the pregnant
mother goes to the physician of her choice.
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Embryo donation offers a greater
level of privacy compared to conventional adoption.
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While quite variable, some insurance
plans will cover for some aspects of the Frozen
Donor Embryo Transfer (FDET) process while they
will not cover adoption fees.
Adoption is still an excellent option for some couples
while embryo donation has a number of interesting
advantages.
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Who
Are The Potential Embryo Recipients?
The following are some of the potential patients who
are embryo recipients:
- Both partners have significant
fertility issues.
- Patients are seeking a less expensive
alternative compared to other technologies and adoption.
- Patients are unable to adopt
(i.e., cancer survivor, single, alternative lifestyle, in their
40's).
- Patients with a family history
of genetic disease where direct reproduction is
not recommended.
Significant medical
conditions such as diabetes and recurrent pregnancy
loss may exclude an embryo recipient from participation
in the program.
In addition, because of the fact that EDI may have fewer
embryos donated than people requesting them, we will
often limit the donations to individuals and couples
who truly have limited options and are at a higher priority. While not an exact science, this is a rough estimate of priroity rating of the embryo recipient.
| Priority |
Characteristics |
1. |
No children.
Few fertility options with limited financial resources. |
| 2. |
No living children (death of a child).
Few fertility options with limited financial resources. |
| 3. |
Adopted children only. |
| 4. |
One partner has children and the other has not. |
| 5. |
Both partners have children, but not together. |
| 6. |
No children, but other fertility options exist, but couple reluctant to use them |
| 7. |
Couples with children together. |
The greater the number, the lower the priority. We also take into account how long the recipient may have been waiting here at EDI for embryos. We also try to offer the embryos fairly to established patients as well as those that have yet to visit EDI.
The priority listing may be able to be relaxed
in the future as EDI obtains more donated embryos but, embryos should currently be considered a rationed commidity, just as donated kidneys and donated livers are. Some sort of priority listing is necessary to be fair to all participants.
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How
Do I Choose The Donated Embryos?
You may choose your donated embryos using a number
of parameters. Recipient couples commonly try to match
such characteristics as race and the educational background of those donating the embryos.
Highly Desired Donor
Parent Characteristics:
- History of conception from
the same batch of embryos (i.e., the fresh embryo
transfer resulted in a pregnancy of the donor
and the excess cryopreserved embryos are from
that same cycle were donated)
- Donated maternal age less than
34 at the time of ART
- No family history of genetic
diseases
- No history of sexually transmitted
diseases
Moderately Desired Donor Parent
Characteristics
- Maternal age 35-40 at the time
of ART
- Family history of genetic diseases
- Past history of treated sexually
transmitted disease*
*A donated embryo recipient who already has hepatitis
may receive donated embryos from embryo donors with
hepatitis.
Donated embryos will
frequently differ in quality based on the following:
- If the original fresh transfer
resulted in a conception, the entire batch of
embryos will tend to be excellent.
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The larger the number of cryopreserved
donated embryos, the greater the likelihood for
success and the more chances the recipient will have to conceive.
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The more advanced the embryo is
in development at the time of cryopreservation
(i.e., morula or blastocyst stage cryopreserved
donor embryos), the healthier the embryos and
the greater the likelihood of implantation.
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The younger the female donor parent,
the better the implantation rates.
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The younger the female donor parent,
the less likely that a genetic amniocentesis will
need to be performed during a successful Frozen
Donor Embryo Transfer (FDET) pregnancy.
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What
Kind Of Screening Did The Embryo Donors Receive?
All embryo donors underwent intensive screening processes
including history & physical exams, detailed genetic
histories and extensive laboratory testing for communicable
diseases. Please remember that
these couples had medical problems just like you, so
their medical histories were not perfect. Nearly
all of them will have some reproductive issues.
Per standard of care, all embryo donors underwent
various evaluations including screening for Sexually
Transmitted Infections (STI's) including hepatitis,
syphilis and HIV. Ideally, the embryo donors should
be re-screened for STI's before the donated embryos
are thawed and transferred. Embryo donors often want closure and are unwilling to repeat this evauation, so this post-retreival screening is not always possible. Screening also adds further costs to the embryo recipient. The
likelihood for ART patients, such as you, to be negative
for HIV just prior to ART, only to turn positive later,
is quite low. We simply has a very low risk population
for these types of concerns. We
must always keep perspective on this issue since conversion
to an active infection is extraordinarily unlikely.
In addition, it should always be remembered that you
are considering the transfer of very minute quantities
of tissue (i.e., multi-celled embryos) compared to organ
and blood donation where billions of cells are donated.
It is also of interest that the embryo culturing and cryopreserved process itself
may also render some underlying infections harmless. Even if the embryo donors were positive for STI's,
the chances of transferring
HIV or Hepatitis to the embryo recipient are astronomically
small, and perhaps, only a theoretical concern.
In fact, it is uncertain if any STI's have ever been transferred to recipients...ever.
Some of the parents
will have agreed to be re-tested upon request, although
doing so will increase the costs of the embryo donation
procedure. Interestingly, if the embryo donors agree to testing, we are probably obligated to do so by the FDA.
Lastly, the FDA does not require rescreening while the American Society for Reprodutive Medicine recommends it. If the embryo donors are not retested or the recipients prefer to not spend the extra money, we here at EDI do not feel that this is a good reason to exclude embryos, or worse, to discard or abandon them. |
Was
Genetic Screening Performed On The Embryo Donors?
Routine genetic screening laboratory tests, including
Sickle Cell for African-American patients and Tay Sachs
for Jewish patients, were inevitably offered to the embryo donors during their original ART cycle. If
there was a significant history for other genetic diseases,
testing for these disease were also offered. Offered
does not necessarily meant that they were done.
Changing recommendations regarding genetic screening
now make the FDET process more complex. For example,
Caucasian couples considering conception are now to
be offered genetic testing for the gene that causes
Cystic Fibrosis. A Caucasian woman is estimated to have
close to a 1/29 risk for carrying the abnormal gene, which can
result in Cystic Fibrosis in about one out of every 3,400
deliveries (http://www.cff.org/).
It is an uncommon disease, but genetic testing is now
offered to couples considering conception.
In all likelihood, the embryo donors may not have
this level of genetic screening. If the embryo donors
are currently available and willing, this genetic test
can be performed in addition to the updating of other
STI's. Once again, if requested, this will increase
the costs to the embryo recipient. Genetic screening and repeat testing
for STI's will therefore remain optional to
the embryo recipient assuming the consent for retesting
by the embryo donors.
Having children is a risk. Ilness can occur. Unexpected issues may be found. Overall, the risks are small and must be kept in perspective. |
Are The Children Born Via Embryo Donation Different Than
Other Children?
Gestations that result from the embryo donation
are essentially the same to children conceived through
a more "natural" process. There are, however,
a few potential exceptions:
- If the embryos were created
from subfertile parents, the offspring may have
similar reproductive issues when they reach adulthood.
For example, there does seem to be genetic predisposition
to gynecologic diseases (i.e., endometriosis)
much as the way that cancer and heart disease
may run in various families.
- Along the same lines, additional
data has been published that indicates some male-factor
problems may be passed on to the children. This
seems to occur at a very low rate, but may occur.
The overall outcome is usually similar to that
of the father (i.e., reproductive issues). Fertility
and other medical issues may occur to the male
child or the female offspring may carry a genetic
problem that could eventually affect her children.
Once again, the medical outcomes are usually no
different than the male partner who originally
provided the sperm.
- Please keep in mind that what
ever brought you to the embryo donation process may have
been transmitted to your own genetic offspring but, you were willing to take the risks. In
addition, these concerns generally pale in comparison
to conventional adoption, where much less are
known about the genetic parents and their family.
- There have been some studies
which indicate the average ART pregnancy will
deliver somewhat earlier with a smaller-for-gestational-age
baby compared to those conceived through natural
means. Placing these same embryos in healthy surrogates leads to normal gestational lengths and normal delivery weights truly suggesting that these delivery issues are mostly likely caused by the higher risk subfertile woman carrying the pregnancy than the procedure that was used to create the embryos.
In summary, ART conceptions are not more prone to
significant abnormalities. We offer no guarantee,
however, that the child will be normal, but hundreds of
thousands of children have been created by the IVF
process and the children are generally as healthy
as those conceived through a more "natural"
means. It
is very important that the embryo recipients not try to seek "perfection" in finding
the "ideal" embryos. It is doubtful
that your own genetic children would have been perfect
given the issues that have brought you to the point
of considering embryo donation.
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What
Are The Success Rates For Embryo Donation?
As data accumulates, these success rates will be published
on the EDI web site. You can view the most current success rates. It is a complex process when there are so many variables including the donors, the recipients, the facility that created the embryos, and the facility thawing and transfering them. Nevertheless, we will provide you with as much information possible to judge the likelihood of success with a specific set of embryos.
Do The Embryo Donors Have Any Legal Rights To The Offspring?
Currently, there are no parental rights of the embryo donors to the offspring from embryo donation here
in the state of Florida. As with blood and other organs,
once donated, the donor loses all legal rights to
the tissues once they are donated.
It should be noted that the
embryo donors are free to change their mind and
request that their donated embryos be returned up
to the point of the actual thaw and transfer, although
this is expected to rarely occur. We
allow this to encourage patients to consider embryo donation. They want to know, and quite frankly, we agree, that they should be able to reclaim their embryos should a catastrophic occurance occur such as the death of their children. Once the embryos are transferred to the
embryo recipient, however, the embryo donors lose any
legal rights to the offspring.
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What Types Of Embryo Donation Options Do I Have?
We here at EDI have three main types of embryo donation procedures; Anonymous Embryo Donation, Approved Embryo Donation and Open Embryo Donation. The most common form is anonymous where the donors and recipients never meet. The Approved Embryo Donation process also maintains anonymity, but allows the donors to learn a little more about the recipients through an interview by a qualified Mental Health Professional.The donors, however, never learn the recipient's names or other specific identifying information.
Open Embryo Donation is an entirely different set of circumstances. While infrequently requested, in this type of donation, the donors and recipients will know each other and may indeed meet if they so choose. The relationship following the embryo transfer is also up to the participants themselves.
Can The Children Ever Find The Embryo Donors?
Except in the Open Embryo Donation process, the embryo donation programs here are anonymous. EDI is required to keep medical charts by the state of Florida for only seven
years. The FDA states that we are supposed to keep embryo donation records for at leat 10 years. To track new genetic diseases in the donating and recieving families really requires the records be kept much longer. We do feel, however, the contracts that were originally signed by the donors and recipients should be honored, so requests for past medical records beyond ten years may not
be honored without legal intervention. We will do what ever we can to protect all participants in the process within the bounds of future legislation.
If an offspring from embryo donation needed to find
the embryo donors for medical reasons (i.e., bone
marrow or kidney transplant) and upon request, EDI
would act as a neutral entity to assist all parties
while keeping confidentiality intact. In this case, for the greater good of the child, anonymity may need to be broken but only following the clear permission from all participants.
Are
Embryo Donors Paid For Their Embryos?
The embryo donors have donated by their own free
will and were not compensated for their decision.
Upon occasion, residual cryopreservation fees
may have been waived or reimbursed, in some part, to the cryopreservation facility when the parents decided to donate
their embryos. While EDI does want to encourage people to donate their embryos, we do not want to
entice them inappropriately to do so. The reimbursement issue may eventually
change given the fact that sperm, egg and plasma donors are reimbursed for their services. The reality is that the embryos cost the donors a tremendous amount of time, money and effort and it may be entirely appropriate in the future to consider reimbursement at some level, never allowing an embryo donor to truly profit from the donation.
EDI does donate to one of a list of charities when embryos are donated. The donors choose the charity as a gentile motivation to donate themselves. We like to think of this as "paying it forward". If you would like to see our list of charities, click here.
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How
Long Can The Donated Embryos Stay Frozen?
We really do not know the limit of the cryopreservation
process. Animal research has shown that offspring
are possible after many years of cryopreservation.
Human data suggests decades or perhaps even hundreds or thousands of years. More research will need to be done before this question
can be adequately answered. For practical reasons, we will not hold donated
embryos indefinitely and will certainly encourage
their transfer as quickly as possible.
Will You Send The Embryos To My Local Clinic?
When embryo donors donate to EDI, they are asking that we take special care of their gift. The donors want to to be certain that their stipulations are adheared to. We also promised to make certain their recipients are well screened finding the best home for their embryos we can. Lastly, the embryo donors are counting on our experience and success rates to succeed in building families. By "re-gifting" them to another facility, we loose all control of our promise.
Will You Accept Donated
Embryos From Other ART Facilities?
We absolutely will accept some cryopreserved donated embryos from facilities from around the world. We will not, however, accept
all embryos. We must evaluate each
set of embryos on a case-by-case basis. Below are some of
the reasons why EDI will reserve the right to refuse
to accept the transport of donated embryos:
- The ART facility that is called
upon to transfer donated embryos has very poor
frozen embryo transfer success rates.
- We have a history of working with the facility, with a large number of embryos either not surviving the thaw process or implanting.
- The embryos originated from
women with advanced maternal age.
- Very few embryos are available.
- The embryos are at a high risk of carrying genetic disease.
Please understand that our goal is to accept the transport
of embryos likely to build families. We do not want to
become an international storage facility for unwanted embryos. |
Could
the children from embryo donation inadvertently meet
their siblings and reproduce (Inadvertent Consanguinity)?
It is quite common to be concerned about the potential
for related siblings raised in different families
meeting and reproducing.
Similar concerns have existed and have been examined
in detail for egg and/or sperm donation cycles. According
to existing guidelines, it is recommended that we
limit a single egg/sperm donor from producing no more
than 15 offspring per 500,000 population. Please recall
that we here at EDI cater to an ever increasing referral population throughout the country and beyond.
The chances of the offspring meeting and reproducing continues to become more and more unlikely as EDI continues to expand.
What
Are The Psychological Affects Of The Embryo Donation
Process?
Embryo donation is relatively new path to parenthood,
bringing with it the potential for complex psychological,
social, emotional, and ethical considerations. We
have neither significant long-term experience nor
solid psychosocial research to draw upon. While possible,
it seems unlikely that there will be any significant
psychological impacts to all parties involved, but
this is uncertain. One must always compare the potential psychological consequences of never having had children. Hopefully, in the years ahead, we will continue to gather information and answer this question more completely.
The issues regarding disclosure to friends, family
and the offspring are important. We will attempt to
cover some of these topics at the web site and social media. It is
also encouraged for all interested parties to discuss
these issues with qualified personnel. Psychological
counseling will always be available upon request.
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How
Do We Get Started?
You have already started the first step by reading these
segments here on the web site.
A full packet of information is available for your immediate
review visiting our Download
Center. These forms are in a PDF file format. You will want to click on the "Embryo Donation, Recipient" packet and
download each pdf file one at a time or all at once.
You may next want to review the specific information
we have on our available donated embryos (see below).
After you review the pdf files and web site information
and you are still interested in the program, you should
next complete the
Embryo Recipient Application.
Once we review this, we will contact you and discuss the process in greater detail and we will
try to get back to you within ten business days.
Eventually, if accepted, we will ask that you make an appointment to be seen by the staff here at
EDI. You will be asked to forward all pertinent medical
records, laboratory tests, copies of prior operative
procedures, radiology X-rays such as the hysterosalpingogram
(HSG) and any pertinent information on the evaluation
of you and your partner prior to being seen by EDI.
Depending upon the age of the recipient, additional
testing including an EKG, treadmill, psychological evaluation,
mammogram, vaginal ultrasound and screening blood tests
may be requested. We try to be as cost-effective as possible, but we also want to make sure the recipient has the best chance of having a healthy pregnancy and that the embryos have a wonderful chance at life.
Be sure to review all the information in the Embryo Donation, Recipient category. If you choose Approved or Open Embryo Donation, additional documents will need to be obtained.
How Do We Find The Donated Embryos?
Please visit the Embryo Donor database. You will be able to select your choices regarding Anonymous, Approved and/or Open donation embryos. Do not forget to register if you want to save your favorate embryos into your personalized folder or be notified when new embryos are posted to the site.
Remember that if there is something we have missed, please do let us know. Good luck in finding just the right set of embryos for you! |
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